Serial ultrasound in amoebic liver abscess.

Serial ultrasound examinations were conducted in 93 patients with amoebic liver abscess. The initial size of the abscesses ranged from 3 to 17 cm. The time taken for complete healing to occur varied from 10 to 300 days and correlated directly with the initial size of the abscess cavity. As healing progressed, the abscess cavity became increasingly hypoechoic and assumed a smoother margin. In uncomplicated cases, complete healing occurred and, on ultrasound, no residual lesions were seen in the liver. There were two cases each of delayed healing and recurrence of amoebic liver abscess and the value of ultrasound in these situations is discussed. Ultrasound examination of the liver appears to be very suitable for assessing satisfactory progress of healing in amoebic liver abscess.

Experiences with ultrasonic parasagittal sector B-mode scanning in pericardial effusion.

During parasagittal B-mode scanning of the liver, pulsatile cardiac interfaces are demonstrable by increasing the swept gain. In a normal patient the interface of hemidiaphragm and pericardium is combined. In a patient with a pericardial effusion there is a transsonic semilunar space which separates the combined diaphragmatic and pericardial interface from that of a pulsatile epicardium. A review of 30 cases of proven pericardial effusions revealed that the diagnostic accuracy of this method is virtually the same as that of M-mode scanning and, furthermore, that by using both methods some of the pitfalls of M-mode scanning can be avoided.

Experiences with grey scale ultrasonography in hepatic amoebiasis.

Ultrasound examination was conducted in 151 proven cases of amoebic liver abscess. In the majority of patients the lesion was solitary but 25% of patients had multiple lesions; 17% of all the abscesses were in the left lobe of the liver. Most abscesses had no, or very few internal echoes and these were either of the same density as the normal liver (15%) or less dense (84%). In all cases there were relatively fewer echoes in the lesion. Abscesses in critical areas were accurately located especially in relation to the pericardium. Other liver lesions such as hepatoma which may enter into the clinical diagnosis can be recognised. Ultrasound has particular value in accurate localisation of the lesion for aspiration, demonstration of unsuspected multiple abscesses and size estimation in serial studies of the patient under treatment. The diagnostic errors were mainly due to initial inexperience and demonstrated some of the diagnostic pitfalls. It is concluded that the introduction of this technique has proved to be of considerable value in the diagnosis and management of amoebic liver abscess in our area, where the disease is still a major clinical entity. If diagnosed early and treated adequately the condition has an excellent prognosis.

Pancreatic pleural effusion with endoscopic retrograde cholangiopancreatography: A case report.

A case is discussed of a 30-year-old Black woman who developed a massive pseudocyst of the pancreas while under investigation in hospital for a left pleural effusion. An internal pancreatic fistula to the pleural space was demonstrated at endoscopic retrograde cholangiopancreatography. The patient recovered completely after distal pancreatectomy with splenectomy.