Ascites sonography

Sonography Sonography facilitates the diagnosis of ascites in its early stages (< 200 ml). If the fluid accumu-... 

Latent ascites (< 250 ml) can be determined by sonography. Detection of fluid in the abdominal cavity signals decompensation of cirrhosis and the corresponding inefficacy of prophylactic measures. Medication is recommended as part of a stepwise therapy. To start with, the prophylactic measures for ascites should be applied more intensively and consistently. Both ascites itself and its treatment harbour risks for the patient. 

Before denoting ascites as refractory to conservative therapy in cases of liver cirrhosis, it is essential to rule out what would appear to be pathogenetically or causally derived resistance to therapy. The multiple causes of resistance to therapy must be considered in each individual case and excluded as far as possible. This can often be extremely difficult and is sometimes even impossible, (s. tab. 16.13) Assessment of the renal cortical blood flow is facilitated by colour-encoded Doppler sonography successful diuretic therapy of ascites requires good circulation in the renal cortex. A continuous decrease in the cortical blood flow correlates with growing therapy resistance of the ascites. 

Sonography has a role in high intestinal obstruction, especially in patients with lack of air in the gastrointestinal tract whenever marked distension of the flanks and elevation of the diaphragms is observed on the plain radiograph. In such cases, sonography is useful to differentiate the presence of multiple dilated loops filled with fluid from ascites (Fig. 1.18). It is also useful in demonstrating associ-... 

Sonography may be used in patients with intestinal tuberculosis to document its classic features, i.e., bowel wall thickening, hyperemia, stricture, and mesenteric lymphadenopathy. When tuberculous peritonitis coexists, sonography shows ascites, omental cake, and thickened mesentery with an adherent small bowel loop thus, ultrasonography maybe used as a primary investigative tool in patients with suspected or recurrent tuberculosis. 

Fig. 9.13. Struma ovarii. Transaxial CT in a young woman who presented with a complex adnexal mass at sonography and no evidence of hyperthyreosis. A left adnexal (arrow) surrounded by ascites is demonstrated in the cul-de-sac. It is well defined, shows a thin wall, and demonstrates a solid and cystic architecture. Within the lesion a locule (asterisk) of high density presents hemorrhage. By bladder. Courtesy of Dr. T.M. Cunha, Lisbon...

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