Malattie infettive

Objective: To prospectively evaluate the vascularization of the thickened terminal ileum in Crohn's disease patients using contrast enhanced ultrasound (CEUS) and to compare the clinical activity measured by the Crohn's disease activity index (CDAI) with the CEUS findings. Patients and methods: Forty-eight of 104 consecutive patients (17 females and 31 males, aged 42.4 ± 13.8 years) with a thickened terminal ileum at sonography were recruited for the study. CEUS examinations were performed using a real-time low mechanical index harmonic ultrasound technique after intravenous injection of a second generation contrast agent. We used two parameters to assess the vascularization of the bowel wall: a semi-quantitative method, the pattern of enhancement (which is the description of the arrangement of the enhanced layer in the bowel wall) and a quantitative method, the E/W ratio (which is the ratio between the major thickness of the enhanced layer, E, and the thickness of the entire wall section, W). In order to assess the accuracy of the CEUS findings in discriminating between active and inactive patients according to CDAI values (>150 and ≤ 150, respectively), the patterns of enhancement (four patterns) were dichotomized in two groups and an E/W ratio cutoff value was calculated to differentiate between poor and abundant bowel wall enhancement. Results: The CEUS findings, namely the pattern of enhancement and the E/W ratio (best cutoff value ranging between 0.43 and 0.47), had a sensitivity of 81.0% and 81.0%, respectively, a specificity of 63.0% and 55.6%, respectively, a positive predictive value of 63.0% and 58.6%, respectively, and a negative predictive value of 81.0% and 78.9%, respectively, in distinguishing patients with active and inactive disease. Conclusions: CEUS assessment of diseased bowel wall vascularization may be a sensitive tool for the detection of inflammatory activity.

Ectopic livers are autonomous islands of normal liver parenchyma located outside the liver. They are rare and are usually found by chance during autopsy or laparoscopy. They occur in various sites near the liver, such as the gallbladder, hepatic ligaments, omentum, retroperitoneum, and thorax, and may harbor the same disease affecting the liver and occasionally cause significant clinical problems, such as compression of adjacent organs (1-3), abdominal pain, and bleeding. Because an ectopic liver does not possess a complete vascular and ductal system like a normal liver, it is perhaps functionally "handicapped" and more prone to develop benign and malignant neoplasms. A review of the literature reveals more than 27 cases of hepatocellular carcinoma (HCC) arising outside the liver, most of them in Asian patients (4-9). Benign neoplastic lesions in ectopic livers have been described less frequently: only eight cases of ectopic hemangioma and no cases of focal nodular hyperplasia (FNH) and adenoma arising from an ectopic liver have been reported so far. We describe an additional case of pedunculated hemangioma and the first detailed description to our knowledge of FNH and adenoma arising from an ectopic liver. CASE REPORT 1: ADENOMA WITH PELIOSIS HEPATITIS A 50-year-old woman was admitted to our outpatient department for biochemical cholestasis, without symptoms. She had used oral contraceptives for many years and had stopped using them 18 months before admission. The medical history was unremarkable. Physical examination showed slight hepatomegaly.

The purpose of the study described here was to prospectively evaluate the significance of embolization of the spleen in patients with definite left-sided infective endocarditis (IE) using contrast-enhanced ultrasound (CEUS). From March through October 2012, 6 consecutive patients (4 females and 2 males, aged 27 to 83 years) with definite left-sided IE according to the revised Duke criteria were enrolled. All patients gave informed written consent, and the study was performed in conformity with the ethical guidelines of the Declaration of Helsinki. All patients underwent CEUS of the spleen within 1 week of the definite diagnosis of IE. A blood pool secondgeneration contrast agent and an ultrasound machine with contrast harmonic imaging technology were used for CEUS. Fifteen consecutive patients (7 females and 8 males, aged 39 to 88 years) who underwent CEUS from October through November 2012 for the study of focal liver lesions constituted the control group. The number of patients did not permit statistical analysis. Splenic CEUS revealed infarctions in 5 patients and an infarcted area in the only patient with negative echocardiography. All splenic CEUS procedures in the control group were negative. In this study, CEUS of the spleen, a repeatable and low-cost imaging technique, easily allowed bedside detection of asymptomatic and even tiny infarctions, and revealed a high rate of embolization in patients with definite left-sided IE. Indeed, splenic CEUS, if applied to the workup of patients with suspect IE, has the potential to accelerate or upgrade the diagnosis itself.

Purpose To prospectively evaluate the prevalence of the embolization of the spleen in patients with definite leftsided infective endocarditis (IE) using a contrast-enhanced ultrasound (CEUS). Methods From March 2012 through September 2013, 18 consecutive patients (9 females and 9 males, aged 21-83 years) evaluated at our hospital and with definite left-sided IE according to the revised Duke criteria were enrolled. All of the patients gave informed written consent and the study was performed in conformity with the ethical guidelines of the Declaration of Helsinki. All of the patients were submitted to a CEUS of the spleen within 10 days after the definite diagnosis of IE. For the CEUS, a blood pool second-generation contrast agent and an ultrasound machine with a contrast harmonic imaging technology were used. Results The splenic CEUS showed infarctions in 11 patients (61 %) and resulted positive in the 2 patients with negative echocardiography. Conclusions In this study, CEUS of the spleen, a repeatable and low-cost imaging technique, easily allowed the bedside detection of asymptomatic and even tiny infarctions and showed a high rate of embolization in patients with definite left-sided IE. Therefore, in the setting of IE (possible or definite), CEUS of the spleen has the potential to better define or accelerate the diagnosis itself.

The case report is a description of a single case of hepatic myelolipoma, a very rare benign hepatic tumor, evaluated with contrast sonography, in a 72-year-old female. It was previously reported as hyperechoic lesions at sonography. CEUS features of the lesion were: homogeneous hyperenhancement in the arterial phase and a slight hyperenhancement in the portal venous phase typical of benign tumors. The case report shows CEUS may help in differential diagnosis between benign and malignant lesions, but only the biopsy of the tumor and the pathological evaluation allows the diagnosis.