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J H Lim

Publications and source records attributed to J H Lim.

At least 109 records · Page 6Linked to original sources
PubMed1994

Determining the site and causes of colonic obstruction with sonography.

OBJECTIVE: We studied the value of sonography in determining the site and cause of colonic obstruction. MATERIALS AND METHODS: Sonographic findings in 26 patients with known (n = 21) or suspected (n = 5) colonic obstruction on the basis of clinical findings and abdominal radiographs were correlated with radiologic and surgical findings. Colonic obstruction was proved in all with findings from surgery (n = 18) or from barium enema and CT (n = 8). Causes of the obstructions included colorectal cancer (n = 13), ileocolic intussusception (n = 11), transverse colonic adhesion (n = 1), and sigmoid volvulus (n = 1). Sonographic criterion of obstruction was the demonstration of a continuous distension of colonic loop with an abrupt transition to an empty distal colon. The value of sonography in terms of indicating the level and cause of colonic obstruction was evaluated. RESULTS: The location of colonic obstruction was established by using sonography in 22 (85%) of 26 cases, and the cause of obstruction was identified in 21 (81%) cases. Sonography depicted a mass (n = 5) or a segmental wall thickening (n = 5) in cases of colon cancer, and a target or doughnut sign in cases of ileocecal intussusception (n = 11). Sonography failed to depict the cause of obstruction in three cases of colon cancer and one case each of adhesion and sigmoid volvulus. CONCLUSION: Our experience suggests that sonography is useful for examining patients with colonic obstruction to determine the level and cause of the obstruction.

Adenocarcinoma↗
PubMed1994

Sonography and color Doppler imaging of Budd-Chiari syndrome of membranous obstruction of the inferior vena cava.

We examined 18 patients with Budd-Chiari syndrome (membranous obstruction of the hepatic IVC). IVC obstruction was detected by sonography in 17 cases (94%). The causes were a web in 10 cases and a fibrous cord in four cases. In three cases, the cause was unspecified. Obliteration of the hepatic veins or intrahepatic collateral vessels or both was delineated in 16 cases (89%). With seven cases of color Doppler imaging, there was no detectable color or Doppler signal within the IVC, and the direction of hepatic venous blood flow through intravenous communications was fairly well demonstrated in all cases. In four cases of follow-up color Doppler imaging, the patency of the IVC was well demonstrated. Sonography is useful in detecting obstruction of the hepatic IVC and in demonstrating the hepatic venous obstruction and intrahepatic collateral vessels. Color Doppler sonography is useful in demonstrating the direction of blood flow through interconnecting vessels and in evaluating the patency of the IVC after treatment.

Adolescent↗
PubMed1993

Carcinoma of the ampulla of Vater: sonographic and CT diagnosis.

Twenty patients with carcinoma of the ampulla of Vater were studied with sonography (N = 9) or both sonography and CT (N = 11). The tumor was shown by sonography in 16 patients (80%) as a small, round or oval, fairly well delineated mass in between the dilated distal common bile duct and duodenum which was delineated owing to luminal fluid or gas (N = 13); or as a polypoid mass within the dilated distal common bile duct resulting in abrupt obstruction (N = 3). In the remaining four patients, the mass was not delineated. Bile ducts were dilated down to the level of mass or ampullary region in all cases (100%), while the pancreatic duct was dilated in five cases (45%). We believe that sonography is the technique of initial choice in the diagnosis of carcinoma of the ampulla of Vater by identifying the mass at the distal end of the dilated common bile duct and/or pancreatic duct.

Adenocarcinoma↗
PubMed1993

Small intestinal phytobezoars: sonographic detection.

Three cases of small intestinal phytobezoar, suggested by sonography and later confirmed at surgery, are reported. Sonographic findings of bezoar were intraluminal mass presenting as an arc-like surface echo casting clear posterior acoustic shadow within the lumen of the dilated small bowel. Compression of the mass with a transducer induced fluid shift around the mass. We propose that diagnosis of bezoars can be suggested on the basis of sonographic findings.

Aged↗
PubMed1993

Small bowel obstruction: sonographic evaluation.

