Abdominal Sonographic Findings Research Articles

Ultrasound role in diagnosis and as an assisting tool in prognostication of surgery in neonates with necrotizing enterocolitis

ObjectiveAbdominal ultrasonography (AUS) assessment of the neonatal abdomen is emerging as a potential useful addition to traditional abdominal radiographs (AXR) to confirm the diagnosis of necrotizing enterocolitis (NEC). The goal of this study was to assess the abdominal sonographic findings of premature infants with NEC, in order to determine whether AUS is more effective than AXR in the diagnosis of NEC. MethodsThis cross-sectional study was performed on consecutive neonates with clinical suspicion of NEC admitted in our hospital’s NICU (Ali-Asghar Children’s Hospital, Tehran, Iran). We prospectively evaluated the hospitalized subjects using AXR and AUS from May 2018 to May 2020. ResultsA total of 53 neonates were included in the study. These patients were divided into two groups: suspected NEC patients (stage I) including 31 subjects and definite NEC patients (stage II and III) including 22 neonates. We found a substantial agreement between the two modalities regarding the detection of pneumoperitoneum and pneumatosis intestinalis (κ: 0·658 for both). The concordance concerning portal venous gas detection was considered slight (κ: 0·315). Thirty-eight patients did not show any signs of portal venous gas in either of AUS or AXR. On the contrary, four patients demonstrated evidences of portal venous gas in both AUS and AXR. AUS detected ten more portal venous gas than AXR. AXR found no cases with positive portal venous gas that were undetected by AUS. The most predictive indicator for surgical intervention in neonates was the presence of free echogenic ascites and loculated fluid. ConclusionOur findings demonstrated that AUS is superior to AXR in demonstrating portal venous gas and pneumatosis intestinalis. Hence, it seems that AUS is a useful adjunct to AXR in the management of NEC.

Portable Abdominal Sonographic Findings and Characteristics of Service Users in the Community

Portable Abdominal Sonographic Findings and Characteristics of Service Users in the Community

Sonographic detection of abdominal pathologies in human immunodeficiency virus/acquired immunodeficiency syndrome patients and its correlation with CD4 counts – A prospective analysis

Objectives: Abdominal pathologies are the second most common after pulmonary diseases in human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) patients. Ultrasonography (USG) is a vital imaging technique for the evaluation of abdominal pathologies. This study was aimed at evaluating the abdominal pathologies using USG in HIV/AIDS and further analysis of its correlation with CD4 count. Material and Methods: The present study was carried out on 392 HIV-positive patients with abnormal abdominal sonographic findings. All data were analyzed by Chi-square test and one-way analysis of variance using SPSS 16.0 software. Results: Of these 392 patients, 66.3% were males, the mean age was 35.7 years, (range 7–64 years) and most of them were in 4th decade. On ultrasonographic evaluation, spleen was involved in 45.2% patients and liver as well as lymph nodes each was involved in 43.6% patients. Other cases displayed ascites and bowel thickening in 5.3% and 3.8% patients, respectively. Less involvement of kidney (2.3%), pancreas (1.5%), and biliary system (1.3%) was observed. In addition, pathologies such as hepatomegaly, splenomegaly, splenic microabscess, focal pancreatic lesion, mesenteric, and periportal lymphadenopathy showed significant correlation with CD4 counts. Lymphoma was found in 1% of patients, involving liver, pancreas, and retroperitoneal lymph nodes. Conclusion: Our study highlights the clinical utility of abdominal USG in HIV/AIDS patients. CD4 counts largely affect the differential diagnosis in HIV/AIDS patients. USG findings interpreted in the context of CD4 count may help in guiding the exact diagnosis.

