High Frequency Linear Transducer Research Articles

Role of High-Resolution Ultrasonography With Colour and Duplex Doppler in the Evaluation of Acute Scrotal Diseases.

Introduction The term 'acute scrotum' denotes the sudden initiation of pain in the scrotal region. Acute scrotum is a frequent medical condition in children and adults. Ultrasound facilitates precise diagnosis and differentiation of numerous causes of acute scrotum. The objective of our research was to assess the utility of ultrasonography in the identification and prevalence determination of causes of acute scrotum. Materials and methods Patients with acute scrotal pain referred to the Department of Radiodiagnosis at Great Eastern Medical School & Hospital (GEMS), Srikakulam, India, were added in the research. This is a prospective observational study. High-frequency linear transducer (4-15 MHz) was used for imaging. Grey scale, colour and duplex Doppler were performed routinely. The ultimate diagnosis was established by considering the clinical results, follow-up observations, intraoperative observations and, when accessible, histopathological analysis. For the statistical analysis, IBM SPSS Statistics for Windows, version 22 (released 2013; IBM Corp., Armonk, New York, United States). was used. Descriptive analysis was conducted. The Kendall rank correlation coefficient was used to evaluate the non-parametric association between side and torsion. Results A total of 120 patients were included for statistical analysis. Inflammatory pathology was the most commoncause of acute scrotum, followed by testicular torsion and torsion of testicular appendage. Testicular torsion and side of pain did not show a significant association. Conclusion High-resolution ultrasonography with colour and duplex Doppler sonography is an excellent imaging modality exhibiting exceptional sensitivity and specificity for the accurate diagnosis of acute scrotal diseases. Inflammatory pathology was the most commoncause of acute scrotum, followed by testicular torsion and torsion of the testicular appendage.

Ultrasonography as a Tool in Assessment of Breast Pain among Women

Background: Breast pain or mastalgia is a common breast symptom in women after breast lump. The increase in awareness of breast cancer and the possibility that a breast pain may be associated with underlying breast disease prompt women to seek medical attention. Ultrasound is a valuable imaging modality in evaluation of breast pain and breast diseases in general.
 Objectives: To determine the role of ultrasound and the outcome of breast ultrasound among women with breast pain.
 Methods: This cross-sectional descriptive study was conducted on 87 women who were referred for ultrasound scan on account of breast pain from July 2015 - December 2016 at radiology department of UATH. A high frequency linear transducer 7.5 MHz of EMP G70 ultrasound machine manufactured by Shenzhen Emperor Electronic Technology®, China 2011 was used in scanning the breast.
 Results: The mean age of study population was 32±15years with age range of 16 and 69 years. Majority of the patients were in the age group 30-39 years representing 54.0%. 32(36.8%) of women with breast pain had abnormal ultrasound findings. Sonographic findings included mass 13 (14.9%), cyst 10 (11.5%), ductal dilation 4(4.6%), calcification 3(3.5%), architectural distortion 2(2.3%). BIRADS 1 (normal/negative) was the commonest category seen in 55(63.2%) of patients, 21(24.1%) were benign (BIRADS 2), 6(6.4%) were probably benign (BIRADS 3), 3(3.4%) were suspicious BIRADS 4 and 2(2.3%) were highly suggestive of malignancy BIRADS 5. There was positive correlation between ultrasound findings with age This was however not statistically significant (P=0.67). There was positive correlation between abnormal ultrasound findings with type of pain (P=0.08), location of pain (P=0.63), contraception (P=0.39), and family history of breast cancer (P=0.11). However, this was not statistically significant
 Conclusion: Evaluation of breast pain in a woman is very essentially not only to alleviate her fears but also to detect any abnormalities which may require treatment medically or surgically. Ultrasound is an important imaging tool in evaluating women with breast pain.

