Comparison of Contrast-Enhanced Ultrasound Versus Magnetic Resonance Imaging in the Detection and Characterization of Uterine Leiomyomas.

OBJECTIVES: Uterine fibroids are common findings in women with pelvic pain and abnormal uterine bleeding. The reference standard test in the pretreatment evaluation of fibroids is contrast-enhanced magnetic resonance (MR) imaging. This study compared the number, size, location, and enhancement of uterine fibroids identified by contrast-enhanced ultrasound (CEUS) and MR. The aim of this study was to demonstrate that CEUS performs similarly to MR and could be used as an alternative imaging modality. METHODS: In this prospective observational study, 26 women underwent transabdominal CEUS and MR examinations. Blinded to the original clinical MR interpretations, 2 readers reviewed the MR and CEUS studies for each patient. The number, size, location, and enhancement of each fibroid per patient were reported by MR and CEUS. A Pearson correlation coefficient was calculated for the number of fibroids identified by each modality. RESULTS: In total, 126 fibroids were imaged: 115 (91.3%) were observed on both examinations; 9 (7.1%) were observed by MR only; and 2 (1.6%) were observed by CEUS only. A high correlation was found between the modalities for the number of fibroids identified per patient (r = 0.97; P < .001). There was also no significant difference between the modalities for each patient in the fibroid number, size, location, or enhancement. CONCLUSIONS: These findings suggest that transabdominal CEUS may represent an alternative to MR in pretreatment evaluation of uterine fibroids and could serve as a test of choice in patients with a contraindication to MR.

Ultrasonographic Diagnosis of Intrauterine Fetal Decapitation Secondary to Amniotic Band Sequence: A Case Report.

BACKGROUND: Amniotic band sequence (ABS) is a rare disorder that can result in a wide spectrum of congenital craniofacial, limb, trunk, and viscera deformities. One of the more rare manifestations of ABS is intrauterine fetal decapitation. CASE REPORT: This case report presents the ultrasonographic diagnosis of first-trimester intrauterine fetal demise resulting from decapitation secondary to amniotic band sequence. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: This case report presents a rare and atypical presentation of intrauterine demise valuable for an emergency physician to recognize while performing or reviewing pelvic ultrasounds. It is important for the clinician to understand and counsel the patient that subsequent pregnancies will not be at increased risk due to a prior miscarriage from ABS, as opposed to other etiologies of first-trimester spontaneous abortion.

Imaging of a gastrobronchial fistula after gastric bypass surgery and the contrast dilemma.

Obesity and bariatric procedures have become more common in the United States over the past 20 years. Therefore, the incidence of previously rare complications is also on the rise. One of the more ominous complications is a gastric leak with subsequent creation of a fistulous tract. A very rare subset of this complication is when the fistulous tract connects the gastric pouch to the bronchial tree. Several contrast agents can be utilized for imaging of the upper gastrointestinal tract, some of which may cause significant adverse effects if not properly tailored to the specific pathology in question. We present a case of a gastrobronchial fistula developing several years after a laparoscopic Roux-en-Y gastric bypass and discuss the ideal choice of contrast material when imaging this specific pathology.

Carotid Doppler: low velocity as a sign of significant disease.

Hemodynamically significant stenosis of the internal carotid artery (ICA) is usually diagnosed by elevated velocities in a region of luminal narrowing. Many other significant diagnoses can be made based upon lower-than-normal velocities. Analysis of the combinations of low ICA velocity, abnormal ICA waveform, and abnormal velocities and waveforms in ipsilateral or contralateral ICA, common carotid artery, and vertebral arteries can allow diagnosis of significant vascular or valvular disease from the heart to the brain.