Wang JY, Luo Y, Wang WY, Zheng SC, He L, Xie CY, Peng L. Contrast-enhanced ultrasound using SonoVue mixed with oral gastrointestinal contrast agent to evaluate esophageal hiatal hernia: Report of three cases and a literature review. World J Clin Cases 2021; 9(11): 2679-2687 [PMID: 33889636 DOI: 10.12998/wjcc.v9.i11.2679]
Corresponding Author of This Article
Li Peng, MD, Associate Chief Physician, Department of Ultrasound, First People's Hospital of Longquanyi District, Longquan Hospital of West China Hospital of Sichuan University, Longquanyi District, Chengdu 610100, Sichuan Province, China. 912435936@qq.com
Research Domain of This Article
Radiology, Nuclear Medicine & Medical Imaging
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Clin Cases. Apr 16, 2021; 9(11): 2679-2687 Published online Apr 16, 2021. doi: 10.12998/wjcc.v9.i11.2679
Contrast-enhanced ultrasound using SonoVue mixed with oral gastrointestinal contrast agent to evaluate esophageal hiatal hernia: Report of three cases and a literature review
Jing-Yu Wang, Yan Luo, Wen-Ying Wang, Shi-Cheng Zheng, Lian He, Chun-Yan Xie, Li Peng
Jing-Yu Wang, Wen-Ying Wang, Lian He, Li Peng, Department of Ultrasound, First People's Hospital of Longquanyi District, Longquan Hospital of West China Hospital of Sichuan University, Chengdu 610100, Sichuan Province, China
Yan Luo, Department of Ultrasound, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China
Shi-Cheng Zheng, Chun-Yan Xie, Department of Gastroenterology, First People's Hospital of Longquanyi District, Longquan Hospital of West China Hospital of Sichuan University, Chengdu 610100, Sichuan Province, China
Author contributions: Wang JY, Peng L, and Luo Y designed the study and wrote the manuscript; Wang WY performed the literature search and edited the manuscript; He L collected the data; Zheng SC and Xie CY performed the data analysis and interpretation; all authors approved the final version of the submitted manuscript and agree to ensure that any questions related to the work are appropriately resolved.
Supported byThe Research Project of Sichuan Medical Association, Nos. S19080 and S18075.
Informed consent statement: All study participants provided informed written consent prior to study enrollment.
Conflict-of-interest statement: All authors declare that they have no financial relationships to disclose.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Li Peng, MD, Associate Chief Physician, Department of Ultrasound, First People's Hospital of Longquanyi District, Longquan Hospital of West China Hospital of Sichuan University, Longquanyi District, Chengdu 610100, Sichuan Province, China. 912435936@qq.com
Received: December 16, 2020 Peer-review started: December 16, 2020 First decision: January 10, 2021 Revised: January 20, 2021 Accepted: February 8, 2021 Article in press: February 8, 2021 Published online: April 16, 2021
Abstract
BACKGROUND
Due to a thicker abdominal wall in some patients, ultrasound artifacts from gastrointestinal gas and surrounding tissues can interfere with routine ultrasound examination, precluding its ability to display or clearly show the structure of a hernial sac (HS) and thereby diminishing diagnostic performance for esophageal hiatal hernia (EHH). Contrast-enhanced ultrasound (CEUS) imaging using an oral agent mixture allows for clear and intuitive identification of an EHH sac and dynamic observation of esophageal reflux.
CASE SUMMARY
In this case series, we report three patients with clinically-suspected EHH, including two females and one male with an average age of 67.3 ± 16.4 years. CEUS was administered with an oral agent mixture (microbubble-based SonoVue and gastrointestinal contrast agent) and identified a direct sign of supradiaphragmatic HS (containing the hyperechoic agent) and indirect signs [e.g., widening of esophageal hiatus, hyperechoic mixture agent continuously or intermittently reflux flowing back and forth from the stomach into the supradiaphragmatic HS, and esophagus-gastric echo ring (i.e., the “EG” ring) seen above the diaphragm]. All three cases received a definitive diagnosis of EHH by esophageal manometry and gastroscopy. Two lesions resolved upon drug treatment and one required surgery. The recurrence rate in follow-up was 0%. The data from these cases suggest that the new non-invasive examination method may greatly improve the diagnosis of EHH.
CONCLUSION
CEUS with the oral agent mixture can facilitate clear and intuitive identification of HS and dynamic observation of esophageal reflux.
Core Tip: In this research, we used a new contrast ultrasound examination method to evaluate esophageal hiatal hernia (EHH). An oral agent mixture was created by mixing microbubble-based SonoVue with a gastrointestinal contrast agent, and applied in contrast ultrasound for evaluation of EHH. This new examination method not only allowed for clear image direct visualization but also dynamic observation of esophageal reflux. To our best knowledge, this is the first report on the use of SonoVue mixed with an oral gastrointestinal contrast agent in the diagnosis of EHH.
