Color Doppler imaging findings in patients with Budd-Chiari syndrome: correlation with venographic findings.

OBJECTIVE: This study was undertaken to evaluate color Doppler imaging findings in patients with Budd-Chiari syndrome and to compare these findings with results of venography. SUBJECTS AND METHODS: In a prospective study, 21 patients with proved Budd-Chiari syndrome had color Doppler imaging. Sonographic evaluations ware performed to detect appropriately directed flow in the hepatic veins, portal vein, and inferior vena cava. Intrahepatic collaterals were characterized when present. Results of color Doppler imaging were compared with those of angiography in 20 patients. Color Doppler images of the hepatic veins were also obtained in a reference group (20 control subjects, 20 patients with hepatomegaly, and 20 patients with cirrhosis). RESULTS: Color Doppler imaging showed abnormalities of anatomy or flow in one or more of the main hepatic veins in all 21 patients with Budd-Chiari syndrome. Commonly observed abnormalities were visualization of a hepatic vein on real-time sonograms that had no flow or retrograde flow on color Doppler sonograms (11 cases) and no visualization of part or all of a hepatic vein on either real-time or color Doppler sonograms (10 cases). When compared with venographic findings (16 patients), findings on color Doppler sonograms could be used to distinguish patent from occluded hepatic veins in all cases. In our reference group, real-time and color Doppler sonograms showed normal hepatic veins in all control subjects. Real-time sonograms clearly showed hepatic veins in 12 of 20 patients with hepatomegaly; color Doppler sonograms showed flow in the hepatic veins in all 20 of these patients. Among 20 patients with cirrhosis, real-time sonograms showed hepatic veins in only seven; color Doppler imaging confirmed patent veins in 17. Intrahepatic collaterals typical of Budd-Chiari syndrome were observed in 10 of 21 patients with the syndrome. The portal vein was assessed by using color Doppler imaging in all 21 patients with Budd-Chiari syndrome; portograms were available for comparison in 10 patients. Findings were consistent in eight; in two cases, the direction of flow was reversed on color Doppler sonograms compared with portograms. For the inferior vena cava, venographic and sonographic findings correlated in 16 of 20 cases. Color Doppler sonograms did not show a caval web in one patient. CONCLUSION: Abnormalities of the hepatic veins, portal veins, and inferior vena cava detected on color Doppler sonograms in patients with Budd-Chiari syndrome correlate well with findings on venograms.(ABSTRACT TRUNCATED AT 400 WORDS)

Prognostic significance of nonvisualization of the fetal stomach by sonography.

OBJECTIVE: To establish the prognostic significance of nonvisualization of the fetal stomach, we prospectively studied the course and outcome of 31 pregnancies in which a normal fluid-filled fetal stomach could not be seen during sonographic examination after 14 weeks' gestation. SUBJECTS AND METHODS: Between April 1989 and May 1991, 7200 sonographic examinations of fetuses after 14 weeks' gestation were done at our hospital. In 31 pregnancies (0.4% of all scans), a normal fluid-filled fetal stomach could not be seen on one or more sonograms after 14 weeks' gestation (range, 14-40 weeks; mean, 22 weeks). The following data were recorded for each examination: gestational age, visualization of the stomach, other fetal abnormalities, and volume of amniotic fluid. In each pregnancy, the average number of sonograms obtained was three (range, one-five). The fetal stomach was regarded as abnormal if the stomach bubble was absent or remained very small and unchanged for at least 45 min during sonography. RESULTS: The outcome was normal in 16 cases. The 15 abnormal outcomes included spontaneous fetal or neonatal death in five, pregnancy terminations in three, and persistent postnatal disability in seven. In 15 pregnancies (48%) lack of visualization of the fetal stomach was the only significant abnormal sonographic finding, but an abnormal outcome occurred in three. In 12 pregnancies, nonvisualization of the fetal stomach was a transient finding, yet three of those pregnancies resulted in persistent postnatal disability, and one was terminated because of severe maternal preeclampsia. A normal fluid-filled stomach was seen on the next sonogram in 15 cases, but five had an abnormal outcome. Only one of the four pregnancies in which a normal stomach was not seen on any subsequent sonogram had an abnormal outcome. Six of seven pregnancies with oligohydramnios had an abnormal outcome, and all three cases with polyhydramnios had an abnormal outcome. The prevalence of abnormal outcome was 88% when additional sonographic abnormalities were observed, but 20% when no other sonographic abnormality was seen. The overall prevalence of abnormal outcome when the fetal stomach was not visualized was 48%. CONCLUSIONS: Not all fetuses with a nonvisualized stomach after 19 weeks' gestation have a poor outcome. Not all fetuses with a transiently nonvisualized stomach have a normal outcome.

The New Zealand biota: Historical background and new research.

New Zealand's origin as part of Gondwana, the composition of its ancestral biota, its geographic isolation for 80 million years, its tectonic history of changing shorelines and mountain building, and its changing climate, have all influenced the composition and distribution of its plant and animal communities, and thus its ecology and evolutionary biology. Recent DNA-sequencing studies combined with palaeogeographic analysis suggest that an Oligocene marine transgression had a major genetic bottle-neck effect on the biota and, together with recent advances in avian biogeography and paleontology, are leading to new hypotheses on the origin of many bird groups.

Color Doppler imaging of the hepatic vasculature.

Duplex sonography added a new dimension to real-time sonographic imaging and can be used to characterize flow dynamics. Unfortunately, duplex sonography also has significant drawbacks, most of which are the result of the limited sampling ability of pulse-gated technology and the inability to provide a global display of Doppler information. Sonographic imaging of intraabdominal vessels has improved markedly with the advent of color Doppler techniques. This article reviews the use of color Doppler sonography in the evaluation of hepatic vessels. The complementary role of Doppler spectral analysis is also considered.