Normal Sonograms Research Articles

Vas deferens sonographic appearances of tuberculosis lesions of 19 cases of male genital systemic tuberculosis.

To investigate the sonographic findings of the vas deferens in male genital tuberculosis.The ultrasonographic findings of the vas deferens of 19 cases of genital tuberculosis were retrospectively analyzed.According to the pathological and ultrasound findings, the ultrasonographic appearances of the vas deferens tuberculosis could be divided into 4 groups, 1 of normal sonograms, 3 of abnormal sonograms. The abnormal ultrasonographic appearances of the vas deferens tuberculosis were considered 3 categories as follows: diffusely thickening of vas deferens, nodular thickening of vas deferens, and space-occupying lesions adjacent to the vas deferens.The ultrasound manifestations of vas deferens in tuberculosis of the male genital system have certain characteristics. Combination of clinical manifestations, history of tuberculosis, experimental antituberculosis treatment, and ultrasound examination of vas deferens can suggest tuberculosis of vas deferens. Furthermore, it can provide objective basis for the comprehensive and noninvasive evaluation of the impact of genital tuberculosis on the reproductive ability for further treatments.

Normal Development of the Corpus Callosum and Evolution of Corpus Callosum Sexual Dimorphism in Infancy.

The aim of this study was to establish reference ranges for the corpus callosum in infancy and to clarify how sexual dimorphism evolves between the fetal stage and infancy. Normal sonograms from cerebral ultrasonographic examinations of 1- to 6-month-old healthy full-term infants were selected. The length and thickness of the corpus callosum were determined, and the effect of sex on these values was analyzed. Studies on corpus callosum sexual dimorphism were reviewed. In total, sonograms from 236 1- to 6-month-old infants (120 male and 116 female) were collected, and the typical values (5th-95th percentiles) of the corpus callosum were determined for each group. During the first 2 months, with and without brain size adjustment, the corpus callosum in female infants was significantly thicker than that in male infants (mean thickness ± SD: 1 month, male infant, 1.8 ± 0.3 mm; female infant, 2.1 ± 0.3 mm; P = .005; 2 months, male infant, 1.8 ± 0.2 mm; female infant, 2.0 ± 0.3 mm; P = .002). The corpus callosum thickness of male and female infants had no significant differences after 2 months of age. Sexual dimorphism was not detected in corpus callosum length. Our study provides reference data on typical corpus callosum development in infants. In the fetal period and early infancy, the corpus callosum in female infants is thicker than that in male infants. From 3 months onward, the corpus callosum sexual dimorphism becomes insignificant throughout childhood. The evolvement of corpus callosum sexual dimorphism suggests that maternal factors may influence brain development.

Hip joint development in children with type IIb developmental dysplasia

The aim of this study was to analyse the results of treatment of sonographically diagnosed type IIb developmental hip dysplasia and to identify residual hip dysplasia using clinical and radiological assessment. We retrospectively reviewed the data of 49 children (59 type IIb and 39 type I hips, according to Graf's monographic classification) treated in abduction braces. The mean age was 9.1years (range 4-15) at latest follow-up. According to the clinical classification of Mckay in Barrett's modification, all the type I and type IIb hips had very good results. No statistical differences were found between type I and IIb hips when comparing both measured radiological parameters and radiological results according to the Severin classification at latest follow-up. Using our criteria (two or more radiological parameters were outside of their normal range), 12 out of 49 type IIb hips demonstrated persistent dysplasia. Of the 12 hips, eight sonograms were normal at the end of treatment and four patients failed to normalise. No type I hips demonstrated two or more abnormal radiographic parameters at latest follow-up. Despite obtaining normal sonograms at the end of treatment, some children with type IIb dysplasia may demonstrate radiographic evidence of persistent hip dysplasia over a longer follow-up period. Our results suggest that these children should be monitored until skeletal maturity.

Does the Selective Progesterone Receptor Modulator Ulipristal Normalize the Uterine Cavity in Women with Leiomyoma?

