Radial artery mycotic pseudoaneurysm: an unusual complication of catheterization.

Radial artery pseudoaneurysms are rare, and those that become infected are rarer still. We present the case of a patient who developed a radial artery pseudoaneurysm as a late complication of arterial catheterization. Blood cultures were positive for Staphylococcus aureus, and a pulsatile mass, with associated tissue necrosis, was palpable over the radial artery. The diagnosis was confirmed by gray-scale and color Doppler sonography, which showed a partially thrombosed pseudoaneurysm and turbulent flow in the pseudoaneurysm and native artery.

Cholesterol crystals in hydroceles: sonographic detection and possible significance.

OBJECTIVE: The aim of this study of seven patients who had elective surgical repairs of a hydrocele was to try to differentiate by microscopy and chemical analysis hyperechoic hydrocele fluid from the more typical anechoic hydrocele fluid. CONCLUSION: Hyperechoic hydrocele fluid is related to the presence of cholesterol crystals. Cholesterol crystals were noted on microscopic examination in all three patients with hyperechoic hydrocele fluid. No cholesterol crystals were evident in the four patients with typical anechoic hydrocele fluid.

Growth hormone replacement in healthy older men improves body composition but not functional ability.

OBJECTIVE: To determine whether growth hormone replacement in older men improves functional ability. DESIGN: Randomized, controlled, double-blind trial. SETTING: General community. PATIENTS: 52 healthy men older than 69 years of age with well-preserved functional ability but low baseline insulin-like growth factor 1 levels. INTERVENTION: Growth hormone (0.03 mg/kg of body weight) or placebo given three times a week for 6 months. MEASUREMENTS: Body composition, knee and hand grip muscle strength, systemic endurance, and cognitive function. RESULTS: The participants' mean age was 75.0 years (range, 70 to 85 years). At 6 months, lean mass had increased on average by 4.3% in the growth hormone group and had decreased by 0.1% in the placebo group, a difference of 4.4 percentage points (95% CI, 2.1 to 6.8 percentage points). Fat mass decreased by an average of 13.1% in the growth hormone group and by 0.3% in the placebo group, a difference of 12.8 percentage points (CI, 8.6 to 17.0 percentage points). No statistically or clinically significant differences were seen between the groups in knee or hand grip strength or in systemic endurance. The mean Trails B score in the growth hormone group improved by 8.5 seconds, whereas scores in the placebo group deteriorated by 5.0 seconds, a difference of 13.5 seconds (CI, 3.1 seconds to 23.9 seconds; P = 0.01). However, the growth hormone group's score on the Mini-Mental Status Examination deteriorated by 0.4, whereas the placebo group's score improved by 0.2, a difference of 0.6 (P = 0.11). The two treatment groups had almost identical scores on the Digit Symbol Substitution Test (P > 0.2). Twenty-six men in the growth hormone group had 48 incidents of side effects, and 26 placebo recipients had 14 incidents of side effects (P = 0.002). Dose reduction was required in 26% of the growth hormone recipients and in none of the placebo recipients (P < 0.001). CONCLUSIONS: Physiologic doses of growth hormone given for 6 months to healthy older men with well-preserved functional abilities increased lean tissue mass and decreased fat mass. Although body composition improved with growth hormone use, functional ability did not improve. Side effects occurred frequently.

Assessment of carotid artery stenosis by ultrasonography, conventional angiography, and magnetic resonance angiography: correlation with ex vivo measurement of plaque stenosis.

PURPOSE: Several studies have investigated the correlation between Doppler ultrasonography (DUS), angiography (CA), and magnetic resonance angiography (MRA) in the evaluation of stenosis of the carotid bifurcation. However, these studies suffer from the lack of a true control-the lesion itself-and therefore conclusions about the diagnostic accuracy of each method remain relative. To determine the absolute accuracy of these modalities, we have prospectively studied lesion size with DUS, MRA, and CA in 28 patients undergoing 31 elective carotid endarterectomies and compared the percent of carotid stenosis determined by each technique to the carotid atheroma resected en bloc. METHODS: All patients were evaluated by each modality within 1 month before the thromboendarterectomy. With DUS, stenosis size was determined by standard flow criteria. For angiography and MRA, stenosis was defined as residual lumenal diameter/estimated normal arterial diameter (European Carotid Surgery Trial criteria). At surgery the carotid atheroma was removed en bloc in all patients. Patients in whom the lesion could not be removed successfully without damage were excluded from the study. Stenosis of the atheroma was determined ex vivo with high-resolution (0.03 mm3) magnetic resonance and confirmed by acrylic injection of the specimen under pressure and measurement of the atheroma wall and lumen. RESULTS: The measurements of the ex vivo stenosis by high-resolution magnetic resonance imaging correlated closely with the size of stenosis determined by the acrylic specimen casts (r = 0.92). By ex vivo measurement, the lesions were placed in the following size categories: 40% to 59% stenosis (n = 2), 60% to 79% stenosis (n = 6), 80% to 89% stenosis (n = 7), and 90% to 99% stenosis (n = 16). CONCLUSIONS: In general, the correlation of measurements of ex vivo stenosis with all modalities was good in these severely diseased arteries, although it was better for DUS (r = 0.80; p < 0.001) and MRA (r = 0.76; p < 0.001) than for CA (r = 0.56; p < 0.05).

