Characteristic Ultrasonographic Findings Research Articles

Foot pain in children and adolescents: a problem-based approach in musculoskeletal ultrasonography.

Various etiologies and risk factors contribute to foot pain in children and adolescents, including conditions such as Kohler's disease, Sever's disease, Iselin's disease, rigid flat foot, accessory navicular, Freiberg's disease, sesamoiditis, os trigonum syndrome, and more. High-frequency musculoskeletal ultrasonography can show both the bone surface and the surrounding soft tissue clearly from various angles in real-time, thereby providing a higher level of detail that is helpful for identifying the etiology of foot pain and monitoring disease progression compared with other imaging modalities. This review provides an overview of the epidemiology, pathophysiology, clinical manifestations and characteristic ultrasonographic findings of select foot pain conditions in children and adolescents.

Management of iodine contrast induced salivary gland swelling (sialadenitis): experiences from an observational study

Background Iodine contrast-induced sialadenitis (CIS) is an uncommon adverse effect to iodine-containing contrast exposition. There is scarce literature about its clinical course and demography. Objectives (1) To determine the clinical course and management of CIS. (2) To understand if CIS might be as rare as reported. Material and Methods A 2-month prospective observational study was conducted in the emergency room of a tertiary institution. ENT physicians on call received clinical formation about CIS while emergency physicians did not. During the study period, patients admitted at the emergency room matching the clinical and radiological features of CIS, were included. Information about demographics, iodine exposure, diagnostic workup, clinical course, and management was analyzed. Results ENT physicians on call detected 4 cases, however, emergency physicians did not. Patients were aged 68–76 years and presented a bilateral submandibular gland swelling debuting 12 to 72 h after an exposure to iodinated contrast. Characteristic ultrasonographic findings supported the diagnosis and the clinical course was self-limited after 60 to 150 h. Conclusions and significance Physicians’ familiarity with CIS allows its detection and avoids costly and potentially harmful therapeutic/diagnostic efforts. The incidence is probably underestimated; however, further incidence studies are needed.

Polar Vessel: A New Ultrasound Sign for Complementary Diagnosis of Major Salivary Gland Adenoid Cystic Carcinoma.

To investigate the characteristic ultrasonographic findings of adenoid cystic carcinoma (ACC) in major salivary glands and identify the value of polar vessel in color Doppler flow imaging (CDFI) for the diagnosis of ACC. From January 2017 to December 2021, 76 patients with parotid and submandibular gland tumors, including 14 patients with ACC, as confirmed by surgery and histopathology, were enrolled. Their clinicopathologic information and ultrasound (US) features were recorded and analyzed. The performance of polar vessel in CDFI for differentiating ACC from non-ACC (benign tumors and mucoepidermoid carcinoma [MEC]) was analyzed. ACC in the major salivary gland was more likely to be associated with pain symptoms (P=.027) and unclear borders and rough edges in grayscale US (P=.002, .015, respectively) than benign tumors. Compared to MEC, ACC tended to feature a homogeneous internal echo (P=.008). ACC of the major salivary gland had a significantly higher incidence of polar vessel sign than that of non-ACC (benign tumors and MEC) (P <.0001, .0001, respectively). The polar vessel sign showed good performance in distinguishing between ACC and non-ACC, with an area under the receiver operating characteristic curve of 0.857, a sensitivity of 71.4%, a specificity of 100%, and an accuracy of 94.7%. Positive predictive value and negative predictive value were calculated at 100% and 93.9%, respectively. The US sign of polar vessel has high diagnostic efficiency, and it may have important potential for use as a new complementary sign for the diagnosis of ACC in major salivary glands.

Ultrasonographic evaluation of lacrimal glands in patients with primary Sjögren's syndrome.

