Search

Background: Recent reports indicate that numerical assessment of B-lines during transthoracic ultrasound may aid the differential diagnosis of acute diffuse pleuropulmonary disorders. Purpose: To determine whether B-lines are different in normal and diseased lungs and whether they can be used to discriminate between different types of pulmonary disorders in acutely ill patients. Material and Methods: In this multicenter study, transthoracic ultrasonography was performed on 193 patients with acute dyspnea, 193 healthy non-smokers, and 58 patients who had undergone pneumonectomy for lung cancer. Examinations were done with a low-medium frequency (3.5-5.0 MHz) convex probe and a high-frequency (8-12.5 MHz) linear probe. Video recordings were re-examined by a second set of examiners. In each participant, we measured the number of B-lines observed per scan. Results: B-lines counts were higher in dyspnoic patients (means: 3.11 per scan per linear probe scan vs. 1.93 in healthy controls and 1.86 in pneumonectomized patients; P < 0.001 for all); all counts were higher when convex probes were used (5.4 in dyspnoic patients and 2 in healthy controls; P < 0.001 vs. the linear probe). Subgroups of dyspnoic patients defined by cause of dyspnea displayed no significant differences in the number of B-lines. Conclusion: Our results demonstrate that there are a significant higher number of B-lines in the lungs of patients with dyspnea compared to healthy subjects and to pneumonectomized patients. Nevertheless, the quantification of B-lines does not make any significant contribution to the differential diagnosis of dyspnea. [ABSTRACT FROM AUTHOR]

Objective: The aim of our study was to evaluate the role of standardized video clips compared with still images in the diagnostic accuracy of remote sonographic interpretation., Methods: We compared the remote interpretation of sonographic examinations acquired with a standardized video clip approach to examinations performed with still images alone in 60 patients with various hepatic and extrahepatic pathologies., Results: The use of video clips improved the diagnostic accuracy of sonographic studies interpreted remotely compared with the use of still images (p < 0.0001). The sensitivity, specificity, and positive and negative predictive values increased from 47.3% to 68.3%, 81.8% to 87.8%, 71.5% to 81%, and 63.8% to 74.5%, respectively., Conclusions: Standardized video clips are easy to obtain, less operator-dependent than still images, and can be transferred to remote sites without loss of important data. We recommend this method in remote interpretation (teleradiology and distant consultation) of sonographic examinations., (Copyright © 2012 Wiley Periodicals, Inc.)

Purpose: The aim of this study was to investigate the clinical applicability of transthoracic ultrasound (TUS) in the diagnosis and follow-up of community acquired pneumonia (CAP)., Methods: We designed a pilot study in 15 patients and subsequently investigated 342 patients (206 men and 136 women) consecutively admitted to our Department from September 2005 to November 2009 because of radiographically diagnosed CAP. All patients underwent standard chest radiography, and consequently TUS. Follow-up TUS were performed at 4th and 8-10th day, in most patients., Results: Concerning the reproducibility of TUS method, no reader's bias was present (P=0·18), overall variability and between-subject variability (inter-reader agreement) did not show any difference between readers (P = 0·62 and P = 0·32 respectively), and estimated within-subject variabilities (intra-reader agreement) suggested a very high repeatability of the method (P ∼ 1). Of 342 patients with Rx diagnosis of CAP, in 314 patients (92% of cases) a pulmonary consolidation was also detected using TUS, whose ultrasonographic patterns were studied. Pleural effusion was detected in 120/342 (35%) patients using ultrasound and in 111/342 (32%) patients using chest radiography. Overall dimensional changes of the lung consolidated areas assessed with TUS method showed highly significant results. (1st day mean ± SD: 66·34 ± 19·25; 4th day: 39·92 ± 14·61; 8-10th day: 7·41 ± 1·50; P < 0·0001)., Conclusions: TUS is easily reproducible and we proved it to be a useful complementary diagnostic tool for the diagnosis and the follow-up of CAP., (© 2010 The Authors. European Journal of Clinical Investigation © 2010 Stichting European Society for Clinical Investigation Journal Foundation.)

