Duplex Doppler examination in renal disease: evaluation of vascular involvement.

Evaluation of renal disease and transplant rejection has been limited to excretory urography, nuclear isotope flow studies and other more invasive procedures. The B-scan ultrasound findings are often nonspecific. The development of duplex pulsed Doppler sonography has permitted evaluation of both arterial and venous flow. Duplex ultrasound studies in patients with a suspected diminution in renal function demonstrated the ability to delineate normal and abnormal flow, limiting the differential diagnosis, and in some cases actually documented an abnormality before gross pathologic changes became evident.

Ultrasonography of the normal fetal brain.

Since the early 1960s it has been possible to identify the fetal head using A-mode ultrasound. The introduction of high-resolution, real-time, gray-scale ultrasound in the mid-to-late 1970s first enabled the routine display of subtle internal anatomy. Using presently available equipment, the fetus can be imaged from 7 weeks after the last menstrual period until term and the internal anatomy of the fetal head can be detected after 11-12 weeks. The ultrasonic anatomy of the normal fetal head throughout the second and third trimesters is discussed, as are the normal changes taking place with growth.

Intraoperative ultrasound examination of the brain: possible pitfalls in diagnosis and biopsy guidance.

The use of ultrasound during surgical procedures is frequently beneficial for both demonstration and diagnosis of various pathologic conditions. In the neurosurgical suite, localization of subcortical brain tumors is easily accomplished with real-time imaging. The depth and size of the tumor are easily assessed, and the relationship of the lesion to adjacent normal structures ascertained. However, there are pitfalls that may result in diagnostic inaccuracies during the evaluation of abnormalities. These include artifacts, use of inappropriate equipment, and poor technique. These problems are illustrated and discussed.

Mesenteric chylous (lymph-containing) cyst.

Mesenteric cysts are uncommon entities and chyle (lymph)-containing cysts are the rarest of this group. A case report of a chylous cyst with CT demonstrating unique fat and soft tissue fluid-fluid levels is presented.

Diagnostic capabilities of high-resolution scrotal ultrasonography: prospective evaluation.

The use of scrotal ultrasonography has been advanced with the development of high-resolution real-time equipment. A group of 284 consecutive patients referred for scrotal examination was studied ultrasonically and followed over a three-year period. Abnormal scrotal contents were accurately detected in 98.5 per cent of cases. Separation of testicular from extratesticular pathology was 99 per cent accurate. While all malignant testicular lesions could be identified, there were examples which could not be differentiated from benign lesions prior to surgical exploration and biopsy. However, there are many examples where the ultrasound results can change clinical management of the patient.

Noninvasive diagnosis and follow-up of childhood renal vein thrombosis by ultrasound, Doppler, and renal scintiscan.

Childhood renal vein thrombosis (RVT) usually occurs in infants less than one year of age, and in recent years, more RVTs are diagnosed with the help of various diagnostic imaging modalities. RVT produces immediate physiologic, anatomic, and functional changes within the involved kidney or kidneys and these changes can be detected readily and noninvasively by Doppler ultrasound, ultrasound scan, and renal scintiscans. Childhood RVTs are associated with substantial morbidity, and the earlier the diagnosis and treatment, the better the prognosis. The most important factor in the diagnosis of childhood RVT is a high clinical index of suspicion. With a high degree of clinical suspicion, one can make the specific diagnosis of RVT using the noninvasive methods. Such methods can also be used for follow-up of patients with RVTs.

Postasphyxial encephalopathy in term infants. Sonographic demonstration of increased echogenicity of the thalamus and basal ganglia.

Sonographic abnormalities secondary to postasphyxial encephalopathy in neonates are reviewed. This report emphasizes an additional finding, increased echogenicity of the thalamus and basal ganglia, demonstrated in four term infants. This abnormal finding is generally noted in the second week following asphyxia. In some cases, the increased thalamic echogenicity may be a temporary finding. A representative case is described and possible pathologic correlates are discussed.

Real-time neurosonography of the brain through calvarial defects with computed tomographic correlation.

