Ultrasonography of digestive diseases

Ultrasonography of digestive diseases

Ufrmsound in Med. & Bid.. Vol. 5. pp. IS-126 Pergamon Press Ltd., 1979. Printed in Great Britain BOOK REVIEW ULTRASONOGRAPHY OF DIGESTIVE By FRA...

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in Med. & Bid..

Vol. 5. pp. IS-126

Pergamon Press Ltd., 1979. Printed in Great Britain



By FRANCISS. WEILL, The C. V. Mosby Company, illus. U.S. $54.00. The whole atmosphere of this new ultrasound book is humerous and charming and thereby very well reflects the spirit of its author, known by most ultrasonographers from many previous publications and numerous international meetings. Besides, it is until now the most comprehensive book on the use of ultrasound in gastroenterology. It is based on 10 yr of ultrasonic experience combining real-time and contact scanning techniques. The book is very well organized, the extensive text is thorough and detailed and the language is quite fluent and easy to read. Where most other books have one or two typical pictures illustrating a point, Dr. Weill liberally uses 8 or 10, many of which are excellent. The result being 1336 illustrations. However, like every other author currently writing books on diagnostic ultrasound (including our group) Dr. Weill has had problems caused by the rapidly developing technology in this field. As pointed out by the author himself, some of his extensive experience is documented by images which are not quite up to date. The extremely important combined use of dynamic and static scanning in abdominal diag nostics is stressed several times by Dr. WeilI, who himself seems to prefer the dynamic scanning in the majority of situations. This rapidly provides one with an infinite number of live images. This considerably facilitates the tracing of tubular structures, for example. Since ultrasound physics and principles are covered in several other books the author has chosen not to go into very much detail concerning these matters. The drawings demonstrating the physical principles and the various examination procedures later in the book suffice, but do not represent the strength of the book. The technology part is followed by an excellent chapter on echoangiography which serves as a most useful guide to ultrasonic exploration of the upper abdomen, not least because of the numerous illustrations. Early in the book Dr. Weill introduces to the reader two distinguished gentlemen who-according to the author-lived in the first century B.C.: Hillel and Schammai. Several times in the rest of the book they take strong opposite stands on various controversial matters.


St. Louis,

1978. 505 pp. 1336

The main parts of the book deal with the liver, the pancreas and the spleen. Everything one can think about related to these topics is covered: examination procedures, normal and pathological findings, very rare diseases, indications, relations to other diagnostic procedures etc. In order to evaluate the size of a liver the author has introduced various marginal angles which in normals are not supposed to exceed certain values. The reviewer has taken the liberty to consult Hillel and Schammai. Hillel thinks that this indirect way to determine size is ingenious, while Schammi finds the approach a little awkward since, for example, summation of the areas of a series of saggital scans through the liver, can easily provide the volume of the liver directly. Chapter 10 which-to quote Dr. Weill-is a specifically French chapter, deals with cirrhosis and portal hypertension. The cirrhosis pattern is divided in 1, II, IIIa, IIIb and IV. Zor thoseincluding Schammai and -myself-who sometimes have difficulties in diagnosing &rho& at all, this chapter, which undoubtedly is the most comprehensive in the literature is most enlightening. In the pancreas chapter, variations in the Thickness of the normal pancreas are given. The maximal volumes for the head, the neck and the bodytail are 30, 21 and 28 mm respectively. These figures are surprisingly high. However, the author himself stresses that one of the most important features when evaluating the pancreas with regard to tumor, is whether the gland has a harmonious appearance or not, and that sounds very reasonable. Dr. Weill is a most perceptive observer and gives the reader numerous useful ultrasonic tricks and signs, e.g. the “mesenteric vein sign”, which is important in the diflerential diagnosis of pancreatic cancer and retroperitoneal lymphoma, since the vein in the first case is located posteriorly and in the last case anteriorly to the mass. The chapter on jaundice covers 30 pages and 1s systematic and very good. It is stressed that the use of real-time scanning is of the utmost importance especially in this type of patient. It is first determined which part of the biliary tree is dilated and then the cause of obstruction is visualized, if possible. Some experience is certainly necessary to recognize each of the many tubular structures



Book Review

visible with modern ultrasonic equipment in the upper abdomen. This chapter will be of great help. The last brief chapter contains a sections on “diagnostic policy” where the relationship between conventional radiological procedures, CTscanning and ultrasound scanning is discussed in a well-balanced and most competent way. Also a section on “selection of an ultrasonic machine’* is included which should be read by everybody before choosing ultrasonic equipment. In such an extensive book on digestive diseases

radiology in the diagnosis of gastrointestinal tumors and it may be predicted that ultrasound in the future will play a more important role in this field than is the case today. Another diagnostic procedure which undoubtedly in the future will gain increasing use, is the uhrasonically guided puncture. Dr. WeiII stresses the usefulness of this technique several times and

points out important indications. There is absolutely no disagreement between Hillel, Schammai and the reviewer: “Ultrasonography of digestive diseases’* is an excellent book and no serious ultrasonographercan do without it.

one may wonder why only a couple of gastrointestinal tumors are shown and a chapter covering the whole topic is lacking. The author gives the explanation in the last chapter: the diagnosis of H. H. HOLM this type of tumor is a function of conventional Kobenhavns Amts Sygehus I Herlve radiology, not ultrasonography. Ultrasonic Labomtory Ha&v However, in our experience ultrasound (in Ringvej combination with 6ne needle biopsy) has proved 2730 Hedve sometimes to be a very useful supplement to Denma*