The purpose of this study was to identify the ultrasonographic features of mild, moderate and severe pulmonary fibrosis. Between December 2005 and November 2007, transthoracic ultrasonography (US) was performed by a single operator with specific training in lung sonography on 84 consecutive patients (51 males and 33 females, aged 46 to 73 y) with pulmonary fibrosis. The obtained data were compared with those from a sample of 162 healthy subjects (78 men and 84 women, aged 18 to 76 y). The disease was idiopathic (biopsy confirmed) in 53/84 cases (63%). In the remaining (all histologically confirmed) cases, it was associated with systemic sclerosis (n = 18), rheumatoid arthritis (n = 4), mixed connective tissue disease (n = 4), Sjogren syndrome (n = 4), polymyositis (n = 2) or primary biliary cirrhosis (n = 1). Disease severity was classified as mild, moderate or severe based on clinical findings and the results of standard chest radiography, high-resolution computed tomography and pulmonary function tests. Pulmonary fibrosis was associated with the following US findings: (1) fragmented, irregular thickening (micro3 mm) of the "pleural line" distributed over the whole surface of the lung, especially in the lower posterior lobe (observed in all 84 patients); (2) subpleural cysts (seen in 57/84 (68%) cases of moderate-severe disease); (3) reduction or absence of the physiological "gliding sign" related to disease severity (observed in 33/84 to 39% cases); and (4) increased number of horizontal (and to a lesser extent vertical) reverberation artifacts (seen in 41 patients with advanced fibrosis, 34% of the total series). All abnormalities were detected in both lungs. Although lung biopsy is still the gold standard for diagnosis of interstitial lung disease, transthoracic ultrasound can document early and late-stage changes associated with this disease.

The use of contrast-enhanced ultrasound (CEUS) for the study of peripheral lung lesions has never been systematically investigated. We evaluated the CEUS patterns of 98 peripheral lung lesions before performing US-guided fine-needle biopsies (FNB). The examinations were done with an Esaote Technos MPX scanner in the harmonic mode with a mechanical index of 0.04 or less. Contrast enhancement was achieved with a 4.8 mL bolus of SonoVue (Bracco) administered via an antecubital vein. All FNBs performed under CEUS guidance were adequate for pathologic diagnosis. Seventy-eight lesions were malignant: 33 (41.9%) were adenocarcinomas, 29 (36.5%) were squamous-cell carcinomas, 13 (17.6%) were undifferentiated large-cell carcinomas and the remaining three (4.1%) were small-cell carcinomas. All presented intralesional enhancement consistent with tumor neovascularization. In some cases, there were unenhanced areas consistent with zones of necrosis and these areas were avoided during FNB. The other 20 lesions were benign (four lipomas, two fibrous lung tumor, two noncaseous granulomas, six abscesses, one rheumatoid nodule, one histiocytosis X, one chondroid hamartoma, one sclerosing hemangioma, two sarcoid nodules) and none presented intralesional enhancement. This initial and admittedly limited experience suggests that CEUS may provide diagnostically useful information on peripheral lung lesions and increase the diagnostic yield of transthoracic FNB by reducing the risk of inadequate tissue sampling.

Purpose: Transrectal ultrasound can reveal potentially malignant prostate lesions while they are still small. However, based on ultrasound alone they are often difficult to distinguish from benign focal lesions. We tested the reliability of a new technique for the sonographic evaluation of typical prostate lesions in differentiating adenocarcinoma from benign lesions., Materials and Methods: During 18 months 398 consecutive male patients 45 to 76 years old underwent transrectal ultrasound for the early detection of prostate cancer. When suspicious hypoechoic lesions were noted in the peripheral regions of the prostate, moderate pressure was applied on the lesion using the ultrasound probe to evaluate consistency. Based on the response lesions were classified as deformable (the shape changed from approximately spherical to oval) or nondeformable (the original shape was retained). All lesions were then diagnosed based on fine needle biopsy., Results: Peripheral hypoechoic prostate lesions were sonographically identified in 146 of 398 patients (36.7%). In 68 cases nondeformable lesions proved to be adenocarcinoma in 63 (92.6%), and chronic prostatitis and/or adenomatous hyperplasia in 5. In contrast, 62 of the 78 deformable nodules (79.5%) showed histological features of hyperplasia and/or chronic inflammation. The remaining 16 nodules, which showed more limited changes in shape during compression, were characterized by hyperplasia with acute inflammatory changes. In 5 cases there was also evidence of adenocarcinoma., Conclusions: Ultrasound guided compression of suspicious prostate lesions detected on transrectal sonography is a simple, rapid and reliable maneuver that may increase the diagnostic potential of this examination.

