RESUMO
OBJECTIVE: To evaluate the technical feasibility and utility of ultrasonography in the study of diaphragmatic motion at our institution. METHODS: The study consisted of 2 parts. For part I, in 23 volunteers we performed 23 studies on 46 hemidiaphragms with excursions documented on M-mode ultrasonography For part II, in 22 patients we performed 52 studies in 102 hemidiaphragms. In 50 studies both hemidiaphragms were studied, and in another 2 studies only 1 hemidiaphragm was studied. Patients' ages ranged from birth to 66 years (mean, 23 years). There were 16 male and 6 female patients. Indications for the study were (1) suggestion of paralysis of the diaphragm (n = 22); (2) if the diaphragm was already known to be paralyzed, for evaluation of response to phrenic nerve or pacer stimulation (n = 9); and (3) follow-up of previous findings (n = 21). Patients were examined in the supine position in the longitudinal semicoronal plane from a subcostal or low intercostal approach. Motion was documented with real-time ultrasonography and measured with M-mode ultrasonography. RESULTS: Of the 102 clinical hemidiaphragms studied, findings included normal motion (n = 42), decreased motion (n = 22), no motion (n = 6), paradoxical motion (n = 10), positive pacer response (n = 13), negative pacer response (n = 2), positive phrenic stimulation (n = 6), and negative phrenic stimulation (n = 1). There were no failures of visualization. CONCLUSIONS: Ultrasonography proved feasible and useful in evaluating diaphragmatic motion. In our practice it has replaced fluoroscopy. Ultrasonography has advantages over traditional fluoroscopy, including portability, lack of ionizing radiation, visualization of structures of the thoracic bases and upper abdomen, and the ability to quantify diaphragmatic motion.
Assuntos
Diafragma/diagnóstico por imagem , Diafragma/fisiologia , Adolescente , Adulto , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , UltrassonografiaRESUMO
The purpose of this study was to determine the sensitivity of emergency ultrasound (US) for the detection of blunt splenic injury (BSI), and to describe sonographic parenchymal patterns. Over 3 years, 2138 emergency US were performed, and 162 patients had BSI. CT was performed for 76 patients, and there were 86 laparotomies. Seventy patients (43%) had concomitant intraabdominal injuries. Ultrasound detected free fluid in 109 patients (67%), and parenchymal injury in 31 patients (19%). There were 48 false negative US (30%). Sonographic patterns included a diffuse heterogeneous appearance, hyperechoic and hypoechoic perisplenic crescents, and discrete hypoechoic or hyperechoic areas within the spleen. Overall sensitivity of US for detection of BSI was 69%, but was 86% for grade III or higher injuries. Ultrasound is most sensitive for the detection of grade III or higher BSI based on the presence of haemoperitoneum. Ultrasound may also identify BSI on the basis of parenchymal abnormality, with a diffuse heterogeneous pattern most commonly encountered. Sonographic evaluation for both free fluid and parenchymal injury improves sensitivity of US.
