Journal of Diagnostic Medical Sonography RSS feed -- OnlineFirst Articles

Evaluation of Renal Resistivity Index Before and After Voiding Cystoureterography Examination in Patients With Vesicoureteral Reflux

Avcu, S., Akpinar, I., Biren, T. — Thu, 19 Nov 2009 13:42:16 PST

Vesicoureteral reflux (VUR) occurs commonly in children and can cause significant renal damage. The purpose of this study is to assess the changes in renal vasculature with spectral Doppler sonography in patients with VUR. In addition, the possible effects of voiding cystoureterography (VCU) on the kidneys in patients with VUR are investigated by calculating renal resistivity index (RI) values before and after VCU using spectral Doppler sonography. In this prospective study, 114 kidneys of 58 children ages 0 to 16 years were included. The RI values that were calculated before and after VCU and RI values in different grades of VUR were compared statistically. In patients with VUR, the renal parenchymal RI values before and after VCU were significantly higher than those in patients without VUR (P < .05). The mean pre-VCU RI values were 0.68 ± 0.03 and 0.65 ± 0.05 in patients with VUR and in the control group, respectively, and the mean post-VCU RI values were 0.68 ± 0.03 and 0.65 ± 0.04 in patients with VUR and in the control group, respectively. Calculating renal RI values from arcuate or interlobar renal arteries with spectral doppler sonography while the patients are in a supine or lateral decubitus position is a useful technique in patients with VUR, being significantly higher in high-grade VUR patients than in low-grade VUR patients. There is no significant effect of the contrast agent reaching the renal calycial system during VCU examination on renal RI values.

A Holistic Evaluation of Risk Factors for Work-Related Musculoskeletal Distress Among Asymptomatic Sonographers Performing Neurosonology: A Pilot Study

Evans, K. D., Roll, S. C., Li, X., Sammet, S. — Mon, 16 Nov 2009 15:06:42 PST

A pilot study was conducted to gather holistic data points on female sonographers who executed neonatal neurosonography over four portable scanning sessions. The hypothesis was that specific risk factors contributed to work-related musculoskeletal distress in the hand and wrist as a result of neonatal neurosonography. A preexperimental pre-post research design was used to gather data on work demands, self-rated physical and mental health, posture/position during scanning, physiologic change, and pain scores. No statistically significant changes were detected between pre-post measures for work demands, physical and mental health, or pain scores as a result of portable scanning sessions. The physiologic changes, between scanning sessions, were recorded with the use of a hand-carried sonographic unit. Sonographic measures were less than the published criteria for carpal tunnel syndrome with a proximal cross-sectional area ≥10 mm² and an anterior bulge of the retinaculum of >4 mm. Sonography documented a statistically significant cross-sectional area change, within the median nerve, at the distal radius only after the first scanning session. Power and spectral Doppler was used to document perineural vascular flow within the median nerve, but it was not consistently obtained to allow for a rigorous comparison between pre- and postscanning sessions. This is the first pilot study to explore using a hand-carried sonographic unit to document change in the median nerve for an isolated sonographic examination. The results are only reflective of these particular participants, but much larger N and shorter scanning sessions are needed to confirm the hypothesis proposed.

Echocardiographic Values for Cardiac Dimensions and Left Ventricular Mass of Normal Chinese Adults: A Pilot Study

Leung, N. K. W. — Thu, 12 Nov 2009 08:42:49 PST

Studies evaluating potential differences in normal cardiac dimensions and body mass indices of various ethnic populations using 2D echo-cardiography have reported variations based on gender and ethnicity. With the currently accepted echocardiographic reference values from US studies, and the limited information available on Chinese populations, the aim of this pilot study was to determine the normal cardiac dimensions and left ventricular mass of adult Chinese using 2D-guided M-mode echo-cardiography. Of healthy Chinese adults (age 18 years and older) living in Hong Kong, 57 suitable participants (26 men, aged 35.7 ± 10.2 years; 31 women, aged 44.2 ± 8.5 years) were recruited. The results indicated that the mean sizes of the aortic root, left ventricular wall thickness, and left ventricular mass of Chinese men were significantly larger than those of Chinese women. Left ventricular mass of the Chinese sample population (men, 116.0 ± 20.6 g; women, 99.8 ± 20.9 g) was significantly smaller than US-based studies. The conclusions drawn are of clinical importance, especially in the assessment and management of hypertensive cardiac effects. The results of this study strongly indicate the need for a large-scale study to further establish ethnic-specific and gender-specific echocardiographic reference values for the Chinese population.

