RESUMEN
Liver steatosis is often observed in different clinical situations. Oncological patients undergoing systemic therapy often develop liver steatosis, which can be diagnosed with normal routine scans such as CT and ultrasound. In this case report, we show that an isolated infiltration of the portal triad with tumor cells could mimic a fatty-like infiltration of the liver. Radiologists and clinicians should be aware of this pitfall and should perform a biopsy in cases of doubt.
RESUMEN
INTRODUCTION: In clinical practice the temporal artery biopsy (TAB) in suspected giant cell arteritis (GCA) is still believed to be the "gold standard". The purpose of this study was to compare the histopathological findings of the TAB with duplex sonography of the temporal artery. PATIENTS AND METHODS: In our retrospective study we analysed 85 consecutive patients (52 female, mean age 71.5, range 55 - 91 years; 33 male, mean age 71.6, range 44 - 91 years) with suspected GCA who underwent TAB in our clinic between January 1999 - February 2011. All patients received a preoperative duplex sonography, 57 patients including description of the temporal arteries. RESULTS: 38 of 85 (44.7 %) of the artery biopsies were proven positive for GCA by histopathology. Interpretation of the duplex sonography was congruent of histopathological interpretation of the biopsy in 39 patients (68.4 %) and incongruent in 18 patients (31.6 %). Sensitivity of duplex-sonography was 44.4 %, specificity 90 %, positive predictive value 80 %. DISCUSSION: Duplex sonography is a non-invasive and very helpful diagnostic tool to guide the clinician in cases of suspected GCA but needs considerable skills. It shows a good specificity and relatively high positive predictive value as there are only few false positive results. A negative report however does not rule out GCA, so that in our opinion the TAB - at least in those cases - should still be performed.
Asunto(s)
Biopsia/métodos , Arteritis de Células Gigantes/diagnóstico , Arterias Temporales/diagnóstico por imagen , Arterias Temporales/patología , Ultrasonografía Doppler Dúplex/métodos , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Reproducibilidad de los Resultados , Sensibilidad y EspecificidadRESUMEN
Ultrasound is an excellent tool for the diagnosis of benign or malignant intra- and extratesticular lesions depending on their structure and location in the scrotum. Besides the sonographic appearance, the clinical history and the location of a scrotal mass is crucial for the differential diagnosis between benign and malignant masses. In cases of acute scrotum or of vascular and inflammatory lesions, Doppler ultrasound is mandatory. This article gives a systematical survey of the most frequent scrotal lesions and their appearance in ultrasound.
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Escroto/diagnóstico por imagen , Enfermedades Testiculares/diagnóstico por imagen , Neoplasias Testiculares/diagnóstico por imagen , Ultrasonografía Doppler , Absceso/diagnóstico por imagen , Enfermedad Aguda , Adolescente , Adulto , Niño , Criptorquidismo/diagnóstico por imagen , Diagnóstico Diferencial , Quiste Epidérmico/diagnóstico por imagen , Epididimitis/diagnóstico por imagen , Humanos , Masculino , Orquitis/diagnóstico por imagen , Seminoma/diagnóstico por imagen , Tumor de Células de Sertoli-Leydig/diagnóstico por imagen , Torsión del Cordón Espermático/diagnóstico por imagen , Espermatocele/diagnóstico por imagen , Hidrocele Testicular/diagnóstico por imagen , Testículo/diagnóstico por imagen , Ultrasonografía Doppler en ColorRESUMEN
PURPOSE: Contrast enhanced sonography using phase-inversion harmonic mode is a promising technique to detect and characterize hepatic lesions. Aim of the following study was to evaluate whether this technique can characterize liver tumors. MATERIAL AND METHODS: During January and December 2004, 46 patients with a solitary liver lesion were examined. The age of the 21 women and 25 men ranged between 37 and 82 years. The tumor size was between 8 mm and 14.5 cm. First conventional B-mode sonography and color-coded sonography were performed, followed by intravenous injection of the contrast agent SonoVue and continuous sonographic examination over 5 minutes using "low MI real-time" phase-inversion mode. The examination was video taped. The enhancement was evaluated qualitatively. RESULTS: Of the 21 malignant lesions, 20 could be correctly diagnosed as malignant. One of the malignant lesions was classified as benign. Of the 25 benign lesions, 21 could be classified correctly as benign, however, 4 lesions (2 hemangiomas, 1 adenoma, 1 teratoma) showed no enhancement in the portal and late phase and were incorrectly classified as malignant as well. CONCLUSION: Using pulse-inversion harmonic US with SonoVue, liver lesions showing an isoechoic or hyperechoic enhancement can be classified as probably benign. Further work up is necessary in case of little or no enhancement on delayed phase imaging.
