Convex Probe Research Articles

Point-of-Care Ultrasound-Guided Versus Conventional Bladder Catheterization for Urine Sampling in Children Aged 0 to 24 Months.

It can be difficult to obtain urine samples, especially in children aged 0 to 24 months who have not yet completed toilet training. Bladder catheterization is a common method for urine sampling in this age group. However, if the bladder is not adequately filled, this process fails and repeat catheterization is necessary. Point-of-care ultrasonography (POCUS) is often used to assist invasive procedures in the pediatric emergency department. This study aimed to compare success rates of bladder catheterization in patients with and without POCUS to guide the timing of the procedure. This was a prospective cohort study of children 0 to 24 months presenting to a pediatric emergency department in a tertiary center hospital. Patients were divided into 2 groups; the one group received conventional catheterization (CC group) without POCUS and the other group had catheterization after POCUS (POCUS group). The transverse and anterior-posterior diameter measurements of the bladder were obtained from one view in the transverse orientation using the (6-3 MHz) convex probe. Successful catheterization was defined by obtaining 3 mL or more of urine. A total of 110 patients were included in the study, with 56 in the POCUS group and 54 in the CC group. There was no difference between the mean age and sex of the groups. The success rates of obtaining urine samples were 93% and 78% in the POCUS group and CC group, respectively. This difference was statistically significant (P = 0.03). No significant difference was found between measurements of bladder catheterizations with and without obtaining 3 mL or greater urine volumes in the ultrasound group (P > 0.05). The use of POCUS during bladder catheterization in children was found to be effective and successful. In addition, the detection of any amount of urine in the bladder using POCUS increases the success rate of bladder catheterization.

The Visual Measurement of Velocity Profile Distribution in Silt Carrying Flow by Using Ultrasound PIV and Iterative Multi-Grid Deformation Technique

Flow velocity in silt carrying flow is one key parameter to many river engineering problems. A visual measurement technique of velocity profile distribution in silt carrying flow is provided using a portable ultrasound imaging system and an improved iterative multi-grid deformation algorithm. A convex array probe in the system is used to obtain a series of ultrasonic images at different times. Window offset and an iterative computing scheme for reducing interrogation window size in the algorithm improve the accuracy and efficiency of flow velocity measurement in regions with velocity gradients. Results show that the measured profile velocities can be more acceptable after being compared with time-averaged stream-wise velocities of profiles at ten positions in the same silt carrying flow and subsequently verified by comparing the point-by-point standard value. The measured velocity is more in agreement with the theoretical value, with the minimum root mean square error in the ultrasound beam sweep effect calculated by using optimal interrogation size parameters. The system is a feasible alternative to the single-point measurement technique in silt carrying flow. The iterative multi-grid deformation algorithm can analyze velocity profile distribution with gradients simultaneously, which can help the real-time measurement of multiple spatial velocity distribution and turbulence.

Sonographic Association Between Fatty Liver and Gall Baldder Stone

Background : Fatty liver (chronic liver disease) was most frequently found associated with gall stones. It arises due to accumulation of lipid in hepatocytes mainly triglyceride. Due to high existence of obesity in the population, the risk of fatty liver and gall stones also increases. In Pakistan the prevalence of fatty liver was 15-20 %. Fatty liver and gall stones could easily be observed on ultrasound. Objective: To evaluate the sonographic association between fatty liver and gall bladder Stone. Study Design : Descriptive Study was conducted Settings: Sanabil health services. Lahore Period: Four months Material & Methods: In our study patients presents with epigastric pain high cholesterol level and previous history of gall stones.While patient with the history of cholecystectomy were excluded. All the data had been composed from Sanabil Health Services Lahore. After informed consent, data was composed through ultrasound machine GE LOGIQ P7 with convex probe (frequency 2.5- 5MHZ) Results: According to results total volume of patient was 220. Now we were comparing between cholelithiasis and grading of fatty liver. Total no of GRADE 1 fatty liver patients were 63 out of 220 in which 13 patients were showing absence of GS while 50 patients showed GS. Total no of GRADE II fatty liver patients were 89 out of 220 in which 36 patients were showing absence of GS while 53 patients showed GS. Total no of GRADE III fatty liver patients were 68 out of 250 in which 20 patients were showing absence of GS while 48 patients showed GS. Total no of 69 out of 220 patients showed absence of GS while 151 patients out of 220 showed with GS. Conclusion: We concluded that the patients who had high cholesterol level, gall stones are associated with fatty liver disease. Moreover fatty liver disease was more common in females than males. Keywords : Nonalcoholic fatty liver, chronic liver disease, Gallbladder, Gall stones, Ultrasound and cholecystokinin. DOI: 10.7176/JHMN/91-09 Publication date: July 31 st 2021

