Percutaneous treatment of liver hydatid cysts

Hydatic disease caused by Echinococcus granulosus is an endemic disease and an important public health problem in some countries of the world. The results of surgical treatment are associated with a high rate of mortality, morbidity, postoperative recurrence and a long period of hospital stay and the medical treatment results are still controversial. Although the percutaneous aspiration and treatment of liver hydatid cysts were considered to be contraindicated due to risks of anaphylactic shock and dissemination of clear-crystal fluid into the abdomen, several reports of successful percutaneous treatment of liver hydatid cysts have been published in the literature. Today, percutaneous treatment of liver hydatid cysts is the most effective and reliable treatment procedure in the selected cases. In this review, indications, contraindications, method and techniques, healing criteria, complications, results and importance of the percutaneous treatment of liver hydatid cysts are discussed.

US and CT findings of multicentric leiomyosarcomatosis

This article presents a case of leiomyosarcomatosis with widespread lesions involving the soft tissues and the most unlikely organs such as thyroid and salivary glands, pancreas, ligamentum teres, bladder wall, and bones without lymph node or distant metastasis. The CT and US findings of this rare phenomenon are discussed with regard to the literature.

Gallbladder duplication: imaging findings and differential considerations

Duplication of the gallbladder, a rare congenital anomaly, is important in clinical practice because it may cause some clinical, surgical, and diagnostic problems. We present imaging findings of a double gallbladder including coronal reformatted computed tomographic sections, to our knowledge not previously presented, and discuss the radiologic signs that may be helpful in diagnosis. We also present another case of a double gallbladder in which only one gallbladder was imaged 10 years after cholecystectomy.

Interobserver and intraobserver variations in sonographic measurement of thyroid volume in children

OBJECTIVE

To determine the interobserver and intraobserver variations in sonographic measurement of thyroid volume in children.

DESIGN

Thyroid volumes of 30 healthy children were measured by three separate observers. Additionally each observer measured thyroid volumes of ten separate children three times.

METHODS

The data were used to assess intraobserver and interobserver variations in measurement of thyroid volume. Interobserver and intraobserver variations in measuring each diameter of the thyroid gland were also determined. The effect of thyroid size on interobserver and intraobserver variations was analyzed.

RESULTS

Intraobserver variation in measurement of thyroid volume was 8.4+/-6.7% (mean+/-s. d.). Interobserver variation was 13.3+/-8.2%. The widest interobserver variation was encountered in determining the craniocaudal diameter of the thyroid gland. No correlation was found between thyroid volume and interobserver variation (r=-0.12, P=0.27), whereas a slight but statistically significant correlation was found between thyroid volume and intraobserver variation (r=-0.26, P=0.012).

CONCLUSION

Significant interobserver and intraobserver variation occurs in sonographic measurement of thyroid volume in children.

Renal diuretic duplex Doppler sonography in childhood hydronephrosis

OBJECTIVE

The purpose of this study was to determine the diagnostic value of diuretic duplex Doppler sonography in distinguishing between obstructive and nonobstructive hydronephrosis in children by calculating the resistive indices (RI) before and after administration of furosemide.

MATERIAL AND METHODS

We prospectively evaluated 28 kidneys (2 solitary) in 15 patients with unilateral or bilateral neonatal hydronephrosis. All patients underwent diuretic renography and duplex Doppler sonography before and after administration of furosemide.

RESULTS

According to the half-time drainage patterns at diuretic renography, 13 kidneys were classified as nonobstructed and 15 as obstructed. At baseline, the mean RI values of nonobstructed and obstructed kidneys were not significantly different (0.66 and 0.64, respectively). Ten minutes after the injection of furosemide, the mean RI values of the nonobstructed and obstructed kidneys were 0.68 and 0.70, respectively. The increase in RI over the baseline 10 min after the diuretic injection was statistically significant (p<0.00001) in the obstructed kidneys.

CONCLUSION

The baseline RI value of 0.70 is not a definite value for distinguishing obstructed from nonobstructed systems. An increase in RI of at least 10% over the baseline seems to be a more reliable criterion, especially when it is used in conjunction with diuretic renography.