Sonographic assessment of the common carotid artery luminal diameter in adults with co-existing diabetes mellitus and hypertension

Background: Diabetes mellitus (DM) and hypertension (HTN) are known to cause major in changes in arterial morphology and function, (remodelling) including alterations in carotid intima media thickness (CIMT), carotid artery luminal diameter (CALD), and arterial compliance and blood flow velocity. However, there is a paucity of data evaluating common carotid luminal diameter (CCALD) in an adult with both DM and HTN (DM+HTN) in the study locality. Objective: This study is therefore aimed at evaluating the CCALD in adults with DM+HTN. Methodology: One hundred and fifteen (115) adult subjects with co-existing DM+HTN and one hundred and fourty four (144) healthy controls participated in the study. Their ages ranged from 18 to 80 years. The common carotid artery luminal diameter (CCALD) at the diastolic phase of the cardiac cycles was scanned and measured using a venue 50 ultrasound scanners with electronic calipers and high frequency linear array transducer. Result: The overall mean CCALD was 6.43±0.87 mm and 5.88±0.77 mm for subjects with DM+HTN and healthy controls, respectively. The mean CCALD value was significantly higher in subjects DM+HTN compared to the healthy controls (0.000). The mean CCALD correlated positively with age in males with DM+HTN hypertensive females, while no significant correlations were observed among healthy controls. Males had significantly higher mean CCALD value when compared to their female counterparts in both subjects with DM+HTN and healthy controls. Conclusion: In this study, the mean CCALD value in subjects with DM+HTN is significantly higher compared to those of healthy controls.

Ultrasound of the palmar aspect of the hand: normal anatomy and clinical applications of intrinsic muscles imaging.

Intrinsic hand muscles play a fundamental role in tuning the fine motricity of the hand and may be affected by several pathologic conditions, including traumatic injuries, atrophic changes induced by denervation, and space-occupying masses. Modern hand surgery techniques allow to target several hand muscle pathologies and, as a direct consequence, requests for hand imaging now carry increasingly complex diagnostic questions. The progressive refinement of ultrasound technology and the current availability of high and ultra-high frequency linear transducers that allow the investigation of intrinsic hand muscles and tendons with incomparable resolution have made this modality an essential tool for the evaluation of pathological processes involving these tiny structures. Indeed, intrinsic hand muscles lie in a superficial position and are amenable to investigation by means of transducers with frequency bands superior to 20 MHz, offering clear advantages in terms of resolution and costs compared to magnetic resonance imaging. In addition, ultrasound allows to perform dynamic maneuvers that can critically enhance its diagnostic power, by examining the questioned structure during stress tests that simulate the conditions eliciting clinical symptoms. The present article aims to review the anatomy, the ultrasound scanning technique, and the clinical application of thenar, hypothenar, lumbricals and interossei muscles imaging, also showing some examples of pathology involving these structures.

769 In Vivo Evaluation of Spinal Cord Perfusion Using Contrast-Enhanced Transcutaneous Ultrasound

INTRODUCTION: Ultrasound (US) imaging is cheap, portable, and widely available. It has been used in multiple medical disciplines, both as a means of diagnosis and therapy. Developing US as a platform for spinal cord perfusion monitoring in patients with spinal cord injury (SCI) would provide a cheap, accessible, and real-time platform for managing spinal cord perfusion in the acute setting. METHODS: Four patients with previous cervical decompression and instrumentation were evaluated at a single center with transcutaneous US. We included adult patients with at least 2 levels of continuous cervical laminectomies greater than 3 months prior to US and no history of SCI. The first two patients underwent US imaging without contrast and the second two patients underwent contrast-enhanced US imaging with Lumason, a microbubble agent. Imaging was performed by a board-certified radiologist with US expertise using a General Electric (GE) Logiq E10 ultrasound scanner ans a high frequency linear transducer. The study was approved by the institutional ethics committee. RESULTS: In the non-contrast study (n = 2), the dura, spinal cord, and vertebral body were apparent on US. Application of Doppler was insufficient to discern intramedullary perfusion, so contrast-enhanced ultrasound was pursued (n = 2). With contrast, anatomic structures were again visible, and we were able to quantify differential spinal cord perfusion within and between cross-sectional sections of the cord. We demonstrated spinal cord hemodynamic perfusion by measuring peak signal intensity and the time to peak signal intensity after microbubble contrast injection. Then, a time-intensity curve was created and the area under the curve was calculated as a surrogate of spinal cord perfusion. CONCLUSIONS: Contrast-enhanced US is a viable platform for monitoring spinal cord perfusion in patients who have undergone prior cervical laminectomies.

Use of Ultrasonography in Diagnosis of Medial Compartment Disease of the Elbow in Dogs.

