Joo Won Lim

Nutcracker Syndrome in Children With Orthostatic Proteinuria Diagnosis on the Basis of Doppler Sonography

Objective. To evaluate the Doppler sonographic findings of the left renal vein in children with orthostatic proteinuria in comparison with healthy children and to propose more reliable sonographic criteria for diagnosing nutcracker syndrome in children. Methods. Doppler sonographic findings in 47 children with orthostatic proteinuria and in 27 healthy control subjects were compared. The diagnosis of orthostatic proteinuria was made on the basis of clinical and laboratory findings. The peak velocity and anteroposterior diameter were measured at the hilar and aortomesenteric portions of the left renal vein. The means ± 2 SD of the anteroposterior diameter ratio and peak velocity ratio between the 2 portions were calculated for control subjects and used as the cutoff levels for nutcracker syndrome. Results. The peak velocity ratios between aortomesenteric and hilar portions were 5.21 ± 2.55 in the patient group and 2.57 ± 0.70 in the control group. The anteroposterior diameter ratios between the 2 portions were 5.31 ± 2.65 in the patient group and 2.77 ± 0.69 in the control group. We set the cutoff level of anteroposterior diameter and peak velocity ratios for the diagnosis of nutcracker syndrome at mean ± 2 SD of the value for the control group (3.98 for the peak velocity ratio and 4.16 for the anteroposterior diameter ratio). When these cutoff levels were applied, the patients with orthostatic proteinuria had abnormal levels of anteroposterior diameter in 27 (57.4 %) of 47, peak velocity in 30 (63.8%) of 47, and both in 23 (48.9%) of 47. Conclusions. Nutcracker syndrome may be an important cause of orthostatic proteinuria in children. Doppler sonography of the left renal vein may be a useful screening tool in patients with suspected orthostatic proteinuria to evaluate whether the cause is nutcracker syndrome.

Acetic Acid as a Sclerosing Agent for Renal Cysts: Comparison with Ethanol in Follow-Up Results

AbstractPurpose: To compare follow-up results of sclerotherapy for renal cyst using 50% acetic acid with those using 99% ethanol as sclerosing agents. Methods: Eighty-one patients underwent sclerotherapy and 58 patients, 23 males, 35 females, aged 6–76 years, having a total of 60 cysts, were included in this study; the others were lost to follow-up. The renal cysts were diagnosed by sonography, computed tomography (CT), or magnetic resonance imaging (MRI). Sclerotherapy was performed using 50% acetic acid for 32 cysts in 3 1 patients and 99% ethanol for 28 cysts in 27 patients. Under fluoroscopic guidance, cystic fluid was aspirated as completely as possible. After instillation of a sclerosing agent corresponding to 1 1.7%–25% (4–100 ml) of the aspirated volume, the patient changed position for 20 min and then the agent was removed. Patients were followed up by sonography for a period of 1–49 months. The volume of the renal cyst after sclerotherapy was compared with that of the renal cyst calculated before sclerotherapy. Medical records were reviewed to analyze complications. Results: The mean volume after sclerotherapy of the 17 cysts followed for 3–4 months in the acetic acid group was 5.1% of the initial volume, and for the 14 cysts in the ethanol group it was 10.2%. Complete regression during follow-up was shown in 21 cysts (66%) in the acetic acid group; the mean volume of these cysts before the procedure was 245 ml. The mean volume of the nine (32%) completely regressed cysts in the ethanol group was 184 ml. Mild flank pain, which occurred in three patients in each group, was the only complication and resolved the next day. Conclusion: Acetic acid was an effective and safe sclerosing agent for renal cysts, tending to induce faster and more complete regression than ethanol.

Sonographic Findings of Solid and Papillary Epithelial Neoplasm of the Pancreas

To evaluate the sonographic findings of solid and papillary epithelial neoplasm of the pancreas, a rare tumor occurring in young women.

CT of serous cystadenoma of the pancreas and mimicking masses.

OBJECTIVE The purpose of this article is to illustrate the varied CT appearances of serous cystadenoma of the pancreas and of masses that mimic serous cystadenoma. CONCLUSION Serous cystadenomas of the pancreas have a wide range of CT findings. Familiarity with the varied CT appearances and awareness of the diagnostic limitations of CT are important for accurate diagnosis and management of serous cystadenoma of the pancreas.

Treatment of prostatic abscess: value of transrectal ultrasonographically guided needle aspiration.

The purpose of this study was to assess the effectiveness of transrectal ultrasonographically guided needle aspiration in the treatment of prostatic abscess. Fourteen patients with prostatic abscess were evaluated with this technique and treated with sonographically guided needle aspiration. Using this technique, all cases (100%) had one or more hypoechoic areas within the prostate that contained inhomogeneous materials; in 10 patients (71.0%), the lesion showed internal septa or solid portion. The margins of the hypoechoic area were well defined and thick in 11 patients (79.0%) and poorly defined in 3 patients (21.0%). The estimated volume of the prostatic abscess ranged between 2 and 28 ml (mean, 12.0 ml). The presence of a pus collection within the prostate was confirmed by transrectal ultrasonographically guided aspiration in all patients. However, successful treatment of prostatic abscess with transrectal needle aspiration was done in 12 (86.0%) of 14 patients; the treatment failed in 2 (14.0%) of 14 patients. One patient was treated with perineal incision and drainage and the other with transurethral resection. The amount of pus drained ranged between 1 and 39 ml (mean, 12.0 ml). On follow‐up transrectal ultrasonographic examination, no remaining abscess pocket was found within the prostate in any of the cases. One year later, the prostatic abscess recurred in one case. In conclusion, transrectal ultrasonographic guidance is useful in the diagnosis of prostatic abscess as well as in the guidance for aspiration and the drainage of such abscesses. Transrectal ultrasonographically guided needle aspiration could be an effective method for treating prostatic abscess.

