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A 71-year-old woman was admitted to our hospital with the complaint of upper abdominal pain. Laboratory studies were within normal limits, except for slight anemia. Hypotonic duodenography and gastroduodenoscopy demonstrated a tumor in the papilla of Vater, and endoscopic biopsy revealed moderate epithelial dysplasia. Pancreatoduodenectomy was performed and postoperative histopathological examination revealed tubular adenoma of the papilla of Vater. The diagnostic and therapeutic problems related to adenoma of the papilla of Vater are discussed with respect to its precancerous nature.

偽腺管形成により,超音波像で高エコー型を示したと考えられる肝細胞癌の1例を報告した.症例は71歳の男性で右季肋部痛を主訴に来院した.超音波検査で,肝右葉後区域に高エコー型を呈する6.7×6.2cmの腫瘤エコーを検出した.肝右葉切除を施行し,切除標本の病理組織学的検索を行ったところ,肝には肝硬変の所見はなく,腫瘤はEdmondson II型の被包型肝細胞癌で,腫瘤内には,ほぼ全体的に偽腺管の増生を認めた.従来から,肝細胞癌の超音波像で高エコーを示す原因として,凝固壊死,脂肪浸潤,類洞の拡張によるものが報告されているが,本症例は偽腺管の増生によって高エコー型を示したと考えられ,まれな1例として報告した.

A 43-year-old man, a chronic alcohol abuser for 23 years, was admitted to our hospital complaining of high fever and abdominal fullness. Plain films of the abdomen revealed pancreatic calcification. Ultrasonography and computed tomography showed a dilated pancreatic duct associated with pancreatic stones. On admission, ultrasonography revealed a hypcechoic area in the ventral side of the body and tail of the pancreas and the left anterior pararenal space. We suspected a pancreatic abscess and performed ultrasonographically guided percutaneous puncture and drainage of the abscess by the use of an 8-Fr catheter. After 2 months the pancreatic abscess disappeared, and the patient recovered without surgery and was discharged. The purpose of this case report is to evaluate the safety and effectiveness of percutaneous catheter drainage guided by ultrasound for pancreatic abscess. Ultrasonographically guided percutaneous catheter drainage may be considered as an alternative to surgery in the treatment of pancreatic abscess.

We studied the significance of ultrasonography in the diagnosis and treatment of liver abscess in 6 patients. The most common ultrasonographic patterns of liver abscess were hypoechoic or mixed internal echo, irregular contour and distal sonic enhancement. One patient was treated with antibiotics only, but the other 5 patients underwent ultrasonically guided percutaneous catheter drainage and received concomitant antibiotics. Ultrasonically guided percutaneous catheter drainage was useful for 4 of 5 patients. There was one death that was attributable to sepsis relating to inadequate drainage. We conclude that ultrasonically guided percutaneous catheter drainage is an effective method for treatment of liver abscess.

Carcinoid tumors arising in the duodenum are relatively uncommon. We reported a case of duodenal carcinoid with diffuse splenic metastases showed a peculiar ultrasonogram. A 75-year-old woman was hospitalized because of left abdominal pain and a weight-loss. Ultrasonogram revealed a hepatosplenomegaly and the spleen filled with many round nodules son the ultrasonogram. In spite of several image examinations and aspiration cytologic examinations with fine needle of the spleen, liver and ascites, final diagnosis was unknwon. After three months from admission she died becaused of hepatorenal failure. Autopsy revealed a carcinoid tumor localized to the duodenal bulb, and metastases in multiple organs such as the liver, pleen, ovary, kidney, lung and lymphnodes. Especially the spleen was severely swelling and filled with multiple metastatic nodules, which showed a good coincidence with the ultrasonographic findings. Hepatic metastasis of carcinoid has been well decribed but splenic metastasis is rare. We think this is the first case in which diffuse splenic metastases of duodenal carcinoid could be visualized by ultrasound.