Dennis A. Sarti

Gray-scale ultrasonography of the jaundiced patient.

In 143 jaundiced patients, ultrasound demonstrated the extrahepatic biliary system in 38% of those with medical and 74% of those with surgical jaundice. The size of the extrahepatic biliary system indicated that surgical was best differentiated from medical jaundice when 5 mm served as the upper normal limit for the common hepatic or common bile duct in patients without prior biliary surgery. Half of those patients with prior biliary bypass surgery had nondiagnostic sonograms. In 22% of the jaundiced patients, no additional imaging procedures were performed before definitive therapy. The role of ultrasound in evaluating jaundiced patients is discussed.

Ultrasonic evaluation of abdominal gastrointestinal tract duplication in children.

Ultrasonographic evaluation of a suspected abdominal mass in children is becoming routine. Recognition of a rare congenital anomaly known as duplication of the gastrointestinal tract might aid in diagnosis and obviate the need for an extensive workup. Two cases are presented that clearly demonstrate the ultrasonographic spectrum of findings in this condition, ranging from a sonolucent cyst to an echogenic mass. An echogenic inner rim seen ultrasonographically is highly suggestive of the diagnosis.

Computed Tomography and Gray Scale Ultrasonography of the Adrenal Gland: A Comparative Study

A prospective analysis of computed tomography and gray scale ultrasonography of the adrenal gland in 34 patients is presented. The diagnostic probabilities were similar for both modalities. Pitfalls common to both procedures and specific to one technique are demonstrated. The relative role of computed tomography and gray scale ultrasonography in evaluation of adrenal abnormalities is discussed in light of specific pathologies and other noninvasive imaging procedures.

Rapid development and spontaneous regression of pancreatic pseudocysts documented by ultrasound.

Three cases of pancreatic pseudocyst were followed serially by ultrasound examination. The entity was found to be more dynamic than has been generally thought. The rapid development and spontaneous regression of pancreatic pseudocysts was documented. The timing of surgical intervention in these cases must be reevaluated.

Detection of thymoma in myasthenia gravis

Twenty patients with myasthenia gravis had chest radiography, conventional tomography, and computed tomography (CT) of the thorax within 1 month of thymectomy. Four of the six macroscopic tumors were detected on routine chest radiography; conventional tomography provided no additional information. CT detected all six macroscopic tumors and provided additional information that was not available by other procedures. However, 18 patients (90%) had anterior mediastinum densities on CT, which could not be distinguished preoperatively from thymic tumors. All six patients with macroscopic tumors had serum antistriational muscle antibody titers; this test was negative in 10 of 11 patients (91%) without thymoma. Chest radiography, CT of the thorax, and antistriational antibodies are the tests recommended for detection of a thymoma in patients with myasthenia gravis.

Ultrasonographic spectrum of choledochal cysts in children

Four different sonographic patterns which may be encountered in choledochal cyst are described. The most common form is concentric dilatation of the common bile duct (Type I). Rarely eccentric dilatation of the common bile duct, diverticulum, may be seen (Type II). Both forms of the disease may (Types IB and IIB) or may not (Types IA and IIA) be associated with intrahepatic biliary dilatation.

The ultrasonic and biochemical diagnosis of pancreatitis in children

Pancreatic ultrasonography and the determination of serum amylase and amylase creatinine clearance ration were performed on 17 normal children and on 35 children with abdominal pain. In all 17 normal subjects the echodensity of the pancreas was equal to or greater than that of the liver. Nineteen patients with abdominal pain had reduced echodensity of the pancreas when compared to that in normal children, and two of the 19 had pseudocysts. Serum amylase values and/or amylase creatinine clearance ratio correlated poorly with ultrasonic and clinical evidence of pancreatitis.

Ultrasound Imaging of Peyronie’s Plaques

AbstractWe herein present the results of our successful attempts to depict and to measure the plaques of Peyronie’s disease with an ultrasound technique. The potential use of this technique also is discussed.

Value of Gallbladder B-Scan Ultrasonography

The gallbladder B-scans of 20 patients who had subsequent surgery were separated into three categories based upon certain sonographic criteria. Our data, in this limited series, revealed gallbladder pathology in each patient who had any one or combination of the following scan characteristics: (1) internal echos, (2) irregular wall, or (3) absence of recognizable gallbladder sonolucency. The category which demonstrated a normal sonographic gallbladder, namely a smooth wall and no internal echos, contained a number of false negatives which proved to have either small stone cholelithiasis or extraphepatic ductal obstruction. Within the described limitations, the B-scan can be a valuable test in confirming the significance of a radiographically nonvisualized gallbladder or in detecting a biliary tract lesion in a patient with a disease entity that precludes radiographic visualization by conventional techniques.

Ultrasonography of the diaphragmatic crura.

The diaphragmatic crura are being recognized with increasing frequency on routine sonograms. In a study of 100 random patients the right crus was seen in parasagittal scans in 50% of patients and in transverse scans in approximately 90%. The left crus was not specifically identified on parasagittal scans, but was visible in about 50% of patients on transverse scans. Longitudinal coronal approaches can significantly improve visualization of the crura.