This case report describes the radiographic and ultrasonographic findings of three surgically confirmed cases of mesenteric volvulus or intestinal torsion in dogs. In all three cases, ultrasonographic findings include...This case report describes the radiographic and ultrasonographic findings of three surgically confirmed cases of mesenteric volvulus or intestinal torsion in dogs. In all three cases, ultrasonographic findings included segmental ileus and absent or markedly reduced peristalsis of the affected small intestine, and partial loss of wall layering with increased overall echogenicity of the intestinal wall, but with normal to mildly increased wall thickening. No blood flow was detected in the affected small intestinal wall when assessed with colour Doppler. A moderate amount of peritoneal effusion was also detected with hyperechoic omental and mesenteric fat tissue throughout the peritoneal cavity. Few reports describe ultrasonographic findings of small intestinal ischemia in small animals. In all three cases presented here, ultrasound was helpful in demonstrating typical intestinal wall changes and helped to obtain the correct diagnosis of ischemic disease of the small intestine.展开更多
AIM:To compare computed tomography enteroclysis(CTE) vs small intestine contrast ultrasonography(SICUS) for assessing small bowel lesions in Crohn's disease(CD),when using surgical pathology as gold standard.METHO...AIM:To compare computed tomography enteroclysis(CTE) vs small intestine contrast ultrasonography(SICUS) for assessing small bowel lesions in Crohn's disease(CD),when using surgical pathology as gold standard.METHODS:From January 2007 to July 2008,15 eligible patients undergoing elective resection of the distal ileum and coecum(or right colon) were prospectively enrolled.All patients were under follow-up.The study population included 6 males and 9 females,with a median age of 44 years(range:18-80 years).Inclusion criteria:(1) certain diagnosis of small bowel requiring elective ileo-colonic resection;(2) age between 18-80 years;(3) elective surgery in our Surgical Unit;and(4) written informed consent.SICUS and CTE were performed ≤ 3 mo before surgery,followed by surgical pathology.The following small bowel lesions were blindly reported by one sonologist,radiologist,surgeon and histolopathologist:disease site,extent,strictures,abscesses,fistulae,small bowel dilation.Comparison between findings at SICUS,CTE,surgical specimens and histological examination was made by assessing the specificity,sensitivity and accuracy of each technique,when using surgical findings as gold standard.RESULTS:Among the 15 patients enrolled,CTE was not feasible in 2 patients,due to urgent surgery in one patients and to low compliance in the second patient,refusing to perform CTE due to the discomfort related to the naso-jejunal tube.The analysis for comparing CTE vs SICUS findings was therefore performed in 13 out of the 15 CD patients enrolled.Differently from CTE,SICUS was feasible in all the 15 patients enrolled.No complications were observed when using SICUS or CTE.Surgical pathology findings in the tested population included:small bowel stricture in 13 patients,small bowel dilation above ileal stricture in 10 patients,abdominal abscesses in 2 patients,enteric fistulae in 5 patients,lymphnodes enlargement(> 1 cm) in 7 patients and mesenteric enlargement in 9 patients.In order to compare findings by using SICUS,CTE,histology and surgery,characteristics of the small bowel lesions observed in CD each patient were blindly reported in the same form by one gastroenterologistsonologist,radiologist,surgeon and anatomopathologist.At surgery,lesions related to CD were detected in the distal ileum in all 13 patients,also visualized by both SICUS and CTE in all 13 patients.Ileal lesions > 10 cm length were detected at surgery in all the 13 CD patients,confirmed by SICUS and CTE in the same 12 out of the 13 patients.When using surgical findings as a gold standard,SICUS and CTE showed the exactly same sensitivity,specificity and accuracy for detecting the presence of small bowel fistulae(accuracy 77% for both) and abscesses(accuracy 85% for both).In the tested CD population,SICUS and CTE were also quite comparable in terms of accuracy for detecting the presence of small bowel strictures(92% vs 100%),small bowel fistulae(77% for both) and small bowel dilation(85% vs 82%).CONCLUSION:In our study population,CTE and the non-invasive and radiation-free SICUS showed a comparable high accuracy for assessing small bowel lesions in CD.展开更多
BACKGROUND Although the overall incidence of tuberculosis in underdeveloped areas has increased in recent years, esophageal tuberculosis(ET) is still rare. Intestinal tuberculosis(ITB) is relatively more common, but t...BACKGROUND Although the overall incidence of tuberculosis in underdeveloped areas has increased in recent years, esophageal tuberculosis(ET) is still rare. Intestinal tuberculosis(ITB) is relatively more common, but there are few reports of ET complicated with ITB. We report a case of secondary ET complicated with ITB in a previously healthy patient.CASE SUMMARY A 27-year-old female was hospitalized for progressive dysphagia, retrosternal pain, acid regurgitation, belching, heartburn, and nausea. Upper gastrointestinal endoscopy showed a mid-esophageal ulcerative hyperplastic lesion. Endoscopic ultrasonography showed a homogeneous hypoechoic lesion, with adjacent enlarged lymph nodes. Biopsy histopathology showed inflammatory exudation,exfoliated epithelial cells and interstitial granulation tissue proliferation.Colonoscopy revealed a rat-bite ulcer in the terminal ileum and a superficial ulcer in the ascending colon, near the ileocecal region. The ileum lesion biopsy showed focal granulomas with caseous necrosis. Polymerase chain reaction for Mycobacterium tuberculosis was positive in the esophageal and ileum lesion biopsies. The T-cell spot tuberculosis test was also positive. The patient was diagnosed with secondary ET infiltrated by mediastinal lymphadenopathy and complicated with ITB, possibly from the Mycobacterium tuberculosis-infected esophageal lesion. After 2 mo of anti-tuberculosis therapy, her symptoms improved significantly, and upper gastrointestinal endoscopy showed healing ulcers.CONCLUSION When dysphagia or odynophagia occurs in patients at high-risk for tuberculosis,ET should be considered.展开更多