A Quick Method of Phase Fitting in RF Segmented Demodulation

Ultrasound image of B-mode is reconstructed by DC(Direct Current) removal, quadrature demodulation, low-pass filtering, envelope detection and scanning conversion. Demodulation is the most important of the above. Because of the diversity of human organs and their corresponding acoustic properties, the shift frequency of echo signal changes as the depth increases. For a more accurate recovery signal, segmented function is used to describe the process. Traditionally, polynomial fitting or smooth spline was used to eliminate the discontinuity between the neighbor segment. In this brief, a phase-based quick-fitting method is proposed to optimize the step. Experimental investigation revealed that the phase fitting is applied to the linear array, and the mean-variance is 0.0002( MHz <sup xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">2</sup> ) compared with the smooth spline( 0.0033MHz <sup xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">2</sup> ). For convex probe, the mean-variance( 0.0005MHz <sup xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">2</sup> ) is also smaller than that of polynomial fitting( 0.0046MHz <sup xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">2</sup> ). Otherwise, this algorithm can overcome the boundary oscillation caused by frequency fitting. Especially, the results are stable even if the number of segments is large. Complex calculations are not required, the process can be implemented regardless of software and hardware.

Comparison of Radiologic Diagnosis with surgical findings in 900 pts of acute appendicitis at AIMH, Sialkot

Aim: To compare the radiological diagnosis with surgical findings of acute appendicitis Methods: This study included patients presenting with the complaint of pain in the right iliac fossa suggestive of acute appendicitis. The criteria for inclusion; twelve to sixty-five years of age, the existence of pain in the abdomen especially right iliac fossa or lower quadrant. Patients who presented with shock were excluded. Subjects suspected of acute appendicitis were referred for ultrasonography, which was carried out by a senior radiologist. A linear and convex probe was used for ultrasonography. Patients with insignificant findings on ultrasonography were evaluated for pain in the lower right quadrant. Those with ultra-sonographic findings strongly suggestive of acute appendicitis underwent a further evaluation to rule out complications. Results: Our study is based on 900 patients who fulfilled criteria of inclusion, age ranged from 6-55 years (mean 35±6.9 years) male to female ratio (2.22:1), 1036 ultrasonographic scans were done in these patients, 964 urine routine examination. The radiological confirmation of acute appendicitis 723, while clinical diagnosis of 900 patients leading to operative intervention. Laparoscopic appendectomy was done in 288 patients while open surgery in 612 patients. Histopathology of specimen of all the patients were obtained. In sonographic findings, appendix was visualized in 723 (80.33%) patients, uncompressible tubular structure in 723(80.33%), fluid in right iliac region 118(13.11%), mesenteric node enlargement in 103(11.44%), high up subhepatic appendix in 23(2.55%), and mass formation in 24(2.66%) patients. The surgical operative findings in the patients are as: hyperemic swollen appendix 648(72%), Blackened/ gangrenous appendix 84(9.33%), Appendix with pus in surrounding area 57(6.33%), appendix swollen with enlarged mesenteric lymph nodes 210(23.33%), Perforated appendix 58(6.44%), Early mass formation 35(3.88%) and Subhepatic appendix 23(2.55%). Conclusion: Ultrasonography being non invasive investigation is advised to diagnosis appendicitis. It has optimal sensitivity and for its diagnosis and suitable diagnostic method for assessing complications of appendicitis. The false negative diagnosis at ultrasonography for acute appendicitis is quantified as 14.44% with accuracy or sensitivity of 85.46%. Keywords: Appendicitis, incompressible, tubular structure, clinical diagnosis.