This study focused on distinguishing the characteristic ultrasonographic findings of lacrimal glands in primary Sjögren's syndrome (pSS) from those in idiopathic sicca syndrome. We aimed to set up a semi-quantitative scoring system of lacrimal gland ultrasonography (LGUS) for patients with pSS. Fifty-six patients with pSS and 40 patients with idiopathic sicca syndrome were evaluated. Lacrimal glands were examined with ultrasonography using area, major/minor axis length, and five components (presence of intraglandular branch of lacrimal artery, inhomogeneity, hyperechoic bands, hypoechoic areas, and delineation). Except for the area and maximal/minimal length of lacrimal glands, other components were classified as dichotomous variables (present or absent). Using the receiver operating characteristics curve, we inferred the most appropriate combination of LGUS scoring for pSS diagnosis. Patients with pSS had a higher proportion of intraglandular branch of lacrimal artery (70.5% vs. 42.5%, p<0.001), inhomogeneity (72.3% vs. 46.3%, p<0.001), and hyperechoic bands (56.2% vs. 37.5%, p=0.016) than patients with idiopathic sicca syndrome. LGUS A, which represents the summation of one point assigned for the presence of intraglandular branch of lacrimal artery and one for inhomogeneity, was the most suitable diagnostic criterion (area under curve = 0.724, 95% confidence interval 0.620-0.828). If both sides have a score of 2, it results in a total of 4 points. With a cut-off value of 3 out of 4 points, LGUS A had 60.7% sensitivity, 71.1% specificity, 60.7% positive predictive value, and 72.5% negative predictive value. Semi-quantitative scoring of LGUS was useful when distinguishing patients with pSS from those with idiopathic sicca syndrome. The combination of intraglandular branch of lacrimal artery and inhomogeneity on both sides was most suitable for classifying pSS using LGUS.

Differentiation of Yersinia enterocolitica enteritis from other bacterial enteritides by ultrasonography: A single-center case–control study

The diagnosis of Yersinia enterocolitica (Ye) enteritis is not easy because detection from stool culture is more difficult for Ye than for other bacterial enteritides. The establishment of characteristic ultrasonographic findings for Ye enteritis would help improve the detection rate of Ye enteritis along with performance of several cold cultures. This would facilitate appropriate selection of antibiotics based on antimicrobial susceptibility testing and contribute to a more accurate understanding of local public health. This study aimed to retrospectively compare ultrasonographic findings and clinical features between children with Ye enteritis and other bacterial enteritides. We identified patients treated for Ye enteritis (Ye group; n=27) or other bacterial enteritides (Other enteritis group; n=29) between 2014 and 2018. Ultrasonographic findings (including mean maximum diameter and mean major-minor axis ratio of ileocecal lymph nodes, wall thickness of the terminal ileum, and presence of a pericecal hyperechoic region), clinical symptoms, and laboratory findings at first visit were compared between groups. No difference in mean maximum diameter of ileocecal lymph nodes was seen between groups. However, mean major-minor axis ratio of ileocecal lymph nodes was lower in the Ye group than in the Other enteritis group (p<0.001). Presence of a pericecal hyperechoic region was more frequent in the Ye group than in the Other enteritis group (p<0.001). The combined presence of a mean ileocecal lymph node major-minor axis ratio <1.51 and a pericecal hyperechoic region offered 100% sensitivity. Characteristic ultrasonographic findings identified in this study may improve ultrasonographic differentiation of Y. enterocolitica enteritis from other bacterial enteritides.

Diffuse sclerosing variant of papillary thyroid carcinoma: ultrasonographic and clinicopathological features in children/adolescents and adults

