Routine Abdominal Ultrasonography Research Articles

Liver involvement in patients with erythropoietic protoporphyria.

In erythropoietic protoporphyria (EPP), which presents with severe painful phototoxicity, progressive deposition of protoporphyrins in hepatocytes and bile canaliculi may result in liver disease. Clinically EPP related liver disease ranges from mildly elevated liver enzymes to cirrhosis and acute cholestatic hepatic failure. The prevalence of liver disease in EPP, and factors predicting the risk of developing liver disease, have not been defined in a large series of unselected EPP patients. To determine the prevalence of liver disease in EPP-patients. A single-center prospective unselected cohort study of 114 adult EPP patients, who underwent routine laboratory testing, abdominal ultrasonography and transient elastography to assess the presence of steatosis (controlled attenuation parameter,dB/m) and liver stiffness (kPa). 114 adult EPP patients were included. Elevated liver enzymes were found in 6.2% of the patients. Liver steatosis was detected in 29.0%, and significant fibrosis as assessed with liver stiffness measurements was present in 9.6% of patients. BMI positively predicted CAP-values (p=0.026); and protoporphyrin IX levels (p=0.043) positively predicted liver stiffness. This study demonstrates a prevalence of hepatic steatosis and fibrosis in adult EPP-patients comparable to that found in the general population. Protoporphyrin IX levels correlate with increased liver stiffness in EPP.

Lymphoepithelioma-like cholangiocarcinoma mimicking hepatocellular carcinoma imaging features in a young patient with Hepatitis B virus infection: A case report and literature review

Lymphoepithelioma-like cholangiocarcinoma (LEL-CC) is a rare variant of intrahepatic cholangiocarcinoma. Only a few cases of LEL-CC have been reported, and the understanding of LEL-CC remains limited. Herein, we describe a case involving a 38-year-old Asian man with hepatitis B virus infection and LEL-CC. The patient's liver tumor was incidentally discovered during routine abdominal ultrasonography without obvious clinical signs or symptoms. Dynamic magnetic resonance imaging (MRI) revealed features of hepatocellular carcinoma and he underwent laparoscopic partial hepatectomy. Histologically, the liver tumor exhibited a lymphoepithelioma-like appearance and features of cholangiocarcinoma with Epstein–Barr virus infection.

Thulium laser enucleation of prostate: Novel therapy for benign prostatic hyperplasia

Background: Transurethral resection of the prostate (TURP) has been the undisputed gold standard treatment for benign prostatic enlargement (BPE). However, morbidity after TURP remains significant with increased risk of bleeding and TUR syndrome. In recent years, the role of laser technology in endoscopic prostatic surgery has gradually increased. In our study, we evaluate the efficacy and safety of a novel technique of Thulium laser enucleation of prostate (THULEP) in the treatment of BPE.Materials and Methods: Five hundred and thirty-six patients with symptomatic benign prostatic hyperplasia (BPH) were treated with THULEP. The inclusion criteria were acute retention of urine with the failure of trial without catheter, dissatisfaction with medical treatment, maximum urinary flow rate (Qmax) <15 ml/s, and International Prostate Symptoms Score (IPSS) >15. Patients were evaluated by Digital rectal examination (DRE), uroflowmetry, IPSS, prostate-specific antigen (PSA), blood and urine routine tests, abdominal ultrasonography, and trans-rectal ultrasonography (TRUS).Results: The efficacy of THULEP was assessed by comparing preoperative variables with postoperative data. IPSS score got reduced from 24 to 3.5, quality of life score improved to 0–1 from 4–5. Qmax improved from mean 7 to 20 ml/s, Postvoid residue reduced from a mean of 110 to 12 ml. Hospital stay was < 36 h in the majority of patients. The average operative time was 45 min. No postoperative blood transfusion was required.Conclusion: THULEP is a safe procedure and has a lesser number of complications. THULEP can replace monopolar TURP as a gold standard for the treatment of BPH.

Vena Cava Thrombosis after Congenital Diaphragmatic Hernia Repair: Multivariate Analysis of Potential Risk Factors.