Assuntos
Baço/lesões , Ferimentos não Penetrantes/diagnóstico por imagem , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Emergências , Feminino , Humanos , Lactente , Escala de Gravidade do Ferimento , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Estudos Retrospectivos , Sensibilidade e Especificidade , Baço/diagnóstico por imagem , Tomografia Computadorizada por Raios X , UltrassonografiaAssuntos
Malformações Arteriovenosas/diagnóstico por imagem , Pelve/irrigação sanguínea , Ultrassonografia Doppler em Cores , Diagnóstico Diferencial , Feminino , Humanos , Pelve/diagnóstico por imagem , Sensibilidade e Especificidade , Doenças Uterinas/diagnóstico por imagem , Útero/irrigação sanguínea , Útero/diagnóstico por imagem , Vagina/irrigação sanguínea , Vagina/diagnóstico por imagem , Doenças Vaginais/diagnóstico por imagemRESUMO
The goals of this study were to evaluate the feasibility of using ultrasonography of the spine in the follow-up evaluation of patients with repaired myelomeningocele at birth and to compare sonography with the accepted modality of magnetic resonance imaging. Over a period of 4 years we performed 165 sonographic studies in 101 patients; 107 sonographic studies had MR imaging results for comparison. We collected our data prospectively. The quality of the sonograms was good in 110 of 129 studies, acceptable in 17 of 129, and poor in two of 129. The sonographic examinations failed in 33 of 165 studies (20%). Concordant information was obtained between ultrasonography and magnetic resonance imaging in the following percentage of studies: level of the distal end of the cord in 82%, position of the cord in the canal in 59%, presence of hydromyelia in 63%, cord duplication in 96%, adhesions in 16%, intradural mass in 37%, cord measurements in 85%, and dural sac measurements in 83%. At the lumbosacral level, we saw no cord pulsation in 57% of the studies in patients with cord adhesions and in 20% of those without adhesions. At the lower thoracic level, we saw no pulsation in 35% of the studies in patients with cord adhesions and in 7% of those without adhesions. Postoperative studies of cord release surgery in eight patients showed varied findings. We conclude that in those patients who have a spinal defect or interlaminar space allowing proper visualization of the lumbosacral spinal canal, ultrasound can provide fairly similar information to that obtained with magnetic resonance imaging of that area with no need for sedation and at a reduced cost. Ultrasonography seems more sensitive than magnetic resonance imaging in the detection of cord adhesions, which is particularly relevant in the diagnosis of tethering.
Assuntos
Imageamento por Ressonância Magnética , Meningomielocele/cirurgia , Coluna Vertebral/diagnóstico por imagem , Adolescente , Adulto , Criança , Pré-Escolar , Dura-Máter/diagnóstico por imagem , Dura-Máter/patologia , Estudos de Viabilidade , Seguimentos , Humanos , Lactente , Vértebras Lombares , Meningomielocele/diagnóstico por imagem , Meningomielocele/patologia , Estudos Prospectivos , Sacro , Canal Medular/diagnóstico por imagem , Canal Medular/patologia , Medula Espinal/anormalidades , Medula Espinal/diagnóstico por imagem , Medula Espinal/patologia , Doenças da Medula Espinal/diagnóstico , Doenças da Medula Espinal/diagnóstico por imagem , Doenças da Medula Espinal/cirurgia , Coluna Vertebral/patologia , Siringomielia/diagnóstico , Siringomielia/diagnóstico por imagem , Aderências Teciduais/diagnóstico , Aderências Teciduais/diagnóstico por imagem , Aderências Teciduais/cirurgia , UltrassonografiaRESUMO
The purpose of this study was to assess the use of emergent ultrasonographic examination in acute traumatic renal injuries. Over a 3 year period, prospective data of all patients who had an emergency ultrasonogram were recorded. Thirty-two patients with 37 renal injuries were studied retrospectively to identify in how many patients the sonogram detected free fluid or a renal parenchymal abnormality. Free fluid in the abdomen was identified in 19 of 32 patients (59%). However, 12 of these 19 patients had concomitant injury, such as splenic rupture requiring splenectomy, severe liver lacerations, or bowel lacerations requiring repair, that were possible causes of the free fluid. Eliminating these patients, only seven of 20 patients with isolated renal injuries had free fluid in the abdomen (35%), whereas 13 of 20 patients (65%) had no evidence of free fluid. All seven patients with free fluid had moderate or severe renal injuries. Renal parenchymal abnormalities were identified on ultrasonograms in eight of 37 (22%) of injured kidneys. The abnormalities were detected more commonly in cases of severe injury (60%). In conclusion, acute injuries of the kidney from blunt abdominal trauma often are associated with significant splenic, hepatic, or bowel trauma. Isolated renal injuries frequently occur without the presence of free fluid in the abdomen. Furthermore, the ultrasonogram of the kidney often is normal with acute renal injuries, but it is more likely to be abnormal with severe (grade II or greater) renal injuries. Sonography may be used in the triage of patients with blunt abdominal trauma and possible renal injury. However, a negative ultrasonogram does not exclude renal injury, and, depending on clinical and laboratory findings, other imaging procedures such as computed tomography should be performed.
