Comparison of contrast-enhanced with non-contrast endosonography in the diagnostics of anal fistulas

The objective of this paper is to compare the accuracy of standard, non-contrast endosonography (EAS) with contrast-enhanced endosonography (CE-EAS) in the diagnosis of anal fistulas. The group consisted of 126 patients (mean age: 43.1 years) with the clinical diagnosis of anal fistula. For anal endosonography, a Bruel & Kjaer unit with a 7.0-MHz transducer was used with a 3% solution of hydrogen peroxide as the contrast agent (1, 2, 3). In each case, EAS and CE-EAS diagnoses of the type and complexity of anal fistula, as well as the location of the internal opening, were determined. Results showed that CE-EAS was significantly more accurate in diagnosing the type of anal fistulas than NC-EAS (97 vs. 94%, respectively; P=02275), and in differentiating simple from complex tracks (92 vs. 75%, respectively; P<0.00001). CE-EAS was much more accurate in patients with recurrent fistulas (57 vs. 92%, respectively; P<0.00006), whereas in a subgroup of primary tracks, both methods were of comparable accuracy. Sensitivities of CE-EAS and EAS for internal opening were 89 and 65%, respectively. The conclusion of this paper is that CE-EAS significantly increases the accuracy of standard non-contrast EAS and is especially beneficial for the differentiation between simple and complex tracks.     

高频彩色多普勒超声在肛周脓肿、肛瘘的应用价值

目的探讨高频彩色多普勒超声诊断肛周脓肿与肛瘘的临床应用价值。方法使用高频彩色多普勒超声对90例肛周脓肿或肛瘘患者进行检查,并将检查结果与手术结果对照。结果肛周脓肿与肛瘘的声像图与周围正常组织有明显的区别,对肛周脓肿的诊断特异度、阳性预测均是100%,灵敏度为94.3%;对肛瘘的诊断特异度与阳性预测值分别为95.1%、95.5%,灵敏度为85.7%。结论高频彩色多普勒超声检查对肛周脓肿的位置、大小、数目、范围及肛瘘瘘管的走行、数目具有很高的诊断价值,且方便、直接、无痛苦、诊断准确、易被患者接受。     

Evaluation of perianal sepsis: comparison of anal endosonography and magnetic resonance imaging

The purpose of this study was to compare prospectively the diagnostic yield of anal endosonography (AES) and magnetic resonance imaging (MRI) in the assessment of perianal fistulae and abscesses. There were 39 patients (14 men, 25 women; mean age, 40 years) who underwent AES, performed with a 10-MHz rotating endoanal probe and MRI at 1.0 T (axial and coronal T2-weighted turbo spin-echo (TSE) and turbo-STIR sequences). Fistulae were classified as subcutaneous, intersphincteric, transsphincteric, high (i.e., high extrasphincteric or suprasphincteric), rectovaginal, and horseshoe and were compared with the surgical findings in all patients. Overall, 58 fistulae (subcutaneous, N = 7; intersphincteric, N = 9; transsphincteric, N = 16; high, N = 17; rectovaginal, N = 5; and horseshoe, N = 4) were detected at surgery. MRI showed a sensitivity of 84% and AES of 60% (P <.05). False-positive diagnoses were made in 6 patients (15%) with MRI and in 15 patients (26%) with AES, for a specificity of 68% and 21%, respectively (P <.05). Our findings show that MRI is superior to AES in the assessment of fistula-in-ano before major surgery. AES should be used only for orientation before minor procedures, such as incision or drainage of subcutaneous fistulae.     