The treatment of newborns with congenital diaphragmatic hernia (CDH) is associated with a significant complication rate. Information on major thrombotic complications and their incidence in newborns with CDH is lacking. The aims of our analysis were to evaluate the frequency of vena cava thrombosis and to determine its predictors within a consecutive series of patients with CDH. We retrospectively analyzed charts of all neonates of our department that underwent CDH repair from 2007 to 2021, focusing on vena cava thrombosis. Vena cava thrombosis was diagnosed sonographically and classified as complete or partial venous occlusion. Complete occlusion was confirmed by cavography. Variables evaluated were CDH side, liver position, central vein line, surgical approach, and extracorporeal membrane oxygenation (ECMO). Univariate and multivariate tests were utilized. Among 57 neonates who underwent CDH repair, vena cava thrombosis was diagnosed in 14 (24.6%), seven of whom had complete occlusion of the vena cava. Factors associated with vena cava thrombosis were femoral or saphenous venous catheter (p = 0.044), right sided CDH (p = 0.027) and chylothorax (p < 0.0001). ECMO was not associated with vena cava thrombosis. Seven patients (50%) with vena cava thrombosis were treated interventionally with angioplasty and seven (50%) conservatively with anticoagulation only. Mortality was not higher in patients with compared with patients without vena cava thrombosis. The incidence of vena cava thrombosis in newborns with CDH in our series is high. Routine postoperative abdominal sonography focusing on vena cava thrombosis is mandatory in all patients with CDH. Patients who developed vena cava thrombosis were more likely to develop chylothorax after CDH repair. Considering the good outcome of medical therapy of partial vena cava thrombosis, it may be discussed whether low dose anticoagulation may be provided to all newborns with CDH.

Unusual Case of Uterovesical Polyp in a Patient Following Repeated Caesarean Section

NE is a 36yr old petty trader who has had four previous caesarean sections. She went for her routine abdominal ultrasonography at 36weeks of her fifth pregnancy and an incidental posterior bladder polypoid mass was found with a normal singleton fetus. Patient declined cystoscopy but accepted exploration of bladder at same time with a caesarean section. At Surgery, a polyp was found arising from the lower uterine segment traversing the thin posterior bladder wall into the bladder. The polyp was carefully dissected out and separated from bladder. Bladder and uterus were repaired, and patient had uneventful recovery.

FREQUENCY OF CONGENITAL ANOMALIES OF THE KIDNEY AND URINARY TRACT BY MEANS OF ULTRASONOGRAPHY IN NEONATES AT A TERTIARY-CARE HOSPITAL

Objective: To determine the frequency of congenital anomalies of the kidney and urinary tract by means of ultrasound in neonates.&#x0D; Study Design: Cross-sectional study.&#x0D; Place and Duration of Study: Department of Radiology and Diagnostic Imaging, Rehman Medical Institute, Peshawar, from May 2015 to Jan 2016.&#x0D; Methodology: A total of 150 neonates reporting for routine abdominal ultrasonography were included. Honda Convex Scanner model HS-2000 with probe of frequency of 5-7 MHz was used for the ultrasonography.&#x0D; Results: Mean age of the neonates was 13.8 ± 7.5 days. Seventy-six (50.7%) were male and 74 (49.3%) were female. Congenital anomalies of the kidney and urinary tract were observed in 10 (6.7%) neonates. Most neonates had more than one anomaly. The left side was involved in 6 (4%) neonates while right side was involved in 4 (2.7%). Hydronephrosis was the most common abnormality found in 8 (5.3%) cases. The location of kidneys was abnormal (ectopic) in 2 (1.3%) neonates. Abnormal dimension was seen in seven cases and abnormal corticomedullary differentiation was found in 5 (3.3%) cases. Non-symmetrical cases were 5 (3.3%). Hydroureter was observed in 3 (2%) neonates and urinary bladder was abnormal in 2 (1.3%) neonates.&#x0D; Conclusion: The frequency of congenital anomalies of the kidney and urinary tract in neonates by means of postnatal ultrasonographic scan in our study population was 6.7%. Hydronephrosis was the most common anomaly.

