A case of human Dirofilaria repens infection, causing an asymptomatic subcutaneous nodule.

We present a case of subcutaneous dirofilariasis, a vector-borne zoonotic disease, in a young woman from Austria. The diagnosis was confirmed by ultrasound and histology of the excised subcutaneous nodule. The parasite species was identified as Dirofilaria repens by polymerase chain reaction. We expect to see more cases of human dirofilariasis also due to climate change and associated increase of the spectrum of suitable mosquito vectors.

Newly emerging ulceroglandular tularaemia in Western Austria.

Tularaemia is a rare zoonotic disease caused by Francisella tularensis in humans. In Europe infections of humans and animals are mainly caused by F. tularensis subspecies holarctica. We report the first three documented cases of tularaemia in humans in Western Austria.

Diagnostic imaging of gout: comparison of high-resolution US versus conventional X-ray.

The aim was to compare X-ray and ultrasound (US) in diagnosing gout. In a prospective study, 105 consecutive patients with clinical suspicion of gout underwent conventional X-ray und high-resolution US in order to help in arriving at a definite diagnosis. X-ray findings suggestive of gout included soft-tissue opacifications with densities between soft tissue and bone, articular and periarticular bone erosions, and osteophytes at the margins of opacifications or erosions. US findings suggestive of gout included bright stippled foci and hyperechoic soft-tissue areas. Fifty-five patients had a definite diagnosis of gout (102 involved sites), 31 patients were diagnosed as having another disease (59 involved sites), and 19 patients were excluded from the study because a definite diagnosis could not be established. X-ray suggested gout with a sensitivity of 31% (32/102) and a specificity of 93% (55/59), whereas US suggested gout with a sensitivity of 96% (98/102) and a specificity of 73% (43/59). US was much more sensitive than conventional X-ray but less specific. Our data show that US often provided additional diagnostic information in patients with clinical suspicion of gout when laboratory findings and X-ray results were negative or inconclusive and should therefore be used in these cases.

Focal liver lesions: role of contrast-enhanced ultrasound.

The introduction of microbubble contrast agents and the development of contrast-specific techniques have opened new possibilities in liver imaging. Initially, only intermittent imaging with Doppler detection was available. Second-generation contrast agents and low mechanical index real-time scanning techniques are decisive advances that enable convenient liver examinations with high sensitivity and specificity. Hepatic lesions usually show typical perfusion and enhancement patterns through the various contrast phases, which help their characterization. Several published studies and the daily clinical routine show that, as opposed to conventional ultrasound (US), contrast-enhanced US can substantially improve detection and differentiation of focal liver lesions. Today, contrast-enhanced US is the dynamic imaging modality of choice for differentiation of focal liver lesions. Contrast uptake patterns of the most relevant liver lesions, as well as important clinical indications are presented and discussed.

Our experiences using contrast-enhanced ultrasound in focal liver lesions.

In investigation of liver lesions, continuous observation of contrast behaviour is possible with, and is an important strength of, contrast ultrasound at a low mechanical index. In many institutions contrast enchanced ultrasound using SonoVue in focal liver lesions has become a routine investigation. At our department contrast ultrasound is predominantly used to further characterise lesions which appear uncharacteristic at grey-scale ultrasound. We were able to show that contrast ultrasound with SonoVue is superior or equal to CT in the majority of cases. Using contrast ultrasound after inconclusive grey-scale ultrasound testing often enables adequate lesion characterisation without the necessity of CT or MRI.

Schwannoma of the brachial plexus: cross-sectional imaging diagnosis using CT, sonography, and MR imaging.

Primary brachial plexus tumors are rare, usually benign, and in general have a good prognosis after surgical excision. We present a case of a schwannoma in which sonography enabled the correct diagnosis of a probably benign brachial plexus tumor. Key to the diagnosis was the demonstration of a smooth-bordered, longish, and well-defined nodule along a brachial plexus nerve root. Cross-sectional imaging modalities that provide a high degree of soft tissue contrast and spatial resolution, such as sonography and MR imaging, were suitable methods to establish the correct preoperative diagnosis. Findings at CT, sonography, MR imaging, and surgery are discussed.

Ovoid shape of the vermiform appendix: a criterion to exclude acute appendicitis--evaluation with US.