Assuntos
Traumatismos Abdominais/diagnóstico por imagem , Rim/diagnóstico por imagem , Rim/lesões , Ferimentos não Penetrantes/diagnóstico por imagem , Traumatismos Abdominais/cirurgia , Doença Aguda , Adolescente , Adulto , Criança , Pré-Escolar , Diagnóstico Diferencial , Feminino , Humanos , Rim/cirurgia , Masculino , Pessoa de Meia-Idade , Nefrectomia , Estudos Retrospectivos , Sucção , Tomografia Computadorizada por Raios X , Índices de Gravidade do Trauma , Ultrassonografia , Ferimentos não Penetrantes/cirurgiaRESUMO
The purpose of this report is to provide an illustrative case of spontaneous hepatic and renal hematomas that occurred during a pregnancy complicated by preeclampsia and the HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome. The sonographic and computed tomographic findings included intrahepatic, subcapsular hepatic, and extracapsular perihepatic hematomas in addition to a large subcapsular renal hematoma. Since hepatic and renal hematomas that occur in association with preeclampsia and the HELLP syndrome are rare but potentially life-threatening complications, prompt laboratory and radiologic evaluations are essential and may reduce the associated morbidity and mortality.
Assuntos
Síndrome HELLP/diagnóstico por imagem , Hematoma/diagnóstico por imagem , Nefropatias/diagnóstico por imagem , Hepatopatias/diagnóstico por imagem , Pré-Eclâmpsia/diagnóstico por imagem , Adulto , Coagulação Intravascular Disseminada/diagnóstico por imagem , Coagulação Intravascular Disseminada/etiologia , Feminino , Síndrome HELLP/complicações , Hematoma/etiologia , Humanos , Rim/diagnóstico por imagem , Nefropatias/etiologia , Fígado/diagnóstico por imagem , Hepatopatias/etiologia , Pré-Eclâmpsia/complicações , Gravidez , Tomografia Computadorizada por Raios X , UltrassonografiaRESUMO
Ischemic colitis is a clinicopathologic condition that commonly occurs in elderly patients with atherosclerotic disease or diabetes mellitus. Uncommon etiologies include vasculitis and use of drugs such as oral contraceptives, phenobarbital, nasal decongestants, dextroamphetamine, and cocaine. Recent studies have shown sonography and CT to be helpful in the evaluation of the colitides. We report the sonographic and CT findings in an unusual case of methamphetamine-induced ischemic colitis. Sonography and CT revealed diffuse thickening of the large bowel wall. Methamphetamine abuse should be considered in the differential diagnosis of the colitides, particularly in the setting of a young patient with a history of drug use and no other predisposing conditions.
Assuntos
Estimulantes do Sistema Nervoso Central/efeitos adversos , Colite Isquêmica/induzido quimicamente , Colite Isquêmica/diagnóstico por imagem , Metanfetamina/efeitos adversos , Transtornos Relacionados ao Uso de Substâncias/diagnóstico por imagem , Abdome Agudo/diagnóstico , Abdome Agudo/etiologia , Abdome Agudo/cirurgia , Adulto , Colectomia , Colite Isquêmica/cirurgia , Diagnóstico Diferencial , Seguimentos , Humanos , Masculino , Transtornos Relacionados ao Uso de Substâncias/etiologia , Transtornos Relacionados ao Uso de Substâncias/cirurgia , Tomografia Computadorizada por Raios X , UltrassonografiaRESUMO
Patients with right lower quadrant (RLQ) pain referred for imaging studies with a clinical diagnosis of appendicitis may have other pathologic conditions mimicking appendicitis. Appropriate diagnostic imaging may establish other specific diagnoses and thereby play a significant role in determining proper medical or surgical treatment. In this pictorial essay, we present a spectrum of imaging findings in patients whose clinical features were suggestive of appendicitis, but the diagnoses of a broad spectrum of other diseases were established with the imaging studies. The differential diagnoses of diseases mimicking appendicitis are reviewed.
