Ultrasonographic Information Research Articles

Ultrasonography of Facial and Submandibular Hidradenitis Suppurativa and Concomitance with Acne Vulgaris.

To describe the ultrasound characteristics of facial and submandibular hidradenitis suppurativa (HS) and detect acne vulgaris (AV) concomitance in these cases. We performed a retrospective study of the ultrasound images of patients with facial HS who had been clinically evaluated by dermatologists. The reported ultrasound diagnostic criteria, severity (mSOS-HS), and activity (US-HAS) staging of HS were used to categorize the patients. The finding of fragments of hair tracts within the key lesions (dilated hair follicles, pseudocysts, fluid collections, and tunnels) was considered a pivotal sign to discriminate HS from AV. Demographic and morphological analysis of the images were considered. Thirty-three patients met the criteria (78.8% male/21.2% female). Of these, the mSOS- HS scoring was stage I in 51.5%, stage II in 27.3%, and stage III in 21.2%. Dilation of the hair follicles and the presence of pseudocysts, fluid collections, and tunnels were detected in the HS cases; 63.1% of pseudocysts, 62.4% of tunnels, and 46.2% of fluid collections contained fragments of hair tracts. In all HS cases, there was a key lesion(s) with fragments of hair tracts. Four (12.1%) patients showed concomitant facial HS and acne ultrasound lesions. The acne lesions were pseudocysts without inner hair tract fragments in all cases, and the SOS-Acne scoring was stage II for all of them. Facial HS can be detected on ultrasound and shows a morphology similar to that of HS in other corporal regions. In some cases, facial HS could be concomitant with AV. The subclinical ultrasonographic information can support a better management of these cases.

A model based on ultrasound and clinical factors to predict central lymph node metastasis in cN0 papillary thyroid microcarcinoma

ObjectiveThe prevalence of thyroid malignancies has sharply elevated in the past few years, and a large number of newly diagnosed thyroid malignancies was papillary thyroid microcarcinomas (PTMC). The efficacy of prophylactic central lymph node dissection (PCLND) in patients with clinical lymph node-negative (cN0) PTMC is still debatable. In this study, we aimed to create a predictive model to assess the likelihood of central lymph node metastasis (CLNM) in cN0 PTMC. MethodsTwo hundred and fifty three patients diagnosed with cN0 PTMC who received surgery in the First People's Hospital of Kunshan from October 2018 to June 2023 were enrolled. Multivariate logistic regression was employed to evaluate the patient's clinical and ultrasonographic information to determine independent factors. Two prediction models were generated and their ability to evaluate the likelihood of CLNM in cN0 PTMC was determined and compared. ResultsMultivariate analysis based on clinical characteristics revealed that, CLNM was markedly linked to age, tumor size, and extrathyroidal infiltration in cN0 PTMC. Multivariate analysis utilizing clinical and ultrasound features demonstrated that age, tumor size, extrathyroidal infiltration, shape, microcalcification were independent risk factors for CLNM. The analysis of the receiver operating characteristic curve demonstrated that the predictive nomogram utilizing clinical and ultrasound features was more beneficial for predicting CLNM. And decision curve demonstrates the same. The model's calibration curve exhibited strong consistency. ConclusionsAge, tumor size, extrathyroidal infiltration, shape, microcalcification are significant independent factors of CLNM in cN0 PTMC. A predictive model derived from these independent clinical and ultrasound factors has a good value, but further validation is still required.

Preoperative Diagnosis of Warthin Tumors Combining Cytological, Clinical and Ultrasonographic Information within a Multidisciplinary Approach in a Lump Clinic.

