Common Ultrasound Findings Research Articles

Clinical profile of children with Fanconi anemia from a tertiary center in Southern India

Objectives: The aim of this study is to observe the clinical spectrum of presentation of Fanconi anemia (FA) in children presenting to the Hematology Department of Victoria Hospital, Bangalore Medical College and Research Institute. Materials and Methods: This observational study was carried out from February 2010 to December 2016 on all the 16 consecutive children <18 years of age, with FA. Those with high frequency of chromosomal breakage in G-banded metaphases from mitomycin-treated cultures were considered as positive cases. Results: The mean age at presentation was 6.79±1.34 years, but for those with dysmorphic featureson examination, it was 4.77±0.98 years. Symptoms of anemia were seen in 14 (87.5%) and of bleeding in 8 (50%) cases. There was a history of prolonged fever at presentation in 5 (31.2%) cases. Dysmorphic features on examination were seen in 10 (62.5%) cases. Short stature and microcephaly and microphthalmia were the most common features. Pancytopenia was seen in 68.7% of the subjects at presentation and anemia in 87.5% of cases while thrombocytopenia was universal (100%). The mean hemoglobin was 5.33±0.36 g/dL, mean white blood cell count was 3429.37±477.65/mm3, and mean platelet count was 28156.25±4199.44/mm3. The bone marrow was hypoplastic in 14 (87.5%). Pelvic kidney seen in 5 (31%) was the most common ultrasound finding. Parentalconsanguinity was seen in 50% of cases. Conclusion: Parental consanguinity was common, and there was a male preponderance in our study. The most common presenting manifestations were anemia followed by bleeding. Two-third of the patients had pancytopenia at diagnosis while thrombocytopenia was universal (100%). In the presence of a family history and/or dysmorphic features, even mono- or bi-cytopenias should be evaluated for inherited bone marrow failure syndromes.

A prospective study of the association between sickle cell disease and hepatobiliary effects in Bahrain.

BackgroundSickle cell disease is a genetic disorder that leads to abnormally high levels of hemoglobin sickling in erythrocytes. Patients suffer debilitating and severe complications that affect multiple organs, though mainly the liver, gallbladder, spleen, bones, and kidneys. It has a significant impact on morbidity and mortality rates and is associated with substantial health care costs.MethodsFor this study, the researchers prospectively reviewed the charts of 154 sickle cell disease patients who had been treated in Salmaniya Medical Complex hospital in Bahrain between September 2013 and December 2014.ResultsThe results obtained showed that 95% of patients had sickle cell hemoglobin type. Of the sample patients, 80% exhibited bone pain, with all patients exhibiting bone crisis. Biochemical tests revealed reduced hemoglobin concentration, elevated bilirubin, compromised liver function, and lower white blood cell counts. The incidence of hepatitis B and C was very low, at 0% and 9%, respectively. There were a large number of hospital admissions, with 11 days as an average length of stay. The most common ultrasound findings in this study were hepatomegaly, hepatosplenomegaly, cholelithiasis, gallbladder sludge, and splenomegaly.ConclusionSickle cell disease had profound negative effects on multiple organs, with a particularly large number of complications related to the hepatobiliary system.

What are the most common first-trimester ultrasound findings in cases of Turner syndrome?

Objectives: To identify the most common first-trimester ultrasound findings in Turner syndrome (TS). To evaluate which first-trimester findings can be best used to predict the likelihood of TS.Methods: This was a prospective study, based on singleton pregnancies. The referrals included 6210 patients. Scan protocol covered a review of the early fetal anatomy and markers of aneuploidy.Results: Study population comprised 5644 pregnancies: 5613 with a normal karyotype and 31 cases of TS. Statistically significant differences (p < 0.05) were found between euploidy and TS groups in terms of nuchal translucency (NT; 1.7 mm versus 8.8 mm) and fetal heart rate (FHR; 160 versus 171 beats per minute). None of the TS cases demonstrated absent markers of aneuploidy as opposed to 5133 (91.4%) cases of euploidy. NT and abnormal DV flow (aDV or revDV) were the most common markers found in combination in TS cases (n = 17; 54.8%). 27 (0.5%) cases of euploidy and 17 (54.8%) cases of TS revealed congenital heart defects. Fetal hydrops was observed in 14 cases of TS (43.8%) and in 5 of euploidy (0.1%). In backward regression model, NT > 3.5 mm and right dominant heart (RDH) augmented the risk of TS risk by 991 and 314 times, respectively.Conclusions: First-trimester sonography is a feasible method to identify the most characteristic features of TS fenotype. When the first-trimester pattern of TS is considered, a highly thickened NT, FHR above the 95th percentile, abnormal ductus venosus velocimetry, fetal hydrops, and RDH should be specifically searched for.