The objective of this prospective study was to evaluate the use of ultrasonography in the diagnosis of medial coronoid process disease in unclear cases. Fifteen elbows (on thirteen dogs) for which radiography and computed tomography did not lead to a clear diagnosis of medial coronoid process disease were included. On each elbow, ultrasonography was performed with a high frequency linear transducer (12-18Hz). Then, arthroscopic examination of the joint was performed by a surgeon who was unaware of ultrasonographic findings to confirm medial coronoid process disease. At least one ultrasonographic lesion was detected in 13 out of 15 elbows. The main reported ultrasonographic lesions were joint effusion (10/15 elbows) and an abnormal shape of the medial coronoid process (irregular, ill-defined or fragmented) (9/15). Ultrasonography can be a helpful additional diagnostic tool to confirm medial coronoid process disease of the elbow joint before performing arthroscopy in unclear cases. Further studies will be needed to evaluate the use of higher frequency transducers and determine if it could improve the diagnostic value of ultrasonography.

ROLE OF COLOUR DOPPLER STUDY FOR EVALUATION OF LOWER LIMB DEEP VEIN THROMBOSIS

Introduction- Deep vein thrombosis is a common clinical problem. It can endanger life of a person by producing pulmonary embolism and may cause venous hypertension. and chronic venous insufciency. Evaluation of patients wi Aim- th suspected deep vein thrombosis by using color Doppler ultrasonography. After obtaining clearance from Institute's ethical commit Method- tee, all the patients fullling the inclusion criteria were selected and written consent is obtained. They will be investigated with color Doppler using GE logic P9 and P5 ultrasound machine's high frequency linear transducer. The protocol begins with the patient in supine position from upper thigh till foot with longitudinal and transverse scanning to examine the veins from the common iliac veins down to calf veins. Results- In our study 50 patients with clinically suspicion of lower limb deep vein thrombosis were subjected for Doppler examination. Out of all the patients the maximum incidences of deep vein thrombosis were noted in the age group of 31-50 yrs. i.e. 48%, and minimum incidence in the age group of 11-30 yrs. i.e. 14%. The age group of 51-70 yrs. had 22% of patients and that of 71-90 yrs. of age group had 16% of patients out of total patients in the study. Out of all the patients it was found that majority of the patients were male 78% while incidence in female patients is 22%. Out of 50 suspected patients of deep vein thrombosis 60% of them were found to be positive or presence of deep vein thrombosis and 40% of them had negative or absence of deep vein thrombosis.Deep vein thrombosis was more common in right extremity i.e. 50% then left extremity i.e. 46%. Only 4% of patients had bilateral involvement. Deep vein Conclusionthrombosis of lower limbs can be detected reliably, non-invasively and rapidly by the use of colour doppler ultrasonography. Gray scale ndings together with colour doppler helps in qualitative evaluation of the venous system of lower limbs and early detection of deep vein thrombosis in clinically suspected Thus it can be concluded that keeping in mind the limitations. and the advantages offered by the colour doppler ultrasonography, it is a good, reliable, inexpensive and rapid method of investigation for deep vein thrombosis of lower limbs.

The impact of high-frequency linear transducer on the accuracy of pelvic ultrasound in early pregnancy pelvic pain and bleeding

IntroductionThe primary concern of emergency physicians (EPs) in symptomatic patients in their early pregnancy is to rule out ectopic pregnancy by identifying a definite intrauterine pregnancy (IUP). Then an assessment of viability is required for the IUPs. Although transvaginal ultrasound (TVUS) stands as the best modality for these patients, it is not available in most emergency settings. This study aimed to investigate the effects of high-frequency linear transducers (HFLT) on the accuracy of point-of-care ultrasound (POCUS) for detection of IUP and the agreement between EPs and obstetricians for patients' diagnosis. MethodA convenience sample of pregnant patients who presented to the emergency department (ED) with vaginal bleeding and abdominopelvic pain was included. The characteristics of diagnostic tests of transabdominal POCUS performed by EPs were compared to TVUS. ResultsThe study population was finalized as 143 patients. For the definite IUP, the diagnostic accuracy of POCUS was 93.0%, with a sensitivity of 89.0%, a specificity of 100%, compared to an accuracy of 97.9% for POCUS plus HFLT with a sensitivity of 96.7%, a specificity of 100%. For the identification of fetal cardiac activity (FCA), utilizing HFLT improved the diagnostic accuracy to 97.9% (from 94.4%) and sensitivity to 95.5% (from 88.1%). In addition, the agreement between the EPs and obstetricians concerning the classification of ED diagnosis was excellent (agreement: 96.5%, kappa: 0.943, p < 0.0001). ConclusionPOCUS plus HFLT performed by EPs in evaluating symptomatic patients in their first-trimester pregnancy improves the accuracy to a non-inferior level compared to TVUS performed by obstetricians. Hence, EPs can securely rely on POCUS to confirm IUP and FCA. However, they should be cautious about using it as a rule-out tool. Moreover, HFLT use could enhance the accuracy of POCUS in viability assessment as an alternative to TVUS.