Objective: To determine if three months of chronic daily administration of ulipristal acetate (UPA), a selective progesterone receptor modulator, normalized the uterine cavity in women with leiomyoma. Methods: Saline sonograms with abnormal uterine cavities from patients participating in a placebo controlled double blind randomized controlled trial evaluating UPA effect on leiomyoma volume were identified prior to initiation of therapy. They were reexamined after 12 weeks of UPA therapy. Normal uterine cavity was defined as having zero percent of leiomyoma volume inside the cavity on repeat sonohysterography. Patients with normal saline sonograms after 12 weeks of UPA therapy were compared with patients with sonographically persistently abnormal uterine cavities. Statistical analysis was performed using the Fisher’s exact test. Results: 28 patients had abnormal sonohysterogram results at baseline (n= 9, n= 8 and n=11 for placebo, UPA 10 mg and UPA 20 mg respectively). At the end of treatment 22% of the placebo group, 38% of the 10 mg group and 27% of the 20 mg group had normal uterine cavities. When the 10 mg and 20 mg groups were combined, 32% of the patients had normal uterine cavities post treatment. The results did not reach statistical significance. Conclusion: If future larger, randomized trials demonstrate a benefit, UPA may offer an alternative to surgical therapy for women requiring normalization of the uterine cavity.

Ultrasound imaging instruction for veterinary students at Colorado State University

Didactic ultrasonography instruction to the veterinary students begins with the physical principles of sonography, machine selection, and operating controls. Subsequently, image artifacts and normal sonograms of the heart and abdominal organs are presented. Sonograms of pregnancy and abnormal sonograms of common diseases are discussed. In the final-year practicum course, small groups of students (2–4) spend a week in the echocardiography lab and the soft-tissue imaging lab. Here, students acquire hands-on sonography skills and become proficient in sonography of small animals and horses. An Internet-based interactive instruction module on the equine limb was developed to enable veterinary students to better learn ultrasonography of tendons/ligaments of the metacarpus. Interactivity was achieved by creating clickable zones on the tendons and ligaments. Students are challenged to apply the knowledge gained studying normal ultrasound anatomy to clinical patients affected with tendon/ligament injuries. Students are asked to identify (by clicking on) the location of the sonographic lesions. The program provides immediate feedback on their ability to recognize the site of the injury. In addition, having the program web-based allows students to review the instructional material on a time schedule that best fits their needs and from remote locations.

The Clinical Significance of Normal Mammograms and Normal Sonograms in Patients with Palpable Abnormalities of the Breast

Purpose: We wanted to evaluate the clinical significance of normal mammograms and normal sonograms in patients with palpable abnormalities of the breast. Materials and Methods: From Apr 2003 to Feb 2005, 107 patients with 113 palpable abnormalities who had combined normal sonographic and normal mammographic findings were retrospectively studied. The evaluated parameters included age of the patients, the clinical referrals, the distribution of the locations of the palpable abnormalities, whether there was a past surgical history, the mammographic densities and the sonographic echo patterns (purely hyperechoic fibrous tissue, mixed fibroglandular breast tissue, predominantly isoechoic glandular tissue and isoechoic subcutaneous fat tissue) at the sites of clinical concern, whether there was a change in imaging and/or the physical examination results at follow-up, and whether there were biopsy results. This study period was chosen to allow a follow-up period of at least 12 months. Results: The patients' ages ranged from 22 to 66 years (mean age: 48.8 years) and 62 (58%) of the 107 patients were between 41 and 50 years old (58%). The most common location of the palpable abnormalities was the upper outer portion of the breast (45%) and most of the mammographic densities were dense patterns (BIRADS Type 3 or 4: 91%). Our cases showed similar distribution for all the types of sonographic echo patterns. 23 patients underwent biopsy; all the biopsy specimens were benign. For the 84 patients with 90 palpable abnormalities who were followed, there was no interval development of breast cancer in the areas of clinical concern. Conclusion: Our results suggest that we can follow up and prevent unnecessary biopsies in women with palpable abnormalities when both the mammography and ultrasonography show normal tissue, but this study was limited by its small sample size. Therefore, a larger study will be needed to better define the negative predictive value of combined normal sonographic and mammographic findings.