Successful laparoscopic resection of gastric lymphangioma under the intraoperative guidance of indocyanine green fluorescence imaging: A case report

Gastric lymphangioma (GLA) is an extremely rare tumor without an established therapeutic strategy. Surgical resection is considered the mainstay of treatment, although there is a high risk of local recurrence if negative margins are not achieved. A 51-year-old man underwent routine abdominal ultrasonography, which incidentally detected a 20-mm tumor adjacent to the lesser curvature of the stomach. GLA was suspected based on its polycystic appearance. After a 16-month monitoring period, laparoscopic resection was performed because of tumor growth and involvement of the left gastric artery. Intraoperative indocyanine green (ICG) navigation system revealed lymphatic drainage from the tumor, which we used to help determine the optimal excision line and minimize the loss of gastric volume. Pathological examination confirmed complete resection with negative margins and supported a diagnosis of lymphangioma. We performed laparoscopic radical resection of GLA under guidance from intraoperative ICG fluorescence imaging, which allowed us to maximize residual gastric volume.

Usefulness of US attenuation imaging for the detection and severity grading of hepatic steatosis in routine abdominal ultrasonography

PurposeTo assess the diagnostic performance of ultrasound (US) attenuation imaging (ATI) for diagnosis and grading of hepatic steatosis with comparison to magnetic resonance imaging-proton density fat fraction (MRI-PDFF) using mDIXON-Quant sequence. MethodsTotal 100 patients who underwent abdominal US ATI and MRI-PDFF within one month were included. Subjects were divided into three groups according to MRI-PDFF; Group 1 (no fatty liver), Q < 5.1%; Group 2 (mild fatty liver), 5.1% ≤ Q < 14.1%; and Group 3 (moderate fatty liver), Q ≥ 14.1%. US attenuation coefficients (AC) of enrolled patients were measured and correlated with MRI-PDFF. And their diagnostic performances were assessed. AC, MRI-PDFF, and liver function tests were compared among all groups. ResultsMean AC value of each group was as follows: Group 1 = 0.58 ± 0.11 dB/cm/MHz, Group 2 = 0.68 ± 0.08 dB/cm/MHz, and Group 3 = 0.77 ± 0.06 dB/cm/MHz. Mean AC value of each group of hepatic steatosis showed statistically significant difference (p < 0.001). There was a significant correlation between AC and MRI-PDFF in Pearson correlation (r = 0.751, p < 0.001). The area under the ROC curve (AUROC) of AC was 0.914 with sensitivity of 91.5%, and specificity of 80.0% for detection of mild fatty liver, and 0.935 for detection of moderate fatty liver with sensitivity of 93.3%, and specificity of 87.1%. ConclusionAC using ultrasound ATI showed high diagnostic performance and provided discriminative values for severity grading of fatty liver disease.

An Asymptomatic Renal Mass

Advancement in imaging techniques has now made it possible for small renal tumors to be detected incidentally. This has led to the use of minimally invasive techniques for treatment of these cases. A 40 year-old woman was diagnosed to have a small renal mass after routine abdominal ultrasonography for epigastric discomfort. Computed tomography scan was used to characterize the mass, and an elective partial nephrectomy was successfully carried out. The procedure is safe, less morbid, and has good oncological outcome. Bangladesh Journal of Urology, Vol. 19, No. 1, Jan 2016 p.49-52

A study on the evaluation of obstructive jaundice using ultrasonography in a tertiary care centre

