Bile duct tumors.

Bile duct tumors are benign or malignant lesions which may be associated to risk factors or potentially malignant lesions. They constitute an heterogenous entities group with a different biological behavior and prognosis according to location and growth pattern. We revise the role of the radiologist in order to detect, characterize and stage these tumors, specially the importance of their classification when deciding an appropriate management and treatment.

Bowel ultrasonography in acute abdomen: beyond acute appendicitis. / Ecografía intestinal y abdomen agudo: más allá de la apendicitis aguda.

Acute abdomen is a common reason for consultation in the emergency department. A broad spectrum of entities, including diverse diseases of the gastrointestinal tract, can cause acute abdomen. Although computed tomography is the technique most widely used to evaluate acute abdomen in the emergency department, abdominal ultrasound is often performed first and allows bowel disease to be suspected. This article describes the ultrasound features of diverse bowel diseases that can cause acute abdomen, such as acute diverticulitis, bowel obstruction, gastrointestinal perforation, bowel ischemia, intraabdominal fat necrosis, and miscellaneous processes such as endometriosis, foreign bodies, or vasculitis. Radiologists must be familiar with the different features of abnormal bowel that can be detected incidentally in patients without clinical suspicion of bowel disease. This article focuses on ultrasonographic signs of bowel disease; other articles in this series cover the ultrasonographic signs of acute appendicitis, inflammatory bowel disease, and infectious diseases.

Evaluation of upper tract urothelial carcinomas by contrast-enhanced ultrasound. / Valoración del carcinoma urotelial de vías superiores mediante ecografía con contraste.

AIM: To describe the findings and behaviour of contrast-enhanced ultrasound in the study of upper tract urothelial tumours and to assess its usefulness for diagnosis. MATERIAL AND METHODS: We reviewed our hospital's database over a period of 45 months to identify patients diagnosed with upper tract urothelial carcinomas. We reviewed the findings on mode B-ultrasound, contrast-enhanced ultrasound (location and qualitative assessment of intensity and washout of enhancement), and made a comparison with other techniques (computed tomography or magnetic resonance), and with the surgical specimen. RESULTS: We found 42 patients with a diagnosis of upper tract urothelial carcinoma confirmed with surgery over the period reviewed. Twenty-eight (67%) patients underwent contrast-enhanced ultrasound. Baseline ultrasound showed hydronephrosis with or without ureteral dilatation with echogenic content occupying the renal calyx (6), pelvis (10) or ureter (12). After injection of contrast, enhancement was noticed in 100% of the lesions, with similar intensity to the cortex in 23, and less in 5. Twenty-four lesions showed early washout, before the cortex, between 40 and 55seconds after the injection. The diagnosis was correct in 27 cases. Localisation coincided with the histological specimen in 28 cases, and 3 patients had additional distal carcinoma foci. CONCLUSION: Contrast-enhanced ultrasound is a useful technique for diagnosing upper tract urothelial tumours that increases confidence in the diagnosis.

Valoración del carcinoma urotelial de vías superiores mediante ecografía con contraste / Evaluation of upper tract urothelial carcinomas by contrast-enhanced ultrasound

Objetivo: Describir los hallazgos y el comportamiento de la ecografía con contraste en el estudio de los tumores uroteliales de vías superiores y evaluar su utilidad en el diagnóstico. Material y métodos: Se revisa la base de datos de nuestro hospital en un periodo de 45 meses para identificar los pacientes con diagnóstico de carcinoma urotelial de vías altas. Se revisan los hallazgos en la ecografía en modo B, ecografía con contraste (localización y valoración cualitativa de la intensidad y del lavado del realce) y se comparan con otras técnicas (tomografía computarizada o resonancia magnética) y con la pieza quirúrgica. Resultados: En el periodo revisado se encontraron 42 pacientes con diagnóstico de carcinoma urotelial de vías superiores confirmados con cirugía. Veintiocho (67%) pacientes tenían ecografía con contraste. La ecografía basal mostró hidronefrosis con o sin dilatación ureteral con ocupación por contenido ecogénico en cáliz renal (6), pelvis (10) o uréter (12). Tras la inyección de contraste se objetivó realce en el 100% de las lesiones, con intensidad similar a la cortical en 23 y menor en 5. Veinticuatro lesiones mostraron lavado precoz, antes que la cortical, entre los 40 y 55 segundos de la inyección. El diagnóstico fue correcto en 27 casos. La localización coincidió con la pieza histológica en 28 casos y 3 pacientes tenían focos de carcinoma distales adicionales. Conclusión: La ecografía con contraste es una técnica útil para el diagnóstico de tumor urotelial de vías altas que aumenta la confianza en el diagnóstico

Aim: To describe the findings and behaviour of contrast-enhanced ultrasound in the study of upper tract urothelial tumours and to assess its usefulness for diagnosis. Material and methods: We reviewed our hospital's database over a period of 45 months to identify patients diagnosed with upper tract urothelial carcinomas. We reviewed the findings on mode B-ultrasound, contrast-enhanced ultrasound (location and qualitative assessment of intensity and washout of enhancement), and made a comparison with other techniques (computed tomography or magnetic resonance), and with the surgical specimen. Results: We found 42 patients with a diagnosis of upper tract urothelial carcinoma confirmed with surgery over the period reviewed. Twenty-eight (67%) patients underwent contrast-enhanced ultrasound. Baseline ultrasound showed hydronephrosis with or without ureteral dilatation with echogenic content occupying the renal calyx (6), pelvis (10) or ureter (12). After injection of contrast, enhancement was noticed in 100% of the lesions, with similar intensity to the cortex in 23, and less in 5. Twenty-four lesions showed early washout, before the cortex, between 40 and 55seconds after the injection. The diagnosis was correct in 27 cases. Localisation coincided with the histological specimen in 28 cases, and 3 patients had additional distal carcinoma foci. Conclusion: Contrast-enhanced ultrasound is a useful technique for diagnosing upper tract urothelial tumours that increases confidence in the diagnosis

Tumores de la vía biliar / Bile duct tumors

Los tumores de la vía biliar son lesiones benignas o malignas que pueden asociarse a factores de riesgo o a lesiones con potencial de malignización. Constituyen un grupo heterogéneo de entidades con diferente comportamiento biológico y pronóstico dependiendo de su localización y del tipo de crecimiento. En este artículo revisamos el papel del radiólogo para detectar, caracterizar y estadificar estos tumores y, sobre todo, la importancia de clasificarlos para planificar el manejo y el tratamiento (AU)

Bile duct tumors are benign or malignant lesions which may be associated to risk factors or potentially malignant lesions. They constitute an heterogenous entities group with a different biological behavior and prognosis according to location and growth pattern. We revise the role of the radiologist in order to detect, characterize and stage these tumors, specially the importance of their classification when deciding an appropriate management and treatment (AU)