Ultrasound Appearance Research Articles

EP30.21: An unusual ultrasound appearance of an ovarian abscess

EP30.21: An unusual ultrasound appearance of an ovarian abscess

Ultrasound Landmarks in the Approach to the Common Peroneal Nerve in a Sheep Model-Application in Peripheral Nerve Regeneration.

Peripheral nerve injury (PNI) remains a medical challenge with no easy resolution. Over the last few decades, significant advances have been achieved in promoting peripheral nerve regeneration, and new assessment tools have been developed, both functional and imaging, to quantify the proportion and quality of nerve recovery. The exploration of new animal models, larger, more complex, and with more similarities to humans, has made it possible to reduce the gap between the results obtained in classic animal models, such as rodents, and the application of new therapies in humans and animals of clinical interest. Ultrasonography is an imaging technique recurrently used in clinical practice to assess the peripheral nerves, allowing for its anatomical and topographic characterization, aiding in the administration of anesthesia, and in the performance of nerve blocks. The use of this technique in animal models is scarce, but it could be a useful tool in monitoring the progression of nerve regeneration after the induction of controlled experimental lesions. In this work, sheep, a promising animal model in the area of peripheral nerve regeneration, were subjected to an ultrasonographic study of three peripheral nerves of the hind limb, the common peroneal, and tibial and sciatic nerves. The main aim was to establish values of dimensions and ultrasound appearance in healthy nerves and landmarks for their identification, as well as to perform an ultrasound evaluation of the cranial tibial muscle, an effector muscle of the common peroneal nerve, and to establish normal values for its ultrasound appearance and dimensions. The results obtained will allow the use of these data as control values in future work exploring new therapeutic options for nerve regeneration after induction of common peroneal nerve injuries in sheep.

Ultrasonographic appearance and histopathological findings of the genital tract in healthy nulliparous female rabbits (Oryctolagus cuniculus).

Female rabbits often exhibit reproductive tract disorders and accurate sonographic descriptions of the normal genital tract are lacking. The aims of our prospective, analytical, and reference interval study were to describe the ultrasonographic appearance of the genital tract of healthy female rabbits, provide reference values, and compare ultrasonographic findings with histopathological samples. Twenty-eight intact female rabbits presented for elective ovariohysterectomy were included. Ovaries, oviducts, uterine horns, cervixes, and vagina were imaged by ultrasound to assess their size, shape, location, margination, echogenicity, and echotexture. The genital tract of 12 rabbits was sent for histopathology. Genitals were visible in all rabbits using the linear probe. The ovaries were oval-shaped and hypoechoic with a variable pattern. The oviducts, uterine horns, and vagina appeared as tubular structures with a consistent distinct layering, and the cervix as two contiguous hypoechoic tubular structures with a variable layering. Incidental findings, including paraovarian cysts, mineralization foci, and luminal fluid were observed. The median values of the height of the left and right ovaries, oviducts, uterine horns, cervixes, and vagina were, respectively, equal to 3.52 3.37, 1.39, 1.39, 4.34, 4.36, 5.57, 5.15, and 2.40mm. Significant correlations were observed among age, body condition score, and some of the measurements. Abnormalities of the reproductive tract were reported in 4 of 28 rabbits. This study supports the use of ultrasonography in the evaluation of the reproductive tract of healthy female rabbits and provides reference values for use in rabbits with genital disorders.

Can High-Frequency Intraoral Ultrasound Predict Histological Risk Factors in Oral Squamous Cell Carcinoma? A Preliminary Experience.

