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Moschouris H, Papadaki MG, Spanomanolis N, Stamatiou K, Malagari K. Percutaneous thrombin injection under contrast-enhanced ultrasound guidance to control active extravasation not associated with pseudoaneurysm. Diagn Interv Radiol 2023; 29:632-637. [PMID: 36976152 PMCID: PMC10679646 DOI: 10.4274/dir.2022.221577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Accepted: 05/13/2022] [Indexed: 01/15/2023]
Abstract
The technique of percutaneous thrombin injection (PTI) under contrast-enhanced ultrasound (CEUS) guidance for control of acute hemorrhage-active extravasation not associated with pseudoaneurysm is demonstrated in three cases: 1) Massive spontaneous retroperitoneal hematoma in a patient with multiple comorbidities. Contrast-enhanced computed tomography (CT) showed extensive active extravasation, which was only partially controlled by transarterial embolization. CEUS was performed in the angiography suite. Contrary to unenhanced US and colour Doppler US (CDUS), CEUS confirmed persistent extravasation; CEUS-guided PTI was performed immediately thereafter. 2) Large rectus sheath hematoma in a patient on anticoagulant therapy. Contrast-enhanced CT and unenhanced US/CD could not definitely diagnose extravasation. CEUS clearly showed extravasation and was used for guidance of PTI. 3) Chest wall hematoma complicating central venous catheter placement in a patient with coronavirus on anticoagulant therapy. CDUS was inconclusive. CEUS was performed at the bedside, clearly showed active extravasation, and was used for guidance of PTI. In all three cases, post-PTI CEUS confirmed the absence of residual enhancement of the hematomas, and the hemodynamic status of the patients improved. PTI appears to be effective in selected cases of hematomas associated with active extravasation. In this context, CEUS may be the most suitable modality for guidance and for an immediate evaluation of the treatment effect.
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Affiliation(s)
- Hippocrates Moschouris
- Department of Radiology, Tzaneio Prefecture General Hospital of Piraeus, Piraeus, Greece
| | - Marina G. Papadaki
- Department of Radiology, Tzaneio Prefecture General Hospital of Piraeus, Piraeus, Greece
| | - Nektarios Spanomanolis
- Department of Radiology, Tzaneio Prefecture General Hospital of Piraeus, Piraeus, Greece
| | | | - Katerina Malagari
- Department of Radiology, Attikon General University Hospital of Athens, Athens, Greece
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2
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Spontaneously Ruptured Hepatocellular Carcinoma: Computed Tomography-Based Assessment. Diagnostics (Basel) 2023; 13:diagnostics13061021. [PMID: 36980330 PMCID: PMC10047024 DOI: 10.3390/diagnostics13061021] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 03/01/2023] [Accepted: 03/04/2023] [Indexed: 03/10/2023] Open
Abstract
Spontaneously ruptured hepatocellular carcinoma (SRHCC) is an uncommon and life-threatening complication in patients with hepatocellular carcinoma (HCC). It is usually associated with chronic liver disease and has a poor prognosis with a high mortality rate during the acute phase. SRHCC can cause a severe and urgent condition of acute abdomen disease and requires a correct diagnosis to achieve adequate treatment. Clinical presentation is related to the presence of hemoperitoneum, and abdominal pain is the most common symptom (66–100% of cases). Although the treatment approach is not unique, trans-arterial (chemo)embolization (TAE/TACE) followed by staged hepatectomy has shown better results in long-term survival. A multi-phase contrast-enhanced CT (CECT) scan is a pivotal technique in the diagnosis of SRHCC due to its diagnostic accuracy and optimal temporal resolution. The correct interpretation of the main CT findings in SRHCC, such as active contrast extravasation and the sentinel clot sign, is fundamental for a prompt and correct diagnosis. Furthermore, CT also plays a role as a post-operative control procedure, especially in patients treated with TAE/TACE. Therefore, a multi-phase CECT scan should be the diagnostic tool of choice in SRHCC since it suggests an immediate need for treatment with a consequent improvement in prognosis.
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3
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Abushamat F, Dietrich CF, Clevert DA, Piscaglia F, Fetzer DT, Meloni MF, Shiehmorteza M, Kono Y. Contrast-Enhanced Ultrasound (CEUS) in the Evaluation of Hemoperitoneum in Patients With Cirrhosis. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2023; 42:247-253. [PMID: 35579375 DOI: 10.1002/jum.16002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 04/09/2022] [Accepted: 04/26/2022] [Indexed: 06/15/2023]
Abstract
Hemoperitoneum in cirrhosis is a life-threatening condition that requires emergent evaluation. Contrast-enhanced ultrasound (CEUS) permits multiple dynamic characterizations of abdominal structures through all vascular phases, and contrast extravasation or the presence of microbubbles in the ascites could be a sensitive tool. We reviewed 13 patients with cirrhosis that underwent CEUS due to high suspicion for intra-abdominal bleeding. In 10 cases, CEUS demonstrated extravasation of contrast, including 2 instances where CEUS detected active bleeding despite negative computed tomography. These data support further study of CEUS in direct comparison to other imaging modalities in this clinical context.
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Affiliation(s)
| | | | | | - Fabio Piscaglia
- Division of Internal Medicine, Hepatobiliary and Immunoallergic Diseases, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | | | | | | | - Yuko Kono
- University of California San Diego, San Diego, CA, USA
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4
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Huolin YMD, Qiannan HMD, Qingjing ZMD, Xuqi HMD, Erjiao XMD, Yinglin LMD, Kai LMD, Rongqin ZMD. Contrast-enhanced Ultrasound for Evaluation of Active Needle Tract Bleeding during Thermal Ablation of Liver Cancer. ADVANCED ULTRASOUND IN DIAGNOSIS AND THERAPY 2022. [DOI: 10.37015/audt.2021.210019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
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5
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Paltiel HJ, Barth RA, Bruno C, Chen AE, Deganello A, Harkanyi Z, Henry MK, Ključevšek D, Back SJ. Contrast-enhanced ultrasound of blunt abdominal trauma in children. Pediatr Radiol 2021; 51:2253-2269. [PMID: 33978795 DOI: 10.1007/s00247-020-04869-w] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 08/26/2020] [Accepted: 09/30/2020] [Indexed: 12/13/2022]
Abstract
Trauma is the leading cause of morbidity and mortality in children, and rapid identification of organ injury is essential for successful treatment. Contrast-enhanced ultrasound (CEUS) is an appealing alternative to contrast-enhanced CT in the evaluation of children with blunt abdominal trauma, mainly with respect to the potential reduction of population-level exposure to ionizing radiation. This is particularly important in children, who are more vulnerable to the hazards of ionizing radiation than adults. CEUS is useful in hemodynamically stable children with isolated blunt low- to moderate-energy abdominal trauma to rule out solid organ injuries. It can also be used to further evaluate uncertain contrast-enhanced CT findings, as well as in the follow-up of conservatively managed traumatic injuries. CEUS can be used to detect abnormalities that are not apparent by conventional US, including infarcts, pseudoaneurysms and active bleeding. In this article we present the current experience from the use of CEUS for the evaluation of pediatric blunt abdominal trauma, emphasizing the examination technique and interpretation of major abnormalities associated with injuries in the liver, spleen, kidneys, adrenal glands, pancreas and testes. We also discuss the limitations of the technique and offer a review of the major literature on this topic in children, including an extrapolation of experience from adults.
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Affiliation(s)
- Harriet J Paltiel
- Department of Radiology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Ave., Boston, MA, 02115, USA.
| | - Richard A Barth
- Department of Radiology, Lucile Packard Children's Hospital at Stanford, Stanford University School of Medicine, Stanford, CA, USA
| | - Costanza Bruno
- Department of Radiology, Azienda Ospedaliera Universitaria Integrata, University of Verona, Verona, Italy
| | - Aaron E Chen
- Department of Pediatrics, Division of Emergency Medicine, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Zoltan Harkanyi
- Department of Radiology, Heim Pal National Pediatric Institute, Budapest, Hungary
| | - M Katherine Henry
- Safe Place: The Center for Child Protection and Health, Division of General Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Department of Radiology, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Damjana Ključevšek
- Department of Radiology, University Children's Hospital Ljubljana, Ljubljana, Slovenia
| | - Susan J Back
- Department of Radiology, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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6
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Francica G, Meloni MF, Riccardi L, Giangregorio F, Caturelli E, Terracciano F, de Sio I. Role of Contrast-Enhanced Ultrasound in the Detection of Complications After Ultrasound-Guided Liver Interventional Procedures. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2021; 40:1665-1673. [PMID: 33085814 DOI: 10.1002/jum.15540] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 08/26/2020] [Accepted: 09/29/2020] [Indexed: 06/11/2023]
Abstract
The role of contrast-enhanced ultrasound (CEUS) in interventional ultrasound-guided procedures in the liver has been increasingly recognized. However, little is known about the capability of CEUS for diagnosing complications after liver biopsy and ablation with special regard to postprocedural hemorrhage. The aim of this Pictorial Essay is to present the CEUS features of a wide spectrum of vascular complications (with or without bleeding) and injuries of the surrounding abdominal and chest wall occurring after liver interventional procedures.
