Color Doppler sonography in afferent loop syndrome.
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Afferent Loop Syndrome↗
Biomedical subjects
J H Lim
Publications and source records attributed to J H Lim.
Membranous obstruction of the inferior vena cava: comparison of findings at sonography, CT, and venography.
OBJECTIVE: Membranous or segmental obstruction of the inferior vena cava is one of the common causes of chronic Budd-Chiari syndrome. In this study, the venographic findings are compared with the results of sonography and CT in order to ascertain their role in the management of these cases. MATERIALS AND METHODS: Fifteen patients with membranous (n = 8) or segmental (n = 7) obstruction of the inferior vena cava who had been examined with sonography and CT were studied retrospectively. Diagnosis was made at surgery (n = 3) or by venacavography (n = 12). Sonographic findings were analyzed on the basis of the initial report, and CT findings were reviewed retrospectively with knowledge of the sonographic findings. RESULTS: Sonography showed membranous obstruction (n = 5), segmental cordlike obstruction (n = 3), and unspecified obstruction (n = 5) of the inferior vena cava, while CT showed a flap of the membrane (n = 1) and segmental narrowing or obstruction of the inferior vena cava (n = 7). In the remaining cases, the inferior vena cava either appeared normal (n = 6) or was not visualized (n = 1) on CT or was not described in the sonographic report (n = 2). In nine cases, CT showed one or several tiny calcific foci in the inferior vena cava. Sonography showed obliteration of at least one hepatic vein (n = 8) and of intrahepatic collateral vessels (n = 12), whereas CT was less sensitive in evaluating obliteration of intrahepatic veins (n = 4) and collateral vessels (n = 7). Sonography and CT both showed hepatic masses (n = 6), evidence of liver cirrhosis and portal hypertension (n = 14), hepatomegaly (n = 14), enlargement of the caudate lobe (n = 9), and intraabdominal (n = 11) and abdominal wall (n = 15) collateral vessels. CONCLUSION: Sonography was superior to CT in delineating pathologic venous anatomy of the inferior vena cava and hepatic veins whereas CT was better in evaluating hepatic cirrhosis and tumor. We believe that these techniques are useful complements to venography in the diagnosis and management of these cases.
Adolescent↗
Sonographic detection of duodenal ulcer.
Using a wall thickness of greater than 5 mm for the first portion of the duodenum as the criterion for the sonographic diagnosis of duodenal ulcer, we studied the value of sonography in detecting this lesion. Endoscopy (88 patients) and upper gastrointestinal barium studies (12 patients) were used as the gold standards for the diagnosis. The study included 100 patients in whom gastrointestinal disease was suspected (20 with duodenal ulcer and 80 with normal findings). Of the 20 duodenal ulcers verified by endoscopy or upper gastrointestinal series, 13 patients had duodenal wall thickening, six had normal wall thickness, and one was nondiagnostic. Of the 80 subjects with normal findings on endoscopy or upper gastrointestinal series, 73 patients had a normal duodenum, four had wall thickening, and three were nondiagnostic. Considering the four nondiagnostic cases as sonographic errors, there were six false-negative cases and four false-positive cases (a sensitivity of 65%, specificity of 91%, positive predictive value of 76%, and negative predictive value of 92%). Our results show that sonography is not sufficiently sensitive to be used as a screening test, nor is it specific for duodenal ulcer, but a thickened duodenal wall of over 5 mm on sonography warrants additional work-up.
Duodenal Ulcer↗
Sonographic findings in tuberculous peritonitis of wet-ascitic type.
Sonograms in 46 patients with tuberculous peritonitis of the wet-ascitic type were analysed retrospectively. The ascites was clear in 24 patients (52%). There were fixed membranes, septa and debris in eight patients (17%), floating debris in six patients (13%), mobile strands or membranes in four patients (9%), and fixed septa in four patients (9%). The patients were divided into two groups depending on the amount of ascites: small amount of ascites with clear fluid in eight patients (17%), and moderate or large amount of ascites with clear or complex fluid in 38 patients (83%). Associated findings were omental 'cake' (26%), hepatomegaly (24%), thickened mesentery with adherent small bowel loop (22%), splenomegaly (20%), pleural effusion (17%), lymphadenopathy (13%), and thickening of the ileal wall (7%). The sonographic findings are not specific for tuberculous peritonitis, but may give valuable information to prevent unnecessary laparotomy.