Frequency of Placenta Previa on Ultrasonography in Females with History of Caesarean Section

Background: Placenta previa (P.P) is a condition where the lower edge of the placenta lies close to the internal os. It may partially or completely cover the internal os. Objectives: To determine the frequency of placenta previa on ultrasonography in females with history of Caesarean section. Methodology: This descriptive study was held in Ghurki Trust Teaching Hospital Lahore and Tehsil Headquarter Hospital, Pattoki. Convex Probe Esotae 2.5 5-7MHz and Logiqv3 (5-7MHz) was used in the study. 140 pregnant women with history of previous Caesarean section were included in the study and were examined through convenient sampling. Data was collected after signing the consent form. Statistical software for social sciences (SPSS version 22.0) is used for the analysis of data. Results: According to the data analysis, minimum age patient was of 18 years and maximum age was 41 years. 37(26.4%) women had 1 previous Caesarean section. 57(40.7%) women had 2, 31(22.1%) women had 3, 15(10.7%) had 4 of previous Caesarean sections. 86(61.4%) women had a history of bleeding. 54(38.6%) women had no history of bleeding. According to analysis of placenta previa, 126(90.0%) women did not have a placenta previa and 14(10.0%) women had placenta previa. Cross tabulation analysis between frequency of patients with placenta previa and previous Caesarean cases evaluated that 126 patients with previous Caesarean rate did not placenta previa confirmed on ultrasound whereas 14 patients with previous Caesarean section had placenta previa on ultrasound. Conclusion: Placenta previa is seen in ten percent of subsequent pregnancies in females who have a history of previous Caesarean section.

Sonographic Measurement of Spleen to Left Kidney Ratio among Saudi Children

Objective: Spleen length varying according to many factors such as individual height, age and weight, determination of mild splenomegaly might be extremely inaccurate. The goal of this study was to determine the spleen to left kidney ratio in different age group among school age children in Saudi Arabia.&#x0D; Methods: A cross sectional study was conducted on 150 healthy subjects (66 boys and 84 girls) their age ranged from 7 to 15 years. The study was conducted at the Taawon clinic in Kharj city, Saudi Arabia. The sonographic examination was performed using Siemens (Acuson X300) machine with convex probe (3.5 – 5 MHz). Spleen and left kidney lengths were measured as well as weight and height of the subjects.&#x0D; Results: The result of the study showed that there is no significant different between boys and girls regarding spleen and left kidney lengths (p &gt; 0.05). The spleen to left kidney ratio was found to be about 1.1 with 1.3 as the normal upper limit in the study sample.&#x0D; Conclusion: Spleen to left kidney length ratio becomes a promising method to detect non palpable splenic enlargement. Mild splenomegaly is considered if the spleen to left kidney ratio is greater than 1.3 in the absence of kidney disorders.

Effect of Chlorhexidine Mouthrinse on Prevention of Microbial Contamination during EBUS-TBNA: A Study Protocol for a Randomized Controlled Trial.