Introduction: Ultrasound examination plays a significant role in demonstrating the aetiology of obstructive jaundice. Routine abdominal Ultrasonography shows the size of the bile ducts, which may define the level of the obstruction and identify the cause, and gives other information related to the disease. The purpose of this work is to study the sonographic features of obstructive jaundice and to identify the most common causes and symptoms of the disease.Method: This is a cross-sectional study conducted in MIMS, Vizianagaram from March 2019 to November 2019. The study population was composed of 200 cases that had been selected randomly with clinical features of jaundice which were examined using an ultrasound machine, 3.5 - 7 MHz probe. Results: The study revealed that 51% of the study population with obstructive jaundice were female, and 49% was male. The common causes of obstructive jaundice were biliary stones which were common in females and abdominal masses, which were common in females, too. Nausea, yellowish discolouration and abdominal pain were the most common symptoms. The causes of obstructive jaundice showed a significant difference between males and females. Conclusion: Ultrasound plays a significant role in detecting and evaluating obstructive jaundice, and it should be the first line of investigation. Gender and age show a considerable difference with the causes of obstructive jaundice.

Correlation of Ultrasonography Parameters with Tissue Transglutaminase Antibody Assay in the Diagnosis of Childhood Celiac Disease

Objective: The present study aimed to evaluate the potential benefits of ultrasonographic (USG) assessment in the diagnostic workup of children suspected of having celiac disease and its correlation with tissue transglutaminase (TTG) antibody assay. Materials and methods: A retro-prospective study, consisting 30 children with biopsy proven celiac disease diagnosis, was conducted. The tissue transglutaminase (tTG) assay was done on all the children, and further the children were subclassified based on the tTG titer values. The transabdominal sonography using convex (3-5 MHz) and linear (7-12 MHz) ultrasound probes was carried on the subjects, assessing the bowel lumen dimeter, bowel wall thickness, abnormal rugal folds count, presence of perihepatic fluid, fatty hepatic changes and mesenteric lymphadenopathy. Routine abdominal sonography was also carried out to complete the detailed evaluation of the abdomen. The sonographic bowel findings and the different classes of the tTG titers were correlated. Results: The median (IQR) age at onset of symptoms and at diagnosis was 6 (4-9) years. The median (IQR) value of blood tissue transglutaminase level (tTG) was 535 U/mL (63-7100), and most of the children belonged to class A (n=18, 60%) subclassification followed by class C (n=7, 23.3%) and class B (n=5, 16.6%). On sonological evaluation, the bowel abnormalities including bowel thickening was seen in 8 (26.6%) of the children, followed by the reduced jejunal folds and transient intussusception in the same frequency (n=5, 16.6%) and, hyper-peristalsis in 4 (13.3%) children. No dilated bowel loops were seen. Extra-intestinal observations like fatty liver changes, mesenteric lymphadenopathy, and peritoneal free fluid were noted in 23 (76.6%), 6 (20%), and 4 (13.3%) of the children respectively. Conclusion: Ultrasound is the most widely used first imaging tool in the evaluation of abdominal ailments. Multiple small bowel abnormalities are found in the celiac patients, which may vary according to the study population’s demographic and clinical features. More than half of the children with celiac disease showed small bowel abnormalities, and small bowel thickening, if present, may vary with the anti-tTg titer level. Multicentric and large size sample studies are required to accurately assess the association of serological antibodies titers with the bowel wall abnormality.

Not so innocent bystander - gallbladder varices without portal vein thrombosis

Introduction. Gallbladder varices (GBV) represent a rare form of ectopic varices that usually occur in patients with portal hypertension and portal vein thrombosis. Case outline. We present a case of a 38-year-old woman with decompensated autoimmune liver cirrhosis who was referred to our institution for evaluation for liver transplantation. She was incidentally discovered to have GBV during a routine B-mode abdominal ultrasonography as part of pre-transplant evaluation. GBV were confirmed by the Color Doppler Sonography, and multi detector computed tomography angiography. Interestingly, portal vein was patent and without thrombus. Conclusion. Despite being asymptomatic in most cases, the presence of GBV is valuable information for a surgeon because they might be a source of potentially catastrophic bleeding, which is particularly poorly tolerated by patients with decompensated liver cirrhosis. Ultrasound has the irreplaceable role not only in discovering GBV, but in prompt diagnosis of rare, but unpredictable and fatal complications as well.

Enhancing cooperation during pediatric ultrasound: Oral midazolam versus conventional techniques.

