Sonographic diagnosis of gallbladder perforation.
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Acute Disease↗
Biomedical subjects
B J Lewandowski
Publications and source records attributed to B J Lewandowski.
Salmonella enteritis: a cause for ascites.
A differential diagnosis of ascites includes many different entities, both benign and malignant. However, no cases of Salmonella enteritis or other infectious enteritis-causing ascites have previously been described. We present the case of a 21-yr-old female admitted with abdominal pain and diarrhea caused by Salmonella enteritis. An abdominal and pelvic sonogram revealed a moderate amount of free fluid in the pelvis. We conclude that Salmonella enteritis is in fact a potential cause of free intraperitoneal fluid, and should be considered in the differential diagnosis of ascites under appropriate clinical circumstances.
Adult↗
Fat-filled postoperative renal pseudotumour: variable appearance in ultrasonography images.
A hyperechoic renal pseudotumour caused by packing an operative renal defect with retroperitoneal fat has been previously described. The authors describe eight patients who underwent such packing of a renal defect and for whom ultrasonography was later performed to determine the frequency of pseudotumours and their ultrasonographic appearance. In four patients an obvious surgical defect but no pseudotumour was apparent in the renal parenchyma. In the others a pseudotumour had developed: in two the mass was hyperechoic, as previously reported, but in two the mass was isoechoic. The isoechoic pseudotumours were initially diagnosed as probable carcinomas by the ultrasonographer. Correlation with the surgical history and computed tomography scans led to the correct diagnosis.
Adipose Tissue↗
A prospective study of ultrasound localization for renal shielding.
Accurate and reproducible shielding of sensitive tissues is essential in clinical radiotherapy. Renal localization is necessary when the kidneys are to be shielded during upper or whole abdominal radiotherapy. Despite extensive clinical experience with intravenous contrast media for renal localization, ultrasound has been proposed as a safer, more cost-effective alternative. In a prospective study, we assessed the accuracy of renal localization by ultrasound. Results show that ultrasound localization covers only 56.5 +/- 27.0% of the renal outline on average; moreover, the ultrasound designed shield results in 57.2 +/- 20.4% of its area being superfluous. Possible explanations and modifications are discussed. We urge others using ultrasound localization for renal shielding to assess its accuracy before using these shields in clinical practice.
Humans↗
Water intoxication: a complication of pelvic US in a patient with syndrome of inappropriate antidiuretic hormone secretion.
A woman was first seen with water intoxication caused by the voluntary ingestion of water in an attempt to fill her bladder before undergoing pelvic ultrasound (US). As in two other reported cases, this woman was receiving medication that causes the syndrome of inappropriate antidiuretic hormone secretion. A patient undergoing transabdominal pelvic US who is receiving these medications and whose bladder is not full should undergo examination by means of a transvaginal or endorectal route.
Aged↗
Experience with intracorporeal injection of papaverine and duplex ultrasound scanning for assessment of arteriogenic impotence.
We present our experience with the intracorporeal injection of papaverine and duplex sonography in the assessment of 47 patients with suspected vasculogenic impotence. Sonography and Doppler analysis were performed before and after the papaverine injection. The anatomy of the penis was easily seen. Flow in the deep arteries was obtained in most patients in both the flaccid and erect state. Patients with a good erectile response to papaverine injection had a larger increase in the inner diameter of the deep cavernosal artery than did those with a poor response. However, the percentage change in the diameter did not correlate with the degree of clinical response. Following injection, the systolic peak flow rates and diastolic minimum flow rates were higher in patients with some clinical response but only the increase in diastolic flow rates correlated in a stepwise fashion with the degree of clinical response. This technique provides a method for the objective assessment of response to intracorporeal papaverine injection. Its potential as a diagnostic test will only be determined after normal values are established. At present it appears most useful in patients responding poorly to papaverine injection by indicating the possible area of vascular impairment and the direction for further evaluation.
Adult↗
The air-filled left hepatic duct: the saber sign as an aid to the radiographic diagnosis of pneumobilia.
In the supine patient, gas rises to the left hepatic duct. Radiographically, this can be recognized as a saber-shaped lucency to the right of the spine. In a retrospective analysis and review of the radiographs of 40 patients shown to have gas in the biliary tree by ultrasound (US), computed tomography (CT), or radiography, the diagnosis could be made in 37 patients. In 18 of these 37 cases pneumobilia could be identified by the saber-shaped distribution of gas. Knowledge of the medial distribution of biliary gas in the supine patient and appreciation of the saber sign can increase the sensitivity of the radiographic detection of pneumobilia.