BackgroundEndobronchial ultrasound‒guided transbronchial needle aspiration (EBUS-TBNA) is a standard diagnostic method for mediastinal and hilar lymphadenopathy. Although rare, fatal infectious complications can occur following EBUS-TBNA. However, to date, there is a lack of effective preventive strategies to reduce these complications. We started a trial to investigate the effect of chlorhexidine mouthrinse on the prevention of microbial contamination during EBUS-TBNA.MethodsThis study is a single-center, parallel-group, assessor-blinded randomized controlled trial (RCT). We will enroll 112 adult participants undergoing EBUS-TBNA using a convex probe, and randomly assign them to two groups at a 1:1 ratio. The intervention group will gargle for 1 minute with 100 mL of 0.12% chlorhexidine gluconate before EBUS-TBNA, while the control group will have no mouthrinse before the procedure. Immediately after completion of EBUS-TBNA on all targeted lesions with an aspiration needle, a needle wash sample will be taken by instilling 5 mL of sterile saline into the used needle. The primary outcome is colony forming unit (CFU) counts in aerobic cultures of the needle wash samples. Secondary outcomes are CFU counts in anaerobic cultures, fever within 24 hours after EBUS-TBNA, and infectious complications within 4 weeks after EBUS-TBNA.ConclusionThis trial was designed as the first RCT to investigate the effect of chlorhexidine mouthrinse on the prevention of microbial contamination during EBUS-TBNA. Results from this trial can provide clinical evidence for a simple, safe, and cost-effective strategy to prevent infectious complications following EBUS-TBNA (ClinicalTrials.gov ID: NCT04718922, registered on 22 January 2021).

Ultrasound Elastography in the Differentiation of Simple Cyst and Type I Hydatid Cyst of the Liver.

Hydatid cyst (HC) is a parasitic disease that is endemic particularly to the sheep-breeding regions of the world, our country included. Given their propensity to materialize most commonly in the liver, our study evaluates the value of ultrasound elastography in the differential diagnosis of simple cyst and type I HCs of the liver.The study involved a total of 73 cysts (22 simple cysts, 51 type I HCs) that were removed using the puncture aspiration injection reaspiration technique between 2016 and 2018. All measurements were made using a Siemens ACUSON S2000 (Siemens Healthcare, Erlangen, Germany) device with a 4-MHZ 4C1 convex probe, an acoustic radiation force impulse elastography procedure, and a Virtual Touch IQ option. The difference between the mean shearwave elastography (SWE) values of both groups was analyzed with an independent t test.Of the 70 patients involved in the study, 29 were female and 41 were male, with a mean ± SD age of 38.85 ± 17.62 years (range, 5-82 years). Upon the examination of the 22 simple cysts and the 51 HCs, the mean ± SD SWE values were found to be 2.6 ± 0.96 (0.96-4.25) and 2.8 ± 1.69 (0.66-4.84), respectively. No statistically significant difference was identified between the SWE values of type I HCs and simple cysts (P > 0.005).Although HCs and simple cysts had similar radiological appearances, and a relative difference was noted in the differentiation of the elastographic measurements, this difference was not statistically significant. Accordingly, more comprehensive and various studies are needed.

