Positive Sonographic Findings Research Articles

THERMOGRAPHIC AND SONOGRAPHIC FINDINGS IN PATIENTS WITH KNEE PAIN: A RETROSPECTIVE STUDY FOR THE PERIOD JANUARY 2010 TO JULY 2023.

Our study is a retrospective study in which, from the total number of patients who were admitted to our institution for knee pain between January 2010 and July 2023, we selected only those who had a positive sonographic finding and were also examined thermographically. The total number of selected patients was 727. Of these, 321 were females and 406 were males aged 11 to 91 years. The mean age was 45 years. The number of positive sonographic findings was 2040. According to the nature of sonographic findings we divided them into: findings with liquid content (gangliomas, cysts, bursae, hydrops, haemarthrosis...) - total 36%. Findings of solid structure (calcifications, ossifications, osteophytes, mucoids, tophi, corpora libera) - 25% in total. Arthrosis femorotibial, femoropatellar - a total of 20%. Lesions (meniscopathies, tendinopathies, ruptures of tendons, muscles, ligaments, fractures, abruptions, usurations) - a total of 17%. Complications after TEP - 1%. Other (growing pains, plicae, chondrocalcinosis, aseptic osteonecrosis, tumors, nerve lesions) - 2% total. Of the 727 patients with sonographic abnormalities, 72% had a temperature distribution disorder. Of these, 67% of patients had hyperthermia of the painful knee, 5% had hypothermia. 28% of patients had a normal temperature pattern of the symptomatic knee compared to the contralateral knee.

Ultrasound Analysis of Patients with Mastalgia with and without Palpable Mass

OBJECTIVES To assess the clinical significance of mastalgia by investigating its association with breast lumps and the utility of diagnostic workup in cases where a palpable abnormality does not accompany mastalgia. METHODOLOGY This prospective cross-sectional study was conducted from May to July 2023 at the Radiology Department, Khyber Teaching Hospital, Peshawar. The sample size was 246, taking 80% prevalence of mastalgia, 5% margin of error and 95% confidence level. All females referred, after physical examination, to ultrasound breast with complaints of mastalgia were included in this study. RESULTSAmong 246 women with a mean age of 30.9 years presented with mastalgia, 17.5% (43) had breast lump. 69.2% (170) women had BIRADS 1, while 31% (76) had BIRADS 2. None had BIRADS 3,4 or 5. 37 (15.1%) had cyclic, while 209 (85%) presented with non-cyclic mastalgia. Pathologies detected in women with lumps were abscess in 15 (34.8%), fibroadenoma in 14 (32.5%), mammary duct ectasia in 9 (20.9%), fibrocystic change in 4 (9.3%) and hematoma in 1 (2.3%) patient. Among 203 patients without palpable lump, 33 (16.3%) had positive sonographic findings, with mammary duct ectasia in 30 (91%), intramammary lymph nodes in 2 (6.1%) and fibroadenoma in 1 (3%) patient. CONCLUSION Sonographic findings of females with mastalgia were either normal or suggestive of benign lesions; hence, excessive use of ultrasound examinations may not be needed due to the fear of breast cancer.

Diagnostic accuracy of transthoracic echocardiography for the identification of proximal aortic dissection: a systematic review and meta-analysis

This systematic review and meta-analysis evaluated the performance of transthoracic echocardiography (TTE) for diagnosis of proximal aortic dissections based on the identification of specific sonographic features. A systematic literature search of major databases was conducted on human studies investigating the diagnostic accuracy of TTE for proximal aortic dissection. The study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. The quality of studies was evaluated using Quality Assessment of Diagnostic Accuracy Studies 2 tool. Data were gathered for the following sonographic findings: intimal flap, tear, or intramural hematoma; enlargement of aortic root or widening of aortic walls; aortic valve regurgitation; or pericardial effusion. Sensitivity, specificity, diagnostic odds ratio, number needed to diagnose values, and likelihood ratios were determined. Fourteen studies were included in our final analysis. More than half of the included studies demonstrated low risk of bias. The identification of intimal flap, tear, or intramural hematoma was shown to have an exceptional ability as a diagnostic tool to rule in proximal aortic dissections. TTE should be considered during the initial evaluation of patients presenting to the emergency department with suspected proximal aortic dissection. Positive sonographic findings on TTE may aid in rapid assessment, coordination of care, and treatment of individuals awaiting advanced imaging.