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Affiliation(s)
- Giampiero Francica
- Unità di Ecografia Interventistica, Pineta Grande Hospital, Castel Volturno, Italy
| | - Maria Franca Meloni
- Servizio di Radiologia, Casa di Cura Igea, Milan, Italy
- Department of Radiology, University of Wisconsin, Madison, Wisconsin, USA
| | - Laura Riccardi
- Medicina e Interna e Gastroenterologia, Università Cattolica del Sacro Cuore Facoltà di Medicina e Chirurgia, Rome, Italy
| | | | | | - Fulvia Terracciano
- Gastroenterologia, Istituto di Ricovero e Cura a Carattere Scientifico, Ospedale Casa Sollievo Della Sofferenza, San Giovanni Rotondo, Italy
| | - Ilario de Sio
- Epatogastroenterologia, Università Degli Studi Della Campania Luigi Vanvitelli, Naples, Italy
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Sul YH, Kim Y. Management for traumatic hepatic injury diagnosed by contrast-enhanced ultrasonography in a patient with an occluded coeliac axis: a case report. J Int Med Res 2021; 49:3000605211019926. [PMID: 34162257 PMCID: PMC8236796 DOI: 10.1177/03000605211019926] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Transcatheter arterial embolization (TAE) is the standard of care for haemodynamically-stable patients with blunt hepatic injury but it is sometimes impossible due to unfavourable vascular anatomies. This case report describes a 43-year-old male patient with abdominal pain following a motorcycle accident. Based on computed tomography (CT) findings, he was diagnosed with high-grade hepatic injury with coeliac axis stenosis (CAS) due to compression by the median arcuate ligament, and an aberrant right hepatic artery. Contrast-enhanced ultrasonography (CEUS) demonstrated multiple high echogenic tubular and ovoid structures suggestive of active bleeding within the injured liver area. Angiography revealed unique interlobar and intrahepatic collateral vessels between the right and left hepatic arteries. Liver haemorrhages were also identified. Catheterization of the feeding arteries through the collateral pathway was unsuccessful, so a decision was made to cannulate the stenotic portion of the coeliac trunk with a 5-Fr Yashiro catheter. After several attempts, the microcatheter was successfully advanced coaxially into the common hepatic artery. Embolization was performed with a 1:2 mixture of N-butyl cyanoacrylate and iodized oil. Successful haemostasis was confirmed following TAE. CEUS helped clinicians identify active bleeding following traumatic solid organ injury. TAE was a safe and effective treatment strategy. Before performing TAE, attention should be given to the presence of CAS associated with compression by the median arcuate ligament.
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Affiliation(s)
- Young Hoon Sul
- Department of Trauma Surgery, College of Medicine, Chungbuk National University, Cheongju, South Korea
| | - Yook Kim
- Department of Radiology, Chungbuk National University Hospital, Cheongju, South Korea
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Meloni MF, Francica G, Chiang J, Coltorti A, Danzi R, Laeseke PF. Use of Contrast-Enhanced Ultrasound in Ablation Therapy of HCC: Planning, Guiding, and Assessing Treatment Response. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2021; 40:879-894. [PMID: 32936485 DOI: 10.1002/jum.15471] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 07/23/2020] [Indexed: 06/11/2023]
Abstract
Contrast-enhanced ultrasonography (CEUS) plays an important role in the management of patients treated with ablation therapies, in the diagnostic, therapeutic and monitoring phases. Compared to contrast-enhanced computed tomography and contrast-enhanced magnetic resonance imaging, CEUS presents several advantages in imaging HCC, including real time imaging capability, high sensitivity for tumor vascularity, absence of renal toxicity, no ionizing radiation, repeatability of injections, good compliance by the patient and low cost. The purpose of this review is to evaluate the role of CEUS in the management of the patients with HCC treated with ablation therapies and describe how in our protocol CEUS is integrated with the other imaging modalities such as contrast-enhanced computed tomography and contrast-enhanced magnetic resonance imaging.
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Affiliation(s)
- Maria Franca Meloni
- Radiology Department, University of Pavia, Italy and Department of Radiology, University of Wisconsin, Madison, Wisconsin, USA
| | - Giampiero Francica
- Interventional Ultrasound Unit, Pineta Grande Hospital, Castel Volturno, Italy
| | - Jason Chiang
- Department of Radiology, Ronald Reagan UCLA Medical Center, Los Angeles, USA
| | - Andrea Coltorti
- Department of Radiology, Federico II University, Naples, Italy
| | - Roberta Danzi
- Department of Radiology, Pineta Grande Hospital, Castel Volturno, Italy
| | - Paul F Laeseke
- Department of Radiology, University of Wisconsin, Madison, Wisconsin, USA
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9
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Zhang T, Xue S, Wang ZM, Duan XM, Wang DX. Diagnostic value of ultrasound in the spontaneous rupture of renal angiomyolipoma during pregnancy: A case report. World J Clin Cases 2020; 8:3875-3880. [PMID: 32953867 PMCID: PMC7479563 DOI: 10.12998/wjcc.v8.i17.3875] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 06/27/2020] [Accepted: 08/05/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Spontaneous rupture and hemorrhage of renal angiomyolipoma (RAML) is a life-threatening clinical emergency. When it occurs during pregnancy, it is compared to a “bomb explosion,” which makes the diagnosis and treatment more challenging. An ultrasound examination is a quick and safe examination with the benefit of no radiation exposure, which is always preferred for pregnant women. Currently, cases of spontaneous rupture and hemorrhage of RAML during pregnancy are rare, as is the diagnostic value and characteristics of ultrasound. The lack of understanding of the condition among ultrasound doctors makes it prone to misdiagnosis. In this study, we present the case of a pregnant woman who was preliminarily diagnosed with spontaneous rupture and hemorrhage of the left RAML using ultrasound and discuss the ultrasound characteristics.
CASE SUMMARY A 38-year-old woman in her 19th wk of pregnancy (G2P1) was referred to our clinic for a sudden, persistent pain on the left side of the waist. She had not undergone any previous related abdominal examination. Ultrasound of the urinary system revealed a giant nonhomogenous lump in the left kidney area. The diagnosis was considered spontaneous rupture and hemorrhage of the left RAML in pregnancy via ultrasound. Her left-side waist pain continued to be intense. Subsequently, she underwent computed tomography, which led to the same diagnosis. Based on many factors, the patient underwent left nephrectomy after the induction of labor. The pathological result was the rupture and hemorrhage of a vascular leiomyoma lipoma.
CONCLUSION Ultrasound examination plays an important role in the diagnosis of the spontaneous rupture and hemorrhage of RAML during pregnancy.
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Affiliation(s)
- Tong Zhang
- Department of Ultrasound, The First Hospital of Jilin University, Changchun 130000, Jilin Province, China
| | - Shuai Xue
- Department of Thyroid Surgery, The First Hospital of Jilin University, Changchun 130000, Jilin Province, China
| | - Zheng-Min Wang
- Department of Thyroid Surgery, The First Hospital of Jilin University, Changchun 130000, Jilin Province, China
| | - Xiu-Mei Duan
- Department of Pathology, The First Hospital of Jilin University, Changchun 130000, Jilin Province, China
| | - Dong-Xuan Wang
- Department of Ultrasound, The First Hospital of Jilin University, Changchun 130000, Jilin Province, China
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10
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Feng C, Huang S, Zhou X, Wang L, Cui X, Chen L, Lv F, Li T. Interventional Ultrasound Assisted Early Local Hemostatic Drug Therapy in Traumatic Intracerebral Hemorrhage. ULTRASOUND IN MEDICINE & BIOLOGY 2020; 46:180-187. [PMID: 31582179 DOI: 10.1016/j.ultrasmedbio.2019.08.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 07/13/2019] [Accepted: 08/30/2019] [Indexed: 06/10/2023]
Abstract
This article aims to test a minimally invasive interventional approach by real-time transcranial contrast-enhanced ultrasound (CEUS) through a small bur hole to achieve an early local hemostatic drug therapy in a novel traumatic intracerebral hematoma (ICH) model of pigs with hemostatic abnormalities. The effects of hemostasis in the hemocoagulase atrox (HA) injection group and saline injection group groups were observed by transcranial CEUS at three time points: 0 s, 10 s, 2nd. We successfully established a novel traumatic ICH model of pigs with hemostatic abnormalities by the methods of interventional ultrasound techniques and observed the effect of hemostasis by using HA in a local injection method with the assistance of minimally invasive interventional ultrasound technique. At 0 s, four pigs (100%) were observed that active bleeding was significantly weakened, and the range of hematoma became smaller in the HA group. At 10 s, four pigs (100%) were observed that active bleeding became much weaker, and the range of hematoma became further smaller in the HA group. At 2nd, zero pigs (0/4, 0%) were observed that active bleeding could be clearly identified and four pigs (100%) with ICH could also be observed in the HA group. We believe this useful technique could minimize the invasiveness and be operated at the bedside, which would bring much more benefits for traumatic ICH patients.
