Ultrasonography of echinococcal cysts

Ultrasonographic examinations were carried out on four patients who had a total of six hydatid cysts. Three different patterns of cyst structure were recognized. These patterns are simple cyst, cyst with non-specific complex internal structure, and a “cyst within a cyst” pattern. The latter pattern depicting a daughter cyst within the primary cyst is thought to be a distinctive feature of echinococcal cysts, if not specific for them. Recognition of the cyst within a cyst pattern should permit a reasonably confident Ultrasonographic diagnosis of hydatid disease.     

Sonography of hemorrhagic ovarian cysts

The sonographic appearance of hemorrhagic ovarian cysts (HOC) has received little attention aside from a recent report in adolescent girls. We reviewed the sonographic findings in 14 adults with 15 pathologically proven HOC to see whether there were any consistent sonographic findings that, along with the clinical history, might make possible the diagnosis. The majority (93%) of patients presented with the abrupt onset of lower abdominal or pelvic pain, and each, when clinically appropriate, had a negative serum pregnancy test. Sonographically, all of the masses were cystic except one. The cyst wall was thin and well defined in six cases and thick and irregular in eight. The majority (87%) had internal echoes. These echoes were scattered and low level or diffuse and homogeneous (27%) or complex and echogenic (53%) in nature. Two cysts had numerous septations, and another had a fluid--debris interface. If the pain subsides and the hematocrit remains stable, the premenopausal patient can be managed conservatively. Sonographic follow-up is recommended so that an underlying hemorrhagic ovarian cystic neoplasm can be excluded. This was present in three of our patients, two of whom were postmenopausal.     

Two- and three-dimensional prenatal sonographic diagnosis of hepatic cysts

We describe the 2-dimensional and 3-dimensional multiplanar sonographic diagnosis and characterization of isolated hepatic cysts in 2 fetuses. Two-dimensional imaging of a fetus at 36 weeks' gestation revealed 2 right upper quadrant cystic masses anterior to the gallbladder, demonstrating no peristalsis or blood flow. Postnatal sonographic examination confirmed 2 simple hepatic cysts. Two- and three-dimensional sonograms suggested 2 hepatic cysts in a 23-week-old fetus that resolved by 33 weeks' gestation. In reporting 2 unusual cases of prenatally diagnosed fetal hepatic cysts, we also demonstrate the diagnostic use of 3-dimensional multiplanar imaging.     

Complications of hepatic hydatid cysts: Ultrasound,computed tomography,and magnetic resonance diagnosis

A total of 179 hepatic hydatid cysts (HHCs) were studied by ultrasound (US), computed tomography (CT), and magnetic resonance imaging (MRI). The diagnosis of HHC complications was established by US and CT, which permitted a distinction between intact cysts and those presenting with contained rupture, as demonstrated by a collapsed endocyst or a globally echogenic appearance. The diagnosis of HHC perforation into the main biliary tree was made by detection of a discontinuity in the cyst wall and/or the presence of hydatid material within the biliary system. Similarly, direct HHC rupture into different thoracoabdominal spaces was diagnosed by demonstrating cyst wall discontinuity and the presence of hydatid material within these spaces. Ruptured and infected cysts were difficult to distinguish from ruptured cysts with sterile content. The role of MRI is yet to be defined in the assessment of HHC complications.     

Echinococcal cysts in the common bile duct: An uncommon cause of obstruction

Obstruction of the biliary system due to intraductal echinococcal cysts is a rare but serious presentation of hepatic echinococcal disease. Four cases are described. There was a 50% mortality rate and morbidity was high. The clinical presentation is difficult to differentiate from other disease processes. Careful preoperative sonograms should be taken to detect echogenic cyst material in the biliary system in all patients with hepatic echinococcal cysts. If biliary pigments are seen in the cyst during surgical removal, or if the patient has a recent history of jaundice or cholangitis, intraoperative cholangiography should be done to rule out intraductal cysts, which may cause obstruction.     

