[Uveal effusion syndrome--case report]

The history and clinical findings of 60-year old man with effusion syndrome are presented. The uveal effusion syndrome typically affects healthy middle age men and causes recurrent, spontaneous, serous retinal and cilio-choroidal detachments which, often results in significant visual impairment. In addition, to the general clinical examinations, indirect ophthalnoscopy, fundus fluorescein angiography, ultrasonography and MRI are used to make definitive diagnosis. Annular cilio-choroidal detachment, shifting non-rheumatogenous retinal detachment, unremarkable inflammation in the anterior segment and normal intraocular pressure are the key features of the idiopathic uveal effusion syndrome. The fundus change is characterized by the "leopard-spot".

Radiology of perinephric fluid collections

The perinephric spaces consist of the subcapsular, perirenal, anterior and posterior pararenal spaces. Fluid may collect in one or more of these compartments; this can be readily demonstrated by cross-sectional imaging, particularly computed tomography (CT). This pictorial review illustrates the radiological manifestations of perinephric fluid collections with their differential diagnosis including perinephric abscess, perirenal urine collection, subcapsular and perirenal hematoma, renal lymphangiomatosis, pancreatic pararenal fluid collections and transudate fluid associated with nephropathies.

Uveal effusion and ultrasonic imaging: a clinical series

PURPOSE

To establish the diagnostic role of imaging by ultrasound for the diagnosis of uveal effusion syndrome.

METHODS

Using ultrasonic imaging features as the main criteria for evaluation, the recorded data from 16 patients with presumed uveal effusion seen between 1994 and 2000 were reviewed and analysed for clinical manifestations and current diagnostic suggestions. Eventually, as cumulating experience suggested that ultrasound is capable of indicating uveal effusion, the study set-up became in part more prospective.

RESULTS

The two main ultrasonic features found were: (1) extended multi-layered detachment patterns by B-scan, often kinetically mobile; (2) a spongy oedematous ciliary body region, often with interstitial lacunae, as demonstrated by high-resolution ultrasound biomicroscopy (50 Mhz).

CONCLUSIONS

In patients with visual loss and ambiguous detachment-like fundus pathology, ultrasonic features are often of practical guidance for diagnosing uveal effusion syndrome.

Perirenal fluid in renal parenchymal medical disease ('floating kidney'): clinical significance and sonographic grading

AIM

To study the clinical significance and radiologic features of perirenal fluid in patients with renal parenchymal disease.

MATERIALS AND METHODS

During the previous 5 years, nine patients were found to have perirenal fluid on sonography associated with renal parenchymal medical disease. The clinical, radiological, histopathological and laboratory data were analysed.

RESULTS

The perirenal fluid is a spontaneous subcapsular transudate in patients suffering from a nephropathy with a sodium retention state, with or without renal failure. Three sonographic patterns of perirenal fluid were observed: grade 1 is a thin layer of perirenal fluid; grade 2 is a moderate amount of perirenal fluid collection with indentations of the renal parenchyma and strands in the fluid, grade 3 is a large fluid collection surrounding the kidney.

CONCLUSION

The perirenal fluid represents a sign of sodium retention state and oedema in patients with intrinsic renal parenchymal medical disease which may be caused by several nephropathies.

Endometrial cavity fluid is associated with poor ovarian response and increased cancellation rates in ART cycles

BACKGROUND

Endometrial cavity fluid (ECF) is occasionally observed during assisted reproductive technology (ART) cycles. However, few reports have described its prevalence or significance.

METHODS AND RESULTS

We examined the relationships between ECF, clinical pregnancy rate (CPR), tubal factor infertility and ultrasound-visible (USV) hydrosalpinges. In 843 ART cycles involving 721 patients, ECF was observed during stimulation in 57 cycles and after human chorionic gonadotrophin (HCG) administration in 12 cycles, with an overall incidence of 8.2% (69/843). When ECF was observed during stimulation, the cancellation rate due to poor ovarian response was significantly higher (29.8 versus 16.9%, P <0.05) and the CPR per started cycle was significantly lower (26.3 versus 42.4%, P <0.05) than cycles without ECF. When ECF developed after HCG administration, the CPR was similar compared with that of the group for which ECF was not observed. In the 327 cycles involving tubal factor infertility patients, USV hydrosalpinges were noted in 71 cycles (71/327; 21.7%), and ECF developed in five of those cycles (5/71; 7.0%). A total of 27 cycles during which ECF developed (27/57, 47.4%) involved non-tubal factor patients.