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Affiliation(s)
- Cong Feng
- Department of Emergency, First Medical Center, General Hospital of the PLA, Beijing, China
| | - Sai Huang
- Department of Hematology, First Medical Center, General Hospital of the PLA, Beijing, China
| | - Xuan Zhou
- Department of Emergency, First Medical Center, General Hospital of the PLA, Beijing, China
| | - Lili Wang
- Department of Emergency, First Medical Center, General Hospital of the PLA, Beijing, China
| | - Xiang Cui
- Department of Orthopedics, First Medical Center, General Hospital of the PLA, Beijing, China
| | - Li Chen
- Department of Emergency, First Medical Center, General Hospital of the PLA, Beijing, China
| | - Faqin Lv
- Department of Ultrasound, Hainan Hospital of the PLA General Hospital, Sanya, China.
| | - Tanshi Li
- Department of Emergency, First Medical Center, General Hospital of the PLA, Beijing, China
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Kummer T, Oh L, Phelan MB, Huang RD, Nomura JT, Adhikari S. Emergency and critical care applications for contrast-enhanced ultrasound. Am J Emerg Med 2018; 36:1287-1294. [PMID: 29716799 DOI: 10.1016/j.ajem.2018.04.044] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Accepted: 04/19/2018] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION Contrast-enhanced ultrasound (CEUS) using intravascular microbubbles has potential to revolutionize point-of-care ultrasonography by expanding the use of ultrasonography into clinical scenarios previously reserved for computed tomography (CT), magnetic resonance imaging, or angiography. METHODS We performed a literature search and report clinical experience to provide an introduction to CEUS and describe its current applications for point-of-care indications. RESULTS The uses of CEUS include several applications highly relevant for emergency medicine, such as solid-organ injuries, actively bleeding hematomas, or abdominal aortic aneurysms. Compared with CT as the preeminent advanced imaging modality in the emergency department, CEUS is low cost, radiation sparing, repeatable, and readily available. It does not require sedation, preprocedural laboratory assessment, or transportation to the radiology suite. CONCLUSIONS CEUS is a promising imaging technique for point-of-care applications in pediatric and adult patients and can be applied for patients with allergy to CT contrast medium or with impaired renal function. More high-quality CEUS research focusing on accuracy, patient safety, health care costs, and throughput times is needed to validate its use in emergency and critical care settings.
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Affiliation(s)
- Tobias Kummer
- Department of Emergency Medicine, Mayo Clinic, Rochester, MN, United States.
| | - Laura Oh
- Department of Emergency Medicine, Emory University, Atlanta, GA, United States
| | - Mary Beth Phelan
- Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Robert D Huang
- Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, MI, United States
| | - Jason T Nomura
- Department of Emergency Medicine, Christiana Care Health System, Newark, DE, United States
| | - Srikar Adhikari
- Department of Emergency Medicine, University of Arizona, Tucson, AZ, United States
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12
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Abstract
BACKGROUND Renal angiomyolipoma (AML) is a common benign tumor of the kidney. The main complication of AML is retroperitoneal hemorrhage caused by AML rupture, which can be severe and life threatening. The risk of AML rupture used to be determined by tumor size. However, these criteria have been challenged by series of clinical studies and case reports, suggesting prediction AML rupture based on tumor size is not always reliable. METHODS The authors searched PubMed using "angiomyolipoma," "AML," and "rupture" and reviewed relevant studies. The authors investigated the risk factors of AML rupture using the retrieved literature. The authors also summarized current modalities to evaluate and manage AML. RESULTS It is established that risk of AML rupture is associated with lesion size. However, genetic abnormality, aneurysm formation, and pregnancy are also risk factors for tumor rupture. Thus, the prediction of AML rupture should be based on a more comprehensive risk assessment system. The management of renal AML and tumor rupture was also discussed in the present paper. CONCLUSION The risk of AML rupture is associated with but not exclusive to lesion size. Any decision to intervene AML must be based on multiple factors including risk, symptoms, and auxiliary findings.
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Affiliation(s)
- Chenyang Wang
- Zhongshan School of Medicine, Sun Yat-Sen University, Guangzhou, Guangdong
| | - Xinyuan Li
- Department of Urology, Chongqing Medical University First Affiliated Hospital, Chongqing, China
| | - Linglong Peng
- Department of Urology, Chongqing Medical University First Affiliated Hospital, Chongqing, China
| | - Xin Gou
- Department of Urology, Chongqing Medical University First Affiliated Hospital, Chongqing, China
| | - Jing Fan
- Department of Urology, Chongqing Medical University First Affiliated Hospital, Chongqing, China
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13
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Huang DY, Yusuf GT, Daneshi M, Husainy MA, Ramnarine R, Sellars MEK, Sidhu PS. Contrast-enhanced US-guided Interventions: Improving Success Rate and Avoiding Complications Using US Contrast Agents. Radiographics 2017; 37:652-664. [PMID: 27860550 DOI: 10.1148/rg.2017160123] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Ultrasonography (US) is an established modality for intervention. The introduction of microbubble US contrast agents (UCAs) has the potential to further improve US imaging for intervention. According to licensing, UCAs are currently approved for clinical use in restricted situations, but many additional indications have become accepted as having clinical value. The use of UCAs has been shown to be safe, and there is no risk of renal toxic effects, unlike with iodinated or gadolinium contrast medium. Broadly speaking, UCAs can be injected into the bloodstream (intravascular use) or instilled into almost any accessible body cavity (endocavitary use), either in isolation or synchronously. In microvascular applications, contrast-enhanced US (CEUS) enhances delineation of necrotic areas and the vascularized target to improve real-time targeting. The ability of CEUS to allow true assessment of vascularity has also been used in follow-up of devascularizing intervention. In macrovascular applications, real-time angiographic images can be obtained with CEUS without nephrotoxic effects or radiation. In endocavitary applications, CEUS can achieve imaging similar to that of iodinated contrast medium-based fluoroscopy; follow-up to intervention (eg, tubography and nephrostography) can be performed at the bedside, which may be advantageous. The use of UCAs is a natural progression in US-guided intervention. The aim of this article is to describe the indications, contraindications, and techniques of using UCAs as an adjunctive tool for US-guided interventional procedures to facilitate effective treatment, improve complication management, and increase the overall success of interventional procedures. Online supplemental material is available for this article. ©RSNA, 2016.
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Affiliation(s)
- Dean Y Huang
- From the Department of Radiology, King's College Hospital, Denmark Hill, London SE5 9RS, England
| | - Gibran T Yusuf
- From the Department of Radiology, King's College Hospital, Denmark Hill, London SE5 9RS, England
| | - Mohammad Daneshi
- From the Department of Radiology, King's College Hospital, Denmark Hill, London SE5 9RS, England
| | - Mohammad Ali Husainy
- From the Department of Radiology, King's College Hospital, Denmark Hill, London SE5 9RS, England
| | - Raymond Ramnarine
- From the Department of Radiology, King's College Hospital, Denmark Hill, London SE5 9RS, England
| | - Maria E K Sellars
- From the Department of Radiology, King's College Hospital, Denmark Hill, London SE5 9RS, England
| | - Paul S Sidhu
- From the Department of Radiology, King's College Hospital, Denmark Hill, London SE5 9RS, England
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14
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Imai K, Kotani T, Tsuda H, Nakano T, Hirakawa A, Kikkawa F. A Novel Approach to Detecting Postpartum Hemorrhage Using Contrast-Enhanced Ultrasound. ULTRASOUND IN MEDICINE & BIOLOGY 2017; 43:615-620. [PMID: 28024660 DOI: 10.1016/j.ultrasmedbio.2016.11.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Revised: 11/10/2016] [Accepted: 11/14/2016] [Indexed: 06/06/2023]
Abstract
The aim of this study was to estimate the efficacy of contrast-enhanced ultrasound (CEUS) in detecting postpartum hemorrhage (PPH) after cesarean section. This is the first study of CEUS in obstetric hemorrhage. A total of 37 patients, operated at Nagoya University Hospital, underwent CEUS. We evaluated the findings of CEUS, which were qualitatively defined as positive when pooling or leakage of contrast agent was observed in the uterine cavity, by measuring the amount of bleeding during the first 4 h after cesarean section. The time-intensity curve patterns of leaked contrast agents were also analyzed for quantitative prediction of the amount of blood loss. Significant differences between the excessive hemorrhage (N = 7) and non-excessive hemorrhage groups (N = 30) were noted in the occurrence of positive CEUS (p = 0.011). Additionally, mean postpartum blood loss markedly increased in patients with a positive CEUS (p = 0.002). From a quantitative perspective, the time until leakage of contrast agents was detected correlated with the amount of bleeding, but the other characteristics of the time-intensity curve pattern did not provide valuable information. In conclusion, CEUS, which enables bedside assessment and rapid diagnosis, is a promising strategy for the detection of PPH.
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Affiliation(s)
- Kenji Imai
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
| | - Tomomi Kotani
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hiroyuki Tsuda
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Tomoko Nakano
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Akihiro Hirakawa
- Biostatistics Section, Center for Advanced Medicine and Clinical Research, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Fumitaka Kikkawa
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Mathur M, Weinreb JC. Imaging patients with renal impairment. Abdom Radiol (NY) 2016; 41:1108-21. [PMID: 27015867 DOI: 10.1007/s00261-016-0709-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Imaging with intravascular contrast media is generally considered safe, particularly in patients without renal failure. However, as renal function deteriorates, the potential risk of nonallergic-type adverse events increases. This presents a unique challenge, particularly when the use of intravenous contrast media is deemed essential for diagnostic purposes. Following a discussion regarding the definition and epidemiology of kidney injury, this review focuses on the evolving understanding of both contrast-induced nephropathy and nephrogenic systemic fibrosis and discusses preventative strategies aimed at minimizing the risk of developing these entities. Alternative non-contrast imaging techniques are also discussed.