Biliary Tract Diseases↗
Echographic appearance of the right hemidiaphragm.
In a prospective evaluation of the right upper quadrant in 100 consecutive healthy subjects, three echogenic lines were visualized in the right posterior, superior, and lateral aspects of the abdomen in the region of the right hemidiaphragm in approximately 80 per cent. A retrospective review was made of the sonograms of 33 patients with right pleural effusions alone, 14 patients with ascites alone, and ten patients with combined ascites and pleural effusions. Analysis of the number of echogenic lines seen in the region of the right hemidiaphragm and their relationship to the gas reverberation artifact suggests that two of the three lines seen in scans of normal subjects represent actual structures (diaphragm--liver capsule complex and lung--visceral pleura an in-vitro model constructed to simulate the liver, diaphragm, lung, and pleural effusion support the hypothesis that the lung and not the diaphragm is the mirror of the right upper quadrant.
Ascites↗
Sonographic demonstration of the right paramediastinal pleural space.
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Humans↗
Incidence of aortic cusp and mitral annulus calcification as determined by echocardiography: significance and interrelationship.
M-mode and two-dimensional echocardiograms of 3,254 patients without evidence of rheumatic heart disease were evaluated retrospectively for evidence of aortic cusp calcification and mitral annulus calcification. Echographic evidence of mitral annulus calcification was found in 6.3% of the patients studied. In 375 patients with echographic evidence of aortic valve calcification, the incidence of mitral annulus calcification was 30.6% and it was more than twice as common in females (44.9%) as in males (19.2%). Mitral annulus calcification in patients with aortic cusp calcification was age- and gender-dependent. It occurred in 25% of women younger than 50, 50% of women over 60, and 60%Q of women over 80 years of age. The incidence in males was 28.5% and 27% in the 70s and 80s, respectively. There was no correlation between the severity of aortic valve calcification of stenosis and the incidence of mitral annulus calcification.
Adolescent↗
Gallbladder wall thickness distortion by ascites.
Eight patients with sonographically demonstrated ascites adjacent to or surrounding a gallbladder wall of normal thickness are described. In two patients, improper transducer placement or angulation caused apparent gallbladder wall thickening. Two in vitro experiments, one with a balloon phantom and the other with a resected gallbladder, confirmed that wall thickness varies with transducer placement and angulation. Ascites per se neither causes gallbladder wall thickening nor results in artifactual thickening if the beam angle is controlled.
Adult↗
Relationship between the pericardial and pleural spaces in cross-sectional imaging.
Sixty patients, including 15 with large pericardial effusions, five with large left pleural effusions, and nine with both, were studied prospectively with two-dimensional echocardiography to verify the relation of pericardial effusions and posterior paramediastinal pleural effusions to the descending thoracic aorta. It was found that large pericardial effusions lie anterior to the descending aorta both at the level of the left atrium and the left ventricle, whereas large posterior paramediastinal pleural effusions lie posterior, lateral, or posterolateral to the descending aorta. A retrospective study of 148 M-mode echocardiograms showed similar findings; but the descending thoracic aorta was less reliably identified, and the lateral position of pleural effusions with respect to the aorta could not be evaluated.
Aorta, Thoracic↗
LGM (Vena Tech) vena caval filter: experience at a single institution.
PURPOSE: The authors describe their experience with LG-Medical (LGM [Vena Tech]) filter placement and follow-up. PATIENTS AND METHODS: LGM vena cava filters were placed in 63 patients. Follow-up was obtained by means of duplex sonography of the introduction vein and inferior vena cava (IVC) and abdominal radiography in 50 patients, and by means of autopsy in an additional four patients. In eight, only clinical follow-up was obtained and one patient was lost to follow-up. RESULTS: Major complications of placement occurred in three patients, all when the right internal jugular vein was used for introduction: In one patient a filter was inadvertently placed in the right renal vein and in two the filter failed to open fully. No serious complications of placement occurred when either the right or left common femoral veins were used. Pulmonary embolism (PE) recurred in four patients (6%) and was fatal in one. Septicemia from an infected filter was the probable cause of death in another patient. Introduction vein thrombosis occurred in five patients (8%) and was symptomatic in two (3%). Occlusion of the IVC occurred in 15 patients (24% of the total patient group, but 28% of those with objective follow-up) and was symptomatic in 12 (19%). Two patients with IVC occlusion had recurrent PE. CONCLUSION: These data suggest that the rate of IVC occlusion is higher than most previous reports have suggested and that IVC occlusion may be a potentially serious complication.
Equipment Design↗