41 Macleaya cordata phytotherapic supplementation can modulate immune response in ponies fed a high starch diet

High amounts of grains in equine diet lead to an excessive starch intake modifying microbial populations and fermentative products. These changes could compromise the gastrointestinal barrier which has serious consequences for equine health. Therefore, feed additives are receiving great attention to minimize negative effects related to high starch level inclusion. Macleaya cordata compounds are being used in animal nutrition for their multiple biological effects, including anti-inflammatory and antibiotic properties. However there is no information about effects on horses. The aim of this study was to evaluate effects of increasing levels of a Macleaya cordata commercial phytotherapic on gastrointestinal tract and systemic inflammation of ponies fed a high starch diet. Eight gelding ponies, Mini-Horse breed, healthy, mean age 8.59+0.17 years old and mean body weight (BW) 146.72+16.53 kg were used. Experimental design was contemporary double Latin-square 4 × 4. Experimental unit was the animal inside each experimental period (n = 8 units per treatment). Each experimental period lasted 20 d. Diet attended daily maintenance nutritional requirement of 1.75% BW in dry matter in a concentrate:roughage proportion of 60:40. Daily starch amount was 4.4 g/kg BW, divided in 2 meals. Water and mineral salt were provided ad libitum . Animals were separated in 4 groups: 1) Control: concentrate without food additive, 2) S1: concentrate with 1 mg of phytotherapic/kg BW, 3) S1.5: concentrate with 1.5 mg of phytotherapic/kg BW, 4) S2: concentrate with 2 mg of phytotherapic/kg BW. Right dorsal colon wall thickness was measured by ultrasonography to determine local inflammation at 9:30 a.m. on d 20. Esaote MyLab TM Delta and a micro convex probe were used. Best image was selected using MyLab TM Desk3 software and 3 measures were taken for mean. For systemic inflammation, blood samples were collected at 9 a.m. on d 19. Fibrinogen was dosed by heat precipitation method and interleukins 6 and 10 gene expression in peripheral blood mononuclear cells (PBMC) was obtained using qPCR. Data were analyzed by Statistical Analysis System program with PROC MIXED. Significant level was 5%. Intestinal wall was thinner ( P = 0.0071) in all treated groups (Control: 3.08 mm; S1: 2.59 mm; S1.5: 2.53 mm; S2: 2.44 mm). There were no statistical differences between groups for systemic inflammatory parameters. In conclusion, Macleaya cordata commercial phytotherapic addition in high starch equine diet modulates local immunity, but has no impact on systemic inflammation.

Technical feasibility and correlations between shear-wave elastography and histology in kidney fibrosis in children.

Ultrasound elastography has been suggested for assessing organ fibrosis. To study the feasibility of shear-wave elastography in children with kidney disease and the correlation between elasticity and kidney fibrosis in order to reduce the indications for kidney biopsy and its complications. Four operators measured kidney elasticity in children with kidney diseases or transplants, all of whom also had a renal biopsy. We assessed the feasibility and the intraobserver variability of the elasticity measurements for each probe used and each kidney explored. Then we tested the correlation between elasticity measurements and the presence of fibrosis. Overall, we analyzed 95 children and adolescents, 31 of whom had renal transplant. Measurements with the convex probe were possible in 100% of cases. Linear probe analysis was only possible for 20% of native kidneys and 50% of transplants. Intraobserver variabilities ranged from moderate to high, depending on the probe and kidney studied. Elasticity was higher with the linear probe than with the convex probe (P<0.001 for left kidney and P=0.03 for right kidney). Measurements did not differ from one kidney to another in the same child. Elasticity and fibrosis were both higher in transplant patients (P=0.02 with convex probe; P=0.01 with linear probe; P=0.04 overall). There was no correlation between elasticity and fibrosis. Of the devices used in this work, kidney elastography was more accurately analyzed with a convex probe. Our study did not identify any correlation between elasticity and kidney fibrosis.

Endobronchial Ultrasound Improves the Diagnosis of the Tracheobronchial Invasion of Advanced Esophageal Cancer.

Accurate diagnosis of the tracheobronchial invasion of advanced esophageal cancer is essential to select appropriate treatment and improve prognosis; however, it is difficult using the conventional modalities. This study aimed to clarify the diagnostic usefulness of convex probe endobronchial ultrasound (CP-EBUS) for the diagnosis of the tracheobronchial invasion of advanced esophageal cancer. We conducted a cadaveric study to clarify the changes in ultrasonic and histopathologic findings in the esophageal tumor and tracheal invasion models. Additionally, we examined CP-EBUS for patients with advanced thoracic esophageal cancer in whom tracheobronchial invasion was suspected on contrast-enhanced computed tomography (CE-CT) scan. We retrospectivity evaluated the diagnosis of CP-EBUS, comparing the pathological findings and treatment outcomes. Cadaveric esophageal tumor and tracheal invasion models showed the disappearance of the third layer observed with CP-EBUS and histologically proven interruption of the adventitia. This indicated that the third layer corresponded with the tracheal adventitia. We examined 40 patients with advanced thoracic esophageal cancer in whom tracheobronchial invasion was suspected. The precise diagnosis was pathologically confirmed in 9 of 14 patients diagnosed with cT3 who underwent radical surgery. 20 of 26 cases diagnosed with cT4b received definitive chemoradiotherapy, and 4 cases received salvage surgery and pathologically confirmed precise diagnosis. CP-EBUS is extremely useful for diagnosing the tracheobronchial invasion of advanced esophageal cancer. It could be an effective modality for determining treatment strategies in cases with a marginal surgical indication.