Objective： The purpose of this study was to search the ultrasound features of small intestinal stromal tumor （SIST） in women by reviewing their clinical data. Methods： The study group consisted of 18 female patien...Objective： The purpose of this study was to search the ultrasound features of small intestinal stromal tumor （SIST） in women by reviewing their clinical data. Methods： The study group consisted of 18 female patients with pathologically proven SIST in our hospital from 2000 to 2009. Medical records were reviewed for clinical information such as manifestation, findings of ultrasonography and immunohistochemical phenotype. Results： The average age of 18 female patients with SIST was 55.2 years （ranged, 39-84 years）. Seventeen cases of them had abnormal hypogastric masses, no mass in one case. The shapes of masses were round or Iobulate beside tightly uterus or ovary. The echo of masses was low. It＇s borders were clear and sometimes irregular. The sizes of the masses varied from 6.89-193.05 cm3, the diameter ranged from 24 tom-110 ram, 85.3% of which 50 mm-110 mm. There were rare color flow signals under color Doppler velocity mode or color Doppler power mode. Exploratory laparotomy confirmed that 16 cases of the tumors originated from small intestine, and 2 cases from the ileocecat. The positive rate of the immunohistochemical phenotype of CDl17 was 88.2%, and CD34 was 76.5%. The examination of pathology confirmed that 16 cases were malignant and 2 cases borderline tumors. Eighteen cases underwent radical surgical resection. Conclusion： The characteristics of SISTs in women pelvic cavity are： age 〉 40 years, a mass （proven not from productive system by ultrasonography） in pelvic cavity, melena, positive findings in pathology and CD117/CD34, especially notice masses which diameter is more than 50 mm and possess potential malignant. Ultrasonography is a convenient and effective tool of screening SISTs.展开更多
Inflammatory bowel disease(IBD) is one of the most common chronic gastrointestinal diseases in pediatric patients.Choosing the optimal imaging modality for the assessment of gastrointestinal disease in pediatric patie...Inflammatory bowel disease(IBD) is one of the most common chronic gastrointestinal diseases in pediatric patients.Choosing the optimal imaging modality for the assessment of gastrointestinal disease in pediatric patients can be challenging.The invasiveness and patient acceptance,the radiation exposure and the quality performance of the diagnostic test need to be considered.By reviewing the literature regarding imaging in inflammatory bowel disease the value of ultrasound in the clinical management of pediatric patients is highlighted.Transabdominal ultrasound is a useful,noninvasive method for the initial diagnosis of IBD in children;it also provides guidance for therapeutic decisions and helps to characterize and predict the course of the disease in individual patients.Ultrasound techniques including color Doppler imaging and contrast-enhanced ultrasound are promising imaging tools to determine disease activity and complications.Comparative studies between different imaging methods are needed.展开更多
A 57-year-old male presenting with spontaneously relieved abdominal cramp and distension was admitted to theWest China Hospital.The diagnosis remained unclear after colonoscopy and computed tomography.Double contrast-...A 57-year-old male presenting with spontaneously relieved abdominal cramp and distension was admitted to theWest China Hospital.The diagnosis remained unclear after colonoscopy and computed tomography.Double contrast-enhanced ultrasonography was then performed and a neoplasm in the small intestine was suspected,supported by a thin-section computed tomography and positron emission tomography/computed tomography.This was confirmed pathologically after surgery to be a small intestinal G1 neuroendocrine tumor.Surgery was performed to remove approximately 25 cm of small bowel and a 3-cm solid mass located in the mesentery.The patient had a complete recovery and was tumor-free at the final follow-up.Small intestinal tumors including neuroendocrine tumors have always posed a diagnostic challenge.This case indicated that double contrastenhanced ultrasonography is feasible in detection of small intestinal neuroendocrine tumors,and it may be an advisable approach assisting diagnosis of small intestinal tumors.展开更多
文摘This case report describes the radiographic and ultrasonographic findings of three surgically confirmed cases of mesenteric volvulus or intestinal torsion in dogs. In all three cases, ultrasonographic findings included segmental ileus and absent or markedly reduced peristalsis of the affected small intestine, and partial loss of wall layering with increased overall echogenicity of the intestinal wall, but with normal to mildly increased wall thickening. No blood flow was detected in the affected small intestinal wall when assessed with colour Doppler. A moderate amount of peritoneal effusion was also detected with hyperechoic omental and mesenteric fat tissue throughout the peritoneal cavity. Few reports describe ultrasonographic findings of small intestinal ischemia in small animals. In all three cases presented here, ultrasound was helpful in demonstrating typical intestinal wall changes and helped to obtain the correct diagnosis of ischemic disease of the small intestine.
