Abdominal Ultrasound Findings Research Articles

A Cross-Sectional Study on Bedside Abdominal Ultrasound Findings as a Diagnostic and Prognostic Tool in Dengue Fever in Manipal Hospital, Bengaluru, India

A Cross-Sectional Study on Bedside Abdominal Ultrasound Findings as a Diagnostic and Prognostic Tool in Dengue Fever in Manipal Hospital, Bengaluru, India

Evaluation of hepatosteatosis and gallstone disease in patients with chronic kidney disease.

The prevalence rates of hepatosteatosis and gallstones are increasing owing to the multifactorial causes of chronic kidney disease, and the prevalence may change with the availability of different forms of renal replacement therapy. We aimed to determine the incidence or prevalence rates of hepatosteatosis, cholelithiasis, and acute cholecystitis in patients with chronic kidney disease and compare them between renal replacement therapy modalities. A total of 270 patients (90 with chronic kidney disease stages III-V, 90 undergoing peritoneal dialysis, and 90 undergoing hemodialysis) were included and categorized into the pre-dialysis, hemodialysis, and peritoneal dialysis groups. The patients were questioned about previous gallbladder surgeries and chronic diseases. The results of abdominal ultrasonography, tomography, and magnetic resonance imaging were retrospectively evaluated with respect to the findings on the hepatobiliary system. Hepatosteatosis and cholelithiasis were diagnosed by expert radiologists on the basis of abdominal ultrasonography, tomography, and magnetic resonance imaging findings. The prevalence rates of hepatosteatosis, cholelithiasis, and other liver findings were compared between the groups. Hepatosteatosis and cholelithiasis were detected in 16.7% and 21.5% of the 270 cases, respectively. Hepatosteatosis was present in 17.8%, 25.6%, and 6.7% of patients in the pre-dialysis, hemodialysis, and peritoneal dialysis groups, respectively. The prevalence of hepatosteatosis was significantly higher in patients undergoing hemodialysis than in patients undergoing peritoneal dialysis (p = 0.002). However, no statistically significant difference was found between the peritoneal dialysis and pre-dialysis groups or between the hemodialysis and pre-dialysis groups (p >0.05). The prevalence rates of cholelithiasis were 15.6%, 28.9%, and 20.0%, in the pre-dialysis, hemodialysis, and peritoneal dialysis groups, respectively, and there were no statistically significant differences among the groups. The incidence of acute cholecystitis was significantly higher in the hemodialysis group than in the pre-dialysis group (p = 0.006). Our study showed that the hepatobiliary system is frequently affected in chronic kidney disease and that the findings may differ depending on the renal replacement therapy modality.

A Simple Clinical Scoring System to Determine the Risk of Pancreatic Cancer in the General Population.

This study aimed to develop and validate a simple scoring system to determine the high-risk group for pancreatic cancer (PC) in the asymptomatic general population. The scoring system was developed using data from PC cases and randomly selected non-PC cases undergoing annual medical checkups between 2008 and 2013. The performance of this score was validated for participants with medical checkups between 2014 and 2016. In the development set, 45 PC cases were diagnosed and 450 non-PC cases were identified. Multivariate analysis showed three changes in clinical data from 1 year before diagnosis as independent risk factors: ΔHbA1c ≥ 0.3%, ΔBMI ≤ -0.5, and ΔLDL ≤ -20 mg/dL. A simple scoring system, incorporating variables and abdominal ultrasound findings, was developed. In the validation set, 36 PC cases were diagnosed over a 3-year period from 32,877 participants. The AUROC curve of the scoring system was 0.925 (95%CI 0.877-0.973). The positive score of early-stage PC cases, including Stage 0 and I cases, was significantly higher than that of non-PC cases (80% vs. 6%, p = 0.001). The simple scoring system effectively narrows down high-risk PC cases in the general population and provides a reasonable approach for early detection of PC.