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Affiliation(s)
- Mahan Mathur
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, 333 Cedar Street, Room TE-2, PO Box 208042, New Haven, CT, 06520, USA.
| | - Jeffrey C Weinreb
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, 333 Cedar Street, Room TE-2, PO Box 208042, New Haven, CT, 06520, USA
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16
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Miele V, Piccolo CL, Galluzzo M, Ianniello S, Sessa B, Trinci M. Contrast-enhanced ultrasound (CEUS) in blunt abdominal trauma. Br J Radiol 2016; 89:20150823. [PMID: 26607647 DOI: 10.1259/bjr.20150823] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Baseline ultrasound is essential in the early assessment of patients with a huge haemoperitoneum undergoing an immediate abdominal surgery; nevertheless, even with a highly experienced operator, it is not sufficient to exclude parenchymal injuries. More recently, a new ultrasound technique using second generation contrast agents, named contrast-enhanced ultrasound (CEUS) has been developed. This technique allows all the vascular phase to be performed in real time, increasing ultrasound capability to detect parenchymal injuries, enhancing some qualitative findings, such as lesion extension, margins and its relationship with capsule and vessels. CEUS has been demonstrated to be almost as sensitive as contrast-enhanced CT in the detection of traumatic injuries in patients with low-energy isolated abdominal trauma, with levels of sensitivity and specificity up to 95%. Several studies demonstrated its ability to detect lesions occurring in the liver, spleen, pancreas and kidneys and also to recognize active bleeding as hyperechoic bands appearing as round or oval spots of variable size. Its role seems to be really relevant in paediatric patients, thus avoiding a routine exposure to ionizing radiation. Nevertheless, CEUS is strongly operator dependent, and it has some limitations, such as the cost of contrast media, lack of panoramicity, the difficulty to explore some deep regions and the poor ability to detect injuries to the urinary tract. On the other hand, it is timesaving, and it has several advantages, such as its portability, the safety of contrast agent, the lack to ionizing radiation exposure and therefore its repeatability, which allows follow-up of those traumas managed conservatively, especially in cases of fertile females and paediatric patients.
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Affiliation(s)
- Vittorio Miele
- Department of Emergency Radiology, S. Camillo Hospital, Rome, Italy
| | | | - Michele Galluzzo
- Department of Emergency Radiology, S. Camillo Hospital, Rome, Italy
| | | | - Barbara Sessa
- Department of Emergency Radiology, S. Camillo Hospital, Rome, Italy
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Gerboni GM, Capra G, Ferro S, Bellino C, Perego M, Zanet S, D'Angelo A, Gianella P. The use of contrast-enhanced ultrasonography for the detection of active renal hemorrhage in a dog with spontaneous kidney rupture resulting in hemoperitoneum. J Vet Emerg Crit Care (San Antonio) 2015; 25:751-8. [PMID: 26453030 DOI: 10.1111/vec.12372] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2013] [Revised: 04/09/2014] [Accepted: 07/26/2015] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To describe the use of contrast-enhanced ultrasonography (CEUS) for the detection of active renal hemorrhage in a dog with spontaneous kidney rupture resulting in hemoperitoneum. CASE SUMMARY A 9-month-old, sexually intact male Boxer dog presented for acute collapse, abdominal pain, and tachycardia. Physical examination findings were consistent with hypovolemia and acute abdomen. B-mode ultrasonography revealed peritoneal effusion and a right kidney mass. Subsequently, a CEUS study was performed on the right kidney, which demonstrated active hemorrhage from that kidney resulting in both hemoretroperitoneum and hemoperitoneum. At exploratory surgery, ultrasonographic findings were confirmed and a right nephrectomy was performed. Histopathology demonstrated severe parenchymal alterations along with the presence of nematode larvae. Fecal and urine testing for the presence of parasitic ova were negative. Identification of the larvae was inconclusive. At 30 days postoperatively, repeat B-mode ultrasound and clinicopathologic testing was unremarkable. The dog was alive at 1 year postsurgery with no ill effects. NEW OR UNIQUE INFORMATION PROVIDED To the authors' knowledge, this is the first report of CEUS for the detection of active hemorrhage from a kidney resulting in hemoretroperitoneum and hemoperitoneum in a dog. Although rare, the finding of nematode larvae within the renal parenchyma may have been the cause of kidney rupture. Importantly, surgical removal of the kidney was curative. Benign processes causing kidney rupture such as parasitic infestation should be considered in the working diagnosis as related to geographical location.
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Affiliation(s)
| | | | - Silvia Ferro
- the Department of Comparative Biomedicine and Food Science, University of Padua, Padova, Italy
| | - Claudio Bellino
- the Department of Veterinary Sciences, University of Turin, Torino, Italy
| | | | - Stefania Zanet
- the Department of Veterinary Sciences, University of Turin, Torino, Italy
| | - Antonio D'Angelo
- the Department of Veterinary Sciences, University of Turin, Torino, Italy
| | - Paola Gianella
- the Department of Veterinary Sciences, University of Turin, Torino, Italy
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Wongwaisayawan S, Suwannanon R, Prachanukool T, Sricharoen P, Saksobhavivat N, Kaewlai R. Trauma Ultrasound. ULTRASOUND IN MEDICINE & BIOLOGY 2015; 41:2543-2561. [DOI: 10.1016/j.ultrasmedbio.2015.05.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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19
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Zhou L, Kuang M, Xu Z, Xie X, Lu M. Contrast-enhanced sonographically guided thermal ablation for treatment of solid-organ hemorrhage: preliminary clinical results. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2015; 34:907-915. [PMID: 25911724 DOI: 10.7863/ultra.34.5.907] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The purpose of this series was to preliminarily evaluate the use of contrast-enhanced sonographically guided percutaneous thermal ablation in the evaluation and treatment of solid-organ bleeding by retrospectively analyzing 6 cases observed in clinical practice. Six patients who underwent contrast-enhanced sonographically guided thermal ablation for treatment of solid-organ bleeding (5 in liver and 1 in spleen) from December 2005 to August 2012 were included in this series. Clinical information, contrast-enhanced sonograms before and after ablation, and the ablation method were retrospectively collected and analyzed. In 5 of the 6 patients, the location of the bleeding lesion was clearly seen. Hemostasis was successfully achieved in 4 of these 5 patients: 1 by radiofrequency ablation and 3 by microwave ablation. Ablation failed to achieve hemostasis in 1 patient who had postbiopsy splenic arterial bleeding because the bleeding vessel was a thick branch of the splenic artery. In the sixth remaining patient, who had bleeding after liver biopsy, hemostasis failed because contrast-enhanced sonography did not precisely locate the bleeding lesion; hence, the ablation zone did not cover the whole lesion. Contrast-enhanced sonographically guided ablation can be an alternative choice for treating solid-organ bleeding because of its effectiveness and minimal invasiveness. However, it should be carefully investigated for those in whom the bleeding lesion cannot be located by contrast-enhanced sonography and in those who have bleeding in a large vessel.
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Affiliation(s)
- Luyao Zhou
- Department of Medical Ultrasonics, Institute for Diagnostic and Interventional Ultrasound (L.Z., Z.X., X.X.), and Department of Hepatobiliary Surgery (M.K., M.L.), First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Ming Kuang
- Department of Medical Ultrasonics, Institute for Diagnostic and Interventional Ultrasound (L.Z., Z.X., X.X.), and Department of Hepatobiliary Surgery (M.K., M.L.), First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Zuofeng Xu
- Department of Medical Ultrasonics, Institute for Diagnostic and Interventional Ultrasound (L.Z., Z.X., X.X.), and Department of Hepatobiliary Surgery (M.K., M.L.), First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Xiaoyan Xie
- Department of Medical Ultrasonics, Institute for Diagnostic and Interventional Ultrasound (L.Z., Z.X., X.X.), and Department of Hepatobiliary Surgery (M.K., M.L.), First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Mingde Lu
- Department of Medical Ultrasonics, Institute for Diagnostic and Interventional Ultrasound (L.Z., Z.X., X.X.), and Department of Hepatobiliary Surgery (M.K., M.L.), First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
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20
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Abstract
US has a relevant role in the initial assessment of non-traumatic emergencies of the abdomen, sometimes being conclusive and some other times for selecting the patients for further imaging with CT. Injection of a contrast medium may give to the radiologist additional information to that obtained at baseline US and Doppler examination, since real-time, contrast-enhanced US (CEUS) may allow observing findings in the abdomen not recognizable at baseline US or even at color Doppler imaging. Extravascular use of microbubbles may also be useful in clinical practice to rapidly solve a number of unclear aspects. CEUS has a number of distinct advantages in acute patients, including its quickness, low invasiveness, and its possible bedside use. The information based on contrast enhancement is useful for initial diagnosis, therapeutic decision making, and follow-up of the critically ill patients. The purpose of this review is to illustrate the possibilities and limitations of abdominal CEUS in the acute setting, with special emphasis on the detection and characterization of acute inflammatory processes, infarcts, and hemorrhages.