Hydrocolonic ultrasonography in the detection of colonic polyps and tumors.

BACKGROUND: Hydrocolonic ultrasonography--abdominal ultrasonography in conjunction with the retrograde instillation of water into the colon--has been advocated as an alternative to colonoscopy for detecting colorectal polyps and cancer. We conducted a prospective, blinded trial to evaluate the procedure further. METHODS: Fifty-two consecutive patients (50 men and 2 women; average age, 62 years) who were referred for colonoscopy underwent hydrocolonic ultrasonography followed by colonoscopy. The physicians performing colonoscopy were blinded to the ultrasound results. Patients who had a history of colonic polyps or tumors or who had previously undergone flexible sigmoidoscopy or colonoscopy were excluded. RESULTS: Twenty-two patients had normal results on colonoscopy, 26 had polyps, 3 had cancer and polyps, and 1 had cancer alone. Twenty patients had polyps less than 7 mm in diameter, eight had polyps 7 mm or more in diameter, and one had a polyp of unknown size. Hydrocolonic ultrasonography did not detect any cancers and detected only one polyp > or = 7 mm and one polyp < 7 mm in diameter. The overall sensitivity of ultrasonography for identifying any polyp was 6.9 percent, and for identifying a polyp > or = 7 mm, it was 12.5 percent. Ultrasonography suggested the presence of five masses and five polyps that were not confirmed by colonoscopy. Six patients had incomplete ultrasound studies because of discomfort or the inability to retain water. There were two complications: one patient had two vasovagal episodes, and another had diaphoresis. CONCLUSIONS: Hydrocolonic ultrasonography was less useful than colonoscopy for detecting colorectal polyps and cancers. The usefulness of the technique in screening for colonic polyps and tumors appears to be limited.

Color Doppler imaging in the subclavian-axillary region and upper extremity.

Thirty-three patients were examined by color-coded Doppler ultrasound of the thoracoaxillary region or upper arm to review the utility of the method in this local area. The subclavian artery and vein were identified in all but one patient, in whom the subclavian vein was occluded and collateral vessels had developed. Masses and foreign bodies were easily distinguished from vascular abnormalities. Sonographic cephalic/basilic vein mapping was effective in seven patients. Carotid subclavian grafts were noted and evaluated appropriately in two patients. Color-coded sonography offered advantages in speed of localization of vessels and visual assessment of vessel location, direction of flow, turbulence, relationship to adjacent soft tissues, and detection of collateralization. Foreign body detection was not enhanced by color coding.

Preoperative imaging for soft tissue tumors of the foot.

Soft tissue imaging modalities are both available and effective. This manuscript describes the use of plain film radiography, ultrasound, and magnetic resonance imaging in both the diagnosis and preoperative planning of a calcified soft tissue tumor of the heel. The soft tissue tumor being presented was secondary to multiple corticosteroid injections.

Sonography of the thyroid and parathyroid.

Ultrasound is a primary imaging tool for thyroid and parathyroid localization. Classic thyroid and parathyroid tumors are easily distinguished by their sonographic appearance and location, but variations are common and complicate the distinction. Thus, biopsy under ultrasound guidance provides proof of the nature of the lesion. When parathyroid localization is problematic with ultrasound, magnetic resonance imaging is an excellent alternative.

Sonographically detected testicular microlithiasis and testicular carcinoma.

Testicular microlithiasis is an uncommon abnormality that produces the characteristic sonographic appearance of diffuse, punctate, hyperechoic foci throughout the testicular parenchyma. We have detected this distinctive sonographic pattern in 4 patients during a seven-year period. Three of the patients had proven concurrent testicular carcinoma. We describe our experience and review previous reports of testicular microlithiasis. We conclude that testicular microlithiasis may be associated with testicular neoplasia, and advocate particularly careful evaluation and follow-up of the testes when this abnormality is detected.

Malignant carotid invasion: sonographic diagnosis.

Malignant invasion of the carotid artery is an ominous complication of squamous cell carcinoma that can be suspected from B-mode sonography. A loss of carotid wall integrity seen as a break or step off of the inner wall suggests early involvement. Frank tumor invading the lumen is an end-stage event. Both ultrasound and magnetic resonance imaging are 100% sensitive in the evaluation that no carotid involvement has occurred. In one study, ultrasound was 75% specific and magnetic resonance was 87.5% specific. If the ultrasound is problematic, magnetic resonance may clarify the issue.

Adrenal, pancreatic, and scrotal ultrasound in endocrine disease.

Ultrasound is an ancillary tool in adrenal imaging in adults and a primary tool in children. Intraoperative sonography is the method of choice for pancreatic endocrine tumors. In the scrotum, the benign adrenal rest tumors must be distinguished from the more common malignant mass.