HENMI, KIMIO

KIKUCHI, SHUNJI

NAKAMOTO, KOHICHI

NIO, YOSHINORI

TANAKA, AKIRA

Kyoto University Research Information Repository

Title Clinical Assessment of Ultrasonography in Diagnosis ofAbdominal TumorsAuthor(s)NAKAMOTO, KOHICHI; TANAKA, AKIRA; KIKUCHI,SHUNJI; NIO, YOSHINORI; HENMI, KIMIOCitation日本外科宝函 (1980), 49(3): 344-352Issue Date1980-05-01URL http://hdl.handle.net/2433/208437RightType Departmental Bulletin PaperTextversionpublisherKyoto UniversityArch Jap Chir 48 (3), 344～352, Mai, 1980 Clinical Assessment of Ultrasonography in Diagnosis of Abdominal Tumors KoHICHI NAKAMOTO, AKIRA TANAKA, SHUNJI KIKUCHI, YosHINORI Nro, and KIMIO HENMI Department of Surgery, Akoh City Hospital (Director WASHIROH 0Grno) R巴ceivedfor Publication, Feb. 29, 1980 The ultrasonography has become one of the routine diagnostic procedures in recent years. The purpose of the present study is to assess clinically the diagnostic faculty of this method in diagnosis of abdominal tumors. 時1ethodsThe sonar was Diasonograph type Aloka SSD 60 equipped with a transducer of lOmm calibre, and ultrasonic frequency of 2.25 MHz was used. The patient’s skin was covered by a thin layer either of paraffin or of olive oil in order to gain better acoustic coupling. Scanning was done by manual movement of the transducer at the speed of about 5cm per second and echoes were displayed on a storage oscilloscope. The storage was recorded with a Polaroid camera. Patient material From about 200 patients examined by ultrasonography in our department during the last two years, eight representative patients were selected and presented herein in order to assess the diagnostic faculty of ultrasonography for abdominal tumors, especially cystic tumors. The tumor was diagnosed as being cystic when no echo was obtained by scanning with a highly sensitive level, namely, +6dB higher sensitive level than that was required to visualize the normal liverめ．Case 1. A 6 month old boy was admitted because of a walnut sized abdominal tumor in the right upper quadrant. His prenatal period and birth were normal. Four months prior to this admission the patient had jaundice and was hospitalized in the Department of Pedriatics Kyoto University for three weeks with a diagnosis of hepatitis. Physical exami-nation on admission revealed poor nourishment, though his development was normal. Key words : U!trasonography, Abdominal tumors, Cystic patterns. 索引語：超音波断層法，腹部腫溜，褒胞性エコー．Present address : Department of Surgery, Akoh City Hospital 3-57 Kariya, Akoh, Hyogo, 678-02, Japan. Fig. 1 Fig. 2 UL TRASONOG RAPHY IN ABDOMINAL TUMORS Choledocha! cy:;i Sup:1'e tra:-isverse sections over the region of the liver at the level of Ll L 2. ·－＝，ー シ圭？＇.＂＂＂~手f-2需. ＝~. －τーでー－ ＂－＇.. －Hydronephrosis Longitudinal s巴ctionof the abdomen in the posterior axillary line. (Above) Transverse section of the abdomen at the level of L2-L3. (Below) 345 346 日外宝第49巻第3号（昭和55年5月）Findings of laboratory examination were as follows: 39%; WBC, 11,900; GOT, 46; GPT, 25; LDH, 403 ; total Bilirubin, 0.4mg/dl. Neither the bile duct nor the gall bladder was visualized on DIC. Abdominal aortography and upper GI contrast study demonstrated a space occupying mass behind the duodenum. A transverse ultrasonic scanning over the right upper quadrant showed an acoustically translucent tumor below the liver (Fig. 1), which was diagnosed as a choledochal cyst ; the diagnosis being confirmed by surgery. Case 2. A 2-year-old boy was admitted because of a fist-sized tumor in the left lower quadrant of the abdomen. IVP failed to show the left kidney and ureter. Ultrasonic scanning sliced vertically and horizontally over the left kidney region demonstrated an acoustically translu-cent mass which was divided into some portions by septa (Fig. 2). Hydronephrosis due to congenital stricture of pelviureteral junction was confirmed by surgery. Case 3. A 71-year-old female was admitted with a chief complaint of jaundice. Physical examination revealed a plum-sized tumor in the right upper quadrant of the abdomen. Laboratory examination showed the followings : Ht, 32% ; Hb, 11. lg/di ; total Bilirubin, 6.9mg/dl; direct Bilirubin, 5.6mg/dl; GOT, 63; GPT, 59; ChoE, 0.42; r GTP, 165mu/ml; LAP 395 GR ; ALP, 52. 