Initial Sonographic Examination Research Articles

Accuracy of sonographic chorionicity classification in twin gestations.

To evaluate the accuracy of sonographic classification of chorionicity in a large cohort of twins and investigate which factors may be associated with sonographic accuracy. We conducted a secondary analysis of a randomized trial of preterm birth prevention in twins. Sonographic classification of chorionicity was compared with pathologic examination of the placenta. Maternal (age, body mass index, diabetes, and hypertension), obstetric (prior cesarean delivery, gestational age at the first sonographic examination, and antepartum bleeding), and sonographic (oligohydramnios, polyhydramnios, and twin-twin transfusion syndrome) factors were assessed for their possible association with accuracy. A total of 545 twin sets in which chorionicity was classified by sonography before 20 weeks' gestation were included; 455 were dichorionic and 90 were monochorionic based on pathologic examination. Sonography misclassified 35 of 545 twin pregnancies (6.4%): 18 of 455 dichorionic twins (4.0%) and 17 of 90 monochorionic twins (19.0%). The sensitivity and specificity of sonographic diagnosis of monochorionicity were 81.1% and 96.0%, respectively. In a multivariable analysis, pregnancies with initial sonographic examinations before 14 weeks' gestation were less likely to have misclassified chorionicity than those with sonographic examinations at 15 to 20 weeks (odds ratio [OR], 0.47; 95% confidence interval [CI], 0.23-0.96). For each week increase in gestational age, the odds of misclassification rose by 10% (OR, 1.10; 95% CI, 1.01-1.2). In the multivariable analysis, maternal age, body mass index, parity, and prior cesarean delivery were not associated with sonographic accuracy. Sonography before 20 weeks incorrectly classified chorionicity in 6.4% of twin gestations. Those with first sonographic examinations performed at earlier gestational ages had improved chorionicity diagnosis.

The role of ultrasound and magnetic resonance imaging in the evaluation of musculotendinous pathologies of the shoulder joint

Aim: To evaluate and characterize the musculotendinous pathologies of shoulder joint using ultrasound (USG) and magnetic resonance imaging (MRI). Background and Objectives: The glenohumeral joint, being the most mobile and unstable of all the joints, is often prone to injuries. To compensate for its unstable bony anatomy, the shoulder is protected anteriorly, posteriorly, and superiorly by a capsule and tendons that form the rotator cuff. Sonography is often considered the first-line imaging modality in the assessment of cuff as well as in nonrotator cuff disorders. MRI is of value in cases of extensive abnormality that is often incompletely characterized by the initial sonographic examination, as in case of sonographically inaccessible areas. However, musculoskeletal imaging is truly a multimodality approach and in order to identify and characterize the lesion, a combination of modalities should be used. Materials and Methods: A prospective study was carried out on 75 patients in the Department of Radiodiagnosis, Padmashree Dr. D. Y. Patil Medical College, Hospital and Research Centre, Pimpri, Pune over a period of 2 years from July 2011 to September 2013. Patients from all age groups including both men and women with shoulder pain, suspected to be arising from the musculotendinous tissues of the shoulder joint, were taken up for study. Results: In our study, USG showed a sensitivity of 95.2%, specificity of 88.8%, and positive predictive value of 80% for demonstrating full-thickness tears. In case of partial-thickness tears, USG showed overall sensitivity of 94.7%, specificity of 85.7%, and positive predictive value of 90%. Overall accuracy of USG in detecting full-thickness as well as partial-thickness tears was 91%. Conclusion: In patients with shoulder complaints, USG is a reliable dynamic diagnostic tool. It reveals high diagnostic accuracy in detecting rotator cuff pathologies including cuff tears and tendinopathy. However, MRI has always been successful in overall assessment of joint structure. Its ability to evaluate labrum and various glenohumeral ligaments cannot be superseded by USG.