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21
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Ierardi AM, Petrillo M, Capasso R, Fontana F, Bacuzzi A, Duka E, Laganà D, Carrafiello G. Urgent endovascular ligature of a ruptured splenic artery pseudoaneurysm in a patient with acute pancreatitis: a case report. J Med Case Rep 2015; 9:6. [PMID: 25575735 PMCID: PMC4326335 DOI: 10.1186/1752-1947-9-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2014] [Accepted: 11/25/2014] [Indexed: 11/30/2022] Open
Abstract
Introduction We report on the successful endovascular treatment of a ruptured splenic artery pseudoaneurysm. Our patient had acute pancreatitis superimposed on chronic calcific pancreatitis and chronic renal impairment. Contrast-enhanced ultrasonography was used to assess post-embolization results. Case presentation Our patient was a 67-year-old white Caucasian man with recurrent pancreatitis. Computed tomography angiography showed a pancreatic pseudocyst with a ruptured pseudoaneurysm, which was successfully embolized using an endovascular percutaneous approach. At six months, persistent renal failure led to contrast-enhanced ultrasonography. This confirmed the absence of turbulent blood flow and extravasation of contrast medium in the pseudocyst. Conclusion Our experience with this case leads us to support the role of interventional radiology as a first-line treatment tool. Contrast-enhanced ultrasonography can be used to follow-up embolization procedures in patients with impaired renal function.
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Affiliation(s)
| | | | | | | | | | | | | | - Gianpaolo Carrafiello
- Department of Radiology, University of Insubria, Ospedale di Circolo e Fondazione Macchi, Viale Borri 57, 21100 Varese, VA, Italy.
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Pinto F, Miele V, Scaglione M, Pinto A. The use of contrast-enhanced ultrasound in blunt abdominal trauma: advantages and limitations. Acta Radiol 2014; 55:776-84. [PMID: 24060814 DOI: 10.1177/0284185113505517] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Computed tomography (CT) is the imaging method of choice in the assessment of multiple trauma patients. However, in patients who suffered from low-energy abdominal trauma, the use of CT is controversial, since the probability of injury is low and therefore most of the studies are normal. Thus, conventional US imaging has increasingly been employed as the initial imaging modality in the work-up of minor traumatic emergency condition. More recently, the introduction of a new contrast-enhanced ultrasound (CEUS) technique, using second-generation ultrasound contrast agents, has led to a notable increase in the diagnostic accuracy of US in many organs. Therefore, in trauma patients, following assessment with conventional US imaging, a CEUS exam can be performed, to provide a more reliable assessment of solid organ injuries. CEUS has the potential to detect active bleeding from a variety of traumatic origins. Similar to CT, active extravasation is considered when there is evidence of contrast agent collection with echogenicity similar to that of an adjacent vessel. On the other hand, at least some drawbacks have to be addressed, including operator competence and reduced panoramic view. Moreover, CEUS, like conventional US imaging, cannot depict some lesions, such as diaphragmatic ruptures, bowel, and mesenteric traumatic injuries. This technique represents a non-invasive and repeatable method that can be performed at patient's bedside and is therefore extremely helpful for the follow-up of solid organs traumas managed conservatively, especially in pediatric patients and women of fertile age. Moreover, it may reduce the number of CT scans and expedite patient discharge.
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Affiliation(s)
- Fabio Pinto
- Department of Diagnostic Radiological Imaging, Marcianise Hospital, Marcianise (CE), Italy
| | - Vittorio Miele
- Department of Emergency Radiology, “San Camillo” Hospital, Rome, Italy
| | - Mariano Scaglione
- Department of Diagnostic Imaging, “Pineta Grande” Medical Center, Castelvolturno (CE), Italy
| | - Antonio Pinto
- Department of Diagnostic Radiological Imaging, “A. Cardarelli” Hospital, Naples, Italy
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Calabrese E, Catalano O, Nunziata A, D'Errico A, Petrillo A. Bedside contrast-enhanced sonography of critically ill patients. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2014; 33:1685-1693. [PMID: 25154953 DOI: 10.7863/ultra.33.9.1685] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The transfer of critically ill patients to the radiology department is, in itself, potentially dangerous, so radiologists are frequently asked to perform bedside sonographic studies in the intensive care unit, surgical or medical department, sterile area, and operating room. In these circumstances, injection of a contrast agent may give the radiologist relevant additional information, which is useful for diagnosis and for better therapeutic management of these critically ill patients. Contrast-enhanced sonography may allow detection of findings not recognizable on baseline sonography or even color Doppler imaging. In this pictorial essay, we highlight the value of real-time contrast-enhanced sonography when performed at the bedside in critically ill patients.
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Affiliation(s)
- Emanuela Calabrese
- Department of Radiology, University of Naples Federico II, Naples, Italy (E.C., A.D.); Department of Radiology, National Cancer Institute, G. Pascale Foundation, Naples, Italy (O.C., A.P.); and Department of Radiology, Local Health District Napoli 1, Naples, Italy (A.N.)
| | - Orlando Catalano
- Department of Radiology, University of Naples Federico II, Naples, Italy (E.C., A.D.); Department of Radiology, National Cancer Institute, G. Pascale Foundation, Naples, Italy (O.C., A.P.); and Department of Radiology, Local Health District Napoli 1, Naples, Italy (A.N.).
| | - Antonio Nunziata
- Department of Radiology, University of Naples Federico II, Naples, Italy (E.C., A.D.); Department of Radiology, National Cancer Institute, G. Pascale Foundation, Naples, Italy (O.C., A.P.); and Department of Radiology, Local Health District Napoli 1, Naples, Italy (A.N.)
| | - Arianna D'Errico
- Department of Radiology, University of Naples Federico II, Naples, Italy (E.C., A.D.); Department of Radiology, National Cancer Institute, G. Pascale Foundation, Naples, Italy (O.C., A.P.); and Department of Radiology, Local Health District Napoli 1, Naples, Italy (A.N.)
| | - Antonella Petrillo
- Department of Radiology, University of Naples Federico II, Naples, Italy (E.C., A.D.); Department of Radiology, National Cancer Institute, G. Pascale Foundation, Naples, Italy (O.C., A.P.); and Department of Radiology, Local Health District Napoli 1, Naples, Italy (A.N.)
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The role of CEUS in the assessment of haemodynamically stable patients with blunt abdominal trauma. Radiol Med 2014; 120:3-11. [PMID: 25142944 DOI: 10.1007/s11547-014-0455-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2014] [Accepted: 07/14/2014] [Indexed: 10/24/2022]
Abstract
Computed tomography (CT) still represents the preferred imaging method in the assessment of patients presenting with multiple trauma. Nevertheless, in patients with low-energy abdominal trauma, the use of CT is debated because of the possible unnecessary radiation exposure. Accordingly, conventional ultrasound (US) imaging has been increasingly employed as the initial imaging modality in the workup of minor traumatic emergency conditions. Focused assessment with sonography for trauma is widely used to detect free intra-abdominal fluid, but its role is controversial, because the absence of free fluid does not exclude the presence of injuries to abdominal organ. Injection of an ultrasound contrast agent (UCA) may give the radiologist relevant additional information to that obtained with conventional US. Thus, in trauma patients, following early assessment with conventional US imaging, a contrast-enhanced US (CEUS) can provide a more reliable evaluation of solid organ injuries and related vascular complications, including active bleeding, pseudoaneurysms, and artero-venous fistulas. CEUS cannot replace abdominal CT, but it represents a noninvasive and repeatable imaging tool capable of providing a reliable assessment of trauma severity and expedite the patient's treatment.
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25
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Lv F, Ning Y, Zhou X, Luo Y, Liang T, Nie Y, Li T, Tang J. Effectiveness of contrast-enhanced ultrasound in the classification and emergency management of abdominal trauma. Eur Radiol 2014; 24:2640-8. [PMID: 25106485 DOI: 10.1007/s00330-014-3232-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2014] [Revised: 04/22/2014] [Accepted: 05/09/2014] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To analyse the correlation between contrast-enhanced ultrasound (CEUS)-based classification of the severity of abdominal parenchymal organ trauma and clinical outcomes, and to explore CEUS in classifying patients with such trauma, expecting that the use of CEUS will potentially enhance the quality and speed of the emergency management of abdominal trauma. METHODS Three hundred six consecutive patients with blunt abdominal parenchymal organ trauma who received CEUS examination were retrospectively analysed. Two CEUS radiologists (identified as Reader A and Reader B in this study) who were not involved in the CEUS examinations of the patients were then asked to classify the patients independently according to their CEUS results. The classification results were later compared with patients' clinical outcomes using Spearman's rank correlation. RESULTS The final clinical outcomes showed that 25.5 % (78/306) of patients received conservative treatment, 52.0 % (159/306) received minimally invasive treatment, and 22.5 % (69/306) received surgery. Spearman's rank correlation coefficients between the CEUS-based classification and clinical outcome were 0.952 from Reader A and 0.960 from Reader B. CONCLUSIONS CEUS can play an important role in the emergency management of abdominal trauma through the classification of patients for different treatment methods. KEY POINTS • The severity of abdominal trauma was classified by contrast-enhanced ultrasound (CEUS) • There was a high correlation between CEUS-based classification and clinical outcomes • CEUS-based classification is helpful for surgeons in the emergency management of abdominal trauma.
