Encapsulated living worms due to periorbital dirofilariasis: detection with high-resolution sonography.

Sonography (US) is commonly required when a superficial lump appears. We present the case of a patient for whom US was highly suggestive of living worms causing a recurrent periorbital mass. After surgery, the final diagnosis was a nodule composed of dirofilariasis larva.

Color Doppler sonography of small bowel wall changes in 21 consecutive cases of acute mesenteric ischemia.

AIM OF THE STUDY: To describe the small bowel wall changes observed with color Doppler sonography in acute mesenteric ischemia with comparison with its outcome. MATERIAL AND METHODS: We reviewed the sonographic findings of 21 patients with a final diagnosis of acute mesenteric ischemia (12 acute arterial forms and 9 acute venous forms). These examinations included identification of non peristaltic thin-walled fluid-filled intestinal loops (with or without pneumatosis), thickened intestinal wall (> 3 mm) (noted as stratified or not), and preserved or absent mural flow assessed with color Doppler. Sonographic findings were compared with the surgical data (n = 16) or with the clinical outcome (n = 5). RESULTS: In acute arterial ischemia, non-peristaltic thin-walled intestinal loops were detected with sonography in five cases, with visualization of pneumatosis in one. Bowel infarction was diagnosed in four of these five patients including one patient with pneumatosis. Thickened bowel loops were sonographically detected in four cases, of which 3 required resection. Conservative therapy was performed in the remaining case having preserved wall stratification and mural flow with color Doppler. In acute venous ischemia, thickened bowel loops were detected with sonography in six cases. Conservative therapy was performed in three cases for whom preserved mural flow was noted. Stratification was present in two of these three cases. CONCLUSION: In acute arterial ischemia, intestinal resection is frequently required when non-peristaltic, thin-walled, fluid-filled loops are detected with sonography. In arterial and venous ischemia, absence of wall stratification and mural flow are frequently associated with ischemia requiring surgery.

Focal bowel wall changes detected with colour Doppler ultrasound: diagnostic value in acute non-diverticular diseases of the colon.

We performed a study to determine if colour Doppler findings may help to identify the cause of wall thickening in acute non-diverticular diseases of the colon. The study group included 66 patients admitted to the emergency department with a final diagnosis of infectious colitis (n=23), inflammatory colitis (n=10), ischaemic colitis (n=23) and malignant tumours (n=10). The following ultrasound features were assessed: maximal wall thickness, wall stratification, arterial flow in the colonic wall and arteriolar resistive index. Higher values of wall thickness were observed in malignant tumour (18.2+/-6.2 mm, p<0.001). Moderately thickened wall (6.6+/-1.3 mm, p< or =0.06), preserved stratification (90% versus 46% in the remainder of the study population) and lower resistive index (0.51+/-0.10, p< or =0.05) were significantly related to inflammatory colitis. Absence of arterial flow was more frequently observed in ischaemia (43% versus 12% in the remainder of the study population). In conclusion, despite some overlap, both ultrasound and colour Doppler features are helpful in the differential diagnosis of colonic thickening related to non-diverticular colonic lesions.

Vascular lesions of the liver and gastrointestinal tract.

In the liver, imaging can show lesions of large and medium-sized vessels, perfusion disorders related to vascular lesions, and parenchymal lesions including infarcts, regenerative nodules, and focal nodular hyperplasia. In the gastrointestinal tract, vascular lesions often result in bowel ischemia. Imaging can be used to show the vascular lesions and bowel wall abnormalities, including mural thickening, lack of perfusion, and pneumatosis. Doppler sonography, multislice helical computed tomography (CT), magnetic resonance (MR) imaging, and angiography are useful to demonstrate vascular lesions. Doppler sonography offers high spatial and temporal resolution. Information about blood flow and velocity can be obtained. However, the visualization of retroperitoneal vessels is often limited because of intestinal gas. A global view of the abdominal vasculature can be observed by using helical CT. High spatial and temporal resolution are obtained, especially when new multislice CT scanners are used. MR imaging has a better contrast resolution than CT, but its spatial resolution is lower. MR imaging can also be used to measure flow with phase contrast methods. The role of arteriography in the diagnosis of vascular lesions is decreasing. However, its role remains important to definitively demonstrate obstruction of the hepatic artery and to show arterial lesions in acute mesenteric ischemia. In addition, it is used as a problem-solving method to detect lesions in medium-sized vessels and to guide intravascular treatment.

Epiploic appendagitis: color Doppler sonographic findings.