Asunto(s)
Aumento de la Imagen/métodos , Neoplasias Hepáticas/diagnóstico por imagen , Microburbujas , Fosfolípidos , Hexafluoruro de Azufre , Adulto , Anciano , Anciano de 80 o más Años , Sistemas de Computación , Medios de Contraste , Femenino , Humanos , Masculino , Persona de Mediana Edad , Reproducibilidad de los Resultados , Sensibilidad y Especificidad , Índice de Severidad de la Enfermedad , UltrasonografíaRESUMEN
Contrast-enhanced sonography performed as phase inversion harmonic imaging is a promising new technique for detection and characterization of hepatic foci. It has been reported that malignant liver tumors can be differentiated from benign entities with almost 100% sensitivity and that diagnosis of the type is possible with an accuracy of over 90%. The following report describes seven of our own cases and then compares the results we obtained with current knowledge, followed by a discussion. In summary, most hepatic lesions can be correctly characterized by supplemental use of enhanced sonography; practitioners should nevertheless be aware of atypical phenomena to be able to critically evaluate the findings.
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Medios de Contraste , Errores Diagnósticos/prevención & control , Aumento de la Imagen/métodos , Neoplasias Hepáticas/diagnóstico por imagen , Neoplasias Hepáticas/secundario , Microburbujas , Ultrasonografía/métodos , Adulto , Anciano , Femenino , Humanos , Interpretación de Imagen Asistida por Computador/métodos , Hígado/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Guías de Práctica Clínica como Asunto , Pautas de la Práctica en Medicina , Reproducibilidad de los Resultados , Sensibilidad y EspecificidadAsunto(s)
Enfermedades Gastrointestinales/diagnóstico por imagen , Adulto , Apendicitis/diagnóstico por imagen , Niño , Colitis Ulcerosa/diagnóstico por imagen , Enfermedad de Crohn/diagnóstico por imagen , Diagnóstico Diferencial , Diverticulitis/diagnóstico por imagen , Diverticulitis del Colon/diagnóstico por imagen , Femenino , Neoplasias Gastrointestinales/diagnóstico por imagen , Humanos , Masculino , Persona de Mediana Edad , Sensibilidad y Especificidad , Enfermedades del Sigmoide/diagnóstico por imagen , Gastropatías/diagnóstico por imagen , Tomografía Computarizada por Rayos X , UltrasonografíaRESUMEN
The purpose of this report is to describe the ultrasonographic features of hepatic inflammatory myofibroblastic tumour (IMT). This tumour presented as an area of periportal soft-tissue infiltration. Because periportal infiltration is a common feature in both IMT and other malignant tumours of the hepatic portal, histological examination should be considered before final diagnosis and treatment.
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Neoplasias de la Vesícula Biliar/diagnóstico por imagen , Neoplasias Hepáticas/diagnóstico por imagen , Neoplasias de Tejido Muscular/diagnóstico por imagen , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Neoplasias de los Tejidos Blandos/diagnóstico por imagen , UltrasonografíaRESUMEN
The segmental anatomy of the human liver has become a matter of increasing interest to the radiologist, especially in view of the need for an accurate preoperative localization of focal hepatic lesions. In this review article first an overview of the different classical concepts for delineating segmental and subsegmental anatomy on US, transaxial CT, and MR images is given. Essentially, these procedures are based on Couinaud's concept of three vertical planes that divide the liver into four segments and of a transverse scissura that further subdivides the segments into two subsegments each. In a second part, the limitations of these methods are delineated and discussed with the conclusion that if exact preoperative localization of hepatic lesions is needed, tumor must be located relative to the avascular planes between the different portal territories.
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Hígado/anatomía & histología , Humanos , Hígado/irrigación sanguínea , Hígado/diagnóstico por imagen , Radiografía , UltrasonografíaRESUMEN
OBJECTIVE. We studied the sonographic findings of symptomatic intestinal metastases and the use and safety of subsequent sonographically guided 22-gauge fine-needle aspiration or 18-gauge core biopsy. CONCLUSION. Symptomatic intestinal metastases can be diagnosed by transabdominal sonography. Extensive hypoechoic segmental bowel wall thickening with loss of stratification and intussusception can be observed. Sonographically guided fine-needle aspiration or 18-gauge core biopsy performed at the end of the examination allows definite diagnosis and is a safe procedure.