To analyse the clinicopathological features and ultrasound findings of the diffuse sclerosing variant of papillary thyroid carcinoma (DSV-PTC) and compare differences between children/adolescents (CAs) and adults. Medical records and ultrasound images of 97 consecutive DSV-PTC patients were reviewed and comparison was made between CAs and adults. The average age was 31.2±12.4 years old and 16.5% patients were CAs. Unilateral lobe was involved in 40.2% patients and 69.1% combined with Hashimoto's thyroiditis. Up to 95.9% patients had lymph node metastasis (LNM). CAs had more contralateral central LNM (CCLNM) and contralateral lateral LNM (CLLNM) than adults (p=0.047, p=0.025). Lung metastasis was also more common in CAs (p=0.002). Involved lobes mostly appeared as diffuse heterogeneous echogenicity on ultrasonography with isoechogenicity as the most common predominant echo (48.4%). Diffuse microcalcifications were observed frequently with grade 2-3 accounting for 52.3%. Lesions involving the whole gland lobe (diffuse type) occurred in 63.9%. Blood flow was poor in 71.6% (with grade 0-1). Microcalcifications of both lobes and metastatic lymph nodes and lesions involving (diffuse type) were more common in CAs (p=0.038, 0.002; 0.011). Of 39 patients with unilateral lobe involvement, ultrasonic sensitivity for CCLNM and CLLNM was only 50% and 66.7% respectively. DSV-PTC has characteristic ultrasonographic findings. DSV-PTC of CAs may be more aggressive than that of adults. Ultrasonic sensitivity for LNM of contralateral compartments was not satisfactory and diagnostic methods with good efficacy are required.

Small palpable masses in face and scalp

Background Small palpable masses are very common in face and scalp. High resolution ultrasound is very useful for the characterization of the masses and adjacent soft tissue evaluation. In addition, ultrasound is very helpful for the differential diagnosis. Purpose The purpose of this study is to demonstrate many various diseases of superficial located small palpable masses, and to learn the characteristic ultrasonographic findings and disease spectrums of the superficial palpable face and scalp masses with the review of literatures. Methods and Materials Materials were retrograde collected in theuniversity hospital for recent 5years using the PACS sorting system, and finally, cases were chosen among the all pathologic proven cases. Results Most cases were located face and scalp area. Categories of Cases are as follows; Lipoma, dermoid, epidermoid, complicated or rupture of epidermoid, osteoma cutis, Pilometricoma (calcifying epithelioma of Malherbe), Trichilemmal cyst (= pilar cyst), Proliferating trichilemmal cyst, Sola elastosis; Palpable hard mass such as osteoma, calcified granuloma, Fibrovascular tissue with calcification(calcinosis cutis), Calcified foreign body,; Vascular mass and malformation (Hemangioma, lymphatic malformation, Venous lake (capillary aneurysm) with thrombosis), neurofibroma, schwannoma, Malignant mass such as melanoma, lymphoma, skin cancer (SCC) Inflammatory mass such as Chronic inflammatory mass, Acute suppurative and granulomatous inflammatory mass, fat necrosis, Fibrofatty mass, Lipogranulomatous inflammatory mass, Chalazion, Scleroderma,; Cosmetic foreign body injection related mass: Foreign body granuloma(filler), cyst, granuloma. Multiple injection droplet, Inflammatory mass, abscess. Trauma related hematoma, Superficial lymph node, parotid mass, Conclusion Superficial palpable masses are very common and the causes and pathologies are variable. Ultrasonography is very helpful for the evaluation of characteristic findings of superficial masses and for the differential diagnosis.

Ultrasonography of the larynx in horses: an update

Laryngeal ultrasonography is a useful adjunctive diagnostic technique for investigation of upper airway disorders in horses. A transcutaneous examination can be completed using equipment that is widely available to the...