High-resolution neurosonographic examination of the lenticulostriate vessels in neonates with hypoxic-ischemic encephalopathy.

To assess the feasibility of visualizing lenticulostriate vessels (LV) using a linear high-resolution ultrasound probe and characterize LV morphology to determine whether morphological alterations in LV are present in neonatal hypoxic-ischemic encephalopathy (HIE) as compared to the unaffected infants. We characterized LV by their echogenicity, width, length, tortuosity, and numbers of visualized stems/branches in neurosonographic examinations of 80 neonates. Our population included 45 unaffected (non-HIE) and 35 with clinical and/or imaging diagnosis of HIE. Of the neonates with clinical diagnosis of HIE, 16 had positive MRI findings for HIE (HIE+MRI) and 19 had negative MRI findings (HIE-MRI). Annotations were performed twice with shuffled data sets at a 1-month interval and intrarater reliability was assessed. Focused comparison was conducted between non-HIE, HIE+MRI and HIE-MRI neonates whose images were acquired with a high frequency linear transducer. Studies acquired with the two most frequently utilized transducers significantly differed in number of branches (p = 0.002), vessel thickness (p = 0.007) and echogenicity (p = 0.009). Studies acquired with the two transducers also significantly differed in acquisition frequency (p < 0.001), thermal indices (p < 0.001) and use of harmonic imaging (p < 0.001). Groupwise comparison of vessels imaged with the most frequently utilized transducer found significantly fewer branches in HIE + MRI compared to HIE-MRI negative and non-HIE patients (p = 0.005). LV can be visualized in the absence of pathology using modern high-resolution neurosonography. Visualization of LV branches varies between HIE + MRI, HIE-MRI neonates and controls. High-resolution neurosonography is a feasible technique to assess LV morphology in healthy neonates and neonates with HIE.

Role of Sonoelastography for Differentiating Benign and Malignant Cervical Lymph Nodes: A Cross-sectional Study

Introduction: Cervical nodes form one of the major groups of Lymph Nodes (LN) that are frequently involved in inflammatory and neoplastic diseases. Metastasis causes the most apparent change in consistency of the node among the various nodal pathologies. Ultrasound elastography provides an estimate of tissue consistency by measuring the degree of distortion under the application of an external force. Aim: To estimate the diagnostic accuracy of sonoelastography in the differentiation of malignant and benign cervical LN with fine needle aspiration cytology/biopsy considered as a gold standard. Materials and Methods: A cross-sectional study was carried out from March 2020 to January 2021 in a tertiary care hospital in south India, a total of 50 patients with cervical lymphadenopathy underwent ultrasonography followed by elastography of superficial neck LN using high frequency linear transducer by freehand technique. The ultrasound characteristics of selected LN were determined and colour elastogram pattern was assessed using colour mapping elastography. The chi-square test was performed. Sensitivity, specificity, positive (PPV) and negative predictive values (NPV) were obtained. The results were then compared to the fine needle aspiration cytology. Results: A total of 50 subjects(median age of 40.5±18.71 years ; 19 (38%) males and 31 (62%) females). The grayscale and colour Doppler features of cervical LN which helped predict malignancy were short axis ≥8 mm, S:L axis ratio ≥0.5, absence of normal central fatty hilum, abnormal echogenicity, lobulated border, presence of calcification and peripheral/mixed vascularity. With reference to the above variables of cervical LN characterisation on grayscale, colour doppler ultrasound and sonoelastography findings, elastography pattern was the most promising variable to differentiate malignant from benign cervical LN with 95.2% sensitivity, 75.0% specificity, 95.2% PPV, 75.0% NPV and 92.0% accuracy. Conclusion: Sonoelastography is useful in the assessment of elastic properties of cervical LN with short examination time required, real-time display, immediate interpretation and limited cost. Sonoelastography had higher diagnostic accuracy than gray scale and doppler ultrasound in differentiating benign from malignant cervical LN. Sonoelastography is an effective supplement to conventional gray scale and colour doppler ultrasound and that the combination is clinically recommended for a more accurate diagnosis of metastatic LN.