Seventy-80% of prostatic carcinoma develops in the peripheral gland. Transrectal ultrasound (TRUS) has the capacity to identify nodules or hypoechogenic areas in the peripheral zone, suspected to be carcinoma. We describe a new echographic technic with endorectal probe (target compression test), to study hypoechogenic areas or nodules in the peripheral gland, during TRUS examination. Thirty-three patients, aged 49-77 years, with prostatic peripheral hypoechoic lesion at transrectal ultrasound, were studied. All patients underwent prostatic biopsy. Ten of the 11 positive patients (non compressible lesion) at the target compression test resulted to be affected by adenocarcinoma. Only 3 of the 22 negative patients (compressible lesion) at the target compression test resulted to be affected by adenocarcinoma. Even if our data have to be confirmed by further studies, they suggest that the target compression test may be a useful complementary test, during TRUS, in the evaluation of hypoechogenic areas in the peripheral gland.

By color-Doppler ultrasound it's possible to visualize urine flow jet from ureter into the bladder. Aim of the study was to evaluate of ureteral jet in patients with benign prostatic hyperplasia before, during and after with one or two drugs medical therapy. Thirteen patients, aged 51-63 years, were studied; they were not affected by metabolic, hepatic, renal diseases and by prostate inflammation. Eco color Doppler p.w. (Toshiba SSA 270A) with a convex probe of 3.5 MHz was used. A transabdominal ultrasound study was performed, prostate volume measured and ureteral jet visualized before and along treatment (at six months interval) with Finasteride and at the end of treatment. Successively, in four patients, with relapse of prostatic synptomatology, a transabdominal ultrasound study was performed, before and along a treatment with Finasteride, 5 mg/die (Finastid, Neopharmed) and Terazosin hydrochloride, 5 mg/die (Teraprost, Malesci), and at the end of treatment.

Intrarenal Doppler US was performed in 20 patients with suspected renal obstruction and standard sonographic appearance of collecting-system dilatation. In 15 patients with true renal obstruction the resistive index (I.R.) was > 0.7. The A.A. think duplex Doppler US is a valuable addition to the standard sonographic evaluation to increase the diagnostic accuracy in patients with suspected renal obstruction.

In some patients undergoing an U.S. study of kidney for lumbodynia, it's sometime possible to visualize hypoechoic and areas poorly demarcated without distal acoustic enhancement, localized within the cortex and disrupting the cortico-medullary junction. These findings, called focal nephritis, associated to minimal retention of urine in the bladder, reflect an inflammatory process involving the renal parenchyma, in spite of normal urine analysis. To confirm this theory, 7 patients who presented these findings at US study of kidney underwent renal scintigram with labeled granulocytes. This test revealed the presence of focal bacterial nephritis in the same hypoechoic areas. Therefore US study of kidney combined with renal scintigram is useful to diagnose inflammatory process of the kidney in patients complaining lumbodynia.

Diabetic nephropathy affects a subset of about 40% patients with Insulin-Dependent Diabetes Mellitus (IDDM); it also develops in a less defined percentage (30-50%) of patients with non Insulin-Dependent Diabetes Mellitus (NIDDM), after a period of 15-20 years. It is usually divided in 5 stages: the first 3 are characterized by renal hypertrophy and increased glomerular filtration surface area (I stage) followed by glomerular histological lesions (II stage) and early nephropathy with microalbuminuria (III stage). At these stages nephropathy is still reversible by medical treatment (ACE inhibitors) and good metabolic control. Aim of this study was to assess the usefulness of duplex sonography with Doppler wave form analysis in the evaluation of early diabetic nephropathy, in order to detected patients at risk for irreversible renal disease. Fifteen patients (10 males and 5 females) aged 28-46 years, affected by IDDM were studied; 15 healthy subjects (7 males and 8 females) aged 20-45 years composed the control group. All of them underwent duplex Doppler sonography of kidney; a scanner with a 3.5 MHz transducer (Toshiba 270 SSA) was used. All patients had renal function tests within normal range. Pulsatily Index (P.I.) and Resistive Index (R.I. of Doppler waveform were obtained at the interlobar arteries; the average value of 3 bilateral measurements was taken. Doppler sonography was done by the same authors without knowledge of the patient group (case or control). Both indexes (P.I. and R.I.) resulted to have higher values in patients with IDDM compared to controls: P.I. = 1.46 +/- 0.30 vs. 1.07 +/- 0.06, p < 0.05; R.I. = 0.77 +/- 0.09 vs 0.60 +/- 0.03, p < 0.05. Even if our data have to be confirmed by further studies, they suggest that duplex Doppler sonography may be a useful complementary test in the evaluation of diabetic nephropathy, even in the early stages.

The Authors emphasize sonographic aspects of Renal Abscess in early phase and in proclaimed disease. The advent of the sonography and its extensive use marked an inversion of tendency in Perinephric Abscess evolution. So it is possible to point out small Abscesses and in early phase. Leukocytes tags Scintiscan and CT can confirm the diagnostic tentative.