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Affiliation(s)
- Faqin Lv
- Department of Ultrasound, Chinese People's Liberation Army General Hospital, 28 Fuxing Road, Beijing, 100853, China,
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26
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Blunt abdominal trauma: role of contrast-enhanced ultrasound (CEUS) in the detection and staging of abdominal traumatic lesions compared to US and CE-MDCT. Radiol Med 2014; 120:180-9. [PMID: 24961341 DOI: 10.1007/s11547-014-0425-9] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Accepted: 04/01/2014] [Indexed: 12/26/2022]
Abstract
PURPOSE This study was undertaken to evaluate the accuracy of contrast-enhanced ultrasound (CEUS) in the detection and grading of abdominal traumatic lesions in patients with low-energy isolated abdominal trauma in comparison with baseline ultrasound (US) and contrast-enhanced multidetector computed tomography (CE-MDCT), considered the gold standard. MATERIALS AND METHODS A total of 256 consecutive patients who arrived in our Emergency Department between January 2006 and December 2012 (159 males and 97 females aged 7-82 years; mean age 41 years), with a history of low-energy isolated abdominal trauma were retrospectively analysed. All patients underwent US, CEUS with the use of a second-generation contrast agent (Sonovue, Bracco, Milan, Italy) and MDCT. Sensitivity, specificity, positive and negative predictive values (PPV and NPV) and overall accuracy for the detection of lesions and free peritoneal fluid on US and CEUS, and sensitivity for the grading of lesions on CEUS were calculated compared with the CT findings, in accordance with the American Association for the Surgery of Trauma criteria. RESULTS CE-MDCT identified 84 abdominal traumatic lesions (liver = 28, spleen = 35, kidney = 21) and 45 cases of free intraperitoneal fluid. US depicted 50/84 traumatic lesions and 41/45 cases of free peritoneal fluid; CEUS identified 81/84 traumatic lesions and 41/45 free peritoneal fluid. The sensitivity, specificity, PPV, NPV and overall accuracy for the identification of traumatic abdominal lesions were 59, 99, 98, 83 and 86 %, respectively, for US and 96, 99, 98, 98 and 98 %, respectively, for CEUS. The values for the identification of haemoperitoneum were 91, 99, 95, 98 and 97 %, respectively, for US and 95, 99, 95, 99 and 98 %, respectively, for CEUS. CEUS successfully staged 72/81 traumatic lesions with a sensitivity of 88 %. CONCLUSIONS In patients with low-energy isolated abdominal trauma US should be replaced by CEUS as the first-line approach, as it shows a high sensitivity both in lesion detection and grading. CE-MDCT must always be performed in CEUS-positive patients to exclude active bleeding and urinomas.
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Experimental Study on Retroperitoneal Artery Bleeding with Contrast-Enhanced Ultrasound. J Emerg Med 2014; 46:e167-72. [DOI: 10.1016/j.jemermed.2013.08.074] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2013] [Revised: 06/27/2013] [Accepted: 08/15/2013] [Indexed: 11/23/2022]
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Severgnini P, Inzigneri G, Olvera C, Fugazzola C, Mangini M, Padalino P, Pelosi P. New and old tools for abdominal imaging in critically ill patients. Acta Clin Belg 2014; 62 Suppl 1:173-82. [PMID: 24881716 DOI: 10.1179/acb.2007.62.s1.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Diagnostic imaging technology has advanced considerably during the past two decades. Different imaging techniques have been proposed for abdominal imaging in critically ill patients like plain radiography, sonography, computed tomography (CT), magnetic resonance and positron emission tomography. Sonography has been proven to be effective to detect free intra-peritoneal fluid and it is considered one of the primary diagnostic modalities for abdominal evaluation for trauma assessment. In our opinion sonography should replace other invasive techniques to rapidly triage blunt trauma patients with unstable vital signs and examine the peritoneal cavity as a site of major haemorrhage to expedite exploratory laparotomy. On the other hand, CT has become the imaging modality of choice in hemodynamically stable patients with multisystem blunt and penetrating trauma. New developments in the quantitative analysis of the CT images will improve our knowledge of pathophysiology, diagnostic and therapeutic management of abdominal pathologies in critically ill patients.
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Badea R, Andreica V, Caraiani C, Procopet B. Atherosclerotic splenic artery aneurysm in a decompensated cirrhotic patient. J Med Ultrason (2001) 2013; 40:487-90. [DOI: 10.1007/s10396-013-0434-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2012] [Accepted: 01/18/2013] [Indexed: 10/27/2022]
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30
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Harkanyi Z. Potential Applications of Contrast-enhanced Ultrasound in Pediatric Patients. ACTA ACUST UNITED AC 2013. [DOI: 10.1016/j.cult.2013.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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The use of contrast-enhanced ultrasound for the evaluation of solid abdominal organ injury in patients with blunt abdominal trauma. J Trauma Acute Care Surg 2013; 73:1100-5. [PMID: 22832765 DOI: 10.1097/ta.0b013e31825a74b5] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The evaluation and management of blunt abdominal trauma is primarily nonoperative. Previous attempts to identify parenchymal solid-organ injury with sonography have been unsatisfactory. The use of Perflutren Lipid Microsphere (Definity) contrast-enhanced ultrasound (DUS) may provide an additional modality for evaluation of solid-organ injury with decreased risk of radiation exposure and contrast-related complications. METHODS Injured patients admitted to a state-designated Level I trauma center (January 2008 to July 2009), who showed evidence of solid-organ injury after blunt abdominal trauma on initial computed tomography (CT) were eligible for entry into the study. Patients underwent DUS examinations within 12 hours of initial CT. Ultrasound images were then compared with findings of CT for organ location, size, and grade of injury. RESULTS Twenty patients with evidence of solid-organ injury on CT were evaluated with DUS. DUS correctly identified five of eight liver lesions, with a sensitivity of 62.5%. DUS correctly identified all nine splenic lesions demonstrating a sensitivity of 100%. DUS correctly identified one of two kidney injuries, demonstrating a sensitivity of 50%. Overall, the positive predictive value for all solid-organ injuries was 100%, with negative predictive value of 20%. The overall sensitivity for DUS was 79% (15 of 19 patients), and specificity was 100% (15 of 15 patients). CONCLUSION Contrast-enhanced sonography is a potential new modality for the evaluation of solid-organ injury for patients with blunt abdominal trauma. With further research, DUS may provide a safe and accurate alternative to CT. LEVEL OF EVIDENCE Diagnostic study, level IV.
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Contrast-enhanced ultrasound performed under urgent conditions. Indications, review of the technique, clinical examples and limitations. Insights Imaging 2012; 4:185-98. [PMID: 23247774 PMCID: PMC3609955 DOI: 10.1007/s13244-012-0209-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2012] [Revised: 10/27/2012] [Accepted: 11/16/2012] [Indexed: 12/12/2022] Open
Abstract
Contrast-enhanced ultrasound (CEUS) is an imaging technique with various indications, most of which refer to scheduled examinations. However, CEUS can also be performed under urgent conditions for the investigation of many different clinical questions. This article reviews basic physics of ultrasound contrast agents and examines the commonest urgent clinical applications of CEUS. These include, among others, abdominal solid organ trauma and infarcts, scrotal and penile pathology and blood vessel imaging. Patients can be examined with a very short time delay at their bedside, without exposure to ionising radiation or risk of anaphylactic reaction and renal failure, while contraindications are minimal. CEUS technique is described for various urgent indications and imaging examples from our department's experience are presented. Safety matters and limitations of CEUS are also mentioned. Teaching Points • Contrast-enhanced ultrasound (CEUS) can be performed urgently for various clinical applications. • Abdominal indications include solid organ trauma and infarcts. • CEUS in abdominal organ trauma correlates well with CT and can replace it for patient follow-up. • CEUS images testicular torsion, infection and infarction, as well as testicular and penile trauma. • Blood vessels can be assessed with CEUS for obstruction, aneurysm, thrombosis and dissection.
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Riccabona M. Application of a second-generation US contrast agent in infants and children--a European questionnaire-based survey. Pediatr Radiol 2012; 42:1471-80. [PMID: 23052725 DOI: 10.1007/s00247-012-2472-5] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2011] [Revised: 06/26/2012] [Accepted: 07/10/2012] [Indexed: 02/06/2023]
Abstract
BACKGROUND No US contrast agent (US-CA) is currently licensed for use in children. OBJECTIVE To survey the off-label use in children of a second-generation US-CA. MATERIALS AND METHODS Questionnaires were e-mailed to European paediatric radiologists, who were asked about their experience with the second-generation US-CA Sonovue® (Bracco, Milan, Italy). Number of examinations per indication and adverse effects were recorded. Examinations were categorised by intravenous or intracavitary use of US-CA. RESULTS Out of 146 respondents, 88 stated that they did not perform contrast-enhanced US in children, but 36 of these (44%) would appreciate paediatric approval. Forty-five centres reported 5,079 examinations in children (age mean: 2.9 years; range: birth-18 years, M/F: 1/ 2.8). The majority (4,131 [81%] in 29 centres) were intravesical applications. The minority (948 [19%] in 30 centres) were intravenous applications. No adverse effects had been recorded from intravesical use. Six minor adverse effects (skin reaction, unusual taste, hyperventilation) had been recorded after five intravenous studies (0.52%). CONCLUSION Responses suggest a favourable safety profile of this second-generation US-CA in children. It also demonstrates a demand for such US-CA from paediatric radiologists.