(1) Background: Warthin tumors account for about 20% of all benign salivary tumors, approaching 50% if we consider only the parotid gland. Wait and see is considered a reasonable option, but the diagnosis should be certain. Diagnosis can be based on morphological and cytological data, but the sensitivity of the fine needle aspiration cytology (FNAC) is not absolute, with a high rate of non-diagnostic findings in the event of a Warthin tumor, hindering the counseling and therapeutic decisions. The aim of the study is to evaluate the reliability of FNAC and its combination with anamnestic, clinical, and ultrasonographic data in diagnosing Warthin tumors. (2) Methods: A total of 413 patients affected by masses within the major salivary gland and managed between 2017 and 2022 at our institution have been included in the present retrospective study. Each patient underwent fine needle aspiration biopsy (FNAB) with a subsequent cytological diagnosis; successively, for each patient, the clinician (otolaryngologist) and the histopathologist discussed the combination of cytological (even non-diagnostic), clinical, and ultrasonographic data in order to make a "multiparametric" diagnosis. A total of 214 cases were subsequently submitted to surgical resection and had a final histopathology report, to which the cytological and the multiparametric diagnoses can be compared. We extracted all the patients with a cytological, multiparametric, and/or histological diagnosis of Warthin tumors in order to assess the sensitivity and specificity of FNAC and of multiparametric analysis in diagnosing Warthin tumors in case of a major salivary gland mass. (3) Results: One hundred thirty-two cases had a cytological, multiparametric, and/or histological diagnosis of Warthin tumors. FNAC displays a sensitivity of 68.4% and a specificity of 98.7% in diagnosing Warthin tumors. The multiparametric evaluation allowed a considerable improvement in sensitivity (92.9% vs. 68.4%), minimizing the number of non-diagnostic results and preserving at the same time a similar value of specificity (95.5% vs. 98.7%). Notably, none of the patients with a cytological or multiparametric diagnosis of Warthin were affected by a malignant lesion in the final histopathological report. (4) Conclusions: In the case of Warthin tumors, a multiparametric evaluation encompassing anamnestic, clinical, and cytological data is effective in reducing the number of non-diagnostic reports and can safely guide the management of a tumor (e.g., antibiotic treatment of infectious complications, assign a low priority to surgery, even consider observation avoiding surgery) which is absolutely benign and can be associated with no clinically relevant issues.

Multimodal Sonographic Appearance and Survival Outcomes of 69 Cases of Primary Thyroid Lymphoma Over 10 Years.

To investigate ultrasound appearance and the survival outcomes for patients with primary thyroid lymphoma (PTL). Ultrasonic images and clinical characteristics from pathologically confirmed 69 PTL patients (2008-2019) were retrospectively analyzed. The clinical characteristics, ultrasonic characters, and prognostic factors were analyzed. Survival curves were plotted using the Kaplan-Meier method. Univariate and multivariate analyses were performed. Of the 69 study patients, 23 were indolent PTL and 46 were aggressive PTL. Age (>70 years old) and elevated lactate dehydrogenase levels were statistically different clinical features between aggressive and indolent PTL. From ultrasonic images, 34 cases were nodular, 11 diffuse, and 24 mixed pattern. Mixed types displayed high invasiveness (45.7%) while diffuse types displayed higher inertness (39.1%), with statistically significant differences (P=.000). Invaded thyroid capsule and increased chaotic vascularity also showed significant differences between aggressive and indolent PTL. We also observed statistical difference in overall survival rates between aggressive and indolent PTL (P=.032). Single factor K-M analyses showed that age >70 years, aggressive pathology, and Ki67 >30% were positively correlated with the risk of poor PTL survival (P < .05). Multimodal ultrasound provides accurate ultrasonographic information and facilitates PTL invasiveness diagnostics for improved clinical treatment. In addition, PTL patients aged >70 years, with aggressive pathology, and Ki67 >30% were more likely to have a poor survival outcome.

Prenatal ventriculomegaly: natural course, survival, and neurodevelopmental status.

Prenatal ventriculomegaly is classified as mild, moderate, or severe based on the atrium diameter. The natural course and intrauterine progression of mild and moderate ventriculomegaly associated with the neurodevelopmental status of these children has been widely reported. One hundred twenty-two pregnancies with mild and moderate ventriculomegaly referred to the pediatric neurosurgery clinic of Children's Medical Center between 2010 and 2018 were retrospectively studied. The authors collected demographic and first and sequential ultrasonographic information, associated abnormalities, information about pregnancy outcomes, and the latest developmental status of these children according to Centers for Disease Control and Prevention criteria by calling parents at least 1 year after birth. The mean gestational age at the time of diagnosis was 29.1 weeks, and 53% of fetuses were female. The width of the atrium was registered precisely in 106 cases, in which 61% had mild and 39% had moderate ventriculomegaly. Information on serial ultrasound scans was collected in 84 cases in which ventriculomegaly regressed in 5, remained stable in 67, and progressed in 12 patients. Fourteen cases (29.7%) in the mild ventriculomegaly group and 6 cases (16.2%) in the moderate group had associated abnormalities, with corpus callosum agenesis as the most frequent abnormality. The survival rate was 80% in mild and 89.4% in moderate ventriculomegaly. Considering survival to live birth and progression of the ventriculomegaly, the survival rate was 100% in regressed, 97% in stable, and 41.6% in progressed ventricular width groups (p < 0.001). Neurodevelopmental status was evaluated in 73 cases and found to be normal in 69.8% of the cases; 16.4% of children had mild delay, and 5.4% and 8.2% of cases were diagnosed with moderate and severe delays, respectively. In spite of a high rate of missed data in our retrospective study, most patients with mild or moderate ventriculomegaly had a stable or regressed course. Most cases had near-normal developmental status. Prospective studies with a larger sample size and detailed developmental evaluation tests are needed to answer the questions related to the natural course, survival, and prognosis of prenatal ventriculomegaly.