Ultrasound-Guided Transthoracic Mediastinal Biopsy: A Safe Technique for Tissue Diagnosis in Middle- and Low-Income Countries.

Background and objectivesThe high cost of video-assisted transthoracic procedures precludes their use in the diagnostics of mediastinal masses in low- and middle-income countries (LMICs). This study aims to assess the technical success rate and diagnostic yield of ultrasound-guided transthoracic mediastinal biopsies at a tertiary care hospital.MethodsThis descriptive cross-sectional study was conducted in patients presenting with mediastinal masses referred to radiology services at Dr. Ziauddin University Hospital. Karachi, Pakistan. Ultrasonography was performed using Toshiba Xario 200 & Aplio 500 using convex and linear probes accordingly. Biopsy was performed using a combination of 18G semiautomatic trucut and 17G co-axial needles. Complications and overall diagnostic yields were determined.ResultsIn all 70 patients referred, the procedure was completed successfully with an overall procedural yield of 95.7%. Inconclusive biopsies due to inadequate specimen were seen in two (4.2%) patients. No post-procedure major complication or mortality was observed. Minor complications were seen in three (4.2%) out of 70, including hematoma (<3 cm) in one patient and small pneumomediastinum in two patients.ConclusionUltrasound-guided transthoracic mediastinal biopsy may be the pragmatic technique of choice in LMICs for the diagnosis of mediastinal masses as they provide real-time visualization and is cost-effective and safe.

Recent advances in convex probe endobronchial ultrasound: a narrative review.

Convex probe endobronchial ultrasound (CP-EBUS) has been widely used in the lymph node staging and restaging of lung tumors and the diagnosis of mediastinal diseases. Recent years have seen continuous progress in this technology. For diagnosis, elastography technology can preliminarily distinguish between benign and malignant lesions, so that reduce the number of punctures. CP-EBUS can also be used as an endoscopic ultrasound (EUS) to guide needle aspirations of liver lesions, retroperitoneal lymph nodes and left adrenal gland (LAG) lesions sometimes. Some advances help diagnosing more accurately and effectively, such as the intranodal forceps biopsy (IFB), the new type of 22G needle, the rapid on-site evaluation (ROSE) and the cancer gene methylation, etc. In addition, special advances are being made in diagnosis using artificial intelligence (AI). For treatment, CP-EBUS has yielded novel research results when applied to transbronchial needle injection (TBNI) and radioactive seed implantation in clinical cases, and blocking of the cardiac plexus in animal studies. The next-generation CP-EBUS is also ready for use in the clinic and the technology will be improving continuously. Through this review, we hope to educate clinicians on the latest uses of CP-EBUS and open up further research ideas for readers interested in this technology.