Splenic calcifications in heterozygote sickle cell patients

A small, fibrotic, and even calcified spleen is the hallmark of homozygote sickle cell disease in adults. Such a condition is very rare in sickle-thalassemia and, to our knowledge, not previously reported in a sickle cell trait. We report two heterozygote sickle cell siblings with splenic calcifications, one sickle cell trait and one sickle-beta+-thalassemia, without any history suggestive of splenic vasooclusive-infarctive crisis.

Radiological findings of intraparenchymal liver Ascaris (hepatobiliary ascariasis)

Ascariasis is a well-known cause of acute cholangitis and cholecystitis; however, very rarely do worms penetrate and colonize the liver parenchyma. Here we present the unique radiological demonstration (US, CT and ERCP) of hepatobiliary ascariasis in which worm was first alive in the parenchyma of the liver and subsequently died and formed liver abscess.

Giant benign cystic peritoneal mesothelioma: US, CT, and MRI findings

Benign cystic peritoneal mesothelioma (BCPM) is a rare tumor, primarily affecting young women; approximately 130 cases have been described mainly in the pathological and surgical literature. We present imaging findings of a giant BCPM in a male patient and discuss the radiological differential diagnosis with a brief review of the literature.

Percutaneous treatment of an orbital hydatid cyst: a new therapeutic approach

PURPOSE

To describe the percutaneous treatment of an orbital hydatid cyst as an alternative approach to conventional surgery.

METHODS

In a 21-year-old man with diplopia and right proptosis, radiologic studies disclosed a 25 x 25 x 20-mm purely cystic mass in the right retrobulbar area. Based on the presumptive diagnosis of hydatid cyst, the cyst was treated percutaneously under ultrasonographic guidance with aspiration, 15% hypertonic saline injection, and reaspiration without any complication.

RESULTS

A substantial decrease in the size of the cyst was observed in the 3 months after treatment. Nine months after treatment, the shrunken cyst had a volume of only 0.5 ml, and the patient was asymptomatic. Twenty-one months after the procedure, the findings were consistent with those at 9 months of follow-up.

CONCLUSION

Percutaneous treatment of orbital hydatid cysts, which is more satisfactory to both the patient and the physician, may be a safe and effective alternative to surgical extirpation.

Percutaneous treatment of a congenital splenic cyst with alcohol: a new therapeutic approach

Percutaneous treatment of a huge congenital splenic cyst in a 23-year-old man is presented. The cyst had been catheterized and drained two times within a 3-month period without injecting any sclerosing agent into the cavity. On the third attempt, catheter drainage and injection of alcohol into the cyst cavity were performed because of insufficient response to drainage alone. He was discharged symptom-free after the procedure. The cyst diminished in size considerably 9 months after the treatment with alcohol. The volume of the cyst was reduced from 5200 to 8 ml. Although percutaneous treatment of a congenital splenic cyst with tetracyclin has been reported, to our knowledge this is the first case of a congenital splenic cyst treated with alcohol as a sclerosing agent. Percutaneous treatment of splenic cyst can obviate the need for partial or total splenectomy and may be an alternative to surgical treatment.

Bilateral cystic adrenal masses in the neonate associated with the incomplete form of Beckwith-Wiedemann syndrome

We report a case of bilateral multilocular cystic adrenal masses in a neonate who demonstrated somatic hypertrophy and macroglossia, which are considered to constitute an incomplete form of Beckwith-Wiedemann syndrome (BWS). After surgical removal of the masses, histological study revealed benign hemorrhagic macrocysts with cortical cytomegaly. There was no evidence of tumor or adrenal apoplexia. Although very rare, association of unilateral hemorrhagic adrenal macrocysts with BWS has been reported before; this is the first case of bilateral benign adrenal macrocysts associated with BWS.

US and CT findings in the diagnosis of tuberculous peritonitis

PURPOSE

To evaluate the ultrasonographic and CT findings of tuberculous peritonitis.

MATERIAL AND METHODS

Ultrasonographic and CT findings of 11 patients with the ascitic type of tuberculous peritonitis were reviewed.