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Biopsia con Aguja , Neoplasias Intestinales/diagnóstico por imagen , Neoplasias Intestinales/secundario , Ultrasonografía Intervencional , Anciano , Femenino , Humanos , Neoplasias Intestinales/diagnóstico , Intestinos/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Estudios RetrospectivosRESUMEN
Advances in abdominal imaging technology in the past 20 years and their widespread application have improved the detection of benign liver tumours. The three most common tumours of this type are hepatic adenoma, focal nodular hyperplasia and haemangioma. Besides these three, other benign tumours of the liver are less important because of their rarity. Diversity of and technical advances in imaging technology make the choice of diagnostic approach difficult. Ideally, a test should be non-invasive, low-risk and commonly available, with high specificity and sensitivity. Therefore, we use sonography as a screening method and MRI as a secondary diagnostic procedure. The value of diagnostic procedures is discussed. Therapy and outcome of each tumour is outlined.
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Adenoma/diagnóstico , Hemangioma/diagnóstico , Neoplasias Hepáticas/diagnóstico , Adenoma/diagnóstico por imagen , Hemangioma/diagnóstico por imagen , Humanos , Hiperplasia , Neoplasias Hepáticas/diagnóstico por imagen , Imagen por Resonancia Magnética , Tomografía Computarizada por Rayos X , UltrasonografíaRESUMEN
PURPOSE: To evaluate the characterisation of liver lesions using power Doppler sonography before and after intravenous injection of the ultrasound contrast agent Levovist. MATERIALS AND METHODS: 39 patients with 41 liver lesions (10 haemangiomas, 2 focal nodular hyperplasias (FNH), 2 focal fatty infiltrations, 1 echinococcal lesion, 11 hepatocellular carcinomas, 14 metastases and one cholangiocarcinoma) were evaluated prospectively. Power Doppler images before and after intravenous injection of the ultrasound contrast agent Levovist were analysed by two radiologists and one gastroeterologist, who subjectively classified the distribution (peripheral, central, diffuse) and amount (none, minimal, moderate and strong) of flow pattern in each sonographic examination. Histological verification was obtained in all liver lesions, except in haemangiomas, where MR imaging and in one FNH where scintigraphy was regarded as sufficient proof. RESULTS: On the whole, power Doppler sonography after contrast injection was superior to unenhanced power Doppler-sonography in 20 liver lesions and equal in 7. After contrast injection, previously visible flow was enhanced in 14 patients, in 6 lesions flow was detected, which was not seen before in the power mode. Moderate or strong flow signals were detected before contrast injection in 8/26, post contrast injection in 18/26 malignant tumours. Contrawise, 13/15 benign lesions did show any or only minimal flow signals before and 10/15 after contrast injection. CONCLUSION: Intratumoural flow signals favour a malignant tumour. The absence of flow signals is a frequent finding in benign lesions but does not rule out malignancy.
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Carcinoma Hepatocelular/diagnóstico por imagen , Hemangioma/diagnóstico por imagen , Hepatopatías/diagnóstico por imagen , Neoplasias Hepáticas/diagnóstico por imagen , Hígado/diagnóstico por imagen , Hígado/patología , Ultrasonografía Doppler/métodos , Medios de Contraste , Diagnóstico Diferencial , Equinococosis Hepática/diagnóstico por imagen , Hígado Graso/diagnóstico por imagen , Humanos , Hiperplasia , Neoplasias Hepáticas/secundario , Polisacáridos , Cintigrafía , Radiofármacos , Reproducibilidad de los Resultados , Lidofenina de Tecnecio Tc 99mAsunto(s)
Enfermedades de la Aorta/diagnóstico por imagen , Rotura de la Aorta/diagnóstico por imagen , Arteriosclerosis/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Úlcera/diagnóstico por imagen , Anciano , Aorta Torácica/diagnóstico por imagen , Aorta Torácica/patología , Enfermedades de la Aorta/patología , Arteriosclerosis/patología , Diagnóstico Diferencial , Resultado Fatal , Humanos , Procesamiento de Imagen Asistido por Computador , Masculino , Úlcera/patologíaRESUMEN
PURPOSE: The application of self-expanding metallic endoprostheses (stents) to treat symptomatic pelvic venous spurs as an alternative to surgery. METHODS: Wallstents with a diameter from 14 to 16 mm and one Cragg stent were placed in the left common iliac vein of eight patients (seven women, one man; mean age 42 years) with a symptomatic pelvic venous spur (left deep venous thrombosis or post-thrombotic leg swelling). Four patients had surgical thrombectomy prior to stent placement. RESULTS: Technical success with immediate reduction of left leg circumference was achieved in all eight patients. A primary patency rate of 100% was observed during an average follow-up of 3 years (range 10-121 months). There were no procedural or stent-related complications. CONCLUSION: The percutaneous transfemoral placement of self-expanding metallic stents is an effective minimally invasive alternative to surgery in the treatment of symptomatic pelvic venous spur.
