The sonographic diagnosis of diffuse thyroid disease has received scant attention in the ultrasound literature. Several authors have described the ultrasound appearance of various diffuse thyroid diseases, such as subacute thyroiditis,' Hashimoto's t h y r~i d i t i s ,~,~ and acute thyroiditi~.~ Our case report describes the sonographic features of acute suppurative thyroiditis. Correlative radionuclide images are included. CASE REPORTThe patient was a 28-yr-old woman who had recently arrived in this country from Jamaica. She was well until 5 yr prior to admission to our hospital, when she was diagnosed as having systemic lupus erythematosus (SLE) after presenting with arthralgia and arthritis. Renal biopsy done at that time revealed basement membrane thickening. She has subsequently suffered from various complications of SLE, as well as from steroid-induced cataracts, hypertension with one episode of pulmonary edema, nephrotic syndrome, and herpes zoster. Medications have included prednisone (up to 40 mg/day), Lasix, digoxin, and Inderal.On present admission, the patient complained of a sore throat with temperatures of up to 103°F. Laboratory tests at that time demonstrated an elevated white blood cell count with a left shift, an erythrocyte sedimentation rate of 103, and a urinalysis revealing red blood cell casts. An infection-induced lupus flare was deduced, for which she was treated with high-dose prednisone. During her hospital stay, she developed rapid swelling of the neck, with the right side greater than 222the left. Nuclear medicine 99mT~ pertechnetate thyroid scan revealed an ill-defined 3 X 3-cm cold nodule in the right lobe (Fig. 1). Ultrasound examination of the thyroid revealed a diffusely enlarged, somewhat irregular gland with decreased echogenicity, but no focal abnormality was demonstrated (Fig. 2). Triiodothyronine (T3), thyroxine (T4), and thyroid-stimulating hormone (TSH) were normal 5 days following plasmapheresis treatment for SLE and a diagnosis of viral thyroiditis was made, which was treated successfully with salicylates. One week after discharge, the patient returned with an acute exacerbation of neck swelling associated with tenderness and an elevated temperature. Repeat nuclear medicine scans and an ultrasound examination of the thyroid were performed (Figs. 3, 4).The patient was taken to the operating room, where 300 cc of purulent material was aspirated from the swelling in the neck. Cultures revealed alpha streptococcus, sensitive to penicillin, and the patient was treated with 6 million units/day. The patient responded well and was subsequently discharged to complete the antibiotic therapy. DISCUSSIONThyroid sonography has been found to be a reliable tool for evaluating the hypo-or nonfunctioning thyroid nodule and for differentiating cystic and solid masses of the thyroid gland.2,4 However, the role of ultrasound in diffuse thyroid disease is less well appreciated. The common entities of subacute thyroiditis and Hashimoto's thyroiditis are usually easily differentiated and man...
A splenic abscess was erroneously diagnosed in a 65-year-old patient. The diagnosis was established on clinical, radiological and ultrasonographic data. At laparotomy the spleen was markedly enlarged by tumoral tissue and contained a large cystic lesion. The histological diagnosis was typical Hodgkin disease with lymphocytic depletion. Ultrasonography adds valuable information in the diagnosis of splenic lesions. Hodgkin disease should be included in the differential diagnosis of cystic lesions detected in the spleen by this method.
Intrathoracic perforated peptic ulceration is uncommon. Two patients are reported with pericardial fistulization secondary to peptic ulceration. These occurred following colonic bypass surgery as a consequence of peptic esophagitis and hiatus hernia.
634 pp. Hardcover. US $80.00.This book is the third of a series by Marshak, Lindner and Maklansky devoted to gastrointestinal tract roentgenology. Even though writing a book on the radiology of the stomach may seem to be a challenge in 1983, it is important to give the proper degree of importance to radiology in comparison with other investigations of the stomach, especially fibroscopy. The authors did it.This book could be entitled: Radiology of the Stomach. The OM and the New. It remains a classic, if by a classic we mean that it deals with what is routinely done in a Department of Radiology. It is now obvious that double-contrast technique will demonstrate tiny lesions better than will barium studies; the technical chapter by Laufer illustrates that point. However, the biphasic examination with compression, as shown in the chapter by Margulis and Ominsky, may better demonstrate larger lesions. The chapters on gastric carcinoma, polyps, and ulcers, are illustrated by pictures of both double contrast and single contrast examinations.A subtly written chapter is devoted to gastritis and shows what the clinician may expect from the radiologist in handling gastritis.A brilliant and beautifully illustrated chapter on early gastric carcinoma is written by Shirakabe.A chapter on CT provides the more recent data on this subject, which is an expanding field.A well put together chapter on Zollinger-Ellison Syndrome explains with drawings, tables, and histological figures the chemical and anatomical disorders of the disease.At a time when radiology of the stomach is challenged by fibroscopy, at a time when some people ask "Is radiological examination really useful? Isn't it nowadays an obsolete investigation?" this book, the latest by Richard Marshak, combines both classical and recent knowledge on the subject. It will probably be usable as a reference for many years.
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