Normal Ultrasound Findings Research Articles

Definitions and reliability assessment of elementary ultrasound lesions in giant cell arteritis: a study from the OMERACT Large Vessel Vasculitis Ultrasound Working Group

ObjectivesTo define the elementary ultrasound (US) lesions in giant cell arteritis (GCA) and to evaluate the reliability of the assessment of US lesions according to these definitions in a web-based...

Case 253: Thrombosed Umbilical Venous Varix in an Infant

History A 3-month-old previously healthy girl presented to an outside institution with a 4-day history of low-grade fever, irritability, and a tender "knot" in the upper abdomen. Ultrasonography (US) was performed at an outside hospital. US images were not available for review; however, they showed a mass in the left hepatic lobe, per the outside report, and the patient was referred to our institution for further evaluation. Her parents reported a normal full-term pregnancy, with regular prenatal care and normal prenatal US findings. The baby was born after an uncomplicated gestation. She was delivered at term via an uncomplicated cesarean section due to a maternal history of cesarean section. The perinatal course was uncomplicated, and there was no history of umbilical catheterization, per the parents. On arrival at our institution, the patient had a temperature of 38.2°C. All other vital signs were normal. Palpation revealed a tender and firm mass in the periumbilical region; otherwise, physical examination findings were normal. Results of laboratory work-up were normal, except for elevated white blood cell count (26 600/mm3 [26.6 × 109/L]; normal, 6000-17 500/mm3 [6-17.5 × 109/L]). The patient underwent US followed by intravenous contrast material-enhanced (10 mL ioversol, Optiray 320; Medtronic, Santa Rosa, Calif) computed tomography (CT) on the same day.

Hepatobiliary Ultrasonographic Abnormalities in Adult Patients with Sickle Cell Anaemia in Steady State in Ile-Ife, Nigeria.

SummaryBackgroundSickle cell anaemia (SCA) is associated with structural manifestations in the hepatobiliary axis. This study aimed to investigate the hepatobiliary ultrasonographic abnormalities in adult patients with sickle cell anaemia in steady state attending the Haematology clinic of a federal tertiary health institution in Ile-Ife, Nigeria.Material/MethodsBasic demographic data as well as right upper abdominal quadrant ultrasonography of 50 consecutive sickle cell anaemia patients were compared with those of 50 age- and sex-matched subjects with HbAA as controls.ResultsEach of the study groups (patients and controls) comprised of 21 (42%) males and 29 (58%) females. The age range of the patients was 18–45 years with a mean (±SD) of 27.6±7.607 years, while that of the controls was 21–43 years with a mean (±SD) of 28.0±5.079 years (p=0.746). Amongst the patients, 32 (64%) had hepatomegaly, 15 (30%) cholelithiasis and 3 (6%) biliary sludge. Fourteen (28%) of the patients had normal hepatobiliary ultrasound findings. In the control group, one (2%) person had cholelithiasis, one (2%) biliary sludge, one (2%) fatty liver and none hepatomegaly. Forty-seven (94%) of the controls had normal hepatobiliary ultrasound findings. There was a statistically significant difference in the prevalence of hepatomegaly and cholelithiasis between the patients and controls (p value <0.001 for both comparisons).ConclusionsIn this study, hepatomegaly, cholelithiasis and biliary sludge were the most common hepatobiliary ultrasound findings in patients with sickle cell anaemia. Ultrasonography is a useful tool for assessing hepatobiliary abnormalities in patients with sickle cell anaemia.

