Duodenal obstruction secondary to date stone impaction.

The use of non-invasive imaging techniques to rapidly establish diagnosis has always been an attempt in emergency situations. Recent significant advances in imaging technology have changed approach and algorithm of many emergencies. We present a case of swallowed date stone resulting in duodenal obstruction in a 10-year old child. Following the suspicion of a foreign body impaction which caused symptoms of acute intestinal obstruction, the case was diagnosed precisely by conventional sonography. This spared the patient the laparotomy scheduled initially. Instead, endoscopic removal of the date stone was accomplished successfully with smooth recovery.

Are they spherules of ovarian cystic teratoma or daughter cysts of echinococcosis?

Teratoma is a germ cell tumour which accounts for approximately 15-20 % of all ovarian cancers. The tumour is possibly derived from ectodermal differentiation of totipotent cells or mitotic germ cells. We present a case of a 37-year-old female patient with multiple spherical structures floating in a large pelvic-abdominal cystic mass seen on sonographic images. A giant echinococcal cyst gravid with its daughters was the presumed preoperative sonographic diagnosis. The patient underwent excision of the lesion, and the pathological diagnosis was teratoma. The striking feature of multiple spherical structures in the cyst was caused by multiple spherules of a mature ovarian cystic teratoma which were representing numerous mobile sebaceous cysts and desquamative keratin formations.

Ultrasound wall-sign in pulmonary echinococcosis (new application).

PURPOSE: We report our experience in diagnosing pulmonary cystic echinococcosis using an ultrasound sign related to the cystic wall. MATERIALS AND METHODS: 40 patients with 46 cysts, suspected of pulmonary echinococcosis, based on plain chest radiographs and clinical findings, were examined by ultrasound over a 9-year period (1996 - 2004), and followed up until discharge. We applied our long experience with echinococcal cysts utilising the wall sign (WS) to diagnose pulmonary hydatid disease. All cysts were subject to surgical removal, and postoperative histopathology was the gold standard. RESULTS: There were 34 (74 %) unilocular and 12 (26 %) multivesicular echinococcal cysts. In the univesicular cysts, the WS was found in 20 cases (66.7 %) while it was present in all multivesicular cysts (100 %). Following surgical removal, echinococcosis was confirmed by histopathology in all cases. CONCLUSION: We conclude that a double layered border in univesicular and double layered internal septum in multivesicular pulmonary echinococcal cysts is a reliable indicator of pulmonary echinococcosis, with a specificity of 66 % and 100 %, respectively.

Tetra-layered sign of adult intussusception (new ultrasound approach).

Two-dimensional ultrasound is the principle method for the detection of intussusception. The aim of this study was to establish a pathognominic ultrasound criterion for diagnosing intestinal intussusception to facilitate a proper clinical decision. We have developed a new approach to diagnosing colonic intussuception based on the hypothesis that ultrasound image of the invaginated segment should reveal four border layers. We called this sign tetra-layered sign (TLS). In a prospective manner, all adult patients diagnosed with intussusception using the TLS approach in the period from July 1990 and July 2005 were included in this study. All patients underwent explorative laparotomy, and our preoperative diagnoses were compared with the surgical outcome. Thirty patients were diagnosed with intestinal intussusception using the TLS ultrasound sign. Surgery confirmed the preoperative diagnosis in all cases. Conventional ultrasound is very reliable in diagnosing intestinal intussusception in adult patients when utilizing the simple ultrasound applicable TLS. This facilitates the decision-making, improves the clinical outcome and reduces the associated costs.

Giant hydronephrosis mimicking echinococcal cyst.

Cases of giant hydronephrosis are rare and usually contain no more than one to two liters of fluid in the collecting system. We report a remarkable case of giant hydronephrosis of > 17.5 Kg mimicking a huge echinococcal cyst.

Segmental portal hypertension due to a splenic Echinococcus cyst.

A 60-year-old Libyan woman developed perihilar splenic varices without other signs of portal hypertension. Plain abdominal X-ray examination showed two calcified structures in the left and right hypochondria. Ultrasound examination disclosed a 3-cm diameter, globally calcified hydatid cyst lodged in a critical location at the hilar region of the spleen. The cyst was compressing the hilar vessels which resulted in dilatation and varix formation. Another hydatid cyst measuring 5 cm in diameter, with extensive wall calcification was visualized in the right lobe of the liver. The splenic size was within normal limits. The liver revealed normal texture and size and the portal vein was of normal caliber. The patient underwent an uneventful splenectomy and was well at discharge.

Intracavitary cardiac hydatid cyst and the wall sign criteria.

Cardiac hydatid is rare at any age, accounting for less than 2% of all hydatid disease. The case is discussed of a 48-year-old female with a cardiac hydatid cyst attached intracavitary in the posterior wall of the right atrium. The Echinococcus cyst grows very slowly and, unless located in a critical anatomic site, it takes many years to evolve. Since the introduction of two-dimensional echocardiography, more cases are being diagnosed. The cyst was discovered incidentally by X-ray computed tomography and confirmed by trans-oesophageal echocardiography utilizing the wall-sign criteria developed by the authors. The cyst was removed surgically and the patient recovered by medical therapy.