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Prótesis Vascular , Vena Ilíaca/cirugía , Trombosis/cirugía , Adulto , Velocidad del Flujo Sanguíneo , Edema/diagnóstico por imagen , Edema/cirugía , Femenino , Estudios de Seguimiento , Humanos , Vena Ilíaca/diagnóstico por imagen , Masculino , Metales , Persona de Mediana Edad , Flebografía , Stents , Síndrome , Trombectomía , Trombosis/diagnóstico por imagenAsunto(s)
Apendicitis/diagnóstico por imagen , Cálculos/diagnóstico por imagen , Perforación Intestinal/diagnóstico por imagen , Adolescente , Apendicectomía , Apendicitis/complicaciones , Cálculos/complicaciones , Cálculos/cirugía , Humanos , Perforación Intestinal/cirugía , Riñón , Hígado , Masculino , Complicaciones Posoperatorias , UltrasonografíaRESUMEN
Our aim was to determine the incidence of synostoses in the bones of the lower limbs in patients with multiple cartilaginous exostosis (MCE) and use the available imaging to suggest the cause and mechanism of its development. Radiographs of the lower legs of 21 patients with MCE were reviewed. With the intention of demonstrating the exact site and extent of synostoses and other bone deformities, such as bone pressure atrophy or erosions in five patients, 8 proximal and 6 distal tibiofibular joints were examined by CT scans. No synostoses were present in 11 patients and 10 patients had 1 to 4 synostoses. Of these synostoses, 14 were localized below the knee joint and 9 above the ankle joint. A growing osteochondroma arising from tibia or fibula can cause an erosion in the contagious surface of the neighbouring bone. If facing osteochondromata are present in both bones and show an interlocking growth at abutting parts, on osseous fusion can take place with formation of a synostosis in the proximal or distal tibiofibular joint region. In adult patients with MCE and abundant osteochondromata synostoses between the neighbouring bones of the lower legs are common findings; they are always caused by coalescence of "kissing" osteochondromata.
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Exostosis Múltiple Hereditaria/complicaciones , Sinostosis/etiología , Adolescente , Adulto , Anciano , Niño , Preescolar , Exostosis Múltiple Hereditaria/diagnóstico por imagen , Femenino , Peroné/diagnóstico por imagen , Peroné/patología , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Sinostosis/diagnóstico por imagen , Tibia/diagnóstico por imagen , Tibia/patología , Tomografía Computarizada por Rayos XRESUMEN
The importance of ultrasound for the diagnosis of gastrointestinal malignant lymphoma is explained by the fact that ultrasound is the first radiologic procedure after clinical examination which is used in diagnostic workup. The main sonographic findings are based on the radiologic appearance of the bowel wall and differentiation of its layers, starlike configuration of the narrowed echogenic center and hypoechoic wall thickening of varying extent. Typically, malignant lymphoma of the gastrointestinal wall shows as hypoechoic circumferential intestinal infiltration. Other findings such as exclusive mucosal involvement, transmural segmental infiltration or bulky tumor are rare. Characteristically, peristalsis is unaffected until a late stage in patients with gastrointestinal malignant lymphoma. These sonographic findings in patients with gastrointestinal lymphoma are not alone specific for the disease, but the combinations of various abnormalities found by ultrasound are helpful in selecting appropriate radiologic, endoscopic and biopsy procedures in the further diagnostic workup.
