Anatomic variations of the hepatic arteries in 200 patients done by angiography.

OBJECTIVE: To evaluate and classify hepatic artery variations of 200 patients by angiography. MATERIAL AND METHOD: Celiac and superior mesenteric artery (SMA) angiographic studies of 200 patients at King Chulalongkorn Memorial Hospital (KCMH) from January 2003 to July 2004 were retrospectively reviewed. Anatomic findings were classified according to Michels and Hiatt's classifications. RESULTS: The vascular anatomy of the liver was classified according to two different established systems. Hepatic arterial patterns were analyzed in order offrequency discovered as the following; normal pattern in textbook descriptions 80.5%, a replaced or accessory right hepatic artery (RHA) originating from the SMA 11.5% and a replaced or accessory left hepatic artery (LHA) originating from the left gastric artery (LGA) 5.5%. In 0.5% of the cases, there was a combination of variations of both RHA and LHA. Variants of the common hepatic artery (CHA) arising from the SMA were found in 0.5%. 1.5% of cases were not classified by either Michels or Hiatt's classifications. CONCLUSION: The present study had the same results by the higher rates of normal hepatic anatomy with lower rates of other types compared to Michels and Hiatt's studies. In addition, the authors found cases of rare variations that were not classified by either Michels or Hiatt but were previously reported by other publications.

Sonographic evaluation of the intrascrotal disease.

PURPOSE: To determine the causes of intrascrotal disease in patients who were sent for scrotal sonography at King Chulalongkorn Memorial Hospital and whether the imaging findings can help differentiate the tumor from infection of the testis. MATERIAL AND METHOD: Retrospective review was performed in 72 cases of extratesticular lesions and 48 cases of the intratesticular lesions to find out the causes of intrascrotal disease. The sonographic findings in the cases with final diagnosis of intratesticular infection and testicular tumor were analyzed according to the following criteria including the size of the testis, number, echogenicity, and margin of the mass, diffuse abnormal echogenicity of the testis, presence of fluid in the scrotal sac, epididymal lesion, scrotal skin thickening and calcification. RESULTS: Hydrocele was the most common extratesticular lesion (29.87%) and epididymitis was the second most common (14.28%). Infection was the most common intratesticular pathology (54.17%) and tumor was the second most common (31.25%). Most testicular tumors appeared as a focal mass while testicular infection usually caused diffuse abnormal echogenicity throughout the testis (p = 0.008). Epididymal lesions and skin thickening were usually detected together with intratesticular infection while they were not present in the cases of tumor (p = 0.000061 and 0.017). The number, echogenicity, margin of the mass, presence of testicular enlargement, fluid in the scrotal sac and calcification did not differ between testicular infection and tumor CONCLUSION: Hydrocele was the most common cause of extratesticular disease, followed by epididymitis. Most of the extratesticular pathology was benign entities. For intratesticular disease, the most common cause was infection, followed by intratesticular tumor Findings of a solitary intratesticular mass without epididymal lesion or skin thickening prefered malignant entity, while diffuse abnormal echogenicity of the testis with epididymal lesion and skin thickening prefered infectious process.