Results of 54 sonographic examinations of patients referred for suspected or known small intestinal obstruction were retrospectively correlated with surgical findings, and the diagnostic value of sonography regarding presence, level, and cause of obstruction was compared with that of plain abdominal radiography. The diagnosis of obstruction was correct in 89% of cases with sonography and in 71% with plain radiography. The level of obstruction was correctly predicted in 76% of cases with sonography and in 51% with plain radiography. The cause of obstruction was correctly predicted in 20% of cases with sonography and in 2% with plain radiography. The authors conclude that use of sonography in evaluating patients with bowel obstruction may be helpful in confirmation of the presence of obstruction, in determination of the level of obstruction, and in identification of the cause of obstruction.

Adolescent↗
PubMed1993

Adhesive capsulitis of the shoulder joint: usefulness of dynamic sonography.

We studied the value of dynamic sonography in adhesive capsulitis of the shoulder joint in patients with clinically suspected frozen shoulder. The sonographic criterion of adhesive capsulitis was continuous limitation of the sliding movement of the supraspinatus tendon against the acromion of the scapula. Arthrography was regarded as a gold standard in the diagnosis of adhesive capsulitis against which the sonographic results were compared. Among 23 patients with arthrographically documented adhesive capsulitis, sonographic examination showed limitation of movement of the supraspinatus tendon in 21. This sonographic sign therefore has a sensitivity of 91%, a specificity of 100%, and an accuracy of 92% for detecting adhesive capsulitis, making dynamic sonography a reliable technique for the diagnosis of this condition.

Adult↗
PubMed1993

Sonographic findings of intestinal tuberculosis.

Sonograms in 41 patients with intestinal tuberculosis were analyzed. The sonographic findings of intestinal tuberculosis were thickening of the wall in the ileum, cecum, or ascending colon (or in more than one of these). We detected the wall thickening in 38 cases by sonography (detection rate, 93%). The ileum was the most frequent site of involvement. The patterns of bowel wall thickening were diffuse in 30 cases and focal in eight cases and were concentric in 28 cases and eccentric in six cases. The associated findings were ascites, lymphadenopathy, omental cake, and cecal spasm in order of decreasing frequency. The sonographic findings are not specific for the diagnosis of intestinal tuberculosis, but when noted in the appropriate clinical situation would be of great help in the diagnosis of intestinal tuberculosis.

Adult↗
PubMed1992

Membranous obstruction of the inferior vena cava: comparison of findings at sonography, CT, and venography.

OBJECTIVE: Membranous or segmental obstruction of the inferior vena cava is one of the common causes of chronic Budd-Chiari syndrome. In this study, the venographic findings are compared with the results of sonography and CT in order to ascertain their role in the management of these cases. MATERIALS AND METHODS: Fifteen patients with membranous (n = 8) or segmental (n = 7) obstruction of the inferior vena cava who had been examined with sonography and CT were studied retrospectively. Diagnosis was made at surgery (n = 3) or by venacavography (n = 12). Sonographic findings were analyzed on the basis of the initial report, and CT findings were reviewed retrospectively with knowledge of the sonographic findings. RESULTS: Sonography showed membranous obstruction (n = 5), segmental cordlike obstruction (n = 3), and unspecified obstruction (n = 5) of the inferior vena cava, while CT showed a flap of the membrane (n = 1) and segmental narrowing or obstruction of the inferior vena cava (n = 7). In the remaining cases, the inferior vena cava either appeared normal (n = 6) or was not visualized (n = 1) on CT or was not described in the sonographic report (n = 2). In nine cases, CT showed one or several tiny calcific foci in the inferior vena cava. Sonography showed obliteration of at least one hepatic vein (n = 8) and of intrahepatic collateral vessels (n = 12), whereas CT was less sensitive in evaluating obliteration of intrahepatic veins (n = 4) and collateral vessels (n = 7). Sonography and CT both showed hepatic masses (n = 6), evidence of liver cirrhosis and portal hypertension (n = 14), hepatomegaly (n = 14), enlargement of the caudate lobe (n = 9), and intraabdominal (n = 11) and abdominal wall (n = 15) collateral vessels. CONCLUSION: Sonography was superior to CT in delineating pathologic venous anatomy of the inferior vena cava and hepatic veins whereas CT was better in evaluating hepatic cirrhosis and tumor. We believe that these techniques are useful complements to venography in the diagnosis and management of these cases.