Studyon Renal Cell Carcinoma Detected by Abdominal Ultrasonography during Routine Health Check-Up

We performed a study on renal cell carcinoma (RCC) detected by abdominal ultrasonography during routine health check-up at Sapporo Teishin Hospital. The study included a total of 13,127 ultrasonographic examinations performed on 4,339 patients who visited our hospital for routine health check-ups during a 21- year period from April 1995 to March 2016. RCC was suspected from ultrasonographic findings and later histopathologically diagnosed in 11 patients in this group (detection rate 0.25%). Patients were male, aged 37 to 64 (median, 52.1 years). None of the patients had subjective symptoms, and all were negative for microscopic hematuria. Greatest dimensions of tumors were 18 to 40 mm (mean, 28 mm) ; anechoic rims, which are a characteristic ultrasonographic finding in RCC, were identified in 8 patients (72. 7%), intratumoral cysts were identified in 8 patients (72.7%), and protrusions from the surface of the kidney were identified in 9 patients (81. 8%). Regarding vascular distribution of renal tumors during Doppler ultrasonography, peripheral patterns or mixed penetrating and peripheral patterns were identified in 100% of cases (8/8). All 11 patients were diagnosed histopathologically with clear cell renal cell carcinoma, and the histological grade was G1 in 6 patients, G1＞G2, in 1 patient G2＞G1, in 1 patient and G2 in 3 patients. All 11 tumors were classified as pT1a pathological stage according to the TNM classification, and no regional lymph node metastases or distant metastases were identified. We consider that ultrasonography plays an integral role in the early detection of RCC during check-ups and examinations.

Diagnostic Bedside Ultrasonography for Acute Respiratory Failure and Severe Hypoxemia in the Medical Intensive Care Unit: Basics and Comprehensive Approaches.

Bedside goal-directed ultrasound is a powerful tool for rapid differential diagnosis and monitoring of cardiopulmonary disease in the critically ill patient population. The bedside intensivist is in a unique position to integrate ultrasound findings with the overall clinical situation. Medically critically ill patients who require urgent bedside diagnostic assessment fall into 2 categories: (1) acute respiratory failure and (2) hemodynamic derangements. The first portion of this review outlines the diagnostic role of bedside ultrasound in the medically critically ill patient population for the diagnosis and treatment of acute respiratory failure, acute respiratory distress, and severe hypoxemia. The second portion will focus on the diagnostic role of ultrasound for the evaluation and treatment of shock states, as well as describe protocolized approaches for evaluation of shock during cardiopulmonary resuscitation. Different respiratory system pathologies that result in acute respiratory failure (such as increased interstitial fluid, alveolar consolidation, pleural effusion) cause characteristic ultrasonographic findings; diaphragmatic assessment may also add information. Intracardiac shunting can cause severe hypoxemia. Protocolized approaches for the evaluation of patients with acute respiratory failure or distress are discussed.

Clinical, laboratory and ultrasonographic findings in Egyptian buffalo (Bubalus bubalis) with caecal and colonic dilatation

The present study was conducted to describe the clinical, laboratory and ultrasonographic findings of caecal and colonic dilatation in Egyptian buffalo (Bubalus bubalis). A total number of forty buffaloes were included in the study and divided into two groups: control group (n=20) and diseased group (n=20). Diseased buffalo were admitted to the Veterinary Teaching Hospital at Assiut University-Egypt. Each of the diseased animals was subjected to clinical, rectal, laboratory and ultrasonographic examinations. Clinically, buffalo with dilated caecum/colon showed reduced appetite, distended right abdomen, abdominal pain and tensed abdomen. Rectal examination indicated empty rectum with the presence of mucus and dilated loop of caecum and/or colon. Buffalo with dilated caecum/colon showed significant (P<0.05) hypoproteinemia and hypoalbuminemia with significant (P<0.05) increase in blood serum activities of aspartate aminotransferase (AST) and alkaline phosphatase (ALK). Ultrasonographically, the dilated caecum and proximal loop of colon occupied the last right three intercostal space (ICSs) particularly their ventral part, intertangled with the liver dorsally in these ICSs. Dilated colon did not hinder the visibility of the liver. The dilated caecum/colon also filled the whole right flank region, with hiding of right kidney, loops and peristaltic movement of the small intestines. The closest wall of the dilated caecum and proximal loop of the colon was imaged as thick semi-circular echogenic line. The furthest wall and contents of dilated caecum/colon were not imaged. In conclusion, buffalo with caecal and/or colonic dilatation have non-specific clinical and laboratory findings; however the affected animals show characteristic ultrasonographic findings.

