Renal calcification incidence in very low birth weight infants.

Serial ultrasound examinations were performed on 31 neonates with birth weights of less than 1,500 g for the detection of renal calcifications. Renal calcifications occurred in 20 (64%) of the infants at a mean age of 39.3 +/- 26.7 days of life. Infants with renal calcifications had shorter gestations (28.2 +/- 1.8 v 31 +/- 1.4 weeks, P less than .004) and lighter birth weights (924 +/- 195 v 1,338 +/- 100 g, P less than .004) than those infants without renal calcifications (n = 11). Furosemide administration was more common in the infants with renal calcifications (65% v 9.1%, P less than .001). The mean total dose of furosemide administered before renal calcifications were noted was 9.59 +/- 7.25 mg/kg. The 20 neonates with renal calcifications had a mean urine calcium level of 12.0 +/- 6.8 mg/kg/24 hours, mean urine calcium to creatinine ratio of 1.32 +/- 1.03 (range 0.3 to 4.45), and a mean alkaline phosphatase concentration of 961 +/- 327 IU. Initial parathyroid hormone levels were not different between the two groups, and subsequent determinations in infants with renal calcifications did not differ significantly from initial values. Renal calcifications are fairly common among very low birth weight infants, particularly in those receiving supplemental calcium and furosemide therapy. Although long-term implications of such findings are not known, close monitoring of renal function by serial determinations of urine calcium and urine calcium to creatinine ratios may identify those infants at risk for renal calcifications.

Ultrasonic evaluation of hepatic and splenic trauma.

Blunt abdominal trauma comprises a major portion of surgical emergencies. These patients require imaging modalities that are rapid and accurate. In two patients with upper abdominal trauma, gray scale ultrasound was successfully used both for initial diagnosis and for monitoring the postoperative course.

Ultrasound with graded compression in the evaluation of acute appendicitis.

Acute appendicitis is the most common diagnosis made (in the Western world) in patients with an "acute abdomen." Although the mortality rate has been vastly reduced, the diagnostic inaccuracy rate of 15% to 20% has remained unchanged in the past 100 years. In this article, the authors report the ultrasonographic findings in 80 patients examined using a small linear-array transducer, which enables direct visualization of the inflamed appendix. During 22 months, 80 patients (28 males and 52 females; age range, 3 to 81 years; mean, 32.3 years) with equivocal clinical signs and symptoms of acute appendicitis were examined sonographically. Of the 29 patients whose appendicitis was verified at surgery, ultrasonography was positive in 26, with an overall sensitivity of 90%. Of the 51 patients who did not have appendicitis, ultrasonography was negative in all, with a specificity of 100%. The authors concur with reports in the literature that ultrasonography is helpful in diagnosing appendicitis.

Carotid blood-flow velocity changes detected by Doppler ultrasound in determination of brain death in children. A preliminary report.

To investigate the value of Doppler ultrasonography of the carotid arteries as a diagnostic test for the determination of brain death in children, we enrolled 17 patients in a blinded fashion in the pediatric intensive care unit of Memorial Miller Children's Hospital of Long Beach between the period of December 1990 and October 1992. After institutional review board approval and parental consent, children who sustained severe brain injury underwent Doppler ultrasonography study of their carotid arteries. Seven of 17 patients were diagnosed as having brain death by clinical criteria (complete loss of cerebral and brainstem functions) and electroencephalogram (EEG). Five of seven (71%) patients with the diagnosis of brain death had bilateral reverse flow (characteristic of increased cerebrovascular resistance and absent cerebral circulation) on their Doppler ultrasonography, yielding a specificity of 100% and sensitivity of 71.4% (P = 0.01). All surviving patients (five) and the five who did not fulfill the brain-death criteria at the time of Doppler ultrasonography and were later taken off life supportive measures had normal Doppler findings. These data indicate that Doppler ultrasonography of the carotid arteries is a very specific test and can be used as an adjunctive modality for determination of brain death in children.

Ultrasound examination of the sigmoid colon: possible new diagnostic tool for irritable bowel syndrome.

OBJECTIVE: Irritable bowel syndrome (IBS) affects about 10% of the population, and is primarily a disease of women. It may cause chronic pelvic pain. As yet there is no imaging test to aid in diagnosis, which relies upon history. We aimed to determine whether transvaginal sonographic investigation of the sigmoid colon could aid in the diagnosis of IBS. METHOD: Transvaginal ultrasound was used in 175 female patients undergoing pelvic ultrasound studies for a variety of reasons, none specifically for bowel complaints. We measured the wall of the sigmoid colon and then obtained the history of positive or negative for IBS. RESULTS: The majority of those 27 reporting a history of IBS had thickening of the wall of the sigmoid colon. A cut-off of 3.0 mm gave a sensitivity for this group of patients of 70%, specificity of 95%, positive predictive value of 73% and negative predictive value of 95%. CONCLUSION: Transvaginal ultrasound may be useful in identifying patients at risk for IBS. Consideration of colon wall measurement during pelvic ultrasound should be studied, as IBS may be a cause of chronic pelvic pain.

Fetal response to sound stimulation: preliminary report exploring use of sound stimulation in routine obstetrical ultrasound examinations.

