Hepatic and thoracic amaebiasis.

Sonographic and radiographic fidings were reviewed in 27 patients with hepatic amebiasis. Sonography usually demonstrated nonspecific, peripheral, hypoechoic lesions. The only diagnostic sonographic appearance was a combination of a hypoechoic lesion and diaphragmatic disruption, which was found in four patients. About 50% of the patients had accompanying radiographic abnormalities that were nondiagnostic. These included elvation of the right hemidiaphragm, basilar pulmonary infiltrates, and pleural effusions. Liver abscesses occasionally grew during the first 2 weeks of treatment even though the patients were responding well to medical therapy. Lesions frequently became more anechoic and better defined on follow-up examinations. Successfully treated abscesses may calcify rather than diminish.

Left lateral decubitus sonography of gallstones in the contracted gallbladder.

A prospective study of the accuracy in diagnosing gallstones using ultrasonography in the absence of a fluid-filled gallbladder was done over a 20 month period; 91 patients were studied. A focal echo complex with acoustic shadowing was shown to be a highly reliable criterion for diagnosing gallstones in a contracted gallbladder when (1) it was demonstrated on longitudinal, transverse, and left lateral decubitus views, and (2) the configuration of the echo complex remained the same.

Significance of low level echoes within the gallbladder.

Thick bile may appear as a nonshadowing, dependent, echogenic layer within the gallbladder. In vivo sonographic imaging of the canine gallbladder showed that highly viscous, desiccated bile appeared echogenic and could potentially prevent imaging an enlarged gallbladder or dilated bile ducts. Selected clinical cases demonstrated that multiple nonshadowing calculi, pus, cholesterol crystals, and possibly abnormal mucous in the gallbladder may be sonographically indistinguishable from thick bile.

Ultrasonic recognition of parenchymal gas.

Abdominal sonography in six febrile patients was suspicious for parenchymal gas. In five, immediate radiographic confirmation was obtained. Four patients had gas-containing abscesses, one had gas sequestered in a hepatic hematoma, and in the other subcapsular hepatic gas probably originated by mesenteric dissection from pneumatosis cystoides intestinals.