Trend of Non-Alcoholic Fatty Liver Disease in Type II Diabetes Mellitus

Background: Non-alcoholic fatty liver disease (NAFLD) is becoming quite common in Type II Diabetes Mellitus (TIIDM) as obesity and insulin resistance are common within TIIDM and it is becoming a widespread liver condition globally. This study evaluated the prevalence of NAFLD patients who also had type II diabetes. Methods: The demographic data (name, age, body mass index (BMI), gender, occupation, duration of TIIDM, and treatment taking for TIIDM), as well as the results of the tests for these enzymes, were also recorded. Alanine transaminase (ALT) and Aspartate transaminase (AST) levels, as well as abdominal ultrasound findings of the liver, were recorded in a proforma after informed consent for a total of 200 Type II diabetic patients. Using SPSS, the data were analyzed, and stratified groups were subjected to the Chi-square tests. Results: There was a significant difference (p<0.05) observed in NAFLD patients of TIIDM concerning age, gender, BMI, treatment, occupation, and duration of diabetes. The sample size consisted of 200 patients of which 111 (55.5%) were men and 89 (44.5%) were women. Patients ranged in the age range of 40-70 years old, with a mean age of 55.08 ± 8.98 years and a mean BMI of 29.69±4.04, respectively. It was concluded that 64% of cases with diabetes mellitus had NAFLD. Conclusion: TIIDM is an independent risk factor for NAFLD so early screening, diagnosis, and appropriate treatment are mandatory to reduce the risk of NAFLD and its related complications.

Hypertrophic pyloric stenosis in a toddler: An atypical presentation in Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria

Gastric outlet obstruction resulting from hypertrophic pyloric stenosis typically manifests in early infancy and seldom occurs after this period. The case is a 14-month-old toddler with multiple episodes of nonbilious, projectile vomiting with persistent hunger, and progressive weight loss for three weeks. The symptoms were preceded by ingestion of a water-based herbal concoction. His barium meal and abdominal ultrasonographic findings were diagnostic of hypertrophic pyloric stenosis (HPS), following which he had an initial pyloromyotomy, which failed before he later had pyloroplasty. The patient was subsequently discharged home four days after the second surgery and has remained stable since then. Although hypertrophic pyloric stenosis is uncommon beyond early infancy, it should be suspected in toddlers with persistent postprandial vomiting that is projectile and nonbilious. Early diagnosis is essential to limit malnutrition as well as other complications associated with HPS.

Evaluating the Diagnostic Accuracy of the Alvarado Score and Abdominal Ultrasound for Acute Appendicitis: A Retrospective Single-Center Study.

Acute appendicitis is a complex diagnosis that often requires both clinical and radiological evaluation. Significant variations in diagnostic approaches are evident among clinicians and healthcare institutions. While certain guidelines advocate for risk stratification based on clinical characteristics, others emphasize the importance of pre-operative imaging. This study seeks to explore the accuracy of the Alvarado Score and abdominal ultrasound (AUS) in diagnosing acute appendicitis. Suspected cases of appendicitis admitted to Al-Thora Hospital in Ibb, Yemen, from Jan 2021 to July 2022 were evaluated. The demographics, clinical, and laboratory data were collected and analyzed. This study assessed Alvarado scores (calculated based on clinical evaluation and laboratory data) and pre-operative AUS findings, correlating them with post-operative and histopathology findings. The Alvarado scores and AUS sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) were assessed using the ROC curve. Out of 1021 cases of acute abdomen, 171 patients were suspected of appendicitis. Using AUS along with the Alvarado score, appendicitis was presumed in 137 patients who underwent appendectomy. 130 (94.9%) patients had positive intraoperative and histopathology findings while 7 (5.1%) had negative findings. The Alvarado Score had a sensitivity and specificity of 94.62% and 87.80% at cutoffs of 6, respectively [Area under the curve (AUC): 0.985; 95% confidence interval (CI), 0.954 to 0.998; p < 0.0001]. Abdominal US showed a sensitivity of 98.46% and specificity of 82.93% (AUC:0.907; 95% CI, 0.853 to 0.946; p < 0.0001). Alvarado's score and AUS exhibited high sensitivity and specificity in diagnosing acute appendicitis. The substantial accuracy and efficacy of both the Alvarado score and AUS support their utilization as primary investigative tools in resource-limited settings. This approach can help avoid unnecessary appendectomies and minimize the financial burden on patients.

