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Resumen El abdomen agudo es un motivo de consulta habitual en los servicios de urgencias. Sus causas son multiples, y entre ellas se encuentran diversas enfermedades del tracto gastrointestinal. Si bien la tomografia computarizada es la tecnica mas aceptada, con frecuencia se lleva a cabo una ecografia abdominal inicialmente, mediante la cual es posible establecer la sospecha de patologia intestinal. Este articulo describe las caracteristicas ecograficas de diversos trastornos intestinales que cursan con abdomen agudo, como la diverticulitis aguda, la obstruccion intestinal, la perforacion gastrointestinal, la isquemia intestinal, la necrosis aguda de la grasa intraabdominal y una miscelanea de procesos, como endometriosis, cuerpos extranos o vasculitis. Debemos conocer las diferentes apariencias ecograficas del intestino anormal, ya que pueden detectarse incidentalmente en pacientes en quienes no se sospecha clinicamente. La semiologia ecografica de la patologia intestinal, asi como la apendicitis aguda, la enfermedad inflamatoria intestinal o las enfermedades infecciosas, se tratan en otros articulos de la serie.

Resumen Objetivo La endometriosis es la presencia de tejido endometrial fuera del utero. La endometriosis intestinal y del tracto urinario son formas de endometriosis extragenital que se manifiestan con sintomas inespecificos, pero su deteccion conlleva estrategias terapeuticas especificas. Las caracteristicas de la enfermedad se han descrito con ecografia transvaginal y resonancia magnetica en numerosas publicaciones, pero existen escasas referencias de ecografia abdominal. El objetivo de este trabajo es ilustrar los hallazgos ecograficos de la endometriosis infiltrante (intestinal y del tracto urinario) desde el abordaje abdominal y mostrar su utilidad en reconocer signos de la enfermedad previamente descritos con otras tecnicas. Conocer la enfermedad y sus caracteristicas ecograficas permite al radiologo sugerir su diagnostico e incluirla en el diagnostico diferencial del dolor pelvico en mujeres en edad fertil. Conclusion La ecografia abdominal constituye una herramienta util en el diagnostico de la endometriosis extragenital. La familiarizacion con sus apariencias ecograficas facilita la orientacion y manejo de este tipo de pacientes.

Acute abdomen is a common reason for consultation in the emergency department. A broad spectrum of entities, including diverse diseases of the gastrointestinal tract, can cause acute abdomen. Although computed tomography is the technique most widely used to evaluate acute abdomen in the emergency department, abdominal ultrasound is often performed first and allows bowel disease to be suspected. This article describes the ultrasound features of diverse bowel diseases that can cause acute abdomen, such as acute diverticulitis, bowel obstruction, gastrointestinal perforation, bowel ischemia, intraabdominal fat necrosis, and miscellaneous processes such as endometriosis, foreign bodies, or vasculitis. Radiologists must be familiar with the different features of abnormal bowel that can be detected incidentally in patients without clinical suspicion of bowel disease. This article focuses on ultrasonographic signs of bowel disease; other articles in this series cover the ultrasonographic signs of acute appendicitis, inflammatory bowel disease, and infectious diseases.

Poster: "SERAM 2014 / S-0607 / Valoracion del carcinoma urotelial de vias superiores mediante ecografia con contraste. " by: " D. P. Gomez Valencia , M. A. Meseguer Ripolles, T. Ripolles Gonzalez, M. J. Martinez Perez, R. Revert Espi, Y. Fernandez Nunez; Valencia/ES"

Aim To describe the findings and behaviour of contrast-enhanced ultrasound in the study of upper tract urothelial tumours and to assess its usefulness for diagnosis. Material and methods We reviewed our hospital's database over a period of 45 months to identify patients diagnosed with upper tract urothelial carcinomas. We reviewed the findings on mode B-ultrasound, contrast-enhanced ultrasound (location and qualitative assessment of intensity and washout of enhancement), and made a comparison with other techniques (computed tomography or magnetic resonance), and with the surgical specimen. Results We found 42 patients with a diagnosis of upper tract urothelial carcinoma confirmed with surgery over the period reviewed. Twenty-eight (67%) patients underwent contrast-enhanced ultrasound. Baseline ultrasound showed hydronephrosis with or without ureteral dilatation with echogenic content occupying the renal calyx (6), pelvis (10) or ureter (12). After injection of contrast, enhancement was noticed in 100% of the lesions, with similar intensity to the cortex in 23, and less in 5. Twenty-four lesions showed early washout, before the cortex, between 40 and 55 s after the injection. The diagnosis was correct in 27 cases. Localisation coincided with the histological specimen in 28 cases, and 3 patients had additional distal carcinoma foci. Conclusion Contrast-enhanced ultrasound is a useful technique for diagnosing upper tract urothelial tumours that increases confidence in the diagnosis.