DIAGNOSING NON OSSEOUS CAUSES OF WRIST PAIN- ROLE OF HIGH RESOLUTION ULTRASONOGRAPHY

Being a fast, less expensive, real time dynamic study, high resolution ultrasonography has provided a better option for diagnosing soft tissue pathologies in painful wrist joint. Diagnosing the cause of painful wrist joint Purpose- is a challenge for physicians especially in soft tissue pathologies, ultrasound imaging can provide an early, real time and efcient diagnosis and help in planning of treatment accordingly whether conservative or surgical approach is needed. So this shortens the course of treatment. A hospital based descriptive study Materials and methodsdone in department of radiodiagnosis SMS hospital Jaipur. Patients with history of both traumatic and non traumatic wrist pain were selected, prior X-ray was done. Total 45 patients were scanned using high frequency linear transducer (7-10 mHz) and hockey stick transducer on canon Aplio700 machine. Diagnosis was conrmed by MRI and clinical course of patient. The data were compiled and analyzed. In our study of 40 Resultspatients, USG detected 2 patients with foreign body, 5 with tendon rupture/ dislocation, 18 with tendonitis and tenosynovitis, 12 with ganglion cyst, 4 with soft tissue mass lesion/ collection, 4 with nerve pathology, 1 with scapholunate ligament injury, 1 with TFCC tear 1 with capsule rupture as a cause of wrist pain. Ultrasound provides a quick, accurate and inexpensive diagnosis Conclusion- in soft tissue pathologies of wrist, foreign bodies, tendon pathologies

Sonographic Evaluation of the Heel Pad Thickness in Diabetics in Nigeria.

Diabetes mellitus is a chronic disease process affecting millions of people worldwide. Its prevalence is forecasted to reach a value of 7.7% by 2030. It carries severe morbidities and even mortality. Hyperglycemia and increased formation of advanced glycosylation end products causes the majority of soft tissue changes seen among diabetics. The effects are observed particularly in the heel pad and plantar fascia where thinning or thickening, fibre disorganization, calcification and hypoechoic foci are among the changes seen. This cross-sectional descriptive study was carried out at the Department of Radiology, OAUTHC, Ile Ife, Osun state, Southwest Nigeria. 40 years old and above subjects with Type 2 diabetes mellitus were recruited from the diabetic clinic of the institution and Ultrasound evaluation of the heel fat pad and plantar fascia were subsequently performed for those who met the criteria using ultrasound machine equipped with a 7.5- 12.0 MHz high frequency linear array transducer. The mean heel pad thickness on the right feet was greater than that of the left in the study subjects. There was statistical significant difference in the heel fat pad thickness of diabetic subjects and the control group, in both feet. (P=0.000). The heel pad thickness is higher in diabetic subject than in non-diabetic control subjects. However, there was no statistical significant difference in the right and left heel fat pad thickness of the participants of this study (P value 0.6062). Only HPT was a statistically significant predictor of foot ulcers among other variables after binary regression was computed. Using Spearman's rank correlation to test the relationship between the BMI of diabetic subjects and mean heel pad thickness, it revealed a moderate positive correlation, with good statistically significance (Spearman's rho = 0.4397, P=0.0000). The relationship between the BMI of diabetic subjects and mean plantar fascia thickness showed a weak positive correlation, with good statistical significance (Spearman's rho = 0.2635, P=0.0008). The duration of diabetes mellitus did not determine the heel pad thickness and plantar fascia thickness. The findings in the study suggested that history of foot ulcer in the diabetic predispose them to have reduce HPT and further foot ulcers. Sonographic measurement of heel pad thickness can therefore be an additional imaging modality to evaluate and be used in the management of the diabetic patients' feet.

Efficacy of ultrasonography in the diagnosis of dento-maxillofacial swellings among an urban population in Nigeria