HYSTEROSCOPY BEFORE IN VITRO FERTILIZATION

In the last decade, success after in vitro fertilization process (IVF) has remained at a similar rate despite all the improvements implemented in the stimulation protocols and laboratory techniques. Hysteroscopy is a method becoming more widely used with patients after a failed IVF cycle, considering a large incidence of uterus cavum pathological states which have a negative impact on the favorable outcome. Numerous studies have provided different results on the IVF outcome with hysteroscopy performed prior to this treatment in cases with no uterus cavum pathology. The aim of the research was to examine the effect of both diagnostic and surgical hysteroscopy on the outcome of IVF. Hysteroscopy was performed with 74 patients 30 to 50 days prior to IVF and in 33 of them (group I) some pathological state was noticed, which was treated during the same procedure. The control group (group III) included 151 patients who had IVF performed with no prior hysteroscopy. There is no statistically significant difference in the rate of post hysteroscopy implantation between I and II group when compared to the control group (20.62% vs 23.28% vs 17.31%), nor in the rate of clinical pregnancies (45.45% vs 46.34% vs 34.44%). Following the correctional treatment of uterus cavum pathological states, implantation and pregnancy rates remain at a level comparable to hysteroscopically normal medical findings. Statistically significant higher pregnancy rate is present in group I after the first IVF cycle, compared to the next IVF in the same group and in comparison to the next IVF cycle in the control group (60.00% vs 27.91%, p&lt;0.05). Hysteroscopy is a simple and safe method allowing nearly identical rate of clinical pregnancies after a surgical treatment of uterus cavum pathological states when compared to the control group, but statistically much higher pregnancy rate if the order of IVF procedure is being compared. In cases of normal ultrasound findings and negative hysteroscopical findings, performing hysteroscopy prior to IVF does not provide significantly better results. Therefore, its routine execution is not recommended.

Development of unstable hips after treatment with the Tübingen splint: mid-term follow-up of 83 hip joints.

Early diagnosis and treatment of hip dysplasia are widely accepted as major factors for beneficial outcome. However, modalities for reduction and retention as well as for imaging are currently under clinical investigation. Local and general risk factors, e.g., breech presentation and the family's desire to avoid in-hospital treatment are major concerns in the decision-making process and consultation. For treatment of unstable hips in newborns the treatment with the Tübingen splint has proven good results in recent studies. However, mid- and long-term outcome studies are missing. We report on clinical results and X-ray parameter of initially unstable hips after treatment with the Tübingen splint at two time points: 12-24 and 24-48months of age. Included were newborns with 83 unstable hips (type D, III, IV according to Graf) which were successfully treated with the Tübingen splint-used as reduction splint 24h per day/7days per week-until type I hips were documented by ultrasound examination. Measurments are based on routine pelvic X-ray control at the age of 12-24 and 24-48months. The acetabular angle was determined and according to the Tönnis-Classification evaluated into: normal findings (< 1s), slightly dysplastic findings (1-2s) and severely dysplastic findings (> 2s). Children with secondary hip dysplasia were not included in this series. In 2nd year of life, 45 hips (54.2%; initial hip type D: 47.4%, III: 63.2%, IV: 42.9%) of the formerly unstable hips show normal X-ray findings. Although final ultrasound showed normal findings, at this time point 28 hips (33.7%; initial hip type D: 34.2%, III: 31.6%, IV: 42.9%) were slightly dysplastic and 10 (12.0%%; initial hip type D: 18.4%, III: 5.3%, IV: 14.3%) still severely dysplastic. At the age of 24-48months, the percentage of radiologic normal hips had increased to 61 hips (73.5%; initial hip type D: 68.4%, III: 81.6%, IV: 57.1%), the number of slightly (19 hips) and severely dysplastic (3 hips) hips had decreased 22.9% (initial hip type D: 28.9%, III: 15.8%, IV: 28.6%) respectively 3.6% (initial hip type D: 2.6%, III: 2.6%, IV: 14.3%). At this time no operative intervention was neccessary. Our mid-term data show on the one hand a good development of unstable hips after successful treatment with the Tübingen splint. On the other hand despite successful therapy and normal ultrasound findings at the end of treatment further imaging by X-ray are mandatory to close follow-up and to detect those which might need surgical correction of residual dysplasia.

Assessment of Agreement between 99mTc-DMSA Renal Scan and Ultrasonography in the Evaluation of Renal Pathology in Children with Recurrent urinary tract infection