Diagnostic assessment of acute respiratory distress syndrome with lung ultrasound – comparison with Computed Tomography- preliminary data

Objectives: Lung ultrasound (LUS) is increasingly used in intensive care medicine to monitor invasive ventilation, however little data exists on the comparison of common lung ultrasound (LUS) findings in Acute Respiratory Distress Syndrome (“b-lines”, consolidations) with the imaging gold standard Computed Tomography (CT). Therefore the aim of our study was to examine these findings under controlled conditions at different Positive End Expiratory Pressure (PEEP) levels in healthy and diseased piglets and compare them with dynamic CT scans. Methods: After approval of the ethics comittee, 8 piglets were studied during pressure controlled mechanical ventilation before and after surfactant depletion injury. Inspiratory, expiratory and dynamic CT scans and ultrasound examinations were performed at defined PEEP levels (0, 5, 15) by one radiologist. (curved transducer 3.5 MHz, in oblique/transverse orientation at approx. 5th/6th intercostal space ventral and dorsal in the anterior axillary line on both sides and and additional transhepatic scans on the right side in 6 pigs). Offline evaluation of the CT images and ultrasound images was performed in separate sessions, blinded to the results. Results: Transhepatic ultrasound evaluation of lung consolidations as compared with CT showed an excellent correlation. Higher B-line counts were present in the diseased lung (compared with healthy lung), dorsally (compared with ventrally), and at lower PEEP levels (compared with higher PEEP levels). No CT correlate for the B-lines could be identified. Conclusion: Transhepatic assessment of consolidations for dynamic modification of respiratory management seems feasible with excellent CT correlation. B lines seemed to be influenced by respiratory parameters and position, however, no CT correlate could be found.

Calcified and non-calcified ductal carcinoma in situ: differences in sonographic and pathologic features

Objective To compare the sonographic and pathologic features of calcified and non-calcified ductal carcinoma in situ(DCIS). Methods A total of 83 lesions in 82 consecutive patients with pathologically confirmed pure DCIS were recruited. One patient had bilateral lesions. All lesions were divided into calcified DCIS and non-calcified DCIS according to the presence of calcifications on mammography. Their sonographic features and pathologic reports for all patients with DCIS were retrospectively reviewed. Statistical comparisons were performed using the chi-square test. Results (1)Calcified DCIS showed positive ultrasound(US) findings in 80% (44/55)of cases. The most common US finding was nonmass lesions (43.6%, 24/55). Nine cases had pure ductal dilatations(16.4%, 9/55). Non-calcified DCIS showed positive US findings in 96.4% (27/28)of cases.The most common US finding was mass (89.2%, 25/28). Two cases had pure ductal dilatations(7.1%, 2/28). No significant difference was found in the shape, margin, orientation, posterior feature of a mass between the calcified and non-calcified groups (P>0.05). Significant difference was observed in the size, boundary, echogenicity on ultrasound of the two groups (P<0.05). (2)At histopathology, the pathological scores high nuclear grade, positive ER status, positive PR status, positive Ki67 status and the presence of Her-2/neu oncogene were more common in the calcified group than in the non-calcified group. Conclusions Calcified and non-calcified pure DCIS have different pathologic and sonographic features. Calcified DCIS has more aggressive histological features than non-calcified DCIS. Key words: Ultrasonography; Breast neoplasms; Calcification

Is Ultrasound a Useful Tool to Predict Severe Dengue Infection?

