The spectrum of heterotopic gastric mucosa in children detected by Tc-99m pertechnetate scintigraphy.

Meckel's diverticulum is the most common site of heterotopic gastric mucosa (HGM). Other sites include intestinal duplication and the small bowel proper. Tc-99m pertechnetate abdominal scintigraphy is used commonly to detect HGM. This article describes various scintigraphic patterns of HGM and reviews technical aspects of the procedure, with emphasis on pharmacologic enhancement.

Significant association between simple renal cysts and arterial blood pressure.

OBJECTIVE: To test the hypothesis that there is an association between simple renal cysts and arterial blood pressure (BP). PATIENTS AND METHODS: The study comprised a review of the case-notes of 115 patients (mean age 67.7 years, range 31-91) in whom renal cyst(s) was an incidental ultrasonographic finding, and 115 age- and sex-matched control patients. The notes were reviewed without knowledge of the origin or treatment. RESULTS: The systolic and diastolic BP were significantly higher in patients with a cyst(s) than in control patients (P = 0.031 and P = 0.0034; mean difference 6.9 mmHg and 5.0 mmHg, respectively). In those aged 30-70 years, the presence of one or more simple renal cysts increased the risk of having a diastolic BP > or = 95 mmHg from seven in 58 to 17 in 58 patients (P = 0.038). CONCLUSION: The association between simple renal cysts and higher arterial BP probably arises from underlying renal disease causing both. Occasionally it is possible that renal ischaemia caused by cyst expansion, and therefore increased renin release, generates the elevation in BP. If so, methods to identify such cysts should be developed.

Accuracy of the diagnosis of pleural effusion on supine chest X-ray.

Diagnosis of pleural effusion (PE) on supine chest X-ray (SCXR) is considered difficult. This study aimed at evaluating the accuracy of the diagnosis of PE on SCXR and was performed in two phases. At phase 1, a formula for the sonographic estimation of the volume of PE was established by correlating 24 measurements (in 7 patients in whom complete drainage was achieved) with the drained volumes. At phase two, 112 consecutive SCXRs were supplemented by sonography of the chest. The films were evaluated for the presence of PE and for the presence of different radiologic signs of PE. Sonography showed PE in 41 right and 30 left hemithoraces. The overall accuracy of the diagnosis of PE on SCXR was 82 %. Only one of the undiagnosed PEs had a volume of > 300 ml. The most accurate signs were increased density of the hemithorax, blunted costophrenic angle, and loss of the hemidiaphragm silhouette.

Can dipstick screening for hematuria identify individuals with structural renal abnormalities? A sonographic evaluation.

The present study presents data from a population study of 659 randomly selected adult volunteers. All participants had a renal sonographic examination and at the same time had their urine tested for hematuria by dipstick. Thirty participants (5%) had dipstick hematuria. Similar rats of abnormal renal findings were obtained in the hematuria-positive and hematuria-negative groups, 10% and 8%, respectively. Our results suggest that dipstick investigation for hematuria in mass-screening programs is not effective for the detection of structural renal abnormalities.

Intraobserver and interobserver variations in sonographic measurements of kidney size in adult volunteers. A comparison of linear measurements and volumetric estimates.

Estimation of renal size by sonography can be performed by measuring renal length, volume, cortical volume or cortical thickness. Observer variation in these measurements is an important factor, especially when repeated measurements are compared. This study was performed to examine the magnitude of intraobserver and interobserver variations for each of the above-mentioned measurements, and to find the measurement with the lowest observer variation. Sonographic measurements were performed by 3 observers on 18 adult volunteers. The standard deviation of the difference (SDD) between any 2 pairs of measurements was used as the indicator of the magnitude of the observer variation. Renal length measurement showed the lowest observer variation with a relative SDD of 4 to 5%. Measurement of cortical thickness showed the poorest reproducibility with a relative SDD of 18 to 23%, while volumetric estimations had a relative SDD of 14 to 17%. Renal length measurement should be preferred to renal volume estimation, especially when comparing repeated measurements.

Sonographic evaluation of renal appearance in 665 adult volunteers. Correlation with age and obesity.

The purpose of this study was to investigate the sonographic appearance of the normal adult kidney. Parenchymal echogenicity, pyramid visibility, and transverse pelvis diameter of the kidneys were prospectively determined in an age- and sex-stratified random sample of 665 volunteers 30, 40, 50, 60, and 70 years old. Furthermore, incidences of kidney stones and split sinus echo were determined. The relation between obesity and above-mentioned parameters was evaluated. In the 30-year-old age group the right kidney was isoechoic as compared to the liver in 1/3, and had clearly or faintly visible pyramids in 2/3 of the cases. These rates decreased gradually with increasing age. Transverse diameter of renal pelvis > or = 10 mm was observed in 13% of participants. Renal stones were observed in 2.1%. The incidence of split sinus echo was 3.6%. Obese participants showed lower incidences of isoechogenicity, pyramid visibility, pelvic ectasia, and split sinus echo. Isoechoic parenchyma, clearly visible pyramids, and transverse pelvis diameter > or = 10 mm are not uncommon sonographic findings in normal adult kidneys and should not be used as indicators of renal pathology.