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Affiliation(s)
- Michael Riccabona
- Department of Radiology, Division of Paediatric Radiology, Universitätsklinikum LKH Graz, Auenbruggerplatz 34, 8036, Graz, Austria.
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Abstract
The administration of a contrast agent is considered an essential tool to evaluate abdominal diseases using Ultrasound. The most targeted organ is the liver, especially to characterize focal liver lesions and to assess the response to percutaneous treatment. However, the expanding abdominal indications of contrast-enhanced ultrasound make this technique an important tool in the assessment of organ perfusion including the evaluation of ischemic, traumatic, and inflammatory diseases.
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Affiliation(s)
- Carlos Nicolau
- Radiology Department, Hospital Clínic, University of Barcelona, Spain.
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Percutaneous treatment of blunt hepatic and splenic trauma under contrast-enhanced ultrasound guidance. Clin Imaging 2012; 36:191-8. [DOI: 10.1016/j.clinimag.2011.09.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2011] [Accepted: 09/29/2011] [Indexed: 11/23/2022]
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Matono T, Koda M, Murawaki Y. Contrast-enhanced sonography with perflubutane revealing active bleeding as a complication of radiofrequency ablation. Hepatology 2012; 55:649-50. [PMID: 22006455 DOI: 10.1002/hep.24745] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Tomomitsu Matono
- Division of Medicine and Clinical Science, Department of Multidisciplinary Internal Medicine, Tottori University School of Medicine, Yonago, Japan
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Lobianco R, Regine R, De Siero M, Catalano O, Caiazzo C, Ragozzino A. Contrast-enhanced sonography in blunt scrotal trauma(). J Ultrasound 2011; 14:188-95. [PMID: 23396988 DOI: 10.1016/j.jus.2011.09.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
The scope of this study was to determine whether contrast-enhanced ultrasonography (CEUS), compared with basic US, can increase diagnostic confidence and provide relevant information on blunt scrotal trauma. Over a period of 75 months we examined 40 patients seen consecutively for blunt scrotal trauma using high-resolution US, color-power Doppler, low mechanical index CEUS, and power Doppler after IV administration of contrast medium (SonoVue(®)). In the 24 cases that were positive, concordance between basal US and CEUS findings was grade 0 (absent) in 4 cases, grade 1 (low) in 3, grade 2 (moderate) in 8, and grade 3 (high) in 9. The relevance of the additional information provided by CEUS was classified as follows: high in 4/40 (10%), moderate 7/40 (17,5%), low 13/40 (32,5%), none in 14/40 (35%). Our findings demonstrate that CEUS is appreciably more sensitive in detecting damage caused by blunt scrotal trauma, particularly small lesions. It is also useful for differential diagnosis and marginalization of corpuscular fluid collections, fractures, and above all ruptures, which require immediate surgery. In our series 2 out of 3 (67%) patients with testicular rupture were diagnosed only by CEUS. We feel that the use of CEUS can significantly improve diagnostic confidence in cases of closed scrotal trauma although these conclusions need to be confirmed in larger case series.
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Affiliation(s)
- R Lobianco
- Radiology Department, Santa Maria delle Grazie Hospital, Pozzuoli, Naples, Italy
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Quiroga Gómez S, Pérez Lafuente M, Abu-Suboh Abadia M, Castell Conesa J. [Gastrointestinal bleeding: the role of radiology]. RADIOLOGIA 2011; 53:406-20. [PMID: 21924440 DOI: 10.1016/j.rx.2011.03.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2010] [Revised: 03/14/2011] [Accepted: 03/15/2011] [Indexed: 12/30/2022]
Abstract
Gastrointestinal bleeding represents a diagnostic challenge both in its acute presentation, which requires the point of bleeding to be located quickly, and in its chronic presentation, which requires repeated examinations to determine its etiology. Although the diagnosis and treatment of gastrointestinal bleeding is based on endoscopic examinations, radiological studies like computed tomography (CT) angiography for acute bleeding or CT enterography for chronic bleeding are becoming more and more common in clinical practice, even though they have not yet been included in the clinical guidelines for gastrointestinal bleeding. CT can replace angiography as the diagnostic test of choice in acute massive gastrointestinal bleeding, and CT can complement the endoscopic capsule and scintigraphy in chronic or recurrent bleeding suspected to originate in the small bowel. Angiography is currently used to complement endoscopy for the treatment of gastrointestinal bleeding.
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Affiliation(s)
- S Quiroga Gómez
- Servicio de Radiodiagnóstico, Hospital Universitari Vall d'Hebron, Barcelona, España.
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Badea R, Stan-Iuga R, Lupsor M, Molnar G, Seicean A, Procopet B. Solid Pseudopapillary Pancreatic Tumor: Added Value Contrast-enhanced Ultrasound in Diagnosis and Follow-up. J Med Ultrasound 2011. [DOI: 10.1016/j.jmu.2011.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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Lv F, Tang J, Luo Y, Li Z, Meng X, Zhu Z, Li T. Contrast-enhanced ultrasound imaging of active bleeding associated with hepatic and splenic trauma. Radiol Med 2011; 116:1076-82. [PMID: 21509551 DOI: 10.1007/s11547-011-0680-y] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2010] [Accepted: 08/30/2010] [Indexed: 12/26/2022]
Abstract
PURPOSE The aim of this study was to evaluate contrast-enhanced ultrasound (CEUS) imaging of active bleeding from hepatic and splenic trauma. MATERIALS AND METHODS Three hundred and ninety-two patients with liver or/and spleen trauma (179 liver and 217 spleen injuries), who underwent CEUS examinations following contrast-enhanced computed tomography (CT), were enrolled in this retrospective study over a period of >4 years. CEUS detected contrast medium extravasation or pooling in 16% (63/396) of liver or spleen lesions in 61 patients, which was confirmed by contrast-enhanced CT. Special attention was paid to observing the presence, location, and characteristics of the extravasated or pooled contrast medium. RESULTS The CEUS detection rate for active bleeding was not different from that of contrast-enhanced CT (p=0.333). Information from surgery, minimally invasive treatment and conservative treatment was used as reference standard, and the sensitivities of the two techniques were not different (p=0.122). Of 63 lesions in 61 patients, CEUS showed that 74.6% (47/63) (21 liver lesions and 26 spleen lesions) presented contrast medium extravasation or pooling, both in the organ and out the capsule, in 14.3% (9/63) and only outside the capsule in 11.1% (7/63). CEUS imaging of active bleeding from hepatic and splenic trauma presented various characteristics, and the sizes and shapes of the active bleeding due to contrast medium extravasation or pooling were variable. CONCLUSIONS CEUS can show the active bleeding associated with hepatic and splenic trauma with various imaging characteristics, thus making it possible to diagnose active bleeding using CEUS.
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Affiliation(s)
- F Lv
- Department of Ultrasound, Chinese People's Liberation Army General Hospital, 28 Fuxing Road, Beijing 100853, China
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Leinonen MR, Raekallio MR, Vainio OM, O'Brien RT. Effect of anaesthesia on contrast-enhanced ultrasound of the feline spleen. Vet J 2010; 190:273-277. [PMID: 21095147 DOI: 10.1016/j.tvjl.2010.10.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2010] [Revised: 10/19/2010] [Accepted: 10/19/2010] [Indexed: 10/18/2022]
Abstract
The spleens of 18 healthy cats were imaged using contrast-enhanced ultrasound (CEUS) to evaluate splenic perfusion and to compare perfusion patterns in awake and anaesthetised cats. Two groups of cats were imaged; the first (Group 1) consisted of 10 young, anaesthetised cats and the second (Group 2) comprised eight young to middle aged cats that were initially imaged when awake and later following anaesthesia. A two-phase enhancement of the spleen was observed both in awake and in anaesthetised cats. The time to first appearance of the contrast was significantly faster in awake (3.9±0.6s) than anaesthetised (4.8±1.0s) cats in Group 2 (P=0.031). A marked heterogeneous perfusion pattern was more prevalent in the anaesthetised (50%) compared to the awake (12.5%) animals in Group 2. The spleen was heterogeneous for approximately 30s in all groups. The results indicated that CEUS suspected focal perfusion defects of the spleen, especially during general anaesthesia, should be evaluated with caution and only after the initial heterogeneity has disappeared.
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Affiliation(s)
- Merja R Leinonen
- Department of Equine and Small Animal Medicine, Faculty of Veterinary Medicine, University of Helsinki, P.O. Box 57, Helsinki 00014, Finland.
| | - Marja R Raekallio
- Department of Equine and Small Animal Medicine, Faculty of Veterinary Medicine, University of Helsinki, P.O. Box 57, Helsinki 00014, Finland
| | - Outi M Vainio
- Department of Equine and Small Animal Medicine, Faculty of Veterinary Medicine, University of Helsinki, P.O. Box 57, Helsinki 00014, Finland
| | - Robert T O'Brien
- Department of Clinical Medicine, University of Illinois at Urbana-Champaign, 1008 West Hazelwood Dr., Urbana, IL 61802, USA
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Abstract
Contrast agents for ultrasonography (US) comprise microscopic bubbles of gas in an encapsulating shell. They are unique in that they interact with the imaging process, oscillating in response to a low-intensity ultrasound field and disrupting in response to a high-intensity field. New contrast-specific imaging modes allow US to show exquisite vascularity and tissue perfusion in real time and with excellent spatial resolution. In Europe, Asia, and Canada, to name only the most obvious, characterization of focal liver masses is the first and best established use of contrast-enhanced (CE) US, allowing for the noninvasive diagnosis of commonly encountered liver masses with comparable accuracy to that of computed tomography and magnetic resonance studies. CE US is a preferred modality for the difficult task of diagnosis of liver nodules detected on surveillance scans in those at risk for hepatocellular carcinoma. Newer body applications include the guidance of ablative intervention, monitoring activity of bowel inflammation in Crohn disease, characterization of kidney masses, especially cystic renal cell carcinoma, diagnosis of prostate cancer, and monitoring the response of tumors to antivascular drug therapies. Microbubble contrast agents are easy to use and robust; their use poses no risk of nephrotoxicity and requires no ionizing radiation. CE US plays a vital and expanding role that improves management and patient care.