To study the role of ultrasound in children with dengue fever and determine its role in predicting the severity of the disease. This was a retrospective hospital based study conducted from 1(st) August 2012 to January 31(st) 2015 at a tertiary care hospital in Puducherry. Two hundred and fifty four children were admitted with dengue fever and among them non-severe dengue and severe dengue were seen in 62.6 % and 37.4% respectively. Mean age of presentation was 7.0 (3.3) years. M: F ratio was 1.2:1 Ultrasound was performed on all children with dengue fever during the critical period of illness as an early sign of plasma leakage and at the time of discharge. The diagnosis was confirmed by NS1 antigen and dengue serology. Ultrasonography showed positive findings in 156 cases (61.4%) during the critical period of illness. Ultrasound findings were analyzed using logistic regression among severe and non-severe dengue and P value of <0.05 was taken as significant. The common ultrasound findings that were significantly associated with severe dengue infection on univariate analysis were gall bladder wall thickening, ascites, pleural effusion, pericardial effusion, pericholecystic fluid, hepatomegaly, splenomegaly and mesenteric adenopathy. On multivariate analysis, gall bladder thickening and hepatomegaly were significantly associated with severe dengue infection. Gall bladder wall thickening (GBWT) with honeycombing pattern was the most specific finding in severe dengue infection in the study and significantly associated with severe thrombocytopenia (Platelet count <50,000/mm(3)). The clinical improvement coincided with resolving of the ultrasound findings at the time of discharge. Ultrasound can be used as an early predictor as well as an important prognostic sign for severe dengue infection especially during an epidemic.

Can Radiology Play a Role in Early Diagnosis of Dengue Fever?

Background:Dengue fever (DF) is a viral hemorrhagic fever causing severe morbidity and mortality in affected patients.Aims:The purpose of our study was to evaluate the changing trends in radiological findings in DF, to find if ultrasound is useful in the diagnosis of DF during an epidemic in absence of serological tests, and also to investigate the effects of DF in pregnancy.Materials and Methods:A prospective study was conducted in 2013 comprising of 400 patients who were serologically positive for dengue. Out of these, radiological investigations were conducted for 107 patients who were analyzed.Results:Out of the 107 patients, 85 patients underwent ultrasound, 12 computed tomography (CT) scans of brain or paranasal sinuses, and 21 chest radiography. The maximum numbers of patients (79%) were in the age group of 20-50 years. The most common ultrasound finding was hepatomegaly that was seen in 62% of the patients. Other findings were splenomegaly (45%), gallbladder (GB) wall edema (45%), right-sided pleural effusion (37%), bilateral pleural effusion (22%), and ascites (36%). Out of 10 pregnant patients, 5 had oligohydramnios, 2 had intrauterine growth restriction, 2 had intrauterine fetal demise, and 5 had a normal antenatal ultrasound.Conclusion:Ultrasound findings of hepatosplenomegaly, GB wall edema, right-sided or bilateral pleural effusion, and ascites in patients presenting with signs and symptoms of DF during an epidemic are virtually diagnostic of DF. There have been recent changing trends with hepatosplenomegaly being the more common manifestation, in comparison to ascites and GB wall edema. DF also has catastrophic effects in pregnancy such as oligohydramnios and intrauterine fetal demise.

Chronic Liver Disease among Adult Patients with Sickle Cell Anemia in Steady State in Ile-Ife, Nigeria

Aim: Chronic liver disease encompasses a range of hepatic pathology arising from a wide variety of insults to the liver which can occur in patients with sickle cell anemia. This study is aimed to investigate the prevalence of chronic liver disease among adult patients with sickle cell anemia in steady state attending the hematology clinic of a federal tertiary health institution in Ile-Ife, Nigeria. Materials and Methods: Basic demographic data, liver ultrasound scan as well as liver function test and Child-Turcotte-Pugh class of 50 consecutive sickle cell anemia (HbSS) patients were compared with those of 50 age- and sex-matched subjects with HbAA as controls. Results: Each of the study groups (patients and controls) comprised of 21(42%) males and 29(58%) females. The age range of the patients was 18-45years with a mean(±SD) of 27.6±7.607 while that of the controls was 21-43years with a mean(±SD) of 28.0±5.079(p=0.746). Amongst the patients, 32(64%) had hepatomegaly while 18(36%) had normal liver ultrasound findings. In the control group, 1(2%) had fatty liver but none had hepatomegaly. Forty-nine(98%) of the controls had normal liver ultrasound findings. There was a statistically significant difference in the prevalence of hepatomegaly between the patients and controls with p value<0.001. Twenty-four(48 %) of the patients were in CTP class A; 7(29.2%) males and 17(70.8%) females, while the remaining 26(52%) patients were in CTP class B; 14(53.8%) males and 12(46.2%) females. None of the patients was in CTP class C. Conclusion : In this study, hepatomegaly was a common ultrasound finding in patients with sickle cell anemia. It is essential to assess for evidence of liver disease in patients with sickle cell anemia even when they are not yet symptomatic.