Context: Ultrasonography as an imaging modality in dentistry has been explored in recent years. It is particularly useful in the examination of superficial structures where the use of a high frequency linear transducer produces clearer sonographic images. Aim: To evaluate the efficacy of ultrasound when compared with other known diagnostic examinations. Materials and Methods: This was a prospective cross-sectional study involving patients with maxillofacial swellings in Aminu Kano Teaching Hospital. They were classified as malignant neoplasms, benign cysts, abscesses and infections and lymphoma, according to clinical, radiographic and ultrasound and diagnosis independently. The findings from these methods were then compared to the gold standard histologic findings. Chi-square test, Pearson contingency coefficient, and 2 x 2 contingency table were used in evaluating the diagnostic accuracy, sensitivity as well as the specificity of the examinations. Results: A total of 36 patients comprising 21 males and 15 females with mean age of 34.97 years were recruited. Diagnostic accuracy of ultrasound was 50% in the diagnosis of malignant tumors, 95.8% in benign cystic swellings, 50% in abscesses and infections, and 100% in lymphoma. Significant relationship exists between ultrasonography with histology, clinical and radiographic diagnosis with a contingency coefficient of 0.833, 0.759, and 0.798, respectively. Overall, the accuracy, sensitivity and specificity of ultrasound was 86.1%, 90.3%, and 60%, respectively. Conclusion: Ultrasonography provides accurate imaging of the maxillofacial region and provides information about the pathological characteristic of lesion, its extent, and relationship with the surrounding structures. Inclusion of ultrasonography to the clinical and histopathological examinations increases the accuracy of orofacial swelling diagnosis.

Trans-orbital sonographic assessment of optic nerve diameter in a sampled Nigerian population

Background: Studies have reported variants in the dimensions of optic nerve diameter among different ethnic groups, just as other body anatomy differs from regions to regions.Aim: To establish normal range of optic nerve diameter in a sampled Nigerian population, sonographically.Materials and Method: A total of 725 apparently healthy adult subjects (362 males aged 32 to 65 years and 363 females aged 30 to 68 years) were recruited from the South South and South Eastern parts of Nigeria for this prospective descriptive study. The optic nerve diameter (OND) was measured using a high-resolution digital dedicated small-parts real time ultrasound machine (Sonoace 5500; Medicol, Medison, Miami, FL, USA) with a high frequency (10-MHz) linear array transducer. Subjects were in supine position and were asked to keep their eyes closed and still. Coupling gel was placed on the closed eye lid with the transducer softly placed over the upper temporal eyelid in an axial plane. The OND was measured perpendicular to the vertical axis of the scanning plane as a horizontal distance between the two walls of the nerve sheath. The height and weight of the subjects were determined using a meter rule and a weighing scale.Results: The mean optic nerve sheath diameter of males and females was 4.2 ± 0.13 mm. It ranged from 4.0 to 4.45 mm. The optic nerve sheath diameter of males was not significantly different from that of females (p = 0.345). No significant difference between the mean OND of both eyes (p = 0.345). Body mass index and age did not have any association with OND (r = 0.017, 0.034), the data were normally distributed.Conclusion: Optic nerve diameter of apparently normal Nigerian adults ranges from 4.0 to 4.5 mm. Values outside this range may demand further evaluation in the study population.

Method of Morphometry of Cartilaginous Part of Ribs for Planning of Auricle Reconstruction

Ultrasound examination of the skin was performed on 63 women, using a 10–22 MHz high frequency linear transducer on the scanning surface in B-mode and Color Doppler Imaging (CDI) mode with the scanning depth of 7 mm, as well as a 6–18 MHz transducer in B-mode with the scanning depth of 15 mm. The thickness of the dermis was measured between the epidermis and the subcutaneous adipose tissue in the middle and lower third of the face at standard points. To determine the border between the dermis and hypodermis, we used the subdermal vascular plexus as an additional anatomical landmark, which was well visualized in the CDI mode. Comparison of three or more groups of independent quantitative parameters was carried out using ANOVA (Analysis of Variance) for looking for dependencies in the data obtained by determining the significance of differences in means. The level of significance was presented according to F. Fisher’s criterion. As a result of the analysis of variance, a significance level was 0.15, based on which it was concluded that there is no difference in measuring the thickness of the dermis with 6–18 MHz and 10–22 MHz high frequency transducers. The optimal scanning depth for measuring the skin thickness is 7–15 mm. Evaluation of the skin microcirculation should be carried out in the Doppler mode at a pulse recurrence frequency of less than 1 kHz.