Pre-operative Predictive Factors for Difficult Laparoscopic Cholecystectomy at Tertiary Care Centre

INTRODUCTION Gallstones are present in 10 to 15% of general population and asymptomatic in more than 80% cases. Laparoscopic cholecystectomy is a gold standard treatment for cholelithiasis. The rate of conversion from laparoscopic cholecystectomy to open is about 1-13%. Predicting the difficulty of laparoscopic cholecystectomy is essential to optimize patient outcomes. The levels of difficulties during laparoscopic cholecystectomy can be predicated based on certain preoperative clinical, laboratory or radiological parameters. The main aim of the study was to find out the pre-operative predictive factors for difficult laparoscopic cholecystectomy at a tertiary care centre. MATERIAL AND METHODS This was an observational cross-sectional study that included sixty nine patients who underwent elective laparoscopic cholecys- tectomy in UCMS. Preoperative predictive parameters such as age, gender, BMI, previous abdominal surgery, gallbladder condition, and ultrasound findings were assessed. A scoring system developed by Randhawa and Pujahari was used to predict difficulty in laparoscopic cholecystectomy, and intraoperative criteria were used to categorize cases as easy or difficult. RESULTS History of acute cholecystitis (p=0.026), previous abdominal scar (p=0.024), thick gallbladder wall (p=0.012), impacted stone (p=0.057), pericholecystic fluid collection (p&lt;0.001) and increased BMI were considered as the significant factors that predict difficult laparoscopic cholecystectomy. Sensitivity and specificity for easy - difficult cut off of the scoring method were 75.6% and 67.16%, respectively, with the area under the ROC curve being 0.524. CONCLUSION The difficult laparoscopic cholecystectomy and conversion to open surgery can be predicted preoperatively based on preoperative scoring system.

A Teenage Boy with Abdominal Pain and Vomiting

This diagnostic image presented a plain abdominal radiograph and ultrasonographic findings from a case of intestinal ascariasis, which is a relatively common cause of abdominal symptoms in developing countries. The plain x-ray highlighted soft tissue mass within the small bowel which could be accompanied by features of intestinal obstruction. The ultrasound study depicted triple-parallel lines or four-parallel lines which are characteristics of the roundworm.

Urinary biomarkers of early kidney injury in children with beta-thalassemia

Beta-thalassemia is considered as one of the most common genetic disorders in the world caused by the reduced or absent synthesis of b-globin chain. The aim of this work was to evaluate renal function in children with b-thalassemia using predictive biomarkers such as urinary neutrophil gelatinase-associated lipocalin (NGAL) and N-acetyl-b-D-glycosaminidase (NAG). This prospective case–control study was carried out on 80 subjects aged between 3 and 17 years. The subjects were divided into two equal groups: thalassemia group which included 40 children with b-thalassemia major, and control group which included 40 age- and gender-matched healthy, non-anemic controls without any diseases that could potentially affect renal function, who underwent routine check-ups. All thalassemia patients received chelation therapy: 35 (87.5%) of them were treated with deferasirox and 5 (12.5%) patients received deferasirox + deferoxamine. The results of echocardiography, kidney function tests (serum creatinine, urea and estimated glomerular filtration rate as well as urinary albumin/creatinine ratio and urinary NGAL/urinary albumin–creatinine ratio were insignificantly different between the two groups. Abdominal ultrasound findings were significantly different between both groups. Total WBC counts, platelet counts, the results of liver function tests (total bilirubin, direct bilirubin, alanine transaminase and aspartate aminotransferase), urinary NAG/creatinine ratios, urinary NGAL/creatinine ratios and serum ferritin levels were significantly higher in the thalassemia group, while hemoglobin, urinary NAG/urinary albumin–creatinine ratios were significantly lower in this group. Urinary markers NGAL and NAG could be used as predictive markers of renal disease in b-thalassemia major patients. The study was initiated after obtaining approval from the Ethical Committee of Menoufia University Hospital. Informed written consent was obtained from the parents of the children involved in the study.

Abdominal ultrasonographic findings of cats with feline infectious peritonitis: an update.