ROLE OF ULTRASONOGRAPHY FOR EVALUATION OF ACUTE APPENDICITIS: A UNAMID EXPERIENCE

Objective: To evaluate the accuracy of ultrasound findings as compared to operative findings and positive predictive value of ultrasonography in the diagnosis of acute appendicitis.
 Study Design: Cross sectional study.
 Place and Duration of Study: Pak Field Hospital – 7 (Level III) United Nations African Union Mission in Darfur (UNAMID) Darfur, Sudan, from Mar 2015 to Mar 2016.
 Methodology: All patients presenting with clinically suspected acute appendicitis (Alvarado’s score >4) were referred for right lower quadrant sonography. Three point scale was used to grade sonographic findings ranging from grade 1 to grade 3. Fifty One patients with persistent symptoms and/or positive sonographic findings were operated. Operative findings were also graded on a 3 point scale. Subsequently, sonographic and operative findings were compared. Surgical findings were considered gold standard to assess diagnostic accuracy of sonography.
 Results: Out of 51 patients 46 (90.2%) were males and 5 (9.8%) were females. Mean age of the patients was 32.3 ± 7.3 years. Among the study subjects, 15 (29.4%) patients were from Nigeria followed by 12 (23.5%) from Pakistan, 7 (13.7%) from Egypt and 17 (33.5%) from other countries.The sonographic findings were detected positive for acute appendicitis in 40 (78.4%) and negative in 11 (21.6%) out of 51. All Fifty-one patients underwent surgery. The surgical findings were positive for appendicitis in 43 patients (84.3%). Four patients with negative sonographic findings did have acute appendicitis according to surgical findings. The positive predictive value was 90.9%. There was good agreement between sonographicfindings and surgical findings..........

Sonographic evaluation of the lateral femoral cutaneous nerve in meralgia paresthetica.

Identify sonographic features of the lateral femoral cutaneous nerve (LFCN) in meralgia paresthetica (MP) and report therapeutic outcomes in sonographically confirmed cases. Retrospective review of 50 patients with clinically suspected MP and 20 controls. Ultrasounds were reviewed for characteristics of the LFCN and compared between groups. When available, MRIs were reviewed. In cases of sonographically pathologic LFCN, subsequent therapeutic interventions were recorded. Thirty-five of the suspected MP cases (70%) had ultrasound findings suggestive of MP, 10 (20%) were negative, and in 5 (10%) the LFCN was not seen. Sonographic findings in positive cases included nerve enlargement in all cases (mean cross-sectional area 9mm2 (standard deviation (SD) ± 5.59) versus 4mm2 (SD ± 2.31) and 3mm2 (SD ± 2.31) in negative cases and normal controls, respectively; p < 0.01), nerve hypoechogenicity (30 of 35 cases, 86%), and focal lesion (7 of 35 cases, 20%). Sixteen ultrasounds positive for MP had MRIs with only 4 (25%) reporting a concordant LFCN abnormality (enlargement or T2 hyperintensity). Twenty-five of the 35 (71%) patients with positive sonographic findings for MP had a US-guided LFCN block (local anesthetic ± corticosteroid), with 24 of 25 (96%) patients reporting immediate symptomatic improvement. Eighteen of 35 (51%) underwent LFCN neurectomy or neurolysis, all of whom experienced symptomatic improvement. Ultrasound is a useful modality for LFCN assessment in clinically suspected MP and is more sensitive for abnormalities than MRI. Nearly all patients who received perineural analgesia and/or neurectomy or neurolysis had symptomatic improvement.

Prediction of Adnexal Torsion by Ultrasound in Women withAcuteAbdominal Pain.

