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A retrospective analysis of 84 ultrasound examinations (in 77 patients) was performed to assess the frequency of sonographic findings in chronic pancreatitis. The findings included: inhomogeneously increased echogenicity in 53% of these examinations, focal or diffuse enlargement in 41%, focal dense echoes in 40%, pseudocyst formation in 21%, and a hypoechoic head mass in 7%. Thirteen per cent of our patients had a normal sonogram. Several presentations of chronic pancreatitis not previously described in the sonographic literature included: pancreatic or common bile duct enlargement or pseudocyst formation with otherwise normal-appearing glands. There was no direct relationship between the presence of focal high-intensity echoes within the pancreatic parenchyma and the presence of radiographic calcification. There was no difference in the frequency of ultrasonic abnormalities between patients with and without clinical evidence of pancreatic insufficiency. These results indicate that the sonographic findings in chronic pancreatitis are significantly more varied than previous reports would indicate.

A retrospective study of 109 patients who underwent renal biopsy was designed to correlate the sonographic appearance of the kidney with the histologic changes and clinical and laboratory findings in various renal parenchymal diseases. The clinical, pathologic, and sonographic data were analyzed blindly and independently by a team from each corresponding discipline. There was no correlation between the specific sonographic appearance and the type of renal disease. There was a significant correlation between renal length and the prevalence of global sclerosis, focal tubular atrophy, and the number of hyaline casts per glomerulus. A significant positive correlation was also found between cortical echogenicity and the severity of global sclerosis, focal tubular atrophy, the number of hyaline casts per glomerulus, and focal leukocytic infiltration. While there was overall significant correlation between the degree of cortical echogenicity and blood urea nitrogen and creatinine concentrations in each group, a wide range of variance was present. It is not currently feasible to distinguish different types of renal medical disorders using diagnostic ultrasound.

Twelve cryptorchid patients had sonographic evaluation of the inguinal region prior to surgical orchiopexy. When the testis was within the inguinal canal, the gonad was localized preoperatively by sonography in eight of nine patients. One patient had an associated inguinal hernia in which loops of bowel concealed the gonad. There were no false positive cases. The authors were not able to show abdominal or pelvic maldescended testes.

Autotransplantation of the kidney was performed in seven adult mongrel dogs. A model of acute tubular necrosis (ATN) was developed by subjecting the kidney to warm ischemia (37 degrees C) for 40 to 60 minutes. Serial ultrasound examinations were performed every 12 hours until the animal died or was killed. Sonographic findings were correlated with laboratory and histological data. Throughout the course of ATN, the characteristic normal echo pattern of the kidney remained unchanged in six of seven dogs. In one animal there were changes in the renal cortex, while the medullary pyramids showed no alteration from the base-line study. This contrasts with extensive abnormalities found during rejection.

Seventeen nephrectomized dogs underwent kidney transplantation from unrelated donors. Routine immunosuppressive therapy was administered. Serial ultrasound studies and biopsies and complete pathological examinations were performed and compared. A number of sonographic changes were observed within the renal parenchyma during rejection, some of which were present before a significant rise in serum creatinine levels. The medulla became enlarged due to edema, followed by growth of the rest of the kidney and thickening of the cortex. The cortical echoes became more sparsely distributed and either increased or decreased in amplitude; distribution was generalized or localized. During rejection, the corticomedullary boundary became indistinct. Later, a decrease in the renal sinus echoes was also noted. In 2 cases, perirenal fluid collections occurred as the result of renal rupture.

A patient with esophageal intramural pseudodiverticulosis (EIPD) was examined with computed tomography (CT). CT demonstrated marked thickening of the esophageal wall, diffuse irregularity of the esophageal lumen, and intramural gas collections--features typical of this entity. In the proper clinical setting, CT can confirm the diagnosis of EIPD, especially when other studies are equivocal. However, this case also demonstrates some of the limitations of CT in differentiating benign and malignant esophageal disorders.

Laser therapy is a new modality for treatment of airway lesions. We examined 18 patients prior to laser photoresection of tracheobronchial lesions. Thirteen had cancers involving the distal trachea, carina, and/or proximal bronchi; five had benign lesions of the middle or proximal trachea. Each patient was examined by conventional linear tomography (CLT) and computed tomography (CT). CT was valuable in patients who had lesions of the distal trachea, carina, and/or proximal bronchi. Its particular usefulness, and its advantage relative to CLT, consisted in its ability to delineate vascular structures adjacent to the planned area of photoresection. Neither CLT nor CT was helpful in evaluation of benign lesions of the proximal trachea.

The sonographic findings in 7 patients with complicated peptic ulcer are reported. Of 4 patients with perforated ulcers, 2 had a subphrenic fluid collection, 1 had subhepatic extraluminal fluid, and 1 had an inflammatory mass in the gallbladder fossa. The ulcer penetrated into the liver in 1 and the pancreas in 2. The sinus tract between the duodenum and the liver could be seen. The patients with penetrating ulcer had a solid mass indistinguishable from other solid pancreatic masses.

