Image-directed Doppler ultrasound in the diagnosis of lower-limb venous insufficiency.

Ninety-eight legs in 73 patients were evaluated with image-directed Doppler ultrasound for suspected chronic venous insufficiency. Examinations of the entire venous system were performed to determine lumen patency and valvular competence. Reflux during Valsalva maneuver in the femoral and great saphenous vein, and, after release of distal compression in the popliteal vein, indicated valvular incompetence. Twenty limbs had normal veins; Baker's cysts were found in three. Superficial venous insufficiency was found in 25 cases. Deep reflux, either alone or in combination with superficial reflux, was the predominant pathological feature (53 legs). Photoplethysmographic studies of the veins were performed on 24 limbs. Image-directed Doppler ultrasound was more successful in defining the exact site of venous incompetence and in detecting nonvenous pathology. By the combination of real-time imaging of the vein with gated Doppler sonography of flow, image-directed Doppler sonography is becoming the method of choice for the investigation of chronic venous insufficiency.

The value of ultrasound in Schoenlein-Henoch purpura.

We report the results of ultrasound studies on 11 children with Schoenlein-Henoch purpura. In 8 children the ultrasound examination was normal. In two of three patients with macroscopic haematuria, haemorrhagic cystitis, a previously undescribed finding in Schoenlein-Henoch purpura, was found. In one case the gall bladder wall and the wall of several adjacent loops of bowel were markedly thickened. Follow up examinations after clinical recovery demonstrated complete resolution of these abnormalities. Our observations demonstrate that diagnostic ultrasound may have an important role before more expensive and invasive procedures are employed in patients with Schoenlein-Henoch purpura.

Intracorporeal calcifications after self-injection of papaverine.

Penile indurations were found at follow-up examination in six of 120 patients with erectile dysfunction who practice intracavernosal self-injection of papaverine-phentolamine. In four of these six, cavernosal calcifications were demonstrated by means of ultrasound (US) and radiography. Most of the calcifications were close to the site of injection, but some were more distant. Cavernosal calcifications must be considered a possible complication of self-injection of papaverine-phentolamine. Baseline US and radiographic studies of the penis are advisable before starting treatment.

Intraoperative ultrasonography in cystic brain lesions.

Four neurosurgical patients were operated on under real-time ultrasonographic guidance. Two had cystic tumors which were drained through the unincised dura. In one patient a brain abscess was located intraoperatively by ultrasound after a small craniotomy. In a fourth patient with multiple abscesses, one abscess was drained under ultrasonographic guidance through a previous craniotomy. Using intraoperative ultrasonography the length of the operation can be shortened and normal brain tissue spared. Intraoperative ultrasonography is of special value in cystic lesions which can be drained under ultrasonographic guidance.

The use of ultrasound scanning in the management of developmental disorders of the hip.

Ultrasound was used, together with clinical examination, to help in the diagnosis and to evaluate the treatment of 48 babies with congenital disorders of the hip. The femoral head, and its relation to the acetabulum, can be demonstrated before it becomes visible on radiographs. Ionising radiation is avoided. Ultrasound scanning can be used to visualise the repositioning of the femoral head. It is also possible to examine babies on an abduction frame.

Progressive diaphyseal dysplasia (Camurati-Engelmann): radiographic follow-up and CT findings.

Sixteen patients with progressive diaphyseal dysplasia (PDD) and aged six months to 76 years were examined. Fourteen cases were hereditary, two were not. The progression of the radiologic manifestations in 13 patients who were followed up from 1 to 32 years and the computed tomography (CT) scans from five patients were obtained. The progression of PDD was slow and unpredictable, from minimal endosteal thickening of the mid-diaphyses in one pair of long bones to severe sclerosis of long bones, skull, and vertebrae. The severity of the osseous changes was not age dependent. A six-stage system was used to grade the severity of involvement and progression of PDD. CT scans demonstrated muscle mass that was preserved and showed the distribution of the osteosclerotic process, which was irregular and inhomogeneous. CT scanning was advantageous over plain radiography in this respect. Endosteal involvement was more extensive than periosteal thickening. CT scans also showed a distinct pattern of vertebral sclerosis that was confined to the posterior areas of the vertebral body and arches. In light of the paucity of characteristic clinical signs of PDD, the recognition of the radiologic features is mandatory for the diagnosis of this disease.

Lithotripsy and the modern imaging department.

Until recently surgery was required to remove unpassed stones from the urinary tract. Today, percutaneous and extracorporeal methods are replacing surgery, such as chemolytic, nephroscopic, ultrasonic, electrohydraulic and extracorporeal shock wave lithotripsy (ESWL). These procedures require close collaboration between the urologist and the radiologist. It is the radiologist who will localize the stone by X-rays or ultrasound and provide the percutaneous approach and dilatation of the tract, leaving the actual stone extraction to the urologist. Even with ESWL supplementary percutaneous procedures are often necessary, again requiring radiologic-urologic teamwork. The percutaneous procedure can be carried out in the imaging department with existing radiologic equipment. Additional X-ray apparatus for the operating room is not necessary. In the Israeli setting of socialized medicine, the involved physicians are unaffected by financial considerations. Collaboration between radiologists and urologists therefore seems assured.

