ABSTRACT
INTRODUCTION: Transabdominal ultrasound (TU) pancreatic 2D-SWE elastography is a developing technique that needs to be protocolized. OBJECTIVES: Establish a protocol for image acquisition and measurement of TU pancreatic - 2D-SWE elastography and estimate the minimum number of measurements to be performed. MATERIALS AND METHODS: Ten measurements of pancreatic elasticity were taken in healthy volunteers using TU-2D-SWE, following a strict protocol for image acquisition and measurement. RESULTS: The 70% of the participants were women, with an average age, weight, and BMI of 49.5±15.7 years, 65.9±11.9kg, and 24.5±4.2kg/m2, respectively. Measurements were taken from the body (70%), tail (16.7%), and pancreatic head (13.3%). The median mean velocity and elasticity were 1.46±0.25cm/sec and 6.46±2.87KPa, respectively. The ROI depth was 4.12±1cm and the SP-ROI distance was 5.2mm on average. There were no statistically significant differences between the 10 measurements. The reliability analysis of the measurements showed high internal consistency and repeatability. Taking 5-6 measurements ensured high concordance with the ten reference measurements. The measurements were significantly lower when the SP-ROI values were intermediate (0.3-0.6cm). The measurement accuracy was higher when performed at a depth less than 4.8cm. CONCLUSION: To measure pancreatic elasticity using TU-2D-SWE, we propose a strict protocol for image acquisition and measurement, taking a minimum of 5 measurements in the best visualized and accessible pancreatic portion, and preferably at a depth of less than 4.8cm.
ABSTRACT
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Subject(s)
Humans , Female , Aged , Carcinoma, Papillary/diagnostic imaging , Bile Duct Neoplasms/diagnostic imaging , Cholestasis/diagnostic imaging , Cholangiopancreatography, Magnetic Resonance/methods , Endosonography/methodsABSTRACT
Intraductal papillary neoplasm of the bile duct (IPNB) is a premalignant disease characterized by a low incidence, a high risk of malignant transformation, and an uncertain prognosis. We hereby present the case of an 8-mm IPNB in the left liver lobe detected by endosonography in a 76-year-old woman followed for a dissociated asymptomatic cholestasis who was treated with a left hepatectomy. The resected IPNB had low-grade dysplasia and no nodal involvement in the surgical piece; however, signs of recurrence of the disease were observed in the right liver lobe a year and a half later. Therefore, given that it can be multifocal and recurrent, IPNB is a disease that requires close follow-up.
Subject(s)
Bile Duct Neoplasms/surgery , Bile Ducts, Intrahepatic , Carcinoma, Papillary/surgery , Neoplasm Recurrence, Local/surgery , Aged , Female , HumansABSTRACT
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Subject(s)
Humans , Male , Middle Aged , Epidermal Cyst/diagnosis , Epidermal Cyst/pathology , Adenocarcinoma/diagnosis , Appendicitis/surgery , Gardner Syndrome/diagnosis , Polyps/diagnosis , Colonoscopy , Appendicitis/radiotherapy , Metastasectomy/methods , Fluorouracil/administration & dosage , Diagnosis, Differential , Cell Nucleus/pathologyABSTRACT
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Subject(s)
Humans , Male , Aged , Spleen/abnormalities , Digestive System Abnormalities/diagnostic imaging , Choristoma/diagnostic imaging , Spleen/diagnostic imaging , Endosonography/methods , Prostatic Neoplasms/complicationsABSTRACT
Accessory spleen is a frequent congenital abnormality (10-20%) resulting in the fusion failure of splenunculi. We present a case report of a 74 year-old man with a nodule identified in the tail of the pancreas of 1.8 cm x 1.5 cm in size. The CT scan showed soft tissue attenuation and arterial hyperenhancement with a lower uptake in the central area, low 18-FDG affinity and no evidence of 111-In-octretide uptake. A solid, round and well-circumscribed nodule was defined as an intrapancreatic accessory spleen (IPAS) by endoscopic ultrasound (EUS), due to shared ultrasonographic characteristics and a pattern of contrast enhancement with the spleen. The material obtained by EUS guided puncture was consistent with a lymph node. A distal pancreatectomy confirmed the presence of an IPAS.
