D.R.M. Lindsell

OXFORD SCREENING PROGRAMME FOR ABDOMINAL AORTIC ANEURYSM IN MEN AGED 65 TO 74 YEARS

824 men aged 65 to 74 were invited for ultrasound screening of the aorta and 426 (51.7%) attended. An abdominal aortic aneurysm was discovered in 23 (5.4%), and in 10 (2.3%) the aneurysm was 4.0 cm or more in diameter. 2 other patients had a common iliac artery aneurysm. The 36 men who had objective evidence of occlusive arterial disease of the lower limbs were twice as likely to be tobacco smokers and accounted for 5 (20%) of the aneurysms discovered. Extension of this screening programme to England and Wales could be expected to identify 52,500 men with an abdominal aortic aneurysm. If elective surgical replacement of the aneurysm were to be accepted by 60% of those with aneurysms 4 cm or more in diameter, 6000 unnecessary deaths from aortic aneurysm rupture could be prevented.

Ultrasound imaging of pancreas and biliary tract

Ultrasound and endoscopic retrograde cholangiopancreatography (ERCP) have been compared in the investigation of abnormalities of the pancreas and biliary tract. 208 patients undergoing ERCP were studied prospectively and all had an ultrasound examination in the 24 hours before ERCP. 15 patients had dilated bile-ducts for which no cause was seen on both ultrasound and ERCP; these patients were excluded. 120 of the remaining patients had an abnormal ERCP. In 101 ultrasound findings were in agreement (sensitivity 84%). 73 patients had a normal ERCP with ultrasound agreement in 70 (specificity 95%). The sensitivity and specificity of ultrasound is now such that patients can proceed directly to ERCP for diagnostic confirmation and papillotomy or endoprosthesis insertion where appropriate.

The role of transvaginal ultrasound in the investigation of women with post-menopausal bleeding

One-hundred and eighty-two women with post menopausal bleeding were examined with transvaginal ultrasound (TVUS) over a 16-month period. The imaging findings were correlated with the pathological specimens. One-hundred and forty had pipelle aspiration cytology and 35 hysteroscopy, dilatation and currettage and seven a hysterectomy. Endometrial thickness on TVUS was classified as either thin (equal to or less than 5 mm), thick (greater than 5 mm), or not seen. A thin endometrium was noted in 87 patients, in whom no pathological abnormality was found in 84 (negative predictive value 95%). There were three cases of hyperplasia or polyps but no carcinomas occurred in this group (negative predictive value for carcinoma 100%). A thickened endometrium was noted in 82 patients. In this group there were five carcinomas, nine polyps and eight cases of endometrial hyperplasia (positive predictive value 29%). In five patients the endometrium could not be identified. One carcinoma occurred in this group. There were an additional eight patients who were taking tamoxifen who were grouped separately. If a clear symmetrical endometrial stripe measuring less than or equal to 5 mm in thickness on TVUS is seen the probability of malignancy is extremely low and endometrial biopsy can probably be avoided in this group particularly in the context of an isolated episode of postmenopausal bleeding. If the endometrium is not seen or is thicker than 5 mm then endometrial biopsy is indicated.

Prenatal deficiency of phosphate, phosphate supplementation, and rickets in very-low-birthweight infants

A preliminary study showed that placental histology was abnormal for babies who subsequently had rickets. The findings--low plasma phosphate concentration; maximum percentage tubular reabsorption of phosphate; and high urinary calcium loss--are those of renal conservation of phosphate in the presence of phosphate deficiency. In a controlled trial no baby receiving phosphate supplements (50 mg per day) had radiological evidence of rickets whereas bone changes were apparent in 42% of the control group. Prenatal deficiency of phosphate, due to placental insufficiency, can be corrected by phosphate supplementation thereby preventing rickets of prematurity.