Medical treatment of renal and perirenal abscesses: CT evaluation

AIM: A retrospective study of our experience of CT evaluation and follow-up of 16 solitary and multiple renal abscesses treated successfully with antibiotics alone and evaluated with CT at the onset of symptoms and after therapy. MATERIALS AND METHODS: Seven patients had a solitary renal abscess, five had multiple renal abscesses and four had renal and perinephric abscess. None of the abscesses were larger than 5 cm. RESULTS: In all 16 patients, the CT examination showed total renal and extrarenal regression of the abscesses. In four patients, scarring of the renal outline was observed on follow-up. CONCLUSIONS: The study demonstrates the opportunity to avoid aggressive interventional or surgical treatment of renal and perirenal abscesses of 5-cm diameter or less which can completely regress after antibiotic therapy of at least 4 weeks. The CT examination results are important both in the diagnostic phase to establish the extent of the lesions and in the follow-up to check the results of medical treatment.     

肛门直肠周围脓肿、肛瘘的磁共振诊断与应用价值

目的:探讨磁共振成像在肛门直肠周围脓肿、肛瘘诊断中的临床应用价值。方法:回顾性分析2008年9月~2010年3月经病理证实的58例肛门直肠周围脓肿/肛瘘患者,其中男性肛周脓肿12例,肛瘘30例,女性肛周脓肿6例,肛瘘10例。病例均于术前行常规盆腔磁共振检查,其中40例行增强检查,扫描序列包括矢状、冠状T2WI,轴位T1WI、T2WI,轴位T2脂肪抑制序列,增强轴位、矢状脂肪抑制T1WI序列。术前诊断与手术及病理结果对照。结果:58位患者,术前磁共振发现脓肿24个,瘘管40条,内口32个;4例内口及5例支瘘管漏诊。结论:磁共振检查对肛门直肠周围脓肿、肛瘘诊断及明确脓肿、肛瘘位置、数目,累及范围、瘘管走行及其与周围结构关系具有很高的应用价值。     

Percutaneous drainage of postappendectomy abscesses complicated by enteric communication

Four patients with postappendectomy abscesses complicated by enteric fistulae were treated by percutaneous drainage. Sinograms, obtained at the time of the initial drainage, demonstrated communication to the cecum in 3 patients and to the small bowel in 1 patient. Complete cure was attained in 3 patients by percutaneous drainage. In the fourth patient, surgery was performed after 7 days of catheter drainage. Percutaneous drainage of abscesses with enteric communication requires a modified technique, which includes longer-term drainage than for simple noncommunicating abscesses.     

短轴追踪扫查法在肛瘘经体表超声检查中的诊断价值

 目的 探讨短轴追踪扫查法在肛瘘经体表超声检查中的诊断价值。方法 回顾性分析解放军总医院海南医院超声诊断科2019-10至2021-10经体表超声检查的617例肛瘘患者资料,对纳入完成长轴和短轴追踪扫查的炎性肛瘘者,比较长轴、短轴追踪扫查对肛瘘内口、主瘘管及支瘘管的诊断准确率。结果 入组患者共75例,包含33例常规超声联合经瘘管超声造影。常规超声检查时,短轴追踪对内口的诊断准确率高于长轴追踪,差异有统计学意义(77.33% vs. 34.67%,P<0.05);主瘘管和支瘘管的诊断准确率对比,长轴、短轴追踪差异均无统计学意义(主瘘管86.67% vs. 85.33%;支瘘管44.12% vs. 38.24%)。联合超声造影后,短轴追踪对内口的诊断准确率高于长轴追踪,差异有统计学意义(90.91% vs. 66.67%,P<0.05);对主瘘管和支瘘管的诊断准确率上长轴与短轴追踪差异均无统计学意义(主瘘管87.88% vs. 93.94%;支瘘管71.43% vs. 66.67%)。结论 经体表短轴追踪扫查可提高肛瘘的超声诊断准确率。     