To investigate the accuracy of ultrasound in the diagnosis of adnexal torsion. Retrospective cohort analysis of 322women, presenting to a tertiary medical center with acute abdominal pain, who underwent gynecological examination, sonographic evaluation and laparoscopic surgery, between 2010 and 2016. Findings for adnexal torsion were compared among three groups: positive sonographic findings consistent with surgically confirmed adnexal torsion (true positive, n = 228); negative sonographic findings inconsistent with surgically confirmed adnexal torsion (false negative, n = 42); and positive sonographic findings inconsistent with a surgical diagnosis other than adnexal torsion (false positive, n = 52). Outcome measures were sensitivity and positive predictive value of ultrasound, and its specific features, for the diagnosis of adnexal torsion. The sensitivity of ultrasound for adnexal torsion diagnosis was 84.4 %, and the positive predictive value was 81.4 %. Edematous ovary and/or tube, as well as positive whirlpool sign had the highest sensitivity and positive predictive value. The false-negative group had the highest frequency of ovarian cysts (p = 0.0086) and the lowest frequency of ovarian edema (p < 0.0001). The false-positive group had the lowest proportion of pregnant women (p = 0.0022). Significantly more women in the true-positive group had a prior event of adnexal torsion (p = 0.026). Ultrasound examination is highly accurate in the diagnosis of adnexal torsion. Clinicians should be aware of the presence of demographic and clinical characteristics that may positively or negatively affect sonographic diagnostic accuracy.

Role of Hepatobiliary Scintigraphy and Ultrasonography in the Diagnosis of Biliary Atresia in Infant with Neonatal Jaundice – Experiences in NINMAS

Objective: The purpose of this study was to determine whether gall bladder visualization can help to exclude the biliary atresia in hepatobiliary scintigraphic studies of infants with persistent jaundice.Methods: This is a retrospective study carried out at the National Institute of Nuclear Medicine and Allied Sciences (NINMAS). Study subjects include infants with neo-natal jaundice who underwent Hepatobiliary scintigraphies for suspected biliary atresia and study period was 2 years. Food was withheld for 4 hours before the examination. Anterior images of liver and gall bladder were taken after i/v administration of 2 -3 mci 99m Tc labeled Brida (HIDA) at 5 min interval for 2 hours then at 4 hours and 24 hours. Non-visualization of bowel activity in HIDA scan in 24hours delayed images was considered as cases of diagnosis of biliary atresia.Results: Thirty-six patients were included in this retrospective study. Patent biliary channels was seen by scintigraphies in 17(47%) patients and biliary atresia was seen in 19(52%) patients. By abdominal US non- visualization of gall bladder were found in 25(69%) cases and gall bladder visualized in 11(30%) cases. Eight (22%) of 36 patients had biopsy confirmed biliary atresia; all of these had positive scintigraphies and (60%) had positive sonographic findings. Among the 5 false-positive scintigraphies caused by hepatic dysfunction and 2 had normal sonography. Thirty-six patients had periscintigraphic sonography. There were 25/36 (61%) abnormal studies, which included cases with small gallbladder (n = 8) and non-visualized gallbladder (n = 17), but not periportal fibrosis.Conclusion: Gall bladder was usually visible on Hepatobiliary scintigraphy of fasting patients with biliary patency. Both hepatobiliary scintigraphy and sonography are currently the standard imaging investigations for suspected biliary atresia. The complementary role, in which scintigraphy and sonography are important, and recommend follow-up imaging reassessment before making definitive surgical decisions. This will serve to decrease the frequency of false-positive imaging diagnoses of biliary atresia, and hence, avoid unnecessary surgeries.Bangladesh J. Nuclear Med. 18(1): 51-53, January 2015

The Relationship Between Sonographic Findings, and Clinical and Paraclinical Symptoms in Henoch Schonlein Purpura

Background: Gastrointestinal (GI) manifestations are common in patients with Henoch Schonlein Purpura (HSP) and it seems that ultrasound is the first modality for detecting GI involvement. This study was performed to evaluate the relationship between sonographic findings and clinical, and paraclinical symptoms. Methods: All patients with HSP referred to our clinic in 2011 and 2012, were enrolled in the study. The data including sonographic and other lab tests were collected and analyzed, and the association between sonographic findings and clinical, and paraclinical symptoms were evaluated. Results: Among 112 patients (68 males and 44 females), 28 cases had abnormality in their sonography that was higher in patients with GI and renal symptoms. Furthermore, length of hospitalization and need for corticosteroids was greater in patients with positive sonographic findings. Conclusions: In patients with HSP, ultrasound is a valuable modality to determine the prognosis of the disease.