CONCLUSIONS

ECF during stimulation was associated with increased cancellation rates and lower CPRs per started cycle, and was not associated with USV hydrosalpinges. Furthermore, ECF observed after HCG administration did not impact CPR and may represent a different clinical entity.

Seroma after laparoscopic repair of hernia with PTFE patch: is it really a complication?

We evaluated the true incidence of seroma formation after laparoscopic repair of incisional hernia with polytetrafluoroethylene (PTFE) patch. In a prospective study, 20 patients who underwent laparoscopic repair of incisional hernia with PTFE were evaluated clinically and with ultrasound examination for seroma formation up to the 90th postoperative day. Seroma was diagnosed clinically in only 35% of cases, while ultrasound examination revealed the presence of seroma in 100% of patients. Ultrasound examination is a reliable tool for diagnosis of early or delayed postoperative seroma formation following laparoscopic repair of incisional hernia with Gore-Tex Dualmesh.

Fetal nuchal translucency: a prenatal screening tool

During fetal nuchal translucency screening, ultrasonography is used to assess for a fluid collection at the nape of the fetal neck. An abnormal fluid collection may be related to genetic disorders and/or physical anomalies. This screening is most accurate when performed between 10 and 14 weeks gestation. Analyzing maternal serum beta-hCG and pregnancy-associated plasma protein A levels increases the accuracy of 1st trimester screening. Nurse practitioners, midwives, and physicians can be certified in performing fetal nuchal translucency screening.

[Uveal effusion in its pseudotumoral form. A case report]

Uveal effusion exhibits various clinical presentations, some of which may lead to erroneous diagnosis and mimic a choroidal tumor. A 73-year-old female patient displayed a choroidal lesion with a tumoral appearance spontaneously affecting her right eye. Ultrasonography did not establish the diagnosis, leaving doubt for a tumor. In addition to the tumor - like lesion, a moderate inflammation was found in her right eye. The clinical course was favorable and one month after the initial examination, no fundus abnormalities were observed. The delay imposed by the MRI examination contributed to the lack of any active treatment. Apart from cases occurring postoperatively, the diagnosis of uveal effusion may sometimes be difficult to establish. In order to avoid enucleation and even if ultrasonography is helpful in reaching the correct diagnosis, it seems appropriate to wait and regularly follow up the patients when the diagnosis is not certain. The clinical course might be helpful to establish the diagnosis. Our case suggests that in pseudotumoral forms of uveal effusion, we should repeat clinical examination and ultrasonography in order to manage these patients appropriately.

Targeted musculoarticular sonography in the detection of joint effusions

This article describes an advanced application for an established technology, specifically the use of bedside sonography in the assessment of the acutely painful joint in the emergency department. The sonographic windows for each of the axial synovial joints are outlined, with a brief discussion of commonly encountered pathologic conditions.

Mandibular haemophilic pseudotumour containing a fluid-fluid level

Osseous haemophilic pseudotumours are uncommon. Mandibular haemophilic pseudotumours are rare, with only approximately 12 cases reported in the literature to date. We present imaging findings of a histopathologically proven mandibular haemophilic pseudotumour. A fluid-fluid level, hitherto not associated with this condition, is also described.

Uveal effusion after cataract surgery: an echographic study

PURPOSE

To determine the incidence of uveal effusion after cataract surgery and to relate its presence to selected preoperative, intraoperative, and postoperative variables.

DESIGN

Prospective consecutive observational case series.

PARTICIPANTS

Two hundred seven eyes of 205 subjects undergoing cataract surgery.