Although real-time sonography is an excellent imaging modality for the neonatal brain, examination of the adult brain has been limited. Attempts to study the older subject through the ossified calvarium have resulted in poor quality and non-diagnostic images. Eighteen patients with various calvarial defects were examined for a variety of intracranial abnormalities. A mechanical sector scanner was used. Disease was clearly defined and accurate correlation with computed tomography resulted. Subjects without intracranial disease and patients with cerebral atrophy, porencephalic cysts, hydrocephalus, hematomas, and neoplasia were included in this study. The midline structures, ventricles and proximal midbrain structures were clearly visualized. This procedure appears useful to evaluate changes in the size of the ventricles and intracerebral masses in the postoperative patient.

Polyorchidism diagnosed preoperatively by ultrasonography.

Polyorchidism, or multiple testes, is a rare condition that has been referred to in both medical literature and mythological folklore. Curious attributes have been ascribed to men with this condition, including supposed increased sexual prowess and virility. In the medical literature, the examples of supernumerary testicles have demonstrated only one additional testis. The first proven case of an extra testicle was by Lane, in 1895. Boggon reviewed 11 additional cases in 1933, and numerous other cases have been reported since then. To date, there has not been a preoperative ultrasonographic study that adequately describes this phenomenon.

The spectrum of sonographic findings in hemorrhagic ovarian cysts.

The sonograms of 76 hemorrhagic ovarian cysts were reviewed to ascertain the full spectrum of sonographic findings. All cases were proved either by surgery or by documented resolution on sonography and/or clinical follow-up. The overwhelming majority (92%) had increased sound through-transmission, signifying the basic cystic nature of the lesion. The sonographic patterns were variable. The most common appearance was that of a heterogeneous mass (83%), almost half of which were predominantly anechoic with hypoechoic material. The other cases (17%) were completely homogeneous, either hypo- or hyperechoic. No masses were completely anechoic. Additional sonographic features included a thick rim, septations, and associated cul-de-sac fluid. A rounded hyperechoic mass, representing blood clot, was contained within 13 masses. In addition, some women appeared to have an increased tendency to form ovarian cysts, suggested by the fact that 26% of them had a past, concurrent, or future episode of simple or hemorrhagic ovarian cysts. Because hemorrhagic ovarian cysts have variable sonographic findings, they should be included in the differential diagnosis of any adnexal mass that has good sound through-transmission.

Sonography of diffuse benign liver disease: accuracy of pattern recognition and grading.

Sonograms of 110 patients were compared to recently performed liver biopsies for evaluation of the accuracy of sonography in predicting the type (pattern) of pathology and its grade of severity (mild, moderate, or severe) in a wide variety of diffuse liver processes. There are two distinct, abnormal sonographic patterns: the fatty-fibrotic pattern seen primarily with cirrhosis, chronic hepatitis, and/or fatty infiltration, and the centrilobular pattern seen primarily with acute hepatitis. Sonography was 88% accurate in assigning the correct pattern to the corresponding pathology (sensitivity 89%, specificity 86%, p less than 0.001). The degree of accuracy was dependent on the grade of pathologic severity, with mild disease offering the greatest difficulty; moderate and severe diseases were accurately detected and placed in the correct pattern in all cases. Sonographic grading of the severity of disease was far less precise (63% overall). This study showed that sonography can distinguish between two abnormal sonographic patterns of diffuse benign liver disease as well as between normal and abnormal patterns.

Ultrasonographic findings in placenta increta.

Placenta increta, invasion of the myometrium by normal placental (chorionic) villi, can be life-threatening to a mother at delivery. In two reported cases of pathologically proven placenta increta, the abnormal areas were retrospectively identified on ultrasonographic images. In both cases, there was consistent focal obliteration of the hypoechoic retroplacental zone by either tissue of echogenicity similar to that of the normal placenta or tissue of slightly decreased echogenicity. This was found to represent extension of the villi through the decidua basalis into the myometrium. The spectrum of non-malignant invasive placentas and the specific ultrasonographic findings that should allow prospective diagnosis are discussed.

Neonatal colonic atresia: ultrasound findings.

High resolution real-time ultrasound examination of the abdomen was performed in a neonate with abdominal distention. Dilated distal small bowel and a complex mass in the course of the ascending colon were noted. Ultrasound correctly suggested the diagnosis of mid-colonic atresia with a patent ascending colon twelve hours prior to the radiographic demonstration of gas in the obstructed right colon. The sonogram was also able to accurately exclude the presence of ascites or a renal or hepatic mass as the cause for abdominal distention.