彩色多普勒超声在监测自体动静脉内瘘中的应用价值

目的探讨彩色多普勒超声对慢性肾功能衰竭患者自体动静脉内瘘的监测作用。方法应用彩色多普勒超声检查41例慢性肾功能衰竭患者动静脉内瘘的功能。结果 41例慢性肾功能衰竭患者17例动静脉内瘘血流通畅,血液透析量达标;24例出现并发症:局部血栓形成未完全闭塞4例(头静脉侧3例,瘘口处1例),完全闭塞9例(瘘口处闭塞7例,头静脉侧闭塞2例),栓塞后再通2例,狭窄6例(瘘口处狭窄5例,流出静脉狭窄1例),假性动脉瘤1例,静脉瘤样扩张2例。根据检查结果,采取相应的临床措施(内瘘重建术,溶栓等)取得满意的效果。结论彩色多普勒超声能够快速、准确地判断慢性肾功能衰竭患者动静脉内瘘的通畅情况,有无并发症,为临床及时治疗提供科学依据。     

CT evaluation of primary epiphyseal bone abscesses

We reviewed the clinical, radiographic, and computed tomographic (CT) findings in eight children with a histologically proven diagnosis of epiphyseal or apophyseal osteomyelitis. In all cases the femur was involved: in five the osteomyelitis was localized in the femoral condyle, in two it was in the greater trochanter, and in one it was in the femoral head epiphysis. In four of the six cases of epiphyseal involvement there was associated joint effusion or septic arthritis. CT examination may demonstrate a serpentine tract, a sequestrum, cortical destruction or adjacent soft tissue swelling and can differentiate osteomyelitis from other epiphyseal lucent lesions, particularly chondroblastoma and osteoid osteoma. CT yielded important new diagnostic information in seven of the eight patients, failing to do so in only one. In one case, CT showed a wooden splinter in an abscess cavity, which had been mistaken for a sequestrum. When combined with accurate clinical and laboratory information and good quality plain radiographs, CT can lead to an early diagnosis of epiphyseal infection. Early diagnosis helps avoid delays in initiating antibiotic or surgical treatment caused by the unusual (epiphyseal or apophyseal) location of the bone abscess.Presented in part at the Closed Meeting of the International Skeletal Society, San Diego, California, September 1991     

肝癌介入术中动静脉瘘的评判与处理

目的 分析肝癌动静脉瘘(AVS)的DSA表现,寻找与其相适应的瘘口封堵方法,改善合并AVS 肝癌的治疗效果.方法 通过对637例患者中发现的183例AVS进行影像学分析,对轻度AVS患者在碘油栓塞后进行供血动脉栓塞,对中、重度患者先行瘘口处理,保证药物在肿瘤组织中的有效灌注与碘油在瘤组织中的良好沉积.结果 89例轻度AVS碘油栓塞后都能成功地进行肿瘤供血动脉的栓塞,94例中、重度患者中68.1%(64例)封堵后碘油得到良好或较好沉积,14.8%(13例)栓塞不完全,进行单纯化疗药物灌注,11.7%(11例)过度栓塞导致碘油沉积不满意,6.4%(6例)痿口过大或瘘口过于弥漫未能封堵.未发生严重并发症.结论 绝大多数肝癌伴AVS患者都能得到有效的瘘口封堵,改善了肝癌合并AVS的疗效,对瘘口的栓塞处理是安全、可靠的.     

Radiological evaluation of anal fistulae: a prospective study of fistulograms.

A review of 33 fistulograms in a four-year study is presented. Four types of communicating tracts have emerged: single (58%), branched (18%), fistulous abscess (15%) and compound (9%). This classification has formed the basis of selection of operative treatment in all the cases. Diminished lumbo-sacral angle was also found in most of the anal fistula cases and this establishes a possible association between the pathology of anal fistula and the low back syndrome.     