The aim of this study was to describe the abdominal ultrasonographic findings in cats with confirmed or presumed feline infectious peritonitis (FIP). This was a retrospective study performed in an academic veterinary hospital. The diagnosis of FIP was reached on review of history, signalment, clinical presentation, complete blood count, biochemistry panel, peritoneal fluid analysis, cytology and/or histopathology results from abnormal organs, and/or molecular testing (immunohistochemical or FIP coronavirus [FCoV] RT-PCR). Cats with confirmed FIP by molecular testing or with a highly suspicious diagnosis of FIP were included. Abdominal ultrasound examination findings were reviewed. In total, 25 cats were included. Common clinical signs/pathology findings included hyperglobulinemia (96%), anorexia/hyporexia (80%) and lethargy (56%). Abdominal ultrasound findings included effusion in 88% and lymphadenopathy in 80%. Hepatic changes were noted in 80%, the most common being hepatomegaly (58%) and a hypoechoic liver (48%). Intestinal changes were noted in 68% of cats, characterized by asymmetric wall thickening and/or loss of wall layering, with 52% being ileocecocolic junction and/or colonic in location. Splenic changes were present in 36% of cats, including splenomegaly, mottled parenchyma and hypoechoic nodules. Renal changes were present in 32%, encompassing a hypoechoic subcapsular rim and/or cortical nodules. Mesenteric and peritoneal abnormalities were seen in 28% and 16% of cats, respectively. Most cats (92%) had two or more locations of abdominal abnormalities on ultrasound. The present study documents a wider range and distribution of ultrasonographic lesions in cats with FIP than previously reported. The presence of effusion and lymph node, hepatic and/or gastrointestinal tract changes were the most common findings, and most of the cats had a combination of two or more abdominal abnormalities.

A rare case of localized peliosis hepatis during adjuvant chemotherapy including oxaliplatin mimicking a liver metastasis of colon cancer

BackgroundOxaliplatin-based regimens are commonly used as adjuvant chemotherapy following surgery for colorectal cancer. Adverse events associated with oxaliplatin include blue liver, which is caused by sinusoidal dilation and diffuse peliosis hepatis. We report herein a case of localized peliosis hepatis closely resembling a metastatic liver tumor.Case presentationThe patient, a 50-year-old male, underwent a robotically assisted colectomy for rectosigmoid colon cancer, which was discovered when hematochezia occurred. The patient received a diagnosis of pStage IIIb and was treated with four courses of CAPOX as adjuvant chemotherapy starting at postoperative month 1. At postoperative month 4, contrast-enhanced computed tomography (CT) of the abdomen revealed a 20-mm, low-density area with heterogeneous internal structure in S6/7 of the liver. Abdominal ultrasound and gadolinium ethoxybenzyl-diethylenetriaminepentaacetic acid-enhanced magnetic resonance imaging (EOB-MRI) findings led to a diagnosis of metastatic liver tumor, for which a laparoscopic partial hepatectomy was performed. The resected lesion was a dark reddish-brown nodule with indistinct margins that appeared to be continuous with the surrounding area. Histopathological analysis revealed severe, localized dilatation of the sinusoids and congestion consistent with the gross nodule. Based on these findings, localized peliosis hepatis associated with oxaliplatin-induced sinusoidal damage was diagnosed.ConclusionsLocalized peliosis hepatis associated with oxaliplatin use can be difficult to distinguish from a metastatic liver tumor on imaging studies.

Development and validation of a model for early diagnosis of biliary atresia

Background and aimsEarly diagnosis of biliary atresia (BA), particularly distinguishing it from other causes of neonatal cholestasis (NC), is challenging. This study aimed to design and validate a predictive model for BA by using the data available at the initial presentation.MethodsInfants presenting with NC were retrospectively identified from tertiary referral hospitals and constituted the model design cohort (n = 148); others were enrolled in a prospective observational study and constituted the validation cohort (n = 21). Clinical, laboratory, and abdominal ultrasonographic features associated with BA were assessed. A prediction model was developed using logistic regression and decision tree (DT) analyses.ResultsThree predictors, namely, gamma glutamyl transpeptidase (γGT) level, triangular cord sign (TC sign), and gallbladder abnormalities, were identified as factors for diagnosing BA in multivariate logistic regression, which was used to develop the DT model. The area under the receiver operating characteristic (ROC) curve (AUC) value for the model was 0.905, which was greater than those for γGT level, TC sign, or gallbladder abnormalities alone in the prediction of BA.ConclusionA simple prediction model combining liver function and abdominal ultrasonography findings can provide a moderate and early estimate of the risk of BA in patients with NC.

