The adrenals were studied prospectively with real-time ultrasound in a series of 60 healthy individuals and 13 patients with small adrenal masses sized 8-20 mm in diameter. In only one of the 60 healthy subjects was a normal adrenal gland delineated as a distinct hypoechoic structure. In all other instances only the highly echogenic suprarenal fat could be displayed. Visualization of small tumors was successful in 12 of 13 patients. The suprarenal area and small lesions were best demonstrated by a lateral intercostal approach using longitudinal and transverse scanning planes. The best access was through the 9th/10th intercostal space at the junction with the anterior and middle axillary lines on the right and the posterior axillary line on the left.

Based on the portal infection root, the hydatid disease of the spleen represents a rarity. Because of a lack of prospective studies, spleen-preserving procedures and splenectomies were published as surgical therapy in case reports. In this report, the case of a 72-year-old woman with symptomatic hydatid disease of the spleen will be reported. Surgical and pharmaceutical strategy to minimize the risk of an OPSI syndrome as well as the value of adjuvant therapy with Albendazole will be discussed.

A prospective examination was carried out to determine the optimum technique for demonstrating the adrenal glands; there were 60 normal persons, 16 with small adrenal tumours (average size 13 mm.) and 10 with large adrenal tumours (average size 38 mm.). A normal adrenal gland was identified only once amongst the 60 patients as a hypoechoic structure. Fifteen of the 16 small, and eight of nine large tumours could be demonstrated sonographically. An intercostal approach was particularly suitable for showing the suprarenal region and for small tumours. Large tumours could be shown by a ventral, lateral or dorsal approach.

In six patients with adrenal pheochromocytoma the tumors were localized by ultrasonography, phlebography of the adrenal glands and by estimation of plasma catecholamines selectively obtained from the vena cava and the adrenal gland veins. All tumors were localized by selective catecholamine estimation, five by ultrasonography, and four by phlebography. The smallest pheochromocytoma of 1.5 g weight was only localized by selective catecholamine estimation but not by ultrasonography or phlebography. This tumor, however, had been visualized by computed tomography. To avoid diagnostic errors by selective catecholamine estimation, it is important to withdraw blood from the adrenal gland veins prior to the injection of any radiographic contrast media, since this may result in an extremely enhanced secretion of catecholamines from the adrenal medulla.

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