Magnetic resonance imaging of anal cancer

AIM: The purpose of this study was to evaluate the magnetic resonance imaging (MRI) appearances of primary and recurrent anal carcinoma, and to demonstrate the commonest patterns of local and distant disease spread. METHODS: A retrospective review was performed of 27 cases of biopsy-proven anal carcinoma, where MRI was used for primary staging (9 patients) or suspected recurrence (18 patients). Two oncological radiologists reviewed the MR images, following a standardized approach. The size, extent and signal characteristics of the anal tumour were documented. Metastatic disease spread to lymph nodes, viscera and bone was recorded. In all, 7 patients with recurrent disease underwent surgery and subsequent histological correlation was performed. RESULTS: Primary and recurrent tumours were of high signal intensity relative to skeletal muscle on T2-weighted images (T2WI), and of low to intermediate signal intensity on T1-weighted images (T1WI). Lymph node metastases were of similar signal intensity to the anal cancer. Recurrent tumours were more locally advanced than primary tumours and extended into adjacent organs and the pelvic skeleton. Recurrent lymph node disease involved perirectal, presacral and internal iliac nodes more commonly than did primary lymph node disease. CONCLUSION: MRI can be useful in the primary staging of bulky tumours or of those with a long craniocaudal extent. MR has a role in the preoperative evaluation and surgical planning of cases of recurrent disease following radiotherapy.     

Non-surgical drainage of intra-abdominal and mediastinal abscesses: A report of twelve cases

Twelve patients with intra-abdominal or mediastinal abscesses were treated by percutaneous drainage. Three abscesses were subphrenic, three were adjacent to enteric leaks, two were intrahepatic, two were pancreatic pseudocysts, one was a pancreatic abscess extending to the lesser sac, and one was an infected adrenal hematoma. All 12 lesions were entered percutaneously using fluoroscopic guidance without traumatizing the adjacent normal tissue. Localization was frequently aided by computed tomography. Various catheters were positioned using basic angiographic techniques. Following drainage all patients had a favorable clinical response. Seven of the 12 patients required no surgical management. Careful radiologic follow-up and frequent changing of catheters was necessary in six of the patients. Two patients benefited from the addition of auxiliary drains. Five of the 12 patients were electively operated upon because of incomplete drainage of the abscess cavity. Causes of failure were: persistent anastomotic leak (two patients), sequestered, loculated extension of abscess cavity (two patients), or necrotic, viscous hepatic tissue requiring removal at laparotomy (one patient).     

Embolisation of both fistulae through the same carotid artery tear in a patient with bilateral traumatic caroticocavernous fistulae

Endovascular treatment of traumatic caroticocavernous fistulae (CCF) may present technical difficulties with specific angiographic dilemmas. We report endovascular techniques used in a patient with bilateral post-traumatic CCF, high-flow on one side, and slow-flow on the other. Complete closure of both was achieved through the same carotid artery tear. To our knowledge, transarterial venous coil embolisation of a low-flow fistula through a contralateral carotid artery tear, with transarterial detachable balloon embolisation of the ipsilateral high-flow fistula has not been described previously.     

Magnification angiography of dural carotid-cavernous sinus fistulae

Summary Eleven patients with dural carotid-cavernous sinus fistulae were studied with selective magnification angiography. The angiographic features of this condition were analyzed in detail. The arterial plexus normally present in and around the cavernous sinus has been thought to rupture into the sinus and establish an arteriovenous fistula with an extensive dural arterial supply. Changeable angiographic and clinical findings, including spontaneous regression, can be explained on the basis of thrombosis and occlusion in the arterial network. The indications for and methods of embolization are also discussed.     

Coronary artery fistulae without adudible murmur in adults

Retrospective analysis of 4886 adults undergoing coronary arteriography for evaluation of angina between October 1988 and December 1991, revealed coronary artery fistulae in eight patients (all men, aged 36–69 years). No murmur was audible in any of these eight patients. Associated significant coronary artery disease was detected in five patients. The feeder arteries to the fistula were both the left main coronary artery and the left anterior desending artery (LAD) in two, the LAD in six, and the right coronary artery in two patients. The fistula terminated in the pulmonary artery in seven patients and in the right atrium in one patient. Successful operative treatment (coronary artery bypass grafting and ligation of the fistula) was undertaken in four patients with severe obstructive coronary artery disease with satisfactory results. Follow-up for up to 2 years of the three patients with coronary artery fistula and no associated coronary artery disease who did not undergo surgery revealed continuing good prognosis. We conclude that coronary artery fistula in adults is a distinct, though rare (incidence in present series 0.11%) entity, without audible murmur, commonly associated with coronary artery obstructive disease, and that the diagnosis is mostly incidental during routine coronary arteriography.     