Subject(s)
Choristoma/diagnostic imaging , Pancreatic Diseases/diagnostic imaging , Spleen/abnormalities , Aged , Humans , Male , Spleen/diagnostic imaging , UltrasonographySubject(s)
Epidermal Cyst/pathology , Neoplastic Syndromes, Hereditary/diagnosis , Skin Diseases/pathology , Adenocarcinoma/diagnosis , Adenocarcinoma/genetics , Adenocarcinoma/therapy , Aged , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Appendectomy , Appendiceal Neoplasms/diagnosis , Appendiceal Neoplasms/genetics , Appendiceal Neoplasms/therapy , Asymptomatic Diseases , Carcinoid Tumor/diagnosis , Carcinoid Tumor/genetics , Carcinoid Tumor/therapy , Chemotherapy, Adjuvant , Combined Modality Therapy , Diagnosis, Differential , Endoscopy, Digestive System , Epidermal Cyst/genetics , Epidermal Cyst/surgery , Fluorouracil/administration & dosage , Gardner Syndrome/diagnosis , Gardner Syndrome/genetics , Head , Hepatectomy , Humans , Liver Neoplasms/diagnosis , Liver Neoplasms/secondary , Liver Neoplasms/therapy , Male , Neoadjuvant Therapy , Neoplastic Syndromes, Hereditary/pathology , Oxaliplatin/administration & dosage , Rectal Neoplasms/diagnosis , Rectal Neoplasms/genetics , Rectal Neoplasms/surgery , Skin Diseases/genetics , Skin Diseases/surgeryABSTRACT
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Subject(s)
Humans , Male , Adult , Intestinal Perforation , Intestines/injuries , Celiac Disease , Lymphoma, Large B-Cell, Diffuse/complications , Intestinal Neoplasms , Intestines/diagnostic imaging , Tomography, Spiral Computed/methodsSubject(s)
Abscess/diagnosis , Abscess/pathology , Salmonella Infections/diagnosis , Salmonella Infections/pathology , Salmonella/isolation & purification , Splenic Diseases/diagnosis , Splenic Diseases/pathology , Abscess/therapy , Aged, 80 and over , Anti-Bacterial Agents/administration & dosage , Endoscopy, Digestive System , Humans , Male , Radiography, Abdominal , Salmonella Infections/therapy , Splenectomy , Splenic Diseases/therapy , Tomography, X-Ray ComputedSubject(s)
Celiac Disease/complications , Intestinal Perforation/etiology , Jejunal Diseases/etiology , Lymphoma, Large B-Cell, Diffuse/complications , Adult , Antineoplastic Combined Chemotherapy Protocols/administration & dosage , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Celiac Disease/diet therapy , Colectomy , Combined Modality Therapy , Cyclophosphamide/administration & dosage , Diet, Gluten-Free , Disease Susceptibility , Down Syndrome/complications , Doxorubicin/administration & dosage , Humans , Intestinal Perforation/surgery , Jejunal Diseases/surgery , Jejunal Neoplasms/complications , Jejunal Neoplasms/drug therapy , Jejunal Neoplasms/prevention & control , Jejunal Neoplasms/surgery , Lymphoma, Large B-Cell, Diffuse/drug therapy , Lymphoma, Large B-Cell, Diffuse/prevention & control , Lymphoma, Large B-Cell, Diffuse/surgery , Male , Positron Emission Tomography Computed Tomography , Prednisone/administration & dosage , Rituximab/administration & dosage , Tomography, X-Ray Computed , Vincristine/administration & dosageABSTRACT
A 60-year-old male was operated upon in 2002 for liver hydatidosis, which included partial right hepatectomy with cholecystectomy and bilioduodenal anastomosis. He then developed liver cirrhosis secondary to left hepatic duct stricture. He presents at the emergency room with dry cough, which he had for a month and then became associated with yellowish, bitter-tasting "fluid" expectoration. A chest-abdominal CT scan revealed a 6 x 5-cm collection roughly located somewhere between the middle pulmonary lobe and subphrenic area . A fistula was suspected, which prompted a sputum biochemistry test that was positive for bilirubin. Given the patient's impaired liver function because of his liver disease conservative treatment was initiated with an inner-outer drain under transparietal hepatic cholangiography (TPHC) to promote bile outflow via the duodenum. Subsequently, TPHC was used to locate the point where contrast leaked from the biliary tree into a pleural cavity, and the fistula was sealed using cyanoacrylate glue, which resulted in improved symptomatology.
