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WFUMB Video of the Month October 2019

WFUMB Video of the Month October 2019

by Admin

Affiliation

Christoph F Dietrich. Medizinische Klinik 2, Caritas-Krankenhaus Bad Mergentheim, Germany.

Video and take home messages

The normal appendix is a wall layered blind-ending, tubular structure that arises from the variably located caecum. The normal appendix visualized without compression can be best seen within free fluid. The arrow indicates the orifice of the appendix.

Featured references

  • Atkinson NS, Bryant RV, Dong Y, Maaser C, Kucharzik T, Maconi G, Asthana AK, Dietrich CF. WFUMB Position Paper. Learning Gastrointestinal Ultrasound: Theory and Practice. Ultrasound Med Biol 2016;42:2732-2742.
  • Atkinson NSS, Bryant RV, Dong Y, Maaser C, Kucharzik T, Maconi G, Dietrich CF. How to perform gastrointestinal ultrasound: Anatomy and normal findings. World J Gastroenterol. 2017;23(38):6931-41.
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WFUMB Video of the Month September 2019

WFUMB Video of the Month September 2019

by Admin

Affiliation

Christoph F Dietrich, Medizinische Klinik 2, Caritas-Krankenhaus Bad Mergentheim,

Video Captions

Benign neuroendocrine pancreatic neoplasia(pNET). B-mode (video 1) and contrast enhanced ultrasound using low mechanical index technique (video 2) are shown (Hitachi Ascendus).

Take Home Message

Endoscopic ultrasound is the method of choice to diagnose and exclude small pancreatic neoplasia. Due to the high spatial resolution provided by EUS small cystic and necrotic areas are easily identified. Typical endosonographic features of pNETs are hypoechogenicity and necrotic areas in B‑mode and arterial hyperenhancement after injection of ultrasound contrast agents.

Featured reference

  • Braden B, Jenssen C, D’Onofrio M, Hocke M, Will U, Moller K, Dietrich CF et al. B-mode and contrast-enhancement characteristics of small non-incidental neuroendocrine pancreatic tumors. Endosc Ultrasound. 2017;6(1):49-54.
  • Dietrich CF, Sahai AV, D’Onofrio M, Will U, Arcidiacono PG, Petrone MC, Hocke M, et al. Differential diagnosis of small solid pancreatic lesions. Gastrointest Endosc 2016;84:933-940

 

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WFUMB Video of the Month August 2019

WFUMB Video of the Month August 2019

by Admin

Affiliation

Christoph F Dietrich. Medizinische Klinik 2, Caritas-Krankenhaus Bad Mergentheim, Germany.

Video 1 and 2

The contrast enhancement of the heart and lung after intravenous injection follows certain anatomical rules. First the right atrium (video 1, RA), right ventricle (video 1, RV), pulmonary artery, lung parenchyma (video 2, LUNG) and pulmonary veins are enhancing followed by the left atrium (video 1, LA), left ventricle (video 1, LV), coronary arteries & myocardium (video 1, MYO), aorta (video 2, AORTA), bronchial arteries (BA) and the systemic vessels (video 2 including hepatic arteries, portal venous system and liver parenchyma). In other words the venous blood from the heart to the lung parenchyma is featured, which is mandatory for the gaseous exchange. Thereafter, the systemic arterial vascular system is enhancing. In the lung the analysis of the dual blood supply allows the differentiation of lung emboli (pulmonary artery vascular supply followed by pulmonary vein washout) and neoplasia (bronchial artery vascular supply followed by bronchial vein washout). In the liver the dual blood supply allows the differentiation of malignant and benign focal liver lesion. Herewith we demonstrate the contrast enhanced ultrasound enhancement step by step in real-time [1, see also EFSUMB Case of the Month “Amyloidosis”, www.efsumb.org].

Take Home Message

The videos demonstrate the contrast phases in the lung, heart, aorta, bronchial arteries and liver in real-time.

Featured reference

Dietrich CF, Averkiou M, Nielsen MB, Barr RG, Burns PN, Calliada F, et al. How to perform Contrast-Enhanced Ultrasound (CEUS). Ultrasound Int Open. 2018;4(1):E2-E15.

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WFUMB Video of the Month July 2019

WFUMB Video of the Month July 2019

by Admin

Author and Affiliation

Alina Constantin1,  Cătălin Copăescu2,  Victor Tomulescu2,  Adrian Săftoiu3

1Gastroenterology Department, Ponderas Academic Hospital Bucharest
2Surgical Department, Ponderas Academic Hospital Bucharest
3Research Center of Gastroenterology and Hepatology, University of Medicine and Pharmacy Craiova, Romania

Video and Figure 1

SPN which occurs in young women in the third decade of life has well-defined borders and variable central areas with cystic degeneration, necrosis, or hemorrhage (Figure 1a). Contrast enhanced EUS reveals  in SPN  hypoenhancement in the the arterial and venous phase (Video 1). In contrast, NETs are hyperenhancing lesions. Elastography shows stiffer tissue compared to the surrounding (Figure 1b). Biopsy and immunohistochemical staining were performed for final diagnosis.

