Jen-Dar Chen

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 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

How to differentiate spontaneous intramural intestinal hemorrhage from acute mesenteric ischemia

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

Segmental pulmonary artery transection after blunt trauma.

364,650 (US

Hepatic portal venous gas: clinical significance of computed tomography findings.

11,395). If a special group of patients with more bizarre clinical patterns were included, the savings per patient would be NT

Prostatic abscess: transrectal color Doppler ultrasonic diagnosis and minimally invasive therapeutic management

3,382 (US

Left flank pain as the sole manifestation of acute pancreatitis: a report of a case with an initial misdiagnosis

106). The total length of hospital stay and complication rate in group A was significantly longer and higher, respectively, than in group B (p Conclusion Routine US study in pediatric patients with suspected acute appendicitis is a worthwhile diagnostic procedure that may save money, shorten hospital stay, decrease the complication rate, and avert unnecessary surgery.

Some Unusual Complications of Malignancies Case 1. Spontaneous Rupture of Hepatocellular Carcinoma Demonstrated by Contrast-Enhanced Sonography

OBJECTSnThe purpose of our study was to assess the diagnostic values of laboratory tests to differentiate spontaneous intramural intestinal hemorrhage (SIIH) from acute mesenteric ischemia (AMI) after abdominal computed tomography (CT) survey in the emergency department (ED).nnnMETHODnWe retrospectively included 76 patients diagnosed SIIH or AMI after abdominal CT.nnnRESULTSnThe mean ages of 28 SIIH patients and 48 AMI patients were 75.9 ± 13.7 years and 75.8 ± 11.6 years, respectively. Patients with SIIH had significantly higher rate of Coumadin use (P < .001) and localized tenderness (P < .05). In laboratory findings, SIIH patients had prolonged prothrombin time (PT) (83.6 ± 30.0 vs. 13.4 ± 3.2, P < .001), lower blood urea nitrogen (P < .05), lower creatinine (P < .05), and lower creatine kinase (P < .05). Prolonged PT showed good discriminative value to differentiate acute abdomen patients with SIIH from AMI after abdominal CT, with an area under the receiver operating characteristic curve of 0.980 (95% confidence interval, 0.918-0.998; P < .0001). Prolonged PT cut-off value of ≧22.5 seconds had a sensitivity of 92.9% and a specificity of 100%. Logistic regression analysis identified prolonged PT as an independent predictor of SIIH (odds ratio, OR, 22.2; P = .007).nnnCONCLUSIONnAbdominal pain patients with either SIIH or AMI are rare in the ED, but abdominal CT sometimes cannot help to differentiate them due to similar CT findings. Prolonged PT might help emergency physicians and surgeons differentiate SIIH from AMI in such cases.

2104: Automated full-field breast ultrasound possesses potential for screening breast cancer in women with dense breasts

Soft-tissue inflammatory myofibroblastic tumor (IMT) is a rare benign lesion. Only six cases of IMT of the skin and subcutaneous tissue have been reported recently. We report a rare case of soft-tissue IMT with multifocal recurrence after surgical excision. Sonographic features of these discrete lesions revealed heterogeneous hypoechoic masses with irregular margins and several echogenic foci in the lesion. Stranding of the adjacent fat and mild thickening of the overlying skin were also evident. Color Doppler ultrasound showed increased flow in some portions of the lesion. Computed tomography showed an ill-defined nodule at each site with homogeneous hypodensity but no obvious enhancement.