ASSOCIATIONS BETWEEN ULTRASOUND AND CLINICAL FINDINGS IN 87 CATS WITH URETHRAL OBSTRUCTION.

Urethral obstruction is a life-threatening form of feline lower urinary tract disease. Ultrasonographic risk factors for reobstruction have not been previously reported. Purposes of this retrospective cross-sectional study were to describe urinary tract ultrasound findings in cats following acute urethral obstruction and determine whether ultrasound findings were associated with reobstruction. Inclusion criteria were a physical examination and history consistent with urethral obstruction, an abdominal ultrasound including a full evaluation of the urinary system within 24 h of hospitalization, and no cystocentesis prior to ultrasound examination. Medical records for included cats were reviewed and presence of azotemia, hyperkalemia, positive urine culture, and duration of hospitalization were recorded. For medically treated cats with available outcome data, presence of reobstruction was also recorded. Ultrasound images were reviewed and urinary tract characteristics were recorded. A total of 87 cats met inclusion criteria. Common ultrasound findings for the bladder included echogenic urine sediment, bladder wall thickening, pericystic effusion, hyperechoic pericystic fat, and increased urinary echoes; and for the kidneys/ureters included pyelectasia, renomegaly, perirenal effusion, hyperechoic perirenal fat, and ureteral dilation. Six-month postdischarge outcomes were available for 61 medically treated cats and 21 of these cats had reobstruction. No findings were associated with an increased risk of reobstruction. Ultrasonographic perirenal effusion was associated with severe hyperkalemia (P = 0.009, relative risk 5.75, 95% confidence interval [1.54-21.51]). Findings supported the use of ultrasound as an adjunct for treatment planning in cats presented with urethral obstruction but not as a method for predicting risk of reobstruction.

P30.19: Application of quantification elastography in patients suspected of endometrial hyperplasia

Endometrial pathologies are common ultrasound findings in group of peri and postmenopausal women and are an indication for further diagnostics including biopsy, curettage, hysteroscopy. This study assessed whether a new elastography application with quantification possibility can differentiate normal and abnormal endometrium and to be a helpful tool to establish further management. The study included a group of 47 patients with endometrial thickness more than 5 mm. Elastographic images of the uterus were achived in all patient, due to pressure applied by operator of transvaginal probe. Mid-saggital view of endometrium was delineated and assessed, according to EITA scale and with the use of elastography index (EI). Subsequently pathological analysis was performed. Correlation between elastography indices, presented in numbers and pathologic results was analyzed. Pathologies of endometrium (7 cases of carcinoma, 12 polyps, 5 hyperplasia) had higher elastography index - above 3. 22 out of 23 patients with normal and atrophic endometrium had EI less than 3. The values of EI for endometrial pathologies were in range from 3 to 8, the highest values were in hyperlasia and cancer. The corellation was significant, p < 0,0001. We did not find any changes in elastograms and EI, depending on the amount of pressure applied during examination. Supporting information can be found in the online version of this abstract Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.

PEDIATRIC ABDOMINAL PAIN;

Objectives: To assess common presenting features of children with abdominalpain and to determine role of High frequency &amp; Doppler Ultrasound in evaluation of thesepatients. Material and Methods: This is a cross sectional study conducted from August 2012 toDecember 2012. Data from patients presenting for evaluation of abdominal pain was analyzed forpresenting complaints and ultrasound findings according to objectives of the study. Results: Intotal 262 cases were included in the study. The mean age of patients was 6.3 years with a male tofemale ratio of 1.47:1. Dysuria followed by Diarrhoea and vomiting were most commonassociated complaints, Urological pathologies were most common ultrasound findings uponevaluation of patients. Conclusions: Abdominal pain is a frequent presenting feature inpeadiatric population, Urological pathologies were most common examination findings.Ultrasound is a useful and safe modality in evaluation of abdominal pain in children.