Three-Dimensional Printing of Prenatal Ultrasonographic Diagnosis of Cleft Lip and Palate: Presenting the Needed "Know-How" and Discussing Its Use in Parental Education.

Parental prenatal counseling is of paramount significance since parents often experience an emotional crisis with feelings of disappointment and helplessness. Three-dimensional (3D) printed model of the unborn child's face presenting with cleft lip and palate, based on ultrasonographic information, could be used to provide visual 3D information, further enhancing the prospective parent's comprehension of their unborn child's pathology and morphology, helping them to be psychologically prepared and improving the communication with the caretaking team. Prospective parents appreciate if prenatal counseling is available with the most detailed information as well as additional resources. The technique necessary to create 3D models after ultrasonographic information is explained, and the related costs are evaluated. The use of such models in parental education is then discussed.

Single injection ultrasound-guided rectus sheath blocks for children: Distribution of injected anesthetic.

Single injection ultrasound-guided rectus sheath blocks are used for postoperative analgesia after midline abdominal incisions, but the ultrasonographic spread of medication posterior to the rectus muscle has not been investigated. The primary goal of this study was to determine the ultrasound-measured medication spread superiorly and inferiorly after single injection ultrasound-guided rectus sheath blocks and to calculate the incidence of cases with spread up to the subcostal margin and below of umbilicus. The secondary goals were to correlate the spread with the volume of medication administered and with the patient's age, weight, height, sex, and body mass index. Pediatric patients who underwent single injection ultrasound-guided rectus sheath blocks and underwent data collection of ultrasonographic information on medication spread along the plane of the posterior rectus sheath were identified retrospectively from an acute pain service database at UPMC Children's Hospital of Pittsburgh. Sixty-eight children, 10.2±4.2 (mean±SD) years old, 41.7±17.9kg, 140±24.6cm, had complete data collection. Mean injected volume of ropivacaine was 8.3±2.8mL (right) and 8.2±2.8mL (left). The average spread was measured as 3.9±1.4cm (right) and 3.4±1.3cm (left) cranial to the umbilicus, and 1.5±1.6cm (right) and 1.6±1.4cm (left) caudal to the umbilicus. Complete spread up to the level of the subcostal margin was observed in 52.9% (n=36; right) and 36.8% (n=25; left) of cases. The spread correlated closely with the volume of injected ropivacaine (right: 0.556, P<0.001; left: 0.541, P<0.001). The spread below umbilicus was 70.6% (n=48, right) and 80.9% (n=55, left). There was a positive strong correlation (P<0.001) between total medication spread and age (right: 0.608; left: 0.538), weight (right: 0.600; left: 0.540), and height (right: 0.593; left: 0.526). After single injection ultrasound-guided rectus sheath blocks, incomplete cephalocaudal medication spread can be expected within the posterior rectus sheath.

Tools of the Trade: Point-of-Care Ultrasonography as a Stethoscope.

Since the advent of portable ultrasonography machines, many providers, including intensivists and pulmonologists, have been trained in point-of-care ultrasonography. When point-of-care ultrasonography is performed with focused clinical question and goal in mind, it serves as a valuable adjunct to physical examination and facilitates patient care and disease management. Its clinical application is now wider than that of a stethoscope in the intensive care unit where the noise level is high. In this review article, crucial ultrasonographic findings, their clinical implication, and their limitations are discussed in the most commonly targeted organ systems: cardiac, thoracic, abdominal, and vascular. In addition, recent studies on the use of multiorgan system point-of-care ultrasonography in diagnoses and management of acutely ill patients are described. As new clinical applications have been identified, a conventional approach to the critical illness must be modified to a new approach that incorporates ultrasonographic information. Clinicians should not only be trained in image acquisition and interpretation but also be up to date on the new ultrasonography-guided diagnosis, therapy, and management.

New, specific ultrasonographic findings for the diagnosis of pulled elbow.

