Sonography of the biliary tract in infants and children

Diseases of the gallbladder and biliary system are particularly well suited for investigation with sonography. As such, sonography has completely supplanted oral cholecystography in the evaluation of these disorders. Because it is easy to perform and does not expose the patient to radiation or contrast agents, sonography is being used more often in children to diagnose disorders of the gallbladder and biliary tract. Many of the sonographic signs of these diseases (e.g., cholelithiasis, cholecystitis) are well established in adults and are the same in children. However, the circumstances under which these diseases occur and their different causal factors are different in children and adults. This article reviews the distinctive aspects of gallbladder-biliary tract disease in children, concentrating on the role that sonography plays in its evaluation and therapy.     

Sonography of the gallbladder, biliary tree, and pancreas in adults with cystic fibrosis

Real-time sonography is an established method of evaluating the gallbladder, biliary tree, and pancreas. Adequate visualization with B-scan equipment has been a problem in adults with cystic fibrosis, a group with an increased incidence of gallbladder disease. We performed real-time ultrasonography on 23 adult patients with cystic fibrosis. The gallbladder was visualized in 22 (96%) and was found normal in 14 (61%). Abnormalities in the remainder included cholelithiasis (17%) and microgallbladder (30%). No dilatation of the biliary tree was demonstrated. The pancreas was well visualized in 18 (78%) and showed increased echogenicity in most. We conclude that real-time sonography of the abdomen reliably permits examination of the gallbladder, biliary tree, and pancreas in adult patients with cystic fibrosis.     

Diagnostic pitfalls of MR cholangiopancreatography in the evaluation of the biliary tract and gallbladder.

Magnetic resonance (MR) cholangiopancreatography is a noninvasive imaging technique that has proved accurate in the diagnosis of biliary obstruction. However, various diagnostic pitfalls have been reported with MR cholangiopancreatography that were not encountered previously at conventional biliary imaging. These pitfalls may simulate or mask various pathologic conditions of the extrahepatic bile duct or main pancreatic duct and may be caused by a variety of factors. Because of its postprocessing nature, maximum-intensity-projection reconstruction may mask a small gallstone if the stone is surrounded by hyperintense bile and may cause false ductal disconnection or duplication when a breath hold is not performed perfectly. Extraductal factors (e.g., metallic surgical clips, intravascular metallic coils, gas in the stomach or duodenum) can cause signal loss in the adjacent part of the extrahepatic bile duct, which may in turn lead to a false-positive diagnosis of ductal narrowing or obstruction. Normal vascular structures including the right hepatic and gastroduodenal arteries can cause pseudo-obstruction of the extrahepatic bile duct by pulsatile compression. Intraductal factors (e.g., gas, hemorrhage, debris, iodinated contrast material) reduce the signal intensity of the bile, which may result in pseudo-obstruction, false filling defects, or a nonvisualized gallbladder or bile duct. Knowledge of the existence and high prevalence of these diagnostic pitfalls should help prevent misinterpretation of MR cholangiopancreatograms.     

Sonography of gallbladder duplication and differential considerations

With the routine use of sonography in the evaluation of suspected gallbladder disease, the familiarity of gallbladder duplication and its differential considerations are essential. Three cases are presented: one surgically proven duplication of the gallbladder, one case in which the sonographic findings were compatible with duplication of the gallbladder, and one surgically proven intraperitoneal fibrous band mimicking a gallbladder duplication. Gallstones were present in all cases and were confined to only one of the two lobes identified in each case. The gallstones did not communicate between individual gallbladder lobes despite multiple patient positions. Contraction of the non-stone-containing lobe was present in one nonfasting patient, which is probably the best indirect sign of a double gallbladder.     

腹腔镜胆囊切除术肝外胆管损伤的原因与防治

目的：研究腹腔镜胆囊切除术中预防肝外胆管损伤的有效措施。方法：分析我院近10年行腹腔镜胆囊切除术10800例，其中肝外胆管损伤8例，损伤率0．08％，以肝外胆管横断伤最多见6例，电灼伤和钳闭坏死各1例。8例损伤均发生在开展腹腔镜前5年的5000例中，后5年5800例LC未发生肝外胆管损伤。结果：8例肝外胆管损伤均行胆肠Ruox-en-Y吻合治愈。结论：良好显露Calot三角，靠胆囊钝性分离Calot三角，认准胆囊壶腹与胆囊管交汇部并游离出其延伸段是确认胆囊管的可行方法，此时，多能辨认清肝总管、胆总管、胆囊管、胆囊壶腹即“三管一壶腹”的相互解剖关系，可有效避免肝外胆管损伤。     

Sonography of the normal elbow

Sonography was performed in 30 normal patients, neonatal to 45 years old, to illustrate our technique for complete and rapid examination of the elbow joint. Sonography is an easy, noninvasive method of evaluating the articulating surfaces, tendinous insertions, and supporting soft tissues of the elbow joint. Reliable identification of both normal and diseased anatomy is possible at all ages. Familiarization with the sonographic appearance of the six elbow ossification centers aids in sonographic interpretation.     

Sonography of the lower urinary tract

According to literature and to our experiences sonography should be the first investigation of the lower urinary tract in children, if there is suspicion of obstruction or malformation. In many cases the localisation of obstruction or the diagnosis of malformation can be found. Furthermore by sonographic follow-up studies of ureter obstructions by tumors, by concrements or after surgery, the normal radiographic investigations like urography or retrograde pyelography can be reduced. Sonography is a valuable enrichment for investigations of functional and morphological changes of the urinary bladder, especially for the classification of bladder tumors: whereas the diagnosis of urethral diseases still is found by clinical investigations and conventional radiological procedures.     

Sonography of adenomyomatosis of the gallbladder: radiologic-pathologic correlation

Sonograms of six patients with adenomyomatosis of the gallbladder were reviewed and correlated with oral cholecystographic and pathologic findings. The gallbladder was visualized in four of the six patients by oral cholecystography, which also revealed intramural diverticula. Five of the six patients showed sonographic evidence of diffuse or segmental thickening of the gallbladder wall and intramural diverticula, seen as anechoic or echogenic foci within the wall. Intramural diverticula containing bile appeared as anechoic spaces; those containing biliary sludge or gallstones appeared as echogenic foci with or without acoustic shadows or reverberation artifacts. There was good correlation between sonographic and pathologic findings in three patients. The authors conclude that adenomyomatosis of the gallbladder should be suspected when (a) there is diffuse or segmental thickening of the gallbladder wall and (b) intramural diverticula are seen as anechoic or echogenic foci with or without associated acoustic shadows or reverberation artifacts.     

Sonography of the normal female urethra

This report of the sonographic appearance of the normal adult female urethra includes discussion of the anatomy and four representative cases. Six sonograms are shown that demonstrate normal urethras in both sagittal and transverse sections of pregnant and nonpregnant women. This anatomy is easily demonstrated with a sonographic B scanner. Insufficient knowledge of the sonographic appearance of the normal female urethra may lead to the erroneous diagnosis of a urinary bladder tumor.     

Sonography of the normal neonatal head

Summary Advances in ultrasound equipment now permit display of anatomic structures not previously shown. Correlation of sonograms obtained in vivo with gross and myelin-stained sections of human autopsy material facilitates understanding of these new images.     

Sonography in pediatric hip disorders

Real-time ultrasonography of the infant hip has proven to be a reliable and safe method of evaluating the joint for dislocation or instability. A number of techniques for diagnosing and quantifying these disorders have been developed. Several other applications of ultrasound in pediatric hip disorders have also been described, most notably the detection of joint fluid.