Hungarian Radiology

[UltraSonography]

LOMBAY Béla

FEBRUARY 20, 2002

Hungarian Radiology - 2002;76(01)

COMMENTS

0 comments

Further articles in this publication

Hungarian Radiology

[FOUNDATION]

Hungarian Radiology

[Conference of the Senior Club and Youth Committee of the Society of the Hungarian Radiologists]

BARKOVICS Mária

Hungarian Radiology

[’Reality instead of abstractions’]

SZÁNTÓ Dezső

Hungarian Radiology

[Web pages of the Society of the Hungarian Radiologists]

BÁGYI Péter, URBÁN László

Hungarian Radiology

[Frequency and diagnosis of pediatric air gun injuries]

MAKRA József, LOMBAY Béla, RIVASZ-TÓTH Gyula

[INTRODUCTION - Air guns are frequently given to children as toys. Air guns have a pellet caliber of 0.17 or 0.22 and are propelled by compressed gas. Though they have little penetrating effect, they may cause life threatening injuries. Our purpose was to evaluate the frequency and the development of the diagnostic opportunities in children with air gun injuries during the last 30 years (1971-2000). PATIENTS AND METHODS - 52 patients (39 boys and 13 girls) were admitted to our pediatric surgery department due to of air gun injuries. The average age was 9 years (range 2 to 14 years). During the first fourteen years conventional X-ray (plain film and fluoroscopy), since 1984 ultrasonography and later (1986) CT has also been used for the diagnosis. RESULTS - In the first ten years 12 patients, in the second decade 18 patients and in the third ten years 22 patients were admitted and treated with air gun injuries. The sites of injury included upper, lower extremities (n=23), head (n=10), neck (n=5), chest (n=9) and the abdomen (n=5). The majority of patients had superficial injury and Xray plain films in different views were obtained, only. Major complication occured in 10 cases: bone fracture (n=1), soft tissue abscess (n=4) pneumothorax and hemothorax (n=4), bowel perforation (n=1). In these cases ultrasonography and/or CT was performed and they were helpful to establish the correct diagnosis. CONCLUSION - The general conception that air guns are toys, is basically wrong. The practice of placing air guns in the hands of children by their parents is very dangerous. On the basis of our results, the frequency of air gun injuries in children increased significantly in the last decade and the injuries were more serious than before (due to thew technologic modification of air gun). Ultrasonography and CT have important role in the diagnosis, but conventional X-ray remains the basic method in most of cases.]

All articles in the issue

Related contents

Hypertension and nephrology

[The importance of assessing subclinical organ damage in risk prediction of hypertensive patients]

GODINA Gabriella, JÁRAI Zoltán

[As the cardiovascular risk influences the quality and intensity of blood pressure lowering therapy, the goal blood pressure values and the frequency of medical control of hypertensive patients, as well as global risk assessment has an important role in the management of hypertension. In the last couple of years many data have been accumulated showing the poor prognostic value of traditional cardiovascular risk factors. This is the reason why recent Hungarian and international guidelines on the management of hypertension advise the screening for subclinical organ damage. Our goal was to summarize the importance of subclinical organ damage by discussing recently published literature on this topic. An overview has been made on the markers of vascular subclinical damage, like carotid atherosclerosis proved with carotid ultrasonography, peripheral arterial disease assessed with ankle-brachial pressure index measurements and vascular rigidity defined with pulse wave velocity measurements. The prognostic values of myocardial hypertrophy assessed with ECG and/or echocardiography and renal damage proved with decreased estimated glomerular filtration rate and proteinuria are also discussed. Summing up what has been said so far, the assessment of subclinical organ damage has a role in cardiovascular risk prediction, however more randomized and prospective studies have to be performed to define the most suitable (i.e. the most reliable and the most cost-effective) markers for this purpose.]

Hungarian Radiology

[Results of breast cancer screening and clinical mammography at the Kenezy Breast Center, Debrecen between 2002-2003]