Pregnancy-Associated Breast Cancer: Significance of Early Detection and Imaging Appearance

Background/Objectives: To evaluate the mammographic and sonographic findings of pregnancy associated breast cancer. Patients and Methods: In this study, we selected 25 patients who were diagnosed with pregnancy associated breast cancer during the previous 10 years. The disease was diagnosed during pregnancy (n = 5) or lactation (n = 20). All patients underwent ultrasonography, the first choice for evaluation of pregnancy associated breast disease. Mammography was performed for 22 patients. Results: The commonest clinical symptom was a breast lump. Ultrasound was abnormal in all cases. The most common ultrasound finding was a solitary hypo echoic mass with irregular shape, irregular margin, and heterogeneous echogenicity. Architectural distortion was seen in two patients. Some unusual sonographic findings for breast cancer were detected in these patients, including parallel orientation, cystic components, and posterior enhancement. Mammography was performed for 22 patients and revealed positive findings in 80% of cases despite a dense breast. The most common mammographic finding was a breast mass with or without microcalcification (n = 10). Microcalcification alone was seen in 2 patients. Lesions, were predominantly invasive ductal carcinoma (96%). Conclusions: Ultrasonography is recommended for the initial diagnosis of pregnancy associated breast cancer. Mammography is indicated when initial evaluation suggests a malignant lesion or when ultrasound is negative in spite of a palpable breast lesion. When the imaging results are suspicious, a biopsy should be performed to obtain a pathologic diagnosis.

Ultrasound Findings in Patients with Visceral Leishmaniasis

Visceral leishmaniasis(VL) has been a major health burden on the Sudanese patients and to the health authorities in Sudan. Delay in diagnosis of VL leads to serious complications and eventually death. This study aimed to study the ultrasonographic findings of VL in Sudanese patients.50 Sudanese patients who were clinically diagnosed as VL, attended to Ultrasound Department and were scanned for abdomen. Subject’s ages, duration of the disease, liver, spleen, lymph nodes, portal vein and inferior vena cava (IVC) diameter, presence of asites and plural effusion, echogenicity of kidneys and pancreas were evaluated. VL affected the age group 15 – 30 years in 20 patients (40%) constituting the high incidence and it was less common in age group <15 years (10%).The diseases was common in males (76%) than females (24%) with a ratio of (3.6: 1). The Eastern states constituted the high incidence of the diseases among the other states 27 (54.0%), and Khartoum State constituted the lower incidence 1(2%). Splenomegally, hepatomegally, lymphadenopathy were the most common ultrasound findings. Portal vein, IVC dilatations were less common and were significantly affected with duration of diseases at p value ˂0.0001. VL associated with asites and plural effusion was found in the sample and has statistically significant relation at p value˂ 0.02. Ultrasound detected changes in kidneys and pancreases echogenecity with prolonged disease duration. Ultrasonography has the capability of diagnosis of VL and by using ultrasound complications could be diagnosed earlier and treated before damaging the spleen, liver, lymph nodes or death to occur.

The role of abdominal ultrasound in the diagnosis of typhoid fever: An observational study

To study the usefulness of abdominal ultrasound in the diagnosis of typhoid fever and to determine the common ultrasound findings early in the course of the disease. Abdominal ultrasound examination was performed within the first week of initiation of symptoms in 350 cases with clinical diagnosis of typhoid fever. Subsequent ultrasound follow-up examination was done 15 days later (beginning of the third week). All the patients proved to have positive Widal test and Sallmonella culture. The study was performed in Erbil-Iraq from the period January 1993 to October 2010. The following ultrasound findings were reported: hepatomegaly (31.4%), prominent intrahepatic bile ducts (64.85%), splenomegaly (100%), mesenteric lymphadenopathy (42.85%), bowel wall thickening (35.71%), acalculous cholecystitis (16.28%), perforations (1.14%), and ascites in (3.4%). The current study showed that the findings are typical enough to justify initiation of treatment for typhoid fever when serology is equivocal and culture is negative, and is fairly safe to say that normal ultrasound examination early in the course of febrile illness rules out typhoid fever.

