Paul Nilsson

Gallstone ileus demonstrated by CT

Objective The appearance and evolution of gallstone ileus as seen by CT are reported. Materials and Methods CT examination was performed on three patients with unspecific abdominal pain. In one patient sequential investigations were performed over 7 months. Results In all cases the gallbladder was greatly distorted, contained air, and was in direct continuity with a thickened duodenal wall. The gallstone was detected in the small bowel in all cases. In one patient sequential CT examinations over several months demonstrated the evolution from uncomplicated gallstone disease to cholecystitis and finally to perforation of the gallstone into the duodenal bulb. Conclusion Awareness of the CT findings in gallstone ileus may result in more rapid diagnosis and treatment, which may lead to a decrease in the rather high morbidity and mortality seen in this disease.

Power Doppler ultrasonography : Alternative to computed tomography in abdominal trauma patients

The aim of this study was to determine if power Doppler ultrasonography, contrast enhanced when necessary, can be used as an alternative to computed tomography in the diagnosis of trauma‐related organ rupture or hematoma. Fifteen patients who had sustained abdominal trauma but who had normal results on B‐mode scans were included in the study. Twenty organs (13 livers and 7 spleens) were examined with both contrast‐enhanced computed tomography and power Doppler ultrasonography in a blinded fashion. Ultrasonographic contrast was used in five patients. Lack of contrast enhancement (computed tomography) or lack of color in power color Doppler ultrasonography in all or part of the organ was taken as a sign of rupture or hematoma. Five ruptures were detected with both modalities (two hepatic and three splenic). Thus, ultrasonography showed no false‐positive or false‐negative studies when compared to the computed tomographic results. No significant difference was found in the estimated size of the damaged area between the two types of investigation. The study indicates that power color Doppler ultrasonography may be considered an alternative when a computed tomographic scan of a trauma patient is impossible.

Color doppler energy : Computer analysis of color to assess angle dependency and detection of volume flow differences

The aims of this study were to assess (1) any angle dependency of color Doppler energy and (2) if computer analysis of the color can distinguish variations in volume flow. Fluid flowing through a silicon tube in a waterbath was insonated and the color in the images analyzed by a computer. The color presentation on the screen decreases rapidly as the angle approaches 90 degrees. At angles that did not produce a saturation of the color in the tube, the computer analysis detected significant differences between different flow volumes. We have concluded that monitoring of volume flow changes by analysis of color Doppler energy is possible, but the angle of insonation must be taken into account.

New sonographic imaging observations in focal pancreatitis.

Abstract. The imaging findings that ultrasonographically differentiate focal acute pancreatitis (FAP) from a malignant lesion of the pancreas are described. Focal acute pancreatitis is ultrasonographically (US) characterized as a hypoechoic, homogeneous, localized, subsegmental, non-expansive and diffusely demarcated lesion located mostly in the head of the pancreas. It could not be visualized using CT. Endoscopic retrograde cholangiopancreatography (ERCP) performed in 13 of the 32 patients, showed chronic pancreatitis. Focal acute pancreatitis disappeared in 1–6 months at US follow-up. The clinical diagnoses were acute pancreatitis in 11 patients, chronic pancreatitis in 12 patients, biliary disease in 5 patients, hepatopathia in 1 patient while the diagnosis was unknown in 2 patients. No patient developed any pancreatic cancer during a median of 85 months of follow-up. In conclusion, the present data indicate that patients with FAP at US, without any focal lesion seen on either CT or ERCP, have a benign pancreatic lesion, which resolves in 1–6 months; thus, such patients probably do not need any further investigation or follow-up at all.

Color Doppler energy: computer analysis for detection of volume flow variations.

The aims of this study were to (1) determine whether analysis of a color Doppler energy image can show small differences in volume flow and (2) determine the performance characteristics of color Doppler energy to aid future analyses. Flow through a silicone tube in a waterbath was insonated, and the images were analyzed by computer producing arbitrary values for the different flow volumes at different machine settings. A significant difference in the derived values was found at volume low changes of 10 ml/min. The differences are most pronounced when small amounts of color are shown in the vessel. This region of high sensitivity can be altered by changing the machine settings of filter, scale, or level. The angle of insonation must be taken into account. In conclusion, computer analysis of color Doppler energy can monitor changes in blood flow volume with a high sensitivity.

Color Doppler energy: detection of hypoperfused areas in renal transplants.

The aim of this study was to determine if an area of decreased color on color Doppler energy scans in a transplanted kidney could be related to significant pathologic conditions. Three hundred and ninety‐eight scans in 150 patients were thus evaluated prospectively, and 12 such areas were found and correlated to B‐mode, spectral, and color Doppler sonography as well as clinical and laboratory findings. A cause for the hypoperfused area was found in all cases; causes included two cases of focal infection, four arteriovenous fistulas, one kinking of an artery, and five perioperatively severed accessory arteries. We conclude that a color Doppler energy evaluation of perfusion differences can be used to detect pathologic lesions in a transplanted kidney.

Transrectal catheter drainage of deep abdominal and pelvic abscesses using combined ultrasonography and fluoroscopy

OBJECTIVE To describe our experience with transrectal drainage of deep abdominal or pelvic abscesses guided by ultrasonography and fluoroscopy. DESIGN Open study. SETTING Teaching hospital, Sweden. SUBJECTS Eight seriously ill patients with deep abdominal or pelvic abscesses. INTERVENTION Ultrasonographic and fluoroscopic transrectal drainage. MAIN OUTCOME MEASURES Clinical follow-up. RESULTS Eight patients (2 septic, 2 with high fever, and 2 with moderate fever) were effectively and safely drained without general anaesthesia. Their condition improved considerably within hours after drainage. Three patients had recurrent abscesses as a result of the underlying disease. The drainage overcame the sepsis in two patients and allowed a later elective operation. CONCLUSIONS Transrectal ultrasonographic and fluoroscopic drainage is an effective and safe method for treatment of deep abdominal or pelvic abscesses in seriously ill patients.

Typical sonographic appearance of duodenal diverticulum

During routine transabdominal ultrasonography of the hepatobiliary tract an occasional persistent bright linear or concave echo was detected that disrupted the normal images we routinely obtained of the pancreatic head. We began to suspect this echo to be the sonographic representation of a duodenal diverticulum. To confirm our suspicions we performed a prospective study. Over a 20 month period, 30 consecutive patients with a sonographically suspected duodenal diverticulum were followed up with either an upper gastrointestinal series, gastroscopy, or, depending on the patients clinical symptoms, endoscopic retrograde cholangiopancreaticography. One patient was examined with simultaneous fluoroscopy and ultrasonography. The results of these examinations were then compared to the respective ultrasonograms by a qualified radiologist and sonographer. The suspected duodenal diverticulum, detected primarily with ultrasonography, was confirmed with follow‐up examinations in all 30 patients. The persistent echo detected sonographically had the same anatomic position as the diverticulum seen during fluoroscopy. We concluded that duodenal diverticulum located near the pancreatic head has a rather typical sonographic appearance.

Splenic hematoma diagnosed with colour doppler energy: Case report

Abstract The method of choice in the work-up of a patient with blunt abdominal trauma is contrast enhanced computed tomography (CT) as B-mode ultrasound alone is insensitive to intraparenchymal changes in the early stages. We describe a case where ultrasound together with Colour Doppler Energy (CDE) correctly diagnosed a splenic rupture/haematoma by demonstrating lack of perfusion in the upper pole of the spleen.