role of computerized axial tomography [CT], ultrasonography [US], transhepatic cholangiography [PTC] and endoscopic retrograde cholangiopancreatography [ERCP] in differentiating inflammatory from malignant pancreatic focal mass lesion

Fifteen patients with focal inflammatory masses of the pancreas were thoroughly studied over 3-year period from 25 patients who have had suspected pancreatic disease. Ultrasound [US] and computerized axial tomography [CT] were performed as a screening. Subjective pancreatic enlargement and/or distortion [nodular or irregular contour] were detected in 15 cases. Transhepatic cholangiography [THC] was performed allowed a diagnosis of inflammatory disease in three patients demonstrating long smooth stricture of the common bile duct [CBD] and the 4th patient had a short, smooth stricture producing incomplete obstruction suggesting malignancy and in three the distal CBD was completely obstructed with rat- tail tapering highly suggestive of malignancy. Endoscopic retrograde cholangiopancreatography [ERCP] was successful in eight patients since they permitted pancreatitis in three, two patients malignancy could not be determined and three patients had findings usually associated with malignancy, two of them had complete obstruction of the pancreatic duct, while one had "double duct sign". The mass identified by CT usually of the same pancreatic attenuation, although five contained small areas of low attenuation suggesting inflammation. Ten patients with pancreatic head mass demonstrated obstructive jaundice. On US the inflammatory masses appeared hypoechoic. The pancreatic duct was identified sonographically in four of five patients seen by CT

Value of scrotal ultrasonography in scrotal swelling evaluation

The value of routine ultrasonography was evaluated in prospective study of 100 men with scrotal swelling. Ultrasonography [US] had a sensitivity of 100% and specificity of 99% for testicular tumor. Clinically, useful information was provided in 55% of patients and 10% might have avoided surgery if the ultrasound report was needed. Ultrasonography did not provide any additional information in patients with scrotal pain and an entirely normal scrotum clinically and in those with epididymal cysts in whom the testis was palpably normal. If these two groups were excluded from routine scrotal Ultrasonography, there would have been a 25% reduction in the number of examinations without any reduction in diagnostic yield

Echinococcosis of the liver and biliary tree: ultrasound, CT and post-operative evaluation

The sonographic and CT appearances of echinococcal lesions of the liver were studied in 100 patients. A classification of these lesions, that reflects the pathology and natural history of the disease [type I, simple fluid-filled cysts, type IR, lesions containing undulated membranes that represent detached endocysts secondary to rupture, type II lesions that contain daughter cysts and/or formed echogenic material called matrix, and type III, dead, densely calcified lesions], was proposed. The natural progression of hepatic echinococcal cysts is from type I to type III. Daughter cyst formation is part of the natural aging process. When hydatid cysts are infected, they lose their characteristic sonographic appearance and become hyperechoic on CT. These lesions were hypodense [30-40 HU] and did not show enhancement after intravenous contrast enhancement. Precise evaluation of the lesions arising from correlative use of ultrasound and CT permits proper staging and treatment

Doppler ultrasound and cavernosography evaluation in infertile man with non-erection

Examination of the penile artery by duplex scanning in the assessment of impotence was evaluated in 140 impotent men. Scanning was done by Technicare, Diasonic DRF400, and penile artery measurements were taken before and after intracorporeal injection of papaverine hydrochloride 60 mg. The penile brachial index was measured in 80 patients and its predictive value compared with the results of duplex scanning and papaverine induced erection. On scanning evidence of good arterial inflow but poor erections, indirect evidence of venous leakage was assumed. The results showed that the deep artery responses best characterized the erectile response, with the dorsal artery being less helpful. All 30 patients with full erections following papaverine exhibited deep artery peak velocities of <25 cm/s, of the remaining 110 sub-optimal responsers, 20 also had this finding, all had undergone dynamic cavernosography, with 19 exhibited venous leakage. A critical value of deep artery response to attain erection is postulated, enabling more logical use of cavernosography. The penile/brachial index was shown to be suspected, and it was concluded that duplex scanning is a useful, noninvasive method in the assessment of impotence

Tumor thrombosis of the inferior vena cava secondary to malignant abdominal neoplasms US, CT and MRI evaluation

18 patients with histologically proved tumor thrombi of the inferior vena cava [IVC] secondary to abdominal neoplasms were studied with the use of ultrasonography [US]. The primary neoplasms were renal cell carcinoma [10 cases], adrenal tumors [2 cases], retroperitoneal tumors [2 cases], and hepatic tumors [4 cases]. The positive diagnosis of tumor thrombus was better demonstrated by US studies, which showed echogenic endoluminal material within an enlarged IVC with a bulging anterior wall. On CT scans the tumor thrombus usually appeared as endoluminal filling defect surrounded by a rim of contrast material. Tumor thrombus could be evaluated by MRI appeared as endoluminal low signal intensity filling the IVC and expanding it. Invasion and extension outside the wall was better. US, CT and MRI are complementary in the preoperative assessment of tumor thrombus and their use obviates. The need for venacavography in many cases which is hazardous because of the possibility of dislodging thrombi and failed to demonstrate the cephalad extension of the tumor thrombus