Sonographic Findings of Groin Masses

The groin contents consist of the spermatic cord and its fascial coverings and vascular, nervous, and muscular structures. Abnormalities in the groin region are variable. The purpose of this image presentation is to describe the sonographic findings of the various kinds of groin lesions.

Torsed Appendix Testis Gray Scale and Color Doppler Sonographic Findings Compared With Normal Appendix Testis

The purpose of this study was to compare the size, shape, echogenicity, and blood flow of the appendix testis on sonography in control subjects and in patients with a torsed appendix testis and to evaluate the usefulness as well as the limitations of these criteria.

Comparison of hydro-US and spiral CT in the staging of gastric cancer

The purpose of this study was to compare the diagnostic accuracy of hydro-ultrasonography (US) and spiral computed tomography (CT) in the staging of gastric cancer. Forty-three patients with gastric cancers confirmed at surgery underwent hydro-US and spiral CT on the same day prospectively. Hydro-US and spiral CT were done after ingestion of water. US and CT images were independently analyzed. After surgery, pathological findings according to TNM classification were compared with US and CT findings. The detection rate for T1 tumors was 75% (12/16), and all T2-T4 tumors were detected (27/27). In the T class, good correlation with pathology occurred in 55.8% of cases for US and 58.1% for CT, and there was no difference in staging accuracy between US and CT (P=.7667). Overstaging occurred in 14% for US and CT. Understaging occurred in 30.2% for US and 27.9% for CT. In the N class, good correlation with pathology occurred in 60.5% for US and 55.8% for CT, and there was no difference in staging accuracy between US and CT (P=.0949). Overstaging occurred in 4.7% for US and 18.6% for CT, and understaging occurred in 34.9% and 25.6%, respectively. The diagnostic accuracy of hydro-US and spiral CT in the staging of gastric cancer was between 55.8% and 60.5%, and there was no significant difference in staging accuracy between hydro-US and spiral CT, except for a tendency to overstaging by CT and understaging by US in the N class (P<.05).

Computed Tomography Appearances of Various Complications Associated with Pancreatic Pseudocysts

Most pancreatic pseudocysts are common complications of acute or chronic pancreatitis. They usually occur within the pancreas or in peripancreatic tissues, and are visualized as round or oval fluid collections with thin or thick walls on computed tomography (CT) scans. However, pancreatic pseudocysts are often combined with various complications, e.g., various organ involvements, infection, hemorrhage with pseudoaneurysm formation, rupture with fistula formation, or gastrointestinal or biliary obstruction, which may necessitate prompt intervention or surgery. This review illustrates the CT appearances of various complications associated with pancreatic pseudocysts.Most pancreatic pseudocysts are common complications of acute or chronic pancreatitis. They usually occur within the pancreas or in peripancreatic tissues, and are visualized as round or oval fluid collections with thin or thick walls on computed tomography (CT) scans. However, pancreatic pseudocysts are often combined with various complications, e.g., various organ involvements, infection, hemorrhage with pseudoaneurysm formation, rupture with fistula formation, or gastrointestinal or biliary obstruction, which may necessitate prompt intervention or surgery. This review illustrates the CT appearances of various complications associated with pancreatic pseudocysts.

Ultrasonographic diagnosis of ovary-containing hernias of the canal of Nuck

Purpose: The purpose of this study is to describe the ultrasonographic findings of ovary-containing hernias of the canal of Nuck. Methods: This was a retrospective analysis of 22 hernia cases of the canal of Nuck. The following gray scale and color Doppler ultrasonographic features were analyzed: the site and the size of the hernia, the texture of the hernia contents, and the presence or absence of blood flow in the hernia contents. Results: All of the patients had swelling of the right inguinal region (n=10), left inguinal region (n=8), or both (n=2). On ultrasonography, the hernias appeared as either solid masses (n=17) or solid masses containing cysts (n=5). The mean anteroposterior diameter of the hernia sac of the canal of Nuck was 9.1 mm (range, 5 to 18 mm). The mean anteroposterior diameters of the hernia sac were 11.6 mm (range, 7.6 to 18 mm) for hernias containing an ovary, and 8.3 mm (range, 5 to 13 mm) for hernias containing omental fat. During surgery, among the 17 cases with solid-appearing hernia contents on ultrasonography, omental fat was identified in the hernia sac in four cases, but no structure was identified in 13 cases. All five cases that appeared as solid masses containing cysts on ultrasonography contained ovary tissue in the hernia sac. Among the four cases of ovary-containing hernias, color Doppler ultrasonography identified blood flow within the ovary in three cases, but no flow signal was seen in one case of incarcerated hernia. Conclusion: Ultrasonography may be helpful for the diagnosis of ovary-containing hernias of the canal of Nuck by detecting solid masses containing small cysts.