Background and Aims:Ultrasound is a safe and non-invasive method for detecting numerous pathologies. Pediatric patients are often uncooperative which leads to decreased quality and increased time of scan. We compared the conventional means alone and combination of oral midazolam for the above cited purpose.Material and Methods:This double blind prospective study (CTRI/2016/06/007030) was conducted after obtaining due approval from institutional ethical committee. One hundred Children aged 2-6 years belonging to ASA class 1 or 2, posted for high resolution ultrasonography of abdomen were included in the study. They were randomised to receive midazolam 0.3 mg/kg mixed in 20 mL of apple juice (Group I) or 20 mL of apple juice alone (Group II) 20 minutes prior to the procedure. The parameters assessed were level of cooperation, sonologist's satisfaction, total scan time, heart rate and SpO2.Results:Out of 100 patients, 44 patients of group I and 42 of group II were analysed. The cooperation score was significantly higher in Group I (35%) than Group II (19%). Likert scale revealed very satisfied and satisfied rating in 61.3% (Group I) and 21.4% (Group II). The time taken by sonologist and number of attempts were significantly less in Group I than Group II. There was no difference in discharge time between the groups. There was no reportable adverse event in either group.Conclusion:Oral midazolam is a safe and effective agent to aid routine abdominal ultrasonography in pediatric patients.

High Rate of Occult Urolithiasis in Normocalcemic Primary Hyperparathyroidism

Introduction: Normocalcemic primary hyperparathyroidism (NPHPT) is characterized by elevations in serum parathyroid hormone levels in the presence of normal serum calcium concentrations after exclusion of secondary hyperparathyroidism. We have previously demonstrated no differences in the prevalence of clinically active urolithiasis between NPHPT and hypercalcemic asymptomatic PHPT, and that it is significantly higher in postmenopausal osteoporotic women with NPHPT in comparison to women with normal serum PTH and calcium concentrations. Few studies have addressed the occurrence of silent or occult kidney stones in asymptomatic hypercalcemic PHPT, but no data are available for NPHPT. Objective: To determine the presence of occult urolithiasis in NPHPT patients using routine abdominal ultrasonography. Methods and Results: We studied 35 patients with NPHPT (mean age 63.2 ± 10.7 years, 96% women; serum PTH 116.5 ± 39.2 pg/mL, 25OHD 38.5 ± 6.82 ng/mL, total calcium 9.1 ± 0.56 mg/dL; albumin 4.02 ± 0.37 g/dL; BUN 34.35 ±10.23 mg/dL; p = 3.51 ± 0.60 mg/dL; estimated glomerular filtration rate 88.44 ± 32.45 mL/min/1.73 m2, and 24-h urinary calcium excretion 140.6 ± 94.3 mg/24 h). The criteria for the diagnosis of NPHPT were as follows: serum PTH above the reference range (11–65 pg/mL), normal albumin-corrected serum calcium concentrations, normal 24-h urinary calcium excretion, serum 25OHD above 30 ng/mL, estimated GFR (MDRD) above 60 mL/min/1.73 m2 (with the exclusion of medications such as thiazide diuretics, lithium, bisphosphonates, and denosumab), a history of clinical symptoms of urolithiasis, and a family history of kidney stones. Thirty-five patients were evaluated and 25 of them met the inclusion criteria. Five patients presented nephrolithiasis corresponding to 20% of the study population. There were no statistically significant differences in any of the clinical or laboratory variables studied between patients with or without urolithiasis, although mean serum PTH levels were higher in patients with stones (180.06 ± 126.48 vs. 100.72 ± 25.28 pg/mL, p = 0.1). The size of the stones ranged from 0.6 to 0.9 cm and all of the stones were located in the renal pelvis. Conclusion: We found a high prevalence of occult kidney stones in NPHPT patients, similar to what is observed in clinically manifested urolithiasis, in hypercalcemic PHPT.

Bilobed spleen, transposition of the inferior vena cava and Riedel lobe: an extremely rare imaging finding in the same case.

