Diagnosis of interstitial pregnancy.
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Diagnosis, Differential↗
Biomedical subjects
F C Laing
Publications and source records attributed to F C Laing.
The pseudo-dilated common bile duct: ultrasonographic appearance created by the gallbladder neck.
A retrospective analysis of 111 ultrasonograms was performed in order to evaluate the relationship of the gallbladder neck to the common bile duct and portal vein. Of the 100 studies deemed technically adequate, eight contained scans that demonstrated a potentially confusing pattern of a pseudo-dilated common bile duct caused by either a redundant or folded neck of the gallbladder. Recognition of this entity as well as the use of real-time ultrasound equipment should minimize false-positive diagnoses of extrahepatic bile duct dilatation.
Common Bile Duct↗
Ultrasonographic evidence of gallbladder wall thickening in association with hypoalbuminemia.
Retrospective evaluation of 125 consecutive gallbladder sonograms was done to determine the conditions under which a thickened gallbladder wall is identified. The population studied included a large number of chronic alcoholics. Forty-two patients (Group A) had thickened (greater than or equal to 3 mm) gallbladder walls, while 48 patients (Group B) had walls of normal thickness. Forty patients in Group A had markedly depressed serum albumin levles, significantly lower (p less than 0.001) than albumin levels in Group B. Ten patients in Group B had cholecystitis, compared to two in Group A. The authors conclude that a thick gallbladder wall can be seen in severe hypoalbuminemic states in the absence of acute or chronic cholecystitis.
Acute Disease↗
Sonographic demonstration of portal hypertension: the patent umbilical vein.
The remnant of the umbilical vein, the ligamentum teres, is seen on a high percentage of normal ultrasonograms. In patients with portal hypertension, the umbilical vein often reopens as a collateral vessel and can be visualized sonographically; the authors have recently demonstrated this finding in 30 patients. Recognition of a patent umbilical vein is important, since it currently is the only ultrasonographic finding specific for portal hypertension.
Adult↗
Ultrasonic demonstration of endometrial fluid collections unassociated with pregnancy.
Intrauterine fluid collections were demonstrated by ultrasound in 17 non-pregnant patients. In nearly all instances, the surrounding echoes were of low to moderate amplitude. This has been noted previously in women with an ectopic or abnormal intrauterine pregnancy. In 2 patients, a well-defined thick rind of high-amplitude echoes encompassed the fluid, simulating an early gestational sac. Small intrauterine fluid collections were seen most frequently in non-pregnant patients who had vaginal bleeding or inflammation of the endometrium or adnexa.
Abscess↗
Rapid water infusion: a technique in the ultrasonic discrimination of the gas-free stomach from a mass in the pancreatic tail.
A technique of rapid water infusion into the stomach is described as an ultrasonic method to differentiate the gas-free stomach presenting as a solid mass from a mass in the tail of the pancreas. The infusion permits delineation of the tail of the pancreas as a discrete structure.
Air↗
Atypical pseudocysts of the pancreas: an ultrasonographic evaluation.
Ultrasonograms of most pseudocysts have a typical appearance--sharply defined, smooth wall, ovoid, located in the region of the pancreas. However, in reviewing the sonographic appearance of pseudocysts, other ultrasonographic characteristics may occasionally be encountered. Eleven patients with atypical pseudocysts are presented. The demonstration of multiple septations, multiple echoes within a sonolucent mass, and even failure to enhance posteriorly should not exclude the diagnosis of pancreatic pseudocyst in the proper clinical setting. The value of serial scans is also stressed. In this series, it was possible to suggest the diagnosis of infection, hemorrhage, and rupture of pseudocysts by demonstrating cysts with more typical appearances on prior examinations.
Adult↗
The decidual cast of ectopic pregnancy: a confusing ultrasonographic appearance.
The appearance of the central uterine cavity was analyzed in 39 cases of ectopic pregnancy. In nearly 20% of cases, a fluid collection surrounded by an echogenic ring was present which could be mistaken for a normal early intrauterine pregnancy. When ectopic pregnancy is suspected clinically, and there is fluid in the cul-de-sac or an adnexal mass on ultrasound, a fetal pole should be evident within the central fluid collection before a definitive diagnosis of intrauterine pregnancy is made.
Decidua↗
Vaginitis emphysematosa. Importance of its radiologic recognition.
Vaginitis emphysematosa (VE) is a benign, self-limited condition characterized by a myriad of gas-filled spaces in the subepithelial lining of the vaginal wall, which give it a distinct radiographic appearance. Failure to make the correct diagnosis may lead to an inappropriate course of treatment, including surgery. Although it is considered rare, we have encountered five cases of VE in the course of a year.
Adolescent↗
Anatomic variation of portal venous anatomy in the porta hepatis: ultrasonographic evaluation.
The appearance of the portal vein as it crosses anterior to the inferior vena cava and enters the liver at the porta hepatis was evaluated on 100 longitudinal and 100 transverse ultrasonograms. Three major variations were noted on the parasagittal scans, while four major variations were evident on the transverse images. These variations were primarily related to the size of the left portal vein and the angle at which the left portal vein coursed away from the main portal vein. The appearance and course of the proximal right portal vein was extremely constant and may therefore be used as a landmark to detect pathologic processes in the porta hepatis. Detection of altered anatomy in this region may be especially helpful in correctly differentiating dilated intrahepatic bile ducts from normal portal veins.