Imaging of urinary tract plays a very important role in children with recurrent urinary tract infection (UTI). Various imaging techniques are used and the imaging protocol in children with UTI continues to be a subject of debate. Most authors recommended combination of imaging. The children with recurrent urine infection may be at increased risk of renal parenchymal scarring, hypertension, impaired renal function and end stage renal disease. But early diagnosis and timely proper treatment has an excellent prognosis. 99m-Tc-dimercaptosuccinic acid (DMSA) renal scan and Ultrasonography (US) are routinely performed studies in children with recurrent UTI. If there is agreement between these two investigation procedures, they will be interchangeable, which will benefit the patient by one procedure instead of two. This will be less time consuming and cost effective. This analytical study was carried out at the National Institute of Nuclear Medicine and Allied Sciences (NINMAS), Bangabandhu Sheikh Mujib Medical University campus, Dhaka, from July 2013 to June 2014, for a period of 12 months. The objective of this study was to assess the agreement between 99mTcdimercaptosuccinic acid (DMSA) renal scan and Ultrasonography (US) US for evaluating the renal size, renal position, pelvicalyceal dilatation, hydronephrosis and renal scarring in children with recurrent UTI. Study population consisted of 85 children with age range of 6 months to 12 years, who had laboratory evidence of at least two incidence of UTI within 6 months period. All children underwent 99mTc-DMSA renal scan (plannar) and renal tract ultrasonography (US). Among 85 children, 26 (30.6%) had normal DMSA scan and 59 (69.4%) had abnormal DMSA scan findings. In case of US, 23 (27.1%) had normal US findings and 62 (72.9%) had abnormal US findings of renal system. The comparison of DMSA renal scan and US findings were done by Kappa analysis to see their agreement in the evaluation of size, position, pelvicalyceal dilatation and hydronephrosis. This study gave an impression that DMSA scan and US has good agreement in the evaluation of renal size, position of the kidney and fair agreement in the evaluation of presence of hydronephrosis. In case of mild pelvicaliceal dilatation evaluation, DMSA was underestimated comparing to US.The overall accuracy of US for the evaluation of focal scarring of right and left kidney were 89.4% and 78.8% respectively. For the evaluation of diffuse scarring the overall accuracy of US were 92.9% and 97.6% for the right and left kidney respectively. Therefore, in the evaluation of renal scarring the accuracy of US was underestimated by using DMSA scan as a gold standard. In the evaluation of kidney size, position and presence of hydronephrosis, both DMSA and US can be interchangeable. Whereas DMSA was underestimated comparing to US in the evaluation of mild pelvicaliceal dilatation. On the other hand DMSA renal scan is more sensitive and specific for detecting cortical scaring compared to the US. In light of present study, both DMSA scan and US are recommended in the combination for complete evaluation of renal abnormalities in recurrent UTI. Bangladesh J. Nuclear Med. 18(1): 32-38, January 2015

Use of the Tübingen splint for the initial management of severely dysplastic and unstable hips in newborns with DDH: an alternative to Fettweis plaster and Pavlik harness.

Hip dysplasia is one of the most common skeletal disorders. As a late consequence 20-25% of the patients are at risk to develop secondary osteoarthritis and may require total hip replacement early in life. The treatment principles of hip dislocation are (1) concentric reposition, (2) retention, i.e., plaster in human post or Pavlik harness and (3) maturation in abduction flexion orthesis. The Tübingen splint was introduced as a further development of abduction devices for the treatment of (residual) hip dysplasia with stable hips. The advantages are easy handling, adjustment according to growth and safe limitation of abduction. The aim of this study was to determine the success of treatment of unstable hips with use of the Tübingen splint from early diagnosis until final end of therapy hence normal ultrasound findings. From January 2003 to August 2016 79 children with 109 sonographic unstable hips were treated with the Tübingen splint initially consequently 24h/day. Inclusion criteria were diagnosis of type D, type III a/b or type IV hips according to Graf and beginning of treatment at an age of less or equal 6weeks, without limitation of abduction on clinical examination. At the time of diagnosis 51 type D (46.8%), 46 type III (42.2%) and 12 type IV (11.0%) hips were noticed. In 30 patients (38.0%) bilateral hip dysplasia (type D-IV) was diagnosed. 104 of 109 hips (95.4%) treated with the Tübingen splint could be transferred in a type I hip after a mean treatment period of 88.9days (SD±26.0). In 5 cases (4.6%, 1 type III and 4 type IV hips) the treatment failed. Our data show, that successful treatment of unstable hips in neonates with the Tübingen splint is a comparably successful treatment modality relative to the Pavlik harness and Fettweis plaster.

