Journal of Diagnostic Medical Sonography recent issues

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

Sonographic Imaging of the Fetal Hard Palate During the Second-Trimester Pregnancy Scan: Setting the Standard for 3D Sonography in a Training Program

Tonni, G., Ventura, A., Centini, G., Rosignoli, L. — Fri, 17 Jul 2009 12:36:02 PDT

Cleft lip and cleft palate are among the more common congenital abnormalities, representing the fourth most common birth defect in the United States, with an incidence of 1 in 700 live births. The study of fetal secondary palate has reached new potential due to new 3D applications— namely, tomographic sonography imaging and volume contrast imaging (VCI). The aim of this review is to describe the 3D sonographic setting for a systematic study of the fetal secondary palate during second-trimester pregnancy. Sonographers can easily achieve appropriate training in 3D scanning of the fetal face under expert tutoring. The sonographic study of the fetal secondary palate should become an integral part of the second-trimester scan. Technically, the axial and coronal sections are those that better display the 3D reconstruction, especially when the fetus is facing the transducer (profile section). The use of static VCI may enhance tomographic sonography imaging of the fetal secondary palate and should therefore be integrated in this target examination.

Confusion of Peripheral Arterial Doppler Waveform Terminology

Scissons, R., Comerota, A. — Fri, 17 Jul 2009 12:36:02 PDT

Characterization of peripheral arterial waveforms is basic to the diagnosis of vascular disease. Surveys indicate inconsistent application of traditional waveform descriptors. This study reviews literature to identify areas of confusion. Publications were reviewed to determine whether triphasic, biphasic, and monophasic terms were defined; if biphasic was linked with diastolic flow reversal; whether pandiastolic flow was associated with biphasic or monophasic terminology; and whether waveform illustrations had a zero baseline. Ninety-four publications were reviewed. Triphasic and monophasic were defined in 81%, biphasic in 48%. Biphasic was classified with flow reversal in 38%. Pandiastolic flow was not addressed in 57% but associated with monophasic in 47% and biphasic in 5%. Twenty-one percent of the publications had an illustration without a zero-flow baseline. This review suggests a lack of consensus when classifying arterial blood flow with traditional waveform descriptors. Waveform characterization inconsistencies are undermining comprehension of Doppler principles and may lead to inappropriate testing. A multisocietal consensus panel should accept responsibility for resolving this issue.

JDMS CME Article-SDMS CME Credit

Fri, 17 Jul 2009 12:36:02 PDT

The Use of En Bloc Infant Kidneys for Adult Kidney Transplants

Digiacinto, D., Mayes, C., Bagley, J. — Fri, 17 Jul 2009 12:36:02 PDT

The increasing need for cadaveric kidneys has caused the criteria for acceptable donor kidneys to include younger and older donors. Researchers have been studying the use of infant kidneys as a source for adult transplant. When used as a pair, infant kidneys transplanted into an adult have been found to filter an adult volume of blood. Sonographers will be asked to evaluate this type of transplant. Understanding the specific features of the transplant will aid in that process.

Acoustic Radiation Force Impulse Imaging: A Literature Review

Iyo, A. Y. — Fri, 17 Jul 2009 12:36:02 PDT

Acoustic radiation force impulse (ARFI) imaging uses high-energy, focused acoustic pulses and conventional diagnostic sonography methods to measure tissue elasticity. Using a modified sonography transducer, a series of high-intensity pushing beams and low PRF tracking beams is transmitted, measuring the magnitude of tissue displacement in response to the applied force. The response to this force can determine the tissue's state of health. Currently, magnetic resonance imaging, computed tomography, and B-mode sonography are considered gold standards for soft tissue imaging. This article presents how ARFI compares to B-mode sonography and reviews the current literature.

Imaging Features of Thyroid Involvement by Langerhans Cell Histiocytosis

Junewick, J. J., Braunreiter, C., Fulton, B., Olsen, A. — Fri, 17 Jul 2009 12:36:02 PDT

A 2-year-old male presented with fever, rash, right upper quadrant pain, and hyperbilirubinemia and was diagnosed with Langerhans cell histiocytosis (LCH). Periportal, hepatic, pulmonary, thymic, and thyroid involvement was noted on initial imaging. Thyroid gland involvement by LCH is rare. This case illustrates computed tomography, ultrasonography, and magnetic resonance imaging features of LCH of the thyroid.

Posttraumatic Pseudoaneurysm of the Temporal Artery

McDowell, J. A. — Fri, 17 Jul 2009 12:36:02 PDT

This is a case presentation of a pediatric patient with severe head trauma resulting from a motor vehicle accident. The patient had been hospitalized for approximately two weeks prior to a request to review a pulsatile mass that had developed after trauma with sonography. Sonographic imaging showed an enlarged vessel with mixed echos throughout. The diagnosis by sonography with duplex confirmed the pulsatile lesion to be a pseudoaneurysm of the temporal artery with mural thrombus.