Prenatal diagnosis and postnatal outcome of fetal intracranial hemorrhage

The aim of this study was to present our experience with six cases of fetal intracranial hemorrhage (ICH) in terms of prenatal diagnostic features, and postnatal outcome. The database of prenatal diagnosis unit was searched for antenatally diagnosed ICH cases. Maternal characteristics, ultrasound (US), and magnetic resonance imaging (MRI) findings, clinical course, and postnatal outcome were noted. We evaluated six consecutive cases of fetal ICH. One case was terminated at 24 weeks, and remaining five cases were delivered between 34 and 38 weeks. Five cases (5/6) had intraventricular, and one (1/6) had intraparenchymal hemorrhage. Hemorrhages were right sided in five cases (5/6), left sided in one case (1/6). Dilated and echogenic ventricular wall were the common US findings. No predisposing factor was detected in four of the cases, and intrauterine growth restriction was an underlying factor in two fetuses. Intrauterine progression of the hydrocephaly, and parenchymal thinning was seen in four cases (4/6). In three of four cases (3/4) with progressive grade 3-4 hemorrhage and hydrocephaly, postnatal outcome were dismal, and one case had mild neurological impairment at three months. In one case which had non-progressive mild ventriculomegaly, the lesion regressed after 4 weeks, and had normal short-term outcome Fetal ICH can be accurately identified and categorized by antenatal sonography, and fetal MRI. Although intrauterine regression or normal short-term postnatal outcome is possible, the outcome is usually poor for fetuses with high grade and/or progressive lesions. Therefore, further studies assessing long-term postnatal outcome are needed.

Wilson's Disease among Children at King Hussein Medical Center

Results: A total of 37 patients diagnosed as Wilson's disease with age ranges between two and 13.5 years were included in this descriptive review. Out of 37 patients, 19 (51%) were males and 18 (49%) were females. Patients with affected siblings were 29 (78%). Central nervous system involvement was found among 9 (24.3%) patients. The commonest presenting symptoms were jaundice (n=16, 43%), abdominal distension (n=13, 35%), fatigue and delayed school performance (n=12, 32.4%). The most common clinical findings were hepatomegaly (n=26, 70%), jaundice (n=16, 43%), splenomegaly (n=14, 37.8%), Kayser-Fleischer ring (n=11, 29.7%), and lower limb edema (n=11, 29.7%) respectively. Low ceruloplasmin level was found in 34 (92%) patients, high liver enzymes in 23 (62%) patients, hemolytic anemia in 13 (35%) patients successively. Twenty-four hour urine collection average copper post Dpenicillamine challenging test was above 230µg/dl. The most common ultrasound findings were hepatomegaly, abnormal echogenecity, splenomegaly and ascitis. Liver biopsies commonly showed liver fibrosis, however fatty liver changes, hepatosteatosis and liver cirrhosis were the least common finding. Conclusion: Family screening is needed once a child in the family is diagnosed. Full investigations to rule out Wilson's disease should be performed in any patient with unexplained elevation of liver enzymes, hepatomegaly, hemolytic anemia, jaundice or neurological/behavioral disturbances.

Role of Ultrasound in Thyroid Pathologies

This is a retrospective study of thyroid patients referred for ultrasound for the period of 2007to 2009 at different hospitals and dispensaries in the Kingdom of Saudi Arabia (Eastern area). Importance of the study is ; to create a reliable reference for the role of ultrasound in thyroid pathologies in King Saudi Arabia. Study aimed to detect the Ultrasonic Differential Diagnosis of Thyroid pathologies. This study was carried out on 303 patients of various types of thyroid diseases in King Saudi Arabia.232 (77 %) were female patients and 71(23 %) were males. Along this series there were 25 % of enlarged thyroid gland which act as the most common ultrasound findings of thyroid disorders followed by, 23 % solitary thyroid nodules, 10 % multinodular goiters, 8 % simple cyst, 7 % nonpalpable thyroid nodules, 4 % goiter and Hashimoto's thyroiditis. The most common ultrasound findings of thyroid gland enlarged of thyroid. The least common is nodal enlargement, adenoma, thyroiditis, microcalcifications, small size thyroid, multiple thyroid nodules, thyroglossal cyst and Graves disease. Out of this study we believe more that ultrasound should be the first-line test owing to its safety and availability.