The aim of this study was to analyze the color Doppler sonographic findings in primary epiploic appendagitis. Color Doppler sonographic findings of ten patients with primary epiploic appendagitis were reviewed. The following sonographic features were analyzed: identification of a mass adjacent to the colonic wall; identification of spotty color areas with arterial flow in this mass and detection of abnormalities of the colonic wall adjacent to the infiltrated fatty tissue. A well-delineated hyperechoic mass adjacent to the colonic wall was detected in each patient with sonography. No colonic wall abnormalities were observed nor color Doppler signal in and around the hyperechoic area. Absence of flow at color Doppler sonography is an additional feature of epiploic appendagitis.

[Chronic arterial mesenteric ischemia: Doppler color ultrasonography demonstration of collateral flow]. / Ischémie mésentérique chronique d'origine artérielle: mise en évidence de réseaux de vicariance par échographie Doppler couleur.

Two cases of atypical mesenteric ischemia where color Doppler US demonstration of the underlying arterial abnormality and collateral supply was possible are presented. Significant stenosis of the celiac axis and thrombosis of the SMA were clearly depicted, along with the presence of collateral arterial supply. Endovascular treatment was successful in both cases. These cases confirm the possibility of detecting collateral flow at Doppler imaging in patients with mesenteric ischemia, both for diagnosis of mesenteric ischemia and endovascular treatment planning.

[The syndrome of external ligament sprain in the horse]. / Le syndrome de l'entorse externe de la cheville.

The treatment of acute complete (grade III) tears of the lateral ligaments of the ankle has generated much controversy in the medical literature. Functional treatment has become the standard treatment as it has been shown that there is no significant difference in long term results whatever the treatment (operative repair and cast, cast alone, or early controlled mobilization). Functional treatment includes only a short period of protection by tape bandage or brace and allows early weight-bearing. Major trauma with avulsion of bone and severe ligamentous damage on both medial and lateral sides of the ankle is however an indication for surgical treatment in the acute phase. Secondary operative reconstruction can be performed in case of persistent instability and laxity of the ankle. Secondary anatomic repair as proposed by Brodström, Duquennoy et al. and Karlsson et al. has a high rate of success and avoids the potential morbidity of harvesting partially or totally the peroneus brevis or other tendon grafts. Evaluation of the injured ankle has improved and in selected patients ultrasonography, arthrography, magnetic resonance imaging or bone scintigraphy may be useful for further evaluation of the injury. The frequency of associated injuries has probably been underestimated. Although ankle sprain is often thought of as an injury involving only the lateral ankle ligaments, there are varied and multiple components to the common sprained ankle. This condition would perhaps more appropriately be designated as the sprained ankle syndrome.

Prognosis of ischemic colitis: comparison of color doppler sonography with early clinical and laboratory findings.

OBJECTIVE: The objective of this study was to compare the value of color Doppler sonography with early clinical and laboratory findings in determining the prognosis of patients with ischemic colitis. SUBJECTS AND METHODS: We reviewed the early clinical, laboratory, and color Doppler sonographic data of 24 patients with ischemic colitis. The patients were divided into two groups on the basis of their outcome. The first group comprised the patients with transient ischemia who recovered uneventfully, and the second group included the patients who needed surgery because of symptomatic transmural colic gangrene or colic stricture. Clinical data and laboratory values were compared with color Doppler sonographic findings including colic wall thickness, presence of stratification, and arterial flow in the bowel wall. RESULTS: At univariate analysis, increased age (p = 0.007), leukocyte count (p = 0.030), lactate dehydrogenase level (p = 0.030), blood lactate level (p = 0.041), and absence of vascular flow in the colic wall (p<0.001) were significantly related to complicated ischemic colitis. At multivariate analysis, absence of arterial flow was the only significant predictor of complicated ischemic colitis (p = 0.002), with a sensitivity of 82%, a specificity of 92%, a positive predictive value of 90%, and a negative predictive value of 86%. CONCLUSION: Absence of arterial flow in the wall of the ischemic colon on initial color Doppler sonography is suggestive of an unfavorable outcome and is more closely associated with outcome than early clinical and laboratory findings.

Sonographic detection of intestinal pneumatosis.

Intestinal pneumatosis is an uncommon affection characterized by the presence of gas in the wall of the gastro-intestinal tract. The prognosis of this condition, observed in benign or severe diseases, is based on the outcome of the underlying affection. The diagnosis of pneumatosis intestinalis is unusually made with sonography. We report a case of pneumatosis intestinalis due to small bowel necrosis, initially suggested with sonography and further confirmed with computed tomography (CT) and pathology.

