Manual of Diagnostic Ultrasound in Infectious Tropical Diseases - part 1 pps

GharbiManual of Diagnostic Ultrasound in Infectious Tropical Diseases... Gharbi Editors Manual of Diagnostic Ultrasound in Infectious Tropical Diseases With 176 Figures and 10 Tables 123

H.T Lutz · H.A Gharbi

Manual of Diagnostic Ultrasound in Infectious Tropical Diseases

Harald T Lutz

Hassen A Gharbi

(Editors)

Manual

of Diagnostic

Ultrasound

in Infectious

Tropical Diseases

With 176 Figures and 10 Tables

123

Prof Harald T Lutz

Klinikum Bayreuth

95445 Bayreuth

Germany

Dr Hassen A Gharbi

Radiology Department Ibn Zohr

Route X2, Cité El Khadra

Tunis 1003

Tunisia

Library of Congress Control Number: 2005927419

ISBN-10 3-540-24446-8 Springer Berlin Heidelberg New York

ISBN-13 978-3-540-24446-2 Springer Berlin Heidelberg New York

This work is subject to copyright All rights reserved, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilm or in any other way, and storage in data banks Duplication of this publication

or parts thereof is permitted only under the provisions of the German Copyright Law of September 9,

1965, in its current version, and permission for use must always be obtained from Springer Violations are liable for prosecution under the German Copyright Law.

Springer is a part of Springer Science+Business Media

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© Springer-Verlag Berlin Heidelberg 2006

Printed in Germany

The use of general descriptive names, registered names, trademarks, etc in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use.

Product liability: The publishers cannot guarantee the accuracy of any information about dosage and application contained in this book In every individual case the user must check such information by consulting the relevant literature.

Editor: Dr Ute Heilmann, Heidelberg

Desk Editor: Wilma McHugh, Heidelberg

Cover design: Frido Steinen-Broo, EStudio Calamar, Spain

Typesetting and production: LE-TEX Jelonek, Schmidt & Vöckler GbR, Leipzig, Germany

It is with great pleasure and pride that the World Federation for Ultrasound

in Medicine and Biology (WFUMB) publishes this “Manual of Diagnostic Ultrasound in Infectious and Tropical Diseases” This is a book that will satisfy a great need that up to now has been unfulfilled Although there are many books that deal with various aspects of ultrasound, this is the only one that deals specifically with infectious and tropical diseases It will provide much-needed knowledge and insight in these areas It will be of especially great value in the teaching of health professionals in those parts

of the world where ultrasound is just beginning to be incorporated into patient care

This book has had the good fortune to be conceived and edited by Drs Lutz and Gharbi They are excellent physician practitioners of ultrasound with much experience in teaching in the developing world They have gathered together an outstanding array of chapter authors to create a most valuable book All of the authors are to be congratulated on a job well done

I trust that readers of this book will benefit from the material contained and will be enabled to provide better medical care to their patients This

is certainly a worthy aim, and one that WFUMB is constantly working to achieve

Marvin C Ziskin, M.D President, WFUMB

Diagnostic ultrasound is a rapidly developing imaging technology widely used in both industrialized and developing countries, as stated by a WHO Study Group in 1996 Ultrasound is especially suitable for poorer countries even outside the centers of population, since ultrasound does not need

a sophisticated infrastructure or expensive installations, but can be used with transportable units even without a direct branch connection Ultra-sound can be used not only as really universal diagnostic method but also

as a suitable guide for simple and careful therapeutic interventions, not at least in infectious and parasitic diseases, such as bilharziosis, amebiasis

or hydatid disease The method is safe concerning the bioeffects, but the safety of a diagnostic tool also depends on the accuracy of the results, i.e.,

on the experience and the skill of the persons using the equipment Therefore the World Federation of Ultrasound in Medicine and Biology (WFUMB) is focusing upon (biological) safety and upon education as well,

in cooperation with the WHO

The stimulus to publish this small manual came from an African col-league during an ultrasound course organized by the WFUMB He said there existed a number of nice and suitable manuals and books about ul-trasound in general, but he had not found a small manual dealing with the specific infectious diseases common in subtropical and tropical regions Following his proposal, we set out to design a small manual on these topics, not for the big libraries, but for direct use during the examination

It should help our colleagues working in these areas and should encourage them to use ultrasound on a large scale, including interventional ultra-sound, for the benefit of their patients

For us it was really a great experience to find that all our colleagues, individual members of the WFUMB from all parts of the world, agreed without reservation to cooperate in writing this manual We really do hope that it was possible to distill the long experience of all these colleagues

VIII Preface

in this small manual At the same time, we recognize that this was a first attempt Therefore, we invite all colleagues to help us to eradicate mistakes and further improve the manual in the future

Harald T Lutz Hassen A Gharbi

The editors would like to thank Drs R Badea, Cluj-Napoca, Romania, Gertrud Jechart, Augsburg, Germany and Gebhard Mathis, Hohenems, Austria for the courteousness to support us with interesting images The editors thank all the colleagues in the board of the WFUMB for encouraging, supporting and advising us, during the preparation of the manual