7 K.AU. DIC failed to show the biliary tract, and PTC demonstrat-ed the distended bile ducts and the gall bladder. It was suspected that a gallstone obstruct-ed the distal portion of common bile duct (Fig. 3). A longitudinal scanning along the right mamillary line demonstrated the dilated gall bladder and common bile duct; the latter being obstructed by a heterogeneous mass (Fig. 4). These findings suggested a pa tho・ logical condition of the common bile duct occluded by the invasion of a pancreatic cancer. This diagnosis was confirmed by surgery. Case 4. A 81-year-old male was admitted with a chief complaint of jaundice. Three months prior to the admission he began to complain of vomiting and loss of body weight. On physical examination he was found to have a goose-egg-sized tumor in the right upper quadrant of the abdomen. Results of the laboratory examination on admission were as follows : Ht, 32%; Hb, 10.9g/dl; total Bilirubin, 20.8mg/dl ; direct Bilirubin, 17.3mg/dl; GOT, 131;GPT, 77; ChoE 0.30; r GTP, 494mu/ml ; LAP, 386 GR ; ALP, Fig. 3 PTC demonstrated the distended bile 148.5 K.AU. DIC failed to show the biliary ducts and the gall bladder. tract, and PTC revealed a markedly distend・ UL TRASONOGRAPHY IN ABDOMINAL TUMORS 347 Fig. 4 Pancreas cancer Longitudinal sections of the abdomen in the right mamillary line. GB : Gall bladder CBD : Common bile duct P : Pancreas L : Liver Fig. 5 PTC revealed a markedly distended bile duct, which looked squeezed and irre-gular at the distal portion of it. ed bile duct. The distal portion of the com-mon bile duct looked squeezed and irregular (Fig. 5). A longitudinal scanning along the right mamillary line demonstrated the markedly distended gall bladder and common bile duct; the latter being obstructed by a hetero-geneous mass. These findings were interpret-ed as a pancreatic cancer invading and obstructing the common bile duct. The dia-gnosis was confirmed by surgery (Fig. 6). Case 5. A 78-year-old male was admitted with pain in the lower abdomen. Physical examination showed a pulsatile mass in the lower abdomen. A vertical scanning along the abdominal aorta showed an abdominal aortic aneurysm which measured 6 cm in diameter at its broadest point, and became narrow both proximally and distally (Fig. 7). Abdominal aortography confirmed the dia-gnos1s. 348 日外宝 i'f,48巻第3号 f昭わ55年5月）λ 、Fig. 6 h ;-icr二日 c•nc::r 1川ぺ（円Fn勺1 ιons of the abdomen in the right mamillary Fre CH : G:>.n blγJd日 CBD Common bile duct P : Pnacreas L : Liver ニ~ ~ －一一ー － 4・Fa でープf 一三；主主＼乏雪害毒f An’ ＼ － ~ － －－ A o ，そ5亘』】ーラ』与a・画聞きーι－圃薗園圃圃喧彊冨盲F智信＝＝ニー －ー－~曾．聞~~二三＝ご三~Fig. 7 Abdominal aortic aneurysm Longitudinal sections along the abdominal aorta. Ao : Aorta An : Aneurysma UL TRASONOGRAPHY IN ABDOMINAL TUMORS Fig. 8 Ovarian tumor Loコg.tuιilc.d'.:CSぺo:iof the abdomen in the midline. (Above) Transverss sεctio:i o~ t!-_c al:Jdo立c.:at the level of the iliac crest. (Below) C: Cys Cranial 349 Fig. 9 Neurogen c s:ircoma Longitudinal section of the abdomen in the midline. (Above) Transverse section of the abdomen 2cm above the level of the iliac crest. (Below) 350 日外宝第49巻第3号（昭和55年5月）Cauda工Fig. 10 Fibrosarcoma Longitudinal section of the abdomen in the left mamillary line. (Above) Cross section 3cm above the umbilicus. (Below) Case 6. A 69-year old female was hospitalized with a chief complaint of abdominal <listen-sion. The celiac and superior mesenteric arteriography revealed a space occupying lesion in the abdomen and lateral displacement of intestines. A vertical and horizontal scanning over the abdomen showed a large acoustically translucent lesion which occupied almost al part of the abdominal cavity and was divided into some portions by septa (Fig. 8). This lesion was interpreted as an ovarian tumor. A huge ovarian tumor weighing lOkg was resected. Histological specimen was pseudomucinous cystadenoma. Case 7. A 74-year-old male was admitted with a chief complatint of a growing tumor in the lower abdomen. Barium enema revealed upward displacement of the sigmoid colon. IVP showed lateral displacement of the bilateral ureters and the bladder. Vertical and horizontal scanning over the region of the lower abdomen demonstrated a translucent mass, which had many scattered echoes in its posterior part (Fig. 9). The mass was suspected of a tumor filled with either blood or necrotic tissue. Laparotomy disclosed a retro・ peritoneal tumor invading surrounding organs, and containing blood and liquefied necrotic tissue in it. Histological