Spinal cord sonography in newborns: anatomy and diseases

Sonography of the spinal cord is a relatively recent acquisition that makes it possible to evaluate the content of the vertebral canal and study its pathologies. The aim of this study was to verify the reliability of ultrasound images by comparing them with magnetic resonance ones in healthy controls as well as in patients referred to us between 1991 and 2004. In this period, we studied 436 newborns: 88 without any suspicion of disease as normal controls, and 348 with suspected congenital diseases or in order to screen the children of diabetic mothers, a group that has shown an increased incidence of dysraphism. After explaining normal sonograms, we describe the pathological pictures observed in the 12 pathological cases in our series: conus hypomobility in five cases; lack of visualization of the conus medullaris in one case; and an enlarged ependymal canal in six cases. Four cases presented all three pathological conditions, and seven the association of two pathologies. All of these patients also underwent magnetic resonance imaging (MRI), which confirmed the ultrasound findings in four cases: three cases of enlarged ependymal canal and one of tethered cord hypomobility of the roots with an associated lipoma; the MRI findings were normal in the other seven cases. Sonography was highly specific but not very sensitive, because it is partially conditioned by patient collaboration. Nevertheless, subsequent MRI confirmed 37% of the suspected pathological cases. The ultrasound resolution of both normal and pathological spinal cord structures was particularly clear. The images were similar, easily comparable and often identical to the MRI results, although MRI was certainly more sensitive. The advantages of sonography are its non-invasiveness, low cost, the virtually ubiquitous availability of ultrasound equipment, the simplicity and rapidity of the examination, and its specificity. We believe that the indications for its use are lumbo-sacral skin alterations, neurological disorders caused by congenital malformations, traumas due to childbirth or a lumbar puncture, occult dysraphism, all of the compressive spinal cord neo-formations involving nerves, the dura mater and vertebral bone and joint structures, and the screening of the newborns of diabetic mothers.

Achilles tendon pathology: the role of ultrasonography

Today the Achilles tendinopathies can be diagnosed early by means of sonography, which is non invasive, easy to perform, pratically ubiquitous, economic, precise, repeatable, specific and sensitive. The purpose of this retrospective study was to verify the usefulness of sonography in the diagnosis of Achilles tendinopathies in 158 cases (105 patients). The sonograms revealed 67 cases of tendinosis with peritendinitis, 40 cases of peritendinitis and 30 cases of tendinosis; 21 Achilles tendons with achillodynia had normal sonograms. The results confirm that sonography is a rapid, safe and accurate means of verifying the extension and location of tendinous lesions, as well as the severity of intratendinous degeneration. During the acute phase of inflammatory Achilles tendinopathy, sonography reveals early peritendinous alterations; in chronic forms with intratendinous degeneration, it shows the loss of the normal anatomy of the tendon, which increases in volume, takes on a spindle-like and rounded appearance, and loses its normal oval shape in transversal sections. Sonography also consents to follow the evolution of tendinopathies during treatment, allowing the therapy to be modified in the absence of improvement and providing instrumental confirmation of treatment.

The accuracy of high-resolution ultrasound for evaluating focal lesions of the hand and wrist

Purpose Although several articles have described the sonographic features of solid and cystic lesions of the hand and wrist, few have investigated its accuracy for diagnosing such lesions. The purposes of this retrospective study were to determine the accuracy of sonography for diagnosing focal lesions of the hand and wrist against the standard of histologic examination of the resected specimen and to compare the accuracy of sonography against the recorded initial clinical impression. Methods A medical record search for all sonographic studies of the hand and wrist at our institution was performed. Eighty-four patients had correlative surgery and made up the study group. All sonogram reports were reviewed for the absence or presence of focal lesions and specific diagnoses and all medical records were reviewed for the initial clinical impression. Both were compared with histologic findings and tested for agreement with the κ statistic and for significant differences with the McNemar test Results Seventy-six of the 84 patients had focal lesions of the hand and wrist and 8 had normal sonograms. Overall, ultrasound correctly diagnosed 83% of the lesions and the initial clinical impression was correct in 54%. Of the 76 lesions ultrasound correctly diagnosed 87% of cystic lesions, 73% of solid lesions, 75% of tenosynovitis cases and the single-vessel thrombosis. The initial clinical impression was correct in 67% of cystic lesions and 75% of tenosynovitis cases. The solid or cystic nature of the 15 solid lesions and the single-vessel thrombosis could not be determined by history or physical examination alone. Of the 35 cases in which the recorded clinical impression was incorrect or not recorded ultrasound provided the correct diagnoses in 71% of these cases. Agreement with the κ statistical analysis was only fair and the recorded initial clinical impression was less accurate than ultrasound. Conclusions Ultrasound was statistically more accurate than the initial clinical impression for distinguishing solid from cystic lesions of the hand and wrist. Ultrasound was very accurate for specifically diagnosing ganglions and slightly less for solid lesions and tenosynovitis.