Despite advancements in multidisciplinary care, oncologic outcomes of oral cavity squamous cell carcinoma (OSCC) have not substantially improved: still, one-third of patients affected by stage I and II can develop locoregional recurrences. Imaging plays a pivotal role in preoperative staging of OSCC, providing depth of invasion (DOI) measurements. However, locoregional recurrences have a strong association with adverse histopathological factors not included in the staging system, and any imaging features linked to them have been lacking. In this study, the possibility to predict histological risk factors in OSCC with high-frequency intraoral ultrasonography (IOUS) was evaluated. Thirty-four patients were enrolled. The agreement between ultrasonographic and pathological DOI was evaluated, and ultrasonographic margins' appearance was compared to the Brandwein-Gensler score and the worst pattern of invasion (WPOI). Excellent agreement between ultrasonographic and pathological DOI was found (mean difference: 0.2 mm). A significant relationship was found between ultrasonographic morphology of the front of infiltration and both Brandwein-Gensler score ≥ 3 (p < 0.0001) and WPOI ≥4 (p = 0.0001). Sensitivity, specificity, positive predictive value, and negative predictive value for the IOUS to predict a Brandwein-Gensler score ≥3 were 93.33%, 89.47%, 87.50%, and 94.44%, respectively. The present study demonstrated the promising role of IOUS in aiding risk stratification for OSCC patients.

Ultrasonographic features of the regressing yolk sac of normal captive Brown kiwi chicks (Apteryx mantelli) vary with age.

Brown kiwi (Apteryx mantelli) are a culturally significant ratite species endemic to New Zealand. Chicks can develop diseases of the yolk sac which can be fatal if not promptly recognized and treated. Ultrasound examination of the yolk sac is an important component in the evaluation of chicks with suspected yolk sac disease. However, there are currently no reports of the normal ultrasonographic appearance of the regressing yolk sac in this species. The objective of this prospective reference interval study was to describe the normal ultrasonographic appearance of the yolk sac in brown kiwi chicks. Focused coelomic sonographic examinations were performed on 29 healthy chicks from >1 day of age until the yolk sac was completely absorbed or was <1mL in volume. 41.6% (57/137) of yolks were round/ovoid in shape and 58.6% (80/137) had lobulated margins with invaginations. All yolks (137/137) were hyperechoic relative to adjacent coelomic structures. The heterogeneity of the echogenicity of the yolk was significantly associated with age (increased heterogeneity in younger birds) and was homogeneous, mildly heterogeneous, and moderately heterogeneous in 33% (46/138), 46% (63/138), and 21% (29/138) of all examinations respectively. Intrasac anechoic pockets were seen in 14% (20/139) of yolk sacs. The rate of yolk sac resorption slowed with age. In all examinations identifying a completely absorbed yolk sac or a yolk sac <1mL in volume, chicks were less than 21 days old. The results of this study provide a reference of normal for the sonographic appearance of the yolk sac in captive brown kiwi chicks.

Ultrasonographic appearance of supraspinatus and biceps tendinopathy improves in dogs treated with low-intensity extracorporeal shock wave therapy: a retrospective study.

This study aimed to determine whether dogs with shoulder tendinopathy diagnosed via musculoskeletal ultrasound would show improvement in imaging after treatment using piezoelectric shockwave therapy and rest. Medical records were reviewed for dogs diagnosed with biceps and/or supraspinatus tendinopathy via musculoskeletal ultrasound, treated using piezowave shockwave, and re-imaged post-treatment. Data collected included patient signalment, duration and grade of lameness, prior rest, piezowave dose, and patient outcome, including a return to sport where applicable. Images were scored using an adapted ultrasound grading scale, in addition to obtaining cross-sectional area measurements. Statistics included Shapiro-Wilk tests (normality), Wilcoxon matched pairs signed rank tests (pre- vs. post-treatment comparisons), and Spearman's correlation coefficients (lameness grade vs. ultrasound score) (significant at P < 0.05). In total, 26 of 30 dogs had pathology involving both the biceps and supraspinatus tendons in one limb, with 27 of 30 having tendon/s affected bilaterally. For both tendons, post-treatment cross-sectional area and ultrasound score were significantly lower than pre-treatment (P < 0.001). Lameness decreased clinically (P < 0.0001) following piezowave shockwave treatment regardless of the tendons involved, but the lameness score did not correlate with the ultrasound score for either tendon. Dogs with tendinopathy of the biceps brachii and supraspinatus showed significant improvement on follow-up musculoskeletal ultrasound and lameness evaluation after the treatment of their tendons using piezoelectric shockwave therapy with rest. Canine biceps brachii and supraspinatus tendinopathy can cause variable lameness and ultrasonographic appearance, which improves after shockwave therapy and rest. The ultrasound scoring system and cross-sectional area assessment provide useful outcome measures for clinical cases.