Take Home Message

Neuroendocrine tumor (NET) and solid-pseudopapillary neoplasm (SPN) are two types of pancreatic tumor that were sometimes difficult to differentiate. Biopsy and immunohistochemical analysis obtained  by a histological needle biopsy plays a crucial role in differentiating these two tumor types, E-cadherin, chromogranin A, and β-catenin representing the most useful markers which should be employed for differentiating between NET and SPN.

Featured reference

Yusuke Ohara, Tatsuya Oda, Shinji Hashimoto. Pancreatic neuroendocrine tumor and solid-pseudopapillary neoplasm: Key immunohistochemical profiles for differential diagnosis, World J Gastroenterol 2016;22(38):8596-8604.

Figure 1a
Figure 1b
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WFUMB Video of the Month June 2019

WFUMB Video of the Month June 2019

by Admin

This was a 45-year old man with severe proteinuria. Color Doppler US of the left renal vein (LRV) in transverse plane shows severe compression between abdominal aorta and superior mesenteric artery and bright-colored jetting flow in the inferior vena cava. Measured peak flow velocity was approximately 3 meters per second which is much higher than normal velocity of 40 to 50 cm/sec. 
[Prof. Seung Hyup Kim, Professor in Radiology and Urology, Seoul National University, Korea]

Diagnosis

Nutcracker Syndrome

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WFUMB Video of the Month March 2019

WFUMB Video of the Month March 2019

by Admin

Affiliation

Christoph F Dietrich, Medizinische Klinik 2, Caritas-Krankenhaus Bad Mergentheim, Germany.

Video caption

The esophagus can be examined in the cervical region left to the thyroid. During swallowing the moving air within the esophagus can be identified.

Take Home Message

The feasibility of using swallow contrast-enhanced ultrasound (swallow-CEUS) to examine the function of the upper esophagus and to diagnose Zenker diverticulum has been shown.

Featured reference

Cui XW, Ignee A, Baum U, Dietrich CF. Feasibility and Usefulness of Using Swallow Contrast-Enhanced Ultrasound to Diagnose Zenker’s Diverticulum: Preliminary Results. Ultrasound Med Biol. 2015; 41(4): 975-81

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WFUMB Video of the Month February 2019

WFUMB Video of the Month February 2019

by Admin

Author and Affiliation

Christoph F Dietrich. Medizinische Klinik 2, Caritas-Krankenhaus Bad Mergentheim, Germany.

Video

The papilla Vateri can be displayed in real-time. Please note the functional movements of the papilla.

Take Home Message

The papilla Vateri is an anatomic structure, which should be identified as own anatomic entity. The size of the papilla is about 13 x 7 mm (own data).

Featured references

None.

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WFUMB Video of the Month January 2019

WFUMB Video of the Month January 2019

by Admin

Author and Affiliation

Christoph F Dietrich. Medizinische Klinik 2, Caritas-Krankenhaus Bad Mergentheim, Germany.

Figure and video 1

The left adrenal gland including the adrenal arterial vessels are shown using endoscopic ultrasound color Doppler imaging [Video].

Take Home Message

Endoscopic real-time ultrasound (US) using high-resolution equipment allows visualization of the left adrenal gland as a routine procedure (99 %). Adrenal arteries can be displayed under good circumstances.

Featured references

  • Dietrich CF, Wehrmann T, Hoffmann C, Herrmann G, Caspary WF, Seifert H. Detection of the adrenal glands by endoscopic or transabdominal ultrasound. Endoscopy 1997;29:859-864
  • Jenssen C, Dietrich CF. Ultrasound and Endoscopic Ultrasound of the adrenal glands. Ultraschall Med 2010; 31(3):228-250.
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WFUMB Image & video of the Month December 2018

WFUMB Image & video of the Month December 2018

by Admin

Newborn with arterial hypertension and focal renal or adrenal lesion (B-mode ultrasound, 40 mm). Contrast enhanced ultrasound allowed to solve the differential diagnosis. The complete lesion was non-enhancing (contrast injection of Sonovue™, see video). Adrenal hemorrhage is non-enhancing in contrast to adrenal neoplasia.

[Dietrich CF, Buchhorn R]

Take home messages

Contrast enhanced ultrasound (CEUS) allows diagnosis of adrenal hemorrhage and to exclude neoplasia.
CEUS is safe in newborn, children and adults [(1)].

