H.T. Lutz · H.A. Gharbi Manual of Diagnostic Ultrasound in Infectious Tropical Diseases

(1)

H.T. Lutz· H.A. Gharbi

Manual of Diagnostic Ultrasound in Infectious Tropical Diseases

(2)

Harald T. Lutz Hassen A. Gharbi (Editors)

Manual

of Diagnostic Ultrasound

in Infectious

Tropical Diseases

With 176 Figures and 10 Tables

123

(3)

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 springeronline.com

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 Printed on acid-free paper 21/3152/YL – 5 4 3 2 1 0

(4)

Foreword

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

(5)

Preface

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 ultrasound 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 ultrasound, 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

(6)

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

(7)

Acknowledgements

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

(8)

Contents

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

(9)

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

(10)

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

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

(11)

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

Zeineb Mnif

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

(12)

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

Arezzo, Italy