Ultrasonographic evaluation of the rotator cuff after shoulder arthroplasty

Ultrasonography of the rotator cuff tendons is a standard imaging technique. Although increasing numbers of shoulder arthroplasty are performed, there is no available data concerning the use of ultrasound after shoulder replacement. Our experimental study was performed to analyse the value of ultrasonography after shoulder arthroplasty a) in an ex-vivo-setting and b) in a retrospective analysis of our patients after shoulder hemiprothesis. After defrosting, anatomic modular humeral head replacement was performed in four fresh-frozen specimens with intact rotator cuffs. The supraspinatus and subscapularis tendons of each specimen were either detached to simulate a cuff defect or reattached anatomically (four times per specimen). Two experienced examiners then performed ultrasonography to evaluate the two tendons to be either intact or deficient. In a retrospective study, 22 patients with 25 hemiprotheses of the shoulder underwent clinical and sonographic examination. For documentation of the clinical findings, the Constant score was used. In the cadaver study, the reliability of the method was slightly higher for the subscapularis tendon (13 correct, 3 false results) than for the supraspinatus tendon (12 correct, 4 false results). In our patients, rotator cuff defects and effusions around the biceps tendon and in the subdeltoid bursa could be detected. Normal sonograms correlated with good clinical results. In the cadaver study, we found a good reproducibility of in-vivo conditions. We believe that ultrasonography is beneficial in follow-up evaluation after shoulder arthroplasty.

Pregnancy outcomes among women with polycystic ovary syndrome treated with metformin.

We sought to determine whether metformin, which had facilitated conception in 72 oligoamenorrhoeic women with polycystic ovary syndrome (PCOS), would safely reduce the rate of first trimester spontaneous abortion (SAB) and increase the number of live births without teratogenicity. Seventy-two oligoamenorrheic women with PCOS conceived on metformin (2.55 g/day). They were prospectively assessed in an outpatient clinical research centre. Outcome measures included number of first trimester SAB, live births, normal ongoing pregnancies >or=13 weeks, gestational diabetes (GD), congenital defects (CD), birthweight and height, as well as weight, height, and motor and social development during the first 6 months of life. Of the 84 fetuses, to date there have been 63 normal live births without CD (75%), 14 first trimester SAB (17%), and seven ongoing pregnancies >or=13 weeks with normal sonograms without CD (8%). Previously, without metformin, 40 of the 72 women had 100 pregnancies (100 fetuses) with 34 (34%) live births and 62 (62%) first trimester SAB. In current pregnancies on metformin in these 40 women (46 pregnancies, 47 fetuses), there have been 33 live births (70%), two pregnancies ongoing >/=13 weeks (4%), and 12 SAB (26%) (P < 0.0001). There was no maternal lactic acidosis, and no maternal or neonatal hypoglycaemia. Fasting entry serum insulin was a significant explanatory variable for total (previous and current) first trimester SAB, odds ratio 1.32 (for each 5 micro U/ml rise in insulin), 95% CI 1.09-1.60 (P = 0.005). On metformin, GD developed in 4% of pregnancies versus 26% of previous pregnancies without metformin, P = 0.025. There have been no major CD in the 63 live births or CD by sonography in the seven fetuses <or=13 weeks. In the 63 live births, neither weight nor height differed from the normal neonatal population. At 6 month follow-up, height was greater (P = 0.008) and weight did not differ from the normal paediatric population; motor and social development were normal. Metformin therapy during pregnancy in women with PCOS was safely associated with reduction in SAB and in GD, was not teratogenic, and did not adversely affect birthweight or height, or height, weight, and motor and social development at 3 and 6 months of life.