Chronic suppurative otitis media complicated by subdural and Bezold abscesses: A case report

Complications of chronic suppurative otitis media (CSOM) are divided into intracranial and extracranial complications. Bezold abscess is a very rare extracranial complication with an incidence of 1.5% of the total complications of CSOM in a study conducted in China, similarly subdural abscess is a rare intracranial complication with an incidence of 0.3% in the same study. If not given proper and immediate treatment, these complications can be fatal. Head and neck computed tomography (CT) scan is the main modality for diagnosing complications of CSOM. We report the case of a 15-year-old girl with CSOM who suffered from multiple rare and life-threatening intracranial and extracranial complications. CT scan of the head and neck revealed multiple complications, including cholesteatoma with the destruction of the ossicles, a Bezold abscess inferiorly and a subdural abscess intracranially. Surgery was performed twice to remove the abscess, accompanied by antibiotic therapy according to the type of bacterial culture.     

CT studies of brain abscesses in cats

Summary Cerebral abscesses were produced in 56 cats by introducing staphylococcus aureus into the white matter of one cerebral hemisphere, using a stereotaxic apparatus. The cats were treated with antibiotics and/or steroids. The size and density of the inflammatory process and the abscess ring were measured on postcontrast CT scans. Differences were found depending on the stage of the abscess, but the deviation of values was too great for determining the age of the abscess from one measurement, to be able to apply proper treatment. The size and density of the abscesses were the same on CT whether the animals were treated or not. This was contrary to the clinical picture, the measurements of edema, and the histopathological studies.     

Usefulness of hydrogen peroxide enhancement in diagnosis of anal and ano-vaginal fistulas

Our objective was to assess if contrast-enhanced (CE) anal endosonography (AES) with hydrogen peroxide is useful in the diagnosis of anal and ano-vaginal fistulas. A Bruel and Kjaer scanner with a 7.0-MHz transducer was used. After visualization of the fistula tract in non-contrast (NC) AES, hydrogen peroxide was introduced into the fistula tract through the external opening in 22 patients with different types of anal fistulas. Both CE and NC AES revealed 13 transsphincteric, 3 intersphincteric, 2 suprasphincteric and 4 ano-vaginal fistulas. Simple tracts were found in 16 cases and complex in 6 cases in non-contrast AES. The CE AES revealed 19 simple and 3 complex fistulas. Fifteen internal openings visible in NC AES were confirmed in CE AES in 6 cases, which additionally found 11 more internal openings. Surgery confirmed all types of fistulas found in NC and CE AES; however, the latter two found 18 simple and 4 complex fistulas, and 21 internal openings. Both NC and CE AES are able to correctly differentiate types of anal fistulas and are of comparable value in differentiating simple from complex fistulas, although a false-negative result was found in CE AES. In the preoperative assessment of the internal opening, CE AES is superior to NC AES. Electronic Publication     

Amplatzer封堵器栓塞肺血管瘘道畸形

目的 评价Amplatzer封堵器作为新型栓塞材料在治疗肺血管瘘道畸形的临床价值。方法 肺血管瘘道畸形5例,包括肺动静脉瘘4例与肺动脉左房瘘1例,采用Amplatzer封堵器对供血动脉行经导管封堵治疗。结果 5例栓塞均获得技术成功,未见封堵器脱落移位,局部右向左分流消失,股动脉血氧饱和度由术前78.2％上升至术后94.5％。结论 Amplatzer封堵器用于肺血管瘘道畸形的经导管治疗安全可靠,近期疗效满意。