BackgroundContrast-enhanced ultrasound (CEUS) has become an established non-invasive, patient-friendly imaging technique which improves the characterization of lesions. In addition, dynamic contrast-enhanced ultrasound (DCE-US) provides valuable information concerning perfusion of examined organs. This review addresses current applications of CEUS in children, focused on DCE-US of the bowel wall in patients with Crohn disease, which enables realtime assessment of the bowel wall vascularity with semi-quantitative and quantitative assessment of disease activity and response to medical treatment.ConclusionsCrohn’s disease is a chronic inflammatory relapsing disease. Frequent imaging re-evaluation is necessary. Therefore, imaging should be as little invasive as possible, children friendly with high diagnostic accuracy. US with wide varieties of techniques, including CEUS/DCE-US, can provide an important contribution for diagnosing and monitoring a disease activity. Even if the use of US contrast agent is off-label in children, it is welcome and widely accepted for intravesical use, and a little less for intravenous use, manly in evaluation of parenchymal lesions. To our knowledge this is the first time that the use of DCE-US in the evaluation of activity of small bowel Crohn disease with quantitative assessment of kinetic parameters is being described in children. Even if the results of the value and accuracy of different quantitative kinetic parameters in published studies in adult population often contradict one another there is a great potential of DCE-US to become a part of the entire sonographic evaluation not only in adults, but also in children. Further control studies should be performed.

Einfluss der Ultraschalluntersuchung auf die klinische Diagnose der akuten Appendizitis bei Erwachsenen Zusammenfassung. Grundlagen: Die Entscheidung für eine Operation bei Verdacht auf Appendizitis basiert auf der typischen Anamnese und dem klinischen Befund. Ziel unsere Analyse war, die Verbesserung der Diagnosesicherheit mit Hilfe der Ultraschalluntersuchung zu überprüfen.Methodik: Bei 300 Patienten mit Verdacht auf Appendizitis wurde neben der klinischen Untersuchung auch die Ultraschalluntersuchung durchgeführt. Die Sensitivität, Spezifität, Genauigkeit, positiver und negativer prädiktiver Wert von Ultraschalluntersuchung und die Rate von negativer Laparotomie wurden berechnet. Die Erfahrungen der verschidenen Untersuchern und Wirksamkeit von verschiedenen Schallkopfen wurden verglichen.Ergebnisse: Die Sensitivität war 91,0%, Spezifität 95,9%, negativer prädiktiver Wert 90,8 %, positiver prädik-tiver Wert 95,9 % und Genauigkeit 93,3%. Die Rate der unnötigen Appendektomien für die gesamte Serie war 4,8%. Die Erfahrung des Untersuchers hatte einen signifikanten Einfluss auf Untersuchungsergebnis. In 23,8% konnte der entzündete Appendix nicht mit dem hochfrequenten linearen Schallkopf dargestellt werden, während in 9,5% beide Schallköpfe gleichermaßen wirksam waren.Schlussfolgerungen: Die Ultraschalluntersuchung ist ein hoch genaues diagnostisches Verfahren in der Auswertung der akuter Appendizitis, wenn sie von einem erfahrenen Untersucher unter Anwendung von verschiedenen Schallköpfen durchgeführt wird. Wenn sie routinemäßig eingesetzt wird, kann eine sehr niedrige Rate von negativen Laparotomien erreicht werden.Schlüsselwörter. Akute Appendizitis, Ultraschalluntersuchung, akutes Abdomen, Schallkopf.Summary. Background: The clinical diagnosis of acute appendicitis is based on the case history and physical examination, which play a major role in decision for operation. We assessed a diagnostic gain of ultrasonography performed by an experienced radiologist in patients with signs suspicious of acute appendicitis.Methods: In 300 consecutive patients with suspected acute appendicitis besides the clinical examination ultrasound examination was performed. The sensitivity, specificity, accuracy, negative and positive predictive value and the rate of negative laparotomy were calculated. The outcome was correlated with examiners' experience and the efficacy of different probes was compared.Results: The sensitivity was 91.0%, specificity 95.9%, negative predictive value 90.8%, positive predictive value 95.9%, and accuracy 93.3%. The negative laparotomy rate was 4.8%. The examiner's experience had a significant influence on examination outcome. In 23.8% the inflamed appendix could not be visualized with the highfrequency linear probe, while in 9.5% both probes were equally effective.Conclusions: Ultrasonography is a highly accurate diagnostic procedure in the evaluation of acute appendicitis, when performed by an experienced sonologist, using probes with a wide frequency range. When performed routinely a very low rate o...

The method is minimally invasive and also feasible in high-risk surgical patients. It requires a team consisting of an interventional radiologist, an ultrasonographer, and an endoscopist. In properly selected patients, the results are excellent.

Background: Patients with bowel injuries resulting from blunt abdominal trauma show no reliable clinical or radiologic signs on initial examination. The mechanism of injury is the only element of some diagnostic value. Intestinal injury may be evaluated by ultrasonography (US), plain abdominal radiographs, computed tomography (CT), and diagnostic laparoscopy. This paper is a retrospective study of diagnostic procedures used in 45 consecutive patients with bowel injuries who presented at our center between October 1996 and December 2001. Patients and Methods: Of 45 patients (mean age 40 years), nine suffered isolated bowel injuries and 36 presented with concomitant injuries. The mechanism of trauma was traffic accident in 30 of 45 patients (in 16 of these 30 patients compression by a seat belt), strong blow to the abdomen in eight, fall from a height in five, and other causes in two patients. US was done in 43 of 45 patients, plain abdominal radiographs in 22, CT in six, peritoneal lavage in one, and diagnostic laparoscopy in one. Results: 37 of 43 patients were evaluated by US immediately upon arrival; in four patients there was a delay in diagnosis of 1 day, and in two patients a delay of several days. At initial sonography, free intraperitoneal fluid was identified in 32 of the 43 patients; in most of them (n = 15) the amount of free fluid was rather small. Free fluid was absent in eleven of 43 patients; yet seven of these eleven patients demonstrated free fluid upon repeat examination. In nine of 32 patients, an increased amount of free fluid was identified upon repeat examination.Two of 43 patients, evaluated 3 and 9 days after arrival, respectively, showed dense intraperitoneal fluid, suggestive of peritonitis. US identified intestinal injuries in 14 of 43 patients; in all of them, the diagnosis was established upon repeat examination or delayed initial examination. Radiographs were performed in 22 of 45 patients (18 of them suffering perforation) and verified the pneumoperitoneum in nine of 18 patients with perforation. CT scanning identified intestinal injury in four of six patients. 17 of 45 patients were operated immediately in the Surgical Emergency Unit, 15 patients in the first 24 h, eight patients 2 days after admission, and five patients > 2 days (max. 9 days) after admission. In our series of 45 patients, there were four deaths, and only two (4.4%) were associated with bowel injury. Conclusion: In patients presenting with a typical mechanism of trauma and an abdominal bruise, plain radiographs should be taken in addition to initial US to identify the presence of free air. In patients with negative radiologic and US findings and in those demonstrating a small quantity of free fluid, US scanning should be repeated soon after the initial evaluation and, if necessary, a CT scan should be taken. The use of laparoscopy is indicated in unclear cases. According to our experience, a judicious and timely decision for laparotomy can only be based on the combination of the mechanism of injury, clinical picture...

tional surgical approaches to this problem are discussed. A technique for laparoscopic repair of a Morgagni hernia is described. The literature on the laparoscopic repair of a Morgagni hernia is reviewed and different operative techniques are discussed.