Subject(s)
Biliary Fistula/diagnostic imaging , Bronchial Fistula/diagnostic imaging , Adhesives , Biliary Fistula/therapy , Bronchial Fistula/therapy , Cyanoacrylates , Drainage , Humans , Male , Middle Aged , Tomography, X-Ray ComputedABSTRACT
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Subject(s)
Humans , Male , Middle Aged , Biliary Fistula/surgery , Biliary Fistula , Bronchial Fistula/therapy , Bronchial Fistula , Liver Cirrhosis/complications , Liver Cirrhosis , Cholangiography , Suction , Self Expandable Metallic Stents/trends , Self Expandable Metallic StentsABSTRACT
Isolated polycystic liver disease (IPLD) is a rare genetic condition characterized by the presence of multiple liver cysts with no association with polycystic kidney disease. Most patients are asymptomatic and acute complications (cyst torsion, bleeding, infection) are uncommon.Imaging techniques, including abdominal ultrasounds, computerized axial tomography, and magnetic resonance imaging, represent a vital diagnostic modality. They are also useful for therapy support in this disease. Below we report a peculiar case of a female patient recentlydiagnosed with IPLD who, having received treatment with ultrasoundguided percutaneous drainage and sclerotherapy for a giant liver cyst, showed symptom and laboratory improvement.
Subject(s)
Cysts/diagnostic imaging , Cysts/therapy , Drainage/methods , Liver Diseases/diagnostic imaging , Liver Diseases/therapy , Sclerotherapy/methods , Cysts/genetics , Female , Humans , Liver Diseases/genetics , Middle Aged , Ultrasonography, InterventionalABSTRACT
La enfermedad hepática poliquística aislada (EHPA), es una rara entidad genética que se caracteriza por la presencia de múltiples quistes hepáticos, sin estar asociada a la poliquistosis renal. La mayoría de los pacientes son asintomáticos, y son infrecuentes las complicaciones agudas (torsión quística, hemorragia e infecciones). Las técnicas de imagen, como la ecografía abdominal, tomografía axial computarizada y resonancia magnética, son un método diagnóstico fundamental. Además, son útiles como apoyo terapéutico en esta enfermedad. A continuación les presentamos un caso clínico peculiar de una paciente recientemente diagnosticada de enfermedad hepática poliquística aislada, quien tras recibir un tratamiento con drenaje percutáneo de un quiste hepático gigante y escleroterapia guiada por ecografía, presentó mejoría sintomática y analítica
Isolated polycystic liver disease (IPLD) is a rare genetic condition characterized by the presence of multiple liver cysts with no association with polycystic kidney disease. Most patients are asymptomatic and acute complications (cyst torsion, bleeding, infection) are uncommon. Imaging techniques, including abdominal ultrasounds, computerized axial tomography, and magnetic resonance imaging, represent a vital diagnostic modality. They are also useful for therapy support in this disease. Below we report a peculiar case of a female patient recently diagnosed with IPLD who, having received treatment with ultrasound-guided percutaneous drainage and sclerotherapy for a giant liver cyst, showed symptom and laboratory improvement
Subject(s)
Humans , Female , Middle Aged , Cysts/therapy , Drainage/methods , Sclerotherapy/methods , Liver Diseases/genetics , Chromosome Disorders/therapy , Surgery, Computer-Assisted/methods , Polycystic Kidney, Autosomal Dominant/complicationsABSTRACT
BACKGROUND AND OBJECTIVE: To establish the nasogastric enteral nutrition tolerance in patients with severe acute pancreatitis. PATIENTS AND METHOD: A total of 12 patients with severe acute pancreatitis (> or = 3 Ranson criteria; C-reactive protein > 210 mg/dl) and adverse clinical course were included during 2006. When we verified the disease severity, nasogastric (10 F) enteral nutrition was initiated. We used a low fat semi-elemental feed (Dietgrif) in a slow infusion rate. We evaluated the enteral nutrition tolerance and the adverse events. RESULTS: The patient (4 women and 8 men) mean age (standard deviation) was 70 (11) years and the mean hospital stay was 86 days (range: 14-405 days). The etiology of pancreatitis was: gallstones 8, alcohol abuse one and unknown 3. All patients had medical and/or pancreatic complications. Seven had significant pancreatic necrosis detected in the abdominal computed tomography. Three patients were admitted in the critical care unit and 2 died. The nasogastric enteral nutrition was well tolerated in 8 out of 12 patients (67%) regardless of their medical or pancreatic complications. Only in 3 patients we had initially to discontinue the feeding because of ileus and total parenteral nutrition was provisionally necessary. Enteral nutrition was impossible in one patient because of duodenal stenosis. CONCLUSIONS: Nasogastric enteral nutrition is well tolerated in patients with severe acute pancreatitis and it is an alternative to others nutritional routes.