Four cases of peptic ulcer penetrating the head of the pancreas were diagnosed by computed tomography (CT). Findings common to 3 cases included (a) an ulcer crater, (b) a sinus tract, and (c) enlargement of the head of the pancreas. Additional findings, not seen in all patients, included (d) edema involving the base of the ulcer and/or the adjacent bowel wall and (e) loss of fascial planes between the base of the ulcer and the head of the pancreas. Unlike other modalities, the inherent spatial resolution of CT allows a confident diagnosis of this important complication of peptic ulcer disease.

Four cases of intramural exogastric lesions studied by ultrasound are presented. In all four patients, a large mass was identified in the left mid- and upper abdomen with a strip of solid tissue extending toward the left hemidiaphragm anteriorly, adjacent to the left lobe of the liver. This finding, best demonstrated on longitudinal scanning, suggested that the mass originated in the stomach rather than in the spleen or splenic flexure of the colon, which are posterior in location. Two of the lesions were leiomyoblastomas and two leiomyosarcomas.

We reviewed medical records and conventional chest radiographs that showed a solitary T1N0M0 nodule in 23 patients who had non-oat-cell bronchogenic carcinoma. No patient had evidence of metastases, either on the chest radiograph or clinically. All patients underwent computed tomography (CT) examination of the thorax, including the adrenal glands. Only one patient (4%) had mediastinal lymph nodes greater than 1 cm in diameter accessible to mediastinotomy; anterior mediastinotomy confirmed metastatic spread in this patient, which precluded curative resection. Three patients each had a mildly enlarged (2 cm or less) adrenal gland; however, follow-up study suggested that metastasis was not the cause of adrenal enlargement in these patients. This study reinforces concern over whether CT is warranted in the preoperative assessment of T1N0M0 bronchogenic carcinoma.

Sonograms of 35 patients with cadaveric renal allografts were reviewed. The patients included five with successful renal transplantations, seven with acute tubular necrosis, 19 with acute rejection, one with complete occlusion of the renal artery, and three with stenosis of a renal artery. During the course of acute tubular necrosis, the renal anatomy remained sonographically unaltered. During the course of acute rejection, there was a spectrum of sonographic findings including increase in renal volume, decreased amplitude of the renal sinus echoes, enlarged medullary pyramids, indistinct corticomedullary boundary, increased echogenicity of the renal cortex, areas of decreased parenchymal echogenicity, sparse cortical echoes, and perirenal fluid collections as a result of hematoma or crescentic collection of fluid around the kidney. In both arterial occlusion and stenosis, no sonographic abnormalities of renal anatomy were seen and the only finding was lack of normal post-transplantation hypertrophy. Our study encourages the use of sonography in acute post-transplantation renal failure. If serial ultrasound studies are available and correlation with clinical and laboratory data and nuclear medicine studies are obtained, the correct diagnosis may be reached without the use of invasive procedures.

Sonograms of 72 patients with pain and swelling in the groin due to intravenous drug abuse were reviewed, together with 2 cases which were due to trauma. There were 27 abscesses, 36 cases of cellulitis or thrombophlebitis, 7 cases of lymphadenopathy, 3 hematomas, and 1 pseudoaneurysm. Most abscesses presented as distinct masses, while cellulitis was seen most often as soft-tissue swelling. However, 5 abscesses were manifested sonographically as diffuse soft-tissue swelling without a distinct mass, while 8 cases of cellulitis appeared as a mass. In most cases, ultrasound was able to distinguish diseases requiring surgery or percutaneous drainage from those that should respond to medical therapy. In some cases, percutaneous aspiration and/or follow-up sonograms after antibiotic therapy will be necessary for a specific diagnosis.

Color Doppler ultrasound (US) with point-spectral analysis was performed on eight patients with postbiopsy renal transplant arteriovenous fistulas. Waveform analysis of the supplying artery documented decreased resistive indices in all cases and increased flow velocities in seven. The peak-systolic flow velocity in the arteries supplying the fistulas ranged from 55 to 180 cm/sec (mean, 92 cm/sec), while the range in normal arteries was 20-52 cm/sec (mean, 32 cm/sec). The resistive indices of the arteries supplying the fistulas ranged from 0.31 to 0.50 (mean, 0.45), while the resistive indices of the normal arteries ranged from 0.60 to 0.92 (mean, 0.74). Arterialization of the venous waveform from the draining vein was also documented in all cases. In six cases, the increased flow velocities resulted in increased color saturation toward white in the supplying artery (n = 2) or in both the artery and the draining vein (n = 4), which was detectable on the realtime image. In six cases, flow turbulence resulted in localized tissue vibration, which appeared as random color assignment in extravascular renal parenchyma adjacent to the fistula. Knowledge of these imaging and Doppler characteristics should aid in the identification of renal transplant arteriovenous fistulas with color Doppler US.