基金Supported by The Fondazione Umberto Di Mario,Largo Marchiafava,1,Roma,Italya Grant Research from PRIN 2008,No. 2008X8NRH4,Italy
文摘AIM:To compare computed tomography enteroclysis(CTE) vs small intestine contrast ultrasonography(SICUS) for assessing small bowel lesions in Crohn's disease(CD),when using surgical pathology as gold standard.METHODS:From January 2007 to July 2008,15 eligible patients undergoing elective resection of the distal ileum and coecum(or right colon) were prospectively enrolled.All patients were under follow-up.The study population included 6 males and 9 females,with a median age of 44 years(range:18-80 years).Inclusion criteria:(1) certain diagnosis of small bowel requiring elective ileo-colonic resection;(2) age between 18-80 years;(3) elective surgery in our Surgical Unit;and(4) written informed consent.SICUS and CTE were performed ≤ 3 mo before surgery,followed by surgical pathology.The following small bowel lesions were blindly reported by one sonologist,radiologist,surgeon and histolopathologist:disease site,extent,strictures,abscesses,fistulae,small bowel dilation.Comparison between findings at SICUS,CTE,surgical specimens and histological examination was made by assessing the specificity,sensitivity and accuracy of each technique,when using surgical findings as gold standard.RESULTS:Among the 15 patients enrolled,CTE was not feasible in 2 patients,due to urgent surgery in one patients and to low compliance in the second patient,refusing to perform CTE due to the discomfort related to the naso-jejunal tube.The analysis for comparing CTE vs SICUS findings was therefore performed in 13 out of the 15 CD patients enrolled.Differently from CTE,SICUS was feasible in all the 15 patients enrolled.No complications were observed when using SICUS or CTE.Surgical pathology findings in the tested population included:small bowel stricture in 13 patients,small bowel dilation above ileal stricture in 10 patients,abdominal abscesses in 2 patients,enteric fistulae in 5 patients,lymphnodes enlargement(> 1 cm) in 7 patients and mesenteric enlargement in 9 patients.In order to compare findings by using SICUS,CTE,histology and surgery,characteristics of the small bowel lesions observed in CD each patient were blindly reported in the same form by one gastroenterologistsonologist,radiologist,surgeon and anatomopathologist.At surgery,lesions related to CD were detected in the distal ileum in all 13 patients,also visualized by both SICUS and CTE in all 13 patients.Ileal lesions > 10 cm length were detected at surgery in all the 13 CD patients,confirmed by SICUS and CTE in the same 12 out of the 13 patients.When using surgical findings as a gold standard,SICUS and CTE showed the exactly same sensitivity,specificity and accuracy for detecting the presence of small bowel fistulae(accuracy 77% for both) and abscesses(accuracy 85% for both).In the tested CD population,SICUS and CTE were also quite comparable in terms of accuracy for detecting the presence of small bowel strictures(92% vs 100%),small bowel fistulae(77% for both) and small bowel dilation(85% vs 82%).CONCLUSION:In our study population,CTE and the non-invasive and radiation-free SICUS showed a comparable high accuracy for assessing small bowel lesions in CD.