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Affiliation(s)
- Stephanie R Wilson
- Department of Diagnostic Imaging, Foothills Medical Centre, University of Calgary, Calgary, AB, Canada.
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Sugihara T, Koda M, Tokunaga S, Matono T, Nagahara T, Ueki M, Murawaki Y, Kaminou T. Contrast-enhanced ultrasonography revealed active thoracic bleeding. J Med Ultrason (2001) 2010; 37:143-5. [DOI: 10.1007/s10396-010-0257-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2009] [Accepted: 12/24/2009] [Indexed: 10/19/2022]
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Active gastrointestinal bleeding: evaluation with contrast-enhanced ultrasonography. ACTA ACUST UNITED AC 2009; 35:637-42. [DOI: 10.1007/s00261-009-9588-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Shuai W, You F, Zhang H, Zhang W, Fu F, Shi X, Liu R, Bao T, Dong X. Application of Electrical Impedance Tomography for Continuous Monitoring of Retroperitoneal Bleeding After Blunt Trauma. Ann Biomed Eng 2009; 37:2373-9. [DOI: 10.1007/s10439-009-9778-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2009] [Accepted: 08/03/2009] [Indexed: 10/20/2022]
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Ripollés T, Puig J. Actualización del uso de contrastes en ecografía. Revisión de las guías clínicas de la Federación Europea de Ecografía (EFSUMB). RADIOLOGIA 2009; 51:362-75. [DOI: 10.1016/j.rx.2009.05.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2009] [Revised: 04/20/2009] [Accepted: 05/05/2009] [Indexed: 12/27/2022]
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Catalano O, Aiani L, Barozzi L, Bokor D, De Marchi A, Faletti C, Maggioni F, Montanari N, Orlandi PE, Siani A, Sidhu PS, Thompson PK, Valentino M, Ziosi A, Martegani A. CEUS in abdominal trauma: multi-center study. ACTA ACUST UNITED AC 2009; 34:225-34. [PMID: 18682877 DOI: 10.1007/s00261-008-9452-0] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The objective of this study was to evaluate the concordance of US and contrast-enhanced US (CEUS) with CT in the assessment of solid organ injury following blunt trauma. Patients underwent complete US examination, including free fluid search and solid organ analysis. CEUS followed, using low-mechanical index techniques and SonoVue. CT was performed within 1 h. Among 156 enrolled patients, 91 had one or more abnormalities (n = 107) at CT: 26 renal, 38 liver, 43 spleen. Sensitivity, specificity, and accuracy for renal trauma at baseline US were 36%, 98%, and 88%, respectively, after CEUS values increased to 69%, 99%, and 94%. For liver baseline US values were 68%, 97%, and 90%; after CEUS were 84%, 99%, and 96%. For spleen, results were 77%, 96%, and 91% at baseline US and 93%, 99%, and 97% after CEUS. Per patient evaluation gave the following results in terms of sensitivity, specificity and accuracy: 79%, 82%, 80% at baseline US; 94%, 89%, and 92% following CEUS. CEUS is more sensitive than US in the detection of solid organ injury, potentially reducing the need for further imaging. False negatives from CEUS are due to minor injuries, without relevant consequences for patient management and prognosis.
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Affiliation(s)
- Orlando Catalano
- Department of Radiology, I.N.T. Pascale, via Semmola, 80131, Naples, Italy.
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Tang J, Li W, Lv F, Zhang H, Zhang L, Wang Y, Li J, Yang L. Comparison of gray-scale contrast-enhanced ultrasonography with contrast-enhanced computed tomography in different grading of blunt hepatic and splenic trauma: an animal experiment. ULTRASOUND IN MEDICINE & BIOLOGY 2009; 35:566-575. [PMID: 19097681 DOI: 10.1016/j.ultrasmedbio.2008.09.028] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2007] [Revised: 06/14/2008] [Accepted: 09/29/2008] [Indexed: 05/27/2023]
Abstract
To compare the diagnostic value of contrast-enhanced ultrasonography (CEUS) with contrast-enhanced computed tomography (CECT) for the detection of different grading of solid organ injuries in blunt abdominal trauma in animals. A self-made miniature tools were used as models to simulate a blunt hepatic or splenic trauma in 16 and 14 anesthetized dogs, respectively. Baseline ultrasound, CEUS and CECT were used to detect traumatic injuries of livers and spleens. The degree of injuries was determined by CEUS according to the American Association for the Surgery of Trauma (AAST) scale and the results compared with injury scale based on CECT evaluation. CEUS showed 22 hepatic injury sites in 16 animals and 17 splenic injury sites in other 14 animals. According to AAST scale, 2 grade I, 4 grade II, 3 grade III, 5 grade IV and 2 grade V hepatic lesions were present in 16 animals; 2 grade I, 4 grade II, 6 grade III and 2 grade IV splenic lesions in 14 animals. On CECT scan, 21 hepatic and 17 splenic injuries were demonstrated. According to Becker CT scaling for hepatic injury, 1 grade I, 2 grade II, 4 grade III, 5 grade IV and 2 grade V hepatic injuries were present. On the basis of Buntain spleen scaling, 2 grade I, 5 grade II, 5 grade III, 2 grade IV splenic injuries were showed. After Spearman rank correlation analysis, the agreement of CEUS with CECT on the degree of hepatic and splenic injury is 93.3% and 92.9%, respectively. CT is currently considered as the reference method for grading blunt abdominal trauma, according to experiment results, CEUS grading showed high levels of concordance with CECT. CEUS can accurately determine the degree of injury and will play an important role in clinical application.
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Affiliation(s)
- Jie Tang
- Department of Ultrasound, Chinese People's Liberation Army General Hospital, 28 Fuxing Road, Beijing, China.
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Kirkpatrick AW, Ball CG, Campbell M, Williams DR, Parazynski SE, Mattox KL, Broderick TJ. Severe traumatic injury during long duration spaceflight: Light years beyond ATLS. J Trauma Manag Outcomes 2009; 3:4. [PMID: 19320976 PMCID: PMC2667411 DOI: 10.1186/1752-2897-3-4] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2009] [Accepted: 03/25/2009] [Indexed: 11/14/2022]
Abstract
Traumatic injury strikes unexpectedly among the healthiest members of the human population, and has been an inevitable companion of exploration throughout history. In space flight beyond the Earth's orbit, NASA considers trauma to be the highest level of concern regarding the probable incidence versus impact on mission and health. Because of limited resources, medical care will have to focus on the conditions most likely to occur, as well as those with the most significant impact on the crew and mission. Although the relative risk of disabling injuries is significantly higher than traumatic deaths on earth, either issue would have catastrophic implications during space flight. As a result this review focuses on serious life-threatening injuries during space flight as determined by a NASA consensus conference attended by experts in all aspects of injury and space flight.In addition to discussing the impact of various mission profiles on the risk of injury, this manuscript outlines all issues relevant to trauma during space flight. These include the epidemiology of trauma, the pathophysiology of injury during weightlessness, pre-hospital issues, novel technologies, the concept of a space surgeon, appropriate training for a space physician, resuscitation of injured astronauts, hemorrhage control (cavitary and external), surgery in space (open and minimally invasive), postoperative care, vascular access, interventional radiology and pharmacology.Given the risks and isolation inherent in long duration space flight, a well trained surgeon and/or surgical capability will be required onboard any exploration vessel. More specifically, a broadly-trained surgically capable emergency/critical care specialist with innate capabilities to problem-solve and improvise would be desirable. It will be the ultimate remote setting, and hopefully one in which the most advanced of our societies' technologies can be pre-positioned to safeguard precious astronaut lives. Like so many previous space-related technologies, these developments will also greatly improve terrestrial care on earth.
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Affiliation(s)
| | - Chad G Ball
- Foothills Medical Centre, 1403 29Street NW, Calgary, Alberta, T2N 2T9, USA
| | - Mark Campbell
- Paris Regional Medical Center, 820 Clarksville St., Paris, Texas, 75460, USA
| | - David R Williams
- NASA Johnson Space Center, 2101 NASA Pkwy #1, Houston, Texas, 77058, USA
| | - Scott E Parazynski
- NASA Johnson Space Center, 2101 NASA Pkwy #1, Houston, Texas, 77058, USA
| | - Kenneth L Mattox
- Baylor College of Medicine, Dept. of Surgery, One Baylor Pl., Houston, Texas, 77030, USA
| | - Timothy J Broderick
- University of Cincinnati, Dept. of Surgery, 222 Piedmont Ave, #7000, Cincinnati, Ohio, 45219, USA
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