Mesenteric and omental cysts: An ultrasonographic and clinical study of 15 patients

The clinical and ultrasonographic (US) features of 15 cases of mesenteric or omental cyst are herein described. This series included seven male and eight female patients, whose age ranged from 2–89 years. Correct clinical diagnosis was made in two children only, but preoperative US examination accurately demonstrated the lesion in 11 of 13 patients (85%). These cystic lesions usually had a thin wall, internal septations, and fluid content with sedimentation. Enteric duplication cysts had a relatively thick wall merging with the muscle layer of bowel loop, and multiloculation was noted mainly with cystic lymphangiomas or pseudocysts. The diagnostic and surgical management of these lesions are briefly reviewed and their US appearance is illustrated.     

Sonography of exophytic gastrointestinal leiomyosarcoma

Five cases of exophytic gastrointestinal leiomyosarcoma were evaluated by sonography. In 3 of the 5 cases, identification of intraluminal air or intestinal lumen in an eccentric location to the mass was helpful in recognizing the exophytic nature of the mass. Tumor necrosis was present in all of the masses and also in 1 case of hepatic metastasis. Recognition of the exophytic nature of the mass and the presence of tumor necrosis favor the diagnosis of leiomyosarcoma.     

MR imaging in intracystic hemorrhage of simple hepatic cysts

Intracystic hemorrhage of simple hepatic cysts is one of the most frequent complications. Ul-trasonography (US) and computed tomography (CT) may show abnormal findings and mimic other diseases. We describe magnetic resonance (MR) imaging in four patients with intracystic hemorrhage confirmed by surgery or percutaneous aspiration. In all cases the lesions were hyperintense on both T1- and T2-weighted sequences. In three of the four cases the signal was heterogeneous on T1-weighted sequences. Two cases of a thickened wall and one case of a fluid-fluid level were also observed. We suggest that MR imaging may be helpful to differentiate intracystic hemorrhage from other cystic lesions by showing high signal on T1- and T2-weighted sequences.     

高渗葡萄糖囊内注射治疗老年性巨大肝囊肿疗效分析

目的评价高渗葡萄糖对老年人巨大肝囊肿囊腔内硬化治疗的效果。方法对直径>10．0cm、首次抽出囊液量>600ml、年龄在70岁以上的老年人肝囊肿32个,穿刺抽净囊液后囊内注入50％GS,治疗2次的21个,3次的8个,4次的3个。结果对每一个肝囊肿治疗后180～360天内超声随访,缩小>80％20个,>50％10个,>30％2个,无一例完全消失,治愈率为62．5％,有效率为31． 5％,好转率为6％,无效率为0％。结论老年单纯性巨大肝囊肿穿刺抽液及高渗葡萄糖硬化治疗是一种安全、经济、简便、病人易接受、重复性强的有效治疗法。     

Sonography and computed tomography of macroscopic tuberculosis of the liver

Four patients with macronodular tuberculosis of the liver were examined with ultrasonography. The findings included 1 case with multiple hypoechoic areas and 3 cases with a solitary lesion, one hypoechoic mass without calcifications, and two partially calcified masses. Some ultrasound features are suggestive: a mass with irregular calcifications, ascites, spleen enlargement with defects, enlarged nodes, and complete resolution of the lesions in a few months with effective antituberculous therapy. The first case was also examinated with computed tomography.     

Sonography of wrist ganglion cysts: variable and noncystic appearances.

OBJECTIVE: In our clinical practice, we have noted wrist ganglion cysts that do not fulfill the criteria for simple cysts. This study retrospectively evaluated the sonographic features of wrist ganglia. METHODS: After Institutional Review Board approval, medical records from 1993 through 2003 were searched using International Classification of Diseases, Ninth Revision codes and key words, and sonography log books from 2000 through 2004 were reviewed, which identified 20 wrist ganglion cysts in 16 patients that were proven at surgery or aspiration. A retrospective review of sonographic images was carried out by 2 musculoskeletal radiologists by consensus. Images were evaluated for cyst location, volume, largest dimension, joint or tendon extension, echogenicity, septations, internal echogenicity, posterior acoustic enhancement, margins, lobularity, and vascularity. RESULTS: Of the 20 wrist ganglia, 15 were volar (10 between the flexor carpi radialis and the radial artery), and 5 were dorsal (2 over the scapholunate ligament). The mean volume was 2081 mm3 (range, 90-15,000 mm3), and the mean largest dimension was 17.3 mm (range, 7-30 mm). Seven volar ganglia showed joint communication. Ten ganglia were anechoic; 7 were hypoechoic; and 3 had anechoic and hypoechoic areas. Eight had septations; 8 had internal echogenic areas; 15 had posterior acoustic enhancement; 13 had well-defined margins; 12 were lobular; and none were vascular. Cysts that were anechoic (P < .0001) or with posterior acoustic enhancement (P = .04) were significantly larger than those that were hypoechoic or without posterior acoustic enhancement. CONCLUSIONS: Small wrist ganglion cysts (< or = 10 mm in the mean largest dimension) often appear hypoechoic without posterior acoustic enhancement and do not fulfill the criteria for a simple cyst.     

