Toshiro Komazaki

Transesophageal real-time two-dimensional Doppler echography—a new method for the evaluation of azygos venous flow

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Colour flow mapping of oesophagogastric varices and vessels in and around the liver with trans-oesophageal real-time two-dimensional doppler ultrasound

Conventional transcutaneous ultrasound examinations are often compromised by intervening intestinal or pulmonary gas and have limited resolution. Ultrasonic probes of frequencies greater than 5 MHz, which enhance resolution, cannot be used successfully on the skin surface, because they do not penetrate enough to to visualise intra-abdominal organs in most adults. To overcome these problems, we have used transoesophageal real-time two-dimensional Doppler echography. The ultrasonic probe, with a 5 MHz, curved array, was integrated into the end of a steerable insertion tube. Fifteen patients with oesophagogastric varices were examined. Oesophagogastric varices were visualised in colour in 10 patients. The direction of blood flow was determined in six patients. The flow velocity was measured quantitatively in five patients by the pulsed Doppler technique. The vessels in and around the liver were also visualised even when they could not be seen with transcutaneous ultrasonography. This technique is useful for the evaluation of both oesophagogastric varices and other abdominal vessels.

Bleeding varices located in the second portion of the duodenum

A 41-year-old woman with cirrhosis of the liver was admitted to our hospital because of a severe melena. Blood pool scanning with labelled red blood cells showed a high concentration in the right upper quadrant of the abdomen. Endoscopy of the second portion of the duodenum revealed fresh blood on the first examination and varices with overlying erosion were evident in the second study. Co-existent esophageal varices were present but were apparently not associated with the bleeding. Because of the continuous hypotension even with blood replacement, ligation and sclerotherapy were performed. To evaluate the efficacy of the procedures, intraoperative two-dimensional Doppler echography was used and the transducer was applied directly to the viscera. Blood flow was visualized in the serosal and submucosal varices. After ligation and sclerosing of the veins, the blood flow velocity signals disappeared. This woman died of multiple organ failure on the ninth postoperative day.

Visualization of Distal Splenorenal Shunt by Isotopic Splenovenography

Radioisotopic angiography of the splenic vein was performed in six patients following a distal splenorenal shunt (Warren procedure). Under echographic guidance, the spleen was punctured with a 22-gauge needle, and Tc-99m pertechnetate was injected into the splenic pulp. In five patients whose esophageal varices had remained atrophic, the splenic vein, the left renal vein, the inferior vena cava, and the heart were clearly visualized within 8 seconds. In one patient, in whom recurrence of esophageal varices had been recognized, the splenic vein was not imaged. The injected material coursed mainly upwards through collaterals.