Evaluation by ultrasound of traumatic rib fractures missed by radiography.

Rib fractures are the most common (25%) injuries resulting from blunt chest trauma, and are usually revealed on radiographs. Radiography sometimes cannot show fractures, especially those in costal cartilages, except for densely calcified ones. Several authors have recently investigated the role of ultrasound in the detection of rib fractures. We conducted this study to investigate possible rib fractures with ultrasound, determine those overlooked on chest x-ray, and analyze the possible clinical predictors of these insidious rib fractures in minor or mild blunt chest trauma. A total of 20 patients with minor mild blunt chest trauma were enrolled into this study. All radiographs were reviewed by two radiologists who noted rib fractures or other complications. Ultrasonography was performed in the radiology department using a linear transducer by one radiologist. The costal cartilage normally appears relatively hypoechoic compared with the osseous rib. Fractures of the rib, costochondral junction, and costal cartilage were denoted by a clear disruption of the anterior echogenic margin. A total of 20 patients with normal radiological findings, but continuing symptoms were evaluated by ultrasound. The most common etiology of trauma was a fall, as seen in 60% of the patients. None of the rib fractures were identified radiographically. Sonography detected 26 rib fractures in 18 of 20 subjects at presentation. Sonography reveals more fractures than radiography and will reveal fractures in most patients presenting with suspected rib fracture.

Evaluation of the patients with renovascular hypertension after percutaneous revascularization by Doppler ultrasonography.

OBJECTIVE: Evaluation of the effectiveness of percutaneous revascularization is based primarily on clinical criteria, and laboratory findings rather than direct investigation of luminal width. The purpose of this study was to evaluate the success of endovascular revascularization with serial Doppler ultrasound (US) examinations. METHODS AND MATERIAL: 19 patients (14 were atherosclerotic, five were with fibromuscular dysplasia) with suspected renovascular hypertension treated by percutaneous revascularization were included in a prospective study. Patients had 23 renal artery stenoses reducing the diameter by more than 50%. Doppler US examinations were performed before intervention, and 1 day, 3 and 6 months after intervention. RESULTS: Initial revascularization was technically successful in 21 of 23 stenoses (91.3%) (18 PTRA, three stent placement). Hypertension was cured in five atherosclerotic and in five fibromuscular dysplasia (FMD) patients, and improved in four atherosclerotic patients. Residual stenosis was determined in six patients and the others were evaluated as normal by initial postprocedure Doppler US. As based on Doppler US, restenosis (>60%-narrowing) was depicted in four of six (66.6%) renal arteries with residual stenosis, and one of 15 (6.6%) normal renal arteries at 1 year. This difference in restenosis rates (residual stenosis vs. normal) was significant (P<0.05). CONCLUSION: Positive predictor for recurrence was a residual renal artery stenosis documented by Doppler US 1 day after percutaneous revascularization in atherosclerotic cases.