Standardized ultrasonic valuation of diffuse liver diseases.
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Biomedical subjects
Publications and source records attributed to F Candiani.
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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.
Eleven cases of pancreatic cystadenocarcinoma were studied with respect to the differential diagnosis from that of pancreatic pseudocysts, using diagnostic ultrasound as the initial investigative technique. Most of the cases presented an ultrasonic picture that correlated well with the gross pathology, but this correlation was not reliable enough to be considered characteristic in differentiating such masses from pseudocysts. The authors divide the cystadenocarcinomas of the pancreas into four echographic classes. In all but one of the classes, diagnostic ultrasound was insufficient by itself to render an accurate diagnosis. In such cases other techniques, i.e. CT, tissue biopsy, and especially angiography, were required for a reliable diagnosis.
A rapid identification of the type of prosthetic heart valve from the plain chest roentgenogram is often of extreme importance in the care of patients who have undergone prosthetic valve replacement. In the present report we have analyzed the radiographic appearances of 9 different models of mechanical and biological prostheses which are or have been employed at our Institution since 1969, with the aim of providing simple guidelines to identify these devices. For this purpose photographs were taken of the postero-anterior and left lateral chest radiograms of patients in whom these particular prostheses were implanted. Once the silhouettes of the radioopaque components of these devices have become familiar, the differentiation of the types and the recognition of the site of implantation is easy and rapid.
An experimental microangiograhic and echographic study was carried out on metastatic autopsy livers which were also examined histologically. Relationships between the echographic pattern and vascularization are explored. In most cases, hypervascular lesions correspond to hyperechogenic patterns, while hypovascular lesions furnish hypoechogenic images.
In polycentric research we studied 62 selected cases of gestosis to evaluate which symptom is greatly correlated with the deficit of fetal growth. According to us, the earlier the syndrome appearance the clearer the deficit of fetal growth.
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Fourteen cases of upper gastrointestinal bleeding (UGIB) were reviewed: 6 (group A) were caused by pancreatitis, 3 (group B) by hemobilia, and 5 (group C) by rupture of esophageal varices due to arterioportal shunts. Elective endoscopy carried out in 7 patients in groups A and B was negative; in 2 actively bleeding patients in group A emergency endoscopy could not detect the source of hemorrhage. Endoscopy was carried out in 4 patients in group C for diagnosis and sclerosis, but severe hemorrhage recurred in spite of treatment. Ultrasonography (US) and computed tomography (CT) were carried out prior to angiography in 5 and 4 patients, respectively, and always suggested a parenchymal lesion. All patients underwent angiography. Transcatheter control of the hemorrhage was attempted as an emergency in 2 patients (as a presurgical step in one); elective embolization was the treatment of choice for 8 patients, with good results in 6. This study suggests the usefulness of US and CT both in the detection of parenchymal lesions causing UGIB not clarified by endoscopy, and in the selection of patients for angiographic treatment.
The authors, studying 72 abdominal aortic aneurysms by ultrasounds, show the main diagnostic problems of this pathology. These aneurysms are divided into two classes: the silent and the acute ones; the second group includes the atherosclerotic aneurysms in rupture and the dissecting aneurysms. Ecography is considered as a preliminar test in the evaluation of the aneurysms of the first group, allowing, in case of good results, the surgical operation without other invasive tests. Ultrasounds can also reduce problems of differential diagnosis. In case of non dissecting acute aneurysms, ecography leads to a quick diagnosis, allowing sudden surgery. In case of dissecting aneurysms, angiography remains the best examination, except those rare cases with atypical symptoms.
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