No abstract

Portal vein aneurysm is very rare, and its relation to portal hypertension has been emphasized. We report six cases of portal vein aneurysm (five extrahepatic and one intrahepatic). All patients were asymptomatic and had no signs suggestive of portal hypertension; the lesion was incidentally detected by ultrasound. Color Doppler sonography showed a constant hepatopetal flow along the aneurysmal wall, which immediately led to the diagnosis. We stress the usefulness of color Doppler sonography for studying the hemodynamics of this vascular anomaly and briefly review the literature.

Liver tumors in fatty liver are expected to show unusual patterns on US, so we should consider this difficulty when interpreting these US findings and we should not make a conclusion without including other imaging modalities.

Mesenteric lipoma (ML) is a relatively rare disease that has been very infrequently reported. We present the clinical data and medical imaging results of an asymptomatic case with ML incidentally detected by sonography (US). On US the lesion was imaged as a well-demarcated hypoechoic mass with multiple linear echoes. The mass also changed location under probe compression. The lesion was imaged as a clearly demarcated non-enhanced homogeneous fat-density mass on CT. Color Doppler US and angiography confirmed the avascular nature of the mass. Knowledge of the US findings in this case is useful for the diagnosis of ML.

We analyzed the primary tumors, sonographic findings, clinical manifestations, and prognosis in five cases of isolated splenic metastases to determine in what situations these rare metastases should be suspected. The metastases were detected by ultrasonography in all five patients, and the primary tumors were colonic cancer in four patients and renal cancer in one patient. Splenectomy was performed and the postoperative course was uneventful in all patients. We conclude that preoperative and follow-up examinations must be performed with special attention given to the spleen in colonic or renal cancer patients.

This study, based on color Doppler and pulsed Doppler sonographic results of 13 cases with gallbladder carcinoma, eight cases of adenomyomatosis, and eight cases of tumefactive biliary sludge, shows that the presence or absence of blood flow signals helps in the differentiation between gallbladder carcinoma and tumefactive biliary sludge (84.6% sensitivity and 80.0% specificity). However, color Doppler sonography is still not fully capable of distinguishing all gallbladder carcinoma, and a further increase in Doppler sensitivity is mandatory for this purpose. Visualization of high-velocity blood flow within the lesion made gallbladder carcinoma more likely than benign tumor. In contrast, there was no difference in the resistive index between gallbladder carcinoma, adenomyomatosis, and normal subject groups, and the significance of the resistive index is a subject of future study.

Color Doppler sonography was very useful for the diagnosis of gastric and duodenal varices and for visualizing fine venous flows in the thickened gastric or duodenal wall. When it shows portal thrombosis in the confluence of the splenic vein and the superior mesenteric vein, duodenal varices should be suspected. The flow direction of the left gastric vein helps to differentiate hemorrhagic gastric varices from nonhemorrhagic ones.

Knowledge of US patterns of Chilaiditi syndrome helps avoid confusion with pneumoperitoneum or hepatic masses.