[Computer tomography in biliary carcinoma (author's transl)].
The computer tomographic appearances of cholangio-, cholecysto- and papillary carcinomas in 22 patients are described and the differential diagnosis is discussed.
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Publications and source records attributed to J Triller.
The computer tomographic appearances of cholangio-, cholecysto- and papillary carcinomas in 22 patients are described and the differential diagnosis is discussed.
Ultrasonic devices with rapid image build-up and high power of resolution enable detailed assessment of the vascular and biliary structures. Visualisation of the biliary tract of normal lumen in the extrahepatic region enables identification of a biliary obstruction at a time where dilatation of the intrahepatic biliary tract has not yet taken place. The identification of small visceral branches of the aorta abdominalis as well as of portal and systemic veins yields sonographically reliable vascular points of reference which enable, apart from the exact localisation of the biliary tract and of the pancreas, accurate topographic identification of abdominal mass lesions.
The examination technique, results and diagnostic value of sonography were evaluated in a retrospective study of 70 patients with pericardial effusion. Small effusions of less than 100 cc can be detected by observing a separation of the epicardium from the pericardium. With larger effusions sonography allows an approximate estimate of the volume. Since ultrasonography is non-invasive, and since it has a very high diagnostic accuracy and only few false-negative findings, it is the method of choice for the examination of patients suspected of having a pericardial effusion.
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The morphology of pancreatic carcinoma as determined by sonography and computer-assisted tomography is described. Differential diagnosis and diagnostic pitfalls are discussed.
The value of sonography and ERCP was studied in a retrospective series of 128 patients with pancreatic and biliary disease. Sonography and ERCP employed singly provided a correct diagnosis in 68% and 75.5% respectively; combined diagnostic accuracy rose to 85%. The inclusion of other diagnostic information produced almost identical figures for sonography and ERCP of 82% and 86% respectively. Consequently, sonography must be recommended in the first place as a non-invasive method for the diagnosis of pancreatic and biliary disease. The indications for ERCP are for the elucidation of chronic pancreatitis without pseudo-cysts and for other pancreatic abnormalities not clearly shown by sonography, and also for the demonstration of the biliary system in non-obstructive jaundice.
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Ultrasonically guided percutaneous fine needle aspiration biopsies were carried out in 179 patients with sonographically proven space occupying lesions of the liver, pancreas and kidneys as well as the retroperitoneal space. The fine needle aspiration biopsies were done using a B-scan-aspiration-biopsy transducer with a special needle having an outer diameter of 0,4--0,6 mm. Liver metastases were proven cytologically in 57/70 patients (81%), pancreatic carcinomas in 20/31 patients (64%), kidney tumours in 15/20 patients (75%), retroperitoneal lymph node metastases and primary malignant lymphomas in 20/32 patients (62%). The ultrasonically guided fine needle aspiration biopsy is simple, practically without pain, risk or complications for the patient, and is an economically feasible examination method.
Retrospective evaluation of indication and technical procedure and its value in sonography of 110 patients with jaundice. A correct diagnosis (by ultrasound) of hepatogenic jaundice was made in 36/38 patients (94%) and of obstructive jaundice in 69/72 patients (96%). In additional 31/72 patients (43%) ultrasound gave important diagnostic clues by demonstrating dilated bile ducts as well as the location of obstruction. For verification and for the demonstration of morphologic changes, sonographically guided fine needle aspiration puncture, percutaneous transhepatic cholangiography with a fine puncture neede (Chiba-needle) and ERCP are indicated.
In a prospective study of 174 patients referred for cholecystography, an ultrasound study (gray scale technique) was also carried out and the results of the two examinations were compared. The ultrasound examination served to demonstrate a normal gall bladder in 96% of the patients and, based on typical sonographic findings, permitted the diagnosis of cholecystolithiasis in 97%. The ultrasound examination can be carried out prior to the X-ray study as a screening method and has particular value in the work-up of patients with unclear right upper quadrant abdominal pain.
The radiological features of congenital choledochal cysts are discussed with reference to three cases seen by the authors. The diagnostic problems are mentioned, and use of scintigraphy and ultrasound tomography at an early stage is recommended in order to define more clearly the indications for invasive radiological methods.
Based on a retrospective study of 14 patients with pancreatic pseudocysts, the ultrasonic evaluation of the pancreas is discussed and correlated to the conventional radiologic, endoscopic and angiographic examinations. The pancreatic sonography, as a non-invasive examination, is the method of choice for pancreatic screening and is recommended whenever a pancreatic pseudocyst is suspected.
The radiological features of cystic and alveolar echinococcal disease of the liver is described, based on 17 patients. Conventional radiographs, liver ultrasound and liver angiography are described.
The sonographic-radiological diagnosis of abdominal abscesses is discussed; these are divided into intraparenchymal, extra-parenchymal-intraperitoneal and extraparenchymal-extraperitoneal lesions. The results of grey scle sonography are most informative and are correlated with the radiological and scintigraphic findings in 25 patients. In addition to the advantages of economy and of a non-invasive method, ultrasound permits aimed fine-needle aspiration of pathological abdominal processes such as abscesses.