Echogenic Line Research Articles

OP13.01: The tracheal print: A prenatal sonographic clue to assess the atretic portion in oesophageal atresia

Oesophageal atresia (OA) is rarely diagnosed prenatally. Sonographic evaluation of the fetal oesophagus is rarely reported in the literature. When suspected, it is always difficult to confirm it. In most of cases, OA is evoked in the presence of indirect sonographic features, such as polyhydramnios associated with a small or non-visualized fetal stomach. However, the prenatal evaluation of the length of the atretic oesophageal portion is never reported. This is still challenging and need to be detailed for an appropriate counselling, especially in OA of type I. Cases series 3 patients were referred in our centres for polyhydramnios and non-visualized fetal stomach during morphological scan. Targeted ultrasound (US) of both fetal cervical and thoracic structures was performed in each case. The prenatal diagnosis of oesophageal atresia (OA) was made in all cases. The evaluation of the upper part of the oesophagus was made indirectly during fetal swallowing with the presence of the “pouch sign”. The atretic portion was assessed directly thanks to the interruption of the four parallel echogenic lines that correspond to the apposition of the collapsed anterior and posterior oesophageal walls, but also indirectly thanks to the presence of “the tracheal print”. This finding could correspond to an abnormal posterior shift of a limited portion of the posterior wall of the trachea, near the atretic portion of the oesophagus. In all cases, the expected length of the gap was correlated either postnatally and with postmortem analysis. It is now possible to detail directly or indirectly the atretic portion of the oesophagus in case of OA. We have to provide this information to the surgeon for an appropriate counselling.

Frequently encountered cranial ultrasound features in the white matter of preterm infants: Correlation with MRI

Background Bilateral symmetrical echogenic and echolucent areas in the white matter are frequently seen on the cranial ultrasound scans of apparently well preterm infants without overt pathology. Aim To determine whether these features reflect maturational processes as seen on MRI. Methods Preterm and term-born infants without overt pathology on contemporaneous brain ultrasound and MRI were studied. Ultrasound scans were compared with T 2-weighted MRI to identify MR correlates for the bilateral and symmetrical echogenic and echolucent phenomena in the white matter seen on ultrasound. Results Forty-four sets of scans (26 preterm, 8 term-born infants) were assessed. Echogenic features were better and more frequently seen on early ultrasound as compared to nearer term age. Echogenic blushes in the white matter correlated well with high signal intensity areas and echogenic lines with low signal intensity lines on MRI. Echolucent areas correlated with the site of the internal capsule and the myelinated posterior pons. The subplate was not reliably identified. Conclusion Many echogenic and echolucent features in the white matter of well preterm and some term-born infants correlated well with areas of differing signal intensity on MRI. They most likely reflect normal maturational processes but the echogenic hemispheric features may represent delayed or abnormal maturation.

Radiation induced carotid vessel injury in patients with nasopharyngeal cancer

17016 Background: Late radiation induced toxicity is mostly related to radiation effect on microvasculature of the tissues. Although the pathophysiology and consequences of radiation injury to the microvasculature of tissues is well-known, the same is not true for large vessels. The consequences of radiation induced large vessel injury as in the carotid arteries can be severe and life-threatening. Recognition and awareness of radiation induced carotid artery changes and its consequences by oncologists are important during follow-up of these patients. Methods: 32 patients with nasopharyngeal carcinoma treated with radiotherapy were evaluated by Doppler ultrasonography (USG) of the neck for the evidence of carotid artery injury. The time interval between the evaluation and treatment was 1–10 years (mean 5,2 years). Radiation doses to the nasopharynx were between 66 to 70 Gy, to the neck 50 to 70Gy, and 50Gy to the supraclavicular lymphatics. Carotid artery injury was evaluated by intima- media thickness (IMT). IMT was defined as the distance between the echogenic line representing the blood-intima interface and the echogenic line representing the media-adventitia interface. Results: IMT values did not differ significantly with radiation doses (50–60 Gy and 60- 70 Gy). No difference was observed with respect to sex. However there was significant statistical correlation between IMT values and age at the time of irradiation (≤40 and >40), time interval after radiotherapy (≤5 and >5 years), cigarette smoking, hypertension, blood cholesterol and low density lipoprotein levels. Conclusions: Radiotherapy to the head and neck area is a risk factor for vascular disease. Irradiation produces a thickening of the intima-media complex with narrowing of the carotid artery lumen. Transient ischemic attack and stroke are the serious consequences of radiation induced carotid artery injury. Hypertension, diabetes, high blood cholesterol levels, cigarette smoking and old age increase the risk of radiation induced carotid artery damage. Attention must be paid to identify and modify these risk factors together with screening Doppler ultrasonography in order to prevent possible future complications. No significant financial relationships to disclose.