Adolescent↗
PubMed1992

Sonographic detection of duodenal ulcer.

Using a wall thickness of greater than 5 mm for the first portion of the duodenum as the criterion for the sonographic diagnosis of duodenal ulcer, we studied the value of sonography in detecting this lesion. Endoscopy (88 patients) and upper gastrointestinal barium studies (12 patients) were used as the gold standards for the diagnosis. The study included 100 patients in whom gastrointestinal disease was suspected (20 with duodenal ulcer and 80 with normal findings). Of the 20 duodenal ulcers verified by endoscopy or upper gastrointestinal series, 13 patients had duodenal wall thickening, six had normal wall thickness, and one was nondiagnostic. Of the 80 subjects with normal findings on endoscopy or upper gastrointestinal series, 73 patients had a normal duodenum, four had wall thickening, and three were nondiagnostic. Considering the four nondiagnostic cases as sonographic errors, there were six false-negative cases and four false-positive cases (a sensitivity of 65%, specificity of 91%, positive predictive value of 76%, and negative predictive value of 92%). Our results show that sonography is not sufficiently sensitive to be used as a screening test, nor is it specific for duodenal ulcer, but a thickened duodenal wall of over 5 mm on sonography warrants additional work-up.

Duodenal Ulcer↗
PubMed1991

Sonographic findings in tuberculous peritonitis of wet-ascitic type.

Sonograms in 46 patients with tuberculous peritonitis of the wet-ascitic type were analysed retrospectively. The ascites was clear in 24 patients (52%). There were fixed membranes, septa and debris in eight patients (17%), floating debris in six patients (13%), mobile strands or membranes in four patients (9%), and fixed septa in four patients (9%). The patients were divided into two groups depending on the amount of ascites: small amount of ascites with clear fluid in eight patients (17%), and moderate or large amount of ascites with clear or complex fluid in 38 patients (83%). Associated findings were omental 'cake' (26%), hepatomegaly (24%), thickened mesentery with adherent small bowel loop (22%), splenomegaly (20%), pleural effusion (17%), lymphadenopathy (13%), and thickening of the ileal wall (7%). The sonographic findings are not specific for tuberculous peritonitis, but may give valuable information to prevent unnecessary laparotomy.

Abdomen↗
PubMed1991

Oriental cholangiohepatitis: pathologic, clinical, and radiologic features.

Oriental cholangiohepatitis, an endemic disease in Southeast Asia, is characterized by recurrent attacks of abdominal pain, fever, and jaundice. Pathologically, the intra- and extrahepatic ducts are dilated and contain soft, pigmented stone and pus. There is proliferation of bile ducts and infiltration of inflammatory cells along the periportal spaces and hepatic parenchyma. Localized intrahepatic segmental ductal stenosis may be present, especially in the lateral segment of the left lobe or posterior segment of the right hepatic lobe. The cause of the disease is not known, but associations with clonorchiasis, ascariasis, and nutritional deficiency have been suggested. Sonographic and CT findings include intra- or extrahepatic duct stones, dilatation of the extrahepatic duct with relatively mild or no dilatation of the intrahepatic ducts, localized dilatation of the lobar or segmental bile ducts, increased periportal echogenicity, segmental hepatic atrophy, and gallstones. Cholangiographic findings include bile duct stones; disproportionately severe dilatation of the extrahepatic ducts with mild or no dilatation of the intrahepatic ducts; and focal strictures, acute peripheral tapering, straightening, rigidity, decreased arborization, and an increased branching angle of the intrahepatic bile ducts.

Bile Ducts↗
PubMed1991

Afferent loop syndrome: sonographic findings in seven cases.