ObjectiveAmong infants and preschool children with complaint of upper extremity immobility, pulled elbow, also known as nursemaid’s elbow or radial head subluxation is the most common cause presenting to pediatric emergency departments. However, proper tools to diagnose pulled elbow remain limited. We conducted a study to determine the feasibility of ultrasonography in diagnosing pulled elbow.MethodsInfants and preschool children presenting to an urban emergency department with the complaint of upper extremity immobility between April and July 2013 were enrolled. The following ultrasonographic information was recorded: (1) whether there was a change in the shape of the supinator muscle, (2) whether there was an annular ligament in place, and (3) whether there was an enlargement of the synovial fringe. We used the affected arms’ ultrasonographic images as the study group and opposite arms’ ultrasonographic images as the control group.ResultsWhen we diagnosed pulled elbow using ultrasonographic findings (i.e., the annular ligament was not in place), we found the following results: sensitivity, 64.9% (95% CI, 47.5% to 79.8%); specificity, 100.0% (95% CI, 90.5% to 100.0%); positive predictive value, 100.0% (95% CI, 85.8% to 100.0%); and negative predictive, 74.0% (95% CI, 59.7% to 85.4%).ConclusionA pulled elbow can easily be confirmed by ultrasonography when the annular ligament is displaced.

Identifying Children at Very Low Risk of Clinically Important Blunt Abdominal Injuries

We derive a prediction rule to identify children at very low risk for intra-abdominal injuries undergoing acute intervention and for whom computed tomography (CT) could be obviated. We prospectively enrolled children with blunt torso trauma in 20 emergency departments. We used binary recursive partitioning to create a prediction rule to identify children at very low risk of intra-abdominal injuries undergoing acute intervention (therapeutic laparotomy, angiographic embolization, blood transfusion for abdominal hemorrhage, or intravenous fluid for ≥2 nights for pancreatic/gastrointestinal injuries). We considered only historical and physical examination variables with acceptable interrater reliability. We enrolled 12,044 children with a median age of 11.1 years (interquartile range 5.8, 15.1 years). Of the 761 (6.3%) children with intra-abdominal injuries, 203 (26.7%) received acute interventions. The prediction rule consisted of (in descending order of importance) no evidence of abdominal wall trauma or seat belt sign, Glasgow Coma Scale score greater than 13, no abdominal tenderness, no evidence of thoracic wall trauma, no complaints of abdominal pain, no decreased breath sounds, and no vomiting. The rule had a negative predictive value of 5,028 of 5,034 (99.9%; 95% confidence interval [CI] 99.7% to 100%), sensitivity of 197 of 203 (97%; 95% CI 94% to 99%), specificity of 5,028 of 11,841 (42.5%; 95% CI 41.6% to 43.4%), and negative likelihood ratio of 0.07 (95% CI 0.03 to 0.15). A prediction rule consisting of 7 patient history and physical examination findings, and without laboratory or ultrasonographic information, identifies children with blunt torso trauma who are at very low risk for intra-abdominal injury undergoing acute intervention. These findings require external validation before implementation.

Does length of ovarian stimulation affect IVF pregnancy and implantation rates?

To determine if day of hCG administration following controlled gonadotropin stimulation affects pregnancy and implantation rates in patients undergoing fresh, non-donor IVF and day 3 embryo transfer. Retrospective analysis of 154 fresh non-donor IVF cycles during a 16 month period. All cycle starts that occurred on a Friday with subsequent day 3 transfer were included in the study. Three groups were compared; transfers occurring on a Thursday or Friday (9 or 10 day med protocol); transfers occurring on a Saturday or Sunday (11 or 12 day med protocol); and transfers occurring on a Monday, Tuesday or Wednesday (13, 14 or 15 day treatment). All retrievals initiated prior to day 9 and after 15 days of drug treatment were excluded from the study. Pregnancy and implantation rates were compared between the groups using Chi Square Analysis. Oocytes were retrieved in HTF (InVitrocare), hyaluronidased after 2 to 3 hours incubation and ICSI'ed following COC removal. Oocytes were placed in IVC-1 (IVC) after ICSI and cultured individually until Day 3. Embryos were placed into CCM (Vitrolife) on the morning of Day 3 for extended culture. The best embryos were identified and laser hatched (Zilos-Hamilton Thorne) prior to transfer. Morphologic assessment occurred on Day 2, 3, 5 and 6. Blastocysts were cryopreserved on Day 5, 6 or 7. All transfers occurred on Day 3 using a Wallace 23cm stylet (Irvine Scientific) and Cook Echotip Catheter (Cook OB/GYN) under abdominal ultrasound guidance and performed by the same physician (RFF). In the 148 cycles analyzed, 352 fresh embryos were AH and transferred (avg. 2.4 embryos/transfer), yielding a clinical implantation rate of 29% and PR of 54.7%. Significant differences in pregnancy and implantation rates were observed between the Sat/Sun and Mon/Tues/Wed transfer groups. The observed differences between groups might suggest that optimally timed drug stimulation regimes could yield significant improvements in IVF pregnancy and implantation rates. Although endocrine and ultrasonographic information are useful in the determination of optimal HCG administration, they may not necessarily reflect appropriate nuclear and cytoplasmic maturational synchrony of the oocytes retrieved. In poor and hyper-responders, abnormally short and long treatment regimes may upset the delicate equilibrium of nuclear and cytoplasmic events within an oocyte, i.e. nuclear mature oocytes with post mature granularity and vacuolation that ultimately results in poor embryo development. An 11 or 12-day ovarian stimulation regime may optimally strike a balance between immature, mature, and post mature nuclear and cytoplasmic events leading to optimized results in the form of better quality embryos. However, inherent patient variables (less stress on weekends, better patient compliance), reduced stress levels amongst clinical and laboratory staff, and practice philosophy cannot be ruled out as important prognostic factors.

