Enrico Biggi

Aneurysms of the splenic artery: Noninvasive diagnosis by pulsed Doppler sonography

Aneurysms of the splenic artery are relatively rare but potentially life-threatening lesions that may be caused by atherosclerosis, infective emboli, infections, congenital factors, or trauma, and seem to be particularly frequent in patients with portal hypertension and in women of childbearing age. 1·2 In many cases, these lesions are asymptomatic, and are discovered incidentally during angiographic procedures performed for other reasons; when symptoms are present, they may be nonspecific and quite variable: vague discomfort or pain in the left hypochondrium, occasionally with radiation to the left shoulder, nausea and vomiting. When an aneurysm is large, it may present as a palpable mass with a systolic bruit over it. Incidences of rupture range from 8 to 46 per cent, and mortality rates are very high, especially when the aneurysms rupture into the stomach. 1 Although a plain radiograph of the abdomen may be of help if a ring of calcification can be seen on the axis of the splenic artery, the diagnosis is based mainly on abdominal angiography. The real-time sonographic appearances of aneurysms of the splenic artery in two patients have been recently described to be rounded hypoechoic masses located at the left hypochondrium. However, in both cases, although the lesions could be imaged, sonography did not provide evidence of their vascular nature, since no definite pulsations could be observed in them; in one of these cases the correct diagnosis was suggested by the closeness of the mass to the proximal splenic artery. Radiographic studies with contrast material were needed to confirm the diagnosis.3. 4 We report the findings in two cases of aneurysms of the splenic artery in which the condition was diagnosed noninvasively by use of pulsed Doppler sonography.

Ultrasonographic appearances of gastric cancer

In 32 patients with known gastric cancer involving different segments of the stomach, an attempt was made to image the tumour by ultrasonography. Identification of the lesion was possible in 31/32 cases. The tumour always appeared as a focal or diffuse thickening of the gastric wall, with irregular outer margins and luminal echoes; in many cases, a target pattern was seen. Although ultrasonography cannot be considered a sensitive test in the diagnosis of gastric cancer, knowledge of the possible appearances of tumours in all different portions of the stomach is important, since this method is often used as the first imaging procedure in a large variety of abdominal complaints, and clinically unsuspected gastric carcinomas may be imaged first by it.

Sonographic appearance of fecal masses.

Fecal impaction, caused by incomplete evacuation of feces over an extended length of time, may lead to the formation of a fecaloma, a large, firm mass of stool. Sonography is commonly used as the first imaging procedure in patients presenting with abdominal masses. In the five cases cited, fecaloma was suspected by sonography in four cases; confirmation was obtained by rectal examination in three cases and by radiographic studies in two cases. A representative case report is presented of a 74‐year‐old woman who had a large pelvic mass detected on physical examination. Sonographically, the fecaloma had a highly echogenic surface and a posterior acoustic shadow. Radiographic examination showed a soap bubble appearance, suggestive of stool. Thus, fecaloma should be considered in the differential diagnosis of patients with highly reflective and shadowing abdominal and/or pelvic masses.