Can pleurisy be detected with ultrasound?

It was the aim of this study to examine whether chest sonography is a useful method for diagnosing infective pleuritis. We assessed the pleural surface, the presence of subpleural consolidations and of pleural effusions. 47 consecutive patients with the clinical diagnosis of pleuritis were examined by means of a 7 MHz linear transducer. We studied the pleural surface, the presence of subpleural consolidations and of pleural effusions. Pathologic findings could be seen in 43 patients (91%). The smooth echogenic pleural line was interrupted and was rough in appearance in 42 patients (89%). Subpleural consolidations from 0.2 to 2 cm in size were observed in 30 cases (63.8%). In 11 (23.4%) of these lesions, colour Doppler signals could be demonstrated. Pleural effusions were visible either as localised pleural effusions (24 patients, 51%) or as basal effusions (11 cases, 23.4%). Aspiration of pleural fluid was performed twice. In one case the diagnosis of tuberculosis could be proven by fast acid stain, in another patient a pleural empyema was drained successfully under ultrasound guidance. In 5 patients therapeutic consequences resulted from sonographic findings. We conclude that chest sonography is a sensitive and cost effective imaging method for the diagnosis of pleuritis. Aspiration of pleural fluid for further diagnostic or therapeutic procedures can be safely performed.

Experimentelle Meniskussonographie: Einfluß der Abbildungsgeometrie auf die Nachweisbarkeit von Meniskusläsionen

Specific meniscal tears were set on prepared cadaver knees to examine the influence of projection factors on the visualisation of these lesions via ultrasound. 7.5 MHz sector- and linear scanner were used. It showed that both the extent of the lesion and also the angle between outgoing echo-direction and reflection plane determines the sonographic findings of meniscal tears. Adapted horizontal tears and vertical radial tears were often not seen. Concentric vertical lesions showed one or two high echogenic lines, depending on the extent of the defect. So it seems that there are limits for an exact sonographic characterization of meniscal lesions.

Ultrasonographic findings in cows with right displacement of the abomasum and abomasal volvulus

Seventeen cows with right displacement of the abomasum (rda) without abomasal volvulus, nine cows with abomasal volvulus and 10 clinically healthy cows were examined ultrasonographically. A 5·0 MHz transducer was...

Congenital absence of the horizontal portion of the left portal vein.

The adult portal vein and hepatic veins are the descendants of the vitelline and umbilical veins in embryo. Early in intrauterine life there are many anatomic channels between the vitelline and umbilical veins. As the embryo matures, certain channels regress and others become more prominent. The anatomic channels connecting the caudal portion of the right vitelline vein and the left umbilical veins form the horizontal portion of the left portal vein. If this anastomosis fails to develop normally, another venous channel maintains the communication. Clinically, this event is represented by the congenital absence of the horizontal portion of the left portal vein and the development of an aberrant vessel feeding the left lobe. As a result, the left lobe is suffi ciently fed by this aberrant vessel and does not atrophy. US demonstrates this anomaly as an echogenic line in the usual location of the horizontal portion of the left portal vein, the undeveloped horizontal portion, and a large aberrant vessel communicating between the anterior segmental branch of the right portal vein and the vertical portion of the left portal vein. The fl ow direction of the aberrant vessel is always from the former toward the latter. If the entire course of the portal vein is carefully observed with US and color Doppler US, there is very little room for ambiguity in diagnosing this extremely rare congenital anomaly.