Simple renal cyst: relations to age and arterial blood pressure.

Simple renal cysts are increasingly common with increasing age, as is elevated arterial blood pressure. We studied the natural history of simple renal cysts, and their possible association with arterial hypertension. Renal sonography was performed in an age- and sex-stratified random sample of 686 healthy volunteers aged 30-70 years. Eleven examinations were excluded for various reasons. One or more renal cysts measuring 10-47 mm were found in 35 individuals. The prevalence of simple renal cysts was 5.2%, ranging from 0% at age 30 to 9.7% at age 70. From the cross-sectional data it is estimated that the average renal cyst needs about 10 years to reach 20 mm in size. Mean arterial blood pressure increased with age, and was significantly higher in individuals with cysts (p = 0.0055). Closer analysis showed that the association was confined to and even stronger (p = 0.00066) for individuals with at least one cyst < or = 20 mm. We assume that smaller cysts are more likely to be totally intraparenchymal, and therefore more able to create an internal hydrostatic pressure and thus to compress the surrounding renal tissue.

Kidney dimensions at sonography: correlation with age, sex, and habitus in 665 adult volunteers.

OBJECTIVE: The purpose of this study was to investigate the normal sonographic measurements of the kidney in adult volunteers. SUBJECTS AND METHODS: Length, width, and thickness of the kidney and its central echogenic area and the parenchymal thickness of the upper pole were measured in an age- and sex-stratified random sample of 665 volunteers 30, 40, 50, 60, and 70 years old. Measurements were made with the volunteers prone. Volumes of the kidney, the central echogenic area, and the renal parenchyma were calculated. Renal dimensions and renal and parenchymal volume were correlated with age, height, weight, body mass index, and total body area. In 94 subjects, renal length was measured with the volunteers supine also. RESULTS: Median renal lengths were 11.2 cm on the left side and 10.9 cm on the right side. Median renal volumes were 146 cm3 in the left kidney and 134 cm3 in the right kidney. Renal size decreased with age, almost entirely because of parenchymal reduction. Renal volume correlated best with total body area. Renal length correlated best with body height. Measurements of renal length obtained with the subjects supine were not significantly different from those obtained with the subjects prone. CONCLUSION: The most exact measurement of renal size is renal volume, which showed the strongest correlation with height, weight, and total body area. Clinically, measurement of renal length is most practical and can be done with the subject prone or supine.

[Ultrasonically guided pericardiocentesis]. / Ultralydvejledt draenage af perikardiehulen.

Ultrasonically guided pericardiocentesis was performed on 25 occasions in 23 consecutive patients. Incipient cardiac tamponade was present in 22 patients and the procedure was performed for diagnostic purposes in one patient. In 21 cases, 5.7 French pig-tail catheters were employed and 1.2 mm lumbar puncture needles in four cases. In 19 out of 22 patients (86%) with incipient cardiac tamponade the ultrasonically guided pericardiocentesis was considered successful. In one patient, the catheter was misplaced in the right atrium, one patient developed pyopericardium and one patient developed transient tachycardia. In two cases, no material could be obtained. Ultrasonically guided pericardiocentesis is preferable to "blind" puncture and the procedure should be carried out by physicians with experience in interventional ultrasound.

[Ultrasonography of the rotator cuff of the shoulder]. / Ultralydundersøgelse af skulderens rotator-cuff.

Clinical examination for rotator cuff (RC) tear is rarely conclusive. Arthrography has been considered the standard diagnostic procedure for detection of rotator cuff tears. Ultrasonography (US) is less time-consuming and less expensive than arthrography and is, in addition, noninvasive. During recent years, many reports concerning US evaluation of RC tears have been published, but with different results about the diagnostic value of the examination. Recently, some authors have pointed out the ability of US in visualizing degenerative changes in the RC and that it is difficult to differentiate between tears and degenerative changes. By review of the English literature, we conclude that the experienced examiner with proper equipment can confidently differentiate between normal and pathological RC an that in quite a number of cases it is possible to differentiate tears from degenerative changes. In case of doubt, the examination should be supplemented by shoulder arthrography. In the hands of an experienced examiner with proper equipment US seems to be suitable as the initial imaging modality for evaluation of RC.

[The Chilaiditi syndrome]. / Chilaiditi-syndrom.

The Chilaiditi syndrome is a condition characterized by interposition of small or large bowel between the liver and the right diaphragm. Four cases of Chilaiditi syndrome in asymptomatic adults are presented. The possible effect of Chilaiditi syndrome on ultrasound examinations of the liver and gallbladder is briefly discussed.