Parental decisions following prenatal diagnosis of sex chromosome aneuploidy in Hong Kong.

According to the published work, pregnancy termination rates due to prenatal diagnosis of fetal sex chromosome aneuploidies (SCA) vary widely. Some potentially modifiable and non-modifiable factors have been reported to be associated with parental decision. This study aimed to evaluate the rate of pregnancy termination for fetal SCA and the factors influencing parents' decisions in Hong Kong. This was a 21-year retrospective cohort study of parents' decisions following prenatal diagnosis of SCA. Univariate and multivariate analyses for the association between demographic factors, prenatal factors, or counseling provided and decision-making were conducted. The study included 399 pregnancies with prenatal diagnosis of SCA and the overall termination rate was 55.6% (91.7%, 48.0%, 23.4%, 4.8%, and 22.7% for 45,X, 47,XXY, 47,XXX, 47,XYY, and mosaicism, respectively). Pregnancies with ultrasound abnormalities were associated with higher termination rates than pregnancies with normal ultrasound findings (91.3% vs 28.3%, P < 0.0001). From multivariate regression analysis on 226 pregnancies with normal ultrasound examination, a higher likelihood to terminate was found in pregnancies affected by 45,X and 47,XXY (adjusted odds ratio, 4.72, P < 0.0001). Increased maternal age and history of infertility were associated with lower likelihood to terminate (adjusted odds ratio, 0.9, P = 0.012; and 5.12, P = 0.038, respectively). The pregnancy termination rate declined over time. A significant correlation was found between the termination of SCA-affected pregnancy and the presence of fetal sonographic abnormalities, type of SCA, maternal age, and presence of infertility.

Incidence of acetabular dysplasia in breech infants following initially normal ultrasound: the effect of variable diagnostic criteria.

PurposeThis study aimed to determine the incidence of acetabular dysplasia at six months of age in patients with breech presentation and previously normal hip ultrasounds, reporting primary radiographic measurements to allow for comparison with other patient cohorts.MethodsA retrospective analysis of breech infants with initially normal clinical examinations and hip ultrasounds was performed to determine the rate of subsequent acetabular dysplasia and to characterise the distribution of acetabular index (AI). At approximately six months of age, AI was measured bilaterally on anteroposterior (AP) pelvic radiographs and reported using descriptive statistics.ResultsA total of 94 hips in 47 breech infants were eligible for analysis. All infants demonstrated normal ultrasound findings at a mean age of 6.9 ± 1.7 weeks and returned for follow-up at a mean age of 6.4 ± 0.5 months. On AP pelvic radiographs, mean right hip AI was 25.0°, with an interquartile range (IQR) (25th -75th percentile) of 23° to 27° and mean left hip AI was 25.5°, with an IQR of 22° to 28°. If one applies a single commonly used threshold value for defining dysplasia (AI ≥ 30°), 10/94 hips (10.6%) meet diagnostic criteria. Alternatively, strict adherence to previously established normative AI values stratified by gender and laterality results in 4/94 hips (4.3%) qualifying as significantly dysplastic.ConclusionsThe proportion of breech infants who, despite normal initial ultrasound findings, were diagnosed with dysplasia at six months supports observation of breech-born patients beyond six weeks. Reliance on different threshold values for diagnosing acetabular dysplasia can lead to discrepancies in incidence rates.

Association between Gallbladder Ultrasound Findings and Bacterial Culture of Bile in 70 Cats and 202 Dogs.

BackgroundBacterial cholecystitis often is diagnosed by combination of gallbladder ultrasound (US) findings and positive results of bile culture. The value of gallbladder US in determining the likelihood of bile bacterial infection in cats and dogs with suspected biliary disease is unknown.Hypothesis/ObjectivesTo determine the value of gallbladder US in predicting bile bacterial culture results, identify most common bacterial isolates from bile, and describe complications after cholecystocentesis in cats and dogs with suspected hepatobiliary disease.AnimalsCats (70) and dogs (202) that underwent an abdominal US and submission of bile for culture were included in the study.MethodsA cross‐sectional study design was used to determine the association of gallbladder US abnormalities and the results of bile cultures, and complications of cholecystocentesis.ResultsAbnormal gallbladder US had high sensitivity (96%) but low specificity (49%) in cats with positive and negative results of bile bacterial culture, respectively. Cats with normal gallbladder US findings were unlikely to have positive bile bacterial culture (negative predictive value of 96%). Gallbladder US had lower sensitivity (81%), specificity (31%), positive predictive value (20%), and negative predictive value (88%) in dogs. The most common bacterial isolates were of enteric origin, the prevalence being higher in cats. Incidence of complications after cholecystocentesis was 3.4%.Conclusions and clinical importanceGallbladder US has a high negative predictive value for bile culture results in cats. This modality is less predictive of infection in dogs. Percutaneous US‐guided cholecystocentesis has a low complication rate.

