Solitary echogenic spot in the liver: is it diagnostic of a hemangioma?
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Adult↗
Biomedical subjects
R L Bree
Publications and source records attributed to R L Bree.
Influence of scan and pathologic criteria on the specificity of cholescintigraphy: concise communication.
The influence of scan and pathological criteria on the specificity of cholescintigraphy was assessed by a prospective study of 211 patients with suspected acute cholecystitis who underwent cholescintigraphy. Sufficient data were available in all to confirm a final diagnosis. Cholescintigraphy was performed in the standard fashion using 5 mCi of Tc-99m disofenin. Sixty patients had acute cholecystitis, 64 had chronic cholecystitis, and 87 had no demonstrable gallbladder disease. As the scan and pathological criteria for acute cholecystitis were varied from strict to liberal, the sensitivity of cholescintigraphy decreased (100% to 95.3%), the specificity increased (85.1% to 98.6%, and the predictive value increased (68.4% to 96.8%). The use of strict scan and pathological criteria for acute cholecystitis obscures the advantages that accrue from such early detection of acute cholecystitis by cholescintigraphy, and thus are to be avoided. To understand the disparate opinions voiced in the literature, an appreciation is required for the effects of changes in criteria on the specificity and predictive value of cholescintigraphy.
Acute Disease↗
Nongynecologic bladder and perivesical ultrasound.
Ultrasound is effective in evaluating pathologic entities in and around the urinary bladder. Abnormalities may be classified into 2 groups: lesions primarily affecting the bladder, including the bladder wall; and perivesical lesions, which secondarily affect the urinary tract. Intrinsic bladder diseases include inflammatory lesions, stones, and tumors, both primary and metastatic. Extrinsic perivesical abnormalities include lesions of the prostate, seminal vesicles, urethra, rectum, and perivesical soft tissues. Since the bladder is routinely visualized on pelvic ultrasonography, awareness and recognition of the ultrasonic appearance of disease in and around the urinary bladder can lead to more accurate diagnosis and detection of unsuspected disease.
Carcinoma, Transitional Cell↗
Suspected acute cholecystitis. Comparison of hepatobiliary scintigraphy versus ultrasonography.
One hundred ninety-five patients with suspected acute cholecystitis (AC) underwent both hepatobiliary scintigraphy (HBS) and static gray-scale ultrasonography (US) to assess the relative value of each imaging modality in this clinical setting. HBS was performed after the intravenous injection of 5 mCi Tc-99m iprofenin. Abnormal HBS indicative of AC visualized the common bile duct, but not the gallbladder, within 1 to 4 hours after tracer administration. Abnormal US indicative of AC demonstrated cholelithiasis and/or gallbladder wall edema. In this series, HBS surpassed US in sensitivity (98.3% versus 81.4%), specificity (90.2% versus 60.2%), predictive value of an abnormal test (91.4% versus 51.6%), and predictive value of a normal test (100% versus 92%), HBS should be the procedure of choice for the rapid detection of AC.
Acute Disease↗
CT of renal and perirenal non-Hodgkin lymphoma.
The CT findings from a retrospective review of 16 patients (32 kidneys) with non-Hodgkin lymphoma involving the kidney are presented. In all cases, computed tomography (CT) accurately depicted the presence, location, and size of the renal lesions and provided information about the adjacent retroperitoneum. CT was helpful in evaluating the course of the disease and its response to therapy. The CT manifestations of renal lymphoma included: solitary nodules (four kidneys), multiple nodules (nine), focal infiltration (five), diffuse infiltration (two), engulfment of the kidney by contiguous retroperitoneal disease (three), and renal enlargement (13 kidneys). Bilateral renal involvement was noted in seven patients. All 16 patients had retroperitoneal adenopathy. The CT findings of intraparenchymal renal nodules, renal infiltration, or renal engulfment by retroperitoneal disease in association with retroperitoneal adenopathy should suggest the possible diagnosis of renal lymphoma.
Humans↗
Contribution of mesenteric fat to unsatisfactory abdominal and pelvic ultrasonography.
Technically unsatisfactory abdominal and pelvic ultrasound examinations may be due to excessive mesenteric fat rather than to the presence of intestinal gas. Ultrasonography and computed tomography (CT) were performed in 34 patients. CT and ultrasound scans were obtained in the same transverse planes, and in five patients multiple ultrasound transducer frequencies were used. Mesenteric fat in the abdomen and pelvis appears on ultrasound scans as a diffuse accumulation of echoes, with poor definition of posterior structures. Ultrasonic beam scattering and defocusing are responsible for the attenuation and echogenicity. When the pattern of abundant fat is recognized with ultrasound, alternative imaging procedures should be performed to visualize the deep abdominal, retroperitoneal, and pelvic structures.
Abdomen↗
Sonography of bladder and perivesical abnormalities.
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Adolescent↗
Prenatal diagnosis of fetal megabladder and urethral agenesis.
This is a case report of antenatal ultrasonographic detection of an enlarged fetal urinary bladder. Serial sonographic examinations revealed a large unilocular fetal intraabdominal mass. Cystocentesis and amniocentesis under ultrasonic control were preformed as well as an amniogram to establish the diagnosis. This is the fourth reported case in the English literature of fetal urethral agenesis diagnosed during the prenatal period. Early detection of potentially lethal fetal malformations is feasible with detailed examination of fetuses at risk.
Adult↗
Differential diagnosis of hypoechoic and anechoic masses with gray scale sonography: new observations.