Spectrum of high-resolution sonographic findings in painful ankle and foot

The most common clinical presentation of patients with ankle and foot pathology is pain and swelling followed by pain alone who attends the musculoskeletal clinic or orthopedic department. This leads to disability in performing regular normal activities. Although magnetic resonance imaging is gold standard for musculoskeletal pathologies, but the recent improvement of technology, wide availability, and radiation-free modality makes ultrasound the first line of investigation in musculoskeletal pathologies. This pictorial essay based on high-resolution ultrasonography (HRSG) study of 70 patients at our institute describes the role of HRSG in the evaluation of spectrum of various pathologies of ankle and foot with their positive sonographic findings.

Effectiveness of Sonography in Detecting Clinically Occult Femoral Hernias

The aim of this study was to evaluate the accuracy of sonography for femoral hernia diagnosis in patients with suspected hernias that were not evident on clinical examination. A retrospective analysis was performed for 39 consecutive patients with 40 clinically suspected but occult femoral hernias and subsequent positive sonographic findings for femoral hernias. Clinical records for all patients were reviewed for surgical outcomes and clinical follow-up. Surgical findings of a femoral hernia sac or widened femoral canal requiring repair, with symptomatic relief after the procedure, were considered positive for a femoral hernia. Among the 40 femoral hernias examined by sonography, 33 of 40 groins underwent surgical exploration, with 32 true-positive findings and 1 false-positive finding on sonography. The false-positive case was an inguinal hernia at surgery. The accuracy of sonography was 96.9% for those with surgical correlations. The remaining 7 patients did not undergo surgery but had clinical follow-up. This study confirms high diagnostic accuracy of sonography for nonpalpable femoral hernias in symptomatic groins compared to surgical findings.

Introducing Digital Mammography in a Resource Constrained Setting: Spectrum of Imaging Findings and Diagnostic Value in Ado-Ekiti, South Western Nigeria

Early diagnosis and treatment achieved through Mammographic screening plays a key role in the reduction of breast related morbidities and mortalities in middle and low income countries. This study highlights the spectrum of digital mammography findings in a tertiary health institution in Ado-Ekiti, South western Nigeria. A cross-sectional descriptive study of clients who presented for digital mammography at a newly equipped hospital was conducted within a year. The mammograms were reviewed by two radiologists and overall imaging findings were classified using the American College of Radiology Breast Imaging Reporting and Data System (ACR-BIRADS). Data analysis was done using SPSS version 20.0. A total of 154 clients with age range of 37 to 85 years (mean age of 51± 9.6years) underwent mammography during the study period. There was one male and 153 females out of which 69(45.1%) were postmenopausal while 84(54.9%) were premenopausal. Major clinical indications for mammography included routine breast cancer screening (N= 59, 38.3%), breast lump (N= 43, 27.9%) and breast pain (N=34, 22.1%). Mammograms were normal in 37(24.0%), inconclusive in 51(33.1%) and abnormal in 66(42.9%) clients. Abnormal mammographic findings included various forms of calcifications (N=56, 36.4%), breast opacities/masses (N=42, 27.3%), axillary lymphadenopathy (N=14, 9.0%), focal glandular asymmetry (N=10, 6.5%) and architectural distortion (N=6, 3.9%). About 55(35.7%) patients underwent additional imaging with ultrasonography, out of which 32(58.2%) had positive sonographic findings. The use of ultrasonography for additional imaging in cases of inconclusive mammograms improves the diagnostic yield. A greater proportion of the clients had mammography done for diagnostic reasons rather than screening purposes. Hence there is the need for increased awareness of screening mammography among the women in resource constrained settings.

Diagnostic Performance of Ultrasonography for Detection of Abruption and Its Clinical Correlation and Maternal and Foetal Outcome.