Kidney outcomes in patients with liver cirrhosis and chronic kidney disease receiving an orthotopic liver transplant alone

Kidney transplant in patients with liver cirrhosis and nondialysis chronic kidney disease (CKD) is controversial. We report 14 liver cirrhotic patients who had persistently low MDRD-6 estimated glomerular filtration rate (e-GFR) <40mL/min/1.73m2 for ≥3months and underwent either liver transplant alone (LTA; n=9) or simultaneous liver-kidney transplant (SLKT; n=5). Pretransplant, patients with LTA compared with SLKT had lower serum creatinine (2.5±0.73 vs 4.6±0.52mg/dL, P=.001), higher MDRD-6 e-GFR (21.0±7.2 vs 10.3±2.0mL/min/1.73m2 , P=.002), higher 24-hour urine creatinine clearance (34.2±8.8 vs 18.0±2.2mL/min, P=.002), lower proteinuria (133.2±117.7 vs 663±268.2mg/24h, P=.0002), and relatively normal kidney biopsy and ultrasound findings. Post-LTA, the e-GFR (mL/min/1.73m2 ) increased in all nine patients, with mean e-GFR at 1month (49.8±8.4), 3months (49.6±8.7), 6months (49.8±8.1), 12months (47.6±9.2), 24months (47.9±9.1), and 36months (45.1±7.3) significantly higher compared to pre-LTA e-GFR (P≤.005 at all time points). One patient developed end-stage renal disease 9years post-LTA and another patient expired 7years post-LTA. The low e-GFR alone in the absence of other markers or risk factors of CKD should not be an absolute criterion for SLKT in patients with liver cirrhosis.

Prevalence of and risk factors for cranial ultrasound abnormalities in very-low-birth-weight infants at Charlotte Maxeke Johannesburg Academic Hospital

Background. Periventricular-intraventricular haemorrhage (IVH) and cystic periventricular leukomalacia (cPVL) contribute to neonatal mortality and morbidity. Low birth weight and gestational age are among the risk factors for IVH and cPVL. Objectives . To assess how many very low birth weight (VLBW) infants had cranial ultrasound screening at Charlotte Maxeke Johannesburg Academic Hospital (CMJAH) and to determine the prevalence of cranial ultrasound abnormalities. To compare the characteristics and risk factors of those VLBW infants with cranial ultrasound abnormalities to those with normal cranial ultrasound findings. Methods. This was a retrospective case-controlled study of infants <1 500 g admitted to CMJAH from 1 January 2013 to 31 December 2015. Cases were identified as infants with IVH or cPVL. Controls were matched 1:2 based on birth weight and gender. Results . Only 55% (856/1 562) of VLBW infants had undergone cranial ultrasound screening. The final sample included 803 VLBW infants. IVH was identified in 26.7% of cases ( n =215; 95% confidence interval (CI) 23.8 - 29.9) and 0.9% had cPVL ( n =8; 95% CI 0.5 - 1.9). A total of 197 cases were identified and matched with 394 controls. Antenatal care attendance was lower in the cases (71% v. 79%; p =0.039). Sepsis, ventilation, metabolic acidosis and patent ductus arteriosus were all significantly higher in the cases. The use of antenatal steroids was significantly higher in the grades I - II IVH/no-IVH group v. grades III - IV IVH group (44% v. 25%; p =0.017). Conclusion . The prevalence of IVH in our setting was consistent with that of developed countries. Improving antenatal care, infection control, and adequate early resuscitation could decrease the incidence of IVH and cPVL. All VLBW infants should undergo cranial ultrasound screening

Avoidance of voiding cystourethrography in infants younger than 3 months with Escherichia coli urinary tract infection and normal renal ultrasound

Background and objectiveUrinary tract infection (UTI) represents the most common bacterial infection in infants, and its prevalence increases with the presence of high-grade vesicoureteral reflux (VUR). However, voiding cystourethrography (VCUG)...