RESULTS

All patients had ascites, and ultrasonography (US) demonstrated fine complete and incomplete mobile septations in 10 patients. In 5 of them, the ascites had a lattice-like appearance. Diffuse regular peritoneal thickening was detected in all patients by CT and in 10 patients by US. CT demonstrated infiltration of the greater omentum in 9 patients, whereas US showed omental thickening in only 5 patients.

CONCLUSION

Peritoneal and omental thickening detected by CT and ascites with fine, mobile septations shown by US strongly suggest the ascitic type of tuberculous peritonitis. The 2 imaging modalities should be used together for accurate diagnosis of tuberculous peritonitis.

US and CT findings in the diagnosis of tuberculous peritonitis

PURPOSE

To evaluate the ultrasonographic and CT findings of tuberculous peritonitis.

MATERIAL AND METHODS

Ultrasonographic and CT findings of 11 patients with the ascitic type of tuberculous peritonitis were reviewed.

RESULTS

All patients had ascites, and ultrasonography (US) demonstrated fine complete and incomplete mobile septations in 10 patients. In 5 of them, the ascites had a lattice-like appearance. Diffuse regular peritoneal thickening was detected in all patients by CT and in 10 patients by US. CT demonstrated infiltration of the greater omentum in 9 patients, whereas US showed omental thickening in only 5 patients.

CONCLUSION

Peritoneal and omental thickening detected by CT and ascites with fine, mobile septations shown by US strongly suggest the ascitic type of tuberculous peritonitis. The 2 imaging modalities should be used together for accurate diagnosis of tuberculous peritonitis.

Liver hydatid disease: long-term results of percutaneous treatment

PURPOSE

To evaluate the long-term effectiveness of percutaneous treatment of liver hydatid cysts.

MATERIALS AND METHODS

Thirty-one patients (19 female patients and 12 male patients; age range, 8-78 years; mean age, 41 years) with 57 liver hydatid cysts underwent percutaneous treatment. The cysts were treated with hypertonic saline (15% NaCl) and/or absolute alcohol. Sonographic and/or fluoroscopic guidance was used.

RESULTS

Repeated sonography revealed a gradual decrease in cyst size. Volume reduction was 18%-99% (mean, 83%). With the disappearance of the fluid component, pseudotumor appearance occurred. In all treated cases, the cyst wall became irregular and thicker during follow-up. No mortality occurred. No abdominal dissemination was encountered during follow-up. Major complications were infection of the cavity, hypersensitivity reaction, and development of biliary fistula. One cyst recurred 11 months after primary drainage.

CONCLUSION

Long-term results indicate that percutaneous treatment of liver hydatid cysts is an effective and safe method in selected cases.

Ultrasonographic diagnosis of intestinal ascariasis

Ascaris lumbricoides is the most common roundworm in warm and temperate areas. Although radiological features of Ascaris lumbricoides are well defined, there are only a few reports on the ultrasonographic findings of intestinal ascariasis. In our two patients with no acute abdominal symptoms, intestinal ascariasis was initially diagnosed by abdominal ultrasonography. In both patients, tubular structures in the segments of the small intestine were demonstrated by ultrasonography.

Systemic oxalosis: pathognomonic renal and specific extrarenal findings on US and CT

Hyperoxaluria is characterized by nephrocalcinosis and nephrolithiasis on radiological examination and may also result in diffuse deposition of calcium oxalate crystals in multiple extrarenal organs (oxalosis). In two cases, the renal findings of primary hyperoxaluria were diagnosed by ultrasound and computed tomography scans. In addition to renal involvement, both patients had liver involvement, and one patient had cardiac involvement.

Percutaneous treatment of pulmonary hydatid cysts

PURPOSE

To evaluate the safety and efficacy of percutaneous drainage of pulmonary hydatid cysts.

METHODS

Eleven pulmonary hydatid cysts in eight patients were drained percutaneously after 1-2 years of treatment with mebendazole (50 mg/kg/day). Percutaneous needle aspiration was carried out under ultrasound (US) in six patients and computed tomography (CT) in two patients. Nine cysts were close to, and two cysts were distant from the thoracic wall. After aspiration, hypertonic (15%) saline solution was instilled for up to 35% of the estimated volume of the cyst and aspirated 5-10 min later. Follow-up ranged from 8 to 31 months (mean 16.3 months).