GALLBLADDER STONES SPECTRUM IN SAUDI POPULATION BY USING ULTRASONOGRAPHY

Objective:This study was designed with an aim to determine the incidence of gallbladder stonesandto evaluate the accuracy of ultrasonography in the diagnosis of calculus, occur in Saudi patients whom presents at the Radiology and Ultrasound Department. Materials and method: Retrospective study in the period 22 August 2020 to 22 December 2020, a total of 108 patientsunderwentultrasound. When the gallbladder is investigated using ultrasound imaging (US) modality. Ultrasound instrument used was spatial digital U22 Philips Convex probe 3.5 Data analysis performed using the tables and computerized systems,ultrasound using different types of ultrasound units with 3.5 MHz and 5 MHz curve linear probes.Statistical analysis was performed using Microsoft Excel Software and the Standard Statistical Package for the Social Sciences version 15 for windows. Result: Out of 108 examined samples [mean age of 29 years male to female ratio of .9:1].Gallstones in this study were more common in the age range from 2 to 39, (58.3%).The most common causes of gallbladder stones are, 0ral contraceptives44(40.7%),Cholesterol28 (25.9%),Biliary dyskinesia 17 (15.7%),Diabetes 12 (11.1%),and Spinal cord injury7 (6.5%)one of the commonest complaints is upper abdominal pain,52(48.1%) and in majority of the cases the etiology is treatable,Nausea30 (27.8%) andVomiting 26(24.1%).Confirmation is done by CT scan 20 (18.5%) for the cases of small gall stones (&lt;2mm) and impacted stones in cystic duct and operations, Cholecystectomy 14(13%) were done for stones large than (&gt;2 cm), who have a nonfunctional or calcified (porcelain) gallbladder and patients for spinal cord injured. Conclusion: Ultrasound (US) is the preferred method for evaluating gallstones with 96% accuracy. The number, size and calcification can be evaluated by virtue of US inversion and attenuation. If there are more than five stones, the accuracy decreases.

Middle-aged Man Recovering from COVID-19 Pneumonia

A 63-year-old man underwent follow-up after having coronavirus disease 2019 pneumonia. He was asymptomatic, with a respiratory rate of 16 breaths/min and oxygen saturation of 97% on room air. He had a number of fine scars on his back. While conducting the lung ultrasonographic examination with a convex probe, the physician observed some superficial unexpected vertical shadows and switched to a high-frequency linear probe. The physician detected a small horizontal hyperechogenic line in the subcutaneous tissue, approximately 1 cm below the skin surface, with posterior acoustic shadowing (Figure 1). There were multiple similar lesions in proximity to the scars. Interviewing the patient, we learned that he had undergone a hunting accident 20 years ago, and chest radiography confirmed the presence of multiple pellets (Figure 2).Figure 2Chest radiograph showing multiple millimetric round particles located throughout the thorax and with metallic density.View Large Image Figure ViewerDownload Hi-res image Download (PPT) Shotgun pellets. In other case reports, lead shotgun pellets have been described as focal echogenicities with strong posterior reverberation echoes.1Amazeen P.G. Whitehead F. Questo W. Ultrasonic appearance of lead shotgun pellets in liver.J Clin Ultrasound. 1981; 9: A31-A32Crossref PubMed Scopus (3) Google Scholar,2Li Q. Deng D. Tao J. et al.Ultrasonic imaging of gunshot wounds in pig limb.Genet Mol Res. 2015; 14: 4291-4302Crossref PubMed Scopus (6) Google Scholar

Ultrasonography-guided post-pyloric feeding tube insertion in medical intensive care unit patients.

In this study, we investigated placement rate, complication rate and time spent of successful post-pyloric enteral feeding (PPEF) tube insertion procedure guided by ultrasonography (USG). The patients who required enteral nutrition and who admitted to medical intensive care unit (MICU) of Gazi University Hospital were included to this single-center, prospective, cohort study. It was aimed to insert the enteral feeding tube into the proximal duodenum as the post-pyloric area by ultrasonography guidance. During the PPEF tube insertion procedure, the linear probe was used to display the proximal esophagus and the convex probe was used to display the post-pyloric area, antrum and pyloric channel. 33 patients were included in this study. The median age was 68 [IQR 52-79] years. There were 17 (51.5%) woman and 22 (66.7%) intubated patients. The enteral feeding tube was successfully passed into the post-pyloric area in 29 (87.9%) patients with this technique. The median time of successful feeding tube insertion was 14 [IQR 10-25] min. The median level of the enteral feeding tube was 74 [IQR 70-76] cm. in successful placement. There was no significant difference in insertion time according to gender (female vs male; 10 [IQR 8-20] min. vs 17 [IQR 12-25] min., p = 0.052) and endotracheal intubation status (intubated vs non-intubated; 14 [IQR 10-25] min. vs 12 [IQR 10-25] min., p = 0.985). Only one complication was seen during study (self-limiting epistaxis in one patient). PPEF tube insertion under USG guidance could ensure the initiation of enteral feeding safely and rapidly without exposure to radiation in ICU patients.