Abdominal Ultrasound Scanning for NEC in Babies at the Threshold of Viability: A Single Centre Experience

AimNeonatal units are caring for increasing numbers of babies born <24 weeks gestation. These babies are vulnerable to developing necrotising enterocolitis (NEC). Their presentation is often atypical, both clinically and radiologically. Optimal diagnostic strategies are not yet known. We report our experience of abdominal ultrasound scanning (AUSS) to clarify its role. MethodsAll babies in a single neonatal surgical centre born <24 weeks gestation undergoing AUSS for suspected NEC from January 2015 to January 2023 were included. We compared abdominal ultrasound findings with plain radiographs and correlated these to intraoperative findings. ResultsThirty-nine babies born <24 weeks gestation were diagnosed with NEC during the study period, and of these seventeen had an AUSS and formed the study cohort. Twelve underwent laparotomy at which NEC was confirmed, and the remaining five were managed non-operatively.Abdominal radiograph findings were: Paucity of gas (12), gaseous dilatation (2), paucity of gas with proximal dilatation (1), pneumatosis (1), and lucencies over the liver (1). In twelve cases who underwent surgery, AUSS findings were (more than one possible): Complex ascites (6), inflamed bowel (4), aperistaltic bowel (3), mass/collection (4), pneumatosis (1). All had NEC confirmed at laparotomy. In five cases who did not progress to surgery, findings were: Simple free fluid (2), pneumatosis (2), inflamed bowel (1), aperistaltic bowel (1). None of these cases subsequently underwent surgery or died of complications of NEC. ConclusionAUSS is a useful imaging modality for NEC in babies born <24 weeks gestation. It can reliably identify babies who would benefit from surgery. Level of Evidence4. Type of StudyRetrospective cohort study.

Liver damage and hepatomegaly in COVID-19 patients.

The aim of this study was to evaluate the patients with high liver function test results detected at admission to the hospital diagnosed with COVID-19. Patients diagnosed with COVID-19 by a nasopharyngeal RT-PCR (+) test in the emergency department were included in the study. CRP, liver function tests, and abdominal ultrasonography (US) findings of the patients were recorded. A total of 367 COVID-19 patients, 254 (69.2%) males and 113 (30.8%) females, with a mean age of 60.39 (16.81) years, were included in the study. It was seen that 236 (68.7%) patients were treated without complications, 131 (35.7%) patients needed intensive care, and 81 (22.1%) patients died. The frequency of hepatomegaly was significantly higher in patients with severe course and mortality (p < 0.001). When COVID-19 patients who developed mortality were compared with other patients with a diagnosis of COVID-19, no additional risk factors affecting mortality were detected, except LDH [OR: 1.009, (1.006-1.012); p < 0.001] and high CK [OR: 1.001 CI: 95%, (1.000-1.001); p = 0.032]. Patients who need to be hospitalized with COVID-19 and who do not have acute and/or chronic liver disease, elevated liver function test results, and an increase in liver sizes at presentation, it was seen that these did not have an effect on the clinical outcome. However, in addition to the presence of advanced age and comorbidity, the presence of hepatomegaly measured by CT at admission, and high LDH and CK levels were associated with poor clinical outcomes.

Retrospective Evaluation of Gastrointestinal Signs in Hypothyroid Dogs.