Maternal psychological responses during pregnancy after ultrasonographic detection of structural fetal anomalies: A prospective longitudinal observational study.

In this longitudinal prospective observational study performed at a tertiary perinatal referral centre, we aimed to assess maternal distress in pregnancy in women with ultrasound findings of fetal anomaly and compare this with distress in pregnant women with normal ultrasound findings. Pregnant women with a structural fetal anomaly (n = 48) and normal ultrasound (n = 105) were included. We administered self-report questionnaires (General Health Questionnaire-28, Impact of Event Scale-22 [IES], and Edinburgh Postnatal Depression Scale) a few days following ultrasound detection of a fetal anomaly or a normal ultrasound (T1), 3 weeks post-ultrasound (T2), and at 30 (T3) and 36 weeks gestation (T4). Social dysfunction, health perception, and psychological distress (intrusion, avoidance, arousal, anxiety, and depression) were the main outcome measures. The median gestational age at T1 was 20 and 19 weeks in the group with and without fetal anomaly, respectively. In the fetal anomaly group, all psychological distress scores were highest at T1. In the group with a normal scan, distress scores were stable throughout pregnancy. At all assessments, the fetal anomaly group scored significantly higher (especially on depression-related questions) compared to the normal scan group, except on the IES Intrusion and Arousal subscales at T4, although with large individual differences. In conclusion, women with a known fetal anomaly initially had high stress scores, which gradually decreased, resembling those in women with a normal pregnancy. Psychological stress levels were stable and low during the latter half of gestation in women with a normal pregnancy.

Doppler sonographic evaluation of venogenic extremity swellings: Analysis of 170 patients from Kano, Nigeria.

Deep venous thrombosis (DVT) is a serious problem that can potentially lead to many complications including life-threatening pulmonary arterial thrombosis. Screening and confirmation of the diagnosis are critical in the care of this condition. The objective of this study was to evaluate the role of Doppler sonography in diagnosing DVT and to illustrate the pattern in 170 suspected cases from our local environment. This study was conducted at our department over 18 months. A total of 170 patients with clinical suspicion of limb DVT were recruited. The characteristics of the patients, risk factor for DVT, and the site of the lesion were documented. Sonographic examination was done using 7.5 MHz linear and 3.5 MHz convex transducers. Out of the 170 patients, there are 89 (52.35%) males and 81 (47.65%) females. Their mean age was 50.6 years (+17.9 years). The common risk factors for DVT include chronic medical illness (28.8%), long distance travel (15.3%), previous DVT (8.8%), stroke/paralysis (5.3%), neoplasms (5.9%), pregnancy (5.9%), and trauma/surgery (5.9%). About 55.8% (95) of them were confirmed to have DVT on ultrasound while 44.2% (75) had normal ultrasound findings. There was a female preponderance among the 95 cases of DVT, 58.9% of them were females while 41.1% of them were males. It was found that contiguous femoro-popliteal and ilio-femoro-popliteal segments were most commonly thrombosed. These lesions were predominantly left sided (59.5%). There was a predominance of females and femoro-popliteal segments in DVT. Doppler ultrasound is very useful in the evaluation of extremity DVT. All clinically suspected cases should be evaluated with this modality due to limited sensitivity of clinical evaluation in the diagnosis of DVT. Further correlative studies in comparison to venography and hematologic indices are also recommended.

Ultrasonography as an integrated tool in clinical decision-making in the Emergency Department.