Diafragma en rayos de sol: signo ecográfico de afectación intersticial de la base pulmonar

The purpose of this article is to present a new ultrasonographic sign: the spiculated diaphragm or sun rays diaphragm, that makes it possible to suspect disease in the base of the lung, generally involving the subpleural interstitium, during abdominal ultrasound examination.We present a study of seven patients in whom the diaphragm was observed as an echogenic, curvilinear, thickened image with numerous echogenic vertical lines or bands radiating from it posteriorly during abdominal ultrasound examination using a sectorial transducer. We have named this spiculated appearance of the diaphragm sun rays diaphragm. All patients underwent posteroanterior and lateral plain-film chest x-rays and high-resolution chest computed tomography (CT) with slices of the bases of the lungs.The chest pathology responsible for this finding was pulmonary fibrosis (n = 2), mitral valulopathy with heart failure (n = 2), unilateral atresia of the pulmonary vein (n = 1); combined miliary tuberculosis and Pneumocystis infection in an AIDS patient (n = 1), and carcinomatous lymphangitis (n = 1).When a spiculated or sun rays diaphragm is observed during abdominal ultrasonography, disease involving the base of the lung (generally the subpleural interstitium) should be suspected; thus, in the absence of prior clinical knowledge of lung disease, additional examinations such as plain-film chest x-rays or thin slice chest CT should be performed.

Serial Correlation between the Ultrasonographic and Pathologic Findings of Intramuscular Hemorrhaging in an Experimental Rabbit

Purpose: to evaluate the serial ultrasonographic findings of experimental intramuscular hemorrhaging to determine if there is a correlation with the pathologic findings. Materials and Methods: An uiltrasonography (US) was performed before and immediately after an intramuscular blood injection in nine rabbits. In addition, follow-up US images were obtained at 1, 4, 7, 10, 14, 21, and 28 days after the intramuscular blood injections in seven of the rabbits. The pathologic specimens, compared to the US findings on each date, and consisted of samples of left thigh muscle. Results: A US, performed immediately after a blood injection, showed two patterns; 6 cases of hyperechoic muscle thickening and 3 cases of hyperechoic muscle thickening with extravasation between the epimysium and muscle bundle or within muscle bundle. A follow-up US showed a marked decrease in intramuscular hemorrhaging and microcalcifications, which appeared on the 4th, 7th and 10th day after the blood injection. The pathologic findings revealed several short echogenic lines in the muscular bundles which were hemosiderin. Moreover, a 28 day follow-up US revealed that the normal findings are correlated with the normal gross pathologic findings. Conclusion: The US findings of the intramuscular hemorrhaging, for each of the follow-up dates, in comparison to the pathologic findings, revealed a high correlation with the pathologic specimens. Consequently, a US transducer with high resolution can be considered as a helpful technique in the diagnosing and evaluating the follow-up treatment of intramuscular hemorrhaging.

ULTRASONOGRAPHIC DESCRIPTION OF CANINE MASTITIS

Ultrasonographic images were acquired of the mammary glands of 40 bitches with physiologically lactating (n = 20) or inflamed glands (n = 20). Echogenicity, structure, homogeneity, thickness, and distinguishability of each tissue layer were assessed. Additionally, overall echogenicity was noted. In the normal lactating gland, different tissues could be differentiated easily. The parenchyma was, without exception, separated from adjacent tissues and was visible as medium echogenic tissue with a coarse-grained structure. The tissue always had some echogenic lines and anechoic areas and was slightly heterogeneous. The loss of distinct layering of the tissue was characteristic of an inflamed mammary gland and inflamed regions had reduced echogenicity. Additionally in five bitches with mastitis, the ultrasound examination was repeated five times for documentation of the progress of the illness and associated changes, supplemented with a color Doppler sonogram to assess changes in blood vessel density. Information from the examinations carried out via B-mode did not allow treatment success to be predicted. Two bitches with reduced blood vessel density centrally had a poor outcome whereas three bitches with increased blood vessel density had a good outcome. Thus, Doppler sonography might be a useful tool to obtain information of the prognosis in acute canine mastitis.