History of Thyroid Ultrasound.

From low-resolution images in the 1960s to current high-resolution technology, ultrasound has proven to be the initial imaging modality of choice for thyroid application. Point-of-care ultrasound has brought the technology to the thyroid specialist. Combined with physical examination, it provides real-time information regarding goiter, thyroid nodules, and thyroid cancer. Ultrasound-guided fine-needle aspiration biopsy has become the accepted norm, with biopsies rarely performed using palpation alone. Advantages of ultrasound-guided biopsy include precise placement of the needle within the nodule, selective sampling of areas with suspicious features, and accurate direction of the biopsy needle to actively growing viable cells in the periphery of the nodule. Education of endocrinologists in thyroid ultrasound began in the late 1990s and by 2016 more than 6000 clinicians had completed an ultrasound course. Concurrent with this rapid expansion of use of thyroid ultrasound was a rise in the diagnosis of small papillary carcinomas, which might have otherwise remained indolent and undetected. The 2009 American Thyroid Association Guidelines for the Management of Thyroid Nodules and Thyroid Cancer recommended biopsy for all solid hypoechoic nodules measuring larger than 1 cm. Attempting to decrease the frequency of biopsies of low-risk nodules, subsequent guidelines have focused on identifying and selectively biopsying those thyroid nodules at higher risk of clinically significant carcinoma based on ultrasound appearance. A major role for thyroid ultrasound has been in both preoperative staging and mapping to help determine the extent of surgery, as well as postoperative monitoring for locoregional soft tissue or lymph node metastases. With the recognition that the increase in papillary carcinoma was predominantly a result of early diagnosis of small often indolent cancers, active surveillance has become a promising management strategy for papillary thyroid microcarcinomas. Thyroid ultrasound is essential to active surveillance of thyroid cancer. Easy access to high-quality ultrasound studies is a requirement for a successful active surveillance program. Thyroid ultrasound has been used to facilitate interventional procedures, including treatment of thyroid nodules, treatment of recurrent thyroid cancer, and therapy of papillary thyroid microcarcinoma.

Anatomical and Ultrasound Study of the Mid-Femoral Sciatic Nerve and Its Division

Abstract OBJECTIVES Anatomical variations of the sciatic nerve were supposed as potential causes for incomplete blocks at the level of the popliteal fossa. Therefore, we aimed to conduct an anatomical and ultrasound survey of the mid-femoral sciatic nerve and its division. BACKGROUND A regional block of the sciatic nerve is a procedure for analgesia and anaesthesia of the lower extremity. Various approaches to the sciatic nerve are used in clinical practice. However, the sciatic nerve demonstrates several variations regarding its topography and division. MATERIALS AND METHODS The anatomical study included twenty lower limbs of ten adult cadavers. The ultrasound study involved ten upper legs of five healthy volunteers RESULTS The sciatic nerve was found distally to the piriformis muscle in all our cadaveric specimens. It was divided into two major branches (common peroneal nerve and tibial nerve) at a mean distance of 68.1 ± 19.3 mm above the popliteal crease. The observed distances ranged widely from 35 to 113 mm. The mid-femoral sciatic nerve and its division were entirely revealed using ultrasound in all volunteers. CONCLUSION The sciatic nerve presents significant anatomical variations, which may cause an incomplete block. Understanding ultrasound anatomy and ultrasound appearance of the sciatic nerve is essential for performing ultrasound-guided sciatic blocks.

Ultrasonographic appearance of retained surgical sponges and gauzes in the acute postoperative period: a phantom and cadaveric study.

