Emergency ultrasound and gallstone ileus.

Gallstone ileus is an uncommon cause of mechanical obstruction due to a biliary stone that wedges the intestinal lumen. It is a surgical emergency representing a clinical and diagnostic challenge: the clinical manifestations are rarely specific, often causing diagnostic delay that can adversely affect the prognosis. Emergency ultrasound could be useful in assessing the level and identifying the cause of bowel obstruction. We report a case of a 74-year-old patient with a 6-day history of constipation and crampy abdominal pain without previous history of abdominal diseases. Emergency ultrasound led to an early diagnosis showing dilated small bowel loops with a shadowing mass inside consistent with an ileal stone, in the absence of aberrant located stone on plain abdominal film.

Characterization of liver lesions by real-time contrast-enhanced ultrasonography.

OBJECTIVE: The aim of this study was to identify the most common patterns of various common liver lesions at real-time contrast-enhanced ultrasonography with second-generation contrast agents and their role in the differentiation of malignant from benign lesions. PATIENTS AND METHODS: The enhancement pattern in the arterial phase and its modifications in subsequent portal and sinusoidal phases were separately evaluated in (i) 171 liver lesions detected at conventional ultrasonography in 125 noncirrhotic patients (87 metastases, six cholangiocellular carcinoma, 38 focal nodular hyperplasia, 30 hemangiomas, seven focal fatty sparing/changes, two hepatocellular adenomas and one hepatocellular carcinoma) and (ii) 75 lesions detected in 67 cirrhotic patients (66 hepatocellular carcinoma and nine dysplastic nodules). The final diagnosis was made by contrast-enhanced helical computed tomography and/or magnetic resonance imaging or by ultrasonography-guided biopsy when the diagnosis was equivocal at conventional imaging techniques (45 lesions). RESULTS: In noncirrhotic patients, the hypoechoic pattern in portal and sinusoidal phase (rapid washout) or the markedly hypoechoic or anechoic pattern in sinusoidal phase (marked late washout) showed a sensitivity, specificity and accuracy of 96.8, 100 and 98.2% for the diagnosis of malignancy. In cirrhotic patients, early arterial enhancement showed a sensitivity of 93.9% for the diagnosis of malignancy, with a specificity as low as 55.5% given the presence of arterial enhancement in 5/9 nodules resulted dysplastic at histological analysis. CONCLUSION: Real-time contrast-enhanced ultrasonography provides sensitive and specific criteria for the differential diagnosis between benign and malignant liver lesions, and in most cases it may replace more expensive and invasive imaging techniques.

Blunt abdominal trauma: emergency contrast-enhanced sonography for detection of solid organ injuries.

OBJECTIVE: The objective of our study was to prospectively compare the diagnostic value of sonography and contrast-enhanced sonography with CT for the detection of solid organ injuries in blunt abdominal trauma patients. SUBJECTS AND METHODS: Sonography, contrast-enhanced sonography, and CT were performed to assess possible abdominal organ injuries in 69 nonconsecutive hemodynamically stable patients with blunt abdominal trauma and a strong clinical suspicion of abdominal lesions. Sonography and contrast-enhanced sonography findings were compared with CT findings, the reference standard technique. RESULTS: Thirty-two patients had 35 abdominal injuries on CT (10 kidney or adrenal lesions, seven liver lesions, 17 spleen lesions, and one retroperitoneal hematoma). Sixteen lesions were detected on sonography, and 32 were seen on contrast-enhanced sonography. The sensitivity and specificity of sonography were 45.7% and 91.8%, respectively, and the positive and negative predictive values were 84.2% and 64.1%, respectively. Contrast-enhanced sonography had a sensitivity of 91.4%, a specificity of 100%, and positive and negative predictive values of 100% and 92.5%, respectively. CONCLUSION: Contrast-enhanced sonography was found to be more sensitive than sonography and almost as sensitive as CT in the detection of traumatic abdominal solid organ injuries. It can therefore be proposed as a useful tool in the assessment of blunt abdominal trauma.