Blind-ending branch of a bifid ureter: multidetector CT imaging findings.

A bifid ureter with a blind-ending branch is a rare congenital anomaly. Although typically found incidentally, this anomaly can be symptomatic and radiologists should be aware of this important variant. To our knowledge, there has been no previous report of this anomaly as seen on multidetector CT urography. We present a patient with haematuria and review the clinical significance, radiological findings and embryological aetiology of this anomaly.

Three-dimensional ultrasonographic imaging of the neonatal brain in high-risk neonates: preliminary study.

The aim of this investigation was to compare the utility of three-dimensional ultrasonography versus two-dimensional ultrasonography in imaging the neonatal brain. Thirty patients in the neonatal intensive care unit underwent two-dimensional and three-dimensional ultrasonography. The resultant two- and three-dimensional images recorded on film and three-dimensional volumes (reviewed on a workstation) were evaluated independently. Comparable numbers of normal and abnormal studies were diagnosed by each modality. Axial images were considered useful in approximately 50% of three-dimensional cases. Image quality, overall and in the far-field, was rated higher on two-dimensional images. Three-dimensional sonographic acquisition time in the neonatal intensive care unit (1.7 min+/-0.7 standard deviation) was significantly shorter than that for two-dimensional sonography (9.0+/-4.5 min). The total time for evaluation on the three-dimensional workstation (4.4+/-1.1 min) was significantly less than that for two-dimensional images on film (10.6+/-4.7 min). In conclusion, three-dimensional ultrasonography is a promising, diagnostically accurate, and efficient imaging tool for evaluation of the neonatal brain; however, visualization must improve before it can replace two-dimensional ultrasonography.

Digital tapping of the superficial temporal artery: significance in carotid duplex sonography.

To determine whether tapping on the superficial temporal artery correctly identifies the ECA during carotid sonography, prospective evaluation of the reflection of the temporal tap on the spectral waveform was recorded and graded as 3+, 2+, 1+, or 0 in each ECA, ICA, and CCA, with 3+ being the most brisk response in each carotid system (ipsilateral CCA, ICA, and ECA). The pattern of response was evaluated in patients with and without hemodynamically significant (> than 50% diameter) stenoses in CCA, ICA, and ECA. The most frequent pattern of response to tapping on the superficial temporal artery was 3+ in the ECA, 2+ in the CCA, and 1+ or 0 in the ICA. This pattern was found in 41% (82/200) of systems overall. Whether or not stenoses were present in any branch of the extracranial carotid system, the strongest response (3+) was found in the ECA (58/200 [87%] with stenosis; 119/200 [89%] without stenosis, and lesser responses in the other arteries: 2+ in the CCA 31/200 [46%] with stenosis; 63/200 [47%] without stenosis, and 1+ or 0 in the ICA 58/200 [87%] with stenosis and 103/200 [77%] without stenosis). This pattern was unaltered by the degree of stenosis in the ECA or in the ICA. In 92.5% of the systems interrogated, the response was greater in the ECA than in the ICA. Tapping on the superficial temporal artery may be used as a reliable method of identifying the ipsilateral ECA even in instances of significant atherosclerotic disease in the ECA, CCA, or ICA.

Duplex sonography of the carotid arteries in patients with isolated aortic stenosis: imaging findings and relation to severity of stenosis.

OBJECTIVE: The purposes of this study were to identify carotid artery duplex waveform abnormalities in patients with isolated aortic stenosis and to determine whether waveform abnormalities correlate with the severity of valvular disease. MATERIALS AND METHODS: Twenty-four patients with various degrees of aortic stenosis diagnosed by echocardiography and/or cardiac catheterization had preoperative carotid artery duplex sonograms that were retrospectively reviewed for acceleration time, peak velocity, waveform contour, upstroke delay, and presence of a dicrotic notch and a second systolic peak. Data were collected for the right and left internal, external, and common carotid arteries separately. These findings were correlated with aortic valve area and compared with data for a control group of 11 age-matched patients with normal echocardiographic findings. Two additional patients with isolated aortic stenosis diagnosed by echocardiography and/or cardiac catheterization were prospectively evaluated in a similar fashion, with acceleration time being calculated directly from the sonography unit. RESULTS: Unlike the patients with mild or moderate stenosis, the patients with critical or severe stenosis had a mean acceleration time that was significantly longer than that in the control subjects (p = .008-.0001). Peak velocities were decreased in all cases of aortic stenosis regardless of severity only in the common carotid arteries. All 13 patients with critical aortic stenosis had delayed upstrokes and rounded waveforms in the common, internal, and external carotid arteries. Twenty percent (one of five) of the patients with severe stenosis and 17% (one of six) of the patients with moderate or mild stenosis also had these characteristics. The two prospectively evaluated patients, who had critical and severe aortic stenoses, had similar findings. None of the control subjects showed these abnormalities. The presence or absence of a second systolic peak or a dicrotic notch was not different between patients with aortic stenosis and control subjects. CONCLUSION: Increased acceleration time, decreased peak velocity, delayed upstroke, and rounded waveform are characteristic abnormalities found in duplex sonographic studies of the carotid arteries in patients with aortic stenosis. The degree of each of these abnormalities correlates with the valve area. Patients with critical or severe aortic stenosis had findings significantly different from those in the control group. Patients with mild or moderate disease showed few or no sonographic abnormalities.

Breast implants: incidental findings on CT.

The mammographic, sonographic, and MR appearances of both normal and abnormal breast implants have been described. Breast implants are occasionally seen on chest CT scans obtained for other reasons; however, we know of no published reports on the CT findings in a series of patients with breast implants. We present a retrospective review of CT findings in 18 patients with 27 breast implants that illustrates the spectrum of findings that can be seen in asymptomatic patients.