Retained surgical sponges or gauzes (RSS) are an uncommon complication of exploratory laparotomy surgery and pose a clinically significant risk to the patient. The purpose of this two-part, prospective, descriptive study was to describe the previously uncharacterized ultrasonographic appearance of RSS in phantom and cadaveric models of the acute postoperative period (24-48h). For the first part of the study, a gelatin phantom containing a woven gauze with a radiopaque marker (radiopaque gauze), a woven gauze with no marker (nonradiopaque gauze), and a laparotomy sponge with a radiopaque marker (radiopaque sponge) was evaluated with ultrasonography. For the second part of the study, a total of 23 gauzes and sponges (of the aforementioned three types) were placed within the peritoneal cavity of 20 cadavers in one of three randomized locations during an exploratory laparotomy laboratory. The cadavers were imaged with ultrasonography 17h later and still images and video clips were reviewed. The retained surgical sponges and gauzes in the gelatin phantom displayed multiple hyperechoic layers and variable degrees of distal acoustic shadowing. In cadavers, 100% (23/23) of the retained surgical sponges and gauzes displayed a single hyperechoic layer of variable thickness and distal acoustic shadowing. In 95.6% (22/23) retained sponges and gauzes, there was a thin hypoechoic layer noted superficially to the hyperechoic layer. An improved understanding of the ultrasonographic appearance of retained sponges or gauzes in the acute postoperative period may assist in the identification of these objects.

The predictive models based on multimodality ultrasonography for the differential diagnosis of thyroid nodules smaller than 10 mm.

The objective of this study was to establish a multimodality ultrasound prediction model based on conventional ultrasound (Con-US), shear wave elastography (SWE), and strain elastography (SE) and contrast-enhanced ultrasound (CEUS) and to explore their diagnostic values for thyroid nodules ≤ 10 mm. This retrospective study included 198 thyroid nodules (maximum diameter≤10 mm) in 198 thyroid surgery patients who were examined preoperatively with above-mentioned methods. The pathological findings of the thyroid nodules were used as the gold standard, and there were 72 benign nodules and 126 malignant nodules. The multimodal ultrasound prediction models were developed by logistic regression analysis based on the ultrasound image appearances. The diagnostic efficacy of these prediction models was then compared and internally cross-validated in a fivefold manner. The specific features on CEUS (enhancement boundary, enhancement direction and decreased nodule area) and the parenchyma-to-nodule strain ratio (PNSR) on SE and SWE ratio were included in the prediction model. The Model one combining American College of Radiology Thyroid Imaging Reporting and Data Systems (ACR TI-RADS) score with PNSR and SWE ratio had the highest sensitivity (92.8%), while the Model three combining TI-RADS score with PNSR, SWE ratio and specific CEUS indicators had the highest specificity, accuracy, and AUC (90.2%,91.4%, and 0.958, respectively). The multimodality ultrasound predictive models effectively improved the differential diagnosis of thyroid nodules smaller than 10 mm. For the differential diagnosis of thyroid nodules ≤ 10 mm, both ultrasound elastography and CEUS could be effective complements to ACR TI-RADS.

Application of Ultrasound in Detecting and Removing Migrating Grass Awns in Dogs and Cats: A Systematic Review.

Migrating grass awns are an important cause of disease in dogs and cats. Plant awns can migrate into several body tissues and cavities because of their fusiform shape and backward-pointing barbs. Their migration causes inflammatory tissue reaction and clinical signs depend upon their localization. Ultrasound has been described as a useful, noninvasive, and readily available tool to identify and guide vegetal foreign bodies removal in animals. The aim of this systematic review was to summarize current knowledge on the application of ultrasonography in the identification and removal of grass awns from various anatomic locations in dogs and cats. We selected and analyzed 46 papers on the application of ultrasonography in dogs and cats affected by migrating grass awns. The ultrasonographic appearance of grass awns is characteristic, although their size and location can influence the visualization and the attempt of removal. In some cases, migrating grass awns are not directly visualized by ultrasonography, but the lesions caused by their migration can be easily seen. Ultrasonography can be considered a useful diagnostic tool to localize and remove migrating grass awns; however, when the migration occurs in less accessible locations or discrete foreign bodies are present, this diagnostic tool should be considered as a part of a multidisciplinary approach with advanced diagnostic imaging modalities.

Ultrasonographic features of Marek's disease in a chicken.