Few observations about gastrointestinal (GI) signs in hypothyroid dogs (hypo-T dogs) are available. We aimed to evaluate the prevalence and characteristics of concurrent GI signs in hypo-T dogs, describe clinicopathological, hepato-intestinal ultrasound findings in hypo-T dogs, investigate changes in GI signs after thyroid replacement therapy (THRT). Medical records of suspected hypo-T dogs from two hospitals were retrospectively reviewed. The inclusion criteria were: (1) having symptoms and clinicopathological abnormalities related to hypothyroidism (i.e., mild anemia, hyperlipemia); (2) not being affected by systemic acute disease; (3) not having received any treatment affecting thyroid axis. Hypothyroidism had to be confirmed using low fT4 or TT4 with high TSH and/or inadequate TSH-stimulation test response; otherwise, dogs were assigned to a euthyroid group. Clinical history, GI signs, hematobiochemical parameters, and abdominal ultrasound findings were recorded. Hypo-T dogs were assigned to the GI group (at least 2 GI signs) and not-GI group (1 or no GI signs). Follow-up information 3-5 weeks after THRT was recorded. In total, 110 medical records were screened: 31 dogs were hypo-T, and 79 were euthyroid. Hypo-T dogs showed a higher prevalence of GI signs (44%), especially constipation and diarrhea (p = 0.03 and p = 0.001), than euthyroid dogs (24%) (p = 0.04). Among hypo-T dogs, no difference in hematological parameters between GI and non-GI groups was found. Hypo-T dogs had a higher prevalence of gallbladder alterations than euthyroid dogs (20/25; 80% and 32/61; 52% p = 0.04). The hypo-T GI group showed a significant improvement in the GI signs after THRT (p < 0.0001). Specific investigation for concurrent GI diseases in hypo-T dogs was lacking; however, improvement in GI signs following THRT supports this association between GI signs and hypothyroidism.

Rheumatic manifestations of hepatitis C virus infection are associated with autoantibodies but not viremia.

To investigate the associations between extrahepatic manifestations, autoantibodies, and viremia in patients with hepatitis C virus (HCV) infection. This cross-sectional study recruited patients with HCV infection from the outpatient department of a tertiary medical center in Northern Taiwan between January 2017 and August 2019. Autoantibody profiles and the clinical parameters of HCV infection were evaluated using laboratory tests, and a questionnaire was used to record extrahepatic manifestations. HCV infection status, including inactive HCV infection, active hepatitis, and cirrhosis, was defined according to abdominal ultrasonography findings and alanine transaminase levels. A total of 77 patients with HCV were recruited, with 19.5% and 16.9% of patients, respectively, presenting with arthritis and dry eyes. Autoantibody screening revealed rheumatoid factor (RF), antinuclear antibody (ANA), anti-Ro antibody, and anti-La antibody positivity in 20.8%, 23.4%, 13.0%, and 2.6% of the patients, respectively. The presence of RF was associated with arthritis, whereas the presence of ANA was associated with dry eyes but not dry mouth. Active hepatitis and HCV-related cirrhosis were associated with viremia, but not autoantibody profiles. In this single-center study, the prevalence of extrahepatic manifestations and autoantibodies did not differ in patients stratified by the HCV infection status. Rheumatic manifestations were associated with the presence of autoantibodies but not with viremia.

Multisystem inflammatory syndrome in children and Kawasaki disease; comparison of their clinical findings and one-year follow-up—a cross-sectional study

BackgroundStudies on Multisystem Inflammatory Syndrome in Children (MIS-C) and Kawasaki Disease (KD) have yielded inconsistent results and are lacking in Asian and African countries. This study aimed to compare the laboratory and clinical features, short-term outcomes, and one-year follow-ups of a large cohort of MIS-C and KD patients.MethodsData from 176 MIS-C and 56 KD patients admitted to Tehran Children's Medical Center between January 2021 and January 2022 were collected. Patients were followed up until January 2023.ResultsWhile lymphopenia and thrombocytopenia were more prevalent in MIS-C (73.2% vs. 20% in KD, p < 0.001), KD patients exhibited a higher median white blood cell count and prevalence of anemia, along with higher fibrinogen and erythrocyte sedimentation rate levels (p < 0.001, p < 0.001, p = 0.005, p < 0.001, respectively). MIS-C patients also exhibited lower ejection fraction, a greater occurrence of pericardial effusion, and a higher incidence of coronary aneurysms and ectasia, and ascites. Echocardiography after seven days of treatment showed a reduction in pathologies for both groups, but it was significant only for MIS-C. After one year, coronary artery abnormalities remained in only six cases.ConclusionsIn conclusion, this study highlights differences between MIS-C and KD, including laboratory indices as well as echocardiographic and abdominal ultrasound findings. These findings contribute valuable data on Iranian patients to the existing literature on this topic and have significant implications for accurate diagnosis and improved management of pediatric patients presenting with these conditions.

