Journal of clinical ultrasound : JCU
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We review our two-year experience with ultrasound-guided fine needle aspiration biopsy of omental pathology. Eleven patients were referred for biopsy of omental abnormalities. ⋯ The discharge diagnosis was ovarian carcinoma in 6 patients, adenocarcinoma of unknown origin in 1, lymphoma in 1, and carcinoma of the colon in 1. The technique requires the use of a linear array transducer for biopsy guidance, and is safe, rapid, and easy to perform.
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A common finding on abdominal ultrasound and CT examinations is variation in the size of the inferior vena cava (IVC). On occasion the infrahepatic IVC even assumes a slit-like appearance. Though commonly related to respiratory change and to the degrees of intra-abdominal pressure, some have claimed the slit-IVC may be an indicator of hypovolemia. ⋯ The subhepatic IVC decreased in size at end-expiration (A-P 1.2 cm) and frequently collapsed with the Valsalva maneuver (A-P 0.7 cm). Dramatic changes in the size of the IVC with changes in ventilation are normal variants. The use of the slit-IVC to diagnose hypovolemia should be done with caution.
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In order to examine the liver during thoracotomy, a new intraoperative imaging technique called "transdiaphragmatic liver scanning" was developed. Transdiaphragmatic scanning performed with high-frequency transducers provided clear visualization of the entire liver from the thoracic cavity through the diaphragm. ⋯ In 3 operations, preoperatively suspected liver metastases were excluded by transdiaphragmatic scanning. Because transdiaphragmatic scanning provides high-resolution images of the liver and is the only method capable of examining the liver during thoracotomy, this intraoperative scanning technique may become a useful tool in the evaluation of liver metastases from thoracic or mediastinal malignancies.
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During the period from 1984 through 1986, 72 ultrasound-guided cyst punctures were performed in 60 young women (less than or equal to 40 years). Thirty-one punctures were performed using the transabdominal route and 41 punctures under the guidance of endovaginal scanning. General or local anesthesia were used in 97% of the transabdominal punctures while the corresponding figure for the endovaginal technique was 49%. ⋯ Of those women with cyst relapses and/or persistent abdominal pain, 7 were subjected to laparotomy and 5 to laparoscopy. Ultrasound-guided puncture of cystic tumors in the lower pelvis of young women seems to be an alternative to laparoscopically guided puncture or laparotomy. As compared to surgery, the ultrasound-guided technique may mean less risk for pelvic adhesions in young women with unproven fertility.
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Comparative Study
Sonographic demonstration of free air in perforated peptic ulcers: comparison of sonography with radiography.
Abdominal sonography was performed in 283 patients with acute abdominal pain. Of these patients, 10 were diagnosed as having an acute perforated peptic ulcer (PPU) and 2 were diagnosed as having a sealed-off PPU. Sonographic findings of acute PPU are summarized. ⋯ Two patients with sonographic evidence of free air, but negative X-ray studies, were later found to have free air in the subsequent radiographic studies. These findings suggest that sonography is highly sensitive in the small number of patients in whom air is found. Sonographic studies also have the advantage of detecting other changes associated with PPU, such as fluid accumulation, inflammatory mass, and thickening of the gallbladder.