The A.A. discuss about a clinical case of acute scrotum in which the echographical aspects aren't been exhaustived for the etiology. Surgical exploration showed Morgagni's hydatid torsion while the echography doubted between acute phlogosis and neoplasia.

Calcifying fibrous pseudotumor of epididymis is a rare neoplasia. The A.A. report echographical aspects about two clinical acses examined in 1993. Peculiar aspects of tumour are characterized by acoustic obstruction of the fibrous tissue and contextual iperechogenic spots, so to stimulate a calcific pseudocapsula. The A.A. revalue the echographical images after surgical exploration and discuss about differential diagnosis with TBC.

Couple's study infertility sometimes need repeated hysterosalpingographical evaluations. In three cases the A.A. value echohysterosalpingography's utility. The echohysterosalpingography gives morphological and functional dates, is easy repeatable and the patients aren't exposed to ionizing radiations.

Since in the early years of 1980, the diagnostic for images about male's urethral injury was exclusively assigned to urethrocystography. Sially in repeated check the gonads too often are exposed to ionizing radiations. Our results show urethrocystography/ultrasonography good correlation (13/15) cases) with 86% sensibility. Even if the urethrocystography is a methodic of first instance, the urethral ultrasonography is efficacious in follow up of urethral injury, particularly in the study of anterior urethra.

By Color-Doppler ultrasound it's possible to visualize urine flow from ureter into the bladder. Aim of the study was to image these ureteral jets in patients with benign prostatic hyperplasia (BPH) before and after therapy. Seven patients were studied, whose age ranged from 52 to 69 years; they were not affected by methabolic, hepatic, renal diseases and by prostate inflammation. A duplex scanner (Toshiba SSA 270 A) with a convex probe of 3.5 MHz was used. A transabdominal ultrasound study was performed, measuring prostatic volume and imaging ureteral jet before and along a treatment (at four months intervals) with Finasteride 5 mg/die (Finastid, Neopharmed) and at the end of treatment. We found that the mean velocity of jets in patient affected by was higher than in healthy subjects (80 cm/sec vs 60 cm/sec) bur during treatment it decreased along with symptom improvements and decreasing volume at US. We concluded that analysis of ureteral jets with Color-Doppler P.W. may add useful informations to real-time us in the study of patients affected by BPH undergoing treatment with Finasteride.

The evaluation of blood flow at the level of renal arteries by echo-Doppler may be useful in detecting a stenosis in patients affected by arterial hypertension. We studied 33 subjects with arterial hypertension using the most suitable scansions to visualize renal arteries. The measured parameters (R.I. and Vmax) resulted to be higher than normal range in 7 and 1 patients respectively. Then these patients underwent renal scintigraphy and arteriography; in 3 of them the presence of a stenosis of a renal artery was confirmed. Therefore the echo-Doppler study of renal arteries, even if has some shortcomings due to technic troubles, revealed to be a useful tool in the screening of hypertensive patients to support the other tools already used to this aim.

The protective role of large spontaneous portosystemic shunts in oesophageal varices bleeding due to portal hypertension in liver cirrhosis is still debated. A series of 20 consecutive patients with haemodynamically efficient collaterals involving the para-umbilical-epigastric venous route (evaluated by Echo-Doppler flowmetry) is reported. All patients presented absent or mild oesophageal varices at endoscopy. During a mean follow-up period of 23.5 months, no patient developed large varices or experienced variceal bleeding. Hepatic encephalopathy was present in 35% of patients. Haemodynamically efficient spontaneous portosystemic shunts may protect cirrhotic patients from the risk of oesophageal varices forming and bleeding. The diversion of large amounts of blood from portal to systemic circulation correlates with the higher trend of hepatic encephalopathy in these patients.

In liver cirrhosis the sodium retention depends on a decreased renal perfusion by arteriolar vasoconstriction. To evaluate the usefulness of echo-Doppler in detecting such hemodynamic impairment, we studied 16 cirrhotic patients and 16 healthy subjects as control group. We measured Pulsatility Index (P.I.) and Resistivity Index (R.I.). Both parameters resulted to be statistically higher in cirrhotic patients than in controls; moreover they resulted to be higher in cirrhotics with ascites than in those without. Therefore echo-Doppler can detect intraparenchymal renal vasoconstriction in cirrhosis, this impaired perfusion is already evident before ascites formation.