There is a wide range of congenital anomalies of the spleen regarding its shape, location, number, and size. Most of these congenital anomalies are commonly detected on ultrasonography, CT, or MRI and may sometimes represent a challenging diagnosis for radiologists and clinicians. The bilobed spleen is an extremely rare form of congenital anomaly. In most cases, it is accidentally discovered during abdominal surgeries. The bilobed spleen is usually large in size when compared with the normal spleen; hence, it is more liable to trauma. Transposition of the inferior vena cava (IVC; also known as left-sided IVC) refers to a very rare variant course of the IVC. The most common variations are duplicate IVC, as well as retroaortic left renal vein and circumaortic venous rings. Left-sided IVC occurs in 0.17–0.5% of the general population. Diagnosis of left-sided IVC is important when planning vascular procedures like portosystemic shunt, the placement of an IVC filter, nephrectomy, and renal transplant. There should be an awareness of the Riedel lobe, which is a common anatomical variant of the liver, as it can simulate a mass. Its misidentification as a pathological abdominal mass can lead to surgery; pathology can also occur (e.g. malignancy or even torsion). In this report, we presented a case of a bilobed spleen that was misdiagnosed as a left renal mass during routine abdominal ultrasonography in a 25-year-old female who complained of recurrent left hypochondrium pain. The bilobed configuration was confirmed with MRI and ultrasound examination of the abdomen.

Comparison of clinical accuracy v/s investigations in the diagnosis of acute appendicitis

Background: Now a day there is a trend to rely more on high-tech investigations rather than taking thorough history and clinical examination of the patients in the diagnosis of acute pain abdomen. Commonest cause of acute abdomen in the surgical practice is appendicitis. Delay in the diagnosis and treatment of acute appendicitis, leads to complications. Objective of this study was to evaluate the accuracy of clinical diagnosis versus sensitivity and specificity of ultrasound examination and histopathological examination of the resected specimen of appendix. This study also assesses the incidence of negative appendectomies in a medical college hospital of North Karnataka.Methods: This study included one hundred and fifty patients with history of pain abdomen where clinical diagnosis of acute appendicitis was made. The study period was of 18 months between February 2014 to July 2015. Routine blood investigations and abdominal ultrasonography were done in all cases. All ultrasound positive cases were subjected to surgery. Some ultrasound negative cases were also taken to surgery on the high suspicion of diagnosis of acute appendicitis depending upon thorough history taking and clinical examination. The diagnosis made depending on the ultrasound findings were compared with clinical findings, operative findings and histopathological examination reports.Results: Out of 150 patients, 104 were male and 46 were female. The common symptoms were pain in the RIF (100%) and anorexia (80%).The overall sensitivity and specificity of clinical diagnosis was 96.9% and 90.48% respectively. The same for ultrasound was 86.99% and 33.33% respectively. The present study shows negative appendectomy rate 6.66% in females and 7.33% in males.Conclusions: The diagnostic accuracy of ultrasound was 84.87% whereas clinical diagnosis was 96%. Thus, detailed history taking, and thorough clinical examination still holds good in the diagnosis of acute appendicitis and should be stressed in the clinical teaching.

Comparative Study between Use of Endoscopic Ultrasound before Endoscopic Retrograde Cholangio Pancreatography vs. Endoscopic Retrograde Cholangio Pancreatography Alone

Endoscopic ultrasound (EUS) could be used as non-invasive procedure instead of Endoscopic Retrograde Cholangiopancreatography (ERCP) in pancreatico-biliary disorders diagnosis. The impact of EUS use before ERCP needs to be evaluated. This study was conducted on fifty patients with pancreatico-biliary disorders prepared to ERCP procedure. Randomly, 25 patients were subjected to ERCP directly (group-I) and for the remaining 25 patients EUS was done before ERCP (group-II). For all patients’ clear written consent, full clinical and routine laboratory assessment and abdominal sonography were done. There was no significant difference between patients of both groups regarding age and sex, clinical features, laboratory parameters, sonographic and diagnostic findings and post ERCP complications. Use of EUS before ERCP showed significant higher rates of successful stone extraction without lithotriptor and reduced the procedure duration. Further study with larger number of patients is highly recommended.