Progressive diaphyseal dysplasia: evaluation of corticosteroid therapy.

Progressive diaphyseal dysplasia is characterized clinically by crippling leg pain, fatigue, headache, poor appetite, muscle weakness, and waddling gait. Twelve affected patients, aged 2 years 4 months to 40 years, were treated with intermittent courses of low doses of prednisone given in a single dose on alternate mornings for periods ranging from 6 months to 10 years. The average initial dose of prednisone was 0.6 mg/kg/d, and average maintenance dose was 0.3 mg/kg/d. Relief of all crippling symptoms was achieved in all patients. No untoward serious side effects have been observed, and the growth of children was not slowed. However, corticosteroid therapy should be restricted to patients suffering from crippling pain. The mechanism through which steroids act remains undefined.

Progressive diaphyseal dysplasia: genetics and clinical and radiologic manifestations.

Progressive diaphyseal dysplasia was found in a three-generation family including 13 affected individuals, the largest family reported to date. Our study confirms that progressive diaphyseal dysplasia, also known as Engelmann's or Camurati-Engelmann disease, is an autosomal dominant disorder with variable osseous and muscular manifestations. Disease distribution among patients, within a given patient, or even in individual bones is unpredictable. The femur is the most commonly and severely affected bone and hence most useful for radiographic screening of possible patients. Radiographs provide a meaningful assessment of disease activity and extent. The severity of symptoms is generally proportionate to severity of involvement shown by roentgenography. Exophthalmos due to osteosclerotic dysplasia of the skull occurred in more than half of the patients with progressive diaphyseal dysplasia. Twelve-year follow-up of this family, with affected individuals ranging in age from 6 months to 12 years, indicates that progressive diaphyseal dysplasia may progress or become quiescent and be remarkably inactive despite advanced osteosclerosis and structural deformity.

Ultrasonography in Crohn's disease.

Eighteen patients with acute and subacute Crohn's disease were examined by ultrasound. In 7, ultrasound was the initial screening procedure leading to the diagnosis of Crohn's disease. This diagnosis was subsequently proved by results of barium studies. The most frequent ultrasonographic finding was conglomeration: an irregular mass containing scattered echodense and sonolucent areas that represented matted inflamed bowel loops. Some of the conglomerations showed a fine diffuse echo pattern with ill-defined posterior borders due to poor transmission. These areas denoted mesenteric fat covering the matted loops (fatty conglomeration). Other ultrasonographic findings were the "target" or "bull's eye" sign, abscess formation, and fluid in the cul-de-sac.

Causes of abnormal right diaphragmatic position diagnosed by ultrasound.

Fifty patients with an abnormal right diaphragmatic position on posterior-anterior and lateral chest films and five patients following right thoracotomy were examined by ultrasound. The transabdominal and intercostal approach with the liver as an acoustic window was used. In all patients the cause for the change in the diaphragmatic position and the nature of an opacified right hemithorax after thoracotomy and pulmonectomy were identified.

Sonography for diagnosis and follow-up of neonatal adrenal hemorrhage.

Neonatal adrenal hemorrhage was diagnosed by ultrasound as an echo-free mass superior to downward displaced normal kidneys in three newborns. In one, the adrenal hemorrhage was bilateral. Fine needle aspiration was performed to confirm the diagnosis in one case. The babies were followed-up until adrenal calcifications were seen on ultrasound as linear echoes with posterior acoustic shadowing. These calcifications were confirmed by plain films. It is suggested that the diagnosis of neonatal adrenal hemorrhage should be based on ultrasound and on one initial intravenous urogram. Follow-up examinations should be restricted to ultrasound and plain films. In doubtful cases fine needle aspiration can be added for confirmation.

Sonographic features of gastrointestinal leiomyosarcoma.

Five cases of gastrointestinal leiomyosarcoma were studied by ultrasound. Sonographic features of a huge mass with a thick echogenic rim and central sonolucent cavitation were seen in four cases with presenting symptoms of an abdominal mass. In a fifth case necrotic metastasis was seen in the liver after removal of a leiomyosarcoma. Although not pathognomonic, such features should strongly suggest the diagnosis of leiomyosarcoma.

Human tails.

Two children and one infant with a "human tail" are presented. The patho-embryology of this medical curiosity is briefly discussed. Treatment is usually unnecessary but resection of part of the coccyx together with the "tail" may become indicated by coccygodynia or for aesthetic reasons.

Non-functioning islet cell tumours of the pancreas: a review of radiological literature and a report on two cases.

Two cases of endocrine inactive malignant islet cell tumors diagnosed by angiography are presented. The angiographic features are described and the differential diagnosis of the tumor and its metastases are discussed. Radiological literature of the past decade on this subject is reviewed.

Splenic echinococcal cyst burrowing into left pleural space.

We describe a rare case of hydatid cyst in the spleen which communicated to the left pleural cavity. The patient presented with respiratory distress, characterized by nonproductive cough and dyspnea. The difficulties in diagnosis, using standard laboratory and radiologic techniques, were overcome by the use of ultrasound examination diagnosing both the cysts and the supra-diaphragmatic extension.