PREOPERATIVE PREDICTION OF DIFFICULT LAPAROSCOPIC CHOLECYSTECTOMY: IN ZAGAZIG UNIVERSITY HOSPITALS

Background : Laparoscopic Cholecystectomy (LC) becomes the standard of care for patients requiring removal of gallbladder. LC may be rendered difficult by various problems encountered during procedure. Several factors have been implicated with a difficult case, but no reliable criteria are available yet to identify patients preoperatively with a difficult LC. Preoperative prediction of a difficult LC can help the patient as well as the surgeon prepare better for the intraoperative challenges and tailored approach accordingly. The present study was undertaken to determine the association between preoperative clinical, laboratory and abdominal sonographic findings in patients undergoing LC for cholelithiasis and the technical difficulty at operation and to predict the most important indicators that affect the operation outcome in order to make the procedure safer for the patient as well as the surgeon. Methods : In 300 consecutive patients who underwent LC during 2014 to 2016 patient‟s characteristics, clinical history, laboratory data, ultrasonography results and intraoperative details were prospectively analyzed to evaluate predictors of difficult LC. Results: Gender, age, obesity, history of hospitalization for acute cholecystitis, history of previous ERCP, history of previous abdominal surgery, Gall bladder size, GB wall thickening, pericholecystic fluid collection, large multiple GB stones and liver US findings; The above mentioned factors were found to have a statistical significant association with the final operation out come. Conclusions: Obesity, presence of history of previous abdominal surgery, gall bladder wall thickness and gallbladder stone size by preoperative ultrasound; were found to be the predictive factors of difficult LC in our study. Keywords: Preoperative, Difficult, Laparoscopic cholecystectomy, Prediction .

Crimean-Congo hemorrhagic fever: aid of abdominal ultrasonography in prediction of severity.

Crimean-Congo hemorrhagic fever (CCHF) is a fatal viral infection that involves multiple organs, and endothelium. We described abdominal sonographic findings of the patients infected with the Crimean-Congo hemorrhagic fever virus (CCHFV) in relation to the severity of the disease. This is a prospective study performed among hospitalized patients infected with CCHF between 2005 and 2011. A total of 210 hospitalized patients with confirmed CCHF infection were included in the study. The mean age was 47 and 49.5% of the patients were female. Patients were classified as mild, moderate, or severe disease according to their clinical and laboratory findings. The relationship between the clinical severity of CCHF and the abdominal sonographic findings was analyzed. Sonographic findings of abdomen included gallbladder wall thickening (GBWT) in 44 (21%), splenomegaly in 39 (19%), hepatomegaly in 52 (25%), decrease in echo of liver parenchyma in nine (4%), increase in echo liver parenchyma in 13 (6%), intra-abdominal fluid collection/ascites in 23 (11%), and enlarged periportal lymph nodes in seven (3%) cases. GBWT was detected in 3% of mild patients, 23% of moderate patients, and 61% of severe patients (p<0.001). In multivariate analysis to predict the severity, GBWT (odds ratio [OR] 5.4, confidence interval [CI] 1.76-16.49, p=0.003) and intra-abdominal fluid collection/ascites (OR 3.5, CI 1.07-12.61, p=0.049) were found to be significantly associated with disease severity. In conclusion, ultrasonography is a reliable, useful, and noninvasive diagnostic tool for evaluation of the abdominal findings of the patients with CCHFV infection. GBWT and intra-abdominal fluid collection/ascites were found to be predictors of severity.

Meaning of free intraperitoneal fluid in small-bowel obstruction: preliminary results using high-frequency microsonography in a rat model.

The aim of this study was to detect the onset, evolution, and meaning of extraluminal free fluid in a rat model of small-bowel obstruction using high-frequency microsonography. Small-bowel obstruction was surgically created in 8 rats divided into 2 groups of 4 rats each. All rats were examined by high-frequency microsonography to monitor the evolution of small-bowel obstruction and the abdominal sonographic findings. In group 2 rats, the obstruction was resolved 2 hours after surgery. In all rats, free peritoneal fluid was detected just near the obstructed loop after 1 hour and in the hepatorenal recess after 2 hours. These features progressively increased in the following hours in group 1 rats. In group 2, the amount of free fluid decreased shortly after removing the obstruction. Free fluid is an early finding in small-bowel obstruction, and the increase or decrease of its amount is correlated with the worsening or resolution of the obstruction.