A 4-year-old chicken was presented with a history of anorexia, depression, and blindness. An ultrasound examination of the coelomic cavity was performed that revealed splenomegaly, hepatic nodules, and hypoechoic thickening of the intestinal wall. Ultrasonography of the coelomic cavity was done and revealed splenomegaly, nodular hepatic changes, and hypoechoic thickening of the intestinal wall. A diagnosis of Marek's disease was made based on the history and extension of the abdominal organ changes and confirmed by histopathology. This study describes an ultrasonographic appearance of Marek's disease in a chicken and emphasizes the importance and benefits of ultrasonography in staging the progression of Marek's disease.

A Pictorial Essay on Ultrasonography of Lymphadenopathies in Children

The purpose of this review is to become familiar with ultrasound (US) characteristics of normal and pathological lymph nodes and with diagnostic imaging approach to lymphadenopaties. Lymphadenopathy is a common finding in the paediatric population. Due to the many pathologies that can present in a similar fashion, imaging is a valuable method used in diagnostic process. Ultrasound is the modality of choice for lymph node detection in children, with a high safety profile as it does not use radiation. In this review the US appearance and characteristics of normal lymph nodes, and of some more common lymphadenopathies, are presented. Special attention is paid to distinguishing between benign and malignant lymph nodes on the basis of US characteristics. All findings must always be correlated with clinical and laboratory findings, and frequently followed by fine-needle aspiration or excisional biopsy as some US morphologies of benign and malignant nodes may overlap. However, the criteria that raise suspicion for malignancy are round shape, predominantly hypoechoic echogenicity, heterogenous echotexture, absent or displaced hilum, irregular outlines, necrosis, multiple confluent lymph nodes, the presence of microcalcifications, and peripheral or mixed flow pattern on colour Doppler imaging.Conclusion - US is the first line imaging method in palpable masses in children, first to confirm the presence of lymph nodes, and second to better delineate the lymph node’s characteristics, which guides further diagnostic decisions and treatment.

Automated Society of Fetal Urology (SFU) grading of hydronephrosis on ultrasound imaging using a convolutional neural network

Grading of hydronephrosis severity on postnatal renal ultrasound guides management decisions in antenatal hydronephrosis (ANH). Multiple systems exist to help standardize hydronephrosis grading, yet poor inter-observer reliability persists. Machine learning methods may provide tools to improve the efficiency and accuracy of hydronephrosis grading. To develop an automated convolutional neural network (CNN) model to classify hydronephrosis on renal ultrasound imaging according to the Society of Fetal Urology (SFU) system as potential clinical adjunct. A cross-sectional, single-institution cohort of postnatal renal ultrasounds with radiologist SFU grading from pediatric patients with and without hydronephrosis of stable severity was obtained. Imaging labels were used to automatedly select sagittal and transverse grey-scale renal images from all available studies from each patient. A VGG16 pre-trained ImageNet CNN model analyzed these preprocessed images. Three-fold stratified cross-validation was used to build and evaluate the model that was used to classify renal ultrasounds on a per patient basis into five classes based on the SFU system (normal, SFU I, SFU II, SFU III, or SFU IV). These predictions were compared to radiologist grading. Confusion matrices evaluated model performance. Gradient class activation mapping demonstrated imaging features driving model predictions. We identified 710 patients with 4659 postnatal renal ultrasound series. Per radiologist grading, 183 were normal, 157 were SFU I, 132 were SFU II, 100 were SFU III, and 138 were SFU IV. The machine learning model predicted hydronephrosis grade with 82.0% (95% CI: 75-83%) overall accuracy and classified 97.6% (95% CI: 95-98%) of the patients correctly or within one grade of the radiologist grade. The model classified 92.3% (95% CI: 86-95%) normal, 73.2% (95% CI: 69-76%) SFU I, 73.5% (95% CI: 67-75%) SFU II, 79.0% (95% CI: 73-82%) SFU III, and 88.4% (95% CI: 85-92%) SFU IV patients accurately. Gradient class activation mapping demonstrated that the ultrasound appearance of the renal collecting system drove the model's predictions. The CNN-based model classified hydronephrosis on renal ultrasounds automatically and accurately based on the expected imaging features in the SFU system. Compared to prior studies, the model functioned more automatically with greater accuracy. Limitations include the retrospective, relatively small cohort, and averaging across multiple imaging studies per patient. An automated CNN-based system classified hydronephrosis on renal ultrasounds according to the SFU system with promising accuracy based on appropriate imaging features. These findings suggest a possible adjunctive role for machine learning systems in the grading of ANH.

