Abstract Objectives To demonstrate the association between the dynamic movements of hyperechoic foci in portal venous gas (PVG) and patients'/sonographic outcomes after congenital heart disease or cardiac events. Methods Thirty‐one pediatric patients requiring management of congenital heart diseases or cardiac events who had PVG on ultrasound were included in this retrospective study. The patient outcome was prognosis: dead or alive. The sonographic outcome was recovery from PVG, measured as days from PVG detection to when it diminished on ultrasound. The following sonographic findings of hyperechoic foci in PVG were compared between patients: detection within the mesenteric vein, having to‐and‐fro movements within the intrahepatic portal vein, distribution (left segment or both left and right segments) and shape (line or punctate) in the liver, and detection within the portal and hepatic veins. Comparisons were made using Fisher's exact/Mann–Whitney U test. Results Four patients died without having recovered from PVG. A significant difference was observed in terms of the to‐and‐fro movement (with/without to‐and‐fro movement in dead vs. alive patients: 3/1 vs. 1/26, respectively; P = 0.003). Furthermore, a significant difference in sonographic outcomes was observed regarding patients with/without hyperechoic foci within the mesenteric vein (days with vs. without this finding: 2.0 ± 1.24(1–5) vs.1 ± 0(1), respectively; P = 0.011). Conclusions In our small limited cohort, when PVG was visualized on ultrasound, close evaluation of the dynamic movement of hyperechoic foci, especially their to‐and‐fro movement within the intrahepatic portal vein and detection of hyperechoic foci within the mesenteric vein, were useful in predicting patients' outcomes and the time to PVG diminishment.
Sonography-guided cutting needle biopsy for the diagnosis of malignant lymphoma has recently come into wide use. However, surgery is sometimes unavoidable for the diagnosis of malignant lymphoma, particularly for low-grade malignant lymphoma such as extranodal marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue, because cutting needle biopsy offers limited diagnostic accuracy for low-grade malignant lymphoma. Of course, unnecessary invasive procedures like open biopsy should be avoided wherever possible, given the cosmetic problems and burden on the patient. We tried to diagnose malignant lymphoma using the combination of cutting needle biopsy, flow cytometry and polymerase chain reaction to identify monoclonal rearrangement of immunoglobulin heavy chain genes. We have used this method in two cases in whom malignant lymphoma was suspected in the head and neck region, allowing diagnosis of mucosa-associated lymphoid tissue lymphoma in both cases. One case involved a 23-year-old woman with mucosa-associated lymphoid tissue lymphoma in the parotid glands, and the other involved a 77-year-old man with mucosa-associated lymphoid tissue lymphoma in the thyroid. The combination of cutting needle biopsy, flow cytometry and immunoglobulin heavy chain gene rearrangement testing might offer a useful alternative to open biopsy for the diagnosis of mucosa-associated lymphoid tissue lymphoma. We recommend this procedure, particularly for young women or patients with poor performance status in whom malignant lymphoma is suspected.
We report a Japanese case of primary cutaneous marginal zone B-cell lymphoma (PCMZL). This 46-year-old woman presented with a subcutaneous nodule on her right forearm. With the combined morphology,the immunophenotype, and molecular analysis, we diagnosed this lesion as PCMZL. Furthermore, we reviewed the 16 cases of PCMZL in the Japanese literature. The ages of the patients ranged from 26 to 75 years (mean 55.7 years) with a slight female predilection. Clinically, most of the skin lesions were erythematous nodular lesions. The involved regions were the face and neck in eight cases, the trunk in six and the arms in five. None had Borrelia burgdorferi infection or a history of thyroiditis. Two patients had suffered from Sjögren's syndrome. Histopathologically, lymphoepithelial lesions were found in nine cases. The chromosomal aberrations in MALT lymphoma such as t(11;18)(q21;q21), t(14;18)(q32;q21) and t(3;14)(p14.1;q32) were not reported in any of the Japanese cases. Although two patients developed metastasis on the skin after radiation therapy, none died of lymphoma.