Ultrasonographic evaluation using the internal echo in normal and cirrhotic livers: Comparison of accuracy of gray-scale and binary black-and-white images and their intraobserver reproducibility and interobserver agreement.

We attempt to determine the possibility of classifying normal and cirrhotic livers by their internal echo texture alone, without using such basic ultrasonographic information as shape and surface character of the liver. We also assessed intraobserver reproducibility and interobserver agreement obtained using this classification to ascertain the diagnostic usefulness of the method. In this evaluation, we used both regional magnified B-mode images and binary black-and-white images, both derived from conventional B-mode images obtained from 10 patients with normal livers and 10 with cirrhotic livers. These 20 echograms were randomly divided into two groups and evaluated independently on two occasions by 12 observers who used the unaided eye and took only internal echo texture into consideration. Accuracy in distinguishing between normal and cirrhotic livers ranged from 41.7 percent to 100 percent. The intraobserver correlation coefficient r1 between evaluations of the regional magnified B-mode images was 0.63, while that for the binary black-and-white images was 0.80. Agreement between the decisions of the 12 observers in the first and second evaluations of the binary black-and-white images showedk values between 0 and 1.0 for binary black-and-white images and between -0.32 and 0.29 for regional magnified B-mode images. Subjective evaluation of normal and cirrhotic livers based on internal echo texture alone was possible: intraobserver correlation was good; and unexpectedly, agreement with black-and-white images was greater than that with the regional magnified B-mode images.

Limited sonography in collaborative midwifery practice

In 1996, the American College of Nurse Midwives published guidelines for midwives who wish to incorporate limited third trimester sonography into their practices. First, however, certain didactic and clinical content needs to be disseminated through basic and continuing midwifery education. To assist the busy practitioner, information is offered related to recommended methods of obtaining learning validation and continuing competency in limited sonography. This article discusses various clinical situations in which the assessment and management of a patient’s condition might be improved by having ultrasonographic information immediately available. In addition, selected data obtained by limited sonography that may necessitate physician collaboration are described through clinical case presentations. The pitfalls of limited sonography are also discussed by use of case descriptions detailing some of the risks inherent in performing a limited ultrasonogram. The recommendation of performing a complete uterine survey with each limited ultrasonogram is emphasized. Finally, some of the controversies surrounding routine sonography in pregnancy and sonograms for entertainment are addressed.

Paediatrics

Paediatrics

Elective sonographic evaluation of inguinal hernia in children ? an effective alternative to routine contralateral exploration

Four hundred sonographic examinations were performed on 200 children admitted for elective inguinal hernia operations. The sonographic evaluation proved to be accurate in 92% of confirmable diagnoses and is a simple, non-invasive mode of investigating inguinal hernia and patent processus vaginalis. Our data support a policy of contralateral groin exploration during unilateral hernia repair based on preoperative ultrasonographic information.

Tables for estimation of individual risks of fetal neural tube and ventral wall defects, incorporating prior probability, maternal serum α-fetoprotein levels, and ultrasonographic examination results

Tables are provided for estimation of the risk of open spina bifida in patients who have elevated maternal serum alpha-fetoprotein levels but normal results on detailed anatomy ultrasonographic scan. Risks are provided for various prior population risks, for various levels of elevated maternal serum alpha-fetoprotein, and for various assumptions about the sensitivity of ultrasonographic examination. The formula used is based on sequential multiplication of odds with the use of Bayes' theorem, but an arbitrary reduction (to the power of 0.5) in the degree to which ultrasonographic information modifies the odds has been made to allow for the nonindependence of ultrasonography and maternal serum alpha-fetoprotein tests. The wide range of resulting risks shows that the decision to offer amniocentesis after a negative scan should be individualized.