The editors express their special appreciation of the valuable and selfless help of Peter N.T Wells With his great experience as editor in chief of the official journal UMB of the WFUMB, he checked the manuscripts arriving from the different parts of the world very carefully and gave us many useful and good advice

Harald T Lutz Hassen A Gharbi

1 Basics of Ultrasound 1

1.1 Physical and Technical Principals 1

1.2 Imaging Techniques 4

1.3 General Remarks and Recommendations on Examination Technique 8

1.3.1 Applications 8

1.3.2 Preparation 8

1.3.3 Positioning 9

1.3.4 Coupling Agents 9

1.3.5 General Recommendations and Guidelines for Ultrasound Examinations (Twelve Golden Rules) 10

1.4 Interventional Ultrasound 11

1.4.1 Technique 12

1.4.2 Evaluation of the Aspirated Material 13

1.4.3 Hazards 15

1.5 Safety 16

1.5.1 Ultrasound Effects 16

2 Typical Sonographic Findings in Inflammatory Diseases 21

2.1 Pathology of Inflammation, Common Findings 21

2.2 Ultrasonic Findings 22

2.3 Organ-related Ultrasonic Findings 27

2.3.1 Lymph Nodes 27

2.3.2 Spleen 32

2.3.3 Lung and Pleura 36

2.3.4 Liver and Biliary Tract 42

2.3.5 Gastrointestinal Tract 49

2.3.6 Kidney 57

XII Contents

3 Ultrasound Diagnosis of Special Infectious

and Parasitic Diseases 63

3.1 Bacterial Infections 63

3.1.1 Ultrasound in Extrapulmonary Tuberculosis 63

3.2 Viral Infections 71

3.2.1 AIDS and Sonography 71

3.2.2 Viral Hepatitis 80

3.2.3 Dengue Fever 89

3.3 Parasitic Diseases 93

3.3.1 Amebiasis 93

3.3.2 Trypanosomiasis 103

3.3.3 Ascariasis 109

3.3.4 Bancroftian Filariasis 115

3.3.5 Liver Trematode Infection (Liver Distosomiasis) 123

3.3.6 Schistosomiasis 130

3.3.7 Echinococcosis 143

4 Ultrasound Features in Childhood Infection 159

4.1 Ultrasound in Osteomyelitis 159

4.2 Ultrasound in Brain Infection in Neonates and Infants 161

4.2.1 Cytomegalovirus 162

4.2.2 Toxoplasmosis 162

4.2.3 Herpes Simplex Virus 162

4.2.4 Congenital Rubella 163

4.2.5 Meningitis 163

4.2.6 Encephalitis and Brain Abscess 165

4.2.7 Viral Encephalitis 166

4.3 Ultrasound in Abdominal and Gastrointestinal Infections 166

Glossary 169

Suggested Reading 173

World Federation for Ultrasound in Medicine and Biology 177

Subject Index 179

List of Contributors

Fernando Amaral

MEDIAX

Memorial Imagem e Diagnostico

Recife, Brazil

Alfonso Julio G Barbato

University of Sao Paulo

Sao Paulo, Brazil

Nestor de Barros

School of Medicine

University of Sao Paulo

Sao Paulo, Brazil

Ibtissem Bellagha

Radiology Department

Children’s Hospital

Place Bab Sardoun

Tunis Jabbari,

1007 Tunisia

Alessandra Caremani

Department of Infectious Disease

San Donato Hospital

Arezzo, Italy

Marcello Caremani

Department of Infectious Disease

San Donato Hospital

Arezzo, Italy

Giovanni Guido Cerri

School of Medicine University of Sao Paulo Sao Paulo, Brazil

Maria Cristina Chammas

School of Medicine University of Sao Paulo Sao Paulo, Brazil

Ferid Ben Chehida

Radiology Department Ibn Zohr Route X2, Cité El Khadra Tunis 1003, Tunisia

Michel Claudon

Department of Radiology University of Nancy France

Josef Deuerling

Klinikum Bayreuth Bayreuth, Germany

Wiem Douira

Radiology Department Children’s Hospital Place Bab Sardoun Tunis Jabbari,

1007 Tunisia

XIV List of Contributors

Gerusa Dreyer

Núcleo de Ensino Pesquisa

e Assistencia em Filariose (NEPAF)

