Hong-Jen Chiou

Sonography of acute right side colonic diverticulitis.

BACKGROUNDnTo describe the prevalence and sonographic findings and ultrasound diagnostic accuracy of the right side colonic diverticulitis in patients having right lower abdominal pain with indeterminate nature.nnnMETHODSnA total of 934 patients with acute right lower abdominal pain of clinically indeterminate nature were referred for ultrasound examination (US). US studies were performed with 3.5 to 7.0 (or occasionally 10) MHz transducers using graded compression method. Twenty-three patients were finally diagnosed to have an uncomplicated acute diverticulitis of the right colon. The gray-scale sonographic images were reviewed. A retrospective study was undertaken to evaluate diagnostic contribution of US.nnnRESULTSnThe prevalence of acute right side colonic diverticulitis was 2.5% in patients with clinically indeterminate acute right lower abdominal pain. Locations of the inflamed diverticula include cecum in 6 patients, proximal ascending colon in 15 patients, and distal ascending colon in only 2 patients. Sonography detected 21 inflamed diverticula with 1 false positive and 2 false negative results. The most typical sonographic feature of an inflamed diverticulum of right side colon was a rounded or oval-shaped hypoechoic or nearly anechoic structure (52%) protruding out from the segmentally thickened colonic wall. Some of them might contain strong echoes representing gas or feces (43%), or stone in the lumen (5%). Regional pericolic or peridiverticular fat thickening was noted in 57% of patients, and segmental colon wall thickening in 38%. US examination yielded a sensitivity of 91.3%, a specificity of 99.8%, an overall accuracy of 99.5%, a positive predictive value of 95.5%, and a negative predictive value of 99.7%. A positive sonogram made the likelihood of acute right side diverticulitis 456.5 times greater compared with the pretest clinical impression. US differentiated acute right side colonic diverticulitis from acute appendicitis with a 100% accuracy.nnnCONCLUSIONSnUltrasound can be extremely useful in diagnosing acute right side colonic diverticulitis. Careful ultrasound evaluation of the right colon and the cecum may facilitate a correct diagnosis and help differentiate from acute appendicitis, and steer the surgeon to a more effective management.

Ultrasound-guided interventional procedures in splenic abscesses

The results of ultrasound (US)-guided interventional procedures over a period of 12 years in 21 consecutive patients with splenic abscess were reviewed. The interventional procedures were done with 21- or 18-gauge needles for aspiration of relatively small abscesses (< 3.5 cm) in eight patients and with an 8.3-9.0 French pigtail catheter for continuous drainage in 13 patients with larger abscesses (> or = 3.5 cm). In some patients, multiple abscesses were treated separately according to their various sizes. More than one catheterization were done in three patients because of detached catheter or recurrent abscesses. The interventional procedures were followed by at least eight weeks of appropriate antibiotic therapy. Only one patient had the complication of minimal subcapsular hematoma which needed no further treatment. All the patients had uneventful clinical courses. US-guided interventional procedure proved to be a treatment-of-choice for splenic abscess, and may avoid splenectomy by conserving the spleen.

Variable Pump Flow–Based Doppler Ultrasound Method: A Novel Approach to the Measurement of Access Flow in Hemodialysis Patients

Decreasing vascular access flow (Qa) is an important predictor of future access thrombosis and malfunction for hemodialysis (HD) patients. Among all of the methods for determining Qa, the variable pump flow (VPF) Doppler method measures Qa according to the change in Doppler signal between the arterial and the venous needles under different pump flow. After this technique was combined with spectral analysis of Duplex Doppler imaging, the variable pump flow-based Doppler ultrasound method (VPFDUM) for Qa measurement was developed. This study compared the reproducibility and correlation of Qa measurements for three different methods-VPFDUM, ultrasound dilution method (UDM), and conventional Doppler ultrasound method (CDUM)-in 55 HD patients. The mean value of Qa by VPFDUM (870.8 +/- 412.0 ml/min) was close to that by UDM (868.6 +/- 417.9 ml/min) but higher than that by CDUM (either of the above values versus 685.1 +/- 303.6 ml/min; P < 0.005). The mean values of coefficient of variation were similar by VPFDUM (1.6%) and UDM (1.4%) but lower than that by CDUM (either of the above values versus 6.8%; P < 0.01). The correlation coefficient and intraclass correlation coefficient of the repeated Qa measurements by VPFDUM (0.985 and 0.993; P < 0.001) were also similar to those by UDM (0.992 and 0.995; P < 0.001) but slightly higher than those by CDUM (0.917 and 0.948; P < 0.005). Either the reproducibility of VPFDUM (r=0.98, P < 0.0001) or the correlation between VPFDUM and UDM (r=0.99, P < 0.0001) in Qa measurements is good. The unassisted patency of vascular access at 6 mo was significantly poorer in patients with Qa <500 ml/min than those with Qa >500 ml/min (13.6% versus 92.2%; P < 0.0001). In conclusion, VPFDUM is a noninvasive, accurate, and reliable procedure for Qa measurement and prediction of the prognosis of vascular access in HD patients.