Altered thyroid feedback loop in Klinefelter syndrome: a cohort study from infancy through the transition into adulthood.

Thyroid dysfunction has been claimed contributing to the spectrum of Klinefelter syndrome (KS); however, studies are scarce. In a retrospective longitudinal study, we aimed at describing the hypothalamus-pituitary-thyroid (HPT) axis and thyroid ultrasonographic (US) appearance in patients with KS throughout the life span. 254 patients with KS (25.9±16.1 years) were classified according to their pubertal and gonadal status and compared with different groups of non-KS age-matched subjects with normal thyroid function, treated and untreated hypogonadism, or chronic lymphocytic thyroiditis. We assessed serum thyroid hormone levels, anti-thyroid antibodies, US thyroid parameters, in vitro pituitary type 2 deiodinase (D2) expression and activity. Thyroid autoimmunity was more prevalent among subjects with KS at all ages, although the Ab negative vs. positive cohorts were not different. Signs of thyroid dysfunction (reduced volume, lower echogenicity, and increased inhomogeneity) were more prominent in KS than in euthyroid controls. Free thyroid hormones were lower in pre-pubertal, pubertal, and adult subjects with KS, while TSH values were only lower in adults. Peripheral sensitivity to thyroid hormones was unaltered in KS, suggesting a dysfunctional HPT axis. Testosterone (T) was the only factor associated with thyroid function and appearance. In vitro testing demonstrated an inhibitory effect of T on pituitary D2 expression and activity, supporting enhanced central sensing of circulating thyroid hormones in hypogonadism. From infancy through adulthood, KS is characterized by increased morpho-functional abnormalities of the thyroid gland, combined with a central feedback dysregulation sustained by the effect of hypogonadism on D2 deiodinase.

Effects of Hormonal Profile, Weight, and Body Image on Sexual Function in Women with Polycystic Ovary Syndrome.

Polycystic ovary syndrome (PCOS) is a hyperandrogenic endocrinological disorder associated with chronic oligo-anovulation and polycystic ovarian morphology. Compared to women without PCOS, women with PCOS have a risk of sexual dysfunction that is more than 30% higher. Although alterations in sex hormones and psychosocial wellbeing have been proposed, the precise mechanisms of FSD in PCOS remain unclear. The aim of our study was to analyze how the hormonal, clinical and psychometric parameters of PCOS patients are involved in the development of sexual dysfunction. The study group consisted of 54 women, aged between 21 and 32 years, diagnosed with PCOS. We collected the following parameters: age, body mass index (BMI), the Ferriman-Gallwey score (FG), maximum duration of oligomenorrhea, abdominal circumference (AC), free testosterone value (FT), luteinizing hormone/follicle stimulating hormone (LH/FSH) ratio value, serum cortisol value and ovarian ultrasound appearance. At the time of the examination, patients were asked to fill in the Female Sexual Function Index (FSFI) and the Body Exposure during Sexual Activities Questionnaire (BESAQ). Statistically significant differences were observed between normal weight and overweight women regarding BESAQ (p-value = 0.02) and FSFI total (p-value <0.001). Elevated BMI, AC or BESAQ scores correlated with a lower FSFI score. The most involved domains of the scale were orgasm, arousal, and desire. Elevated BESAQ scores increase the risk of female sexual dysfunction (FSD) by 4.24 times. FT, BESAQ score, BMI, and LH/FSH ratio were found to independently predict FSD. The cutoff point for the BESAQ score in detecting FSD was found to be 1.97. Weight, body image and anxiety related to sexual activities seem to be significant components in the development of sexual dysfunction in PCOS patients, beyond the effect due to hyperandrogenism. FT value has a U-shape effect in sexual dysfunction, because both in the case of deficit and in the case of excess, sexual function is impaired. BESAQ is a strong predictor for sexual dysfunction in women with PCOS, along with FT value, LH/FSH ratio and BMI.