With the technological advances in gray scale sonography that have permitted the use of higher-frequency transducers and expansion of the acoustic dynamic range, increasing problems in differentiating solid masses and fluid-filled masses have become apparent. These difficulties can be overcome by strict adherence to proper scanning techniques, which involve transducer selection, tissue attenuation compensation, and alterations in patient position. The availability of variable-dynamic-range signal processing and the use of real-time scanning can further increase one's confidence in the correct interpretation of these masses. The primary criteria for determining that a mass is fluid-filled have been expanded to include the presence of reverberation echoes, the "lateral shades" sign, and the presence of septations. In the past, hypoechoic masses with low-level internal echoes were termed "complex". Both fluid-filled masses and solid masses may fall into this category. By use of the sonographic criteria, an attempt should be made to determine whether a mass is primarily fluid-filled or solid. Specific anatomic locations and pathologic conditions in which differential diagnosis may be difficult are illustrated; these include abdominal masses, hepatic and renal masses, and pelvic masses.
Abdominal Neoplasms↗
Use of a high-frequency aspiration-biopsy transducer for direct ultrasound-guided amniocentesis.
The techniques and applications of amniocentesis performed with a new high-frequency aspiration-biopsy transducer are described in detail. The advantages of this technique are greatest in third-trimester patients where active fetal motion and diminished amniotic fluid volumes make unguided punctures difficult or impossible. The ability to visualize small-caliber needles within the fluid space further enhances the effectiveness of this technique.
Amniocentesis↗
Sonographic identification of fetal vernix in amniotic fluid.
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Adult↗
Trophoblastic disease with coexistent fetus: a sonographic and clinical spectrum.
The sonographic and clinical spectrum of coexistent live fetus and trophoblastic disease is illustrated and discussed. Two patients with a single placenta with trophoblastic change and one patient with two placentas, one normal and one with a hydatidiform mole, are described. The clinical and sonographic abnormalities in all three patients were characteristic. In the two patients with single placenta, the histologic findings were minimal. The clinical and sonographic presentations of coexistent mole and fetus are described and etiology is discussed. The implication of the lack of histologic confirmation of hydatidiform mole suggests a spectrum of findings in trophoblastic disease.
Adult↗
The gray scale sonographic appearance of intra-abdominal mesenchymal sarcomas.
Twenty-eight patients with intra-abdominal mesenchymal sarcomas were examined with gray scale ultrasonography. Masses were present in the mesentery, abdominal hollow viscera, liver, and retroperitoneal areas. Four different ultrasonic patterns were observed in the extra hepatic abdominal masses: (a) hyperechoic masses intermixed with anechoic zones; (b) hyperechoic masses with central fluid-filled zones; (c) homogeneous hyperechoic masses; and (d) homogeneous hypoechoic masses. Three of 6 patients with hepatic masses were totally anechoic alongside other more typical metastatic patterns. The presence of a large mass with sonographic signs of necrosis should strongly suggest the possibility of sarcoma. The differential diagnosis is discussed.
Abdominal Neoplasms↗
Giant cystic abdominal masses in children and adolescents: ultrasonic differential diagnosis.
Twelve children and adolescents with a variety of giant cystic abdominal masses are described. These masses are easily evaluated by ultrasonic scanning. Information regarding location, size, origin, and internal structure aid in the differential diagnosis. A correct diagnosis was made in a high percentage of the cases, obviating the need for more invasive studies. Ultrasound examinations at appropriate intervals during patient management can document change in position and/or size.
Abdomen↗
Gray scale features of hematomas: an ultrasonic spectrum.
Forty-eight B-scan ultrasound examinations were performed on 25 patients with hematomas. Hematomas are usually spherical or ovoid within the abdomen, and lentiform within the pleural space or abdominal wall. They generally decrease in size with time, and usually have irregular walls. Hematomas contain a variable amount of internal echoes during the first month, and then gradually become anechoic. The sonographic appearance is not specific; an abscess may have a similar appearance. An old, anechoic hematoma may contain a gelatinous material which cannot be aspirated.
Abdomen↗
Percutaneous fine needle aspiration biopsy of pancreatic and other abdominal masses.
Percutaneous fine needle aspiration biopsy of 18 patients with pancreatic masses, and 19 with other intra-abdominal tumors, showed it to be a safe, accurate procedure. A diagnostic biopsy yield was obtained in over 85% of the cases without clinical complications. Indications for fine needle biopsy are: (a) to avoid surgery by obtaining a histologic diagnosis; (b) to determine the staging of a neoplastic disease process; and (c) to facilitate treatment planning. The technique of "skinny needle" biopsy is discussed.
Abdominal Neoplasms↗
Gray scale ultrasound evaluation of hepatic neoplasms: patterns and correlations.
Ninety malignant hepatic neoplasms were studied by gray scale ultrasound. Four different ultrasonic patterns were observed: (a) discrete, relatively echo-free masses; (b) discrete, relatively echogenic masses; (c) totally echo-free masses; and (d) a diffuse alteration of echo architecture without discrete masses. There has been no apparent association of ultrasonic pattern with either the histologic type of neoplasm or the angiographic vascularity. Corresponding isotopic data is discussed.
Adenocarcinoma↗
Anterior position of the lower pole of the right kidney: potential confusion with right upper quadrant mass.
A group of patients with anterior position of the lower pole of the right kidney were examined with ultrasound to evaluate a palpable right upper quadrant mass. After it was determined, with the use of ultrasound, that the palpable mass represented the kidney, no further evaluations were necessary. This appearance is seen fairly often in normal individuals and should be considered a normal variant. The possible anatomic explanation for this appearance is discussed.
Abdominal Neoplasms↗