[Ménétrier's disease detected by scanner].
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Biomedical subjects
Publications and source records attributed to F Weill.
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A total of 24 cases of hepatic alveolar echinococcosis (HAE) due to Echinococcus multilocularis was assessed by US and CT. The diagnosis was confirmed in all cases by immunologic and histologic study. Both US and CT patterns of HAE showed changes of liver morphology in both contour and size. Abnormal areas of parenchyma were nodular or in fields, irregular, heterogeneous, and basically echogenic. On CT these lesions were hypodense (30 to 40 HU) and did not show enhancement after administration of intravenous contrast medium. Clustered microcalcifications were encountered within the abnormal parenchymal fields in 50% of cases, and necrotized zones occurred in 40% of cases. Dilatation of intrahepatic bile ducts was commonly seen, especially on US; hilar involvement was frequent. Follow-up by both techniques can display increases of primary lesions, occurrence of new foci, and local or regional extensions. Precise evaluation of the lesions arising from correlative use of US and CT permits adequate therapeutic management.
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Evaluation of ganglionic extension in malignant processes rely widely on ultrasound and CT. However the information yielded by those procedures regarding the ganglionic structure is poor. What is appreciated is the size of ganglia, that is presence or absence of adenomegaly. A CT study of subjects in which lymphography did not reveal structural or size changes enables one to specify the following criteria of normality: The transverse diameter of abdominal lymph nodes should not exceed 1,5 cm. The product: transverse diameter X antero posterior diameter should not exceed 2.
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The correlation of sonography with CT was studied in a series of 19 hepatic angiomas. CT is more specific, since it can demonstrate the vascular nature of the lesion. But it is less sensitive: in three cases it remained negative even after bolus injection of contrast medium. A follow-up strategy, and a decision policy regarding the different examination procedures is discussed.
Accessory spleens can contribute to diagnostic difficulties when evaluating a left upper quadrant mass. Sonography often displays a parenchymal bridge between the accessory element and the organ itself. When such a pattern is absent, contrast enhanced CT is instrumental to permit one a correct diagnosis since it confirms isodensity.
A retrospective study of fifty surgically proven cases of acute cholecystitis and a review of the literature enabled the authors to summarise the sonographic features of the disease. These may include one or several of the following signs: thick gall bladder wall with an occasional posterior hypoechogenic rim, diffuse echogenicity of the purulent bile and local tenderness at the passage of the transducer. If an abscess is present, there is a hypoechogenic area in contact with the gall bladder. The technical problems of the B scan performed on an emergency basis make the use of real time intercostal scans invaluable. Ultrasound should be the first and may be the radiological examination performed in this situation.
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