US Evaluation of Topical Hemostatic Agents in Post-Thyroidectomy.

the aim of this study was to describe the ultrasound appearance of topical hemostatics after thyroidectomy. we enrolled 84 patients who were undergoing thyroid surgery and were treated with two types of topical hemostats, 49 with an absorbable hemostat of oxidized regenerated cellulose (Oxitamp®) and 35 with a fibrin glue-based hemostat (Tisseel®). All patients were examined using B-mode ultrasound. In 39 patients of the first group (approximately 80%), a hemostatic residue was detected and in some cases confused with a native gland residue, or with cancer recurrence in oncological patients. No residue was detected in patients in the second group. The main ultrasound characteristics of the tampon were analyzed and arranged according to predefined patterns, and suggestions to recognize it and avoid wrong diagnoses were provided. A part of the group of patients with tampon residue was re-evaluated after 6-12 months, ensuring that the swab remained for months after the maximum resorption time declared by the manufacturer. with equal hemostatic effectiveness, the fibrin glue pad is more favorable in the ultrasound follow-up because it creates reduced surgical outcomes. It is also important to know and recognize the ultrasound characteristics of oxidized cellulose-based hemostats in order to reduce the number of diagnostic errors and inappropriate diagnostic investigations.

Partial hydatidiform mole and coexistent live fetus with placenta previa: a case report.

Here, we report a case of a 24-year-old Indonesian woman with an ultrasonographic appearance of partial hydatidiform mole with initial placenta covering the internal uterine ostium in the late first trimester which then became marginal placenta previa in the third trimester. The woman decided to continue the pregnancy after considering the risks and benefits. The normal anatomy of the premature infant was vaginally delivered alive with a large and hydropic placenta. Proper diagnosis, management, and monitoring remain challenging as this case is still rarely reported. Although embryos from partial mole forms generally do not survive since the first trimester, our case reported the singleton pregnancy with the coexistent normal fetus and the partial mole characteristic of the placenta. Diploid karyotype, few and focal extent of hydatidiform tissue of placenta, low rate of molar degeneration, and the absence of fetal anemia hypothesized as the factors that influenced survival of the fetus. There were two maternal complications such as hyperthyroidism and frequent vaginal bleeding without subsequent anemia in this patient. A rare case of partial hydatidiform mole coexistent with a live fetus with placenta previa was reported in this study. There were also maternal complications. Thus, prompt and regular monitoring of maternal and fetal condition holds an important role.

High-frequency ultrasound biomicroscopy findings of the skin of dogs with atopic dermatitis.

The high-frequency ultrasonographic appearance of skin of dogs with atopic dermatitis (cAD) has not been described. To compare high-frequency ultrasonographic findings among lesional, macroscopically nonlesional skin of dogs with cAD, and the macroscopically nonlesional skin of healthy dogs. Additionally, to determine whether there is any correlation between the ultrasonographic findings in lesional skin and local Canine Atopic Dermatitis Extent and Severity Index, 4th iteration (CADESI-04) or its domains (erythema, lichenification, excoriations/alopecia). As a secondary aim, six cAD dogs were re-evaluated after management intervention. Twenty dogs with cAD (six were re-examined after treatment) and six healthy dogs. In all dogs, ultrasonographic examination was performed on the same 10 skin sites, using a 50 MHz transducer. Wrinkling of skin surface, presence/width of subepidermal low echogenic band, hypoechogenicity of dermis and thickness of the skin were evaluated and scored/measured blindly. Dermal hypoechogenicity was more common and severe in lesional compared to macroscopically nonlesional skin of dogs with cAD. In lesional skin, presence/severity of wrinkling of skin surface and of dermal hypoechogenicity were positively correlated with presence/severity of lichenification, while severity of dermal hypoechogenicity was positively correlated with local CADESI-04. A positive correlation between the change in skin thickness and the change in the severity of erythema during treatment was noted. High-frequency ultrasound biomicroscopy may be useful for the evaluation of skin of dogs with cAD and for evaluating the progression of skin lesions during treatment.