Abdomen↗
Oriental cholangiohepatitis: pathologic, clinical, and radiologic features.
Oriental cholangiohepatitis, an endemic disease in Southeast Asia, is characterized by recurrent attacks of abdominal pain, fever, and jaundice. Pathologically, the intra- and extrahepatic ducts are dilated and contain soft, pigmented stone and pus. There is proliferation of bile ducts and infiltration of inflammatory cells along the periportal spaces and hepatic parenchyma. Localized intrahepatic segmental ductal stenosis may be present, especially in the lateral segment of the left lobe or posterior segment of the right hepatic lobe. The cause of the disease is not known, but associations with clonorchiasis, ascariasis, and nutritional deficiency have been suggested. Sonographic and CT findings include intra- or extrahepatic duct stones, dilatation of the extrahepatic duct with relatively mild or no dilatation of the intrahepatic ducts, localized dilatation of the lobar or segmental bile ducts, increased periportal echogenicity, segmental hepatic atrophy, and gallstones. Cholangiographic findings include bile duct stones; disproportionately severe dilatation of the extrahepatic ducts with mild or no dilatation of the intrahepatic ducts; and focal strictures, acute peripheral tapering, straightening, rigidity, decreased arborization, and an increased branching angle of the intrahepatic bile ducts.
Bile Ducts↗
Afferent loop syndrome: sonographic findings in seven cases.
We studied the sonographic findings in seven patients in whom afferent loop obstruction was first detected by sonography. All seven subsequently were proved at surgery to have afferent loop syndrome. The causes of the obstruction included internal hernia (n = 3), cancer recurrence (n = 2), marginal ulcer (n = 1), and development of cancer at the anastomosis site (n = 1). In all cases, the dilated afferent loop was seen on sonography as a tubular structure in the upper abdomen crossing transversely over the midline. The distal end of the afferent loop could be traced toward the anastomosis. The probable cause of the syndrome was predicted on the basis of sonography in two of three patients with cancer at the anastomosis. Our experience suggests that afferent loop syndrome can be diagnosed sonographically on the basis of the detection, location, and shape of the dilated afferent loop.
Adult↗
Syndrome of partial aniridia, cerebellar ataxia, and mental retardation--Gillespie syndrome.
Here we describe a 5-year-old girl with Gillespie syndrome of cerebellar ataxia, partial aniridia, and mental retardation. The Gillespie syndrome probably is an autosomal recessive trait.
Aniridia↗
Right perirenal space. Computed tomography evidence of communication between the bare area of the liver.
Computed tomography (CT) images from one cadaver and 11 patients with perirenal fluid collection were reviewed to study whether the right perirenal space communicates with the bare area of the liver. CT of a cadaver obtained after meticulous right perirenal injection of contrast media showed that contrast media extended superiorly into the bare area of the liver. CT of 11 patients with right perirenal hemorrhage or infection showed that fluid collection within the right perirenal space continued upward, crossing the coronary ligament, extending into the bare area of the liver. The inferior vena cava were completely or partially surrounded by fluid. CT of two patients with bleeding hepatocellular carcinoma showed that blood in the bare area continued extending downward into the perirenal space. We conclude that the right perirenal space is open toward the bare area of the liver and fluid collection within one space may communicate with the other space across the coronary ligament.
Cadaver↗
Medial extent of the posterior renal fascia. An anatomic and computed tomography study.
To study the medial extent of the posterior renal fascia and the perirenal space, the authors dissected two cadavers and reviewed 50 computed tomographic (CT) abdominal scans. The results demonstrated that the medial extent of the posterior renal fascia depends on the level in a vertical direction and its relationship to the kidney which varies at different levels. At the renal hilus, the fascia inserts posteromedially to the fascia of the quadratus lumborum along its lateral margin; more cranially, the line of insertion is more lateral, onto the diaphragmatic fascia; more caudally, the line of insertion is more medial, inserting onto the anterior surface of the quadratus lumborum. Therefore the posteromedial insertion of the posterior renal fascia extends medially, from the more laterally placed diaphragmatic fascia, to the lateral margin of the quadratus lumborum and then to the anterior surface of the quadratus lumborum, depending on the anatomic level. The clinical implication of these findings are discussed.
Cadaver↗
Clonorchiasis of the pancreas.
