Percutaneous treatment of heterogenous predominantly solid echopattern echinococcal cysts of the liver.

PURPOSE: We report our technique for and results of percutaneous treatment of heterogenous, predominantly solid echopattern hepatic hydatid cysts (HHC), i.e., complex type IV cysts according to Gharbi's sonographic classification of HHC. METHODS: Eight patients with nine complex type IV HHC were treated by percutaneous aspiration followed by hypertonic saline ablation, using a 14 Fr van Sonnenberg sump drainage catheter under sonographic and fluoroscopic guidance. RESULTS: Successful drainage of cysts contents was achieved in all eight patients. No major complications, such as anaphylaxis, abdominal dissemination, cyst recurrence, or death, occurred. Minor complications including pain (n = 4), mild fever (n = 5), right reactive pleural effusion (n = 4), and transient hypernatremia (n = 2) were observed and managed conservatively. Follow-up imaging studies for an average period of 15 months (range 1-48 months) showed either complete healing (n = 3) or significant reduction in the size of the cyst with solidification (n = 6). CONCLUSION: Nine complex type IV HHC were effectively treated by suction of the membranes and hypertonic saline ablation using a 14 Fr sump drainage catheter, without major complications.

Gastrointestinal parasites presentations and histological diagnosis from endoscopic biopsies and surgical specimens.

OBJECTIVE: To diagnose parasitic ova or worms during endoscopy, surgery or by histology from endoscopic or surgical specimen in our patients. METHODS: The diagnosis of parasitic disease in our patients was made by histological examinations from biopsies obtained either during an upper gastrointestinal or lower gastrointestinal endoscopy or from surgical specimens. RESULTS: Parasites were seen in endoscopic biopsies from upper gastrointestinal tract in 21 patients. Schistosoma ova was seen in biopsies from stomach or duodenum (12 patients). Small intestine biopsies showed Giardiasis (8 patients) and strongyloides (1 patient). Colonic biopsies showed schistosoma ova by paraffin section or by squash technique in 216 patients. Surgical specimens from 12 patients, who presented with acute abdomen and had surgery, due to appendicitis in 8 patients, in whom specimens showed (Schistosoma in 5 patients, amoebiasis in 2 patients and Trichuria in 1 patient). Four other patients presented with acute abdomen, where ischemic bowel necrosis or mesenteric vein thrombosis was found during surgery, specimens showed schistosoma ova. CONCLUSION: The diagnosis of gastrointestinal parasites is not only made by stool but the diagnosis can be made by histology from endoscopic biopsies or surgical specimens.

Rare bone infections "excluding the spine".

Bone infections are usually due to haematogenous spread from distant infected organs. Spread of local sepsis or contamination of open wounds are less frequent routes of infection. The commonest cause of osteomyelitis is Staphylococcus aureus. The term rare bone infections refers to diseases where only a few percent affect bone or diseases which are essentially rare; these include bacteria, fungi, parasites and non-specific conditions. Common examples are tuberculosis, salmonellosis, brucellosis, hydatidosis, madura, actinomycosis, aspergillosis and American fungal infections. Certain bone infections have become exceedingly rare, particularly atypical mycobacteria, viral embryopathies and spirochaetes. Rare bone infections are encountered in many parts of the world commonly in the tropics and in the U. S. Immunocompromise and ease of travel can lead to increased incidence. A high index of clinical suspicion is necessary for diagnosis. Specific laboratory diagnosis is not always possible. Radiographs, computed tomography, isotope studies and magnetic resonance are useful but may not make the diagnosis. Aspiration or biopsy is necessary. Rare bone infections may simulate non-infective bone lesions.

Osteomyelitis: a review of currently used imaging techniques.

Conventional radiographs remain the initial imaging modality involved in the diagnosis of osteomyelitis. Bone scintigraphy and its specific agents did not only eliminate the problems of inherent low sensitivity of conventional radiographs, but also increased the specificity to higher degrees. Spiral CT, on the other hand, has solved several diagnostic problems, such as osteomyelitis of the sterno-clavicular junction and hidden areas in the pelvic bones. Magnetic resonance imaging with its multiplanar capability, greater anatomic details and excellent soft tissue bone marrow contrast resolution has a significant role in surgical planning and limb preservation. Ultrasound and US-guided aspiration has recently been involved in the diagnosis and management of osteomyelitis with several advantages particularly in children. Our goal in this review is to outline the ability of various imaging techniques by comparing their strengths and weaknesses in the diagnosis of osteomyelitis. Finally, we suggest various imaging algorithms for specific clinical scenarios. Spondylitis and septic arthritis are not discussed in this review.

Radiological manifestations of liver and gastrointestinal parasitic infections.

There is a wide variation in the prevalence of parasitic diseases in different countries, particularly in the Tropics. The clinical status of affected patients varies from normal to severe ill health. Radiology has acquired a major role in the diagnosis and, in some instances, the management of a significant variety of parasitic infections. Plain films, ultrasound, computed tomography and magnetic resonance imaging, together with the help of clinical and laboratory tests, can reach a diagnosis with a high percentage of accuracy.

Needle track seeding following percutaneous ethanol injection for treatment of hepatocellular carcinoma.

We report two cases of needle track seeding in the subcutaneous tissue and intercostal muscles following percutaneous ethanol injection for the treatment of hepatocellular carcinoma. In one patient, tumor seeding was observed 11 months after a total of 12 alcohol injections, and in the other patient, tumor seeding was observed 30 months after a total of 18 alcohol injections. The cases reported in the literature are discussed.