PD01-05 MULTICENTER VALIDATION OF A CONSENSUS-BASED HYDROGEL SIMULATOR FOR ULTRASOUND GUIDED PERCUTANEOUS NEPHROLITHOTOMY USING MODERN EDUCATION THEORY

You have accessJournal of UrologyCME1 Apr 2023PD01-05 MULTICENTER VALIDATION OF A CONSENSUS-BASED HYDROGEL SIMULATOR FOR ULTRASOUND GUIDED PERCUTANEOUS NEPHROLITHOTOMY USING MODERN EDUCATION THEORY Lauren Shepard, Nathan Schuler, Aaron Saxton, Patrick Saba, Andrew Cook, Tyler Holler, David Tzou, Karen Stern, Helena Chang, Justin Ahn, Thomas Tailly, Thomas Chi, and Ahmed Ghazi Lauren ShepardLauren Shepard More articles by this author , Nathan SchulerNathan Schuler More articles by this author , Aaron SaxtonAaron Saxton More articles by this author , Patrick SabaPatrick Saba More articles by this author , Andrew CookAndrew Cook More articles by this author , Tyler HollerTyler Holler More articles by this author , David TzouDavid Tzou More articles by this author , Karen SternKaren Stern More articles by this author , Helena ChangHelena Chang More articles by this author , Justin AhnJustin Ahn More articles by this author , Thomas TaillyThomas Tailly More articles by this author , Thomas ChiThomas Chi More articles by this author , and Ahmed GhaziAhmed Ghazi More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003218.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Ultrasound-guided approaches for percutaneous nephrolithotomy (US-PCNL) offer several advantages, including significant reduction in radiation exposure; however, they have not been readily adapted. Some of the contributing factors include the lack of a standard training platform and curriculum that has been uniformly approved by experts. As such, there is a current need for a realistic simulator. Herein, we used a consensus-based educational approach for development and multicenter validation of a high-fidelity non-biohazardous PCNL simulator. METHODS: Consensus was reached on a high-fidelity PCNL simulator with 12 international experts using a Delphi methodology over three rounds. The 284 questions were categorized into overall utility, anatomical components, tissue fidelity, and assessment of surgical performance. A hydrogel prototype replicating mechanical properties was developed for experts to evaluate prior to its validation by comparing performances of 20 experts and 28 novices from 5 centers as well as evaluating the models ability to improve novice performance with repeated practice. RESULTS: Consensus (>80% agreement) was reached in 31.3% of questions, within which 65% achieved 100% consensus. The prototype prone PCNL simulator included anatomical landmarks (11th and 12th rib, iliac crest), realistic external and ultrasound appearance with appropriate tactile properties, and a water tight distensible pelvicalyceal system with a stone for laser lithotripsy and retrograde ureteroscopy (Figure 1A). A weighted evaluation checklist was also developed via consensus. Experts agreed that >89.2% of prototype and checklist components conformed to the consensus statement. Novices and experts were graded for US-guided lower pole access, with statistically significant differences for checklist score (42.3±19.0% vs 93.4±4.6%, p<0.001). Furthermore, novices significantly improved both lower pole and upper pole access score (p<0.01, p<0.001) respectively with repeated (x5) training sessions (Figure 1B). CONCLUSIONS: This non-biohazardous benchtop simulator for US-PCNL developed using expert consensus and validated via an educational approach at multiple centers can provide safe, realistic training in a risk-free environment. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e64 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Lauren Shepard More articles by this author Nathan Schuler More articles by this author Aaron Saxton More articles by this author Patrick Saba More articles by this author Andrew Cook More articles by this author Tyler Holler More articles by this author David Tzou More articles by this author Karen Stern More articles by this author Helena Chang More articles by this author Justin Ahn More articles by this author Thomas Tailly More articles by this author Thomas Chi More articles by this author Ahmed Ghazi More articles by this author Expand All Advertisement PDF downloadLoading ...