Resumen Los tumores de la via biliar son lesiones benignas o malignas que pueden asociarse a factores de riesgo o a lesiones con potencial de malignizacion. Constituyen un grupo heterogeneo de entidades con diferente comportamiento biologico y pronostico dependiendo de su localizacion y del tipo de crecimiento. En este articulo revisamos el papel del radiologo para detectar, caracterizar y estadificar estos tumores y, sobre todo, la importancia de clasificarlos para planificar el manejo y el tratamiento.

Bile duct tumors are benign or malignant lesions which may be associated to risk factors or potentially malignant lesions. They constitute an heterogenous entities group with a different biological behavior and prognosis according to location and growth pattern. We revise the role of the radiologist in order to detect, characterize and stage these tumors, specially the importance of their classification when deciding an appropriate management and treatment.

Aim: To describe the findings and behaviour of contrast-enhanced ultrasound in the study of upper tract urothelial tumours and to assess its usefulness for diagnosis. Material and methods: We reviewed our hospital's database over a period of 45 months to identify patients diagnosed with upper tract urothelial carcinomas. We reviewed the findings on mode B-ultrasound, contrast-enhanced ultrasound (location and qualitative assessment of intensity and washout of enhancement), and made a comparison with other techniques (computed tomography or magnetic resonance), and with the surgical specimen. Results: We found 42 patients with a diagnosis of upper tract urothelial carcinoma confirmed with surgery over the period reviewed. Twenty-eight (67%) patients underwent contrast-enhanced ultrasound. Baseline ultrasound showed hydronephrosis with or without ureteral dilatation with echogenic content occupying the renal calyx (6), pelvis (10) or ureter (12). After injection of contrast, enhancement was noticed in 100% of the lesions, with similar intensity to the cortex in 23, and less in 5. Twenty-four lesions showed early washout, before the cortex, between 40 and 55 seconds after the injection. The diagnosis was correct in 27 cases. Localisation coincided with the histological specimen in 28 cases, and 3 patients had additional distal carcinoma foci. Conclusion: Contrast-enhanced ultrasound is a useful technique for diagnosing upper tract urothetial tumours that increases confidence in the diagnosis. (C) 2018 SERAM. Published by Elsevier Espana, S.L.U. All rights reserved.

Resumen Objetivo El objetivo de este estudio es analizar la sensibilidad de los hallazgos de la radiografia simple y de la tomografia computarizada (TC) en el diagnostico del volvulo cecal. Material y metodos Se revisaron las historias clinicas de 11 pacientes con diagnostico endoscopico o quirurgico de volvulo cecal. Dos radiologos analizaron por consenso los hallazgos en la radiografia simple y en la TC y calcularon la sensibilidad. Se realizo de forma retrospectiva un diagnostico de certeza, probable o indeterminado de volvulo cecal sobre la base de la presencia o ausencia de signos previamente descritos. Los signos de sufrimiento parietal en la TC se compararon con los hallazgos anatomopatologicos. Resultados Los hallazgos mas sensibles en la radiografia simple fueron la presencia de un asa desproporcionadamente dilatada y un patron de oclusion de intestino delgado distal (91%), seguidos de un nivel hidroaereo unico en el ciego y colapso del colon distal (82%). En la TC, el signo del grano de cafe con un unico nivel hidroaereo y el colapso de colon izquierdo mostraron una sensibilidad del 100%. El signo del remolino se observo en el 86%. De forma retrospectiva se pudo realizar un diagnostico de certeza en el 36 y el 86% de los casos en la radiografia simple y en la TC, respectivamente. Aunque todos los casos con isquemia tenian signos de deterioro vascular en la TC, no se encontro correlacion significativa entre ambos parametros. Conclusiones La utilizacion de los signos descritos de volvulo cecal permite hacer un diagnostico de certeza con la radiografia simple en un tercio de los pacientes y en la mayoria de los casos con la TC. La valoracion de otros hallazgos adicionales incrementa la posibilidad de realizar un diagnostico correcto.