Water enhanced "non-paralytic" transcutaneous ultrasound of the normal gastric wall layers (WETCUS).

BACKGROUND/AIMS: Barium studies, endoscopies and endoscopic ultrasound are the usual methods for gastrointestinal tract examinations. Endoscopic ultrasound was the only accurate equipment used for imaging the various layers of the stomach wall distinctly. METHODOLOGY: Twenty patients undergoing renal ultrasound were given 600 cc of water to drink. Gastric wall layers were demonstrated in all patients, namely mucosa; submucosa, musculosa and serosa. The echogenic layer of the water-mucosa interface was not included in gastric wall thickness measurement. RESULTS: The normal wall measurement varied from 3-5 mm. This is lower than in previous reports. CONCLUSIONS: Water enhanced "non-paralytic" transcutaneous ultrasound is a simple, safe, non-invasive, and accurate test for visualizing gastric wall layers.

Case report: radiological and endoscopic management of bile leak following laparoscopic cholecystectomy.

Due to the ever increasing popularity of laparoscopic cholecystectomy (LC), many radiologists and gastroenterologists have noticed an epidemic of bile duct injuries due to subsequent complications. We report on five cases of post-LC minor bile duct injuries and document our preliminary experience in their management. Although the majority of minor bile leaks resolve spontaneously, particularly if a surgical drain has been left in situ, percutaneous drainage (PD) can be used alone or in addition to endoscopic management to treat symptomatic bile leaks and biloma formation. Bile leaks without associated abdominal collections should be first identified by endoscopic cholangiography followed by sphincterotomy and/or stenting. Surgery should only be reserved for cases of major bile duct injury if PD and endoscopic management have failed initially.

Non surgical management of pancreatic pseudocyst: two case reports and review of the literature.

We report two patients who had non-surgical management of Pancreatic Pseudocyst. The first patient presented with acute pancreatitis and intestinal obstruction, had laparatomy and found to have hemorrhagic pancreatitis and impacted gallstone in terminal item which was removed. Two weeks after laparatomy U/S and CT showed a dilated CBD and two Pancreatic Pseudocysts. ERCP showed dilated CBD. Endoscopic sphincterotomy and stent insertion in CBD and Cystoduodenostomy was done. A percutaneous drainage was done for the pseudocyst involving the body of the pancreas. The second patient presented abdominal pain and clinically had an abdominal mass which was shown by CT as Pseudopancreatic cyst. This was drained percutaneously and given treatment with somatostatin with good outcome.

Imaging features of musculoskeletal brucellosis.

Brucellosis is endemic in certain parts of the world. Musculoskeletal involvement is the most common complication of brucellosis, and the spine is most frequently affected. Between November 1985 and March 1993, 334 patients with radiologically proved musculoskeletal brucellosis were seen. Involvement of the spine was either focal or diffuse, with a predilection to the lumbar region. Erosions and sclerosis in vertebral end plates, changes of inflammation at scintigraphy or magnetic resonance (MR) imaging, and intact disks were hallmarks of the focal form. Osteomyelitis of neighboring vertebrae, involvement of the intervening disk, and moderate epidural extension were features of diffuse brucellar spondylitis. The great majority of joints with scintigraphic evidence of disease demonstrated normal radiographic findings. Evidence of osteomyelitis or destructive arthritis was encountered in only a few cases. Although radiography is sufficient for demonstrating focal brucellosis, MR imaging is better for assessing diffuse disease.

Premature tracheobronchial, laryngeal and costochondral cartilage calcification in children.

Two children with premature tracheobronchial, laryngeal and costochondral cartilage calcification are described. Both patients had associated congenital cardiovascular anomalies; one of them having features of Keutel syndrome.

Renal colic: diagnosis and outcome.

To assess whether ultrasonography (US) with or without plain abdominal radiography (kidney, ureter, bladder [KUB] radiography) can replace intravenous urography (IVU) in detection of acute urinary tract obstruction, 101 consecutive patients with renal colic were evaluated with US followed immediately by IVU. Receiver operating characteristic (ROC) curves for US diagnosis of acute urinary tract obstruction yielded sensitivities of 91% and 92% for two reviewers at a specificity of 90%. There was no statistically significant difference between US and IVU results. When US was combined with KUB radiography, ROC curves yielded sensitivities of 94% and 97% for two reviewers at a specificity of 90%.KUB radiography alone was of limited diagnostic value. For US alone, no false-positive results occurred, and the false-negative results (n = 9 and n = 6 for two reviewers) were encountered in cases of grade 1 hydronephrosis and nondilated obstructive uropathy. The authors conclude that US combined with KUB radiography can replace IVU in initial evaluation and follow-up of the great majority of patients with renal colic.

MR, CT, and ultrasonography of splanchnic venous thrombosis.

Nine patients with splanchnic venous thrombosis are presented and the value of noninvasive imaging in their initial diagnosis and subsequent follow-up is emphasized. Angiography, traditionally the definitive investigation in such cases, can be reserved for preoperative assessment in those patients considered candidates for surgery. The age of venous thrombi can be estimated by computed tomography (CT) and magnetic resonance imaging (MRI) which aids selection of therapy, and in those anticoagulated, prediction of prognosis.