Subject(s)
Attitude to Health , Enteral Nutrition/methods , Intubation, Gastrointestinal/methods , Pancreatitis/physiopathology , Acute Disease , Aged , Female , Humans , Male , Pancreatitis/diagnosis , Severity of Illness IndexABSTRACT
Fundamento y objetivo: Valorar la tolerancia a la nutrición por sonda nasogástrica de los pacientes con pancreatitis aguda grave. Pacientes y método: Incluimos a 12 pacientes con pancreatitis aguda grave (3 o más criterios de Ranson; proteína C reactiva > 210 mg/dl) y evolución clínica desfavorable ingresados durante el año 2006. Una vez establecida la gravedad de la pancreatitis, se inició alimentación por sonda nasogástrica (10 F) con dieta polipeptídica pobre en grasas (Dietgrif®) mediante bomba de perfusión continua. Se valoraron la tolerancia a la dieta y las complicaciones. Resultados: La edad media (desviación estándar) de los pacientes (4 mujeres y 8 varones) era de 70 (11) años y la estancia media fue de 86 días (intervalo: 14-405 días). La etiología de la pancreatitis fue biliar en 8 casos, alcohólica en uno y desconocida en 3. Todos los pacientes desarrollaron complicaciones médicas y/o pancreáticas. Siete presentaban necrosis pancreática significativa en la tomografía computarizada. Tres ingresaron en la unidad de cuidados intensivos y 2 fallecieron. Ocho de los 12 pacientes (67%) toleraron perfectamente la dieta por sonda nasogástrica independientemente de sus complicaciones. En 3 hubo que interrumpir inicialmente la dieta por íleo paralítico y precisaron nutrición parenteral total de forma transitoria. Sólo en un caso fue imposible la nutrición enteral debido a estenosis duodenal. Conclusiones: La nutrición por sonda nasogástrica en los pacientes con pancreatitis aguda grave es bien tolerada y podría plantearse como una alternativa a las otras formas de nutrición
Background and objetive: To establish the nasogastric enteral nutrition tolerance in patients with severe acute pancreatitis. Patients and method: A total of 12 patients with severe acute pancreatitis ($ 3 Ranson criteria; C-reactive protein > 210 mg/dl) and adverse clinical course were included during 2006. When we verified the disease severity, nasogastric (10 F) enteral nutrition was initiated. We used a low fat semi-elemental feed (Dietgrif®) in a slow infusion rate. We evaluated the enteral nutrition tolerance and the adverse events. Results: The patient (4 women and 8 men) mean age (standard deviation) was 70 (11) years and the mean hospital stay was 86 days (range: 14-405 days). The etiology of pancreatitis was: gallstones 8, alcohol abuse one and unknown 3. All patients had medical and/or pancreatic complications. Seven had significant pancreatic necrosis detected in the abdominal computed tomography. Three patients were admitted in the critical care unit and 2 died. The nasogastric enteral nutrition was well tolerated in 8 out of 12 patients (67%) regardless of their medical or pancreatic complications. Only in 3 patients we had initially to discontinue the feeding because of ileus and total parenteral nutrition was provisionally necessary. Enteral nutrition was impossible in one patient because of duodenal stenosis. Conclusions: Nasogastric enteral nutrition is well tolerated in patients with severe acute pancreatitis and it is an alternative to others nutritional routes