Placental abruption complicates about 1% of singleton pregnancies and is an important cause of perinatal mortality and morbidity. Though sensitivity and reliability of ultrasound are poor for detecting or excluding placental abruption, because of the advances in ultrasound resolution, imaging and interpretation, sensitivity of ultrasound is better than what was reported previously. To determine the diagnostic performance of Ultrasonography (USG) for the detection of placental abruption and whether sonographic results correlate with maternal and foetal management and outcome. Thirty patients with clinical diagnosis of placental abruption were studied in the Obstetrics and Gynaecology Department of Krishna Institute of Medical Sciences, over a period of 6 months. These patients underwent ultrasonography for confirmation. Obstetric and neonatal outcome and sonographic results were compared and reviewed. Sonographic sensitivity and specificity and positive and negative predictive values were calculated. Incidence of abruption in present study was 1.56% (28 patients out of 1786 total deliveries). Sensitivity of ultrasonography in the diagnosis of abruption was 57% (CI 37.15%-75.57%) while its specificity was 100% (CI 15.81%-100%) with a positive predictive value of 100% (CI 79.42%-100%) and a 14% (CI 1.78% - 42.83%) negative predictive value. An 87.5% of patients(14 out of 16) with a positive USG finding of abruption had Intrauterine foetal Death (IUD)/still birth while 91.6% of patients (11 out of 12) with negative USG findings of abruption gave birth to babies who required NICU admission. Sonography is not sensitive for the detection of placental abruption but it is highly specific. Positive sonographic findings are associated with increased maternal morbidity, require more aggressive obstetric management and it is associated with worse perinatal outcome. In case of a negative USG finding, but a strong clinical suspicion of abruption if obstetric intervention is made in due time, foetal as well as maternal outcome are better. Foetal outcome also depends on gestational age. Preterm patients with positive USG and intrapartum findings of abruption have worse foetal outcome compared to full-term patients with abruption.

Ovarian Torsion With Persistent Parenchymal Blood Flow

Ovarian torsion is the complete or partial rotation of the ovary upon its vascular pedicle with subsequent vascular compromise; it is one of a few gynecologic surgical emergencies requiring prompt diagnosis and treatment. The commonly accepted diagnostic sonographic finding in ovarian torsion is the absence of ovarian parenchymal blood flow using color or power Doppler imaging. However, since not all cases of ovarian torsion cause complete vascular obstruction, the presence of ovarian blood flow cannot eliminate this diagnosis in symptomatic patients with other positive sonographic findings. The case presented demonstrates the potential for a missed diagnosis of ovarian torsion when relying predominantly on Doppler findings.

Diagnostic Accuracy of Scintigraphy and Sonography for Biliary Atresia

Objectives: To determine the diagnostic accuracy and predictive values of hepatobiliary scintigraphy and sonography in the evaluation of clinically suspected biliary atresia. Methods: All infants who underwent hepatobiliary scintigraphies for suspected biliary atresia within a 3-year period (2006–2008) in the New Territories East Cluster of Hong Kong were retrospectively analysed. All scintigraphies and peri-scintigraphic ultrasound images were reviewed for signs suggestive of biliary atresia. The accuracy of imaging studies was determined by surgical findings and clinical follow-up. Results: Forty-two cases were retrieved with two excluded due to incomplete clinical records. Seven (18%) of 40 patients had surgically confirmed biliary atresia; all of these had positive scintigraphies and 6/7 (86%) had positive sonographic findings. Among the 40 scintigraphies, there were 7 true-positive, 28 true-negative, and 5 false-positive studies. The scintigraphic sensitivity, specificity, and positive and negative predictive values were 100%, 85%, 58% and 100%, respectively. Among the 5 false-positive scintigraphies caused by hepatic dysfunction, 3 had normal sonography; 2 became negative on repeated scintigraphy, 2 had spontaneous clinical improvement, and 1 had normal intra-operative cholangiography. Thirty-eight of the 40 patients had performed peri-scintigraphic sonography. There were 23/38 (61%) abnormal studies which included cases with small gallbladder (n = 15) and non-visualised gallbladder (n = 8), but not periportal fibrosis. The sensitivity, specificity, positive and negative predictive values of these sonograms were 86%, 45%, 27% and 93%, respectively. Conclusions: Both hepatobiliary scintigraphy and sonography are currently the standard imaging investigations for suspected biliary atresia. This study revealed relatively low positive predictive value for biliary atresia by either investigation. We therefore consider their complementary role in which a correlation between scintigraphy and sonography is important, and recommend follow-up imaging reassessment before making definitive surgical decisions. This will serve to decrease the frequency of false-positive imaging diagnoses of biliary atresia, and hence, avoid unnecessary surgeries.