Can the endometrial thickness as measured by trans‐vaginal sonography be used to exclude polyps or hyperplasia in pre‐menopausal patients with abnormal uterine bleeding?

To combine findings of normal mid-line echoes from TVS (trans-vaginal sonography) with cut-off levels for endometrial thickness, in order to examine the associated risk of abnormalities in the uterine cavity. Two center prospective study at a university clinic and a central hospital in Denmark. Three hundred and fifty-five pre-menopausal patients with abnormal uterine bleeding, and indications for endometrial sampling or surgery. The thickness of the endometrium was measured, and the mid-line echoes were evaluated using TVS. The findings from the endometrial sampling, combined with the evaluation of the uterine cavity using operative hysteroscopy (115), hysterectomy (74) or HSE (hysterosonographic examination) (166), were used as the true values. The mean (+/-s.d.) endometrial thickness was significantly different in patients with hyperplasia 11.5 mm (+/-5.0), polyps 11.8 mm (+/-5.1), sub-mucous myomas 7.1 mm (+/-3.4) and in patients without these abnormalities 8.37 (+/-3.9) (p<0.001). Hyperplasia and/or polyps were present in 20% of all patients, and in 8% of 143 patients with an endometrial thickness of < or =7 mm. This proportion did not decrease with lower cut-off levels for endometrial thickness. Receiver operating characteristic (ROC) curves were not optimal for excluding hyperplasia or polyps by endometrial thickness. In 173 cases with a distinct, regular midline echo without echo-dense foci in TVS the proportion of patients with abnormalities was 16% (11-23). This proportion did not decrease with cut-off levels for endometrial thickness. Using TVS, low levels of endometrial thickness reduced the possibility of abnormalities such as polyps and hyperplasia, but did not exclude them. Low cut-off levels for endometrial thickness did not increase the diagnostic performance in cases with normal sonograms.

Mammographic and sonographic findings in the diagnosis of idiopathic granulomatous mastitis.

The aim of this study was to describe the mammographic and sonographic findings of idiopathic granulomatous mastitis which is a rare inflammatory disease of the breast of unknown etiology. The clinical, radiologic, and pathologic features of 12 cases with idiopathic granulomatous mastitis were retrospectively reviewed. Mammography was performed in all cases, 8 of which showed a focal asymmetric density, 3 had a mass with irregular margins, and 1 had no abnormality. Sonography was performed in 10 cases, and a focal area with inhomogeneous and hypoechoic pattern was depicted in 6 cases, 4 of which were associated with internal tubular hypoechoic structures. One case revealed a hypoechoic mass consistent with malignancy. In 1 case sonography showed an edematous pattern involving nearly the entire breast. Two patients had normal sonograms. If a focal asymmetric density is seen in mammography and inhomogeneous hypoechogenity with internal hypoechoic tubular structures accompany ultrasonographically, these findings should suggest the possibility of idiopathic granulomatous mastitis; however, very often idiopathic granulomatous mastitis mimics a breast carcinoma clinically and the final diagnosis should be reached histopathologically due to high false-positive and false-negative mammographic appearances.

Breast biopsy avoidance: the value of normal mammograms and normal sonograms in the setting of a palpable lump.

To review the authors' experience with patients who presented with breast lumps and had normal mammograms and normal sonograms. The findings from 600 lumps in 486 women with no focal ultrasonographic (US) mass or mammographic finding in the area of clinical concern were retrospectively studied. Evaluated parameters included the individual reporting the lump, qualitative descriptors for the physical finding, mammographic density, US characteristics in the area of concern, whether there was a change in imaging and/or physical examination results, and whether there were diagnostic biopsy findings at follow-up. The study group included 540 lumps in 435 women who had a minimum mammographic and clinical follow-up of 2 years, as well as 60 additional lumps in 51 patients who underwent biopsy. No patient in the nonbiopsy group developed carcinoma at the initial site of concern during a mean mammographic and clinical follow-up period of 43 months, and all biopsy specimens were benign (negative predictive value, 100%). Results of this retrospective study suggest that breast biopsy may be avoided in women with palpable abnormalities when both US and mammography depict normal tissue at the lump site.