Giant pedunculated hepatoblastoma mimicking neuroblastoma in a 4-month-old infant: a case report

BackgroundHepatoblastoma is the most common primary malignancy of hepatic origin in children, with an estimated incidence of 0.5–1.5 per million children. Hepatoblastoma classically has an intraparenchymal location, and pedunculated hepatoblastoma is a relatively rare entity. Accurate diagnosis can be challenging due to its extrahepatic location and possibly its thin peduncle, which is not easily identified in imaging.Case presentationHere, we report a case of asymptomatic giant palpable hepatoblastoma in the LUQ of a four-month-old male infant, initially suspected of neuroblastoma based on abdominal ultrasound findings. The final diagnosis of giant pedunculated hepatoblastoma was made based on the abdominal CT scan and the diagnosis was confirmed by percutaneous biopsy. Due to the size of the tumor, complete removal of the tumor was not initially possible. Therefore, the patient was treated with several courses of chemotherapy. The tumor was shrunk and then completely removed. The patient was treated, and no complications were found in the 6-month follow-up.ConclusionPedunculated hepatoblastoma is rare but should be considered as a possibility in the case of a perihepatic mass in a pediatric patient that can be confused with other upper abdominal masses such as an adrenal mass. Therefore, in such cases, we must look for the vascular pedicle in the imaging and keep the AFP check in mind.

Utilizing ultrasound in suspected necrotizing enterocolitis with equivocal radiographic findings

BackgroundTo examine the use of abdominal ultrasound (AUS) as a diagnostic adjunct in the diagnosis of necrotizing enterocolitis (NEC) in cases where abdominal radiography (AXR) is equivocal in order to reduce unnecessary antibiotic use in neonates.MethodsRetrospective study (2017–2019) of infants undergoing NEC evaluation with equivocal AXR findings (n = 54). Paired AXR and AUS were reviewed with respect to presence or absence of pneumatosis. Concordance of AUS findings with decision to treat for NEC was evaluated.ResultsAmong 54 infants where AXR was equivocal, AUS demonstrated presence of pneumatosis in 22 patients (41%), absence of pneumatosis in 31 patients (57%), and was equivocal in 1 patient. All patients with pneumatosis on AUS were treated for NEC. Of 31 patients without pneumatosis on AUS, 25 patients (78%) were not treated for NEC. Patients without pneumatosis on AUS received a significantly shorter mean duration of antibiotics compared to those with pneumatosis (3.3 days (+/− 4.8 days) vs 12.4 days (+/− 4.7 days)); p < 0.001). Of those patients not treated, none required treatment within 1 week following negative AUS.ConclusionAUS is a valuable tool for evaluating the presence or absence of pneumatosis in the setting of equivocal AXR. Absence of pneumatosis on AUS informs clinical decision making and reduces unnecessary treatment and antibiotic usage.

Triglyceride level and soft drink consumption predict nonalcoholic fatty liver disease in nonobese male adolescents.

Differential metabolic risk factors of nonalcoholic fatty liver disease (NAFLD) in nonobese male adolescents were analyzed examining relationships between NAFLD and clinical parameters of metabolic syndrome, including exercise and soft drink consumption, in male adolescents. In total, 134 male university students (nonobese, n=78; obese, n=56) who underwent the first-year health checkup were divided into the NAFLD and non-NAFLD groups based on abdominal ultrasonography (AUS) findings. Relationships between NAFLD and metabolic parameters, including body mass index (BMI) and AUS score, were examined in nonobese students. Metabolic factors associated with hypertension, abdominal fat, liver damage, dyslipidemia, and impaired glucose tolerance were significantly less common in nonobese students than in obese students. The aforementioned factors and soft drinkconsumption were significantly more common in the NAFLD group than in the non-NAFLD group. The univariate and multivariate analyses of nonobese students showed that the triglyceride level (odds ratio [OR], 1.06; 95% confidence interval [CI], 1.01-1.10, p=0.001) was higher and soft drink consumption (OR, 36.8; 95% CI, 3.69-368, p<0.001) was more common in the NAFLD group than the non-NAFLD group. Triglyceride level and soft drink consumption could aid in the detection of NAFLD in nonobese male adolescents. Our findings could provide useful information related to NAFLD and metabolic syndrome in nonobese adolescents.