Abdominal Sonographic Findings in Severely Immunosuppressed Human Immunodeficiency Virus-Infected Patients Treated for Tuberculosis

Objective: We describe the abdominal sonographic findings among patients with HIV-tuberculosis (TB) co-infection with advanced immune suppression before initiation of ART and relate these findings to the patients’ abdominal symptoms and CD4 T-cell count. Methods: Consecutive HIV-TB co-infected patients, qualifying for ART, were prospectively enrolled in a cohort study at the Mulago National Tuberculosis and Leprosy Programme clinic in Kampala, Uganda. An abdominal ultrasound was performed at enrolment. Results: A total of 209 HIV-TB co-infected patients (76% with pulmonary, 19% with extrapulmonary TB and 5% with extrapulmonary and pulmonary TB) underwent an abdominal ultrasound scan. Only 49 patients (23.4%) had a normal abdominal ultrasound. The following sonographic abnormalities were found: multiple lymphadenopathy (38%), splenomegaly (18%), renal abnormalities (14%), gastro-intestinal tract abnormalities (thickened bowel loops, appendicitis) (13%), splenic abscesses (13%) and ascites (6%). The commonest groups of enlarged lymph nodes were in the porta-hepatis (19%) and peripancreatic (17%) area and 80% of the enlarged lymph nodes were hypoechoic. Conclusion: Most patients with advanced immune suppression and HIV-TB co-infection have sonographic evidence of generalized TB with abdominal involvement, therefore Ultrasound may assist in the early diagnosis of disseminated TB.

Relationship between non‐alcoholic fatty liver disease and pulmonary function

It has been observed that non-alcoholic fatty liver disease (NAFLD) is associated with an increased risk of cardiovascular disease and insulin resistance. Pulmonary function is also known to be related with cardiovascular disease and metabolic syndrome. The objective of this study was to investigate the association between NAFLD and pulmonary function. We performed a cross-sectional study to examine the association of NAFLD based on abdominal sonographic findings and pulmonary function in 2119 Korean men between the ages of 30 and 75. Forced vital capacity (FVC) and forced expiratory volume in 1 s (FEV(1)) were compared according to the presence of NAFLD. Univariate and multivariate logistic regression analyses were conducted to evaluate the relationship of NAFLD with FVC and FEV(1) as pulmonary function tests. The subjects with NAFLD had lower FVC and FEV(1) than their non-steatotic counterparts, and FVC and FEV(1) gradually decreased according to the grade of hepatic steatosis. After adjusting for age, body mass index, smoking status, blood pressure, fasting plasma glucose, total cholesterol, hypertension, diabetes, triglyceride and high-density lipoprotein cholesterol, the FVC and FEV(1) were found to be inversely associated with the presence of NAFLD. NAFLD was independently associated with reduced pulmonary function, and the severity of NAFLD was inversely correlated with pulmonary function.

The Relationship Between Arterial Stiffness and Nonalcoholic Fatty Liver Disease

Nonalcoholic fatty liver disease (NAFLD) is currently the most common form of chronic liver disease and some studies have documented its link with cardiovascular risk factors. This study aimed to investigate the association between arterial stiffness and NAFLD. Among 1,442 health check-up subjects (955 men, 487 women), we examined the association between brachial-ankle pulse wave velocity (baPWV) as a measurement of arterial stiffness and the presence of NAFLD based on abdominal sonographic findings. Multivariate linear and logistic regression analyses were conducted to examine the independent association between baPWV and the presence of NAFLD in gender-specific manners. In multivariate regression analysis, NAFLD was found to be independently associated with baPWV in both men and women. Moreover, in multivariate logistic regression analysis, a graded independent relation was found between higher levels of baPWV and the prevalence risk of NAFLD. Odds ratios (95% CI) for the highest vs. the lowest quartile of baPWV were 1.85 (range, 1.13-2.62) in men and 3.32 (1.45-7.62) in women after adjusting for age, smoking status, regular exercise, body mass index, blood pressure, fasting plasma glucose, triglyceride, HDL-cholesterol, hypertension and diabetes. Arterial stiffness was independently associated with the prevalence risk for NAFLD regardless of classical CVD risk factors.

Abdominal Sonographic Findings in Children With Sickle Cell Anemia

Sickle cell anemia causes systemic abnormalities related to hemolysis, anemia, and other hemoglobin abnormalities. This review describes the categories relating to abnormalities as well as the sonographic appearance visualized in the liver, gallbladder, spleen, and kidney. Increased awareness of hepatobiliary complications will enable more accurate diagnosis of pathology associated with sickle cell anemia.