ULTRASONOGRAPHIC EVALUATION;

Objectives: To assess common presenting complaints and the role of ultrasound in evaluating neck masses in pediatric andadult population. Design: Cross sectional. Setting: Khyber X-Ray, 7 Khyber Medical Centre, Dabgari Gardens, Peshawar. Period: July 2011to December 2011. Material and Methods: Data from patients presenting for evaluation of a neck mass was analyzed for presentingcomplaints and ultrasound findings according to objectives of the study. Results: In total 105 cases were included in the study. The mean ageof patients was 36.8 years with a male to female ratio of 1:2.1. The age wise categorization included pediatric population (10.5%) adultpopulation (89.5%). Both painful and painless neck swellings were common presenting complaints in pediatric population with cervicallymphadenopathy being the most common ultrasound finding. Among Adult males painless neck swelling was the most common presentingcomplaint with cervical lymphadenopathy followed by Multinodular goiter being most common ultrasound findings. Most common presentingcomplaint in Adult females was painless neck swelling with Multinodular goiter being most common ultrasound finding. Conclusions: NeckMasses are commonly encountered in all age groups especially pediatric population and adult females, Ultrasound is a useful and safemodality in evaluation of neck masses.

Pain in patients with equal radiographic grades of osteoarthritis in both knees: the value of gray scale ultrasound

To investigate the association of ultrasound (US) features with pain and the functional scores in patients with equal radiographic grades of osteoarthritis (OA) in both knees. Fifty-six consecutive patients with knee OA: 85 symptomatic knees (81 knees with medial pain) and 27 asymptomatic knees, and 10 healthy patients without knee OA as a control were enrolled. US was done by two ultrasonographers blinded to patient diagnoses. US features were semiquantitatively scored (0-3) when appropriate. In the OA group, common US findings were marginal osteophyte, suprapatellar synovitis, suprapatellar effusion (SPE), medial meniscus protrusion, medial compartment synovitis (MCS), lateral compartment synovitis, and Baker's cyst. Only SPE and MCS were significantly associated with knee pain. Visual analog pain scale (VAS) scores on motion were positively linearly associated with SPE and MCS (P<0.01). Only MCS was degree-dependently associated with VAS scores at rest, the Western Ontario and McMaster Universities pain subscale, and the presence of medial knee pain (P<0.01) after adjustments for age, gender, body mass index (BMI), radiographic grade, and other US features. In the control group, no US features were associated with knee pain. US inflammation features, including SPE and MCS, were positively linearly associated with knee pain in motion. MCS was also degree-dependently associated with pain at rest and the presence of medial knee pain. These findings show that synovitis was one important predictive factor of pain. Further studies to confirm the association of US features and pain are warranted.

Perihepatic lymph node enlargement is a negative predictor of liver cancer development in chronic hepatitis C patients

Perihepatic lymph node enlargement (PLNE) is a common ultrasound finding in chronic hepatitis C patients. Although PLNE is considered to reflect the inflammatory response to hepatitis C virus (HCV), its clinical significance remains unclear. Between December 2004 and June 2005, we enrolled 846 chronic hepatitis C patients in whom adequate ultrasound examinations had been performed. PLNE was defined as a perihepatic lymph node that was at least 1 cm in the longest axis by ultrasonography. We analyzed the clinical features of patients with PLNE and prospectively investigated the association between PLNE and hepatocellular carcinoma (HCC) development. We detected PLNE in 169 (20.0%) patients. Female sex, lower body mass index (BMI), and HCV serotype 1 were independently associated with the presence of PLNE. However, there were no significant differences in liver function tests, liver stiffness, and hepatitis C viral loads between patients with and without PLNE. During the follow-up period (mean 4.8 years), HCC developed in 121 patients. Unexpectedly, patients with PLNE revealed a significantly lower risk of HCC development than those without PLNE (p = 0.019, log rank test). Multivariate analysis revealed that the presence of PLNE was an independent negative predictor of HCC development (hazard ratio 0.551, p = 0.042). In addition, the sustained viral response rate in patients who received interferon (IFN) therapy was significantly lower in patients with PLNE than in patients without PLNE. Patients with PLNE had a lower risk of HCC development than those without PLNE. This study may provide new insights into daily clinical practice and the pathophysiology of HCV-induced hepatitis and hepatocarcinogenesis.