Diagnostic Errors↗
Ultrasonographic identification of dilated intrahepatic bile ducts and their differentiation from portal venous structures.
The appearance of dilated intrahepatic bile ducts was evaluated on ultrasonograms of 50 patients with proven extrahepatic biliary obstruction. Five characteristic changes allowed differentiation between biliary and portal venous systems. These changes included: 1) alteration in the anatomic pattern adjacent to the main right portal venous segment and the main portal vein bifurcation. 2) Irregular walls of dilated bile ducts. 3) Stellate confluence of dilated bile ducts. 4) Acoustic enhancement by dilated bile ducts. 5) Peripheral location of dilated bile ducts. Many patients exhibited more than one of these findings. Parasagittal scans of the main right portal vein were the most sensitive for detection of intrahepatic ductal dilatation. Recognition of the characteristic changes and knowledge of the portal venous anatomy makes it possible to diagnose extrahepatic biliary obstruction with a high degree of confidence.
Bile Ducts, Intrahepatic↗
Ultrasonographic demonstration of inferior vena caval invasion.
Whenever a liver neoplasm is seen ultrasonographically, an effort should be made to visualize the veins within the liver as well as the inferior vena cava for tumor extension. Valuable information can be obtained by the demonstration of this finding which may radically alter the further work-up and treatment of the patient.
Carcinoma, Hepatocellular↗
Problems in the application of ultrasonography for the evaluation of pleural opacities.
Fifty-nine patients with pleural abnormalities on chest radiographs were evaluated by B-mode ultrasonography; the lesions were categorized as echo-free or complex. Echo-free lesions included pleural fluid collections, and abnormalities which did not yield "fluid" through an appropriately positioned large caliber needle. "Complex appearing" lesions yielded fluid through a needle in all cases. Ultrasonography could not accurately predict which lesions were amenable to successful thoracocentesis. Findings from recent radiographs and clinical history must be known when the ultrasonographic findings in patients with chest abnormalities are interpreted.
Humans↗
Analysis of ultrasonographic criteria in the evaluation for ectopic pregnancy.
To assess the usefulness of ultrasound in diagnosing ectopic pregnancy, the ultrasonographic findings, pregnancy test results, and proven diagnoses in 148 patients referred for evaluation for ectopic pregnancy were reviewed. Of these patients, 33 were subsequently proven to have ectopic gestations. The ultrasonograms were coded for uterine size, intrauterine gestation sac, adnexal mass, adnexal ring, cul-de-sac fluid, or normal findings. With a positive pregnancy test, the presence of an intrauterine gestation sac excludes the diagnosis of ectopic pregnancy. Of those patients with positive pregnancy tests and no intrauterine gestation sac, 73% had ectopic pregnancy. All patients with normal ultrasonograms had other diagnoses. With a negative pregnancy test, the intrauterine findings are not helpful, and evaluation of the adnexa is more important. An adnexal ring is a significant, though not absolute, indicator of ectopic pregnancy. A normal scan excludes this diagnosis. Other criteria were not significant. A clinical approach to the evaluation for ectopic pregnancy, based on the data accumulated in this study, is suggested.
Female↗
Gallstones preventing ultrasonographic visualization of the gallbladder.
Ultrasonography can be used to diagnose the presence of multiple gallstones, despite the fact that the gallbladder, per se, may not demonstrated. The finding of many echoes in the area occupied by the gallbladder that cast a large acoustical shadow is strongly suggestive of gallstones.
Adult↗
Ultrasonographic assessment of neck masses.
Fourteen patients are presented to illustrate the usefulness of ultrasonography in assessing masses of the neck. Included are five patients with primary tumors, two with metastasis to a cervical node, three with cervical adenitis, two with simple cysts, and two with hematoma related to endarterectomy for occlusive disease of the carotid artery.
Cat-Scratch Disease↗
Value of ultrasonography in the detection of retroperitoneal inflammatory masses.
The ultrasonographic and radiologic findings for 7 patients with retroperitoneal inflammatory processes are presented. Ultrasonographic findings were critical to the diagnosis in 6 of the 7 patients and allowed for rapid evaluation and the institution of successful therapy. The relative sensitivity and specificity of ultrasonography is compared with conventional radiologic modalities. The application of diagnostic ultrasound to the problem of retroperitoneal inflammation is advocated.
Adult↗
Use of simethicone as a patient preparation for abdominal sonography.
Fifty-eight patients about to undergo abdominal ultrasonography were randomly assigned into groups receiving preparation with oral simethicone and into control groups. A percentage value of sound transmission through the abdomen was calculated for each patient using sonographic measurements taken from a series of prescribed scans by a sonographer unaware of the patient preparation employed. Results indicate a statistically significant improvement in through sound transmission for those groups receiving simethicone preparation.
Abdomen↗