Sparganosis of the breast and lower extremities: Sonographic appearance

Sparganosis is a rare parasitic infection caused by larvae of the genus Spirometra. It can involve any part of the human body and usually manifests as a mass in various locations. We report a case of recurrent sparganosis in the breast and lower extremities. Our patient had recurrent subcutaneous masses in her breast and lower leg that showed characteristic ultrasonographic imaging findings of serpentine, tubular structures with surrounding increased echogenicity. These imaging findings are well correlated with pathologic findings. Worms were identified in resected specimens confirming sparganosis.

Apophyseal avulsion fracture of the greater trochanter of the femur in a Thoroughbred filly

The case report of a 14-month-old Thoroughbred filly with acute onset of severe right hindlimb lameness is presented. The horse had a severe and sudden abduction of the hindlimbs due to a side effect of an overdose of lidocaine, which had been administered in a constant rate infusion after a colic surgery. Transcutaneous ultrasonography and standing radiography of the pelvis revealed proximal and cranial displacement of the greater trochanter and free bone fragments consistent with an apophyseal avulsion fracture of the greater trochanter. The complete diagnosis was obtained with the horse in a standing position. The filly was euthanatized because of deterioration resulting from the colic condition and of the poor prognosis of the fracture of the greater trochanter. Postmortem evaluation confirmed an apophyseal avulsion fracture of the right greater trochanter. To the authors' knowledge, ultrasonographic and radiographic findings of this fracture have not been described in the standing horse. The diagnosis was reached quite easily with the horse in a normal standing position when the characteristic ultrasonographic and radiographic findings were detected.

Tuberculosis of the Male Genitourinary Tract

Background Information In the past decade, there has been a significant rise in the prevalence of tuberculosis as well as an increase in the extrapulmonary manifestations worldwide. Genitourinary tuberculosis is the most common manifestation of extrapulmonary tuberculosis. Diagnosis is often difficult and delayed because tuberculosis has a variety of clinical and radiological presentations, and it can mimic numerous other disease entities. A high level of suspicion is required and positive results on culture or histologic examination of biopsy or surgical specimens is still required in many patients for definite diagnosis. Educational Goals • To review the ultrasonographic features of tuberculosis affecting the kidney, adrenal gland, and male genital tracts. • To know the routes of Tuberculous spread. Imaging Findings Tuberculous infection occur all genitourinary organs, kidney, adrenal gland, ureter, urinary bladder, prostate, epididymis and testes. We reviewed pathophysiology of Tuberculous infection affecting male genitourinary tracts. We also reviewed the characteristic ultrasonographic and CT findings of Tuberculous infection. We compared other differential diagnostic diseases (inflammatory bowel diseases, peritoneal diseases) to these ultrasonographic and CT manifestations. Conclusion Tuberculous infection can mimic numerous other disease entities. Although a positive culture of histologic analysis of biopsy specimens is still required in many patients to yield the definite diagnosis, recognition and understanding of the spectrum of imaging features of extrapulmonary tuberculosis can aid in diagnosis.

