Doppler US of the liver made simple.

Doppler ultrasonography (US) is usually the first-line modality for evaluating flow in native liver vessels and transjugular intrahepatic portosystemic shunts (TIPS). Waveforms, which represent flow in each of the major vessels and in TIPS, have been well described. The appearance of these waveforms should be recognized, and the mechanisms behind their generation should be understood by those interpreting these examinations. Understanding how waveforms are formed--that is, their mechanisms for generation--is predicated on knowing basic vascular Doppler concepts and established nomenclature. This article is a review of these basic concepts and nomenclature as applied to the interpretation of liver Doppler US waveforms.

Comparison of 2 oral ultrasonography contrast agents: simethicone-coated cellulose and simethicone-water rotation in improving pancreatic visualization.

PURPOSE: The purpose of this study was to prospectively compare the efficacy of 2 oral ultrasonography (US) contrast agents (simethicone-water rotation [SWR] and simethicone-coated cellulose [SCC]) in improving visualization of the pancreas. METHODS: Two sessions (SWR and SCC) of transabdominal US studies were performed on 38 healthy volunteers. In each session, US images were obtained in precontrast supine and upright positions and postcontrast supine and upright positions. The visualization of the pancreas was graded on a scale of 1 to 5 (1 = nonvisualization, 5 = excellent visualization), grading the head, body, and tail separately. RESULTS: In the supine position, SWR significantly improved the visualization of the pancreatic head, body, and tail, whereas there were no significant differences between SCC and precontrast images. Simethicone-water rotation showed significantly better visualization than SCC. The average scores of the head, body, and tail of the pancreas that graded 4 or more were 15.8% of precontrast, 21.1% of SCC, and 50% of SWR. In the upright position, both SWR and SCC significantly improved the visualization of the pancreas, except for the pancreatic body on SCC. There were no significant differences between SWR and SCC. The average scores that graded 4 or more were 26.3% of precontrast, 57.9% of SCC, and 65.8% of SWR. CONCLUSION: Simethicone-water rotation was more effective than SCC in improving the visualization of the pancreas.

Safety of ultrasound-guided fine needle aspiration biopsy of neck lesions in patients taking antithrombotic/anticoagulant medications.

We examined records of patients who underwent ultrasound-guided fine needle aspiration biopsy (USGFNAB) of neck lesions to determine whether there was a significantly increased incidence of bleeding complications in patients on antithrombotic and/or anticoagulant (AT/AC) medications compared to patients not receiving AT/AC therapy. Our institutional review board approved this Health Insurance Portability and Accountability Act-compliant retrospective examination of patients' medical data without requiring informed consent. The records of 593 patients (422 women and 171 men ranging from 18 to 91 years of age) who underwent USGFNAB of 788 total neck lesions over an 18-month period were reviewed to determine AT/AC medication used and evidence of USGFNAB-related bleeding complications. Of these, 144 patients (24.3%) were taking one or more AT/AC medications including aspirin, clopidogrel, heparin, and warfarin. The χ2 test was used to assess statistically significant differences in the incidence of USGFNAB-related bleeding complications between patients who were on daily AT/AC medications (test group) and patients who were not (control group). Six USGFNAB-related hematomas (1.0%) occurred. Two hematomas developed in patients on AT/AC medications, and 4 hematomas developed in patients who did not take AT/AC medications (χ = 0.27, df = 1, P = 0.603). This study shows no statistically significant difference in the incidence of hematoma formation after USGFNAB of neck lesions in patients taking AT/AC medications compared to patients not taking AT/AC medications. On the basis of these data, there is no benefit, with regard to incidence of bleeding complications, to discontinuing AT/AC medications in patients undergoing USGFNAB of neck masses.

Tubular ectasia of the epididymis: a sign of postvasectomy status.

PURPOSE: To find out if "tubular ectasia of the epididymis" is suggestive of postvasectomy status. METHODS: Tubular ectasia of the epididymis is defined as enlargement of the epididymis with multiple interfaces (i.e., a speckled appearance). We found 24 cases exhibiting tubular ectasia of the epididymis over a period of six years. We reviewed the sonographic findings of tubular ectasia of the epididymis and evaluated the prevalence of associated findings. RESULTS: In 24 patients with tubular ectasia of the epididymis, 16 cases were bilateral, five were right-sided, and three were left-sided. Twenty-one patients had history of vasectomy, of the three remaining cases, 1 had history of inguinal hernia repair, one had prostatitis, and one had undetermined etiology. Associated abnormalities included dilated vas deferens (n = 4), tubular ectasia of the testis (n = 2), large spermatoceles (n = 6), hydrocele (n = 3), and varicocele (n = 4). In 2 cases, spermatic granulomas were suspected. CONCLUSION: Tubular ectasia of the epididymis is suggestive of postvasectomy epididymis. This sonographic feature is helpful in evaluating a patient with scrotal discomfort. However, this sign can also be associated with other causes of vas obstruction.

Enlargement and hypervascularity of both the epididymis and testis do not exclude involvement with lymphoma or leukemia.

We present 3 cases of diffuse infiltration of the testes and epididymides by malignant lymphoma and leukemia. Gray-scale and color Doppler sonograms showed diffuse hypoechoic enlargement and hypervascularity of the involved testes and epididymides. The authors emphasize that enlargement and hypervascularity of both the epididymis and testis can be caused by lymphomatous/leukemic involvement and is not always indicative of epididymo-orchitis.