The Importance of Sonography in the Evaluation of Neonatal Adrenal Hemorrhage

Valdespino, R.-S. — Fri, 17 Jul 2009 12:36:02 PDT

Neonatal adrenal hemorrhage is a relatively common condition of the newborn. Etiologies of neonatal adrenal hemorrhage include maternal/ fetal stress, birth trauma, congenital syphilis, dehydration, anoxia, or other systemic disorders. Clinical presentation ranges from asymptomatic to anemia, hypotension, vomiting, jaundice/hyperbilirubinemia, scrotal discoloration, hyponatremia, and palpable abdominal mass. Adrenal hemorrhage sonographically appears as an abdominal mass with displacement of the kidney inferiorly, known as mass effect. Differentiation of adrenal hemorrhage from more serious pathologies such as adrenal carcinoma, neuroblastoma, or pheochromocytoma is critical. Bluish discoloration of the scrotum may also occur due to extravasation of blood from the hemorrhage, leading to an incorrect diagnosis of testicular torsion or acute scrotum. Proper sonographic evaluation conservatively avoids unnecessary surgical exploration. Power Doppler imaging, color Doppler imaging, and serial gray-scale sonography can document the characteristics and progression of the condition for accurate diagnosis. Sonography is a preferred noninvasive screening modality for evaluating abdominal masses within the pediatric population because of its sensitivity, avoidance of radiation and sedation, and potential value for avoiding exploratory surgery.

Congenital Abdominal Aortic Aneurysm and Hypertrophic Pyloric Stenosis in an Infant

Callahan, J., Drolshagen, L., Cole, A., Duncan, N. — Fri, 17 Jul 2009 12:36:02 PDT

Infantile abdominal aortic aneurysms are rare, usually detected incidentally, and associated with connective tissue disease or due to iatrogenic causes. The diagnosis should be considered when a large cystic mass (especially pulsatile) is found in a neonate and confirmed using color and duplex sonography. Undiagnosed aneurysms have a high mortality rate. Surgical treatment is warranted when the patient is stabilized and may result in a normal outcome, although future graft replacement may be necessary.

Quantitative Ultrasonography of Calcaneal Bone Mass and Its Relationship to Calcium Consumption Among Impoverished Hispanic Women

Evans, K. D., Scott, J. M., Taylor, C. A., Geraghty, M. E., Ashcraft, C. D. — Mon, 01 Jun 2009 16:18:44 PDT

Perimenopausal Hispanic women need to be able to build and sustain peak bone mass, but this may be affected by their low socioeconomic status. This feasibility research study provided descriptive information on the relationship between calcium consumption and bone mass measured with sonography at the calcaneus. Little research exists to examine bone health with this specific age or ethnic group of women. This research found a strong positive correlation between the amount of self-reported calcium food consumed and the bone stiffness index recorded using quantitative sonography. The translational impact of this project will inform the development of culturally relevant patient education for Hispanic women of low socioeconomic status to encourage the development of peak bone mass.

JDMS CME Article-SDMS CME Credit

Mon, 01 Jun 2009 16:18:44 PDT

Accuracy and Cost Comparison of Ultrasound Versus Alternative Imaging Modalities, Including CT, MR, PET, and Angiography

Bierig, S. M., Jones, A. — Mon, 01 Jun 2009 16:18:44 PDT

Ultrasound (US) has become widely used in clinical medicine for the diagnosis of a variety of disease processes. The unique ability of US to provide accurate information through an efficacious, painless, portable, and nonionizing method has expanded its role and application in diverse medical settings. Given the current economic environment and the related interest in creating the greatest value for health care expenditures, US has been evaluated to compare its clinical accuracy/efficacy and cost-effectiveness versus other imaging modalities. The following literature review reports the results of research studies aimed at comparing the accuracy/efficacy and cost of US versus alternative imaging modalities, including magnetic resonance imaging, computed tomography, contrast angiography, and single-photon emission computed tomography.

Understanding the Advanced Signal Processing Technique of Real-Time Adaptive Filters

Ahman, H., Thompson, L., Swarbrick, A., Woodward, J. — Mon, 01 Jun 2009 16:18:44 PDT

Diagnostic ultrasound manufacturers are advancing the technology of sonographic systems, providing superior image quality and improving the diagnostic confidence for both sonographers and radiologists. Real-time adaptive filters (RTAFs) are perhaps the least known among the advanced signal processing techniques available on most modern sonography machines, which is further complicated by the fact that RTAF appears under various trademark names. Despite the different proprietary names, RTAFs generally employ a postprocessing mathematical algorithm to real-time imaging that improves contrast resolution by reducing noise and artifacts while simultaneously enhancing the edges and smoothing the tissue texture of structures. This technique may be applied across a wide variety of clinical examinations and may not yet be completely understood and appreciated by sonographers. This review aims to educate readers on how RTAFs work, supported by examples of their benefit to image quality. In particular, the authors describe the effectiveness of using RTAF for superficial structures (thyroid, abdominal wall), deep structures (abdomen, pelvis), and dynamic examinations, including musculoskeletal and vascular applications.