SEBŐ Éva, SARKADI László, KOVÁCS Ilona, VAJDA Olga

[INTRODUCTION - Breast cancer screening has been started in January 1. 2002. in Hungary in the course of the National Health Program. Breast cancer is the main cause of death among women’s malignant tomors, and the aim of the project is to reduce this mortality. The chance of survival is highly increased by the early detection of the disease. Kenezy Breast Center was connected to this project. PATIENTS AND METHODES - Females between 45-65 years without symptoms participated in the project. Paralel to this women with symptoms, sometimes with palplable masses were clinically examined. Screening mammography films were read by two radiologists and the complementary examinations of the breast and the axillary lymph nodes - ultrasonography, guided biopsy (FNAB, core biopsy) - were performed always by the same doctor. Results of the two projects were compared. RESULTS - The incidence of malignant breast cancer was 4‰ in the screening and 1,5% in the clinical group. 46.5% of the malignant breast cancers revealed by the clinical examinations was diagnosed in the group of women between the age of 45 to 65 years. This is the age when most women are involved in the screening program. 7.3% of the tumors was diagnosed in the 40- 44 year age-group and 11.3% among women aging 66-77 years. The rate of malignant tumors smaller than 1.5 cm was 49.1% according to screening records and 36% in the clinical trial. In both groups, tumor size of 1.5 cm proved to be a critical limit regarding to the development of metastases, mainly in the axillary region. Above this size, metastases were more frequent. CONCLUSIONS - Both breast screening program and clinical exams are of great significance. Based on the data obtained during two years, authors found that women below the age of 40 and above the age of 65 should also be involved in the screening program. Detection of breast tumor is possible at an early stage by screening. In the case of small tumors (smaller than 1.5 cm) the development of axillary metastases is less likely than in the case of larger ones. The lack of metastases in the axillary lymph nodes offers better prognosis according to the published scientific data, which reinforces the importance and necessity of the screening programs.]

Hungarian Radiology

[The Spring Event of the Society of Hungarian Radiologists Ultrasonography Section Budapest, 28 March 2003]

HARKÁNYI Zoltán, MORVAY Zita

Hungarian Radiology

[Cervical space occupying lesions: diagnosis at sonoelastography]

UJLAKI Mátyás, MAGYAR Péter, KARLINGER Kinga

[Among cervical (neck) region tumours, the thyroid lesions and the metastatic lymph nodes are the most detectable with conventional B-mode ultrasonography (US). The use of MRI and CT scans are limited because of the cost, and in case of CT, the radiation. With the introduction and constant development of sonoelastography, we have in our hands a new imaging procedure which is cheap, fast and harmless, yet giving more information to the examiner than conventional US. The elastographic examination of thyroid lesions is a more explored area than the elastographic visualisation of cervical lymph nodes. The ‘off-line’ elastography showed the highest accuracy allowing to calculate and analyse the strain index of cervical lymph nodes - strain index > 1.5 (85% sensitivity, 98% specificity) - but the ‘off-line’ processing of US elastograms is still too time consuming to be used in busy clinical settings. During the examinations of the thyroid gland both real-time and off-line processed strain imaging were used. An Italian team made a great leap forward as they standardized the degree of distorsion under the application of the external force. Then using the Ueno and Itoh elasticity score they achieved remarkable accuracy with real-time sonoelastography (P <0.0001). On the other hand only those organs are suitable for the US elastography characterization which can be slightly compressed, consequently the examination of a lesion with calcified shell cannot give useful information. Near to the pulsating arteries substantial amounts of decorrelation noise may appear and the examiner has to pay attention what structures are in the ROI box since the sonoelastography method assumes computations relative to the average strain inside the box. To detect a follicular carcinoma in the thyroid gland remains a big challenge. Despite of the limitations most researchers agree on the fact that sonoelastography is a perfect tool to use in addition to the conventional US examination. B-mode US combined with sonoelastography raised the accuracy in differentiation in all cases. With this modality it is also possible to deduce the number of cases when healthy lymph nodes or tissue peaces are taken for biopsy during FNAB.]

Hungarian Radiology

[Gas collection in the superior mesenteric and in the portal veins]

LUDVIG Zsuzsanna, PAP Tímea, SZILÁGYI Adrienn, KOSTYÁL László, BARTA Szabolcs, BOTOS Ákos

[INTRODUCTION - Intrahepatic gas is frequently seen during abdominal ultrasound studies which is generally of biliary origin due to biliary interventional procedures e.g. endoscopic sphincterotomy. In our case, large amount of intrahepatic gas was present originated from the superior mesenteric and portal veins. CASE REPORT - A 94-year-old male patient with vomiting, shivering and heavy abdominal pain was admitted in bad condition to the department of surgery. Billroth II gastric resection was noted in the case history. Chest, plain abdominal X-ray and abdominal ultrasound examination was performed. Ultrasonography showed a large amount gas collection in the region of the left liver lobe (no prior history of endoscopic sphincterotomy). It was difficult to perform abdominal ultrasound due to the intrahepatic gas collection and abdominal bowel gas. Computer tomographic examination confirmed the presence of intrahepatic gas which is localized in the portal venous system. Large amount of gas collection was seen in the abdominal cavity, in the mesenterium and in the retroperitoneum. In addition a gallstone of 2 cm in size was found in the duodenum. CONCLUSION - CT scans confirmed the perforation of gall bladder due to subsequent cholecystic- duodenal fistula. As a consequence of perforation, inflammation of the mesentery and retroperitoneum developed causing mesenteric vein thrombosis and bowel wall necrosis. Bacteria in the necrotic bowel wall produced gas which entered into the veins and reached the portal system.]