Assuntos
Dor Abdominal/diagnóstico , Apendicite/diagnóstico , Diagnóstico por Imagem , Dor Abdominal/cirurgia , Apendicite/cirurgia , Doenças do Ceco/diagnóstico , Neoplasias do Ceco/diagnóstico , Colecistite/diagnóstico , Diagnóstico Diferencial , Feminino , Humanos , Nefropatias/diagnóstico , Doenças Ovarianas/diagnóstico , Planejamento de Assistência ao Paciente , Úlcera Péptica Perfurada/diagnóstico , Cálculos Ureterais/diagnósticoRESUMO
Developmental dysplasia of the hip (DDH) has a broad spectrum of presentation with the minor findings resolving spontaneously and the most severe ones resulting in disability, if not diagnosed early in life. Diagnosis in the first few months of life allows conservative treatment with complete resolution in most cases. Suspicion of DDH is based on ethnic, family, and pregnancy history, and on physical examination of the newborn. Imaging assists in the diagnosis and follows the treatment. Different modalities have their own advantages and disadvantages. This article deals with ultrasonography.
Assuntos
Luxação Congênita de Quadril/diagnóstico por imagem , Humanos , Lactente , Recém-Nascido , UltrassonografiaRESUMO
Developmental dysplasia of the hip (DDH) has a broad spectrum of presentation with the minor findings resolving spontaneously and the most severe ones resulting in disability, if not diagnosed early in life. Diagnosis in the first few months of life allows conservative treatment with complete resolution in most cases. Suspicion of DDH is based on ethnic, family, and pregnancy history, and on physical examination of the newborn. Imaging assists in the diagnosis and follows the treatment. Different modalities have their own advantages and disadvantages. This article deals with the description of the disease, risk factors, statistics, the physical examination as applied to real-time sonography, and imaging (plain radiography, arthrography, computed tomography, and magnetic resonance imaging.
Assuntos
Luxação Congênita de Quadril/diagnóstico , Luxação Congênita de Quadril/diagnóstico por imagem , Luxação Congênita de Quadril/terapia , Articulação do Quadril/diagnóstico por imagem , Articulação do Quadril/patologia , Humanos , Lactente , Imageamento por Ressonância Magnética , Ossos Pélvicos/diagnóstico por imagem , Exame Físico , Tomografia Computadorizada por Raios XRESUMO
GAN tumors are rare and their diagnosis and distinction from other gastrointestinal stromal tumors is based on electron microscopy findings. Although no specific distinctive diagnostic imaging features are seen, this diagnosis should be considered when a large solid mass adjacent to a bowel loop shows the presence of air.
Assuntos
Doenças do Sistema Nervoso Autônomo/diagnóstico por imagem , Neoplasias Duodenais/diagnóstico por imagem , Neoplasias do Sistema Nervoso Periférico/diagnóstico por imagem , Doenças do Sistema Nervoso Autônomo/epidemiologia , Doenças do Sistema Nervoso Autônomo/patologia , Carcinoma de Células Renais/diagnóstico por imagem , Neoplasias Duodenais/epidemiologia , Neoplasias Duodenais/patologia , Feminino , Humanos , Neoplasias Renais/diagnóstico por imagem , Pessoa de Meia-Idade , Neoplasias Primárias Múltiplas/diagnóstico por imagem , Neoplasias do Sistema Nervoso Periférico/epidemiologia , Neoplasias do Sistema Nervoso Periférico/patologia , Tomografia Computadorizada por Raios XRESUMO
RATIONALE AND OBJECTIVES: A radiologist often wishes to measure organ volume or monitor changes in internal lesion volume during treatment. If this can be determined via three-dimensional ultrasound, the relative simplicity of the procedure and the decreased cost and known risks to the patient would make this method an attractive alternative to other modalities. METHODS: Three-dimensional ultrasound scans were made of six phantoms: four nonechogenic spheres, one echogenic sphere, and one echogenic, irregularly shaped phantom. A total of 22 volume scans were produced. Volume estimations were made using data from cross-sectional areas and from linear measurements. In all, 193 volume estimations were made. These results were compared with known volumes and with volume estimates from computed tomography scans. RESULTS: Three-dimensional ultrasound detected size differences of 10% with 95% certainty. CONCLUSIONS: The accuracy and precision of volume estimates via three-dimensional ultrasound is at least as good as those obtained via conventional ultrasound.