Sonographic Detection of Holoprosencephaly With Cyclopia and Proboscis

Diawara, F. M., Diallo, M., Camara, M., Traore, M. — Thu, 05 Nov 2009 14:29:34 PST

The incidence of holoprosencephaly is about 1 in 10,000 to 20,000 births. There are three major forms: alobar, semilobar, and lobar. The alobar form with cyclopia is very rare. The author describes a transabdominal sonographic diagnosis of an alobar form of holoprosencephaly at 20 weeks’ gestational age. The fetus presented with cyclopia, proboscis, absence of ears and nose, polydactyly, hydrocephalus, macrocephaly, and polyhydramnios. After counseling, termination of pregnancy was performed. Two years later, a subsequent pregnancy was normal.

Evaluation of Ultrasonic Scores in Differential Diagnosis of Breast Solid Lesions

Su, Y., An, T., Wang, D., Tian, J. — Tue, 03 Nov 2009 14:07:18 PST

The objective of this study was to evaluate the performance of ultrasonic scores in the differential diagnosis of breast solid lesions. In all, 135 lesions of 125 cases were analyzed, including 62 benign lesions and 73 malignant lesions. Pathology was used as the gold-standard diagnostic criterion. All the sonographic features of breast lesions were recorded routinely by high-frequency sonography, every feature was graded, and the total scores for each lesion were calculated. The results indicated that there were significant differences in ultrasonic scores between benign and malignant lesions in the shape, margin, capsule, attenuation, microcalcification, and blood flow (P < .001), and there were differences in ultrasonic scores in the length-to-width ratio and internal echoes (P < .05). Consequently, the higher the total ultrasonic scores, the increased possibility there was of malignant lesions. The sensitivity and specificity to distinguish breast malignant lesions from benign ones were 84.9% and 88.9%, respectively, and the area (Az) under the receiver operating characteristic curve of diagnosis was 0.915 if the cutoff value of the total ultrasonic scores was 13.5. This promising performance of ultrasonic scores in analyzing the sonographic features for differentiation between benign and malignant lesions semi-quantitatively can increase the diagnostic accuracy of breast solid lesions.

Work-Related Musculoskeletal Disorders (WRMSD) Among Registered Diagnostic Medical Sonographers and Vascular Technologists: A Representative Sample

Evans, K., Roll, S., Baker, J. — Tue, 03 Nov 2009 14:07:18 PST

Literature indicates a significant history of work-related musculoskeletal disorders (WRMSD) among diagnostic medical sonographers (DMS) and vascular technologist (VTs). To gather current data related to this historical trend, the authors administered a survey to a random and convenient sample of 5200 registered DMS and VTs. The invitation to complete the survey on a secure Web site yielded the largest participant sample to date of 2963 completed surveys (57% response). Data relative to the prevalence of WRMSD were analyzed and compared to other WRMSD research over the past decade. Results indicated that 90% of respondents were scanning in pain, a 9% increase since the last large-scale survey in 1997. Across all demographics, shoulder pain is most common, with older and more experienced sonographers having more finger, hand, and wrist pain than other groups. Pain continues to be related to pressure applied to the transducer, abduction of the arm, and twisting of the neck and trunk. Ergonomic equipment and education are provided by application specialists, but the incidence of WRMSD appears to be unabated. Higher order research, including randomized trials, with education and ergonomic interventions is needed to protect DMS and VTs who are necessary to meet increasing health care demands.

Prenatal Diagnosis of Intrapericardial Teratoma

Smyth, B. C. — Tue, 03 Nov 2009 14:07:18 PST

Congenital cardiac masses are rare, with rhabdo-myoma being the most common cardiac tumor occurring in the fetus. Intrapericardial teratomas are the second most common congenital cardiac mass, although reports of prenatal diagnosis in the existing literature are rare. Rapid growth of pericardial teratomas usually occurs after 20 weeks’ gestation, resulting in pericardial effusion and hydrops fetalis. Fetuses diagnosed with pericardial teratomas have a poor prognosis, with surgery being the only definitive treatment option.

Sonographic Appearance of Bilateral Hemorrhagic Cysts of the Ovaries With Rupture on Transvaginal Sonography

Singhal, M., Tiwari, O. — Thu, 22 Oct 2009 15:48:57 PDT

Hemorrhagic ovarian cysts often present with acute abdomen, requiring laparotomy if features are suggestive of rupture. In an appropriate clinical setting, diagnosis may be possible on transvaginal sonography in most cases, but at times it may be difficult to recognize and can be confused with other ominous conditions. The authors describe the sonographic appearance of bilateral hemorrhagic ovarian cysts with rupture.

