Early ultrasonographic diagnosis of retinal detachment: multidisciplinary approach and benefit.

Patients with eye problems are often present in family medicine and emergency wards, whether it is isolated disturbances of vision, or as part of other diseases. A large number of pathological entities of the eye require prompt and accurate diagnosis and appropriate therapy before they get to specialized ophthalmological institutions. Ultrasonography of the eye is a simple, non-invasive, painless method that can be done at the first contact with patients and can provide very important information for accurate diagnosis of pathological changes. Early detection of retinal ablation, intra ocular bleeding and tumors by this method can save sight and lives of patients. Sonography of the eye in 667 patients over two years revealed 27 retinal ablation and hemophthalmos in 36 patients. Every fifth patient with retinal ablation was referred by a doctor of family medicine. Knowing the possibilities of ultrasonography in ophthalmology, teamwork at the level of primary health care can open access to ultrasonography of the eye for other specialty physicians which can improve population health and provide a new quality in the prevention of vision loss.

[Cavernous transformation of portal vein]. / Kavernozna transformacija vene porte.

Cavernous transformation of the portal vein occurs with long-standing portal vein thrombosis (PVT) because of the development and dilatation of multiple small vessels in and around the recanalising main portal vein. Thrombosis and occlusion of the portal vein leads to portal hypertension with enlarged spleen and the development of porto-systemic collaterals. The main clinical presentation is gastroesophageal variceal bleeding and hematologic abnormalities due to splenomegaly (hyperspleenismus-pancytopenia). We described the young patient with splenomegaly and extensive cavernous transformation of portal vein. The patient had thrombosis portal vein in early childhood and massive bleeding from large oesophageal varices at age 13. Full clinical evaluation is required because of abdominal pain. The liver is histologicaly and functionally normal. Diagnosis of cavernous transformation of the portal vein is confirmed by abdominal ultrasography, color Doppler ultrasonography and CT angiography. Oesophagogastroscopy reveals almost complete reduction of oesophageal varices, but confirms portal gastropathy as a source of patient's complaints. Natural course of PVT in this patient shows possibility of full reduction of oesophageal varices, but still the presence of different consequences of portal hypertension.

[Color Doppler sonography of focal abdominal lesions]. / Kolor Doppler sonografija fokalnih lezija abdomena.

Color Doppler sonography (CDS--spectral, color and power), harmonic imaging techniques (THI, PHI), possibility of 3D analysis of picture, usage of contrast agents, have raised the values of ultrasound as a diagnostic method to a very high level. THI--non-linear gray scale modality, is based on the processing of higher reflected frequencies, that has improved a picture resolution, which is presented with less artifacts and limiting effects of obesity and gases. Ultrasound contrast agents improve analysis of micro and macro circulation of the examined area, and with the assessment of velocity of supply in ROI (wash in), distribution and time of signal weakening (wash out), are significantly increasing diagnostic value of ultrasound. Besides the anatomical and topographic presentation of examined region (color, power), Color Doppler sonography gives us haemodynamic-functional information on vascularisation of that region, as well as on pathologic vascularisation if present. Avascular aspect of a focal pathologic lesion corresponds to a cyst or haematoma, while coloration and positive spectral curve discover that anechogenic lesions actually represents aneurysms, pseudoaneurysms or AVF. In local inflammatory lesion, abscess in an acute phase, CDS shows first increased, and then decreased central perfusion, while in a chronic phase, a pericapsular vascularisation is present. Contribution of CDS in differentiation of hepatic tumors (hemangioma, HCC and metastasis) is very significant. Central color dots along the peripheral blood vessels and the blush phenomenon are characteristics of capillary hemangioma, peritumoral vascular ring "basket" of HCC, and "detour" sign of metastasis. The central artery, RI from 0.45 to 0.60 and radial spreading characterize FNH. Hepatic adenoma is characterized by an intratumoral vein, and rarely by a vascular hallo. Further on, blood velocity in tumor defined by Color Doppler, distinguishes malignant from benign lesion, where 40 cm/s is a rough border value. Values of DPI (Doppler perfusion index) over 0.3 and tumor index over 1.0 characterize primary, and lower values characterize secondary liver malignancies. In differentiation of benign and malign tumors of kidneys, besides the aspect of vascularisation, the maximal frequency altitude in tumor artery (the limit around 2.5 kHz) is very important. However, peripheral and penetrating blood vessels are most usually seen in RCC, less often in AML and bigger oncocytomas. CDS with contrast agent is very useful in making differential diagnosis of the focal lesions with 95% specificity for some lesions.