Utility of intrarenal Doppler ultrasound in the diagnosis of renal artery stenosis.

PURPOSE: To determine the utility of intrarenal Doppler parameters and waveform analysis in a hypertensive population screened for renal artery stenosis (RAS). MATERIALS AND METHODS: Sixty five patients were studied (122 kidneys) with intrarenal Doppler sonography. Doppler waveforms of three different areas from each kidney were obtained (superior, middle and inferior level). Waveform morphology, acceleration time (AT), acceleration (Ac) and resistive index (RI) were evaluated in each kidney, comparing retrospectively the Doppler findings with the angiographic results. RESULTS: Arteriography demonstrated 33 (27.2%) renal arteries with stenosis (18 with RAS>75%). Statistically significant differences for AT and Ac were found among the patients with RAS>75% and the other groups (P<0.01). An AT>80 ms and an Ac< or =1 m/s(2) showed a sensitivity of 89% and a specificity of 99%, for the diagnosis of RAS>75%. Better results were obtained in patients less than 50 years old (100% of sensitivity and specificity). The morphologic analysis of the Doppler waveform had poor results but the detection of a waveform grade 0 had a high specificity (98%). An additional comparison of both kidneys didn't improve the results. CONCLUSION: Intrarenal Doppler waveform analysis using quantitative measurements (AT and Ac) is an adequate technique for the diagnosis of severe RAS in previously selected patients, especially in younger patients (<50 years).

Metastasis to the breast from extramammary malignancies: a report of four cases and a review of literature.

Breast metastases from extramammary tumours are rare with few cases reported. Four cases of metastasis to the breast are presented and the diagnostic problems of this condition are reviewed. Correlation between the histology of primary tumour and the cytology of breast metastatic tumour can avoid the surgical breast biopsy and unnecessary mastectomy. Metastasis to the breast has poor prognosis.

Gallstone ileus: increased diagnostic sensitivity by combining plain film and ultrasound.

BACKGROUND: Gallstone ileus is an uncommon cause of mechanical obstruction. Its high mortality rate can be reduced with earlier diagnosis and treatment. We wanted to determine whether ultrasound (US) performed after plain film increases the sensitivity for the preoperative diagnosis. METHODS: We performed a 5-year retrospective analysis of radiologic and sonographic results of 23 patients who had surgery because of gallstone ileus. RESULTS: Rigler's triad was identified by plain abdominal film in two patients (9%) and by US in 16 patients (69%). Plain abdominal film contributed to a definitive diagnosis in four cases and to a probable diagnosis in six cases (sensitivities of 17% for definitive diagnoses and 43% for definitive and probable diagnoses). US confirmed the diagnosis in six cases of probable gallstone ileus and provided the diagnosis in seven of 13 patients without suspected gallstone ileus based on plain abdominal film. The best results were obtained by combining plain film and US findings, with sensitivities of 74% for definitive diagnoses and 96% for definitive plus probable diagnoses. CONCLUSION: The preoperative diagnosis of gallstone ileus significantly increases by combining plain film and US findings.

Appendicular involvement in perforated sigmoid disease: US and CT findings.

We describe four patients in whom ultrasound (US) and/or computed tomography (CT) demonstrated a thickened appendix, secondarily enlarged due to perforated sigmoid diverticulitis (n = 2) or carcinoma (n = 2). The underlying pathology was correctly recognized in all cases. Secondary thickening of the appendix due to perforated sigmoid disease provides a potential pitfall mainly on US and may lead to an incorrect diagnosis and thus to unnecessary surgery or a wrong surgical intervention. Although US alone is enough to diagnose periappendicitis and sigmoid disease, combined use of US and CT may improve assessment of its origin and extension.

Primary epiploic appendagitis: US and CT findings.

A retrospective review is presented of seven cases of epiploic appendagitis, with surgical confirmation in one case. The main clinico-analytical data and the US and CT findings are described, as well as the histopathologic features in the sole case that underwent surgical resection. We also calculated the frequency of this entity in patients undergoing emergency abdominal US on clinical suspicion of diverticulitis. In all seven cases the clinico-analytical evidence was nonspecific (localized acute abdominal pain and slight leukocytosis), mimicking in six cases the clinical presentation of sigmoid diverticulitis and in one case that of acute appendicitis. US imaging findings were characteristic: a hyperechoic mass localized under the point of maximum pain, adjacent to the anterior peritoneal wall and fixed during deep breathing. In none of the cases did color Doppler US show flow. CT findings were also typical and showed a mass with a peripheral hyperattenuated rim surrounding an area of fatty attenuation. Overall 7.1 % of patients investigated to exclude sigmoid diverticulitis finally showed findings of primary epiploic appendagitis. Primary epiploic appendagitis thus shows characteristic US and CT findings that allow its diagnosis and follow-up. This entity is much more frequent than previously reported, especially in patients referred for US to exclude sigmoid diverticulitis.

Diseases that simulate acute appendicitis on ultrasound.

Ultrasound is useful in the assessment of patients with possible appendicitis. A diagnosis of appendicitis can be made in patients with persistent right lower quadrant pain when a non-compressible appendix greater than 6 mm in diameter is shown. When a normal appendix is affected by an adjacent lesion, reactive inflammation can cause secondary enlargement of the appendix. This article reviews ultrasound findings in conditions which can clinically mimic acute appendicitis. Examples of Crohn's disease, tuboovarian abscess, typhilitis, sigmoid diverticulitis, perforated sigmoid neoplasm, perforated peptic ulcer, perforated acute cholecystitis, caecal carcinoma and appendiceal tumours are included.