Laparoscopic fenestration of symptomatic hepatic cysts

Objective： The aim of this study was to evaluate the role of laparoscopic deroofing of congenital liver cysts and the outcome. Methods： Between August 1996 and December 2004, Forty-one patients with Single or multiple cysts of the liver and five patients with polycystic liver disease were roanaged laparoscopically. All cases were confirmed by BUS, CT or MRI. Results： Forty-six patients with congenital liver cysts were operated successfully： The postoperative course was uneventful in Forty-three cases. Three patients developed post-operative complications which included one ascites and two biliary leak. Forty-four patients remained asymptomatic throughout the follow-up period of 8-100 months; two patients with polycystic liver disease developed slightly recurrent symptoms after 5 months and 6 months, respectively, and need not further treatment. Conclusion： The laparoscopic approach in uncomplicated but Symptomatic liver cysts is effective, with low morbidity and mortality. Additional omcntoplasty appears to reduce the recurrence rate.     

肝叶切除术治疗肝囊肿患者对其胃肠功能恢复时间、胆红素及丙氨酸氨基转移酶的影响

目的：探究腹腔镜肝囊肿治疗肝囊肿患者对其胃肠功能恢复时间、胆红素及丙氨酸氨基转移酶的影响。方法：对照组受试者采用腹腔镜囊肿开窗术加肝叶部分切除术进行治疗，研究组受试者在其手术方案上去除肝部分切除术进行治疗。进一步观察受试者临床疗效及丙氨酸氨基转移酶等指标。结果：研究组受试者治疗后疗效总有效率为高于对照组，x2=18.980，P=0.000，其次研究组受试者经治疗后，首次肛门排气时间为（1.55±5.28）h、首次排便时间（26.55±5.57）h、肠鸣音恢复时间（12.33±3.59）h、下床活动时间（12.44±2.25）h均显著低于对照组，P<0.05，同时研究组受试研究组受试者AST（51.67 ±6.01）U/L、胆红素（145.11+17.48）umol/L、丙氨酸氨基转移酶（57.10+9.62）U/L均低于对照组，t=5.686、5.269、11.384，P=0.000，再者研究组受试者8- OHdG（41.89±5.88）μg/L、MPO（62.22±6.56）U/L、Cor（23.10±4.67）ng/L，均低于对照组，t=7.601、8.440、7.082，P=0.000，最终研究组受试者的不良反应发生率为7%明显低于对照组，x2=5.279，P=0.000。结论：肝叶切除术治疗肝囊肿具有较好的治疗效果，能明显减少患者术后胃肠功能的恢复时间，改善患者机体内肝功能指标水平，对患者肝脏代谢功能作用明显。减少患者术后应激反应的发生，两地不良反应发生率，提高治疗安全性和用药有效性，具有较高的临床应用价值和临床推广价值。     

Sonography of appendiceal intussusception

A case in which appendiceal intussusception was diagnosed preoperatively by sonography is described. The sonographic finding of multiple concentric hypoechoic and hyperechoic rings was confirmed at laparotomy to be due to appendiceal intussusception. Demonstration of the sonographic coiled spring sign in the right lower quadrant should raise the possibility of appendiceal intussusception. The differential diagnosis is discussed.     

