Transthoracic Echocardiography: Beginner's Guide with Emphasis on Blind Spots as Identified with CT and MRI.

Transthoracic echocardiography (TTE) is the primary initial imaging modality in cardiac imaging. Advantages include portability, safety, availability, and ability to assess the morphology and physiology of the heart in a noninvasive manner. Because of this, many patients who undergo advanced imaging with CT or MRI will have undergone prior TTE, particularly when cardiac CT angiography or cardiac MRI is performed. In the modern era, the increasing interconnectivity of picture archiving and communication systems (PACS) has made these images more available for comparison. Therefore, radiologists who interpret chest imaging studies should have a basic understanding of TTE, including its strengths and limitations, to make accurate comparisons and assist in rendering a diagnosis or avoiding a misdiagnosis. The authors present the standard TTE views along with multiplanar reformatted CT images for correlation. This is followed by examples of limitations of TTE, focusing on potential blind spots, which have been placed in seven categories on the basis of the structures involved: (a) pericardium (thickening, calcification, effusions, cysts, masses), (b) aorta (dissection, intramural hematoma, penetrating atherosclerotic ulcer), (c) left ventricular apex (infarcts, aneurysms, thrombus, apical hypertrophic cardiomyopathy), (d) cardiac valves (complications of native and prosthetic valves), (e) left atrial appendage (thrombus), (f) coronary arteries (origins, calcifications, fistulas, aneurysms), and (g) extracardiac structures (primary and metastatic masses). Online supplemental material and the slide presentation from the RSNA Annual Meeting are available for this article . ©RSNA, 2021.

A Dynamic Threshold Approach for Tarnished Plant Bug (Hemiptera: Miridae) Management in the Midsouthern U.S. Cotton.

One of the most economically important pests of cotton, Gossypium hirsutum L., in the midsouth region of the United States is the tarnished plant bug, Lygus lineolaris (Palisot de Beauvois, Hemiptera: Miridae). Tarnished plant bug populations across the region have exhibited widespread resistance to numerous insecticide classes. To minimize late season resistance development, reducing unwarranted applications during the late flowering period can aid in resistance management and potentially reduce input costs. Trials were conducted during 2019 and 2020 to evaluate the impacts of tarnished plant bug populations in the later flowering period of cotton by modifying or terminating threshold regimes during the later weeks of bloom. Results showed that dynamic thresholds altered at the fourth week of bloom or later can reduce the number of late season applications made with no penalty to yield. Additionally, when utilizing a week of bloom termination approach, no significant yield losses were seen when terminating applications after the fourth week of bloom. These data may offer an alternative method to managing tarnished plant bug populations during the later flowering period of midsouth cotton.

Pediatric SARS-CoV-2 Seroprevalence in Arkansas Over the First Year of the COVID-19 Pandemic.

BACKGROUND: Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) seroprevalence studies largely focus on adults, but little is known about spread in children. We determined SARS-CoV-2 seroprevalence in children and adolescents from Arkansas over the first year of the coronavirus disease of 2019 (COVID-19) pandemic. METHODS: We tested remnant serum samples from children ages 1-18 years who visited Arkansas hospitals or clinics for non-COVID-19-related reasons from April 2020 through April 2021 for SARS-CoV-2 antibodies. We used univariable and multivariable regression models to determine the association between seropositivity and participant characteristics. RESULTS: Among 2357 participants, seroprevalence rose from 7.9% in April/May 2020 (95% CI, 4.9-10.9) to 25.0% in April 2021 (95% CI, 21.5-28.5). Hispanic and black children had a higher association with antibody positivity than non-Hispanic and white children, respectively, in multiple sampling periods. CONCLUSIONS: By spring 2021, most children in Arkansas were not infected with SARS-CoV-2. With the emergence of SARS-CoV-2 variants, recognition of long-term effects of COVID-19, and the lack of an authorized pediatric SARS-CoV-2 vaccine at the time, these results highlight the importance of including children in SARS-CoV-2 public health, clinical care, and research strategies.