METHODS

Several preoperative, intraoperative, and postoperative variables of potential significance in uveal effusion after cataract surgery were studied. On the first postoperative day and within 2 weeks after the surgery, subjects were examined clinically and echographically with B-scan for evidence of suprachoroidal (uveal) effusion. When effusion was present, follow-up examinations were performed until complete resolution was documented.

MAIN OUTCOME MEASURES

Echographic presence of uveal effusion in the postoperative period.

RESULTS

Uveal effusion was documented echographically in 12 patients (5.8%). Only one of these cases was clinically evident. All effusions were small and resolved with no intervention. The presence of postoperative hypotony related to wound leak (intraocular pressure <10 mmHg) was significantly correlated with uveal effusion after cataract surgery (P<0.0001). The combination of oral acetazolamide and topical pilocarpine gel given after the surgery also correlated with effusion (P<0.02). Intraoperative complications and prolonged phacoemulsification time were not shown to be risk factors for effusion.

CONCLUSIONS

Uveal effusion is rarely seen after modern, small-incision, closed-system cataract surgery. It is correlated with postoperative hypotony related to wound leak and with the administration of both oral acetazolamide and topical pilocarpine after surgery.

The clinical indications for plain radiography in acute knee trauma

OBJECTIVES

to assess the key symptoms and physical signs in the acutely injured knee that are significantly associated with fracture and utilise these to develop an algorithm for the use of radiography in acute knee trauma.

DESIGN

retrospective review of all acute knee injuries presenting to the accident and emergency unit at a District General Hospital over a 6-month period in 1998 (over 500 cases). After exclusions, a study group of 370 eligible adults was obtained. These patients were reviewed for the key symptoms and physical signs, and radiological evidence of fracture.

OUTCOME MEASURES

the X-ray films were interpreted by a consultant radiologist. Of those patients on whom radiographs were not performed, follow up was assessed by a review of any re-attendance to the A&E department.

RESULTS

there was a statistically significant correlation, using chi-square (Mantel-Haentzel) and linear regression analysis, between the presence of a fracture and each of the following variables: age, non-weightbearing in the department (p<0.05), haemarthrosis, point bony tenderness, effusion (p<0.001).

CONCLUSION

these key symptoms and physical signs may form the basis of an algorithm for examining knees radiologically, with acceptable positive and negative predictive values. (This is currently being tested prospectively).

MRI of retroperitoneal collections: a comparison with CT

Retroperitoneal collections in the absence of pancreatitis are rare. Imaging plays an important role in determining the aetiology of these collections and in allowing percutaneous drainage to be performed safely. A review of the imaging characteristics on both CT and MRI is presented, highlighting the advantages and disadvantages of these two modalities and their complimentary roles.

Colour Doppler ultrasonography to detect pannus in knee joint synovitis

OBJECTIVE

To determine if colour Doppler ultrasonography can characterise the nature of intraarticular echogenic structures and synovial villi more precisely than conventional ultrasonography.

METHODS

This is a prospective study on 20 patients--10 with rheumatoid arthritis and 10 with osteoarthritis. Colour Doppler ultrasonography of the knee joints was performed prior to total prosthetic replacement. Two independent, trained physician ultrasonographers examined the knee to be replaced with different ultrasound equipment using colour Doppler and power Doppler ultrasonography. The existence and extent of pannus were then assessed surgically and histologically.

RESULTS

All 9 patients with histologically detected pannus had perfused, echogenic, intraarticular structures (ultrasonographer 2; ultrasonographer 1: 8 out of 9 patients). Sparse perfusion was detected in 1 patient (investigator 1) and in 5 patients (investigator 2) with extensive non-destructive synovial proliferation. Colour Doppler and power Doppler ultrasonography were equivalent in detecting small intraarticular vessels.

CONCLUSION

Colour Doppler ultrasonography improves the differentiation of intraarticular structures compared to conventional ultrasonography.