Botryoid nephroblastoma with pelviureteral and vesical extension mimicking xanthogranulomatous pyelonephritis in children

We report the case of a multicystic renal lesion in a nine-month-old boy, who presented clinically with a left sided flank mass, fever and biological signs of urinary tract infection. The initial sonographic examination revealed an enlarged left kidney showing multiple anechoic fluid-filled formations and a distended left pelviureteral tract with solid appearing luminal echo pattern. Later, CT scan supported these aspects. Our first hypothesis was an inflammatory process such as xanthogranulomatous pyelonephritis. Nevertheless, final histological analysis diagnosed a nephroblastoma with cysts formation. This case highlights one unusual radiological appearance of nephroblastoma, which may result in misdiagnosis.

Facial infiltrative lipomatosis

Although there are multiple case reports and small series concerning facial infiltrative lipomatosis, there is no composite radiological description of the condition. Radiological evaluation of facial infiltrative lipomatosis using plain film, sonography, CT and MRI. We radiologically evaluated four patients with facial infiltrative lipomatosis. Initial plain radiographs of the face were acquired in all patients. Three children had an initial sonographic examination to evaluate the condition, followed by MRI. One child had a CT and then MRI. One child had abnormalities on plain radiographs. Sonographically, the lesions were seen as ill-defined heterogeneously hypoechoic areas with indistinct margins. On CT images, the lesions did not have a homogeneous fat density but showed some relatively more dense areas in deeper parts of the lesions. MRI provided better delineation of the exact extent of the process and characterization of facial infiltrative lipomatosis. Facial infiltrative lipomatosis should be considered as a differential diagnosis of vascular or lymphatic malformation when a child presents with unilateral facial swelling. MRI is the most useful single imaging modality to evaluate the condition, as it provides the best delineation of the exact extent of the process.

Second-trimester sonography and trisomy 18.

This report presents the findings seen on initial second-trimester sonography in a large group of fetuses with trisomy 18. The object of this study was to describe the types and frequencies of abnormal sonographic findings seen and to further evaluate those cases in which no abnormal findings were noted. A retrospective chart review of the prenatal sonograms in cases of trisomy 18 was conducted. Forty-nine fetuses with trisomy 18 were examined by second-trimester sonography. Multiple fetal anomalies were seen in most cases. The most frequent structural findings involved the brain (82%), heart (55%), and upper extremities (53%). Growth abnormalities occurred in 39% of these fetuses. Choroid plexus cysts were the most common individual findings. Larger cysts increased the likelihood of trisomy 18, although no fetuses with trisomy 18 had isolated choroid plexus cysts. Seven fetuses (14%) had no anomalies seen on their initial scans. In each of these scans, the fetal anatomy was incompletely visualized because of technical constraints. Six had subsequent scans approximately 2 weeks later, which showed abnormal sonographic findings. Most fetuses with trisomy 18 were identified by structural anomalies, typically seen in the brain, heart, and upper extremities. Larger choroid plexus cysts were associated with this aneuploidy. Technical factors, which limit fetal visualization, were noted in all cases in which no sonographic abnormalities were detected during the initial sonographic examinations. Detection of abnormal cases will rely on a completed evaluation of a routine fetal anatomic survey.

Sonohysterographic Appearances of Endometrial Carcinoma: An In Vitro Study of Uterine Specimens

Objective: To determine the sonohysterographic appearances of endometrial carcinoma by sonohysterographic examination of uterine specimens.Methods: A prospective study of sonohysterographic examination on 30 uteri obtained immediately after hysterectomy from women 30 to 86 years of age, diagnosed preoperatively with endometrial carcinoma. The transducer was applied directly on the serosal surface of the anterior uterine wall for sonographic visualization. Sonographic examination was performed initially to assess the endometrial thickness, followed by infusion of normal saline into the endometrial cavity through a Foley catheter inserted into the cervix and repeat sonographic evaluation to characterize endometrial carcinoma.Results: The mean (± SD) endometrial thickness on initial sonographic examination was 11.4 (± 6.6) mm. Sonohysterographic examination demonstrated 15 uteri to have large, irregular polyploid masses arising from the endometrium, 6 uteri to have focal endometrial thickening, 4 uteri to contain benign-appearing polyp(s), 2 uteri to contain benign-appearing polyp(s) with focal endometrial thickening, and 3 uteri to have normal endometria.Conclusion: The sonohysterographic appearance of endometrial carcinoma is variable. Although the majority of endometrial carcinomas appeared as large, irregular polyploid masses, a completely normal sonohysterographic appearance may occur.