The aim of this retrospective study was to identify the role of ultrasonography as a decision-making and screening tool inemergency patients with pathological changes. The study was carried out for 28 months in the EmergencyDepartment of the County Emergency University Hospital, Cluj-Napoca. An ultrasound examination was performed aspart of the clinical algorithm within the first hour of treating non-critical patients after they had been triaged. The diagnosticdecision based on the results of the ultrasound examination was compared with the final diagnosis on discharge from the EmergencyDepartment. In study were included 1565 patients with a mean age of 50.61±19.21 years. Ultrasound changes were detected in a statistically significant number of patients from all the examined subgroups (p≤0.002). The concordance between clinical and ultrasound findings was of 54.06%. Of all the examined patients, 20.63% were referred to surgery department based on the results of the ultrasound examination. Surgery was the final therapeutic decision in 5.06% of all the patients with normal ultrasound findings. Ultrasonography as an integrated tool in the clinical examination algorithm allowed the identification of non-critical patients who required emergency surgery (20.63%). The integration of point-of-care ultrasound into the clinical examination allows the management of emergency patients through the ranking of decisions: hospital admission for surgery and medical treatment, other diagnostic investigations, referral to outpatient care and family physician.

65PD Significance of preoperative fine-needle aspiration biopsy for suspected cases of lymph node metastasis in primary breast cancer

Background In patients diagnosed with breast cancer, preoperative assessment of the lymph nodes is performed by palpation and ultrasonography (US). In suspected cases of metastasis, the lymph nodes are evaluated by fine-needle aspiration (FNA) biopsy. In recent years, in some cases, dissections are omitted even if metastasis to the lymph nodes is detected. Thus, among cases where dissection can be omitted even when metastasis is observed, there have been some cases where dissection was initially performed when metastasis was verified by preoperative FNA. The aim of this study was to evaluate the significance of performing preoperative FNA for suspected cases of lymph node metastasis. Methods The study involved 745 patients with cStage I/II primary breast cancer who had undergone axillary dissection. Patients were divided into four groups based on the presence or absence of palpable lymph nodes, US findings, and FNA results: (1) the cN0 group: non-palpable lymph nodes, normal US findings, and no FNA evaluation; (2) the cN?FNA (-) group: non-palpable lymph nodes, US revealed suspicion of metastasis, and FNA revealed no metastasis; (3) the cN?FNA (+) group: non-palpablelymph nodes, US revealed suspicion of metastasis, and FNA revealed metastasis; and (4) the Stage II group:non-palpableorpalpablelymphnodes,USrevealedmetastasis,andFNA revealed metastasis. Using the above four categories, we compared the number of lymph node metastasis in each group. Results The median number of lymph node metastasis in the cN0, cN?FNA (-), cN?FNA (+), and Stage II groups was 2,2,3, and 3, respectively. The percentage of 1-2 lymph nodes metastasis was 74%, 64%, 44%, and 46%, respectively. The percentage of > 10 lymph nodes metastasis was 2%, 3%, 15%, and 11%, respectively. Distribution of the number of lymph node metastasis between the cN0 and cN?FNA (-) groups, and between the cN?FNA (-) and cN?FNA (+) groups differed significantly. In contrast, the distribution of the number oflymph node metastasis in the cN?FNA (+) and Stage II groups showed no significant differences. Conclusions Our study reveals that cN1 patients can be accurately identified from amongthosesuspectedofhavinglymphnodemetastasisbasedonFNAfindings. Legal entity responsible for the study Cancer Institute Hospital, Tokyo, Japan Funding N/A Disclosure All authors have declared no conflicts ofinterest.

Sonographic evaluation of jugulodigastric and juguloomohyoid lymph nodes.

The jugulodigastric (JD) and juguloomohyoid (JO) lymph nodes are levels II and III cervical lymph nodes corresponding to the upper and middle internal jugular chains, respectively. The aim of this study is to delineate the sonographic properties of these two nodes, which are commonly encountered in routine neck sonography, in subjects with normal neck ultrasound findings. Atypical findings can make it difficult to differentiate benign from malignant lymph nodes. The JD and JO lymph nodes of 126 subjects were examined by ultrasonography, and size, shape, presence of echogenic hilus and Doppler activity were recorded. Among the lymph nodes examined, 31.6% were not elliptical. Proportionally more of the JO than the JD nodes were round; there was a significant difference in roundness index between them (P < 0.05). An echogenic hilus was demonstrated in 223 of the 252 JD nodes and in 161 of the 252 JO nodes. Significantly more of the lymph nodes with roundness index <2 lacked a visible echogenic hilus. There was a positive correlation between the visibility of an echogenic hilus and Doppler activity. Normal jugulodigastric and juguloomohyoid lymph nodes are relatively prominent in the upper and middle jugular chains, respectively. Awareness of variations in the sonographic appearance of these nodes could preclude unnecessary procedures. Clin. Anat. 29:943-948, 2016. © 2016 Wiley Periodicals, Inc.

