Gretchen A. W. Gooding

CT Scanning and Ultrasound in the Evaluation of Pancreatic Pseudocysts: A Preliminary Comparison

A retrospective review of 12 surgically proved cases of pancreatic pseudocyst was performed. CT correctly demonstrated 6/8 uncomplicated pseudocysts and 4/4 infected pseudocysts. Ultrasound identified 7/8 uncomplicated and 2/4 infected pseudocysts. Errors by one modality are due to limitations not shared by the other method. This suggests a basis for the complementary use of CT scanning and ultrasound in the evaluation of suspected pancreatic pseudocysts.

Hydrocolonic Ultrasonography in the Detection of Colonic Polyps and Tumors

BACKGROUND Hydrocolonic ultrasonography--abdominal ultrasonography in conjunction with the retrograde instillation of water into the colon--has been advocated as an alternative to colonoscopy for detecting colorectal polyps and cancer. We conducted a prospective, blinded trial to evaluate the procedure further. METHODS Fifty-two consecutive patients (50 men and 2 women; average age, 62 years) who were referred for colonoscopy underwent hydrocolonic ultrasonography followed by colonoscopy. The physicians performing colonoscopy were blinded to the ultrasound results. Patients who had a history of colonic polyps or tumors or who had previously undergone flexible sigmoidoscopy or colonoscopy were excluded. RESULTS Twenty-two patients had normal results on colonoscopy, 26 had polyps, 3 had cancer and polyps, and 1 had cancer alone. Twenty patients had polyps less than 7 mm in diameter, eight had polyps 7 mm or more in diameter, and one had a polyp of unknown size. Hydrocolonic ultrasonography did not detect any cancers and detected only one polyp > or = 7 mm and one polyp < 7 mm in diameter. The overall sensitivity of ultrasonography for identifying any polyp was 6.9 percent, and for identifying a polyp > or = 7 mm, it was 12.5 percent. Ultrasonography suggested the presence of five masses and five polyps that were not confirmed by colonoscopy. Six patients had incomplete ultrasound studies because of discomfort or the inability to retain water. There were two complications: one patient had two vasovagal episodes, and another had diaphoresis. CONCLUSIONS Hydrocolonic ultrasonography was less useful than colonoscopy for detecting colorectal polyps and cancers. The usefulness of the technique in screening for colonic polyps and tumors appears to be limited.

Radial artery mycotic pseudoaneurysm: an unusual complication of catheterization.

Radial artery pseudoaneurysms are rare, and those that become infected are rarer still. We present the case of a patient who developed a radial artery pseudoaneurysm as a late complication of arterial catheterization. Blood cultures were positive for Staphylococcus aureus, and a pulsatile mass, with associated tissue necrosis, was palpable over the radial artery. The diagnosis was confirmed by gray‐scale and color Doppler sonography, which showed a partially thrombosed pseudoaneurysm and turbulent flow in the pseudoaneurysm and native artery.

Color Doppler imaging in the subclavian-axillary region and upper extremity

Thirty-three patients were examined by color-coded Doppler ultrasound of the thoracoaxillary region or upper arm to review the utility of the method in this local area. The subclavian artery and vein were identified in all but one patient, in whom the subclavian vein was occluded and collateral vessels had developed. Masses and foreign bodies were easily distinguished from vascular abnormalities. Sonographic cephalic/basilic vein mapping was effective in seven patients. Carotid subclavian grafts were noted and evaluated appropriately in two patients. Color-coded sonography offered advantages in speed of localization of vessels and visual assessment of vessel location, direction of flow, turbulence, relationship to adjacent soft tissues, and detection of collateralization. Foreign body detection was not enhanced by color coding.

Bamboo splinter: ultrasound localization

Ultrasound was used to identify and localize a 2-cm hyperechoic bamboo splinter in the wrist of a patient with persistent symptoms, 1 month after the initial injury, following an initial negative workup by clinical examinations and X–ray.