Assuntos
Ultrassonografia/métodos , Humanos , Processamento de Imagem Assistida por Computador , Imagens de Fantasmas , Tomografia Computadorizada por Raios X , Ultrassonografia/instrumentação , Ultrassonografia/estatística & dados numéricosAssuntos
Doenças Ovarianas/diagnóstico por imagem , Complicações na Gravidez/diagnóstico por imagem , Adolescente , Adulto , Feminino , Humanos , Laparoscopia , Doenças Ovarianas/cirurgia , Ovariectomia , Gravidez , Complicações na Gravidez/cirurgia , Anormalidade Torcional , Ultrassonografia DopplerAssuntos
Colecistografia , Vesícula Biliar/anormalidades , Vesícula Biliar/patologia , Cirrose Hepática Alcoólica/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Idoso , Atrofia , Diagnóstico Diferencial , Feminino , Humanos , Hipertrofia , Fígado/diagnóstico por imagem , Cirrose Hepática Alcoólica/patologiaRESUMO
Catheter placement and follow-up, including patency check, usually is required in patients with serious conditions, who often cannot be brought to the Radiology Department for the procedure. In a series of 24 consecutive patients, we show the usefulness of color Doppler ultrasonography with its advantages of portable equipment, lack of ionizing radiation, improved catheter visualization, and ability to determine patency.
Assuntos
Cateteres de Demora , Drenagem/instrumentação , Nefrostomia Percutânea/instrumentação , Ultrassonografia/métodos , Adulto , Cateterismo , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , UltrassomRESUMO
This article reviews the available literature on the surgical options for the correction of kyphosis in ankylosing spondylitis and presents the radiologic appearance of the post-operative spine. In the postsurgical evaluation of the spine, the focus is on appreciation of the patterns of correction, early and late determination of angular correction, recognition of various complications (infection, nonunion, improper location, or breakage of hardware), and alertness to the possibility of complications at all levels of the spine.
Assuntos
Cifose/complicações , Cifose/cirurgia , Espondilite Anquilosante/complicações , Adulto , Parafusos Ósseos , Humanos , Cifose/diagnóstico por imagem , Vértebras Lombares/cirurgia , Masculino , Pessoa de Meia-Idade , Osteotomia , Radiografia , Espondilite Anquilosante/diagnóstico por imagem , Vértebras Torácicas/cirurgiaRESUMO
Most lesions of the clavicle are traumatic and pose few diagnostic difficulties. Nontraumatic clavicular lesions, on the other hand, are rare and frequently present problems in diagnosis. This report reviews the clinical, radiologic, and bacteriologic findings in ten patients, six of whom were diagnosed as having acute osteomyelitis and four chronic osteomyelitis. The differential diagnosis of clavicular osteomyelitis is also discussed. The clinical duration of the infectious process in these patients ranged from 2 weeks to 1.5 years. All patients presented with pain; six had fever, three had localized swelling or a mass, and three had soft tissue abscesses. The radiographic findings also varied: the lesion was predominantly sclerotic in four patients, lytic in three, and mixed in two patients; in the one patient in whom magnetic resonance imaging was the only imaging study performed, these features could not be properly evaluated. Periosteal reaction was detected in three patients. Staphylococcus aureus was the causal organism in four patients, while in the remaining six patients different microorganisms were cultured, including Coccidiodes immitis and Mycobacterium tuberculosis. Six patients required biopsy for final diagnosis. Although clavicular osteomyelitis is rare, particularly in adults, it should be considered in the differential diagnosis of a clavicular lesion. The final diagnosis often depends on the results of biopsy and cultures.