Thickness and Biomechanical Properties of Capsule in Adhesive Capsulitis

Fibrous thickening of the capsule is believed to be the main pathology of adhesive capsulitis based on surgical findings or sophisticated imaging data. The thickened capsule might have different biomechanical properties than thinner. As previously reported, the authors were able to identify the unique biomechanical properties of joint capsules using pressure-monitored intra-articular fluid infusion. PURPOSE: To identify the biomechanical significance of thickened joint capsule in adhesive capsulitis METHODS: Clinically diagnosed 52 shoulders with adhesive capsulitis were enrolled. A needle was inserted into the posterior shoulder joint under ultrasonographic guidance. Fluid was infused in a constant-volume rate with real-time pressure monitoring. The pumping of the fluid was continued with a close pressure monitoring before rupture. The pressure, volume and compliance at the point of maximal pressure was determined as the peak pressure (P_peak), the volume at the peak pressure (V_peak), and compliance (C_peak). The ultrasound images of the posterior capsule were stored just after the termination of fluid instillation. The thickness was measured at 5 points with 2mm intervals along the highly echogenic line representing the posterior capsule, 10 mm lateral to the lateral edge of the labrum. One investigator repeated the thickness measurement of posterior capsules in one week interval for assessment of intrarater reliability. For interrater reliability, two investigators measured the thickness independently. RESULTS: Inter-rater and intra-rater reliability for measuring the thickness of posterior shoulder (T_cap) were.805(.650-.891) and.915(.848-.953), respectively. Mean thickness of capsule was 1.6±0.3mm. The Pearson correlation coefficients between T_cap and P_peak was significant (0.32, p-value=0.02), but not between T_cap and V_peak (0.19, p=0.17), and T_cap and C_peak (-0.15, p-value=0.30). CONCLUSIONS: The P_peak showed positive linear correlation with posterior capsular thickness. The thickened posterior capsule might be a characteristic ultrasonographic finding in adhesive capsulitis

Prenatal Detection of Bladder Wall Involvement in Invasive Placentation with Sequential Two-dimensional and Adjunctive Three-dimensional Ultrasonography

The purpose of this study was to determine the diagnostic capability of sequential two-dimensional (2D) and adjunctive three-dimensional (3D) ultrasonography (US) in identifying the location and extent of placental invasion of the bladder. Forty-five patients at risk of placenta previa were examined sequentially with 2D US and then with a targeted scan of the region of interest with adjunctive 3D US to determine whether those patients suspected of having advanced invasive placentation by conventional ultrasonographic evidence had placental invasion of the bladder. The images were coded as positive, negative or indeterminate (equivocal) for bladder invasion. Follow-up postoperative outcomes were obtained. Seven of the 45 patients exhibited characteristic ultrasonographic findings for placenta increta/percreta. Among these seven patients with advanced invasive placentation, a targeted scan with adjunctive 3D US correctly provided additional corroborative information to the 2D US indeterminate diagnosis in patients who were found with variable degrees of bladder wall involvement at surgery. 3D US may be a useful adjunctive tool in refining 2D ultrasonographic techniques to identify the extent and degree of placental invasion of the bladder. The advantages of 3D US are: (1) a multiplanar image display allows viewing of sections from sagittal, coronal and axial planes at the same time, thereby more accurately determining the location and extent of placental invasion; (2) the viewing planes of the spatial angioarchitecture network can be arbitrarily manipulated to better delineate the aberrant vessels protruding into the bladder; (3) 3D reconstruction images can be clearly displayed by live 3D in a rotation mode for a better illustrative effect.

Airway Management in Children: Ultrasonography Assessment of Tracheal Intubation in Real Time?

Pediatric tracheal intubation requires considerable expertise and can represent a challenge to many anesthesiologists. Confirmation of correct tracheal tube position relies on direct visualization or indirect measures, such as auscultation and capnography. These methods have varying sensitivity and specificity, especially in the infant and young child. Ultrasonography is noninvasive and is becoming more readily available to the anesthesiologist. In this study, we investigated the characteristic real-time ultrasonographic findings of the normal pediatric airway during tracheal intubation and its suitability for clinical use. Thirty healthy children with normal airways requiring tracheal intubation were studied. Ultrasonographic measurements of the pediatric airway during tracheal intubation under deep inhaled anesthesia were performed using a Sonosite Titan (Sonosite, Bothell, WA) scanner while recording characteristic images during this process. Correct tracheal tube placement was further confirmed using auscultation and satisfactory end-tidal capnography. The mean (+/- sd) age of studied patients was 48 +/- 37 mo, weight was 19.7. +/- 8.6 kg and the sex ratio (m/f) was 1:2. Successful tracheal intubation was verified using the following criteria: 1) identification of the trachea and tracheal rings, 2) visualization of vocal cords, 3) widening of glottis as the tracheal tube passes through, and 4) tracheal tube position above carina and demonstration of movement of the chest wall visceroparietal pleural interface (i.e., sliding sign) after manual ventilation of the lungs. One esophageal intubation was readily recognized by visualization of the tube in the left paratracheal space. This study describes characteristic ultrasonographic findings of the pediatric airway during tracheal intubation. It suggests that ultrasonography may be useful for airway management in children.