Resumen Objetivos El objetivo de este estudio multicentrico ha sido evaluar si la ecografia con contraste permite aumentar el rendimiento diagnostico de la ecografia basal. Material y metodos En este estudio prospectivo multicentrico realizado en 42 hospitales se incluyeron 1.786 pacientes con estudios ecograficos considerados como no concluyentes. El 84,9% fueron ecografias abdominales (incluyendo estudios hepaticos, renales, esplenicos y de otras localizaciones), el 6,2% fueron estudios vasculares perifericos, el 4,3% fueron estudios mamarios y el 4,6% fueron estudios de otras localizaciones. Se evaluo el tipo de ecografia con contraste (Doppler color o metodo especifico de contraste), el tipo de contraste, la dosis y el numero de dosis y el tipo de administracion (en forma de bolo o infusion). Sobre los hallazgos obtenidos en la ecografia con contraste se valoro si conseguia aumentar el rendimiento diagnostico de la ecografia basal y si permitia un diagnostico concluyente. Resultados El 99,9% de los estudios se realizo con SonoVue, con una dosis de contraste (84,8%) y en forma de bolo (98,5%). En el 91,6% de los casos la ecografia con contraste aumento el rendimiento diagnostico de la ecografia basal, y en el 69,2% permitio un diagnostico de certeza. El mayor rendimiento diagnostico se obtuvo en los estudios de troncos supraaorticos con un diagnostico definitivo en el 95,4% de los casos, seguido por el area abdominal con resultado concluyente en el 72,6% de los casos. Conclusiones El uso de la ecografia con contraste aumento significativamente el rendimiento diagnostico de la ecografia basal, y se obtuvo un resultado concluyente en la mayoria de los casos.

Objective To determine the sensitivity of plain film radiography and computed tomography (CT) in the diagnosis of cecal volvulus. Material and methods We reviewed the clinical histories of 11 patients diagnosed with cecal volvulus at endoscopy or surgery. In consensus, two radiologists analyzed the imaging findings on plain film radiography and CT and calculated the sensitivities. The plain film and CT studies were retrospectively classified as certain, probable, or indeterminate for cecal volvulus on the basis of the presence or absence of previously reported signs. Signs of wall compromise at CT were compared with the histologic findings. Results The most sensitive findings on plain film radiography were the presence of a disproportionately dilated bowel loop and a pattern of distal small bowel obstruction (91%), followed by a single air-fluid level in the cecum and collapse of the distal colon (82%). At CT, the coffee bean sign with a single air-fluid level and collapse of the left colon had a sensitivity of 100%. The whirl sign was present in 86% of cases. Retrospectively, 36% of the plain film radiographs and 86% of the CT studies were correctly classified as positive for cecal volvulus. Although all cases with ischemia had signs of vascular compromise on CT, no significant correlation was observed between these variables. Conclusions The signs reported in the literature for cecal volvulus enable a certain diagnosis on plain film radiography in one third of all cases, while on CT, they allow this diagnosis in most cases The evaluation of additional findings increases the chances of reaching the correct diagnosis.

Objectives: We aimed to determine whether the use of ultrasonographic contrast agents improves the diagnostic accuracy of ultrasonography (US). Material and methods: We carried out a prospective multicenter study in 42 hospitals. We included 1786 patients with inconclusive US; 84.9 % of the inconclusive studies were abdominal US (including studies of the liver, kidneys, spleen, and other sites), 6.2 % were studies of the

La colonoscopia y los estudios baritados siguen siendo las tecnicas de eleccion para la valoracion de las lesiones mucosas de la enfermedad de Crohn. Sin embargo, estas tecnicas tienen una capacidad limitada para demostrar la extension transmural y extramural de la enfermedad. Las tecnicas de imagen seccionales, ecografia, tomografia computarizada y resonancia magnetica, aunque no detectan lesiones precoces, evaluan de forma satisfactoria los cambios parietales y extraparietales de la enfermedad, complementando por tanto la informacion dada por los estudios convencionales. Las tecnicas seccionales permiten valorar la longitud y localizacion anatomica de los segmentos patologicos, la presencia de estenosis y dilataciones y la enfermedad extramural (proliferacion fibrograsa, fistulas, flemones y abscesos), ayudando a clasificar a cada paciente en uno de los tres subtipos evolutivos de la enfermedad de Crohn (inflamatorio, estenotico o fistulizante). Se pueden evaluar tambien los signos que indican actividad inflamatoria (hiperemia o realce de la pared y aumento de vascularizacion mesenterica), que junto al subtipo evolutivo, determinaran el tratamiento. Las tecnicas seccionales deberian ser incluidas en la evaluacion completa del paciente con enfermedad de Crohn, junto con la evaluacion clinica, las pruebas de laboratorio y los estudios de imagen convencionales. En este trabajo revisaremos el papel de las tecnicas de imagen seccionales en el diagnostico y evaluacion de la enfermedad de Crohn, incluyendo una descripcion de la preparacion del paciente y los protocolos de exploracion, asi como los hallazgos de cada una de las tres tecnicas mencionadas. Se discutiran las ventajas y limitaciones de cada una de estas tecnicas, y su papel clinico actual.