Three patients with pancreatic clonorchiasis were examined with endoscopic retrograde pancreatography. On each of the three cases there was diffuse irregular dilatation of tributaries of the pancreatic duct in the pancreatic tail. The main pancreatic duct and tributaries draining into the body and head portion were not dilated. A sonogram from one patient showed diffuse enlargement of the pancreas, especially the tail. All three patients showed typical cholangiographic findings of hepatic clonorchiasis, namely diffuse peripheral intrahepatic bile duct dilatation with no or minimal dilatation of the extrahepatic duct. When the tributaries of the pancreatic duct in the tail of the pancreas are diffusely dilated, in the appropriate clinical setting, pancreatitis caused by Clonorchis sinensis should be considered.
Aged↗
Sonographic detection of pneumoperitoneum in patients with acute abdomen.
We describe five patients who presented with an acute abdomen in whom pneumoperitoneum was first detected by sonography. All five subsequently were proved to have a perforated viscus. In all cases, the pneumoperitoneum was seen as an echogenic line with a posterior ring-down or reverberation artifact between the anterior abdominal wall and the anterior surface of the liver. The finding was shown best in the right upper quadrant with the patient in the left lateral decubitus position. The echoes caused by the pneumoperitoneum overlapped the echoes of the lung during inspiration, but the echoes were separate during expiration. The probable cause of pneumoperitoneum was determined with sonography in four of the five patients: three had perforation of duodenal ulcer and one had perforation of gastric cancer. The fifth patient had a perforated ileum, which was not evident on the sonogram. Our experience with these patients suggests that the detection of pneumoperitoneum on sonography in patients with an acute abdomen is an important sign of a perforated viscus.
Abdomen, Acute↗
Oriental cholangiohepatitis: sonographic findings in 48 cases.
Oriental cholangiohepatitis is characterized by recurrent attacks of abdominal pain, fever, chill, and jaundice and grossly dilated extrahepatic and intrahepatic ducts containing soft, pigmented stone and pus. Sonograms were studied in 48 patients in whom the diagnosis was later proved during surgery (n = 34) or on the basis of clinical and laboratory findings and endoscopic retrograde cholangiography (n = 14). The sonographic findings included intrahepatic and/or extrahepatic bile duct stones (n = 47); moderate to severe dilatation of the extrahepatic ducts with relatively mild or no dilatation of intrahepatic bile ducts (n = 41); localized dilatation of the lobar or segmental bile ducts, especially the left hepatic lobe (n = 16); and gallstones (n = 22). Our experience suggests that the preoperative diagnosis of oriental cholangiohepatitis can be strongly suggested by sonographic findings.
Adult↗
Radiologic findings of clonorchiasis.
Clonorchiasis is a trematodiasis caused by chronic infestation of liver flukes, Clonorchis sinensis. The adult flukes reside in the medium-sized and small intrahepatic bile ducts and, occasionally, in the extrahepatic bile ducts, gallbladder, and pancreatic duct. The result is mechanical obstruction, inflammatory reaction, adenomatous hyperplasia, and periductal fibrosis. Signs and symptoms are usually mild and nonspecific, but heavy infestation results in obstructive jaundice. The disease has a close relationship with recurrent pyogenic cholangitis and cholangiocarcinoma. In this article, the radiologic findings, including cholangiography, sonography, and CT of clonorchiasis are reviewed in light of the pathophysiology of the disease. The relationship to recurrent pyogenic cholangitis and to cholangiocarcinoma is discussed.
Bile Duct Neoplasms↗
Anatomic relationship of intrahepatic bile ducts to portal veins.
To assess the anatomic relationship between the intrahepatic bile ducts and corresponding portal veins, we studied anterior-posterior relationship of the segmental bile ducts to the accompanying portal veins using sonograms and cadavers. On sonograms of the 64 segments in 16 patients with biliary dilation, the segmental bile ducts lay anterior to the corresponding portal veins in 34%, posterior in 39%, superior in 2%, tortuous in 13%, and undetermined in 13%. The relationship was inconsistent in terms of hepatic segments and thus bile ducts lay anterior to the portal vein in one segment and posterior in the other segment within the same liver. Sagittal sections in 11 segments of the 3 cadaveric livers revealed that the bile ducts were anterior to the corresponding portal veins in 1 segment, posterior in 2 segments, superior in 5 segments, anterosuperior in 1 segment, and posterosuperior in 2 segments. It is concluded that, contrary to the common belief, there is no constant anterior-posterior relationship between the intrahepatic bile ducts and the corresponding portal veins.