RESULTS

Neither anaphylactic shock nor death occurred in any of the eight patients. One patient developed fever, ipsilateral hydropneumothorax, and contralateral pleural effusion. One patient suffered from fever, pneumothorax, and abscess and was treated surgically; one developed fever and dyspnea. The volume reduction during follow-up was 47%-93%. The cystic contents turned into a pseudotumor appearance with a thick irregular contour on CT and higher Hounsfield units. On US, the cysts showed a heterogeneous content with internal echoes representing detached and degenerated membranes, and the fluid content almost completely disappeared.

CONCLUSION

We believe that percutaneous therapy of pulmonary hydatid disease is an effective alternative to surgical treatment in patients who have failed medical therapy.

Superior mesenteric artery aneurysm in Behçet's disease

Behçet's disease is a multisystem disorder characterized by recurrent orogenital ulcerations and uveitis. Vascular involvement can include both arteries and veins, with a preponderance of venous lesions. Aneurysms of splanchnic arteries due to Behçet's disease have been rarely reported. We present an unusual case of superior mesenteric artery aneurysm due to Behçet's disease diagnosed by ultrasonography and angiography.

Choledochal cysts: ultrasonographic findings and correlation with other imaging modalities

In the past, choledochal cysts had been infrequently diagnosed prior to surgical exploration for obstructive jaundice. However, with the advance of imaging modalities, preoperative diagnosis is usually apparent. We evaluated the radiological findings of choledochal cysts in 14 patients in whom ultrasonography (US) or computed tomography (CT) were mainly used for diagnosis. In addition, oral cholecystography, intravenous (i.v.) cholangiography, scintigraphy, and percutaneous transhepatic cholangiography were performed in some of them. The diagnosis was confirmed surgically in all patients. Ultrasonographic examinations were diagnostic in 13 of 14 patients. Preoperative specific diagnosis of choledochal cyst was possible with the demonstration of direct entrance of the extrahepatic bile ducts into the cyst in most cases. When US fails to show relation of cystic mass with biliary system, other imaging modalities can be used to clarify the findings.

Peritoneal mesothelioma: sonographic findings in nine cases

Ultrasonographic findings in nine cases of peritoneal mesothelioma are presented. The most common findings were sheet-like or nodular peritoneal thickening, soft tissue masses, fixation of the intestinal loops, mesenteric thickening, and minimal ascites which was disproportional to the degree of tumor dissemination. The authors found that abdominal sonography, using 3.75-7.5 MHz transducers, is a useful imaging method for diagnosis of peritoneal mesothelioma in high-risk groups.

Case report: interruption of the inferior vena cava with anomalous intrahepatic continuation

Infrahepatic interruption of the inferior vena cava (IVC) with azygos and hemiazygos substitution is a rare IVC anomaly which has been documented in the literature (Anderson et al, 1961; Chuang et al, 1974; Floyd & Nelson, 1976; Mayo et al, 1983). Recently Bercoff et al and Ghossain et al reported two cases with portal continuation of the interrupted IVC (Bercoff et al, 1985; Ghossain et al, 1988). In our case, we describe a left sided IVC with infrahepatic interruption which continues by both the azygos system and the hepatic veins via anomalous intrahepatic vessels. To our knowledge such a continuation with intrahepatic anomalous vessels has not been described before.

Wolman's disease: ultrasonographic and computed tomographic findings

Acid lipase deficiency which is an inborn error of lipid metabolism leads to an abnormal accumulation of cholesteryl esters and triglycerides in many tissues. It is manifested in two clinical forms: Wolman's disease (WD) which is fatal in infancy and cholesteryl ester storage disease (CESD) which is a milder form and usually presented in adulthood. An infant with a clinical diagnosis of WD was examined with CT and ultrasound. Where as CT showed an enlarged liver with decreased density and heavily calcified adrenal glands, ultrasound revealed an enlarged liver with normal echogenicity, adrenal calcification and thickening of bowel loops. Bowel wall thickening in WD was not demonstrated in the literature before with any imaging modality.