Hospital das Clinicas

Av Prof Moraes Rego s/n

Cidade Universitária

Recife PE, 50740–900, Brazil

Leandro J Fernandez

Director, Laboratory

of Advanced Ultrasound

La Floresta Medical Institute

Caracas, Venezuela

Alain Gerard

Department of Tropical Diseases

University of Nancy

France

Hassen A Gharbi

Radiology Department Ibn Zohr

Route X2, Cité El Khadra

Tunis 1003, Tunisia

Azza Hammou

Centre National

de Radio-protection

Bab Saadoun

Tunis 1007 Jebbari, Tunisia

Joon-Koo Han

Seoul National University

College of Medicine

28 Yongon-Dong, Chongno-Gu

Seoul 110–744, Korea

Nathan Herszkowicz

School of Medicine

University of Sao Paulo

Sao Paulo, Brazil

Mohammed Salah Kechaou

Department of Radiology Habib Bourguiba Hospital, Sfax, Tunisia

Harald T Lutz

Klinikum Bayreuth Bayreuth, Germany

Alix Martin-Bertaux

Department of Radiology University of Nancy France

Sana Mezghani

Department of Radiology Habib Bourguiba Hospital Sfax, Tunisia

Jamel Mnif

Department of Radiology Habib Bourguiba Hospital Sfax, Tunisia

Zeineb Mnif

Department of Radiology Habib Bourguiba Hospital Sfax, Tunisia

Joaquim Noroes

Dept de Parasitologia Pesquisas, Centro Aggeu

Magalhâes-Fiocruz, Recife, Brazil

Ilka Regina Souza de Oliveira

School of Medicine University of Sao Paulo Sao Paulo, Brazil

List of Contributors XV

Heykel Ben Romdhane

Radiology Department Ibn Zohr

Route X2, Cité El Khadra

Tunis 1003, Tunisia

Waldir Salvi

School of Medicine

University of Sao Paulo Sao Paulo, Brazil

Danilo Tacconi

Department of Infectious Disease San Donato Hospital

Arezzo, Italy

Basics of Ultrasound

Harald T Lutz

1.1

Physical and Technical Principals

Ultrasound is the term applied to mechanical pressure waves with

frequen-cies above 20,000 Hz (beyond the audible range)

A medium must be present for ultrasound propagation to occur In biological tissues, ultrasonic energy is propagated mainly in the form of longitudinal waves, as it is in fluid

The ultrasound wave can be both emitted and received by a piezoelectric transducer The piezoelectric transducer is able to change electrical signals into mechanical waves, that is, transmitting ultrasound (= reverse piezo-electric effect), and vice versa to change mechanical pressure (reflected ultrasound waves, “echoes”) into electrical signals (= direct piezoelectric effect)

Ultrasound in the MHz range (high-frequency) can be emitted as a di-rectional beam, comparable to a light beam, from transducers of practical size

Ultrasound waves propagate in biological tissue at an average speed of

1540 meters (m) per second, with the exception of bones, where the waves move at more than 3000 m per second

Ultrasound waves interact with biological tissue in various ways; they are partially absorbed by the tissue, which means that their energy is con-verted into heat This is important for safety reasons (see Sect 1.5 below)

Ultrasound waves can also be reflected (interference > beam diameter)

or (back-) scattered on their way through the tissue Whether reflected or back-scattered, echoes are received by the transducer These echoes are the source of the diagnostic information

The echoes are analyzed first with regard to their site of origin (time– distance principle), and secondly with regard to their intensity This in-formation is used for example to construct an image (two-dimensional

2 1 Basics of Ultrasound

B-scan technique) One of the preconditions is that only a small part

of the ultrasound is reflected at each interface, and most of the ul-trasound is transmitted to deeper levels Only bones, gas, and foreign bodies (metallic or nonmetallic) cause a very strong reflection (acous-tic shadow); thus no information is obtainable from regions behind such obstacles

Absorption, reflection, and scattering cause a permanent attenuation

of ultrasound energy of approx 1 decibel per cm of propagation in the tissue traversed per 1 MHz of frequency The ultrasound attenuation must

be corrected by amplifying echoes as a function of distance from the transducer (TGC), in order to get a homogeneous display of the echoes (Fig 1.1a–d) Nevertheless this attenuation can seriously limit the depth

Fig 1.1a–d Ultrasound attenuation in the tissue and its correction by the TGC With

3.5 MHz, a homogeneous image is possible (a,c), whereas a frequency of 7.5 MHz (b,d)

is too high for the examination of the abdomen On the other side, the resolution close

to the 7.5-MHz transducer is better (small-part transducer)

1.1 Physical and Technical Principals 3

of penetration of higher frequencies (the so-called small part transducers

are suitable for small and superficial organs only!).

The ultrasonic field is a geometric description of the region

encom-passed by the ultrasound beam There are two main sectors, the near field (interference field), located between the ultrasound transducer and the (natural) focus, and the far field The lateral boundary of the ultrasound field is not sharp, because the beam intensity falls off continuously with distance from the center (Fig 1.2)

The lateral resolution depends on the diameter of the ultrasound beam:

the smaller the diameter, the better the resolution The resolution therefore

is best in the focal area The ultrasound beams are focused (mainly elec-tronically by modern techniques), enabling the clinician to always focus

on the region of interest (Fig 1.3)

The axial resolution depends on the length of the emitted ultrasound

pulses and finally on the wave length, i.e., the frequency

These basic physical principles are still important in regard to the qual-ity of ultrasound equipment despite the advances in electronic techniques:

Fig 1.2 The ultrasonic field of a flat transducer

Fig 1.3 Schematic representation of electronic focusing of a linear array transducer