Mystery of Chronic Cerebrospinal Venous Insufficiency: Identical Venographic and Ultrasound Findings in Patients with MS and Controls

Stenosis of the internal jugular, azygos, and other veins detected by using intracranial and neck Doppler and B-mode sonography and confirmed by venography has been reported in MS with a high degree of sensitivity. This article reports the results of sonographic findings in patients with MS and controls, looking for evidence of the controversial entity chronic cerebrospinal venous insufficiency. Furthermore, the venographic appearance in controls is documented. Thirty consecutive patients with definite MS and 10 controls had TCD and high-resolution Doppler sonography of the neck vessels by using the published sonography criteria of Zamboni et al. Those with 2 positive findings consented to undergo contrast digital subtraction venography for delineation of possible venous stenosis. Nine consecutive patients undergoing digital subtraction venography for petrosal venous sampling or parathormone sampling had images of their internal jugular veins obtained as part of their procedure, and they were assessed for stenosis. No patient with MS or control had 2 positive sonographic findings; therefore, none were subjected to venography. Of the 9 controls undergoing venography for other reasons, 6 had bilateral IJV narrowing of ≥50%, and 2 others had unilateral narrowing. No difference was detected between patients with MS and controls by using the objective sonographic criteria of Zamboni et al. Furthermore, normal physiologic narrowing is found very commonly in the internal jugular veins in healthy individuals. Nonblinded subjective sonographic assessment of the IJV may erroneously lead to venography, the findings of which may be misinterpreted due to the lack of widespread knowledge about the appearance of these veins in healthy individuals.

Distinct sonographic features of acute appendicitis in sickle cell disease

BACKGROUND AND OBJECTIVESThe purpose of this study was to report sonographic findings of appendicitis in patients with positive screening tests for sickle cell compared to normal control patients.DESIGN AND SETTINGA retrospective study of the medical records of 396 patients who underwent appendectomy during a 3-year period from March 2005–2008.PATIENTS AND METHODSThe study included 216 males and 180 females, whose ages ranged from 7 to 55 years. Four patients (0.9%) had sickle cell disease (SCD), 101 had sickle cell trait (SCT) (25%) and 291 (74%) patients were without sickle cell anemia (control group).RESULTSPositive sonographic findings of appendicitis were identified in 95 (90%) SCT patients and in 253 (87%) control patients. The mean maximal mural thickness was higher in sickle cell patients (4.5 [1.4] mm) in comparison with the control group (3.0 [2.2] mm) (P<.0001). Appendicolith was significantly detected in 53% of the control group and in 8.5% of the sickle cell group (P<.0001). Color Doppler showed hypervascularity in 72% of patients with appendicitis in the control group with a significant difference compared to only 12 cases (11%) of SC patients (P<.05). Ultrasonography findings suggesting perforation were found in 35 sickle cell patients and in 75% (3 of the 4 patients) with SCD. Findings suggesting perforation were found only in 49 patients (17%) of the control group. Perforated appendix was significantly higher in sickle cell patients in preoperative US and intraoperatively ( P<.05)CONCLUSIONPositive sonographic findings of appendicitis in sickle cell patients are different from the general population. These findings include mural thickening with a low incidence of appendicolith and wall hypervascularity. Also sonographic features of perforation in sickle cell patients are more common suggesting a need for more urgent operative intervention.

Sonography in the Evaluation of Acute Appendicitis

The purpose of this study was to evaluate the negative predictive value (NPV) of sonography in the diagnosis of acute appendicitis. Right lower quadrant sonograms of 193 patients (158 female and 35 male; age range, 3-20 years) with suspected acute appendicitis over a 1-year period were retrospectively reviewed. Sonographic findings were graded on a 5-point scale, ranging from a normal appendix identified (grade 1) to frankly acute appendicitis (grade 5). Sonographic findings were compared with subsequent computed tomographic (CT), surgical, and pathologic findings. The diagnostic accuracy of sonography was assessed considering surgical findings and clinical follow-up as reference standards. Forty-nine patients (25.4%) had appendicitis on sonography, and 144 (74.6%) had negative sonographic findings. Computed tomographic scans were obtained in 51 patients (26.4%) within 4 days after sonography. These included 39 patients with negative and 12 with positive sonographic findings. Computed tomography changed the sonographic diagnosis in 10 patients: from negative to positive in 3 cases and positive to negative in 7. Forty-three patients (22.2%) underwent surgery. The surgical findings were positive for appendicitis in 37 (86%) of the 43 patients who had surgery. Patients with negative sonographic findings who, to our knowledge, did not have subsequent CT scans or surgery were considered to have negative findings for appendicitis. Seven patients with negative sonographic findings underwent surgery and had appendicitis; therefore, 137 of 144 patients with negative sonographic findings did not have appendicitis. On the basis of these numbers, the NPV was 95.1%. Sonography has a high NPV and should be considered as a reasonable screening tool in the evaluation of acute appendicitis. Further imaging could be performed if clinical signs and symptoms worsen.