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Neoplasias Gastrointestinales/diagnóstico por imagen , Linfoma no Hodgkin/diagnóstico por imagen , Neoplasias Gastrointestinales/patología , Humanos , Linfoma no Hodgkin/patología , Valores de Referencia , Estómago/diagnóstico por imagen , UltrasonografíaRESUMEN
UNLABELLED: The value of fine needle biopsy (FNB) in adrenal masses was investigated in 33 patients presenting with such masses. Representative material was obtained 18 times from 19 patients with a history of tumour. 4 of them were diagnosed to be genuinely benign and 14 to be genuinely malignant. Further representative material was obtained 13 times from 14 patients with incidental findings of adrenal masses. The material gained by puncturing was classified correctly as benign in 9 cases, and twice it was considered benign although the tumours later proved malignant. In one case a clinically not suspected malignant lesion was detected by FNB, while in another case a malignant lesion was suspected by FNB, whereas a benign tumour was proven by means of surgery. The share of malignant diagnoses corresponded with the size of tumour, ascertained by the application of ultrasound or CT. The rate of malignant adrenal masses, which were found incidentally, increased from 7 cm onwards; however, the rate of malignant adrenal masses obtained from patients with a history of tumour increased distinctively already from 4 cm onwards. From 11 patients out of 33, adrenal tissue was obtained and classified as benign lesion (adenoma), although, by means of FNB and the conditions for reasons of method, a well differentiated carcinoma cannot be excluded. CONCLUSION: FNB is indicated for non-functioning tumours examined in patients with a history of tumour, furthermore, for incidental findings of the size between 4-6 cm. A diagnostic approach to adrenal masses is suggested.
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Neoplasias de las Glándulas Suprarrenales/patología , Biopsia con Aguja/instrumentación , Ultrasonografía/instrumentación , Neoplasias de la Corteza Suprarrenal/diagnóstico por imagen , Neoplasias de la Corteza Suprarrenal/patología , Neoplasias de la Corteza Suprarrenal/secundario , Neoplasias de las Glándulas Suprarrenales/diagnóstico por imagen , Neoplasias de las Glándulas Suprarrenales/secundario , Glándulas Suprarrenales/diagnóstico por imagen , Glándulas Suprarrenales/patología , Adenoma Corticosuprarrenal/diagnóstico por imagen , Adenoma Corticosuprarrenal/patología , Diagnóstico Diferencial , Femenino , Humanos , Leiomioma/diagnóstico por imagen , Leiomioma/patología , Masculino , Feocromocitoma/diagnóstico por imagen , Feocromocitoma/patologíaRESUMEN
Benign and malignant obstructions of the superior and inferior V. cava and large central veins are often difficult to treat by conservative and surgical means. In this overview we report a new technique which keeps obstructed veins patent by means of percutaneously-inserted metal endoprostheses. The technique allows rapid and lasting relief of the clinical signs of venous inflow obstruction. The high clinical success rate and longterm patency of 70 to 100% in malignant stenoses, and close to 100% in benign obstruction, makes this technique the method of choice for treating superior and inferior inflow obstructions secondary to diseases of the V. cava and the pelvic and brachiocephalic veins. Patients suffering from malignancies benefit in particular from rapid improvement of their quality of life using an effective method with a low complication rate. Vascular stents may also be used in venous outflow stenosis of hemodialysis shunts. However, because of the high recurrence rate secondary to intimal hyperplasia, particularly in peripheral stenoses in the region of the arm, we recommend a conservative attitude. The use of stents is only indicated after one or more trials with conventional balloon angioplasty.
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Stents , Síndrome de la Vena Cava Superior/terapia , Insuficiencia Venosa/terapia , Adulto , Anciano , Venas Braquiocefálicas , Femenino , Humanos , Masculino , Persona de Mediana Edad , Cuidados Paliativos , Grado de Desobstrucción VascularRESUMEN
During 53 months 14 patients with tumour-induced obstructions of the superior vena cava (n = 8), the inferior vena cava (n = 2) and iliac veins (n = 4) were treated with self-expandable metallic stents. 21 Wall stents and 5 Gianturco double stents were applied. The follow-up lasted from 2 weeks to 16 months (range = 5.7 months). All patients showed a marked relief of inflow obstruction after stent placement. 6 of 7 patients, who died of their disease during follow-up, were asymptomatic regarding vein obstruction until their death (3 weeks to 16 months). In 6 of 7 still living patients no re-obstruction occurred during follow-up (2 to 16 months). Patency rate was 82%. These results suggest that self-expanding stents are a successful palliative therapy of malignant vein obstructions.