Carcinoma of the Breast Mimicking an Areolar Dermal Lesion

This report describes the sonographic features of 2 patients with invasive carcinoma of the breast that sonographically mimicked benign epithelial cysts of the areola. We retrospectively reviewed 2 cases of invasive ductal carcinoma that initially were diagnosed as dermal lesions in the areola after sonographic evaluation. Sonographically, the 2 lesions were centered between the echogenic lines of the deep dermis of the areola. Neither sonogram showed a deeper component arising from the underlying breast tissue that would suggest a breast origin. Lesions in the subcutaneous tissue superficial to the anterior pectoral fascia are extraparenchymal in origin and typically are benign. The areolar tissue, however, is not extraparenchymal because the dermis of the areola contains lactiferous ducts; these ducts extend from a more deeply placed mammary gland and are associated with modified sebaceous glands. All types of breast abnormalities, including malignancies, may affect deeper lactiferous glands and ducts and extend into the areola, independent of nipple involvement.

Robust border enhancement and detection for measurement of fetal nuchal translucency in ultrasound images

Ultrasonic measurement of nuchal translucency (NT) thickness in the first trimester of pregnancy has recently been proposed as the most useful marker in early screening for fetal chromosomal abnormalities. However, manual tracing of the two echogenic lines in the image, using on-screen calipers, is hampered by weak edges, together with noise and other artifacts, leading to variable results and inefficiency. Our semi-automatic method of fetal NT thickness measurement uses a coherence-enhancing diffusion filter to enhance the border and reduce noise, followed by detection of the NT by minimization of a cost function, that combines intensity, edge strength and continuity, using dynamic programming. This method has been validated by determining the correlation between manual and semi-automatic measurements.

Ultrasonography of the omasum in cows with various gastrointestinal diseases

The omasums of 30 healthy cows and 55 cows with various gastrointestinal disorders (10 with left displacement and eight with right displacement of the abomasum, 10 with abomasal volvulus, 10...

Catch me if you scan: ultrasound diagnosis of ectopic pregnancy

In recent years, ultrasound has become an essential tool in the assessment of women with suspected early pregnancy complications1. A large number of studies has already been published, describing the value of ultrasound in the diagnosis of ectopic pregnancy2,3. So, why write yet another review on this topic? We run a busy Early Pregnancy Unit in the area with the highest prevalence of ectopic pregnancy in the UK, which also receives many referrals from other hospitals of women with an uncertain diagnosis of ectopic pregnancy. The most interesting fact that we have learned over the years is that the majority of women referred with suspected ectopic pregnancies in fact had intrauterine ones that were either missed on ultrasound examination or misinterpreted as ectopics. This may sound surprising to many, as ultrasound diagnosis of intrauterine pregnancy is considered to be relatively simple and accurate. In many cases, ultrasound examination failed to identify a small amount of retained products of conception, due in part to inconsistencies in the sonographic diagnosis of incomplete miscarriage; this is often based on the use of arbitrary cut-off levels for endometrial thickness4. In other cases, however, sonographers were unable to decide whether a visible gestational sac represented an intrauterine or an ectopic pregnancy. In some cases with uncertain diagnosis, women had already received medical treatment with methotrexate prior to referral, leading to the loss of wanted normal intrauterine pregnancies. Another common problem is difficulty in differentiating between the various types of ectopic pregnancy. An accurate differential diagnosis is important in ectopics, as the management often differs depending on the type and exact location of the pregnancy. The purpose of this review is to summarize the sonographic criteria for the diagnosis of both intrauterine and ectopic pregnancies and to describe the principles of differential diagnosis of various types of ectopic pregnancy. We will not cover management of pregnancies of unknown location, as this issue has been covered extensively in recent publications5.

Ultrasonographic examination of the omasum in 30 healthy cows

A 3·5 MHz linear transducer was used to scan the intercostal spaces of 30 healthy cows from dorsal to ventral on the right side, and the appearance, dorsal and ventral...