Deep vein thrombosis: can a second sonographic examination be avoided?

Our objective was to determine the prevalence of deep vein thrombosis in symptomatic patients and its distribution based on the assessment of prior clinical probability. We evaluated whether repeated sonography is necessary in patients with either intermediate or high clinical probability for deep vein thrombosis after an initial examination with negative findings. We prospectively evaluated 438 consecutive patients with clinical suggestion of deep vein thrombosis of the lower limbs, classified according to the prior clinical probability (high, intermediate, low). Sonography with positive findings was diagnostic for deep vein thrombosis. Negative findings in low-risk patients excluded thrombosis. Patients with intermediate or high clinical risk whose initial sonographic examination showed negative findings underwent a second examination after 1 week. Of the 438 patients with clinical symptoms, 112 patients (26%) had positive findings on sonography, and 326 (74%) had negative findings. Of the 202 intermediate- and high-risk patients with negative initial sonography, 140 patients underwent a single follow-up sonographic examination 1 week later. In three cases, findings were positive for deep vein thrombosis. Two other patients developed pulmonary embolism. Sonographic follow-up increased the detection of deep vein thrombosis in the patients with intermediate or high probability from 32.5% to 33.5%; the prevalence of thromboembolic disease in this group was 34%. The prevalence of deep vein thrombosis studied by sonography in the patients with intermediate or high clinical risk was 33.5%. Initial sonography revealed a 32.5% prevalence, and a second examination 1 week later detected an additional 1%. Sonography did not reveal 0.5% of thromboembolic events. Our results do not justify a routine second scanning at 1 week.

Sonolucency of a fresh hematoma in a case of marginal placental abruption

A 33-year-old primigravid woman was referred at 37 weeks of gestation for an unexpected vaginal bleeding with continuous weak uterine contractions. The antenatal course was uneventful until presentation. The amniotic membrane was intact, and vaginal discharge was blood-stained on vaginal examination. The fetal heart rate was reactive. An initial sonographic examination at that stage showed that the placenta was attached to the anterior uterine wall, but no previa or abruption was noted. Approximately 10min after the initial examination, a small wedge shaped sonolucent area appeared at the highest placental margin (Fig. 1). The lesion gradually increased in size. The diagnosis of marginal placental abruption was made. Cesarean section conducted immediately showed a couvelaire uterus. A female infant weighing 2.592g was born with Apgar scores of 1 and 5 at 1and 5min, respectively. A hen egg-sized retroplacental hematoma was located at the margin of the removed placenta. The patient and her infant had uneventful postoperative course.

Prenatal Sonographic Diagnosis and Subsequent Conservative Surgical Management of Bilateral Ureteroceles

Prenatal sonographic diagnosis of ureteroceles usually involves clearly duplicated urinary collecting systems associated with ectopic ureters draining the upper renal moieties. We present an unusual case in which an initial sonographic examination was consistent with bilateral orthotopic ureteroceles in association with bilateral single renal systems. The possibility of single systems raised perinatal considerations unique to this anomaly. Repeat prenatal sonography was suggestive of duplex systems and subsequently confirmed as such by neonatal ultrasound and voiding cystourethrogram. At the age of 1 month, the infant underwent bilateral ipsilateral ureteroureterostomy with conservation of the bilateral dilated upper renal moieties. We discuss the possible pathophysiology underlying the different conflicting sonographic findings and address current management of such lesions.