A Man With Testicular Pain

An 86-year-old male with a history of diabetes presented to the emergency department (ED) with left testicular pain for 2 days. Physical examination demonstrated an uncircumcised male with a normal testicular lie, left testicle enlargement, erythema, and tenderness to palpation. The patient was afebrile, with a WBC count of 9,000 cells/uL, and urinalysis revealed leukocytes. ED point-of-care ultrasonography was obtained (Figures 1 and 2).Figure 2Sonographic image of the left testicle in the sagittal plane obtained with a high frequency linear transducer demonstrated a hypoechoic structure (arrow) with increased surrounding vascular flow demonstrating inflammatory changes (star) within the testicle. Scrotal wall thickening was seen (asterisk).View Large Image Figure ViewerDownload Hi-res image Download (PPT) Testicular abscess. Testicular abscess on ultrasonography is typically spherical or elliptical, with a focal area of mixed echogenicity due to necrotic cellular debris.1Gaillard F. Testicular abscess: radiology reference article.https://radiopaedia.org/articles/testicular-abscess?lang=usDate accessed: December 12, 2020Google Scholar,2O’Rourke K. Kibbee N. Stubbs A. Ultrasound for the evaluation of skin and soft tissue infections.Mo Med. 2015; 112: 202-205PubMed Google Scholar Testicular abscess may also demonstrate enlargement of the affected testicle and a reactive hydrocele. Testicular abscess is rare and typically results from untreated or severe epididymo-orchitis. In sexually active patients, common pathogens include Neisseria gonorrhea and Chlamydia trachomatis. However, those who are not sexually active can have other gram-negative and gram-positive organisms.1Gaillard F. Testicular abscess: radiology reference article.https://radiopaedia.org/articles/testicular-abscess?lang=usDate accessed: December 12, 2020Google Scholar,3Mevorach R.A. Lerner R.M. Dvoretsky P.M. et al.Testicular abscess: diagnosis by ultrasonography.J Urol. 1986; 136: 1213-1216Crossref PubMed Google Scholar,4Hackett B. Sletten Z. Bridwell R.E. Testicular abscess and ischemia secondary to epididymo-orchitis.Cureus. 2020; 12e8991PubMed Google Scholar Typically, patients will report testicular pain, swelling, and fever. The differential diagnosis includes testicular torsion, epididyomo-orchitis, epididymal abscess, testicular cancer, and testicular trauma. Ultrasound is the initial imaging modality needed to differentiate testicular abscess from other similarly presenting diagnoses. Treatment depends on the size of the testicular abscess and clinical parameters. Minor cases (those in patients who have normal WBC counts, are afebrile, are able to urinate, and do not have signs of necrotizing fasciitis) can be treated with antibiotics, while more severe cases may require surgical debridement or orchiectomy. ED treatment includes initiation of antibiotic therapy and urology consultation.

Comparative Analysis of Ultrasound Examination of the Skin High Frequency Transducers

Ultrasound examination of the skin was performed on 63 women, using a 10–22 MHz high frequency linear transducer on the scanning surface in B-mode and Color Doppler Imaging (CDI) mode with the scanning depth of 7 mm, as well as a 6–18 MHz transducer in B-mode with the scanning depth of 15 mm. The thickness of the dermis was measured between the epidermis and the subcutaneous adipose tissue in the middle and lower third of the face at standard points. To determine the border between the dermis and hypodermis, we used the subdermal vascular plexus as an additional anatomical landmark, which was well visualized in the CDI mode. Comparison of three or more groups of independent quantitative parameters was carried out using ANOVA (Analysis of Variance) for looking for dependencies in the data obtained by determining the significance of differences in means. The level of significance was presented according to F. Fisher’s criterion. As a result of the analysis of variance, a significance level was 0.15, based on which it was concluded that there is no difference in measuring the thickness of the dermis with 6–18 MHz and 10–22 MHz high frequency transducers. The optimal scanning depth for measuring the skin thickness is 7–15 mm. Evaluation of the skin microcirculation should be carried out in the Doppler mode at a pulse recurrence frequency of less than 1 kHz.

Ultrasound in forearm fractures: a pragmatic study assessing the utility of Point of Care Ultrasound (PoCUS) in identifying and managing distal radius fractures.

