Living donor transplantation is now an accepted and successful method of treating end-stage liver disease in Japan. Ultrasonography is the initial imaging modality of choice for detection and follow-up of early and delayed complications after liver transplantation. During the graft harvesting from the living donor, the anatomy of the hepatic vein must be confirmed. Vascular complications include thrombosis and stenosis of the hepatic artery, portal vein or hepatic vein. Biliary complications include leaks, strictures, stones or sludge. Perihepatic fluid collection and ascites are common after liver transplantation. We will describe ultrasonic examinations performed in living donor transplantation recipients and donors during and after the operation.

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Although ultrasonographic diagnosis of gynecologic disorders is used primarily to distinguish between benign and malignant uterine or ovarian tumors, recent improvement in resolution and advances in Doppler technology empowers ultrasound to diagnose other intrapelvic disorders. Ultrasonography is also useful in diagnosing such uterine disorders as myoma, adenomyosis, and endometrial carcinoma, while sonohysterography combined with introduction of sterile saline into the uterine cavity provides definitive findings of endometrial polyps. Ultrasonography can also show the location of IUDs and cirsoid aneurysms. Most noteworthy, however, is its usefulness in the differential diagnosis of benign and malignant ovarian tumors. Even malignant, mucinous, nonmucinous, and metastatic lesions can be differentiated with ultrasound. Ultrasonography can also visualize such intrapelvic disorders as pyosalpinx, peritonitis, and the presence of foreign bodies, including gauze, and its ability to diagnose ascites or pseudomyxoma peritonei is also clinically significant.

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The heel bone is often chosen for ultrasound assessment of bone. Ultrasound velocity generally serves as a diagnostic index and varies with the temperature of the medium. While commercial quantitative ultrasound systems assume that the temperature of the heel is stable, heel bone temperature is influenced more by ambient temperature than by body temperature, especially in the winter. The effect of heel temperature has received more attention as quantitative ultrasound measurement systems have gained wider use. Although the effect of heel temperature has been reported, few studies show a correlation between ultrasound parameters and measured temperature and the temperature characteristics of soft tissue and the like. We determined the temperature characteristics of cortical bone, trabecular bone, bone marrow, superficial skin, muscle, fat, and subcutaneous fat, major components of the heel by using the bovine extirpated samples. While temperature coefficients of muscle and superficial skin were low, those of bone marrow and fat were high. The temperature coefficients of cortical bone and bone marrow were the same, although the temperature coefficient of trabecular bone was half that of cortical bone. We then estimated temperature characteristics and calculated ultrasound velocity in the heel using thickness and the temperature coefficient of each heel component. The estimated temperature characteristics were consistent with those actually observed in 21 women volunteers.

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A 24-year-old woman was admitted to this institution for right lower abdominal pain that had begun 2 weeks earlier. Physical examination showed localized and rebound tenderness in the right lower abdomen, and abdominal CT scan showed a mass in the ascending colon. Ultrasound reveled an edematous appendix with a hypoechoic mass suggestive of acute appendicitis. The patient underwent emergency explorative laparoscopic surgery. Intraoperative findings revealed an inflammatory granuloma 3 cm in diameter in the upper ascending colon. The granuloma and appendix were resected. Pathologic study discovered filamentous material in the granuloma that was identified as an anisakiasis body. Our presumptive diagnosis was anisakiasis with intraperitoneal granuloma. Upon re-evaluation of the ultrasound study, we found that the ultrasonographic images closely resembled the cross section of the specimen. This finding suggests the possibility of using ultrasound in the early diagnosis of anisakiasis granuloma. Laparoscopic surgery proved effective.

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Appendiceal mucocele is rarely seen in the clinic. Rather, it is found incidentally or on examination of pain or a palpable mass in the right lower quadrant. We describe three cases of appendiceal mucocele, each of which produced characteristic ultrasound images. Case 1 occurred in a 19-year-old man who complained of a palpable mass in the right lower quadrant of the abdomen. The ultrasonogram showed a 9.1×3.7 cm hypoechoic mass with a calcified wall and internal echogenic layers resembling the cross section of an onion in the right paracolic gutter. Case 2 was that of a 70-year-old woman with discomfort in the right lower quadrant. Abdominal examination detected a palpable mass with no tenderness in the area. The ultrasonogram showed a 9.6×3.1 cm cystic mass with internal echogenic layers similar to those in Case 1 in the medial part of the ileocecum. Case 3 occurred in a 59-year-old woman who complained of pain in the right lower quadrant. Abdominal examination detected a palpable mass accompanied by tenderness in the right lower quadrant. The ultrasonogram showed a multiple concentric ring sign and a cup-and-ball shaped cystic mass in the right upper abdomen, which indicated intussusception with an appendiceal mucocele. The ultrasonogram after barium enema reduction showed a 2.5×2.0 cm oval mass in the cecum connected with the dilated appendix 1.1 cm in diameter. Ultrasonography proved useful for diagnosing appendiceal mucocele.

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