Hepatic amebiasis among patients in a public teaching hospital.

The increase in immigration to the United States is associated with diseases, such as amebiasis, that are endemic to developing countries. We retrospectively reviewed 49 public-hospital patients with hepatic amebiasis occurring between 1985 and 1995. Most patients were immigrants (47) from Latin America (43), male (43), and young (mean age, 39.8 years). Symptoms noted by more than half were abdominal pain and fever. Ultrasonography showed single lesions in 70% and right-sided involvement in 85%. Serologies against Entamoeba histolytica were noted in 86%. After treatment, the median interval from admission to defervescence was 2 days, to normalization of white cell count 3 days, and to resolution of abdominal pain 4 days. Morbidity (one case of pericarditis) and mortality (one death in a cirrhotic man) were low. Hepatic amebiasis continues to be diagnosed in the United States, primarily among Hispanic and Asian immigrants. When appropriately considered, current diagnostic and therapeutic modalities result in rapid improvement and excellent outcome.

Hypertrophic pyloric stenosis in the neonate--diagnostic criteria revisited.

The authors analysed 45 ultrasonography (US) studies of 43 infants with surgically confirmed hypertrophic pyloric stenosis (HPS) to ascertain whether the current US criteria for pyloric stenosis are applicable to all infants, including those 30 days of age and younger. Most articles in the radiologic literature cite a muscle thickness of 4 mm or greater and a pyloric canal length of 17 mm or greater as diagnostic of HPS. However, the results of this study suggest that in infants 30 days of age or younger the muscle thickness considered diagnostic for HPS be 3 mm or greater.

Sonographic demonstration of air in the myometrium. A complication of culdocentesis.

Six cases are presented in which air was seen in the myometrium in the distribution of the arcuate vessels during sonography performed after culdocentesis to exclude ectopic pregnancy. Three of these patients had viable intrauterine pregnancies; the others had an incomplete abortion, a complete abortion, and a right ectopic pregnancy. This relatively rare complication of culdocentesis should be kept in mind, especially when scanning patients with suspected inflammatory process of the uterus, so as not to confuse air in the arcuate vessels with a uterine abscess.

Metastasis to the bladder from pancreatic adenocarcinoma presenting with hematuria.

Pancreatic adenocarcinoma infrequently involves the urinary tract. Hematuria may result from either direct invasion of the kidneys or from metastases to the urinary tract. The bladder may be involved in the late stages from metastases, but rarely is it associated with hematuria since mucosal involvement is very unusual. We report a second case of bladder metastases and hematuria as a presenting symptom of pancreatic carcinoma.

Comparison of transvaginal and transabdominal ultrasonography in ectopic pregnancy.

The authors retrospectively reviewed 45 consecutive cases of proven ectopic pregnancy for which both transvaginal (TV) and transabdominal (TA) ultrasonography had been performed to compare the diagnostic efficacy of the two imaging techniques. The criteria for a diagnosis of ectopic gestation included an extrauterine gestational sac containing a fetus or a fetal pole, or an empty extrauterine sac. Solid or complex adnexal masses with evidence of hemoperitoneum were considered suggestive but nondiagnostic. TV ultrasonography was superior to TA ultrasonography in 22 cases (49%) and inferior in 3 (7%). In the remaining 20 cases (44%) the two methods yielded similar information. For cases in which TV ultrasonography was superior, this method provided clear evidence of ectopic pregnancy in 11 cases in which TA ultrasonography demonstrated nonspecific masses or normal adnexa; in the other 11 cases both methods led to the correct diagnosis, but TV ultrasonography provided additional useful information. The authors conclude that TV ultrasonography has a definite role in improving the diagnosis of ectopic pregnancy.

Massive hepatic necrosis in the HELLP syndrome: CT correlation.

We present a patient with toxemia of pregnancy and the HELLP syndrome [hemolysis (H), elevated liver enzymes (EL), and a low platelet count (LP)] resulting in massive hepatic necrosis. Cross-sectional imaging, including sonography, computed tomography, and nuclear medicine, was instrumental in the diagnosis and differentiation from hepatic abnormalities of other pregnancy related entities especially acute fatty liver of pregnancy.

The spectrum of sonographic findings in endometriomas.

The sonographic features of 40 pathologically proven endometriomas in 32 patients were reviewed to evaluate their sonographic spectrum. Acoustic enhancement was present in 88% and indeterminate in 10% due to technical factors. With respect to internal echo texture, the majority of endometriomas were predominantly anechoic (80%): 7 were totally anechoic; 4 contained septations; 12 contained scattered internal echoes, with or without septations; and 9 contained dependent echoes, with or without septations. Seven endometriomas contained diffuse, low-level internal echoes and were considered hypoechoic, but still fluid-containing masses. Only 1 was echogenic. The overall appearance frequently simulated that of hemorrhagic ovarian cyst, but in some cases endometriomas resembled tubo-ovarian abscess, cystadenoma/cystadenocarcinoma, or ectopic pregnancy.

Aggressive infantile fibromatosis. Pulmonary metastases documented by plain film and computed tomography.

Aggressive infantile fibromatosis, one of the juvenile fibromatoses, is generally considered a benign lesion, but it does tend to recur locally because of its invasive nature. Distant metastases are considered rare. This case report documents pulmonary metastases arising 2 years after resection of the primary lesion from the thigh of an infant. This is the seventh reported case of distant metastasis from aggressive infantile fibromatosis. Computed tomography of the original lesion as well as the metastases are presented.