JDMS CME Article-SDMS CME Credit

Mon, 01 Jun 2009 16:18:44 PDT

Optimal Use of 3D and 4D Transvaginal Sonography in Localizing the Essure(R) Contraceptive Device

Mon, 01 Jun 2009 16:18:44 PDT

Current protocol in the United States does not include sonographic imaging for assessing proper placement of the Essure^® microinsert coils. An alternative to the current requirement of hysterosalpingography for imaging the metallic coils is described using 3D and 4D multiplanar imaging. Studies showing the advantages of using optimal sonographic techniques over other imaging modalities are shown to be less invasive, simpler, and with fewer risks. A review of 3D and 4D sonography reveals advantages in imaging the Essure microdevices.This article explores optimum techniques for localizing the Essure microdevices with 3D and 4D transvaginal sonography.

Congenital Cystic Adenomatoid Malformation: A Brief Review With Images

Moore, L., Handy, R. — Mon, 01 Jun 2009 16:18:44 PDT

Congenital cystic adenomatoid malformation (CCAM) is a rare lung lesion that may be diagnosed antenatally by ultrasonography. It is believed to result from an arrest in lung development. The differential diagnosis of a mass in the fetal thorax includes CCAM, congenital diaphragmatic hernia, and pulmonary sequestration. This brief review discusses classifications of CCAM with images of each type, sonographic findings, factors that affect the prognosis, and important aspects of management once the diagnosis is made.

Confusion and Direction in Diagnostic Doppler Sonography

DuBose, T. J., Baker, A. L. — Mon, 01 Jun 2009 16:18:44 PDT

Spectral and color sonographic Doppler information has become critical to medical imaging and diagnosis. However, there are no standards for the display of the Doppler frequency-shifted sonographic directional information. The display of the spectral and Doppler directional information is arbitrary and under operator control. The authors discuss the current situation of the Doppler directional displays and the problems that may be caused by this confusion.

Uterine Artery Doppler and Its Value in Predicting Preeclampsia

Digiacinto, D., Graves, M. — Thu, 02 Apr 2009 14:42:45 PDT

Prematurity is the leading cause of fetal morbidity and mortality. One of the most common reasons for women to have preterm delivery is due to a condition called preeclampsia. Early detection of preeclampsia is key to providing the best obstetric care and lessening the chance of maternal or fetal demise. The problem has been finding accurate ways to detect or predict women who will develop preeclampsia so that they can be closely monitored before the actual symptoms occur. Uterine artery Doppler has been shown to predict pregnancy complications such as preeclampsia. Investigators have shown that many women who develop preeclampsia have abnormal Doppler waveforms. Alone, uterine artery Doppler shows promise but is more accurate when combined with maternal factors such as maternal health history and first-trimester pregnancy-associated plasma protein—A values.

JDMS CME Article-SDMS CME Credit

Thu, 02 Apr 2009 14:42:45 PDT

The Feasibility of Using an HCU System for Investigating Ergonomic Injury Among Autoworkers

Evans, K. D., Sommerich, C. — Thu, 02 Apr 2009 14:42:45 PDT

A preexperimental case study was conducted to determine the feasibility of imaging musculoskeletal changes in the anatomy of the elbow, which might be attributed to the use of a tool, commonly blamed for ergonomic injury among autoworkers. The aim of the feasibility study was to determine if a hand-carried ultrasound (HCU) system could be used to document any physiologic changes. An HCU system with a 12-MHz linear probe was taken portably to image a patient's elbow before and after use of the tool. Increased vascular flow within the muscle tissue was noted, but no changes to the musculature were noted with sonography 1, 12, and 24 hours after prolonged use. The preexperimentally designed case study provided evidence that it was possible to document the elbow and forearm anatomy before and after tool use. Higher level evidence is needed on the ability to use an HCU system to detect musculoskeletal injury at the job site. The portability and high-resolution imaging provided by the specific HCU system used have potential for this innovative clinical application.

What Does Government Regulation Really Mean?

Wilson, M., Wilson, A. — Thu, 02 Apr 2009 14:42:45 PDT

The terminology used to describe healthcare's regulatory environment can be daunting and often confusing. Idioms such as accreditation, certification, registration, and licensure are often erroneously interchanged and used in the wrong context. While standardized language within individual states is an important first step, standardization would be even more effective if it were incorporated in every state for the regulation and licensure of all health professions. The lack of uniformity in language between different healthcare professions limits effective professional practice and mobility, as well as adding confusion to legislators, professionals, and the public. This article will define and analyze the close nexus between the terminology used in regulating the healthcare field and how these terms specifically apply to the profession of sonography.

