Hiten M. Malde

Roundworm obstruction: Sonographic diagnosis

We describe the sonographic findings in five pediatric patients with roundworm obstruction. All patients were referred with a clinical diagnosis of acute appendicitis. On ultrasonography (US), an individual worm, when viewed along its longitudinal axis, appeared as a hypoechoic tubular structure with well-defined, echogenic walls. Frequently, the individual body segments could be distinctly visualized. The alimentary canal of the worm was seen either as a single central echogenic line (when in a collapsed state) or as two parallel hyperechoic bands with a hypoechoic center (when distended). When examined transaxially, the individual worm resembled a target with its circular, echogenic body wall and its central dot-like alimentary canal. On prolonged scanning, the worms always showed curling movements. In two patients, a bolus of worms mixed with fecal matter and air produced an unusual appearance of a complex, echogenic mass (helminthoma). Although, an individual worm occasionally resembled an inflammed appendix, visualization of the alimentary canal and individual body segments along with its curling movements helped establish the correct diagnosis. All patients promptly responded to a hypertonic saline enema and no patient was subjected to surgery. Sonographic findings in roundworm obstruction are fairly characteristics to advocate the routine use of sonography for diagnosing this entity.

Isolated gastric varices: Ultrasound detection

Isolated gastric varices (IGV) (resulting from varying etiologies) were diagnosed in six patients using ultrasound examination of the wall of the fluid-filled stomach. Small gastric varices are seen as circular or linear anechoic channels within the gastric wall without a significant intraluminal projection. Large varices are seen as anechoic, lobulated “bulging masses” projecting into the fluid-filled lumen of the stomach. Doppler technique assists in confirming the vascular nature of these lesions and thus avoids confusion with other hypoanechoic lesions of the gastric wall. The technique is simple, noninvasive, and extremely useful in diagnosing IGV in patients investigated for recurrent undiagnosed gastrointestinal bleeding.

Meconium thorax: prenatal sonographic diagnosis.

Meconium peritonitis, although a rare entity, has frequently been diagnosed in utero in recent years by means of prenatal ultrasonography. The association of fetal intra-abdominal calcification with ascites and poly· hydramnios is strongly indicative of meconium peri· tonitis. 1 Less commonly, meconium peritonitis may be detected by the presence of calcified nodules in uncommon sites, such as the scrotum and inguinal canal.1 We report a case of meconium peritonitis with intrathoracic extension through the foramen of Bochdalek, diagnosed in utero at 32 weeks, with normal outcome. Although two cases of meconium thorax diagnosed after birth have been reported,•3 antenatal diagnosis has not been described previously.