Can ultrasound reliably detect renal scarring in children with urinary tract infection

One hundred children with a proven urinary tract infection were studied prospectively using both ultrasound (US) and 99mTc dimercaptosuccinic acid (DMSA) scintigraphy to assess the efficacy of US in the detection of renal scarring. Sixty-nine girls and 31 boys with an age range of 0.5-11.8 years were studied. DMSA scintigraphy detected 19 scarred kidneys in 17 children. Scarring was classified as mild, moderate or gross. US detected a total of seven of the scarred kidneys (sensitivity 37%). US detected 0/6 kidneys with mild scarring, 1/7 kidneys with moderate scarring and 6/6 kidneys with gross scarring. Four kidneys with scarring on DMSA showed abnormalities other than scarring on US. 8/19 scarred kidneys were thought to be normal on US. It is important to detect renal scarring in young children and US cannot be relied upon for this purpose. It should therefore be supplemented with DMSA scintigraphy.

A community screening programme for abdominal aortic aneurysms

Three-hundred and sixty-nine unselected men aged 65-79 years were invited for screening for abdominal aortic aneurysm. One hundred and forty-one men were examined and 4 aneurysms detected. 43.2% of men aged 65-74 attended for examination in response to a single unsolicited letter of explanation with the date of an appointment, but only 29.1% of those aged 75-79 years. It is suggested that community mortality from ruptured aortic aneurysm could be reduced by ultrasound screening of the aorta in men aged 65-74 years and early selective aneurysm surgery.

The role of micturating cystourethrography in antenatally detected mild hydronephrosis

Background. The postnatal imaging of infants with antenatally detected mild hydronephrosis remains controversial. Objective. Our aim was to establish the role and timing of micturating cystourethrography (MCUG) in mild hydronephrosis. Materials and methods. We performed a retrospective study of 61 infants (122 kidneys) referred with an antenatal diagnosis of hydronephrosis who showed persistent postnatal dilatation. All had follow-up postnatal ultrasound (US) and MCUG performed. The degree of dilatation at each follow-up scan was recorded. Results. Of the 122 kidneys, 65 showed mild hydronephrosis. A substantial proportion of these (21.5 %) demonstrated reflux. Serial US of these infants showed that the 6-week scan was the most informative and that any changes that warranted further investigation had occurred by this time. Conclusion. We recommend that all infants with mild hydronephrosis should undergo MCUG. MCUG need not be delayed until 3 months but could be performed following a 6-week US scan.

Opportunistic screening for abdominal aortic aneurysm.

Objective– To contribute to the current debate on screening for abdominal aortic aneurysm (AAA). Setting– Radiology department of the John Radcliffe Hospital, Oxford. Methods– The prevalence of AAA in 317 clinically referred male patients aged 65–74 undergoing abdominal ultrasonography with no clinical suspicion of an AAA was investigated over a period of one year. Results– Over the year 15/317 (5%) patients were found to have an aneurysm (defined as aortic diameter (≥30mm), with eight (3%) patients having an aortic diameter of ≥40 mm. Six months later appropriate management for the AAA had been started for only four patients. A knowledge assessment questionnaire sent to 245 hospital clinicians and general practitioners showed that 17 (12%) of the 139 respondents would initiate no review of patients found to have an aneurysm of 30–39 mm and two would take no action with aneurysms of 40–49 mm. Thirty two (23%) respondents would seek advice on management for all categories of aneurysm, 14% from the radiologist. Conclusions– Opportunistic screening for AAA in men undergoing clinically indicated abdominal ultrasonography is easy, productive, without discernible cost, and discloses a prevalence of AAA comparable with that of population screening programmes. Routine opportunistic measurement of aortic diameter during abdominal ultrasonography in the at risk group would allow 12–15% of men aged 65–74 to be screened for AAA within five years without the need for any additional resources.

An unusual appearance of renal lymphoma

The kidney is a relatively common site of extranodal involvement by lymphoma and various patterns have been documented (Richmond et al., 1962). We describe a patient in whom renal involvement by non-Hodgkins lymphoma produced unusual appearances on ultrasound and computed tomography (CT). The possible causes and relevance of these findings are discussed.

Hereditary pancreatitis: Early ultrasound appearances

The radiological findings in a family with hereditary pancreatitis (HP) are presented. The value of ultrasound in the diagnosis and in the screening of family members is illustrated, in addition to its use in following the clinical course and complications in a severely affected child. We demonstrate that pancreatic duct abnormalities, not previously described, are present prior to the appearance of the typical pancreatic calcifications of HP.