Bile Duct Diseases↗
Sonographic sliding sign in localization of right upper quadrant mass.
Sonographic sliding sign is the observation of dynamic motion of a mass against adjacent organs during respiratory movement or extrinsic pressure. We applied this sign for prospective study in nine patients, each of whom had a large posterior right upper abdominal mass arising from the liver, kidney, or adrenal gland. The sign was found to be very reliable as a criterion for the localization of the origin of the mass in all patients except in the following two cases: a Wilm's tumor that invaded the retroperitoneum and posterior abdominal wall was regarded as a retroperitoneal tumor invading the kidney; and in the other one, an adrenal pheochromocytoma, the sliding sign against the liver and the right kidney was equivocal. In conclusion, judicious use of the sonographic sliding sign will greatly assist in the localization of a large right upper abdominal mass, especially when there is a paucity or lack of retroperitoneal fat.
Abdominal Neoplasms↗
Biliary cystadenoma and cystadenocarcinoma: CT and sonographic findings.
Eight women (ages 18-65 years; mean, 47 years) with biliary cystadenoma (n = 3) or cystadenocarcinoma (n = 5) were examined with computed tomography and sonography. The appearance of the tumors varied from unilocular cystic masses to multilocular cystic masses with multiple satellite tumors, although the majority (n = 6) of tumors were single, multilocular, and cystic. Cystic areas showed attenuation numbers under +30 HU. Papillary excrescences, nodular thickening of internal septa, and mural nodules, which showed contrast enhancement, were seen in one case of cystadenoma and all five cases of cystadenocarcinoma. One cystadenoma and one cystadenocarcinoma contained calcifications. Three cases showed connection to the intrahepatic bile ducts. Biliary cystadenoma and cystadenocarcinoma should be the primary diagnostic consideration when one detects in a middle-aged woman a well-encapsulated, multilocular cystic mass connected to the biliary system or prolapsing into the bile duct.
Adult↗
Clonorchiasis: sonographic findings in 59 proved cases.
Clonorchiasis is a parasitic disease of the bile ducts that occurs in endemic areas after ingestion of the raw flesh of freshwater fish. We analyzed the sonographic findings in 59 patients with clonorchiasis, suspected prospectively from sonographic findings and proved subsequently by demonstration of eggs in their stools. Diffuse dilatation of the small intrahepatic bile ducts with no or minimal dilatation of the large intra- and extrahepatic ducts was observed in all cases. The extrahepatic ducts were patent throughout in all except one case. This characteristic finding reflects diffuse intrahepatic bile duct obstruction and resultant proximal dilatation caused by an adult worm or aggregates of worms, as worms reside diffusely in the medium and small intrahepatic bile ducts. Cholangitis and multifocal periductal fibrosis with proximal dilatation may play an additional role. Increased echogenicity of the intrahepatic bile duct wall was present in 39 cases (66%), reflecting cholangitis and periductal fibrosis. In 17 cases (29%), floating or dependent, discrete, nonshadowing, intraluminal, echogenic foci caused by adult worms in the bile were demonstrated in the gallbladder. These echogenic foci were distinguished from stones because they were fusiform, weak in echogenicity, and floated with a change in position. Clonorchiasis should be considered when sonography discloses the characteristic pattern of bile duct dilatation with increased wall echogenicity and nonshadowing, discrete, echogenic foci in the gallbladder lumen.
Adult↗
Superior aspect of the perirenal space: anatomy and pathological correlation.
To study the anatomy of the superior aspect of the perirenal space, we analysed 50 computed tomographic (CT) scans with reference to the anatomy of Gerota's fascia, and dissected five cadavers laying special emphasis on the ascent of Gerota's fascia. We also reviewed 10 scans of patients with a large lesion in the right upper abdomen regarding localisation of the lesion. We conclude that Gerota's fascia does not cover the upper portion of the kidney and adrenal gland so that the superior aspect of the perirenal space is open towards the upper abdominal extraperitoneal space. Thus, a large lesion arising from the right adrenal gland or kidney easily invaginates the liver through the bare area mimicking a hepatic lesion, and vice versa. This explains the difficulty in localising a large lesion in the right upper abdomen.
Humans↗