3572: Changes of veins after deep vein thrombosis: CT and Doppler ultrasound findings and their correlation

Objectives: To clarify and compare thin section CT findings and Doppler Ultrasound findings in the patients with previous acute deep vein thrombosis of lower extremity. Methods: Nine patients who had had apparent acute deep vein thrombosis diagnosed by CT and followed up more than 2 month period were enrolled in this study. Three min delayed phase indirect CT venography with MDCT after 2 ml/kg of iodine contrast and Doppler ultrasounds including 2D morphology and venous insufficiency with stand position were done. CT venography and Doppler ultrasound findings were analyzed and correlation of findings of both studies was done. Results: CT showed luminal obliteration (n = 4), residual thrombi (n = 8), and fibrotic band in lumen (n = 12). In these lesions, Doppler ultrasound demonstrated noncompressed low echoic thrombi (n = 6) or echogenic lines (n = 3). Doppler ultrasound demonstrated loss of flow fluctuation according to respiration at CFV segments with all four obliterate iliac venous segments. Deep venous insufficiency was detected in 10 of 11 segments with abnormal CT findings and three of nine segments with normal CT findings. Conclusions: CT features of chronic lower extremity deep venous thrombosis reveal strong correlation on sonographic findings. Abnormal findings on CT strongly suggest deep venous insufficiency at affected segments.

2216: Sonography in the diagnosis of nasal bone fractures in children

Objectives: To describe the sonographic findings of nasal bone fractures and evaluate the diagnostic value of US of nasal bone fractures in children.Methods: Twenty-three children with sustained nasal trauma underwent radiography (lateral view of the nose and Waters view), US and CT. The US findings were retrospectively reviewed and compared with plain radiographs and CT, which were used as gold standard.Results: Sonographic findings of nasal bone fractures were irregularity (n = 4), discontinuity (n = 14), displacement with discontinuity (n = 16) of the thin smooth echogenic line formed by ventral cortex of the nasal bone. Thirty four nasal bone fractures in 23 patients were identified by CT and US but only 17 by plain radiographs. US and CT demonstrated unilateral involvement of nasal bone fracture in ten bones and bilateral involvement in 12, while plain radiograph revealed unilateral involvement in seven and bilateral involvement in five.Conclusions: The US features of nasal bone fractures were similar to those of CT in detecting the location and degree of depression or displacement of nasal bone fractures. We believe that US is a very useful for the evaluation of such fractures, especially in children with equivocal abnormalities on plain radiographs. Objectives: To describe the sonographic findings of nasal bone fractures and evaluate the diagnostic value of US of nasal bone fractures in children. Methods: Twenty-three children with sustained nasal trauma underwent radiography (lateral view of the nose and Waters view), US and CT. The US findings were retrospectively reviewed and compared with plain radiographs and CT, which were used as gold standard. Results: Sonographic findings of nasal bone fractures were irregularity (n = 4), discontinuity (n = 14), displacement with discontinuity (n = 16) of the thin smooth echogenic line formed by ventral cortex of the nasal bone. Thirty four nasal bone fractures in 23 patients were identified by CT and US but only 17 by plain radiographs. US and CT demonstrated unilateral involvement of nasal bone fracture in ten bones and bilateral involvement in 12, while plain radiograph revealed unilateral involvement in seven and bilateral involvement in five. Conclusions: The US features of nasal bone fractures were similar to those of CT in detecting the location and degree of depression or displacement of nasal bone fractures. We believe that US is a very useful for the evaluation of such fractures, especially in children with equivocal abnormalities on plain radiographs.

Imaging of penile traumas—therapeutic implications

Injury to the penis may result from penetrating or nonpenetrating trauma. Nonpenetrating injury to the erect penis can produce albugineal tear, intracavernous hematoma, or extraalbugineal hematoma from rupture of the dorsal vessels. Nonpenetrating injury to the flaccid penis usually follows blunt perineal traumas producing extratunical or cavernosal hematomas or cavernosal artery tear followed by high-flow priapism. Differential diagnosis between albugineal tear and other penile injuries must be obtained as soon as possible, since early surgical repair of albugineal tear reduces significantly the rate of posttraumatic curvature and fibrosis. Ultrasonography (US) is able to detect the exact site of the tear in most patients as an interruption of the thin echogenic line of the tunica albuginea. Other imaging techniques are rarely required in the clinical practice. Color Doppler US is the imaging modality of choice to evaluate patients with high flow priapism. Focal or diffuse cavernosal fibrosis can be identified with US as echogenic areas in the cavernosal bodies. Posttraumatic erectile dysfunction can result from fibrotic changes, nerve and vascular impairment, or both. Doppler evaluation of penile vasculature is required in young patients with posttraumatic impotence before surgical revascularization procedures.