The incidence and distribution of anomalies found in the pregnant women applied to Kayseri City Hospital for obstetric ultrasound in 2019: a retrospective analysis

Objective Our aim is to determine the incidence and distribution of anomalies found in the pregnant women referred to the first obstetric radiology outpatient clinic of our hospital for ultrasound (US) examination in 2019. Methods A total of 5661 obstetric US examinations were performed in 4018 pregnant women, 588 of whom were foreigners, for routine control, follow-up and screening purposes between January 1 and December 31, 2019, and their results were analyzed retrospectively after obtaining the approval of ethics committee. All US examinations were conducted by a single radiologist (ŞT) with Canon Aplio 500 ultrasound device (Canon Medical Systems Corporation, Tokyo, Japan) using 3.5 Mhz convex probe. The results of the cases with anomalies were accessed and grouped systematically, and their incidence and distribution were reviewed by comparing with the literature. Results As a result of the reviewed obstetric US examinations, a total of 62 fetuses with anomalies, 17 of whom were from the foreign pregnant women, were found to have anomalies. Of these anomalies, 29 were craniospinal, 10 were genitourinary, 6 were cardiac, 6 were skeletal, 3 were gastrointestinal, 2 were thoracic and 6 were unclassified. The pregnant women were between 17 and 43 (27.5±7.21) years old and their weeks of gestation were varying between 11 and 39 (22.3±8.63) weeks. There were 8 (13%) pregnant women younger than 20 years old, 43 (69%) pregnant women between 20 and 35 years old, and 11 (18%) pregnant women older than 35 years old. Anomaly diagnosis was established during first trimester in 14 (22.5%) fetuses, 26 (42%) fetuses during second trimester, and 22 (35.5%) fetuses during third trimester. Conclusion We found in our study that the incidence of fetuses with congenital anomaly was 1.54% in total, 2.89% in foreigners and 1.31% in Turkish citizens. The most common anomaly is acrania with 7 (0.15%) cases, and the diagnosis was established during first trimester in six of them. Detailed fetal screening during first trimester is very important for the detection of non-chromosomal anomalies. However, second- and third-trimester examinations are also important for the accurate diagnosis in pregnancies without follow-up.

Thyroid cancer diagnosis with transdermal probe 22G U/S versus EBUS-convex probe TBNA-B 22G and 19G: pros and cons

ABSTRACT Introduction Thyroid cancer is usually diagnosed both with imaging techniques and transdermal biopsy. Laboratory tests are also included in the initial work-up. Patients and Methods One hundred and thirty patients were included in our study with pathological imaging findings in the thyroid region. Biopsies were performed with 22 G with transdermal convex probe, EBUS 22 G Mediglobe® needle and 19 G Olympus® needle. We investigated the efficiency and safety of both techniques and identified the best candidates for each method. Discussion 19 G needle identified cancer types such as; Lymphoma, Medullary thyroid cancer, and Hurthle cell cancer, which we know from previous pathology studies that a larger sample is necessary for diagnosis. No safety issues were observed for both techniques and the EBUS technique produced more cell block material when 22 G needle was compared to transdermal biopsy in peritracheal lesions. Conclusion The method of biopsy should be made based on the size and accessibility of the lesion.

Endoscopic transoesophageal fine-needle aspiration with convex probe bronchoscope for diagnosis of coeliac lymphadenopathy.

EUS-B-FNA is a feasible and accurate technique for diagnosis of extrathoracic lesions https://bit.ly/34TFMR8