Comparing thyroid ultrasonography to thyroid function in long‐term survivors of childhood lymphoma

We studied the value of thyroid ultrasonography as a follow-up tool in survivors of childhood lymphomas and correlated morphologic abnormalities with thyroid function tests. A prospective follow-up study of 45 long-term survivors of histology-proved childhood lymphomas was performed. Mean age at diagnosis was 9.1 years (range 2.1-16.4 years) and mean follow-up duration 10.9 years (range 3.9-22.2 years). Among the 26 survivors of Hodgkin disease (HD) who received mantle field irradiation, 14 (54%) had abnormal ultrasonograms. Elevated thyroid-stimulating hormone (TSH) concentrations were found in 14 (54%), and 6 of them (42%) had normal thyroid functions. Six of twelve patients with normal ultrasonograms had abnormal thyroid function, and 5 of 11 patients with normal function had abnormal sonograms. Among the 19 non-HD survivors who did not receive radiotherapy, 18 (95%) had both normal sonograms and normal function. Thus thyroid gland abnormalities were detected in 54% of HD survivors after mantle field irradiation. No correlation between the abnormalities detected on ultrasonography and serum levels of TSH and thyroid hormones were found. Both ultrasound and thyroid function tests independently provide clinically useful information; the former examines gland morphologogy and the latter evaluates hormonal changes associated with thyroid disease. The high frequency of thyroid abnormalities detected by ultrasonography suggests that periodic thyroid ultrasonography is advisable in the follow-up of patients treated with mantle irradiation to screen for morphologic changes that may presage malignant transformation.

Comparing thyroid ultrasonography to thyroid function in long-term survivors of childhood lymphoma

We studied the value of thyroid ultrasonography as a follow-up tool in survivors of childhood lymphomas and correlated morphologic abnormalities with thyroid function tests.A prospective follow-up study of 45 long-term survivors of histology-proved childhood lymphomas was performed. Mean age at diagnosis was 9.1 years (range 2.1-16.4 years) and mean follow-up duration 10.9 years (range 3.9-22.2 years).Among the 26 survivors of Hodgkin disease (HD) who received mantle field irradiation, 14 (54%) had abnormal ultrasonograms. Elevated thyroid-stimulating hormone (TSH) concentrations were found in 14 (54%), and 6 of them (42%) had normal thyroid functions. Six of twelve patients with normal ultrasonograms had abnormal thyroid function, and 5 of 11 patients with normal function had abnormal sonograms. Among the 19 non-HD survivors who did not receive radiotherapy, 18 (95%) had both normal sonograms and normal function. Thus thyroid gland abnormalities were detected in 54% of HD survivors after mantle field irradiation. No correlation between the abnormalities detected on ultrasonography and serum levels of TSH and thyroid hormones were found.Both ultrasound and thyroid function tests independently provide clinically useful information; the former examines gland morphologogy and the latter evaluates hormonal changes associated with thyroid disease. The high frequency of thyroid abnormalities detected by ultrasonography suggests that periodic thyroid ultrasonography is advisable in the follow-up of patients treated with mantle irradiation to screen for morphologic changes that may presage malignant transformation.

Transrectal ultrasound anatomy of the prostate and seminal vesicles in healthy men.

This study involved transrectal ultrasound (TRUS) examination of the prostate and seminal vesicles in healthy males, for use as a reference. A total of 125 men (aged 20-69 years) with no history or symptoms of urogenital disease underwent TRUS. Prostate size (both total and central gland), focal lesions such as calcifications, hyper- and hypoechoic areas, cysts, and size and lobulation of the seminal vesicles were noted and related to age. The prostate measured 19.2 +/- 4 cm3 and calcifications were found in 23.1% of men aged 20-29 years compared with 35.5 +/- 12.5 cm3 and 83% for men aged 60-69 years. Overall, hyperechoic areas were found in 59.2% of those examined, cysts in 16.8% and hypoechoic areas in about 11%, predominantly in the peripheral zone. Totally normal sonograms were seen in 29% of the men under the age of 40 and in 5% of the men aged 40 or older. TRUS examinations of healthy males are seldom without sonographic changes. This study provides the frequencies with which these changes occur in healthy males of various ages, all without urogenital symptoms, and may be used for future comparisons with different pathological conditions.

