Image Spectrum of Anal Ultrasound in Patients with Peri Anal Disease

Endoanal ultrasonography has recently emerged as a popular diagnostic modality for mapping and imaging the anal sphincter. This procedure can be performed as an outpatient procedure; it is relatively quick and virtually painless. The imaging typically is performed in a proximal to distal manner with defining a variety of levels of the anal canal as it progresses. Anal ultrasond can provide a detailed image of the anal sphincter musculature. The internal anal sphincter appears endosonographically as a hypoechoic circular band that is most prominently seen at the level of the mid-anal canal. The external anal sphincter appears as a thicker circular mixed echogenic band outside of the hypoechoic internal sphincter. Anal ultrasond can be used to evaluate patients with anal fistulas with or without abscess. Imaging is performed and the fistulous tracts or abscesses are identified by hypoechogenicity within the external sphincter muscle or the ischiorectal fossa. Its ability to clearly image the anal sphincters has allowed its use for the evaluation of anal fistulas. Moreover, anal ultrasound has emerged as the technique of choice for imaging the anal sphincters and for evaluating incontinence. Each of the individual physiologic tests offers valuable information that is relevant to the continence mechanism, and the ultrasound yields results that are complementary to other tests. Ultrasound serves as a surveillance tool to monitor the results after sphincterplasty. We illustrate the endo-anal sonographic features of various anal diseases and the ultrasound-anatomic correlation for the anus.

Fine Needle Aspiration of Focal Lung Lesion under CT Fluoroscopic Guidance

PURPOSE: We wanted to assess the efficacy of using CT fluoroscopy during Fine Needle Aspiration (FNA) for focal lung lesion. MATERIALS AND METHODS: We retrospectively reviewed 22 patients who had undergone FNA under CT fluoroscopic guidance. The final diagnosis of focal lung lesion was based on surgery, the results of biopsy taken from another site or the clinical diagnosis with imaging follow-up. We reviewed the imaging and recorded the location of the lesion, the lesion size and the depth from the puncture site. RESULTS: In 24 cases of 22 patients, 16 lesions were benign and 8 were malignant. The sensitivity and specificity for malignant lesions were 100%, and 75%, respectively. The mean size of the malignant lesions was 3.75+/-1.68 cm, and that of the benign lesion was 3.05+/-2.98 cm. The mean depth of the lesion divided by the size was 1.85+/-1.09 for 20 lesions of the correct result group and 3.13+/-1.73 for 4 lesions of the incorrect result group; the difference between the two groups was statistically different (p=0.030). The complications after FNA were pneumothoraces in three cases and parenchymal hemorrhage in one case, but no significant complication was noted after the procedures. CONCLUSION: We could perform the FNA accurately and safely under CT fluoroscopy guidance, so this technique can be used for FNA of focal lung lesion for obtaining a correct result with fewer complications.