Journal of Diagnostic Medical Sonography current issue

Sonography in the Diagnosis of Renal Transplant Torsion

Gutknecht, M. — Wed, 30 Sep 2009 13:59:10 PDT

Torsion following kidney transplant is a complication occurring when the kidney rotates around the vascular pedicle. It is a relatively rare occurrence but one that the sonographer should be aware of when a patient presents with severe abdominal pain and decreased urine output. In the best of circumstances, renal torsion can be repaired; in the worst cases, the kidney is lost. Prompt diagnosis of renal vein thrombosis, renal artery stenosis, and occlusion resulting from torsion permits graft detorsion and possible salvage of the kidney.

JDMS CME Article-SDMS CME Credit

Wed, 30 Sep 2009 13:59:10 PDT

Feasibility of Using a Hand-Carried Sonographic Unit for Investigating Median Nerve Pathology

Roll, S. C., Evans, K. — Wed, 30 Sep 2009 13:59:10 PDT

Numerous research studies describe the prevalence of work-related musculoskeletal disorders (WRMSD) in diagnostic medical sonographers, but little research has investigated contributing factors and biological changes in symptomatic individuals. Improved image quality and portability, combined with lower cost and dynamic capabilities, have led to increased use of sonography over magnetic resonance imaging (MRI) in musculoskeletal evaluations. The purpose of this pilot study was to develop a valid and reliable sonographic protocol for the evaluation of work-related median nerve pathology with a hand-carried sonographic unit. A GE Logiq i (Milwaukee, Wisconsin) hand-carried unit with a 12-MHz linear transducer was used to collect nine longitudinal and transverse images of the median nerve at various anatomical locations in the distal upper extremity of three healthy volunteers. Doppler waveforms were also collected in the median nerve sheath. Qualitative review indicated high-quality images with well-defined structures, resulting in valid measures between multiple researchers of anterior-posterior diameter, cross-sectional area, anterior transverse carpal ligament bulge, and Doppler flow. The use of a hand-carried sonographic unit appears to be a feasible alternative to MRI to detect musculoskeletal changes in symptomatic sonographers. Additional basic and clinical studies are necessary to validate the use of hand-carried sonography as a measure of biological changes in longitudinal WRMSD research.

Pelvic Congestion Syndrome and Its Relationship to Varices of the Lower Extremities: A Literature Review

Wheelock, K. — Wed, 30 Sep 2009 13:59:10 PDT

Pelvic congestion syndrome occurs when the ovarian veins are incompetent; it is a common cause of chronic pelvic pain, which often goes undiagnosed and is also a cause of lower extremity varicose veins. Through the review of pelvic venous anatomy, the complexity of pelvic congestion syndrome and the relationships that create this chain reaction of symptoms can be diagnosed, and a holistic course of treatment can be applied.

Right Subclavian Artery Aneurysm: An Incidental Finding

Riley, J. T. — Wed, 30 Sep 2009 13:59:10 PDT

Subclavian artery aneurysms are rarely seen in the clinical setting, representing 1% of all peripheral artery aneurysms. The cause of a subclavian artery aneurysm is variable, and the symptoms are sometimes vague. Although other nonsonography imaging modalities are more likely to incidentally diagnose a subclavian artery aneurysm, sonographers must be aware of a subclavian artery aneurysm as a possible incidental finding to help prevent a potential fatal rupture.

Cholangiocarcinoma

Whitlock, P. J. — Wed, 30 Sep 2009 13:59:10 PDT

Cholangiocarcinoma is a rare, primary cancer of the biliary tree that can be difficult to diagnose with all imaging modalities. The presenting clinical symptoms of nausea, vomiting, and jaundice can be consistent with classic cholecystitis symptoms, increasing the risk of a missed diagnosis. The most often seen risk factor for cholangiocarcinoma is primary sclerosing cholangitis (PSC). In most cases, the initial diagnostic finding is intrahepatic ductal dilatation. Once an actual mass is seen, liver transplantation is the necessary treatment plan because of likely hepatic metastasis. There is a slight recurrence rate of cholangiocarcinoma even in a transplanted liver. A high percentage of cases are treated with only palliative care. This case presents a classic example of cholangiocarcinoma at the porta hepatis, involving a hyperechoic mass in a dilated common bile duct with abnormalities of the intrahepatic bile ducts and gallbladder.

Arrhythmogenic Right Ventricular Cardiomyopathy

Stoughton, S. J. — Wed, 30 Sep 2009 13:59:10 PDT

Arrhythmogenic right ventricular cardiomyopathy (ARVC) is an inherited cardiac muscle disorder. Damaged myocardium is replaced by scar tissue and fat. ARVC was discovered in the late 1970s on postmortem examinations of young athletes who had died suddenly. This disease has since been observed to affect the left ventricle as well.

Sonographic Diagnosis of Caudal Regression Syndrome

Diawara, F., Camara, M., Thera, M., Diallo, M., Traore, M. — Wed, 30 Sep 2009 13:59:10 PDT

Caudal regression syndrome is a partial or complete agenesis of the lumbosacral vertebrae. Other abnormalities may be associated, such as polyhydramnios, single umbilical artery, club feet, and renal, gastrointestinal, and genitourinary defects. This report of caudal regression syndrome is about a woman in her mid-20s who was first seen for a routine obstetrical sonogram in her second trimester. Her last menstrual period was unknown. She had no history of diabetes, and her glycemia was normal. Sonographic examination showed a 27-week singleton fetus with polyhydramnios, club feet, multicystic kidneys, sudden termination of the spine at the sacral level, short femurs, a single umbilical artery, and a cystic umbilical cord with excessive Wharton’s jelly. These findings confirmed the diagnosis of caudal regression syndrome. After counseling, the patient elected for termination of the pregnancy and delivered a female fetus with an imperforate anus at 800 grams in weight. Anteroposterior and lateral radiographs of the fetus confirmed the sacral agenesis.

Fetus in Fetu

Ghazle, H., Dolbow, K. — Wed, 30 Sep 2009 13:59:10 PDT

Fetus in fetu is a congenital abnormality in which a nonviable, parasitic fetus grows within its twin. It is a rare cause of retroperitoneal abdominal mass in infants and children. The authors report a recent case of a six-month-old girl who presented with unexplained abdominal distention. A sonogram and a magnetic resonance imaging examination showed a multiloculated, complex cystic mass with calcified and soft tissue components. A definitive diagnosis and discrimination from a teratoma was difficult to make because of the absence of a distinctive criterion, the presence of a vertebral column. Pathologic examination showed a complex mass consisting of well-formed bowel and upper respiratory tract segments as well as mature neuroglial tissue, skeletal muscle tissue fibers, and bone tissue that contained bone marrow, supporting the diagnosis of fetus in fetu. Therefore, the nonvisualization of a vertebral column on imaging should not exclude fetus in fetu from the differential diagnosis.

Electronic Systems for Student Clinical Records

Baker, A. L., Dubose, T. J. — Wed, 30 Sep 2009 13:59:10 PDT

Proper documentation of a student’s clinical education is a critical component of a diagnostic medical sonography program’s administrative functions. Traditional paper documents have been used for decades to record and verify a student’s clinical training. However, these paper records can rapidly become a paperwork nightmare, especially for large sonographic programs spread over a broad geographical area. This article examines the reasons for keeping accurate clinical records, discusses paper clinical records systems, and reviews some of the new electronic systems for student clinical records that are now emerging in the allied health professions.

Letter to the Editor

Baun, J. — Wed, 30 Sep 2009 13:59:10 PDT