Esophageal perforation in premature infants is a life-threatening condition that requires prompt treatment. Contrast-enhanced computed tomography (CECT) is recommended for diagnosis. However, it is difficult to obtain CECT images in premature infants because of their unstable conditions. We encountered a case of esophageal perforation in an extremely-low-birth-weight female infant. Bedside ultrasonography was useful in the diagnosis and follow-up evaluation of leakage in the mediastinum. Ultrasonography can be a useful modality for the evaluation of perforation of the lower part of the esophagus in premature infants.
This study aimed to investigate the associations between the sonographic findings and duration of symptoms in children with pilomatricoma. This study included 86 children with 95 lesions confirmed to be pilomatricoma after pathological examination. The associations between symptom duration and sonographic observations, including the presence or absence of peritumoral hyperechogenicity, calcification, and vascularity were investigated. The internal echogenicity of each pilomatricoma was scored using a 5-point scale based on echogenic spots and calcification with posterior acoustic shadowing. The Mann–Whitney U and Kruskal–Wallis tests were used for statistical analysis. We found that the absence of peritumoral hyperechogenicity and severity of calcification were associated with increased symptom duration. Calcification, (present, 19.19 ± 18.99 months vs absent, 4.31 ± 3.24 months; P < .01) and peritumoral hyperechogenicity (present, 5.02 ± 5.80 months vs absent, 16.17 ± 18.24 months; P < .01), and grade of internal echogenicity (grade 0/1/2/3/4 = 3 months [1 patient]/4.33 ± 3.26 months [range, 1–12]/4.57 ± 3.46 months [range, 2–12]/10.89 ± 9.17 months [range, 3–28]/35.27 ± 19.16 months [range, 9–60], respectively; P = .01 and <.01) were associated with significant differences in symptom duration. There were no significant between-group differences in vascularity (6.01 ± 7.24 months; range, 1–48 vs 15.50 ± 19.12 months; range, 1–60; P = .08). Pilomatricomas with a relatively short symptom duration were more likely to exhibit peritumoral hyperechogenicity and calcification with less severe posterior acoustic shadowing compared to lesions with a longer symptom duration. These sonographic findings provided useful information that facilitated the correct and rapid diagnosis of pilomatricoma.
The purpose was to evaluate the association between operative time and findings noted on computed tomography (CT) immediately before interval appendectomy.Forty-two children who underwent CT before interval appendectomy were included. We evaluated the association between operative time and these image findings: (1) appendicolith, (2) increased intra-abdominal fat density around the appendix, (3) location of the appendix, (4) ascites, (5) abscess formation and (6) maximum appendix outer wall diameter. Appendix location was classified as (#1) just below the anterior abdominal wall; (#2) retrocaecal or retro-ascending colon and (#3) pelvic. Results were analysed using Pearson's correlation coefficient or Mann-Whitney U test.The mean patient age and operative time were 116.24 ± 38.66 months (range, 31-195) and 67.76 ± 31.23 min (range, 30-179), respectively. Ascites was detected in only one case, and no abscess occurred in any patient; therefore, these findings were not analysed. Factors that significantly prolonged the operative time included increased intra-abdominal fat density around the appendix (absent, 59.43 ± 22.14 [range, 30-108] vs. present, 84.43 ± 40.13 [range, 32-179] min; P = 0.03) and retrocaecal or retro-ascending colon appendix (location 1, 40.83 ± 8.35 [range, 30-50]; location 2, 99.25 ± 18.56 [range, 74-135]; location 3, 64.54 ± 30.22 [range, 30-179] min; P < 0.01). There was a weak but significant association between maximum appendix outer wall diameter and operative time (R = 0.353; P = 0.02).These pre-operative CT findings are important predictors of operative time for interval appendectomy. Radiologists and surgeons should use these specific image findings to predict the operative time and need for additional procedures during an interval appendectomy.