specimen was neurogenic sarcoma. Case 8. A 20-year-old male was hospitalized because of a gooseegg-sized tumor in the left upper quadrant of the abdom巴n and the loss of body weight. Upper GI contrast study revealed upward and forward displacement of the stomach. A cyst of the pancreas was suspected by celiac and superior mesenteric arteriography. Vertical and horizontal scanning UL TRASONOGRAPHY IN ABDOMINAL TUMORS 351 over the region of the tumor showed an acoustically translucent structure in the tumor and many scattered internal echoes in the dorsal part of the tumor (Fig. 10). The lesion was presumed to be a sarcoma. Laparotomy disclosed a retroperitoneal sarcoma invading the abdominal aorta and the left renal artery and vein and containing both blood and necrotic tissue in it. It was impossible to remove the tumor. Histological specimen was fibrosarcoma. Discussion An ultrasonic scanning has brought a new method of investigation in clinical 6巴lds1l2l3J7l It has the following advantages and disadvantages4l. Advantages 1. It is a non invasive and repeatable procedure. 2. No preparation is required. 3. The pictures ar巴 formednot according to the specific gravity but according to the acoustic property of the tissue. 4. It provides sectional views. 5. There is no contraindication. Disadvantages 1. Its useful application is limited only to those organs which are not covered by air or bone 2. Skill is required to gain a fine view. Among the eight cases reported above, in the four cases (No. 3, 6, 7 and 8) better diagnostic information was obtained by ultrasonic scanning than by other diagnostic mea-sures. It was concluded from our experiences that ultrasonic scanning established its usefulness in diagnosis of abdominal tumors, especially of the lesions of the biliary system, the ovarium, and the retroperitoneal structures. Summary Presented are eight cases with abdominal tumors which were examined by ultrasono-graphy. Abdominal tumors of cystic configurations were diagnosed more accurately by ultrasonography than by other diagnostic measures. It is anticipated in near futur巴 thatultrasonography will be widely used and provide much more accurat巴 informationswith development of methods such as color display5l8l and computerized simultaneous ultrasonic scanning9l The gist of this paper was reported at the 126th Meeting of Kinki Surgical Association, Kobe, November 17, 1979. Acknowledgement The authors wish to express their sincere gratitude to Dr. YoRINORI HrKASA, Professor of the 2nd Department of Surgery Kyoto University School of Medicine for his kind advice. 352 日外宝第49巻第3号（昭和55年5月）Referごnces1) Damascelli B, Fossati F et al . B-scan ultrasound exploration of neoplastic disease. Amer J Roentgenol 105 428-437, 1969. 2) Freimanis A K and Asher WM : Development of diagncstic criteria in echographic study of abdominal lesions. Amer J Roentgenol 1()8 : 747-755, 1970. 3) Holm H H : Ultrasonic scanning in the diagnosis of space occupying lesions of the upper abdomen. Brit J Roent-genol 44 : 24-36, 1971. 4) Holm H H and Mortensen T : Ultrasonic scanning in diagnosis of abdominal disease. Acta Chir Scan 134 : 333 341, 1968. 5) Ide M and Masusawa S : Electronic color display system for ultrasono-tomography. Jap J Ultrasonics 21 123-124, May 1972. (written in Japanes巴）6) Natori H, Fukuda M et al On upper abdominal tumors with cystic Pattern on ultrasonic echogram. Jap J Ultrasonics 17 ; 75-76, May, 19/0. (written in Japanese) 7) Templeton A W and Stuber J L : Abdominal and retroperitoneal sonography. Amer J Roent-genol 113 . 741-748, 1971. 8) Urushizaki I, Natori H et al ・ Colour display of ultrasonotomograms. Internal Medicine 34 : 659 664, 1974. (written in Japanese) 9) Yokoi H and Tatsumi J : Ultrasonic diagnostic equipment controlled by computer. Jap J Ultrasonics 23 : 109-110, 1973. (written in Japanes巴）和文抄録Cystic patternを呈した腹部腫癌の超音波断層に於ける診断的意義赤穂市民病院外科中元光一，田中 明，菊池俊二仁尾義則，辺見公雄超音波断層法は，補助的診断法として，広く普及 に関し，充分に満足できる情報を提供し，有力な診断しつつある．我々は，接触複合操作法にて， Cystic 法ど恩われる．装置の操作上の技術的な問題点を克服patternを呈した腹部腫癌8例を供覧し，その診断的 するとともに，無病無害という長所を生かし，スクり意義を検討した本診断法は，特に胆道系，卵巣，後 一ニングとしてだけでなし精密検査としても，幅広腹膜腫場において，腫場の大きさ，形，内容等の性状 し臨床に応用されることが，望まれる．

Cystic patternを呈した腹部腫瘤の超音波断層に於ける診断的意義

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Cystic patternを呈した腹部腫瘤の超音波断層に於ける診断的意義

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