An artificial larynx was used to sound-stimulate 693 human fetuses with gestational age ranging from 21 to 42 weeks. Fetuses were monitored, with simultaneous ultrasound, for immediate, increased motor activity after the stimulus. Each was scored as either demonstrating for startle response or having no visible response to the stimulus. Four zones of gestational development were determined: nonstartle zone (gestation age below 24 weeks), in which none reacted; transitional zone A (24 to 27 weeks), in which 30% reacted, transitional zone B (27 to 30 weeks), in which 86% reacted; and startle zone (above 31 weeks), in which 96% reacted. A review of the 17 patients not responding to sound in the startle zone, revealed a wide spectrum of complications of pregnancy in eight, including sepsis, meconium aspiration, short umbilical cord, abruption of the placenta, bradycardia, and death, while nine were without recorded abnormalities. Sound stimulation designed to elicit a startle response on ultrasound may have some potential benefit in identifying fetuses at risk or needing closer physiologic evaluation. Adding sound stimulation to the routine ultrasound study may warrant further study.

Sonographic imaging of the glycogen stage of the fetal choroid plexus.

At 8-22 weeks gestation, the lateral ventricular choroid plexus swells with glycogen deposits, which are thought to be an important source of anaerobic energy for a relatively hypovascular stage of brain development. Sonographic images during this phase demonstrate enlarged and echogenic ventricles, accounting for up to 80%-90% of the cerebral axial dimension in the earliest gestations studied. This increased echogenicity may be due to these glycogen stores. Because a rapid but sonographically definable decrease in the relative size of these structures occurs, routine imaging for the presence and character of the choroid plexus might prove to be a useful parameter in fetal examination.

In utero appearance of idiopathic infantile arterial calcification: ultrasound study of a 28-week fetus.

An ultrasound study of a 28-week gestation demonstrated changes of poor cardiac function associated with calcifications of the wall of major arteries. Sudden in utero deterioration into hydrops prompted the delivery of a female infant who was diagnosed at autopsy of having a rare disease entity, idiopathic infantile arterial calcification. When a hydropic fetus is defined by ultrasound, this rare diagnosis should be included in the diagnostic considerations. Recent reports suggest successful therapy regimens for an otherwise fatal disease, making accurate diagnosis especially important.

The ultrasonically enhanced abdominal examination.

Ultrasound is a unique diagnostic imaging tool that enhances the physical examination of the abdomen, without the hazards of radiation. The physician can instantly visualize palpated masses or areas of tenderness during ultrasound examination, and immediate correlation of tissue texture and clinical findings is possible. This combined approach aids in identifying inflammatory, neoplastic and degenerative pathology, as well as normal anatomic variations mimicking disease.

The acardiac twin: a case report using color Doppler ultrasonography.

The use of color Doppler sonography has expanded our understanding of the normal and abnormal pregnancy. A case is presented here in which color Doppler imaging was utilized to confirm a long-held theory concerning the strikingly abnormal dynamics of arterial flow to an acardiac twin and observations are also presented concerning the possible route of venous return contrary to presumed theories established within the literature.

Acute focal bacterial nephritis (acute lobar nephronia).

Acute lobar nephronia (ALN) refers to a renal mass caused by acute focal infection without liquefaction. The radiological findings in 12 patients with 13 episodes of ALN are described. A characteristic combination of uroradiological findings is (a) a relatively sonolucent mass which disrupts corticomedullary definition on ultrasonography; (b) a solid-appearing mass on other uroradiological studies; and (c) a positive gallium image in the region of the mass, which may be associated with increased activity elsewhere in the same or opposite kidney. The angiographic finding of significant venous narrowing within the mass associated with only minor arteriographic abnormalities is characteristic of ALN as well.

Anatomy and pathology of the kidney by gray scale ultrasound.

Gray scale ultrasound can define intrarenal structures which could not previously be visualized. The normal calyces and infundibula within the renal sinus can be evaluated for abnormalities. Parenchymal anatomy (cortex, medulla, and arcuate vessels) of the right kidney is best demonstrated with the patient supine, using the liver as a window; anatomy of the left kidney is best appreciated using coronal scans in the right lateral decubitus position. Criteria and differential diagnosis of "Type I" parenchymal changes, in which the echo intensity within the cortex is increased, and "Type II" changes, in which there is a focal or diffuse disruption of normal renal parenchymal anatomy, are presented.

Surgical and pathologic correlation of cholecystosonography and cholecystography.

To define the accuracy of varying ultrasonic patterns in the diagnosis of gallstones, the records of 145 patients with ultrasound examination of the gallbladder prior to cholecystectomy were reviewed. Three abnormal scan categories were established: category 1--shadowing opacities that move with gravity within the gallbladder lumen; category 2--nonvisualization of the gallbladder lumen; and category 3--nonshadowing opacities within the gallbladder lumen. The accuracy of these criteria for gallstone diagnosis was found to be 100%, 96%, and 61%, respectively. Overall accuracy was 96% for gallbladder disease, with a 4% false negative rate. Oral cholecystography demonstrated an accuracy of 93% in this series. A preoperative ultrasound diagnosis of gallstones should probably be limited to category 1 and 2 appearances only.