Testicular microlithiasis: Analysis of prevalence and associated testicular cancer in Taiwanese men

To determine the incidence of testicular microlithiasis (TM) in Taiwanese males who were referred for scrotal sonography (US) and to evaluate the association between TM and cancer, with state‐of‐the‐art equipment.

Hereditary haemorrhagic teleangiectasia: hepatic lesions demonstrated with colour Doppler and power Doppler sonography

Visceral vascular abnormalities in patients with hereditary haemorrhagic teleangiectasia (HHT) include teleangiectasis, arteriovenous fistula (AVF), and aneurysms. Sonographic findings and colour Doppler ultrasound (CDU) features of HHT in the liver have been described in a few reports. Presented here is the CDU finding of liver with HHT involvement in two patients, aged 52 and 29 years, respectively. Power Doppler sonography was also performed in the first patient in whom both CDU and power Doppler sonography could demonstrate the abnormal vascular channels in the liver. In the second patient, aneurysms in the left hepatic lobe and of the splenic artery were noted. Angiography was performed in both patients and confirmed the abnormal vascular lesions demonstrated by CDU and/or power Doppler sonographic findings.

Echo-enhancing sonography of a large-vessel hemangioma of the neck

Because of the slow flow in the venous spaces of large‐vessel hemangiomas, demonstration of color flow signals with conventional color Doppler or power Doppler sonography may be difficult. We report the case of a 22‐year‐old female patient with a soft tissue tumor containing multiple fluid‐filled spaces in the right supraclavicular region. Gray‐scale, color, and power Doppler sonography could not differentiate between cystic lymphangioma and large‐vessel hemangioma. The intravenous echo‐enhancing contrast agent Levovist was administered, and a significant echo‐enhancing effect on color and power Doppler imaging was demonstrated in the fluid‐filled spaces and lasted for about 3 minutes. Histopathologic study of the excised tumor confirmed the sonographic diagnosis of hemangioma. Levovist appears useful in depicting slow flow in a large‐vessel hemangioma.

Ultrasound Diagnosis of Acute Appendicitis: Impact on Cost and Outcome in Pediatric Patients

Background There are only a few reports on the influence of ultrasound (US) diagnosis on the outcome of appendectomies in children. The purpose of this study was to define patterns of care and outcomes of appendectomies in children who underwent preoperative US examinations and compare them with children who did not in two consecutive periods of time. Materials and Methods This study included 347 consecutive pediatric patients with clinically suspected acute appendicitis, of whom 200 subsequently underwent surgery and were proven to have appendicitis. Two pediatric surgeons clinically evaluated 113 patients (group A) without US examinations over 34 months. The other 87 patients (group B), enrolled in the following 24 months, were referred for US examination before surgery. Graded compression US examination was applied using 7.0–10-MHz linear array transducers. A detailed US examination of the right lower abdomen was followed by a general survey of the whole abdomen to decrease the possibility of misdiagnosis. Costs were compared in the two groups. Results A total of 153 pediatric patients with acute appendicitis and adequate data were included for cost analysis, 91 in group A (mean age, 8.4 years) and 62 in group B (mean age, 8.2 years). Using the reimbursement code for 1998, the total savings per person was NT

Different and Identical Features of Chondroblastic Osteosarcoma and Chondrosarcoma: Highlights on Radiography and Magnetic Resonance Imaging

2,210 (US

Inflammatory Myofibroblastic Tumor of the Soft Tissue — Sonographic and Computed Tomographic Features: A Case Report

69) with US diagnosis. If this amount was applied to all 165 patients undergoing appendectomy in 1998 (not only children), the total savings for the year could be as high as NT

Right-Sided Colonic Diverticulitis: Clinical Features, Sonographic Appearances, and Management

364,650 (US