Sonography of Gastrointestinal Tract Diseases: Correlation With Computed Tomographic Findings and Endoscopy

Abdominal hereditary angio-oedema caught on magnetic resonance imaging

A 17-year-old woman presented with a 3-year history of recurrent, severe abdominal pain with spontaneous resolution within a few days. An ultrasound revealed nothing more than free fluid within the pelvis. An MRI of the small bowel was done within 24 hours of abdominal pain onset, which revealed extensive submucosal oedema associated with moderate volume ascites. A repeat MRI of the small bowel after 72 hours showed near-complete resolution of these changes. Checking C1 inhibitor levels confirmed a diagnosis of hereditary angio-oedema with an abdominal presentation. This is a rare cause of recurrent abdominal pain and, to our knowledge, the first case in which MR images have been obtained during and after an acute attack.

Transabdominal ultrasound sonography findings in peritonitis due to the spread of Crohn's disease to the penetration

In the presence of the clinical signs of peritonitis, transabdominal ultrasound sonography by experienced technicians or physicians could be a fast and reliable imaging tool for confirmation of disease status.

Ultrasound features and the diagnostic strategy of subhepatic appendicitis

Background

This study aimed to compare the differences of ultrasound findings between subhepatic appendicitis and appendicitis at a normal position, then discuss the diagnostic strategies and improve the accuracy of diagnosis.

Methods

A retrospective analysis was performed in our hospital. One thousand five hundred ninety-one patients with appendicitis were diagnosed from January 2014 to January 2018. Eighteen patients with subhepatic appendicitis and 25 patients with appendicitis with regular positions were selected randomly as the control group. The difference in ultrasound features between the two groups was studied. Comparisons between the two groups showed statistically significant differences in the frequencies of the fishbone sign, enlarged appendix, appendicoliths, and hyperechoic omental cap (P<0.05).

Results

Statistical significance was not observed with the difference in the frequency of whether there was lymphadenectasis (P>0.05) in the abdominal cavity between the two groups. The Pareto chart was drawn to look for the main factors associated. The results of interpretation on the critical points of diagnosis for subhepatic appendicitis: (I) the fishbone sign of a dilated ileum in the right lower abdomen; and (II) the fishbone sign of a dilated ileum in the right lower abdomen + presence of an enlarged appendix in the right upper abdomen.

Conclusions

An abnormally dilated ileum in the right lower abdomen – the fishbone sign, is a vital sign leading to the diagnosis of subhepatic appendicitis. The fishbone sign of a dilated ileum in the right lower abdomen + whether there is a vermiform structure is an important diagnostic indicator for subhepatic appendicitis.

Bowel ultrasound: examination techniques and normal and pathologic patterns

Ultrasound is being increasingly used to study the digestive tract because it has certain advantages over other techniques such as endoscopy, CT enterography, and MR enterography. Ultrasound can be used to evaluate the bowel wall and the elements that surround it without the need for contrast agents; its ability to evaluate the elasticity and peristalsis of these structures is increasing interest in its use. This article describes the techniques and modalities of bowel ultrasound, as well as the normal features of the bowel wall and contiguous structures. It uses a practical approach to review the main pathological findings and their interpretation, and the different patterns of presentation, which will help orient the diagnosis.

Pitfalls in ultrasound imaging of the stomach and the intestines

The gastrointestinal tract is an extraordinary human organ in terms of its morphology and function. Its complex structure and enormous length as well as frequent presence of gas discourage many doctors performing ultrasound examination from its exploration. Moreover, there are anatomical structures in multiple locations which can mimic certain abnormalities. It is difficult to present an exhaustive account of the problem of gastrointestinal tract ultrasound imaging errors in a single work; therefore, this study focuses mainly on false positive errors which usually result from a lack of knowledge of anatomical variants of the gastrointestinal tract structure. In the case of the stomach, rugae and muscle layer thickening towards the pylorus have been mentioned, which constitute variants of the structure of this organ examined when empty. Diagnostic pitfalls in the small intestine may include the dudenojejunal flexure (ligament of Treitz), the horizontal part of the duodenum and the ileocaecal valve. The status of the apparent lesions in all of the cases mentioned will be resolved following fluid intake by the patient. In the colon, the varied structure of semilunar folds should be taken note of. Their large thickness can warrant suspicion of wall invasion or a polyp. In addition, the study emphasises the importance of appropriate preparation of a patient for gastrointestinal tract examination since it determines the accuracy of the diagnosis. The authors also take note of common ‘sins’ of physicians such as hasty examination and failure to comply with the stomach and appendix examination protocol.