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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 springeronline.com © 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 Printed on acid-free paper 21/3152/YL – 5 4 3 2 1 0 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 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. Ultrasound 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 colleague 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 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 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 Contents 1 1.1 1.2 1.3 Basics of Ultrasound . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Physical and Technical Principals . . . . . . . . . . . . . . . . . . . . . . . . . . Imaging Techniques . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . General Remarks and Recommendations on Examination Technique . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.3.1 Applications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.3.2 Preparation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.3.3 Positioning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.3.4 Coupling Agents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.3.5 General Recommendations and Guidelines for Ultrasound Examinations (Twelve Golden Rules) . . . 1.4 Interventional Ultrasound . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.4.1 Technique . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.4.2 Evaluation of the Aspirated Material . . . . . . . . . . . . . . . . . 1.4.3 Hazards . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.5 Safety . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.5.1 Ultrasound Effects . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 2.1 2.2 2.3 Typical Sonographic Findings in Inflammatory Diseases . . . . . Pathology of Inflammation, Common Findings . . . . . . . . . . . . . . Ultrasonic Findings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Organ-related Ultrasonic Findings . . . . . . . . . . . . . . . . . . . . . . . . . 2.3.1 Lymph Nodes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.3.2 Spleen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.3.3 Lung and Pleura . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.3.4 Liver and Biliary Tract . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.3.5 Gastrointestinal Tract . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.3.6 Kidney . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 1 4 8 8 8 9 9 10 11 12 13 15 16 16 21 21 22 27 27 32 36 42 49 57 XII Contents 3 Ultrasound Diagnosis of Special Infectious and Parasitic Diseases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.1 Bacterial Infections . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.1.1 Ultrasound in Extrapulmonary Tuberculosis . . . . . . . . . . 3.2 Viral Infections . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.2.1 AIDS and Sonography . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.2.2 Viral Hepatitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.2.3 Dengue Fever . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.3 Parasitic Diseases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.3.1 Amebiasis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.3.2 Trypanosomiasis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.3.3 Ascariasis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.3.4 Bancroftian Filariasis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.3.5 Liver Trematode Infection (Liver Distosomiasis) . . . . . . . 3.3.6 Schistosomiasis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.3.7 Echinococcosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63 63 63 71 71 80 89 93 93 103 109 115 123 130 143 4 Ultrasound Features in Childhood Infection . . . . . . . . . . . . . . . . 4.1 Ultrasound in Osteomyelitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4.2 Ultrasound in Brain Infection in Neonates and Infants . . . . . . . . 4.2.1 Cytomegalovirus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4.2.2 Toxoplasmosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4.2.3 Herpes Simplex Virus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4.2.4 Congenital Rubella . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4.2.5 Meningitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4.2.6 Encephalitis and Brain Abscess . . . . . . . . . . . . . . . . . . . . . . 4.2.7 Viral Encephalitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4.3 Ultrasound in Abdominal and Gastrointestinal Infections . . . . . 159 159 161 162 162 162 163 163 165 166 166 Glossary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 169 Suggested Reading . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 173 World Federation for Ultrasound in Medicine and Biology . . . . . . . . . 177 Subject Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 179