We studied the sonographic findings in seven patients in whom afferent loop obstruction was first detected by sonography. All seven subsequently were proved at surgery to have afferent loop syndrome. The causes of the obstruction included internal hernia (n = 3), cancer recurrence (n = 2), marginal ulcer (n = 1), and development of cancer at the anastomosis site (n = 1). In all cases, the dilated afferent loop was seen on sonography as a tubular structure in the upper abdomen crossing transversely over the midline. The distal end of the afferent loop could be traced toward the anastomosis. The probable cause of the syndrome was predicted on the basis of sonography in two of three patients with cancer at the anastomosis. Our experience suggests that afferent loop syndrome can be diagnosed sonographically on the basis of the detection, location, and shape of the dilated afferent loop.

Adult↗
PubMed1990

Right perirenal space. Computed tomography evidence of communication between the bare area of the liver.

Computed tomography (CT) images from one cadaver and 11 patients with perirenal fluid collection were reviewed to study whether the right perirenal space communicates with the bare area of the liver. CT of a cadaver obtained after meticulous right perirenal injection of contrast media showed that contrast media extended superiorly into the bare area of the liver. CT of 11 patients with right perirenal hemorrhage or infection showed that fluid collection within the right perirenal space continued upward, crossing the coronary ligament, extending into the bare area of the liver. The inferior vena cava were completely or partially surrounded by fluid. CT of two patients with bleeding hepatocellular carcinoma showed that blood in the bare area continued extending downward into the perirenal space. We conclude that the right perirenal space is open toward the bare area of the liver and fluid collection within one space may communicate with the other space across the coronary ligament.

Cadaver↗
PubMed1990

Medial extent of the posterior renal fascia. An anatomic and computed tomography study.

To study the medial extent of the posterior renal fascia and the perirenal space, the authors dissected two cadavers and reviewed 50 computed tomographic (CT) abdominal scans. The results demonstrated that the medial extent of the posterior renal fascia depends on the level in a vertical direction and its relationship to the kidney which varies at different levels. At the renal hilus, the fascia inserts posteromedially to the fascia of the quadratus lumborum along its lateral margin; more cranially, the line of insertion is more lateral, onto the diaphragmatic fascia; more caudally, the line of insertion is more medial, inserting onto the anterior surface of the quadratus lumborum. Therefore the posteromedial insertion of the posterior renal fascia extends medially, from the more laterally placed diaphragmatic fascia, to the lateral margin of the quadratus lumborum and then to the anterior surface of the quadratus lumborum, depending on the anatomic level. The clinical implication of these findings are discussed.

Cadaver↗
PubMed1990

Clonorchiasis of the pancreas.

Three patients with pancreatic clonorchiasis were examined with endoscopic retrograde pancreatography. On each of the three cases there was diffuse irregular dilatation of tributaries of the pancreatic duct in the pancreatic tail. The main pancreatic duct and tributaries draining into the body and head portion were not dilated. A sonogram from one patient showed diffuse enlargement of the pancreas, especially the tail. All three patients showed typical cholangiographic findings of hepatic clonorchiasis, namely diffuse peripheral intrahepatic bile duct dilatation with no or minimal dilatation of the extrahepatic duct. When the tributaries of the pancreatic duct in the tail of the pancreas are diffusely dilated, in the appropriate clinical setting, pancreatitis caused by Clonorchis sinensis should be considered.

Aged↗
PubMed1990

Sonographic detection of pneumoperitoneum in patients with acute abdomen.

We describe five patients who presented with an acute abdomen in whom pneumoperitoneum was first detected by sonography. All five subsequently were proved to have a perforated viscus. In all cases, the pneumoperitoneum was seen as an echogenic line with a posterior ring-down or reverberation artifact between the anterior abdominal wall and the anterior surface of the liver. The finding was shown best in the right upper quadrant with the patient in the left lateral decubitus position. The echoes caused by the pneumoperitoneum overlapped the echoes of the lung during inspiration, but the echoes were separate during expiration. The probable cause of pneumoperitoneum was determined with sonography in four of the five patients: three had perforation of duodenal ulcer and one had perforation of gastric cancer. The fifth patient had a perforated ileum, which was not evident on the sonogram. Our experience with these patients suggests that the detection of pneumoperitoneum on sonography in patients with an acute abdomen is an important sign of a perforated viscus.

Abdomen, Acute↗