Search

The ultrasound and CT findings in two patients with hemangioma of the adrenal gland are presented. Ultrasound showed large masses with heterogeneous nonspecific structural pattern. Unenhanced CT demonstrated lesions with hypodense centers and thick irregular peripheries with higher density. A few small peripheral calcifications were noted in one patient. Following contrast medium injection, patchy enhancement of the peripheral zone of the tumor was seen in both cases.

A double-blind trial of alpha-mercaptopropionylglycine (1500 mg/day per os) against a placebo was run in 40 aged subjects. Liver function parameters and lipid and sugar metabolism were evaluated before and after the test. The results are discussed, with particular reference to those relating to lipid metabolism.

During sonographic examination of the neck using high-resolution small-parts equipment, the minor neurovascular bundle may be identified in virtually all patients. Postmortem studies in three cadavers demonstrated that this structure is actually the recurrent laryngeal nerve (RLN). Furthermore, findings observed during sonographic examinations of the neck in nine patients with RLN paralysis of unknown origin were reviewed. Compression, displacement, or infiltration of the nerve from thyroid (seven cases) or parathyroid (two cases) nodules were noted, and this allowed the site and cause of the paralysis to be identified.

The sonographic images obtained in 32 patients with known gastric cancer, who were referred to sonography for evaluation of liver metastases and in whom a specific attempt was made in order to visualize the tumor, were reviewed and evaluated for the extent of exogastric neoplasm. Surgical correlation was available in 21 cases. Sonography allowed identification in five of seven patients who had distant metastases, 12 of 15 who had lymphadenopathy, and nine of 12 patients who had direct spread to structures surrounding the tumor; ascites was always correctly identified. In only one case, a false-positive diagnosis of lymph nodes metastases was made. These results indicate that sonography has good specificity in the staging of gastric cancer and that, when patients are referred for evaluation of liver metastases, it is worthwhile to gather useful additional information about tumor extent by performing a complete sonographic examination of the abdomen and pelvis and by making an attempt to visualize the primary neoplasm and its relations to surrounding organs.

Sonographic (US) and computed tomographic (CT) images obtained in 47 patients with renal cancer have been reviewed; attention was paid to detection of neoplastic spread to structures surrounding the tumor, presence of lymph node metastases and of thrombosis of renal vessels and to identification of distant metastases. The results of the revision process were then compared with surgical or autoptic findings. In a relatively high number of patients, a complete examination of the upper abdomen could not be performed by US, due to patient habitus or bowel gas; on the contrary, a diagnostic study could be obtained by CT in virtually all cases. Furthermore, differentiation of stage I and stage II lesions could never be obtained by US; only CT gave this possibility. As regards the sensitivity of the two methods, in patients with stage III or stage IV disease, US showed relatively lower sensitivity in the diagnosis of lymph node metastases, but it was significantly less sensitive in the study of distant metastases. On the contrary, the specificity of the two imaging methods was similar, and US gave better results in the evaluation of renal vein or inferior vena cava thrombosis.

The radiologic findings in 13 patients with pathologically proved adrenal myelolipomas were reviewed. All lesions involved the right adrenal gland; they ranged from 2 to 9 cm in diameter. Sonograms showed hyperechoic tumors in 11 cases (five homogeneous, six heterogeneous). Two myelolipomas composed primarily of myeloid tissue were hypoechoic. A propagation speed artifact was seen in seven lesions, all of which were composed primarily of fat and larger than 4 cm. CT identified fat-density tissues in all lesions. Contrast-enhanced CT showed positive attenuation values in the two predominantly myeloid tumors. CT appears to be sensitive for the diagnosis of adrenal myelolipomas. However, precontrast images are required to avoid errors.

We have recently examined a patient in whom sonographic visualization of the most lateral part of the right lobe of the liver was impossible due to the presence of subcutaneous emphysema of the right flank. To our knowledge, this is the first ultrasonic report of this condition.

Two patients in whom computed tomography (CT) and sonography suggested the diagnosis of Caroli's disease are reported. The biliary/nonbiliary nature of the hepatic cysts was evident on a CT scan of the liver obtained immediately after intravenous cholangiography. This allowed an accurate analysis of the relationship of the biliary ducts to the cysts and easy identification of contrast medium, where present, within them. The use of this technique may avoid more invasive procedures that, although accurate in defining anatomic changes of the biliary ducts, may cause infection in patients with biliary stasis and cholangitis.

Congenital urethral polyps are an uncommon cause of urethral obstruction in male children. The diagnosis is obtained at voiding cystography by demonstrating a filling defect which (typically) moves during micturition. A small polypoid mass with a stalk arising from the region of the verumontanum was observed by sonography in one such patient. We believe sonographic findings may be considered specific of this condition.

Twenty-four patients with bowel lesions that could be imaged on a sonogram underwent ultrasound-guided fine-needle aspiration biopsy. Indications for biopsy included: poor condition of the patient precluding the use of barium studies and/or endoscopy (9 cases) or hindering technically adequate examinations (3); nonspecific radiographic images (6); inability to obtain an adequate biopsy sample during endoscopy (6). The results of biopsy were correct in the 18 cases proven by surgery or autopsy; in the remaining 6 patients, histologic results were considered conclusive, and were later confirmed by clinical, radiographic, and ultrasound follow-up. Fine-needle aspiration biopsy may be considered a simple, rapid, and accurate diagnostic procedure when an alternative approach to the study of gastrointestinal tract lesions is needed.