PURPOSE: To investigate whether the shape of the appendix in transverse section may be considered an ultrasonographic (US) criterion to exclude or confirm acute appendicitis. MATERIALS AND METHODS: The shapes of appendices of 100 control subjects, of 174 patients with clinical suspicion of acute appendicitis but without acute appendicitis, and of 108 patients with acute appendicitis were prospectively evaluated with US. Definite diagnoses in patients with clinical suspicion of acute appendicitis were established and confirmed either with surgery and histologic examination in 161 patients or with clinical follow-up in 121 patients. Statistical measures such as sensitivity, specificity, positive and negative predictive values, and accuracy were assessed for the appendiceal shape as a diagnostic US criterion for acute appendicitis. RESULTS: An at least partly round appendix indicated acute appendicitis with a sensitivity of 100%; specificity of 37%; positive and negative predictive values of 50% and 100%, respectively; and accuracy of 61%. In 67 of 174 patients with clinical suspicion of acute appendicitis but without acute appendicitis, the partly ovoid appendiceal shape aided in the exclusion of acute appendicitis, since it indicated a normal appendix with a probability of 86%. In 65 of 174 patients with clinical suspicion of acute appendicitis but without acute appendicitis, the ovoid shape over the entire appendiceal length excluded acute appendicitis with confidence. CONCLUSION: The shape of the appendix in transverse section is a useful US criterion, since an ovoid shape over the entire appendiceal length reliably rules out acute appendicitis.

Appendicitis: should diagnostic imaging be performed if the clinical presentation is highly suggestive of the disease?

BACKGROUND & AIMS: Our aim was to investigate whether diagnostic imaging is required if the clinical presentation suggests acute appendicitis with high probability. METHODS: On the basis of clinical findings, 350 consecutive patients with clinical suspicion of acute appendicitis were prospectively divided into 3 groups as follows: low, intermediate, and high probability of having appendicitis. All patients then underwent diagnostic ultrasonography. The clinical likelihood of appendicitis and the ultrasonographic results were correlated with the definite diagnoses. RESULTS: In the patients with clinically low probability of having appendicitis, appendicitis was present in 10% (11 of 109 patients), and, in those with intermediate probability, appendicitis was present in 24% (23 of 97 patients). Patients with clinically high probability of having appendicitis had appendicitis in 65% (94 of 144 patients), an alternative diagnosis in 18% (26 of 144 patients), and no specific definitive diagnosis in 17% (24 of 144 patients). Ultrasonography diagnosed appendicitis and the differential diagnoses with a sensitivity of 98% and 97%, specificity of 98% and 100%, positive predictive value of 96% and 99%, negative predictive values of 99% and 99%, and accuracy of 98% and 99%, respectively. CONCLUSIONS: Even in patients with clinically high probability of acute appendicitis, diagnostic imaging should be performed because it accurately depicts a high percentage of normal appendices and differential diagnoses.

Sonography of soft tissue masses of the neck.

In many clinical conditions, high-resolution sonography and color (power) Doppler sonography can be used as the first-line modality for evaluating cervical soft tissue masses. Cervical cysts, lipomas, paragangliomas, neurogenic tumors, hemangiomas, and lymphangiomas often exhibit characteristic sonographic appearances. Sonography can be used for lymph node assessment, and most salivary gland diseases can be diagnosed sonographically. Sonography can be used to guide needle biopsy of soft tissue neoplasms and lymph nodes. In addition, the relationship between a cervical mass and the great vessels can be evaluated.

Transabdominal sonography of the gastrointestinal tract.

Like other cross-sectional imaging methods, transabdominal sonography is increasingly used for evaluation of gastrointestinal diseases. The potentials and limitations of sonography in evaluation of the gastrointestinal tract are discussed. Transabdominal sonography proved to be of clinical value in assessment of appendicitis, diverticulitis, bowel obstruction, chronic inflammatory bowel diseases, intussusception and infantile hypertrophic pyloric stenosis. The sonographic morphology of the most common gastrointestinal diseases is discussed. In experienced hands sonography can be used as primary imaging in several gastrointestinal diseases. The gastrointestinal tract should be included in the sonographic examination of the abdomen, especially if symptoms could be related to the intestine.