Gaucher's disease involving the spleen.

Gaucher's disease is a rare inherited disorder that results from progressive accumulation of glucocerebrosides within the reticuloendothelial system and affects the liver, the spleen, the bone marrow and the lymph nodes. Ultrasonography of the spleen typically demonstrates hypoechoic focal masses; however, the lesions may be hyperechoic if they contain extensive fibrosis or infarction. The authors describe a young Ashkenazi man who presented with splenomegaly as the single clinical manifestation and in whom were found splenic masses of mixed echogenicity, none of which demonstrated fibrosis or infarction when studied pathologically.

Duplex carotid sonography. Peak systolic velocity in quantifying internal carotid artery stenosis.

Duplex ultrasonography combining high-resolution imaging and Doppler spectrum analysis was performed in 92 consecutive patients (total, 180 vessels) and compared with the findings of conventional arteriography. All duplex studies were categorized into four groups based upon the maximum internal carotid artery (ICA) velocity: group 1: less than 125 cm/sec; group 2: 125 to 224 cm/sec; group 3: greater than 225 cm/sec; and group 4: no flow. Sensitivities and specificities were highest when peak ICA velocity was used as one of several criteria in quantifying the degree of ICA stenosis. These additional criteria were: (1) the presence of extensive sonographically visible plaque within the ICA; (2) an abnormal spectral waveform with elevated diastolic velocity (greater than 100 cm/sec); (3) resistive pattern ("externalization") of the common carotid artery (CCA) waveform; and (4) the ratio of the right CCA peak velocity to the left of less than 0.7 or greater than 1.3. The overall accuracy for the combined groups using all criteria was 94%.

Intravascular tumors: transvenous biopsy.

A technique is described for transfemoral biopsy of intravenous tumors. Positive results were obtained at biopsy in three patients who had an intraluminal mass in the inferior vena cava and in one patient with a mass in the iliac vein. Transvenous biopsy is helpful in obtaining a histologic diagnosis and provides an alternative method to surgery or percutaneous transabdominal needle biopsy.

Gallbladder and bile duct abnormalities in AIDS: sonographic findings in eight patients.

Gallbladder and biliary tract abnormalities were observed on sonography in eight patients with AIDS. The studies were obtained to evaluate right upper quadrant pain (two patients), tenderness (three patients), and abnormal liver function tests (eight patients). The two major sonographic findings were gallbladder wall thickening (eight patients), which often was marked, and bile duct dilatation (two patients). Gallbladder wall thickness varied from 4 to 15 mm and was greater than 1 cm in four patients. Follow-up sonograms in five patients showed increasing wall thickness in four and decreasing thickness in one, but these findings did not correlate well with the clinical status of the patient. Pericholecystic fluid was shown in three cases. None of the patients had gallstones. Common bile duct dilatation varied from 12 to 15 mm; no specific cause for dilatation was found by cholangiography. Mycobacterium avium intracellulare was recovered from the gallbladder in one patient, and Cryptosporidium was recovered from the duodenum in two patients. AIDS should be considered in the differential diagnosis of gallbladder wall thickening or bile duct dilatation in the appropriate clinical setting. These findings may indicate opportunistic infection of the biliary tract. A disparity may exist between the mild symptoms and signs (or lack of symptoms and signs) related to the gallbladder and bile ducts and the sometimes marked sonographic abnormalities.