[Radiology and emergency medicine: state of the art]. / Radiologie et medecine d'urgence: etat de la question.

Emergency medicine has emerged as a specific medical specialty for 30 years. To be efficient, the emergency clinician frequently needs the contribution of radiological examinations. This is the reason why emergency radiology has emerged as a new radiologic subspecialty. The aim of this paper is to review the recent history of emergency medicine and to summarize the present state of the radiological organisation for emergency care in the Western countries.

[The contribution of ultrasonography to the diagnosis of acute intestinal diseases in adults]. / Contribution de l'echographie au diagnostic des affections intestinales aigues de l'adulte.

Various acute intestinal diseases can be imaged with ultrasound and in particular intestinal occlusion, acute ischemia and inflammatory diseases such as appendicitis and diverticulitis. We review the contribution and limitations of ultrasound to these diagnoses.

Early diagnosis of acute intestinal ischaemia: contribution of colour Doppler sonography.

The aim of this study was to evaluate the contribution of colour Doppler sonography in the diagnosis of acute intestinal ischaemia. In a two years experience, all patients admitted for acute abdominal pain in our emergency department were evaluated with colour Doppler sonography of the abdomen. The final diagnosis based on clinical evolution, endoscopic or surgical findings and further radiological investigations was compared to the sonographic results. Therapy and final outcome of the patients with acute intestinal ischaemia were also evaluated. In twenty-one patients a final diagnosis of acute intestinal ischaemia (mesenteric ischaemia (n = 13) and ischaemic colitis (n = 8)) was made. Intestinal ischaemia was correctly diagnosed by initial clinical and biological data and further confirmed by sonography in eight cases (mesenteric ischaemia (n = 2) and ischaemic colitis (n = 6)). Eleven other cases were detected by suggestive colour Doppler sonography features (mesenteric ischaemic (n = 10) and ischaemic colitis (n = 1)). Sixteen of the 21 patients had a final favourable outcome (mesenteric ischaemia (10/ 13) and ischaemic colitis (6/8)). We conclude that sonography has a place in the diagnosis of acute intestinal ischaemia and has to be integrated in the diagnostic algorithm of this acute condition. By this way, this diagnosis may be suspected earlier and may allow a prompt and adapted treatment with possible improvement in survival rate.

[Value of echography in the diagnosis of acute intestinal occlusion]. / Intérêt de l'échographie dans le diagnostic de l'occlusion intestinale aiguë.

OBJECTIVE: The aim of our study was to assess the value of sonography in the diagnosis of acute intestinal occlusion. MATERIAL AND METHODS: Sonographic findings were reviewed in 50 cases of intestinal occlusion (39 small bowel and 11 colonic occlusions). The final diagnosis was based on surgical findings (n = 40) or clinical course and further imaging findings (n = 10). RESULTS: Occlusion was correctly detected with sonography in 48 cases (96%). The location was correctly established with sonography in 43 cases (86%). The precise cause was suggested with sonography in 21 cases (42%). COMMENTARY: These results confirm the value of sonography for the diagnosis of intestinal occlusion and the identification of its level and its cause.

Acute intestinal ischemia due to occlusion of the superior mesenteric artery: detection with Doppler sonography.

The aim of our study was to assess the feasibility of using Doppler sonography for the detection of acute intestinal ischemia due to occlusion of the superior mesenteric artery. Between September 1993 and March 1995, abdominal sonography with Doppler imaging of the mesenteric vessels was performed in 770 patients with emergency admissions for acute abdominal pain. In six cases, the diagnosis, based on surgery or arteriography and computed tomography, was acute intestinal ischemia due to complete or localized occlusion of the superior mesenteric artery. Five cases of occlusion of the superior mesenteric artery were correctly detected by Doppler sonography. These results suggest that Doppler sonography may be a feasible method for detecting acute intestinal ischemia due to proximal superior mesenteric artery occlusion.

Diagnosis of acute intestinal ischemia by color Doppler sonography. Color Doppler sonography and acute intestinal ischemia.

Detection of acute intestinal ischemia is a diagnostic challenge. Color Doppler sonography of the abdomen may contribute to its diagnosis by showing lesions of the gut wall associated with occlusion or stenosis of the mesenteric vessels. Our overview of the sonographic findings of acute intestinal ischemia is presented as well as a proposition of algorithm for the working up to the diagnosis based on recent clinical experience.