Neurodevelopmental Outcomes in Preterm Infants with Intraventricular Hemorrhage in Canada

Abstract BACKGROUND: Conflicting evidence exists in regards to outcomes of infants with mild IVH [subependymal hemorrhage (SEH) and IVH without ventricular dilatation (VD)] with recent reports suggesting poor outcomes. OBJECTIVES: To compare 1) neurodevelopmental (ND) outcomes of infants &amp;lt; 29 wks GA with normal head ultrasound scan findings (Group 1: no IVH/PVL/VD to those with a) Group 2: SEH or IVH without VD, b) Group 3: IVH with VD (ventricle size &amp;gt; 10 mm) and c) Group 4: persistent intraparenchymal echogenicity (IPE) or lucency with or without IVH and 2) composite outcome of death or ND impairment (NDI)/severe NDI (SNDI) at 18-24 months in these groups. DESIGN/METHODS: Retrospective cohort study of data from Canadian Neonatal Network (CNN)and Canadian Neonatal Follow-up Network (CNFUN) from April 2010 to September 2011. NDI was defined as any one of Bayley III score &amp;lt; 85 (cognition, language or motor), cerebral palsy (CP) or visual/hearing impairment. SNDI was defined as Bayley III score &amp;lt; 70 for any of the 3 components, CP with GMFCS &amp;gt; 3, severe visual impairment &amp;lt;20/200 or hearing impairment needing aids/cochlear implants. Data for the 4 groups were compared using Chi-squared test or ANOVA as appropriate. Multivariable regression was conducted to obtain adusted OR (95% CI). RESULTS: See tables on page e51. CONCLUSION: In this large national cohort, infants with SEH and/or IVH without VD had similar outcomes to infants with no IVH. The risk of death or adverse ND outcome was significantly higher ininfants with IVH with VD and those with IPE.

Imaging Findings in Patients with Granulomatous Mastitis.

BackgroundGranulomatous mastitis (GM) is a rare inflammatory breast disease that may mimic the clinical characteristics and radiologic imaging findings of breast carcinoma. Considering the importance of making a correct diagnosis, careful radiologic evaluations and recognition of imaging features are necessary.ObjectivesThe aim of this study was to review the radiological findings and diagnostic value of the imaging in GM.Patients and MethodsThis retrospective study involved a total of 29 patients who were diagnosed with GM between 2009 and 2013 and who underwent mammography (MG) and/or ultrasound (US) examination in addition to magnetic resonance imaging (MRI) before diagnosis.ResultsAmong 14 patients over 35 years of age who underwent MG imaging, focal asymmetric, ill-defined nodular, or diffusely increased densities were detected in nine (64.3%), two (14.3%), and one (7.1%) subjects, respectively, while there were no pathological findings in two (14.3%) patients. In the overall group of 29 patients, US showed heterogeneous hypoechoic lesions with tubular extensions in 16 (55.2%), well-demarcated heterogeneous hypoechoic lesions in eight (27.6%), parenchymal heterogeneous appearance in three (10.3%), and a heterogeneous hypoechoic lesion with irregular margins in one (3.4%), with another (3.4%) patient having normal US findings. MRI findings included lesions consistent with solitary or multiple separate or confluent abscesses with marked peripheral ring enhancement in 25 (86.2%) patients, accompanied by intensity changes suggesting edematous inflammation in the peripheral parenchyma, as well as non-mass-like heterogeneous segmental and regional contrast enhancement. Four (13.8%) patients had non-mass-like segmental and regional contrast enhancement only. A histopathological diagnosis of GM was established in all patients with biopsy.ConclusionGM presents with a wide range of conventional radiological findings, hampering the diagnosis. In patients with inconclusive conventional findings, MRI may assist in the differential diagnosis and assessment of the extent of disease. However, a definitive diagnosis and relevant treatment require histopathological confirmation.