Juri V. Kaude

Ultrasonography in primary hepatic tumors in early childhood

Ultrasonography was useful in preoperative investigation of primary hepatic tumors in nine children, aged 4 weeks to 4 years. In all patients, the hepatic origin and the solid or mixed echogenic nature of the tumor was determined. In two children (one with hemangioendothelioma, one with cystic mesenchymoma) the ultrasonographic findings were even more specific when correlated with angiography and/or histology. Ultrasonography in children with hepatomegaly should be performed as a screening procedure before angiography, to determine if enlargement of the liver is of tumorous origin. For follow-up, ultrasonography should be preferred over radionuclide imaging because it does not require the use of ionizing energy.

Ultrasonographic demonstration of systemic artery feeding extrapulmonary sequestration

An extralobar pulmonary sequestration in an infant was diagnosed by ultrasound. The sequestration appeared as an echogenic mass interpositioned between the liver and the right lung. The main feeding vessel of the sequestration was demonstrable. Ultrasound should be the first diagnostic modality used for evaluation of a supraphrenic chest mass seen on chest roentgenogram in childhood.

Correlation of lymphangiography, computed tomography, and laparotomy in the staging of Hodgkin's disease

PURPOSE To determine the predictive value of lymphangiography and computed tomography of the abdomen and pelvis for infradiaphragmatic involvement of Hodgkins disease. METHODS AND METHODS We retrospectively reviewed the findings on 125 patients with Hodgkins disease treated at the University of Florida who underwent lymphangiography and staging laparotomy; 33 patients also underwent computed tomography of the abdomen and pelvis. The positive predictive value and negative predictive value were calculated for both studies. RESULTS The positive predictive value of lymphangiography for paraaortic or pelvic disease was 35%, while the negative predictive value was 95%. The positive predictive value of computed tomography of the abdomen and pelvis for paraaortic or pelvic disease was 20%; the negative predictive value was 93%. There was no advantage in predicting paraaortic or pelvic disease when both studies were obtained as compared to either study alone. For splenic disease, the positive predictive value of computed tomography was 43%; the negative predictive value was 77%. Of the patients with a positive lymphangiography, 57% were found at laparotomy to have either no abdominal disease or upper abdominal disease only, with or without minimal splenic disease, making them reasonable candidates for radiotherapy alone. Of the patients with a negative lymphangiogram, 14% were found at laparotomy to have either lower abdominal disease or extensive splenic disease, and so were not good candidates for radiotherapy alone. CONCLUSION We recommend laparotomy for patients who may be candidates for radiotherapy alone or combined modality therapy with limited chemotherapy.

Ultrasonographic demonstration of gastric duplication in infancy

A case of gastric duplication in an infant is reported. Preoperative ultrasound demonstrated a cystic mass lesion with a thin inner echogenic (mucosa) and a wider outer hypoechoic rim (muscle layer). These findings correlated well with the resected specimen.

Renal peripelvic lymphatic cysts (lymphangiomas) associated with generalized lymphangiomatosis

Renal peripelvic lymphatic cysts (lymphangiomas) are usually seen as an isolated finding. They appear as multiple mass lesions with low attenuation on computed tomography (CT), and show no contiast enhancement. We present a case of renal peripelvic lymphatic cysts associated with generalized lymphangiomatosis, and examined with magnetic resonance imaging (MRI), CT, and lymphangiography. Multiplanar MRI demonstrated the extent of disease, including retroperitoneal lesions. The lesions had low-signal intensity on T1-weighted and high-signal intensity on T2-weighted images. The diagnosis of generalized lymphangiomatosis was verified by renal sinus cyst puncture, lymphangiography, and tissue biopsy.

Pancreatic Ultrasound Following Blunt Abdominal Trauma

Ten patients with suspected pancreatic injury from blunt abdominal trauma were evaluated by ultrasound. One examination performed on the day of the trauma was nondiagnostic. Nine examinations were performed between 6 days and 9 months following the trauma and revealed a pseudocyst in 3, and pancreatic enlargement in 2 patients. The remaining 4 examinations were normal and helped to exclude pancreatic injury.

Evaluation of chronic renal failure by digital gray-scale ultrasound

Forty-two patients presenting with chronic renal failure (serum creatinine 1.5–22.2 mg/dl) were examined with digital gray-scale ultrasound using high-frequency transducers. In 41 patients both kidneys were diffusely hyperechoic. Corticomedullary boundary could be defined in only a few patients. In one patient with focal glomerulopathy and mildly reduced renal function, the kidneys were ultrasonographically normal. The increased echogenicity of kidneys was not specific to any renal parenchymal diseases, and there was no definite correlation between the echogenicity of the kidneys, kidney size, and the degree of decrease of renal function.

Renal ultrasound in the neonatal period

Ultrasound was used for imaging the kidneys in 55 neonates. The normal kidney in a neonate is characterized by prominent medulla and fetal lobulation, the main renal vessels are frequently demonstrated. Of 29 infants with normal kidneys by ultrasound, 4 had renal disease (3 acute tubular necrosis, one partial renal artery thrombosis) and one had a pelvic kidney. In 24 infants congenital abnormalities or acquired renal disease was diagnosed. Multicystic dysplastic kidney and hydronephrosis were the most frequently observed abnormalities. Polycystic kidneys at the early stage (both adult type and infantile) appeared as enlarged hyperechoic kidneys. In 2 neonates the kidneys were normal but they had adrenal mass lesions.

Loss of Corticomedullary Demarcation on Magnetic Resonance Imaging: An Index of Biopsy-Proven Acute Renal Transplant Dysfunction

A prospective study of 19 cadaveric renal allograft recipients with suspected graft rejection was undertaken to compare the histological findings of the renal transplant biopsy with the results of magnetic resonance imaging (MRI). All 19 patients underwent a biopsy of the transplant allograft. Biopsy results included acute cellular rejection, acute vascular rejection, chronic vascular rejection (CVR), and acute tubular necrosis (ATN). Recipients of cadaveric renal allografts with normal function served as controls. The control showed distinct corticomedullary demarcation (CMD) on T1-weighted imaging. In contrast, CMD was absent or diminished in all the patients with suspected allograft rejection. Unfortunately, the loss of CMD did not correlate with a specific biopsy diagnosis. Patients with biopsy evidence of acute and chronic rejection or ATN demonstrated loss of CMD with similar image patterns. In conclusion, MRI is capable of detecting renal allograft dysfunction, but does not permit the determination of a specific cause.

Abdominal ultrasound in patients with acute right upper quadrant pain

Ultrasonography was performed as the first imaging procedure in 100 patients who presented with acute right upper quadrant pain suggestive of cholecystitis or cholelithiasis. In the final analysis 46 patients were found to have gallbladder disease (40 patients with cholelithiasis, 5 with acalculous cholecystitis, and 1 with a cholesterol polyp in the gallbladder). In 22 of 54 patients with a normal gallbladder, other abdominal disease was found. The error rate for ultrasound was 5%, and in 4 patients ultrasound was not the suitable procedure for the diagnosis. In 91 patients the ultrasonographic diagnosis was correct.