1195: The fetal abdomen from end to end

[Embryology and ultrasound evaluation]. Fetal structures develop very rapidly in early pregnancy. Unmistakable human characteristics are obvious by 10 weeks menstrual age. By 12 weeks swallowing starts and the stomach becomes visible. By 15 to 16 weeks, meconium starts accumulating and peristalsis can be noted by ultrasound. The standard AIUM/ACR views of the abdomen include abdomen circumference, stomach, kidneys, urinary bladder and umbilical cord insertion site and intactness of the anterior abdominal wall. [Hollow gut]. The esophagus is visible even in the early second trimester as a slightly echogenic line in its expected location in the chest. [Stomach]. The stomach is usually visible by the end of the first trimester. Failure to see the stomach is suspicious for abnormality. Small bowel excessive bowel echogenicity occurs in about 0.2 to 1.8 percent of pregnancies and about 35% have problems including aneuploidy, anomalies 11%, cystic fibrosis 8%, infection 3% and others. Bowel obstruction may not be evident until after 20 to 24 weeks. Meconium peritonitis causes chemical peritonitis but often does not need surgery. [Large bowel]. The colon becomes visible in some by 18 weeks and in all by 25 weeks. Contained meconium may be hypoechoic or echogenic. [Liver]. The liver and its vessels are readily identified. Vascular variants occur and are not a functional problem but there is high association of associated anomalies. Calcifications of the liver are common but often not recognized. Isolated calcification after exclusion of infection and aneuploidy has good outcomes. Tumors are unusual. [Gallbladder and bile ducts]. The gallbladder is virtually always visible. Gallstones can be seen and virtually always resolve spontaneously. Bile duct dilations are rare. [Adrenals]. Normal adrenal glands are visible. Masses in the adrenal area include extralobar pulmonary sequestration (these are usually left sided), hemorrhage and neuroblastoma. Prenatally diagnosed cases have a good prognosis and may regress spontaneously. [Ascites]. Ascites commonly occurs with generalized hydrops due to multiple etiologies. Isolated ascites is more commonly due to obstructive urinary disease and urine leak than gastrointestinal disorders with perforation. A surprisingly common cause of ascites in our lab has been fetal infection due to Parvovirus B19. [Miscellaneous]. Cystic masses are frequently seen in the abdomen, especially ovarian cysts in females. Other cystic masses include mesenteric cysts, duplication cysts and urachal cysts. Mixed and solid abdominal tumours are rare and include lymphangiomas, liver adenomas and hemangiomas, hepatoblastomas and hemoangioendotheliomas. Summary: prenatal ultrasound can find numerous abdominal abnormalities. Some of these do not become apparent until after 20 weeks. This is especially true for obstructive lesions of the bowel. As with other fetal anomalies, there is a high association with additional abnormalities.

Analysis of refractive artifacts by reconstructed three-dimensional ultrasound imaging.

Refractive artifacts are frequently encountered in clinical settings, and they have been analyzed on the basis of conventional two-dimensional (2-D) ultrasound (US) images, but this method is restricted to monoplane data and is limited by its inability to assess the three-dimensional (3-D) structure of refractive artifacts. The aim of this study was to evaluate the role of reconstructed 3-D US images in the analysis of refractive artifacts. The following representative refractive artifacts were analyzed on the basis of reconstructed 3-D US images: (a) a distorted image of a fine tube behind a cyst (balloon); (b) a deformed image of the bottom of a balloon; and (c) a duplication artifact due to the acoustic lens effect. (a) A tube was imaged as a fine echogenic line with two points of sudden interruption, unlike a curved needle, which was imaged without interruption. (b) 3-D US allowed us to visualize the mode of deformity in the image of the bottom of a fluid-filled balloon in a water bath. When the acoustic velocity in the fluid was greater than that in the surrounding water, the bottom of the balloon appeared to be shrunken. When the acoustic velocity in the fluid was less than that in the surrounding water, the bottom of the balloon appeared to be swollen. (c) When we placed two pieces of white chicken meat in front of a fine needle, the needle was duplicated in the resulting image. In this case, the needle appeared to be vague and fuzzy. In this case, 3-D US did not add further information to the 2-D images. Our study suggests that reconstructed 3-D US images provide a better understanding of the mode of refractive artifacts than do 2-D US images.