Lung sonographic findings in patients with suspected pulmonary embolism.

To assess the feasibility and diagnostic performance of lung transthoracic sonography in patients with suspected pulmonary embolism. In a prospective clinical study we compared sonographic findings of the peripheral lung with various scintigraphic gradings and D-dimer plasma concentrations. One hundred and nineteen consecutive patients with clinical signs of pulmonary embolism were investigated within 24 hours of the onset of symptoms. Seventy patients with suspected pulmonary embolism (59%) had sonographic lesions, which were echo poor, homogeneous and rounded or wedge-shaped with a hyperechoic reflexion in the centre. Of the patients with high-probability scintigraphic scans 86% had such sonographic lesions as had 79% with intermediate, 64% with low-probability and 33% with normal scintigraphic scans. Of the patients with positive sonographic findings and normal or low-probability scans only a minority (14%) had negative D-dimer tests. We found a high rate of specific sonographic lesions in patients with suspected pulmonary embolism when investigating the peripheral lung with ultrasound.

The Value of Sonography With Micro Convex Probes in Diagnosing Meniscal Tears Compared With Arthroscopy

Meniscal tears are common in knee injuries. Sonography has been used in the knee to evaluate meniscal tears. Linear probes with high resolution have been used, and the overall accuracy of sonography has been more than 70% in many studies. In this study, we used a 6.5-MHz micro convex probe to evaluate meniscal tears, and the results were compared with arthroscopic findings. Four hundred six knee joints with knee pain and a clinical indication for arthroscopy were examined from the popliteal fossa with the 6.5-MHz micro convex probe. Those patients with positive sonographic findings who had an arthroscopic examination (100 patients) were included in our study, and the results were compared. The results were statistically analyzed by the Fisher exact test. One hundred knees with sonographic examinations underwent arthroscopic evaluation. Three age groups were included in the study (20-30, 30-40, and >40 years). Comparison of the results between the two methods showed sensitivity of 100% and specificity of 95% for sonography in detecting meniscal tears. The positive predictive value for the medial meniscus was 95%, and the negative predictive value was 100%; these values for the lateral meniscus were 93% and 100%, respectively. Meniscal tears are common in all age groups. The use of sonography allows rapid, low-cost, and noninvasive exploration of meniscal tears as a first-line diagnostic method. We recommend high-resolution micro convex probes, which better fit the anatomic concavity of the popliteal fossa, as efficient investigation tools.

Screening Sonography in Pregnant Patients With Blunt Abdominal Trauma

Abdominal injury of pregnant women, if not recognized, may cause preventable fetal deaths. The physical findings are very unreliable. Computed tomography (CT) screening entails the assessment of many patients, and the findings are negative in 90% or more of cases. In addition, potential harm from exposure to ionizing radiation must be considered, and this is also the case for intravenous urography and cystography. Diagnostic peritoneal lavage is an invasive procedure. For all these reasons, the investigators retrospectively evaluated abdominal sonography-a relatively safe procedure-in 5173 women screened after blunt abdominal trauma. There were 947 women of reproductive age (15-45 years), and 102 of them (11%) were pregnant. Certified sonographers performed the examination using equipment with Doppler capabilities. Five of the 101 women evaluated, 5% of the total, had injury confirmed and underwent either laparotomy or emergency cesarean delivery. Sonography was positive in four of the five injured women, for a sensitivity of 80% (95% confidence interval [CI], 28-100%). The placenta and spleen were injured in two patients each, and both the liver and kidney in one patient. There was a single false-negative study that missed a placental hematoma. All 96 noninjured women had negative sonography findings, for a specificity of 100% (95% CI, 96-100%). Sonography had a positive predictive value of 100% (95% CI, 40-100%) and a negative predictive value of 99% (95% CI, 94-100%. Three patients had their positive sonographic findings confirmed (and localized) by CT scanning. These findings affirm the value of sonography as a screening measure to detect injury in pregnant women subjected to blunt abdominal trauma. It is a safe examination that in most cases precludes the need for more risky tests such as CT and peritoneal lavage. Any woman with negative sonographic findings must be observed.