Point of Care Ultrasound (PoCUS) is a safe, non-invasive tool for identifying distal radius fractures and can potentially be utilised to assist clinicians to reduce displaced fractures. We aim to test whether PoCUS is accurate to identify distal radius fractures and to determine how PoCUS performs as a tool to confirm a successful fracture reduction. A pragmatic prospective observational study was done in adult patients presenting with forearm injuries resulting in Colle's type distal radius fractures. Adults who presented to the emergency department (ED) with a suspected distal forearm fracture from August 2018 to July 2019 were conveniently sampled for inclusion into the study when a trained ED ultra-sonographer was available. PoCUS scans over the point of maximal tenderness were done using a high frequency linear transducer (7.5-10mHz) prior to X-ray. Patients who required a manipulation of the fracture had a second ultrasound scan immediately after the procedure before the second X-ray was ordered. PoCUS scans were compared to X-rays for accuracy in both groups. Fractures were identified in 44 out of 47 included patients using both PoCUS and X-ray modalities. This showed a sensitivity of 100% (95% CI: 90-100%) and specificity of 100% (95% CI: 31-100%). Fracture manipulation was required in 35 out of 44 patients. The sensitivity and specificity of PoCUS in determining alignment accuracy when compared to X-ray were 100% (95% CI: 83-100%) and 64% (95% CI: 32-88%) respectively. The PPV and NPV were 86% (95% CI: 66-95%) and 100% (95% CI: 56-100%) respectively. Ten out of 44 (23%) patients with distal radius fractures ultimately required an Open Reduction and Internal Fixation (ORIF). Our study supports the use of PoCUS for identifying distal radius forearm fractures and may have some value in assisting clinicians to determine post reduction success. We still advocate using standard X-ray radiographs to confirm successful or adequate cortical alignment following a manipulation.

Incidentally detected focal fundal gallbladder wall thickening: Differentiation contrast enhanced ultrasound features with high-resolution linear transducers.

To investigate the value of contrast enhanced ultrasound with high resolution linear transducers (HF-CEUS) for differential diagnosis of focal fundal gallbladder (GB) wall thickening. A total of 32 patients with incidentally detected focal fundal GB wall thickening were included. After conventional B mode ultrasound (BMUS) examinations, HF-CEUS were performed with a 7.5-12 MHz 9L4 linear transducer (S2000 HELX OXANA unit, Siemens). Two radiologists independently reviewed the HF-CEUS enhancement patterns to determine the differential features between malignancy and benignity with a five-point confidence scale. The diagnostic accuracy of BMUS and HF-CEUS for GB wall thickening was compared. The final gold standard was surgery with histological examination. Final diagnoses included GB adenocarcinoma (n = 16), adenomyomatosis (n = 12), Xanthogranulomatous (n = 2) and cholecystitis (n = 2). HF-CEUS features associated with GB adenocarcinoma including arterial phase inhomogeneous hyperenhancement, venous phase hypoenhancement and disruption of GB wall layer structure (P < 0.05). Two small (5 mm) liver metastasis were confirmed by HF-CEUS during the late phase liver sweep as hypoenhanced lesions. Nonenhanced Rokitansky-Aschoff sinuses were clearly observed in 83.3% focal adenomyomatosis. Overall sensitivity, specificity and accuracy for differentiation between malignant and benign focal fundal GB wall thickening of HF-CEUS and BMUS were 84.3% vs 53.1%, 90.6% vs 59.3% and 87.5% vs 56.2% (P < 0.005). CEUS performed with high frequency linear transducers could be a useful alternative in the differential diagnosis of focal fundal GB wall thickening on conventional ultrasound.

Grading of Ultrasonography in Rheumatoid Arthritis of Wrist and Hand Joints

To evaluate the role of musculoskeletal ultrasound (MSUS) in the grading of rheumatoid arthritis (RA) wrist and hand joints and correlate it with clinical, laboratory, and radiological data. A cross-sectional study recruited 50 patients in a tertiary care hospital. RA activity was assessed by DAS28. MSUS dorsal longitudinal scan was performed on the wrists, MCPs, and PIPS joints using high frequency (18 MHZ) linear transducer. 100 wrists in three different views, 500 MCPs, 500 PIPs were evaluated using the grayscale ultrasound and power Doppler ultrasound semiquantitative scale and scores ranging from 0-3. The results were correlated with clinical, laboratory and radiological data. All patients' wrist and hand joints X-rays were evaluated using the Larsen score. The mean age of the patients (49 females and one male) was 44.58 ± 10.07 years, and their mean disease duration was 16.26 ± 1.07 years. The mean DAS28 was 5.19 ± 0.95. 97.5% of joints had grade I Larsen score, 11.07% of the joints had erosions, 9.2% of the joints had effusions, 23.8% of the joints had synovial thickening, 11.9% of the joints showed PD signals and 3.5% of the joints were accompanied with tenosynovitis. Significant relations (p < 0.05) found among DAS28 and (PD signals, synovial thickening, tenosynovitis, effusion, and Larsen score). A nonsignificant relation (p > 0.05) among DAS28 and erosions detected by MSUS and X-ray. MSUS is powerful in the detection of early RA regarding synovitis, joint effusion, tenosynovitis, and bone erosions, which were correlated with clinical and laboratory parameters.