Evaluation of Urethra and Anterior Wall Vaginal Leiomyoma by Translabial/Transurethral Sonography

Goss, J. — Thu, 22 Oct 2009 15:48:57 PDT

Recent advances in sonography have dramatically improved the evaluation of the female urethra and vaginal canal. Widespread use of sonography for the detection of vaginal masses presents a less expensive way to identify pathology. The author recently encountered a patient with a rare vaginal mass. The following case illustrates translabial and transurethral sonography defining a vaginal mass directly under the urethra with no urethra luminal abnormalities. In general, the identification of a vaginal mass would lead most physicians to consider magnetic resonance imaging for characterization. Sonography presents an opportunity to provide accurate information without increasing medical cost to the patient. To the author’s knowledge, this is the first report describing translabial and transurethral sonography using a 10-MHz linear transducer to determine extension of a tumor from the vaginal wall into the lumen of the urethra.

Atypical Adenopathy Associated With Cat Scratch Disease in a Chronically Ill Woman

Hill, D. S. — Thu, 22 Oct 2009 15:48:57 PDT

Cat scratch disease is a relatively common bacterial infection caused by contact with infected feline saliva. This case demonstrates an unusual presentation of adenopathy involving the superficial subcutaneous tissue of the upper extremity. Because of the location, adenopathy was not the primary consideration. The ultimate cause was identified as cat scratch disease caused by the Bartonella henselae organism in a chronically ill woman.

Fetal Decapitation Associated With Amniotic Bands

Glass, J. M. — Thu, 22 Oct 2009 15:48:56 PDT

Amniotic band syndrome (ABS) occurs secondary to rupture of the amnion in early pregnancy. This may result in entrapment of fetal structures, which in turn can cause a wide range of congenital malformations, including constriction or amputation. Presented here is a case involving a live fetus at 13 weeks’ gestation with the rare finding of fetal decapitation caused by amniotic band syndrome.

Hemochromatosis: A Literature Review

McElroy, V. — Thu, 22 Oct 2009 15:48:56 PDT

Hemochromatosis is an iron metabolism disorder in which the intestines absorb excessive amounts of iron, which is eventually deposited into soft tissues. Hereditary hemochromatosis is the most common single-gene disorder in the US white population. Typically, adults do not begin to exhibit manifestations of the disease until the age of 40, after years of iron accumulation. Neonatal hemochromatosis is a very rare and serious disorder with no known etiology. It is unrelated to the hereditary mutation of the HFE gene and is thought of as a variety of fulminant hepatic failure. Neonatal hemochromatosis is associated with extremely poor outcomes, and liver transplant is the only reliable treatment. This literature review aims to describe hereditary and neonatal hemochromatosis as well as the sonographic characteristics and treatment.

Distal Revascularization-Interval Ligation (DRIL) for the Treatment of Dialysis Access Steal Phenomenon

Hubbard, J., Markel, K., Bendick, P., Long, G. — Mon, 12 Oct 2009 14:45:50 PDT

The incidence and prevalence of end-stage renal disease continues to grow, even as treatments improve. The vascular steal phenomenon is an infrequent but often debilitating complication of dialysis access placement, and management can be difficult. A specific technique called distal revascularization–interval ligation, or the DRIL procedure, has been used with success in managing this problem. Anatomically, the site of the steal is bypassed, and the native vessel just distal to the steal site is ligated, making duplex sonography evaluation complex. An examination algorithm is presented, with illustrative examples, to assist the sonographer in evaluating dialysis access patients when they have had the DRIL procedure. The algorithm is based on breaking the study into more easily managed components: (1) duplex sonographic evaluation of arterial inflow and runoff as well as venous outflow, (2) duplex sonographic evaluation of the bypass graft, (3) duplex sonographic evaluation of the fistula/shunt, and (4) physiologic testing of flows to the hand and digits. Based on the knowledge of the pathophysiology of steal and the configuration of the DRIL reconstruction, a complete and accurate evaluation can be performed with confidence.

Sonography of the Neonatal Brain

Fox, T. B. — Mon, 12 Oct 2009 14:45:50 PDT

Neurosonography is a critical part of the care of the sick newborn. Sonography is superior to other modalities in imaging of the brain because it can be performed at the bedside, is easily reproducible, and does not require ionizing radiation or sedation. This article refreshes the sonographer in the normal anatomy and appearance of the neonatal brain using sonography, as well as some of the more common pathologic conditions that may be encountered.

Cysticercosis of the Breast

Upadhyaya, V., Narain, D., Sarkar, S. — Tue, 22 Sep 2009 14:00:37 PDT

Cysticercosis, although common in developing nations, is an uncommon cause of a breast lump. This article reports a case from India, where a young woman presented with a firm, nontender breast lump. Breast sonography imaging with a high-frequency transducer revealed a well-defined cystic lesion with an internal echogenic nodule and surrounding hypoechoic area. Subsequently, fine-needle aspiration cytology was performed, which confirmed the diagnosis of cysticercosis.