Temporal Variations in Seroprevalence of Severe Acute Respiratory Syndrome Coronavirus 2 Infections by Race and Ethnicity in Arkansas.

Background: The aim of this study was to estimate severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection rates in the small rural state of Arkansas, using SARS-CoV-2 antibody prevalence as an indicator of infection. Methods: We collected residual serum samples from adult outpatients seen at hospitals or clinics in Arkansas for non-coronavirus disease 2019 (COVID-19)-related reasons. A total of 5804 samples were identified over 3 time periods: 15 August-5 September 2020 (time period 1), 12 September-24 October 2020 (time period 2), and 7 November-19 December 2020 (time period 3). Results: The age-, sex-, race-, and ethnicity-standardized SARS-CoV-2 seroprevalence during each period, from 2.6% in time period 1 to 4.1% in time period 2 and 7.4% in time period 3. No statistically significant difference in seroprevalence was found based on age, sex, or residence (urban vs rural). However, we found higher seroprevalence rates in each time period for Hispanics (17.6%, 20.6%, and 23.4%, respectively) and non-Hispanic Blacks (4.8%, 5.4%, and 8.9%, respectively) relative to non-Hispanic Whites (1.1%, 2.6%, and 5.5%, respectively). Conclusions: Our data imply that the number of Arkansas residents infected with SARS-CoV-2 rose steadily from 2.6% in August to 7.4% in December 2020. There was no statistical difference in seroprevalence between rural and urban locales. Hispanics and Blacks had higher rates of SARS-CoV-2 antibodies than Whites, indicating that SARS-CoV-2 spread disproportionately in racial and ethnic minorities during the first year of the COVID-19 pandemic.

Successful thrombectomy and thrombolysis of deep vein thrombosis in a patient with acute phlegmasia cerulea dolens with May-Thurner anatomy.

Phlegmasia cerulea dolens (PCD) is a rare and important diagnosis to consider in the setting of a painful, swollen, and cyanotic lower extremity. We report a 59-year-old female diagnosed with PCD 3 days status post extended head and neck surgery with additional imaging findings concerning for May-Thurner anatomy. This case presentation is pathognomonic for PCD. Risk factors, pathogenesis, and management are described.

Nested stromal epithelial tumor of the liver: A multidisciplinary approach to the treatment of an extremely rare malignancy.

Nested stromal epithelial tumor (NSET) of the liver is an extremely rare and unusual liver neoplasm with limited evidence of best practice for management. We report a 28-year-old male with NSET managed with primary partial hepatectomy with subsequent disease recurrence with follow-up metastectomy and successful radiofrequency ablation (RFA). Management of NSET of the liver requires a multidisciplinary approach. RFA proves beneficial in a patient with disease recurrence following tumor resection. In order to validate the regular use of RFA, more long term studies would be required.

Radiation-induced osteosarcoma following treatment of Ewing's sarcoma.

Radiation-induced sarcomas are a known, rare, complication from prior therapeutic radiation therapy. Radiation-induced sarcomas have been reported to have poor associated prognoses with increased morbidity and mortality when compared to primary sarcomas. In this case report, we discuss a 27-year-old female who presented at the age of 17 during pregnancy with an inability to bear weight and was subsequently diagnosed with Ewing's sarcoma of her femur. Adequate response to treatment was obtained with the initial treatment and the patient represented with acute, severe pain of her femur at the site of prior Ewing's. Extensive workup demonstrated radiation-induced osteosarcoma at the site of her prior Ewing's sarcoma in the radiation field. Multidisciplinary teams including orthopedics, pathology, medical oncology, and radiology are vital for appropriate and efficacious diagnosis of radiation-induced sarcomas. Despite the rarity of radiation-induced sarcoma, the ability to recognize and diagnose recurrent sarcoma is important for radiologists, particularly considering the associated poor prognosis. Early diagnosis and aggressive multidisciplinary treatment is crucial to improving patient morbidity and mortality. In this case, the diagnosis of radiation-induced osteosarcoma allowed expedited workup and initial aggressive, lifesaving treatment for our patient.