A polygonal mosaic-like pattern of colonic mucosa is a rare radiological finding that was first described in studies using barium enema. We describe the CT findings of this pattern in a case of cecal volvulus.

To determine the sensitivity of plain-film radiography and computed tomography (CT) in the diagnosis of cecal volvulus.We reviewed the clinical histories of 11 patients diagnosed with cecal volvulus at endoscopy or surgery. Two radiologists working in consensus analyzed the findings at plain-film radiography and at CT and calculated the sensitivities. The plain-film and CT studies were retrospectively classified as certain, probable, or indeterminate for cecal volvulus on the basis of the presence or absence of previously reported signs. Signs of wall suffering at CT were compared to the histologic findings.The most sensitive findings at plain-film radiography were the presence of a disproportionately dilated bowel loop and a pattern of distal small bowel occlusion (91%), followed by a single air-fluid level in the cecum and collapse of the distal colon (82%). At CT, the "coffee bean" sign with a single air-fluid level and collapse of the left colon had a sensitivity of 100%. The whirl sign was present in 86%. Retrospectively, 36% of the plain-film studies and 86% of the CT studies were classified as certain for cecal volvulus. Although all cases with ischemia had signs of vascular compromise on CT, no significant correlation was observed between these variables.The plain-film signs reported for cecal volvulus enable a certain diagnosis in a third of all cases; the CT signs enable a certain diagnosis in most cases. The evaluation of additional findings increases the chances of reaching the correct diagnosis.

We aimed to determine whether the use of ultrasonographic contrast agents improves the diagnostic performance of ultrasonography (US).We carried out a prospective multicenter study in 42 hospitals. We included 1786 patients with inconclusive US; 84.9% of the inconclusive studies were abdominal US (including studies of the liver, kidneys, spleen, and other sites), 6.2% were studies of the peripheral vessels, 4.3% were breast studies, and 4.6% were other studies. We evaluated the type of contrast-enhanced US (color Doppler or contrast-specific method), type of contrast agent, dose and number of doses, and type of administration (bolus or infusion). We evaluated whether the findings at contrast-enhanced US improved the diagnostic performance of unenhanced US and whether they enabled a conclusive diagnosis to be reached.The contrast agent SonoVue was used in 99.9% of the studies; a single dose of contrast agent was used in 84.8%, and the contrast agent was administered in bolus in 98.5%. Contrast-enhanced US improved the diagnostic performance in 91.6% of cases and enabled the conclusive diagnosis in 69.2%. The best diagnostic performance was obtained in the supraaortic trunks, where a definitive diagnosis was reached in 95.4% of cases, followed by the abdominal area, with a conclusive diagnosis in 72.6% of cases.The use of contrast-enhanced US significantly improved the diagnostic performance of US and enabled a conclusive diagnosis in most cases.

Colonoscopy and Barium contrast studies continue to be the techniques of choice for the evaluation of mucosal lesions in Crohn's disease. However, these techniques have limited capacity for demonstrating the transmural and extramural extension of the disease. Although ultrasound, CT, and MRI cannot detect early lesions, these techniques satisfactorily show parietal and extraparietal changes caused by the disease, thus complementing the information provided in conventional studies. These three techniques enable the evaluation of the pathological segments, the presence of stenosis and dilatation, and extramural disease (fibrofatty proliferation, fistulae, phlegmons, and abscesses). This information is essential for classifying each patient into one of the three subtypes of Crohn's disease (inflammatory, stenotic, or fistulating). These techniques also enable the evaluation of signs that indicate inflammatory activity (hyperemia, wall enhancement, and increased mesenteric vascularization), and this information, together with the subtype, will determine the treatment. Ultrasound, CT, and MRI should be included in the complete evaluation of the patient with Crohn's disease, together with clinical examination, laboratory tests, and conventional imaging studies. We review the role of ultrasound, CT, and MRI in the diagnosis and evaluation of Crohn's disease, describing patient preparation and examination protocols, as well as the findings in these three techniques. We also discuss the advantages and limitations of each of these techniques and their current clinical roles in this context.