The role of diagnostic ultrasonography in varicocele evaluation.

Twenty-one patients with the clinical diagnosis of varicocele were evaluated with static and superficial organ scanners. The sonogram was able to image the dilated scrotal veins in all of these cases. The small, clinically subtle varicocele could be demonstrated only with high-resolution, dedicated real-time small-parts scanners, whereas larger lesions could also be imaged with B-mode contact equipment. Varicoceles are a well-documented cause of male infertility amenable to surgical treatment. From this study it is felt that ultrasonography can accurately detect varicoceles. It can be used as a screening procedure so that only those men requiring therapy need undergo more extensive and complicated diagnostic procedures.

Real-time ultrasonography of the spinal cord: intraoperative and postoperative imaging.

Fourteen subjects with spinal cord pathology were studied with 10 MHz linear array or 5 MHz mechanical sector ultrasound scanners. Twelve patients were studied intraoperatively. The examinations were rapid, aiding the surgeon at the time of exploration. Sonography defined cysts, outlined the extent of neoplasia and aided in the localization of bone fragments. Guidance for placement of syringo -subarachnoid shunts reduced the amount of surgical manipulation. Four patients were examined postoperatively through laminectomy defects, three confirming adequate position and function of shunts and in one case demonstrating tumor recurrence.

Outpatient therapy of intra-abdominal abscesses following early discharge from the hospital.

Although percutaneous aspiration and drainage of abdominal abscesses will frequently avert an open surgical procedure, patients remain hospitalized during drainage. The authors treated 9 patients for abscesses using percutaneous drainage catheters and sent them home with the catheter in place. All had an uneventful recovery. An average of $12,050 was saved in each case. The authors suggest that outpatient drainage of abdominal abscesses is significantly less expensive than inpatient treatment, yet does not jeopardize patient care.

In utero analysis of heterozygous achondroplasia: variable time of onset as detected by femur length measurements.

Seven cases of heterozygous achondroplasia were examined in utero. Although the head shape and growth were normal, the initially normal femur length showed a decrease in growth and fell below the lower 99 per cent confidence limit in all cases. The time of presentation of achondroplasia varied between 21 and 27 gestational weeks. This study suggests that the diagnosis of achondroplasia can be reasonably made when the femur is abnormally short. When the femoral length is appropriate prior to 30 weeks, more caution should be taken in interpretation. Because of the variability in presentation, the fetus could be normal or still could be affected.

Ventricular configuration and cerebral growth in infants born to drug-dependent mothers.

Cranial ultrasound examinations were performed during the first 3 days of life and at age 1 month on 22 infants with the neonatal abstinence syndrome. The results were compared to those obtained in 15 control infants who were not exposed to narcotic drugs in utero. The ultrasound images were examined for ventricular configuration, intracranial hemidiameters, area of thalami, and width of temporal lobes. At 24 to 72 h and at 1 month of age, significantly more drug-exposed than control infants had a slit-like ventricular configuration. The intracranial hemidiameter was significantly smaller in the drug-exposed than in the control infants. All cerebral measurements except the right temporal lobe demonstrated significant growth over the first month of life in both groups of infants. By means of ancillary examinations (computerized tomography and transfontanel pressure measurements) the pathogenesis of the slit-like ventricles was found not to be related to edema or to increased intracranial pressure. Whether or not the ventricles remain small and brain growth remains parallel after the period of abstinence awaits further investigation.

The Kimray-Greenfield filter: evaluation by duplex real-time/pulsed Doppler ultrasound.

The Kimray-Greenfield filter is a wire cage which is inserted into the inferior vena cava (IVC) to prevent thrombi originating in pelvic and leg veins from embolizing to the lungs. Duplex real-time/pulsed Doppler ultrasound was used to evaluate placement and function in 38 patients (46 examinations). Real-time examination successfully identified the IVC and filter in 89% of cases. Pulsed Doppler studies demonstrated flow above and below the filter in 76%, accurately predicting normal flow in most cases. In 4 patients, Doppler scans revealed little or no flow distal to the filter; contrast cavograms confirmed obstruction secondary to thrombosis. This appears to be an accurate, noninvasive method of assessing postoperative reliability of the Kimray-Greenfield filter.