Материал: Advanced Imaging of the Abdomen - Jovitas Skucas

Leriche’s Syndrome

Contrast-enhanced magnetic resonance angiography (MRA) can detect Leriche’s syndrome (occlusion of distal aorta) and, in fact, often provides better femoral artery visualization than does intraarterial digital subtraction angiography (DSA). A 3D MRA classification of Leriche’s syndrome is based on the level of aortic occlusion: (1) juxtarenal; (2) infrarenal but cranial to the inferior mesenteric artery origin; and (3) caudal to the inferior mesenteric artery (99).

Acquired Immune Deficiency

Syndrome (AIDS) Related

Prostatic tubercular abscesses develop in men with AIDS. Epididymo-orchitis is not uncommon and tends to be more severe than in non-AIDS patients. Unusual opportunistic pathogens are common. At times MRI reveals obliteration of interlobular septa and mimics a cancer. Some of these infections evolve into an epididymocutaneous fistula.

Testicular stromal tumors have developed in HIV-infected men. Fournier’s gangrene can also be initial presentation of an HIV patient.

Postoperative Changes

Prostate

A false urethral passage may not fill with contrast after prostatic surgery and thus be missed on a voiding cystourethrogram. At times an introduced catheter elevates an adjacent mucosal flap and identifies the false passage. If needed, US is useful for guidance in inserting a catheter.

Urinary incontinence is a complication after prostatectomy. Evaluation of the bladder outlet sphincter mechanism in these patients is discussed in Chapter 11.

Anecdotal reports describe a gossypiboma (retained surgical sponge) after radical prostatectomy and pelvic lymph node dissection resulting in recurrent bladder neck strictures.

Similar to other surgical procedures, a radical retropubic prostatectomy is associated with thromboembolic complications. Pelvic lympho-

ADVANCED IMAGING OF THE ABDOMEN

celes and hematomas appear to have a role in thrombi formation; postoperative pelvic US detects most lymphoceles and hematomas, although small collections are overlooked.

Postvasectomy

A vasectomy is associated with few complications. Granulomas and cysts develop postvasectomy. Granulomas are probably secondary to spermatozoal extravasation and a resultant inflammatory response. Extravasation presumably is secondary to increased pressure in epididymal tubules. The epididymis enlarges.

A granuloma appears as a hypoechoic tumor within either the epididymis or adjacent structures.

Postbiopsy

Arteriovenous fistulas, detectable with color Doppler US, occur with a minority of endorectal prostate needle biopsies; almost all of these fistulas close spontaneously.

Similar to other sites, US-guided transperineal prostatic biopsy can result in perineal tumor implantation.

Testicular US after testicular biopsy reveals a range of findings, such as focal hypoechoic tumors ranging from well marginated to poorly defined, peritesticular hyperechoic foci or linear striations, and focal contour defects (100); some of these findings even suggest a neoplasm, and thus knowledge of a past biopsy is necessary.

Other Findings

After a pancreas–kidney transplant, with the exocrine pancreatic drainage into the bladder, anecdotal reports describe urethral disruption, presumably secondary to enzymatic digestion.

Vesicourethral dysfunction is a complication of radical rectal surgery. The bladder does not empty normally. Radical transurethral prostate resection appears effective in some.

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