An Incidentally Discovered Quadricuspid Aortic Valve: Echocardiographic and Clinical Characteristics

Chen, M. A., Mcree, D. — Thu, 02 Apr 2009 14:42:45 PDT

In this case study, 2D and 3D transesophageal echocardiogram images revealed a quadricuspid aortic valve in a patient undergoing an evaluation for an infection. Quadricuspid aortic valves are rare and frequently associated with other anomalies (most frequently coronary anomalies). They are often discovered incidentally but may become clinically apparent because of valvular dysfunction (most commonly valvular regurgitation). The incidence and clinical aspects of congential quadricuspid aortic valves are reviewed briefly.

Marfan's Syndrome (MFS): Rare Association With Aneurysm of Feeding Artery to Intralobar Pulmonary Sequestration

Pedrick, R., Robichaud, P., Benson, J. — Thu, 02 Apr 2009 14:42:46 PDT

Sonographic screening of patients with Marfan syndrome (MFS) with echocardiograms and abdominal aortic sonography has become the standard of care to monitor aneurysm and/or dissection development. These anomalies are the leading cause of morbidity and mortality related to this syndrome. Other cardiovascular changes associated with MFS include mitral valve prolapse leading to severe mitral regurgitation and dilation of the aortic root at the sinus of Valsalva. Careful interval follow-up using modern sonographic equipment ensures that any significant vascular changes will be detected. This case documents a finding of an aberrant aneurysmal artery branching off the abdominal aorta discovered during annual follow-up screening of a patient with Marfan syndrome. This aneurysmal artery was subsequently found by computed tomographic angiography to be supplying an intralobar lung sequestration.

Sonographic Evaluation of Neuroblastoma

Perry, C. L. — Thu, 02 Apr 2009 14:42:46 PDT

Neuroblastoma is a malignancy arising from the sympathetic nervous system that accounts for approximately 7% of childhood cancers. Most occur between the ages of 2 months and 2 years. The majority arises in the adrenal medulla but may also occur in the neck, chest, or pelvis. Diagnostic medical sonography is a significant imaging tool that involves no radiation exposure for detecting neuroblastoma. Further imaging studies are needed so that the stage and spread of the disease can be determined. Factors including age, MYCN (v-myc myelocytomatosis viral-related oncogene) amplification, and stage are used to determine treatment and prognosis of a child with neuroblastoma. This case demonstrates the sonographic findings of an 8-month-old child with stage IV neuroblastoma.

Hypertrophic Tuberculosis of the Uterine Cervix

Ech-Cherif el Kettani, N., Dafiri, R. — Thu, 02 Apr 2009 14:42:46 PDT

Tuberculosis of the uterine cervix is extremely rare. An awareness of sonographic findings is necessary when evaluating for cervical lesions because it can mimic other masses, especially cervical cancer. This is a case of hypertrophic tuberculosis of the uterine cervix presented with chronic leucorrhea. Initial diagnosis was made by endovaginal sonography and confirmed after biopsy.

Congenital Mesoblastic Nephroma: Prenatal Diagnosis by Sonography

Celik, H., Kefeli, M., Tosun, M., Cetinkaya, M. B., Alper, T., Yildiz, L. — Thu, 02 Apr 2009 14:42:46 PDT

Congenital mesoblastic nephroma is a rare renal tumor of early infancy with a favorable outcome after complete surgical removal. It consists of a heterogeneous group of spindle cell tumors. Early and accurate prenatal diagnosis of the renal tumor may improve the outcome of affected pregnancies by implementing the best strategy for prenatal management and delivery. But detection of congenital mesoblastic nephroma in a fetus is rare. To the authors' knowledge, there are fewer than 30 reports of a prenatal diagnosis of a mesoblastic nephroma in the literature. This case describes the prenatal sonographic diagnosis of cellular congenital mesoblastic nephroma.

Bioprosthetic Aortic Valve Infective Endocarditis

Duarte Rodriguez, J. — Thu, 02 Apr 2009 14:42:46 PDT

Infective endocarditis of the aortic valve usually presents with vegetations attached to the ventricular surface of the valve. Vegetations can be large, pedunculated, and freely mobile, making the risk of embolization high. The author reports a case of bioprosthetic aortic valve endocarditis caused by the rare organism Cardiobacterium hominis with an atypical presentation of the vegetation on the aortic surface.

HSPnet: A Canadian National Student Placement System . . . and More

Chouinard, N. T. — Thu, 02 Apr 2009 14:42:46 PDT