Faculty Bibliography

A case of a duplicated collecting system with an ectopic ureter draining into the ipsilateral vas deferens is presented. The embryology of this entity is reviewed

Ultrasound was correlated with angiography for assessment of tumor extension to the intrahepatic inferior vena cava, hepatic veins, and portal vein branches in 15 cases of hepatocellular carcinoma (HCC) and 85 cases of hepatic metastases. Sonography revealed intraluminal tumor thrombus in 5 cases of HCC (33%), which were confirmed by angiography (sensitivity and specificity = 100%), and in 1 case of hepatic metastases (1%). Sonography was superior in depicting veins obscured or nonopacified on angiography, which in turn demonstrated arteriovenous shunting not appreciated on sonography. Used as the initial procedure for evaluation of venous extension of HCC, ultrasound can suggest the histology (though this must be confirmed by biopsy) and determine the feasibility of resection

Solid and papillary epithelial neoplasm of the pancreas is a nonfunctioning tumor seen a slowly enlarging upper abdominal mass in young women. It is usually large, well encapsulated, and undergoing necrotic degeneration. On ultrasound, it is sharply defined, nonhomogeneous, and lacking central enhancement. On angiography, it can be avascular or hypovascular depending on the degree of necrosis. Calcification has not been reported, and metastatic deposits are rare. Excision leads to an excellent prognosis

Two cases of congenital renal arteriovenous fistula and one case of intrarenal arterial aneurysm that were prospectively evaluated by real-time sonography are presented. The cirsoid type arteriovenous fistula had a characteristic sonographic appearance and was seen as a cluster of tubular anechoic structures within the kidney; it was supplied by an enlarged renal artery and drained by a dilated renal vein. Both the fistula (aneurysmal type) and the renal artery aneurysm were associated with a peripheral thrombus in the wall of the aneurysm and a central tubular anechoic lumen. The arterial aneurysm was also associated with visible pulsations on real-time sonograms. When present, the sonographic features as seen in these cases should facilitate a correct diagnosis, or at least suggest a renal lesion of vascular origin to be confirmed by renal angiography

The availability of real-time sonography has facilitated its use in the assessment of patients suspected of portal hypertension. Dilatation of the portal venous system may occur in portal hypertension, and a portal vein diameter greater than 13 mm is indicative of portal hypertension with a sensitivity of about 50%. Sonographic demonstration of lack of caliber variation of the portal system has a sensitivity of about 80%. The presence of venous collaterals can be demonstrated in about 90% of patients suitable for sonography. The coronary gastroesophageal varices can be seen in 90% when they are large sized, and in 65% when they are small sized. Other collaterals such as umbilical vein, duodenal varices, and gastrorenal and splenorenal varices can be detected. Sonography is a valuable screening procedure in the evaluation of portal hypertension and provides valuable information regarding the size and morphology of the liver and spleen, caliber and patency of the portal venous system, and the existence and location of the varices

Sonograms of 73 patients with 92 hydronephrotic kidneys were prospectively reviewed in an attempt to differentiate hydronephrosis from pyonephrosis. Sonographic diagnosis of pyonephrosis was based on the presence of persistent internal echoes, dispersed or dependent, within the dilated pelvocaliceal system. In group 1, consisting of 38 patients without clinical evidence of renal infection, sonography revealed the collecting system distended by urine to be anechoic, for a specificity of 100%. In group 2, consisting of 34 patients with clinical suspicion of renal infection, sonography showed internal echoes within the fluid-filled collecting system in 10 cases; nine of these had pyonephrosis (sensitivity of 90%), and one had hemorrhagic debris without infection (false-positive rate 3%). In the other 24 patients, sonography correctly predicted the absence of infection in all but one case (specificity 97%, false-negative rate 10%). It is concluded that in patients with clinical suspicion of renal infection, sonography has a high degree of accuracy (96%) in the differentiation of pyonephrosis from hydronephrosis

Portosystemic venous collaterals were studied with sonography in 40 patients with known portal hypertension. Eight patients had technically inadequate scans, while 32 had optimal scans. Sixty groups of venous collaterals were identified. At least one collateral pathway was seen in 28 patients, for a sensitivity of 88% for the 32 patients with optimal scans and 70% for the total group. The overall sensitivity for detection of coronary-gastroesophageal collaterals was 80% and 64%, respectively. The small size of the coronary-gastroesophageal varices in early portal hypertension seems to be the most important factor limiting detection in patients suitable for sonography

Although hydronephrosis can usually be diagnosed by urography and/or pyelography, the etiology of the obstruction may not be apparent. Computed tomography (CT) is usually helpful in evaluation of these cases. In 36 cases in which CT was performed solely to determine the cause of ureteral obstruction of uncertain etiology, it proved to be of value in 33 instances (91.7%). The disease processes encountered in this series included metastatic carcinoma to the ureter or periureteral tissues(22), lymphoma (one), primary ureteral tumor (two), radiolucent ureteral stone (four), adjacent ileocolitis (two), aortic or iliac artery aneurysm (two), fibrous band(one), urinoma (one), and radiation fibrosis (one). In three cases (8.3%) an etiologic diagnosis could not be made by CT. These patients had radiation therapy to treat malignant disease, and recurrent tumor responsible for ureteral obstruction could not be distinguished from radiation fibrosis