Congenital hepatic cyst: Prenatal and postnatal imaging findings

IntroductionCongenital hepatic cyst is a rare hepatobiliary malformation that can present as an asymptomatic, unilocular, upper abdominal cystic mass in the fetus.CasesWe report two cases of congenital hepatic cyst in which the diagnosis was made by prenatal ultrasound at 25 and 33 weeks’ gestation. The diagnosis was confirmed postnatally by abdominal ultrasound and radiologic imaging studies. Although the infants remained asymptomatic, laparoscopic excision was performed due to the increasing size of the cyst in both cases. Pathological examination of the resected specimens confirmed a simple cyst in one case and an epidermoid cyst in the other.ConclusionsOur cases and those described in the literature demonstrate the usefulness of incidental prenatal detection of congenital hepatic cyst, especially during late pregnancy. Such a diagnosis can allow for proper perinatal surveillance, selection of the route of delivery, and timely postnatal surgical intervention if required.     

Echinococcal hepatic disease: Magnetic resonance appearance

The magnetic resonance (MR) appearance of an echinococcal hepatic cyst is described. A previous report has suggested that a low-intensity rim surrounding the cyst may be useful in differentiating hydatid cysts from other hepatic lesions. No such rim was identified in our case; however, MR was found to be superior to other modalities in delineating the internal contents of the hydatid cyst.     

Hodgkin's and non-Hodgkin's hepatic lymphoma: Sonographic findings

The sonographic studies of 72 patients with pathologically proven Hodgkin's or non-Hodgkin's hepatic lymphoma were retrospectively reviewed. Sixty-eight patients (94%) had secondary hepatic lymphoma (nine of them had AIDS-related lymphoma) and four patients (6%) had primary lymphoma of the liver. Forty-six of 72 patients (64%) had diffuse hepatic involvement, and 26 of 72 patients (36%) had focal liver lesions as demonstrated by sonography. Four patterns of disease were identified: (a) hepatomegaly was depicted by sonography in 26 of the 59 patients with secondary hepatic lymphoma not related to AIDS, in two of the nine patients with AIDS-related secondary hepatic lymphoma, and in one of the four patients with primary hepatic lymphoma; (b) multiple rounded well-delineated hypoechoic liver lesions were found in 22 of the 68 patients with secondary hepatic lymphoma; (c) a large heterogeneous echoic mass, which was an evocating clue to the diagnosis of primary lymphoma of the liver, was found in the four patients with primary lymphoma of the liver; and (d) an absence of sonographic abnormalities was found in 20 of the 59 patients with secondary lymphoma not related to AIDS. Liver involvement with lymphoma should be considered in any patient who develops multiple homogeneous hypoechoic liver masses, even in the absence of known underlying lymphomatous disease.     

Radiological evaluation of hepatic artery aneurysms

The authors report 4 cases of hepatic artery aneurysm confirmed by computed tomography, sonography, angiography, and/or surgery. Three aneurysms involved the right hepatic artery and 1 involved the common hepatic artery. Two cases were treated with surgery, and the other 2 cases with transcatheter embolization. The clinical and radiological features of this entity are described together with a review of the pertinent literature.     

Ultrasonographic patterns in hepatic hemangiomas

Twenty-one cases of hepatic hemangioma were examined by ultrasound, and three main sonographic patterns were identified. In 14 cases hyperechoic focal areas were observed, in five cases larger hemangiomas exhibited a complex pattern, and in two cases hemangiomas appeared as rounded sonolucent areas with distal enhancement mimicking cysts. Hemangiomas may have significantly variable ultrasonographic features. According to the authors' experience, only in cases of hyperechoic well-defined lesions in asymptomatic patients can a definite diagnosis of hemangioma be made.     

Ultrasound findings in liver hydatid cysts.

Eighty-one liver hydatid cysts evaluated by gray-scale ultrasound were accumulated in our experience over a period of 2 years. The echographic evidence in accordance with our experience can be categorized as follows: (a) nonsuppurative hydatid cysts in which echo-free area within the fine homogeneous structure of the organ provide the basic clue to the diagnosis; then the echographic appearance of the wall offers further hints to the identity of solitary, multiloculated, and multiple cysts; (b) suppurative hydatid cysts in which, depending on the intensity of secondary microbial infection, the echo-free area turns to a low, medium, or high level of echoes while holding its constitutional pattern. This report is designed to present the various ultrasound patterns of hydatid disease of the liver and show how ultrasound may be most effective in achieving the correct diagnosis.