文摘BACKGROUND Although the overall incidence of tuberculosis in underdeveloped areas has increased in recent years, esophageal tuberculosis(ET) is still rare. Intestinal tuberculosis(ITB) is relatively more common, but there are few reports of ET complicated with ITB. We report a case of secondary ET complicated with ITB in a previously healthy patient.CASE SUMMARY A 27-year-old female was hospitalized for progressive dysphagia, retrosternal pain, acid regurgitation, belching, heartburn, and nausea. Upper gastrointestinal endoscopy showed a mid-esophageal ulcerative hyperplastic lesion. Endoscopic ultrasonography showed a homogeneous hypoechoic lesion, with adjacent enlarged lymph nodes. Biopsy histopathology showed inflammatory exudation,exfoliated epithelial cells and interstitial granulation tissue proliferation.Colonoscopy revealed a rat-bite ulcer in the terminal ileum and a superficial ulcer in the ascending colon, near the ileocecal region. The ileum lesion biopsy showed focal granulomas with caseous necrosis. Polymerase chain reaction for Mycobacterium tuberculosis was positive in the esophageal and ileum lesion biopsies. The T-cell spot tuberculosis test was also positive. The patient was diagnosed with secondary ET infiltrated by mediastinal lymphadenopathy and complicated with ITB, possibly from the Mycobacterium tuberculosis-infected esophageal lesion. After 2 mo of anti-tuberculosis therapy, her symptoms improved significantly, and upper gastrointestinal endoscopy showed healing ulcers.CONCLUSION When dysphagia or odynophagia occurs in patients at high-risk for tuberculosis,ET should be considered.
文摘Objective： The purpose of this study was to search the ultrasound features of small intestinal stromal tumor （SIST） in women by reviewing their clinical data. Methods： The study group consisted of 18 female patients with pathologically proven SIST in our hospital from 2000 to 2009. Medical records were reviewed for clinical information such as manifestation, findings of ultrasonography and immunohistochemical phenotype. Results： The average age of 18 female patients with SIST was 55.2 years （ranged, 39-84 years）. Seventeen cases of them had abnormal hypogastric masses, no mass in one case. The shapes of masses were round or Iobulate beside tightly uterus or ovary. The echo of masses was low. It＇s borders were clear and sometimes irregular. The sizes of the masses varied from 6.89-193.05 cm3, the diameter ranged from 24 tom-110 ram, 85.3% of which 50 mm-110 mm. There were rare color flow signals under color Doppler velocity mode or color Doppler power mode. Exploratory laparotomy confirmed that 16 cases of the tumors originated from small intestine, and 2 cases from the ileocecat. The positive rate of the immunohistochemical phenotype of CDl17 was 88.2%, and CD34 was 76.5%. The examination of pathology confirmed that 16 cases were malignant and 2 cases borderline tumors. Eighteen cases underwent radical surgical resection. Conclusion： The characteristics of SISTs in women pelvic cavity are： age 〉 40 years, a mass （proven not from productive system by ultrasonography） in pelvic cavity, melena, positive findings in pathology and CD117/CD34, especially notice masses which diameter is more than 50 mm and possess potential malignant. Ultrasonography is a convenient and effective tool of screening SISTs.
文摘Inflammatory bowel disease(IBD) is one of the most common chronic gastrointestinal diseases in pediatric patients.Choosing the optimal imaging modality for the assessment of gastrointestinal disease in pediatric patients can be challenging.The invasiveness and patient acceptance,the radiation exposure and the quality performance of the diagnostic test need to be considered.By reviewing the literature regarding imaging in inflammatory bowel disease the value of ultrasound in the clinical management of pediatric patients is highlighted.Transabdominal ultrasound is a useful,noninvasive method for the initial diagnosis of IBD in children;it also provides guidance for therapeutic decisions and helps to characterize and predict the course of the disease in individual patients.Ultrasound techniques including color Doppler imaging and contrast-enhanced ultrasound are promising imaging tools to determine disease activity and complications.Comparative studies between different imaging methods are needed.
基金This article was supported by the National Natural Science Foundation of China(Grant No.81101061)the 1.3.5 Project for Disciplines of Excellence,West China Hospital,Sichuan University(Grant No.ZYJC18037).
文摘A 57-year-old male presenting with spontaneously relieved abdominal cramp and distension was admitted to theWest China Hospital.The diagnosis remained unclear after colonoscopy and computed tomography.Double contrast-enhanced ultrasonography was then performed and a neoplasm in the small intestine was suspected,supported by a thin-section computed tomography and positron emission tomography/computed tomography.This was confirmed pathologically after surgery to be a small intestinal G1 neuroendocrine tumor.Surgery was performed to remove approximately 25 cm of small bowel and a 3-cm solid mass located in the mesentery.The patient had a complete recovery and was tumor-free at the final follow-up.Small intestinal tumors including neuroendocrine tumors have always posed a diagnostic challenge.This case indicated that double contrastenhanced ultrasonography is feasible in detection of small intestinal neuroendocrine tumors,and it may be an advisable approach assisting diagnosis of small intestinal tumors.