A prospective study of soft-tissue ultrasonography in sickle cell disease patients with suspected osteomyelitis

AIM

A prospective study was done to assess the accuracy of soft tissue ultrasonography in patients with sickle cell disease (SCD) presenting with suspected osteomyelitis.

MATERIALS AND METHODS

Thirty-one SCD patients had soft tissue ultrasonography on 38 occasions (18 men, 13 women; mean age 8.2 years). The initial ultrasonographic signs and diagnosis were compared with the final clinical diagnosis, which was based on clinical progress and scintigraphy.

RESULT

The overall sensitivity of ultrasound in diagnosing osteomyelitis was 74% with a specificity of 63%. The principal ultrasonographic finding of subperiosteal fluid was present in 14 (74%) patients with osteomyelitis and seven (37%) patients without infection. A finding of a subperiosteal fluid depth of 4 mm or more was significantly associated with osteomyelitis (P < 0.01).

CONCLUSION

Ultrasonography should be the initial investigation in SCD patients if osteomyelitis is suspected clinically. In such a clinical setting, a finding of 4 mm depth or more of subperiosteal fluid appears to be diagnostic. Previous statements that the presence of any subperiosteal fluid indicates infection are shown to be inaccurate. Patients with less than 4 mm of subperiosteal fluid require further imaging or aspiration to establish the diagnosis of osteomyelitis.

[Ultrasound examination in patients with peritonitis]

Ultrasonographic features of developed intraabdominal complications were in 73 patients, in 43 of them being local and in 30-diffuse peritonitis. The diagnosis was based on the complex manifestations of' sonographic changes of the small bowel and other organs of the abdominal cavity which the authors suggest to interpret as an ultrasound syndrome of "the bowel deficiency". The possibility of dynamic ultrasound control in postoperative period for registration of the features indicating elimination or progressing of peritonitis is shown.

Sonography for hip joint effusion in adults with hip pain

OBJECTIVE

To study the prevalence of ultrasonic hip joint effusion and its relation with clinical, radiological and laboratory (ESR) findings in adults with hip pain.

METHODS

Patients (n = 224) aged 50 years or older with hip pain, referred by the general practitioner for radiological investigation, underwent a standardised examination. The distance between the ventral capsule and the femoral neck, an increase in which represents joint effusion, was measured sonographically. Joint effusion was defined in three different ways: "effusion" according to Koski's definition, "major effusion", and "asymmetrical effusion" based on only individual side differences.

RESULTS

"Effusion" was present in 80 (38%), "major effusion" in 20 (9%), and "asymmetrical effusion" in 47 (22%) patients. Pain in the groin or medial thigh, pain aggravated by lying on the side, decreased extension/internal rotation/abduction/flexion, painful external rotation, and pain on palpation in the groin showed a significant relation (adjusted for age and radiological osteoarthritis of the hip) with ultrasonic hip joint effusion. "Major effusion" showed a significant relation with an increased ESR. When patients with bilateral pain and increased ESR were excluded, a side difference in the range of motion of extension of the hip was shown to be a good predictor for "asymmetrical effusion" (positive predictive value: 71%, negative predictive value: 80%).

CONCLUSION

This study showed a relatively high prevalence of ultrasonic joint effusion in adults with hip pain in general practice. Furthermore the results indicate a relation between joint effusion and clinical signs.

Ultrasound biomicroscopy in the diagnosis of supraciliochoroidal fluid after trabeculectomy

PURPOSE

To report supraciliochoroidal effusion after trabeculectomy with the use of ultrasound biomicroscopy.

METHODS

In a prospective study, 28 eyes of 19 patients with primary open-angle glaucoma that underwent trabeculectomy were evaluated preoperatively and postoperatively by ultrasound biomicroscopy.

RESULTS

Four eyes showed a hypoechogenic suprachoroidal space that remained stable for 6 months postoperatively. These four eyes had intraocular pressures of 11 mm Hg or less on no antiglaucoma medications and without signs of choroidal detachment.