Relationship between white blood cell count and nonalcoholic fatty liver disease

Background Higher levels of white blood cell (WBC) count are known to be associated with metabolic syndrome and insulin resistance. Nonalcoholic fatty liver disease (NAFLD) is also considered a hepatic manifestation of insulin resistance. Aims The present study aimed to determine the relation between WBC count and the presence of NAFLD based on abdominal sonographic findings. Methods A cross-sectional study with 3681 healthy subjects (2066 men, 1615 women) undergoing medical check-up was conducted. The odds ratios (ORs) and 95% confidence intervals (CIs) for NAFLD were calculated using multivariate logistic regression analyses across WBC quartiles. Results A graded independent relationship between higher levels of WBC count and the prevalence risk of NAFLD was observed. After adjusting for age, smoking status, regular exercise, body mass index (BMI), blood pressure, fasting plasma glucose, triglyceride, and HDL-cholesterol, the ORs (95% CIs) for NAFLD according to WBC quartiles were 1.00, 1.48 (1.10–1.98), 1.59 (1.18–2.14), and 1.84 (1.35–2.51) for men and 1.00, 1.15 (0.67–1.96), 1.88 (1.13–3.11), and 2.74 (1.68–4.46) for women. Conclusions WBC count was found to be independently associated with the presence of NAFLD regardless of classical cardiovascular risk factors and other components of metabolic syndrome.

Biliary fascioliasis: Sonographic appearance patterns

To describe the sonographic findings of biliary fascioliasis. The study included 27 patients with fascioliasis and abdominal sonographic findings in biliary system. All diagnoses were confirmed via serologic enzyme-linked immunosorbent assay, and 5 patients underwent cholecystectomy. Sonographic findings in the biliary system were defined as primary and secondary. Primary findings included spontaneously moving echogenic structures, linear echoes, curvilinear echoes, oval-shaped echogenic structure, matted echogenic particle, echogenic particle adherent to the gallbladder wall, motionless freely floating round echogenic foci, and leaf-like echogenic structures. Secondary findings were dilatation or wall thickening of the biliary system. In the liver, multiple confluent subcapsular nodules were also noted on sonography and CT in 14 of 27 patients. Sonography can detect biliary system lesions in fascioliasis and can aid diagnosis of the disease. However, the radiologist should be familiar with the different sonographic appearances of biliary fascioliasis.

Sonographic Features of Liver Involvement by Lymphoma

The liver is one of the most frequent extranodal locations of non-Hodgkin lymphoma and Hodgkin disease. Nevertheless, lymphoma constitutes only 6% to 8% of focal lesions of the liver. Few studies have evaluated the sonographic patterns of lymphoma with liver involvement. The purpose of this study was to describe the sonographic features and to evaluate the accuracy of sonography for the diagnosis of lymphoma with liver infiltration. The abdominal sonographic findings of 23 consecutive patients with histologically proven diagnosis of lymphoma with liver involvement were reviewed. The most prevalent sonographic features were hepatomegaly and splenomegaly. Abdominal lymphoadenopathies were identified in 34.8% of cases. Liver nodules were seen in half of patients, and the most frequent sonographic appearance was as multiple small focal lesions. Differences in sonographic patterns between high- and low-grade non-Hodgkin lymphoma were not seen. None of the patients with Hodgkin disease had liver nodules. Concordance between sonography and computed tomography for the diagnosis of focal liver lesions was observed. Sonography may contribute to the diagnosis of liver infiltration by lymphoma. The presence of multiple focal liver lesions associated with splenomegaly and lymphoadenopathies should make us consider the diagnosis of lymphoma with liver involvement. Nevertheless, the low specificity of these findings requires histologic confirmation of lymphomatous infiltration of the liver.