Featured reference

1.              Sidhu PS, Cantisani V, Deganello A, Dietrich CF, Duran C, Franke D, Harkanyi Z, et al. Role of Contrast-Enhanced Ultrasound (CEUS) in Paediatric Practice: An EFSUMB Position Statement. Ultraschall Med 2017;38:33-43.

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WFUMB Video of the Month November 2018

WFUMB Video of the Month November 2018

by Admin

Author and Affiliation

Christoph F Dietrich. Medizinische Klinik 2, Caritas-Krankenhaus Bad Mergentheim, Germany.

Figure and video 1

The right adrenal gland is shown using transcutaneous B-mode [Figure 1] and the adrenal arterial vessels using color Doppler imaging [Video 1].

Take Home Message

Transabdominal real-time ultrasound (US) using high-resolution equipment allows visualization of the right adrenal gland as a routine procedure (99 %). Adrenal arteries can be displayed under good circumstances.

Featured references

  • Dietrich CF, Wehrmann T, Hoffmann C, Herrmann G, Caspary WF, Seifert H. Detection of the adrenal glands by endoscopic or transabdominal ultrasound. Endoscopy 1997;29:859-864
  • Jenssen C, Dietrich CF. Ultrasound and Endoscopic Ultrasound of the adrenal glands. Ultraschall Med 2010; 31(3):228-250.
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WFUMB Image & video of the Month October 2018

WFUMB Image & video of the Month October 2018

by Admin

Pancreatic metastasis from a rectal cancer

Alina Constantin1, Cătălin Copăescu2, Adrian Săftoiu3

  1. Gastroenterology Department, Ponderas Academic Hospital Bucharest
  2. Surgical Department, Ponderas Academic Hospital Bucharest
  3. Research Center of Gastroenterology and Hepatology, University of Medicine and Pharmacy Craiova, Romania

Endoscopic ultrasound elastography (Fig. 1) + Contrast enhanced harmonic EUS (CE-EUS) (Fig. 2, Movie 1) + EUS-fine needle biopsy (FNB) (Fig. 3). Malignant pancreatic tumors are typically stiff hypoenhanced lesions.

For contrast-enhanced EUS, a peripheral rim (visible during microbubble trace imaging mode) with central hypoenhancement in the arterial and venous phase is suggestive of a pancreatic metastasis. In patients with a personal history of a colorectal cancer this indicates the need to use a histological needle biopsy followed by immunohistochemistry (IHC) analysis, performed in order to rule out pancreatic metastasis.

Featured reference

Palazo M., Role of contrast harmonic endoscopic ultrasonography in other pancreatic solid lesions: Neuroendocrine tumors, autoimmune pancreatitis and metastases. Endoscopic Ultrasound, 2016, Volume 5, Issue 6 [p. 373-376]

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WFUMB Image & video of the Month September 2018

WFUMB Image & video of the Month September 2018

by Admin

“The 90 % rule”: Conventional ultrasound to detect and exclude choledocholithiasis in biliary pancreatitis.

Conventional B-mode ultrasound allows detection and exclusion of choledocholithiasis in about 90 %.

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WFUMB Image of the Month AUGUST 2018

WFUMB Image of the Month AUGUST 2018

by Admin

Endoscopic ultrasound elastography. Soft small solid pancreatic lesions have a high predictive value to be benign.

In patients with small solid pancreatic lesions, EUS elastography can rule out malignancy with a high level of certainty if the lesion appears soft. A stiff lesion can be either benign or malignant [(1)].

Featured reference

1.         Ignee A, Jenssen C, Arcidiacono PG, Hocke M, Moller K, Saftoiu A, Will U, et al. Endoscopic ultrasound elastography of small solid pancreatic lesions: a multicenter study. Endoscopy 2018.

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WFUMB Image & Video of the Month JULY 2018

WFUMB Image & Video of the Month JULY 2018

by Admin

Contrast enhanced ultrasound. Benign focal liver lesions are typically hyperenhancing in the portal venous phase.

Benign focal liver lesions are typically hyperenhancing in the portal venous and late phases of contrast enhanced ultrasound. Here we demonstrate a typically hyperenhancing hemangioma with peripheral nodular contrast enhancement and next to the hemangioma also a focal nodular hyperplasia with central arterial blood supply (contrast injection of Sonovue™ using the Aixplorer. [(1)].

Featured reference

1.         Dietrich CF, Tana C, Caraiani C, Dong Y. Contrast enhanced ultrasound (CEUS) imaging of solid benign focal liver lesions. Expert Rev Gastroenterol Hepatol 2018;12:479-489.

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