Abdominal cryptococcoma in AIDS: a case report.

Cryptococcosis is a recognized opportunistic pathogen in the acquired immune deficiency syndrome. Although central nervous system infection and disseminated cryptococcosis is common in acquired immune deficiency syndrome, localized infection is rare. We present a case of massive retroperitoneal and mesenteric adenopathy in a male homosexual patient with acquired immune deficiency syndrome with clinical and radiologic features suggestive of lymphoma. However, this was proven pathologically to represent cryptococcal infiltration of the lymph nodes. Our experience indicates that Cryptococcus neoformans should be included in the differential diagnosis of massive abdominal adenopathy in the acquired immune deficiency syndrome.

Sonographic findings in traumatic hemobilia: report of two cases and review of the literature.

Hemobilia consists of an arteriobiliary fistula, usually due to central liver rupture with bleeding into the biliary tree. It is due to trauma in over 50% of cases, with an increasing incidence of iatrogenically caused hemobilia. The sonographic findings in two cases of traumatic hemobilia are presented and the literature is reviewed. These findings include clot within the gallbladder and the extrahepatic ducts, liver hematoma, and aneurysm of the hepatic artery.

Sonography of ovarian fibromas/thecomas.

The sonographic findings in 14 patients with ovarian fibromas/thecomas are described. A broad spectrum of sonographic features are presented and include hypoechoic mass with posterior shadowing (two cases); anechoic mass with good through transmission (with septations, two cases; without septations, four cases), echogenic mass with well-defined posterior wall (three cases); calcified mass (two cases); mixed echogenicity mass (one case). The pattern of a hypoechoic adnexal mass with acoustic shadowing should still suggest a fibroma/thecoma, but in most cases the appearance is nonspecific.

Sonographic features of Brenner tumor of the ovary.

The sonographic findings in four patients with benign Brenner tumors of the ovary are described. Computed tomography (CT) was also obtained in one case. The neoplasms were solid, hypoechoic masses, usually exhibiting good through transmission of sound. Two neoplasms contained peripheral calcifications; one was inseparable from the uterus and was misdiagnosed as a leiomyoma; the other was well-demonstrated by CT but only in retrospect was the peripherally located calcification identified. Sonographically, Brenner tumors are similar to other solid ovarian neoplasms, particularly fibromas-thecomas, and can also be confused with pedunculated leiomyomas.

Sonography in the diagnosis of hepatic artery aneurysms.

In five cases of hepatic artery aneurysms, the findings on sonography suggested the diagnosis or indicated the need for angiography. The intrahepatic aneurysms (four cases) were anechoic, well-circumscribed masses with good through transmission of sound. None were pulsatile, but flow within the mass was observed in one case. An intrahepatic mass adjacent to the aneurysm was identified in every case, representing hematoma in three and postoperative abscess in one. The sonogram in a patient with a common hepatic artery aneurysm (one case) showed a lobulated, pulsatile, anechoic mass within a pancreatic head pseudocyst. Sonography offers a noninvasive means of screening for this abnormality.

Psoas abscess in children.

In children, psoas abscess does not head the list in the differential diagnosis of the child who presents with a limp or lower abdominal pain. Therefore, the road to this diagnosis can be long and complicated leading to numerous studies and specialty consultations. Over a 7-year period, seven psoas abscesses have been drained surgically. All were Staphylococcal though one was mixed. In each case, the original admitting diagnosis was that of septic arthritis of the hip. In general, this diagnosis was ruled out by negative hip aspirations and bone scans. Often, the severity of symptoms led to persistent evaluation with noninvasive tests such as gallium scan, intravenous pyelogram, or barium enema. Though these tests were often suggestive, a positive ultrasound or CT scan was the key studies diagnostic enough to warrant surgical exploration and drainage. During this time period, there have been no negative explorations for psoas abscess. Upon surgical drainage, all patients improved, with subsequent recovery of hip function. The child who presents with a limp or painful hip should be considered for ultrasonography or computerized tomography once hip pathology is ruled out. We feel that the results of other tests such as gallium scan, IVP, or barium enema are not sufficiently specific to indicate surgery.

Recurrent and metastatic retroperitoneal hemangiopericytoma.

The computed tomography findings in a case of recurrent retroperitoneal hemangiopericytoma with an abdominal wall metastasis are reported. The lesions were well-circumscribed solid masses with varying computed tomography densities. The computed tomography findings in hemangiopericytoma are not pathognomonic; however, a patient with a history of this tumor, computed tomography can suggest recurrence or metastasis and define the location and extent of disease prior to surgical intervention.

Sonographic features of parovarian cysts.

Parovarian cysts are responsible for about 10% of all adnexal masses. They arise from the tissues of the broad ligament, predominantly from mesothelium covering the peritoneum but also from paramesonephric and mesonephric remnants. When large, they become symptomatic due to pressure effect. Clinically it is difficult to distinguish an ovarian mass from one arising in the parovarium. A series of eight surgically and pathologically proven parovarian cysts is presented. All were symptomatic and most were palpable. Sonographically they were thin-walled, smoothly marginated, unilocular cysts. Six of the eight were located superior to the fundus of the uterus. Parovarian cysts should be included in the differential diagnosis along with large physiologic ovarian cysts and unilocular ovarian cystadenoma when a mass with the above sonographic features is demonstrated.