[Ileal occlusion with strangulation: importance of ultrasonography findings of the dilated loop with intraluminal fluid-fluid resulting from sedimentation]. / Occlusione ileale con strangolamento: importanza del segno ecografico dell'ansa dilatata con livello fluido-fluido intraluminale da sedimentazione.

To identify some dynamic or morphological patterns for the diagnosis of small bowel obstruction by hernia, adhesions or volvulus, we submitted to ultrasonography (US) 61 patients with clinical and radiographic syndromes of mechanical small bowel obstruction. The cause of obstruction was demonstrated in 58 patients-namely, with surgery in 56 patients and further instrumental examinations in 2. Three patients died before surgery. In our series, small bowel obstruction with strangulation was demonstrated at surgery in 31/56 patients. In 27/31 patients, US showed the coexistence of dilated loops with different kinetic behavior in the abdominal cavity-i.e., the simultaneous presence of akinetic loops with an intraluminal fluid-fluid level by sediment and peristaltic loops with solid particles in suspension. In 4/31 patients with strangulating small bowel obstruction. US provided no useful elements to explain the mechanism of obstruction. The US pattern of fluid-fluid levels due to intraluminal sediment in all the intestinal mass above the occluded segment was observed in 6/6 patients with uncompensated mechanical intestinal obstruction. This sign is due to the absence of intestinal muscular activity in the late stages of mechanical intestinal obstruction; its value is purely prognostic. To conclude, the US pattern of fluid-fluid levels by sediment diffused in the whole intestinal mass provides no useful elements to explain the cause of obstruction: on the contrary, the US pattern characterized by isolated intraluminal fluid-fluid levels or by the association of akinetic and peristaltic loops in the abdominal cavity appears pathognomonic of strangulating obstruction caused by volvulus, adhesion or hernia, with 87% sensitivity and 100% specificity.

[The role of echography in the diagnosis of neonatal clavicular fractures]. / Ruolo dell'ecografia nella diagnosi delle fratture clavicolari del neonato.

The authors' aim was to investigate the utility of US in the diagnosis of clavicular fractures in neonates. The technique, which is quite simple, consists in obtaining longitudinal scans of the bone by directing the probe along its axis. Ten cases of clavicular fracture were demonstrated in 11 neonates. Some patients were reexamined after 15 days to investigate fracture healing. After US examination, plain X-rays were always performed and the results compared: perfect correspondence was demonstrated between US and X-ray findings. Since clavicular fractures have a very good prognosis, this affection only needs documenting, for which purpose US can fully replace conventional X-rays, being quite simple to perform and avoiding the use of ionizing radiations, though yielding the same diagnostic results.

[Echographic aspect of the diaphragm]. / Considerazioni sull'aspetto ecografico del diaframma.

The authors investigated the sonographic patterns of the right hemidiaphragm, with high-resolution real-time equipments. Sixty healthy subjects and two patients were examined; the patients suffered from ascites and pleural effusion, and ascites and pulmonary emphysema, respectively. Even though the muscle is generally described as a thin, highly echogenic line surrounding the liver, in a large number of cases the diaphragm could be demonstrated as a hypoechoic layer, bordered by thin echogenic lines (pleural and peritoneal membranes). This pattern was observed in the lateral part of the muscle in 81% of cases, and along the whole border of the liver in 37% of cases. Such findings were detected in pathological cases too. Thus, the patterns described in previous experimental works on specimens of human diaphragm were confirmed in vivo. As the perfect knowledge of normal appearance is the first step towards diagnosis, the above peculiarities of the normal diaphragm should become more widely known.