CONCLUSION

Ultrasound biomicroscopy proved to be a useful method of detecting, after trabeculectomy, supraciliochoroidal fluid without clinically detectable choroidal detachment. This fluid may signify an iatrogenic cyclodialysis during surgery or, less likely, subclinical ciliochoroidal detachment.

Prosthetic valve obstruction with normal disk motion: usefulness of transesophageal echocardiography to define cause

We describe a rare case of Björk-Shiley prosthetic valve obstruction with normal motion of the tilting disk. The cause of obstruction was the annular pannus ingrowth and was well defined by transesophageal echocardiography, but not by cardiac catheterization nor cineradiography.

The assessment of acute knee injuries by Senior House Officers in the Accident and Emergency department

This study in a large inner city Accident & Emergency (A&E) department investigated the awareness of new Senior House Officers (SHO's) of the major symptoms and signs of significant trauma to the knee. They were able to identify a knee effusion clinically but were unable to differentiate a haemarthrosis from a reactive effusion. An acute haemarthrosis is suggestive of significant damage such as fracture, cruciate ligament rupture, major meniscal tear, synovial tear or patella dislocation (Maffulli N, Binfield PM, King JB, Good CJ. J Bone Joint Surg [Br] 1993;75(6):945-949 [1]; Noyes FR, Basset RW, Grood ES, Butler DL. J Bone Joint Surg [Am] 1980;62-A:687-695 [2]; Jain AS, Swanson AJG, Murdoch G. Injury 1983;15:178-181.] [3]). In many cases a haemarthrosis may be the only abnormality demonstrable in the acute setting (Dehaven KE. Am J Sports Med 1980;8:9-14 [4]; Visuri T, Koskenvuo M, Dahlstrom S. Milit Med 1993;158(6):378-381 [5]). If this diagnosis is missed then patients may be inappropriately sent home without suitable treatment and follow up. Greater emphasis should be placed on the differentiation between reactive effusion and haemarthrosis in the knee during the teaching of orthopaedics both at medical school and also on arrival at the A&E department.

The value of late computed tomographic scanning in identification of vascular abnormalities after abdominal aortic aneurysm repair

PURPOSE

The purpose of this study was to determine the prevalence of late arterial abnormalities after aortic aneurysm repair and thus to suggest a routine for postoperative radiologic follow-up examination and to establish reference criteria for endovascular repair.

METHODS

Computed tomographic (CT) scan follow-up examination was obtained at 8 to 9 years after abdominal aortic aneurysm (AAA) repair on a cohort of patients enrolled in the Canadian Aneurysm Study. The original registry consisted of 680 patients who underwent repair of nonruptured AAA. When the request for CT scan follow-up examination was sent in 1994, 251 patients were alive and potentially available for CT scan follow-up examination and 94 patients agreed to undergo abdominal and thoracic CT scanning procedures. Each scan was interpreted independently by two vascular radiologists.

RESULTS

For analysis, the aorta was divided into five defined segments and an aneurysm was defined as a more than 50% enlargement from the expected normal value as defined in the reporting standards for aneurysms. With this strict definition, 64.9% of patients had aneurysmal dilatation and the abnormality was considered as a possible indication for surgical repair in 13.8%. Of the 39 patients who underwent initial repair with a tube graft, 12 (30.8%) were found to have an iliac aneurysm and six of these aneurysms (15.4%) were of possible surgical significance. Graft dilatation was observed from the time of operation (median graft size of 18 mm) to a median size of 22 mm as measured by means of CT scanning at follow-up examination. Fluid or thrombus was seen around the graft in 28% of the cases, and bowel was believed to be intimately associated with the graft in 7%.

CONCLUSION

Late follow-up CT scans after AAA repair often show vascular abnormalities. Most of these abnormalities are not clinically significant, but, in 13.8% of patients, the thoracic or abdominal aortic segment was aneurysmal and, in 15.4% of patients who underwent tube graft placement, one of the iliac arteries was significantly abnormal to warrant consideration for surgical repair. On the basis of these findings, a routine CT follow-up examination after 5 years is recommended. This study provides a population-based study for comparison with the results of endovascular repair.