Clinical Pattern and Abdominal Sonographic Findings in 251 Cases of Brucellosis in Southern Turkey

The aim of this study was to report the clinical features, complications, abdominal sonographic findings, and treatment outcomes for a series of brucellosis cases in southern Turkey. This prospective study involved 251 patients (age range, 2-77 years) who were hospitalized with brucellosis during a 4-year period. Patients were classified as having acute (< 3 months), subacute (3-12 months), or chronic (> 12 months) disease. Physical, laboratory, and abdominal sonographic findings were analyzed. The disease was acute in 92 cases (36.7%), subacute in 48 (19.1%), and chronic in 111 (44.2%). Sonographic examination of the abdomen showed enlarged periportal lymph nodes in 23 patients (9.2%), splenomegaly in 21 (8.4%), hepatomegaly in 15 (6%), pleural effusion in 7 (2.8%), splenic abscesses in 4 (1.6%), splenic cysts in 2 (0.8%), acute appendicitis in 2 (0.8%), and acute acalculous cholecystitis in 1 patient (0.4%). The main hematologic and biochemical manifestations were anemia, elevated erythrocyte sedimentation rate, elevated C-reactive protein, and elevated transaminase levels. All patients were treated with combinations of either two or three antibiotics. Surgery was performed in the patients with acute appendicitis, acute cholecystitis, and multiple splenic cysts. Brucellosis is endemic to Turkey. Sonographic examination is the method of choice for diagnosing abdominal complications of human brucellosis. This disease should be included in the differential diagnosis for any patient with enlarged periportal lymph nodes. The specific treatment regimen and duration of therapy should be based on sites of organ involvement and complications.

3002: Abdominal sonographic findings in HIV/AIDS patients at Mengo Hospital, Uganda

3002: Abdominal sonographic findings in HIV/AIDS patients at Mengo Hospital, Uganda

3467: Abdominal sonographic features of hemophagocytic lymphohistiocytosis in children

Objectives: Hemophagocytic lymphohistiocytosis (HLH), a variant of histiocytosis, is characterized by an overproduction of cytokines and diminished immune surveillance. The purpose of this study is to evaluate the abdominal sonographic findings in children with HLH.

Early abdominal sonographic findings in patients with dengue fever.

This study was conducted to evaluate the early sonographic findings in dengue hemorrhagic fever. From July 2002 to September 2002, 86 patients were referred to our center with suspected dengue fever during an outbreak of the disease in Taiwan. All the patients underwent immediate abdominal sonography when they arrived at our emergency room. The diagnosis of dengue fever was subsequently confirmed by serology in 65 patients. All our patients had type 2 dengue fever, as confirmed by serologic tests. The sonographic features included a thickened gallbladder wall in 38 patients (59%), ascites in 24 patients (37%), splenomegaly in 22 patients (34%), and pleural effusion in 21 patients (32%); pleural effusion was either right-sided or bilateral. Abdominal sonography can be used as a first-line imaging modality in patients with suspected dengue fever to detect early signs suggestive of the disease prior to obtaining serologic confirmation test results, especially in a dengue fever epidemic area.

Spectrum of abdominal sonographic findings in 103 pediatric patients with Gaucher disease.

The purpose of this study was to catalogue spleen and liver features by US in a cohort of 103 pediatric patients with Gaucher disease, and to document response to enzyme replacement therapy by serial US examination. There were 42 boys and 61 girls, 2 were splenectomized. Forty-eight patients received enzyme replacement therapy (ERT). At presentation all patients evinced organomegaly and 4.9% had focal (splenic or hepatic) lesions (hypo- and hyper-echoic or mixed). Fifteen patients began ERT before 11 years of age. There was a mean liver volume reduction from 230 to 137% after 2 years of ERT, with further reduction of 91% up to 6 years later. Mean spleen volume reduction was 38.4% at 2 years of ERT and a further reduction to 40.8% at last evaluation. Fourteen children began ERT between ages 11 and 16 years. Mean liver reduction was from 230 to 124% at 2 years and further reduction to mean of 104% recently. Mean splenic reduction was 37.7% after 2 years of ERT, with a mean of 43.8% recently (mean 4.5 years later). Organ volume changes in untreated and treated children were documented by US which is the modality of choice for repeat measures in this population. Our results highlight the initial dramatic and then continued response to ERT in pediatric patients with Gaucher disease.