The role of the color Doppler ultrasonography and computed tomography in estimation of portal hypertension.

Introduction: Liver diseases with disturbances of hepatic and splanchnic circulation lead to the portal hypertension, with or without a portal vein thrombosis. Objective: This study was based on the testing of hypothesis that more data and more precise diagnosis in patients with disorders of portal circulation can be obtained by using color Doppler ultrasonography (CDU) and computed tomography (CT) with contrast. Methods: The study was conducted from February 2011 to May 2014 and it comprised 120 patients who were suspected to have portal hypertension or already had clinical confirmation of the portal hypertension, patients with hepatitis, and some patients with hematological diseases. The first group of 40 patients was examined by conventional ultrasonography and CDU, the second group by contrast CT, and the third group of patients was examined by both methods (CDU and contrast CT). After six months of adequate therapy, the patients had control examinations with the same diagnostic technique used during their first examination. Results: Retrospective analysis showed that CDU is more sensitive than CT in the assessment of presence and age of thrombi (CDU 93.9%; CT 86.1%). CT gives precise data in detection of portosystemic collaterals. Sensitivity of CT is 100% and its specificity is 67%. Cumulative sensitivity and specificity for most parameters were increased in patients with portal hypertension when both methods were applied. Conclusion: This study emphasizes the possibility of early and more accurate diagnosis achieved when combining two radiological techniques (CDU and contrast CT scan), which is not the case when these methods are used separately.

Double primary tumors-renal cell carcinoma and duodenal mucinous adenocarcinoma.

A 59-year old patient was admited to the Gastroenterology Clinic with the signs of gastrointestinal bleeding. Computerized tomography (CT) and a barium-meal radiography revealed a circumferential nodular wall narrowing and incomplete stricture at the D2 part of the duodenum. CT also showed a poorly demarcated mass in the upper and lower poles of the left kidney. During the operation, the whole kidney together with the tumor was removed and also a part of the duodenum. Morphological features of both tumors were typical and distinctive enough to set the diagnosis of two independent primary tumors. The possibility of one being the metastasis of the other was excluded. The diagnosis of double primary malignant neoplasms - renal cell carcinoma and duodenal mucinous adenocarcinoma was made.