Sonographic Measurements of Renal Size in Normal Children and Children with Compensatory Renal Hypertrophy

Renal length and anteroposterior diameter of both kidneys were measured from normal renal sonograms of 326 children (aged from newborn to 15 years) and graphed to provide a growth chart of normal renal size against age. Mean renal lengths are reported for each year of age. The renal size of 20 children with single kidney, either congenital or postnephrectomy, were also evaluated. Our data showed actual nephromegaly of the solitary kidney indicating compensatory renal growth.

Value of abdominal sonography in the assessment of children with abdominal pain.

We retrospectively evaluated the usefulness of sonography in the diagnostic assessment of children with abdominal pain. From July 1988 to October 1996, 676 children who had abdominal pain and were referred for sonography underwent abdominal and pelvic sonographic examination. Of these, 644 children had recurrent abdominal pain (RAP) and 32 children had acute or subacute abdominal pain (ASAP). The mean ages and relative risks of underlying abnormalities were calculated for children with RAP and ASAP. Abdominal abnormalities were sonographically detected in 10 children with RAP (2%), a significantly lower incidence than in children with ASAP (56%, p < 0.0001), with a relative risk of 0.028 (95% CI, 0.014-0.055). In the RAP group, an underlying abnormality was more likely (p < 0.001) to be sonographically detected in children who had atypical clinical features (5 of 46%; 11%) than in those with typical clinical features (5 of 598; 1%), with a relative risk of 12.94 (95% CI, 3.90-43.30). Children with RAP were found to have hydronephrosis (3), urinary cystitis (2), duplex kidney (1), hypoplastic low-lying kidney (1), choledochal cyst (1), ovarian teratoma (1), and gross gaseous distention with fecal masses (1). Children with ASAP had urinary cystitis (4), intussusception (2), appendicitis (2), appendiceal abscess (1), perforated gut with ascites (1), gut duplication (1), thickened gut wall with fluid from severe gastroenteritis (1), gross gaseous distention with fecal masses (1), hepatosplenomegaly (1), cholecystitis (1), gross hydronephrosis (1), Wilms' tumor (1), and abdominal neuroblastoma (1). Abdominal sonography is useful in children with ASAP. Although an underlying abnormality was rarely found in children with RAP, children who have RAP with atypical clinical features should have sonographic screening. If no abnormalities are found, the normal sonograms may be reassuring to parents.

Risk Factors for Cystic Periventricular Leukomalacia in Very-Low-Birth-Weight Infants † 1232

Cystic periventricular leukomalacia (PVL) occurs most commonly in very-low-birth-weight (VLBW, <1500 gm) infants and is associated with poor developmental outcome. Ischemia has been implicated in the pathogenesis of PVL and recently intrapartum magnesium sulfate (MAG) treatment has been suggested to be neuroprotective; however, clinically relevant risk factors and preventive measures for PVL in VLBW infants remain unclear. We performed a retrospective, matched case-control study of the predictors of PVL in all infants <1500 gm BW from 6/90 to 12/95, during which early and late sonographic screening was routine. We studied anteparum, intrapartum, and postnatal factors, concentrating on vascular, respiratory, and infectious factors, and on intrapartum MAG exposure. We identified 1417 VLBW infants and 54 cases of cystic PVL (inc. 3.8%) and matched 54 controls with normal sonograms (latest at least 30 days) for ±150 gm BW and date of birth. Controls and cases were similar in mean BW (978±234 vs 945±250gm) and gestational age (28±2 wks). PVL cases were more likely to be outborn (37% vs 19%), to have a rapid(≤3 hrs) period from rupture of membranes (ROM) to birth (62% vs 41%), to have a patent ductus arteriousus (60% vs 37%), and to have a higher max PaCO2 in the first 72 hrs (55±16 vs 48±16) and were less likely to have pre-eclampsia (4%vs 15%) (all P≤0.05). The proportions of any intrapartum MAG, tocolytic MAG, steroid use, chorioamnionitis, SGA, RDS, and indomethacin use were similar. When controlled for indomethacin use, MAG use, PaCO2, and delivery location, a logistic regression model determined that predictors for PVL were as in Table. We conclude that PDA and rapid labor course are risk factors for PVL and that pre-eclampsia is more important than MAG use in reducing brain injury.