In the last 10 years, interest about the employment of bile acids, especially of ursodeoxycholic acid (UDCA), in the treatment of chronic liver diseases has increased. The mechanism has not been completely explained yet, but this agent has been thought to act mainly by making bile less toxic for the liver cells, reducing the fraction of hydrophobic detergent bile acids. UDCA is effective in decreasing serum concentrations of liver enzymes in chronic liver diseases, especially in those associated with cholestasis. This effect discloses new perspectives about the employment of this agent, even in association with other drugs, i.e. interferon; however, further investigations will be necessary in order to standardize the use of UDCA in the treatment of chronic liver diseases.

The combined use of B-mode ultrasonography and doppler (p.w. and/or color doppler) provides a more accurate and detailed study of vascular pathology than B-mode ultrasonography alone. In fact, besides to document the presence of blood flow and to assess its direction, doppler US provides a quantitative evaluation of blood flow. Chromatic codification of blood flow (usually red if flowing towards the probe, blue if flowing away from the probe and yellow or green in the case of turbulence) permits to assess the presence of blood flow even in areas where a vessel cannot be depicted by B-mode ultrasonography. In fact in the study of blood flow to the kidney it's possible with color-doppler to visualize not only the main renal arteries but segmental-intraparenchymal arteries too; that is very useful in the detection of rejection of allograft. In renal artery, blood flow presents a pattern of low resistance: a brief systolic phase followed by a longer diastolic one, without inversion of flow. In renal vein, blood flow is, on the contrary, continuous. The main disorders of the kidney and urinary tract, which can be detected by color doppler are the following: renal-vascular hypertension, rejection of allograft, renal vein thrombosis, portal hypertension with spleno-renal collateral channels, disorders of ureteral motility, space occupying lesions, medical nephropathies and obstructive uropathies. Sophisticated analysis of the flow pattern to the kidney with color doppler, by some doppler sonographic parameters (resistance index RI, pulsatility index PI), in these disorders adds a functional element to the traditional ultrasonographic imaging with a better characterization of the disease.

This report discusses hypertrophic pyloric stenosis (HPS) and the current approach to diagnostic imaging in the vomiting infant. Signs and symptoms include dehydration and vigorous gastric peristalsis with vomitus. Palpation of an olive-shaped firm muscular tumor is pathognomonic of this condition. The radiographic signs of HPS are well known. Previously published criteria for the sonographic diagnosis of HPS are discussed, these include: measurements of pyloric length, diameter and muscle thickness. The thickened muscle is the most discriminated and accurate one. It was concluded that real-time ultrasound is a simple, and reliable method for the diagnosis of HPS and should be the initial imaging procedure.

Hypoechoic focal liver lesions are described, for the first time, in two patients with granulomatous hepatitis and hemochromatosis, and presenting a 'bright liver pattern' at ultrasonography. CT-scan was not able to make evident such areas in both cases, while hepatoscintigraphy revealed them only in the patient with granulomatous hepatitis. Echoguided fine-needle biopsies on the focal lesions were suitable for the correct final diagnoses. The finding of such areas was probably due to different intensity of the diseases in contiguous zones of liver parenchyma.

Two cases of Cruveilhier-Baumgarten syndrome not clinically evident and without esophageal varices in patients with liver cirrhosis and portal hypertension are presented. The diagnosis was made by real-time ultrasonography, which showed echographic caput medusae with large afferent umbilical veins and efferent inferior superficial epigastric veins. Doppler flowmetry documented high blood flow rates in these collateral portal-systemic circulations, and this explained the absence of large varices at endoscopy. The role of massive spontaneous portal-systemic shunts in preventing the formation of other shunts and particularly esophageal variceal bleeding is discussed.

The immunocytochemical characterization of neoplastic cells recognized by a large panel of monoclonal antibodies in fine needle aspirates obtained from 16 subjects with superficial or profound tumoral masses of unknown origin was carried out using alkaline phosphatase anti-alkaline phosphatase (APAAP) immunoenzymatic method. The patients were selected on the basis of particular clinical criteria or since a correct cytohistological diagnosis was not available. APAAP immunophenotyping allowed to establish the existence of non-Hodgkin lymphoma in 6 cases, hairy cell leukemia in 1 case and carcinoma in 5 cases, while in other 2 patients the existence of Hodgkin's disease was suspected and subsequently confirmed; only in 2 subjects diagnostic informations were lacking. Furthermore, the evaluation of growth fraction by means of Ki 67 monoclonal antibody revealed a high degree of malignancy in all cases of lymphoma. Although some cautions have to be considered in the interpretation of results, APAAP immunocytochemical typing of fine needle aspirates appears a simple and reliable noninvasive diagnostic tool in selected patients.