Autoimmune pancreatitis: with special reference to a localized variant.

In 2006, the Japan Pancreas Society revised the diagnostic criteria for autoimmune pancreatitis (AIP) so as to more clearly define its morphological, pathological, and immunological features, as follows: (1) diffuse or segmental narrowing of the main pancreatic duct with an irregular wall and diffuse or localized enlargement of the pancreas recognized by imaging studies; (2) high serum gamma globulin, IgG, or IgG4 levels, or the presence of autoantibodies; and (3) marked interlobular fibrosis and prominent infiltration of lymphocytes and plasma cells in the periductal area, occasionally with lymphoid follicles in the pancreas. Establishing a diagnosis of AIP has become easier with knowledge of its immunological abnormalities, including serum IgG4 levels. However, the localized form of AIP sometimes mimics pancreatic cancer. The rate of focal mass formation in patients with AIP is reportedly 24%-43%; however, there have been few reports on the histological findings of localized AIP, in contrast to mass-forming pancreatitis (MFP). Our review of patients who had undergone resection due to a preoperative diagnosis of MFP with possible cancer revealed 72% to be patients with localized AIP. For the discrimination of these conditions, it is important to recognize the characteristic ultrasonographic findings of AIP, i.e., (1) diffuse or localized enlargement and hypoechogenicity of the pancreas; (2) rarity of calcification, cystic lesions, and peripancreatic fluid collection; (3) thickened layer structure of the bile duct wall; (4) iso/hypervascularity in the swollen portion of the pancreas; (5) attenuation of pancreatic swelling and bile duct wall thickening after steroid therapy; and (6) multiple hypoechoic masses in various organs, including the pancreas. Contrast-enhanced endoscopic ultrasonography is potentially a useful tool in the differential diagnosis and for assessment of the efficacy of steroid therapy by enabling evaluation of the vascularity of the lesions. Along with the presence of IgG4-positive plasma cells, verification of obliterative phlebitis is highly specific for the histological diagnosis of AIP.

Prenatal Diagnosis of Tetralogy of Fallot with Pulmonary Atresia

Tetralogy of Fallot involves an abnormal embryological development in which an unequal conotruncal division results in a small pulmonary artery and a great aortic artery. In its most severe form, the infundibulum of the right ventricle and the pulmonary artery can be atretic with the anomaly commonly referred to as pulmonary atresia with ventricular septal defect. Reported here is a case of prenatal diagnosis of tetralogy of Fallot with pulmonary atresia. The characteristic ultrasonographic findings included a small pulmonary artery, a large aorta, and a ventricular septal defect. The search for an atretic pulmonary valve and a ductus arteriosus with reversed blood flow was emphasized in the presence of asymmetrically dilated fetal heart. After birth, the newborn received single-stage total correction for the tetralogy of Fallot and was discharged a month later in stable condition. In this case report, the neonatal angiogram is added for confirming the prenatal diagnosis, which is of value in teaching fetal echocardiography to novice practitioners. We believe a prenatal diagnosis of tetralogy of Fallot can improve neonatal outcome.

160: Ultrasound findings in complete trisomy 22

Trisomy 22 is a rare chromosomal abnormality complicating approximately one in 30,000 to 50,000 live births. The objective of this study was to identify the characteristic ultrasonographic findings of fetal complete trisomy 22.