Cholelithiasis in a Filipino Child with Chronic Neuronopathic Gaucher Disease: A Case Report

Gaucher disease is the most common of the lysosomal storage diseases caused by a defect in the lysosomal enzyme βglucocererbrosidase resulting in multi-organ involvement. The presence of cholelithiasis has been rarely observed among patients with non-neuronopathic type of Gaucher disease and the exact pathophysiology is still unknown. We report a Filipino child with chronic neuronopathic Gaucher Disease noted to have cholelithiasis on routine whole abdominal ultrasonography as part of the regular monitoring of the disease.

Role of routine abdominal ultrasonography in intensified tuberculosis case finding algorithms at HIV clinics in high TB burden settings

BackgroundHigh proportion of TB in people living with HIV (PLHIV) is undiagnosed. Due to this active TB case finding is recommended for HIV clinics in high TB burden countries. Presently sputum examination and chest radiography are frontline tests recommended for HIV infected TB presumptives. Abdominal TB which occurs frequently in PLHIV may be missed even by existing programmatic intensified case finding protocols. This study evaluated the routine use of ultrasonography (USG) for active case finding of abdominal TB in HIV clinics.MethodsRetrospective analysis of eight years’ data from an HIV Clinic in a TB hospital in India. Patients underwent chest x-ray, sputum examination, USG abdomen and routine blood tests at entry to HIV care. Case forms were scrutinized for diagnosis of TB, USG findings and CD4 cell counts. Abdominal TB was classified as probable or possible TB. Probable TB was based on presence of two major USG (abdomen) findings suggestive of active TB, or one major USG finding with at least two minor USG findings or at least two symptoms, or any USG finding with microbiologically confirmed active TB at another site. Possible TB was based on the presence of one major USG finding, or the presence of two minor USG findings with at least two symptoms. Bacteriological confirmation was not obtained.ResultsEight hundred and eighty-nine people PLHIV underwent a baseline USG abdomen. One hundred and thirteen of 340 cases already diagnosed with TB and 87 of the 91 newly diagnosed with TB at time of HIV clinic registration had abdominal TB. Non-abdominal symptoms like weight loss, fever and cough were seen in 53% and 22% cases had no symptoms at all. Enlarged abdominal lymph nodes with central caseation, ascitis, splenic microabsesses, bowel thickening and hepatosplenomegaly were the USG findings in these cases.ConclusionsAbdominal TB is a frequent TB site in PLHIV presenting with non-abdominal symptoms. It can be easily detected on basis of features seen on a simple abdominal ultrasound. Abdominal USG should be essential part of intensified TB case finding algorithms for HIV infected people living in high TB burden settings.

Routine abdominal ultrasonography has limited value in the care for patients with indolent systemic mastocytosis

ABSTRACTObjectives: Systemic mastocytosis (SM) is a myeloproliferative disease characterized by the accumulation of aberrant mast cells. Since advanced subtypes of SM can lead to organ dysfunction and shortened survival, timely recognition of progressive disease is important for the adequate treatment of SM patients.Methods: Here, we report the results of our cohort study on the value of routine abdominal ultrasonography for the detection of progression of indolent systemic mastocytosis (ISM).Results: We included 88 patients with ISM, of whom 9 developed new hepatosplenomegaly during follow-up. In this group, the median serum tryptase level increased by 11.60 μg/l, compared with a decrease of −0.20 μg/l in the 79 patients with unchanged ultrasonography results (p = 0.016). A change in liver and/or spleen size never led to a change in clinical classification, nor management.Discussion: Based on the finding that a change in ultrasonography findings did not correlate to disease progression in general, it appears that isolated hepatosplenomegaly does not have prognostic implications in patients with ISM.Conclusions: Routine abdominal ultrasonography is redundant in the follow-up of patients with ISM. A combination of physical examination with serum tryptase levels can be used to screen for hepatosplenomegaly.