Ultrasound Scan Findings Research Articles

EP69 Real Life Assessment of Diagnostic Imaging In Acute Appendicitis. A Multi-Centre Audit from The United Kingdom

Abstract Objectives Ultra-sound scan (USS) and Computed Tomography (CT) are commonly used in the diagnosis of acute appendicitis (AA). This audit aims at assessing their sensitivity and implications on the rate of negative appendicectomy (NA) and the number of scans patients have. Methods This is a retrospective multi-centre audit from tertiary (TH) and secondary (SH) hospitals in the United Kingdom. We enrolled patients who underwent appendicectomy over the last year and compared their scans findings to the histopathological findings as the gold standard for AA. Results This is a preliminary report of the first 405 (49.4% females). 69% had USS and 51% had CT scan. USS sensitivity was 57.6%. This sensitivity did not change significantly with age, sex or the size of hospital. CT sensitivity was 95.7%. Females and SH patients tended to have more scans (p< 0.001 for both). 26.4% of the patients had no scans and underwent appendicectomy based on clinical diagnosis. The positive predictive value of this clinical diagnosis was 85% which is equal to USS. 12.1% of the patients had NA, of which 16.4% were females Vs 7.8% males (p= 0.008). The mean age in NA was 26.96 years old Vs 34.12 years old in positive appendicectomy (p=0.009). Conclusion USS sensitivity is low and does not improve in females or younger patients who are also more likely to have NA. Females and SH patients are more likely to have more scans. Findings of USS should be interpreted with care, especially in young and female patients.

The Pattern of Abdominal Ultrasound Scan Findings at the Department of Radiology at the University of Port Harcourt Teaching Hospital

The Pattern of Abdominal Ultrasound Scan Findings at the Department of Radiology at the University of Port Harcourt Teaching Hospital

Hemodynamic surgery of varicose veins of the lower extremities with the introduction of modern technologies

Minimaly invasive and pathogenetically based methods are currently prevalent in phlebology, as they are in other fields of surgery. CHIVA (Сure conservatrice et hemodynamiу que de l’insuffisance veineuse en ambulatoire) hemodynamic surgery is one of these popular minimally invasive surgical procedures. The execution technique relies on the findings of a duplex ultrasound scan that is used to analyse the hemodynamics of the superficial venous network. The CHIVA strategy aims to preserve the venous material while also restoring normal distal venous pressure and venous function. However, this technique has a number of disadvantages, including the possibility of vein recanalisation and relapses, as well as the fact that the immediate cosmetic outcome is not always satisfactory. Objective — to compare the outcomes of lower extremity varicose vein treatment based on the employed method: the CHIVA method executed via open surgery versus the CHIVA method combined with other minimally invasive methods (sclerotherapy, endovenous laser coagulation (EVLC)). Materials and methods. A randomised prospective study was conducted on 52 patients with varicose veins of the lower extremities categorised as C1‑C3 according to the CEAR classification. The patients were divided into 2 groups of 26 patients each, with one group undergoing the CHIVA procedure using the classic open technique, and the other group receiving a combination of CHIVA with EVLC and sclerotherapy. To evaluate the results, we used Hobb’s criteria, measured the diameter of the great saphenous vein via ultrasound, analysed alterations in the Venous Clinical Severity Scoring (VCSS) , studied data from the Chronic Venous Insufficiency Quality of Life Questionnaire (CIVIQ 20), and determined the incidence of relapses. Results. After CHIVA and CHIVA + EVLC + sclerotherapy, the normalisation of hemodynamics and interruption of the venous shunt led to a substantial reduction in the diameter of the great saphenous vein within 6 months after the operation (p<0.01). Both groups had an improvement in VCSS 6 months after surgery. No statistical difference was observed between the treatment groups. All methods had a positive impact on the quality of life of patients, as shown by the CIVIQ 20 questionnaire. Of the 52 operated patients, there were 4 relapses (7.7%). No relapses were noted in the group receiving CHIVA with EVLC and sclerotherapy (p=0.039). As evaluated by Hobb’s criteria, patients exhibited greater satisfaction with the outcomes of hemodynamic surgery combined with EVLC and sclerotherapy due to its better and faster aesthetic outcomes (р=0.012 and 0.05). Conclusions. All 52 patients exhibited favourable treatment outcomes, demonstrating a reduction in CVI symptoms during a comprehensive clinical assessment using ultrasound within 6 months and 1 year. The combination of CHIVA with EVLC and sclerotherapy showed distinct advantages in the treatment of varicose veins, yielding the most favourable cosmetic outcomes according to Hobb’s criteria and achieving a reccurence rate of 0%.

Investigating the relationship between clinical, laboratory and radiological findings in hospitalized patients diagnosed with xanthogranulomatous pyelonephritis who referred to Ali Ebn Abitaleb Hospital fron 2018-2022

Background and Objective: Considering the high rate of unfavorable diagnosis of XGP and doctors’ inadequate familiarity, this research was conducted with the aim of determining clinical, laboratory, and radiological findings in patients diagnosed with xanthogranulomatous pyelonephritis referred to Ali Bin Abitalib Hospital from 2018 to 2022. Materials and Methods: In this retrospective study, 23 patients diagnosed with xanthogranulomatous pyelonephritis were assessed in Ali Bin Abitalib Zahedan Hospital between 2018 and 2022. The diagnosis of XGP was evaluated retrospectively based on the findings of renal ultrasound and CT scan, according to the distribution and extent of XGP, kidney size, the presence of stones, the pattern of renal lesions, and lack of contrast enhancement in the affected kidney. In addition, the diagnosis of pathological cases of XGP was determined based on the presence of focal or diffuse processes with the presence of lipid-laden macrophages in a chronic inflammatory context in the kidney. Finally, the information obtained was analyzed using SPSS statistical software (version 26). Results: The mean age of patients diagnosed with xanthogranulomatous pyelonephritis was 48.17±11.45 years, respectively. The frequency distribution of gender in the study subjects was 18 (78.27%) women and 5 (21.73%) men. The rate of clinical symptoms in patients diagnosed with xanthogranulomatous pyelonephritis was as follows: flank pain or tenderness (91.3%; n=17), history of fever (over 38 degrees) (73.91%; n=17), hematuria Gross 6 (26.08%), dysuria (21.73%; n=5), weight loss (17.39%; n=4), and palpable mass (8.69%; n=2). The findings from the tests of patients diagnosed with xanthogranulomatous pyelonephritis demonstrated that 20 (86.95%) patients had pyuria, 17 (73.91%) cases had leukocytosis, 13 (56.52%) patients had anemia, 11 (47.82%) patients had hematuria, 9 (39.13%) subject had high CRP, and 7 (30.43%) cases had high ESR. The results of CT-Scan interpretation in patients diagnosed with xanthogranulomatous pyelonephritis illustrated that 13 (56.52%) patients had Renal Calculi, and 4 (17.39%) cases had Staghorn Stone. Moreover, regarding fluid/air accumulation, 14 (60.86%) patients had abdominal abscesses (retroperitoneal, intraparenchymal or psoas) and 1 patient had a fistula of Nephrocutaneous Fistula type. Conclusion: Despite the low prevalence of xanthogranulomatous pyelonephritis, it is recommended that when faced with chronic pyelonephritis (characterized by clinical symptoms such as fever and chills, tenderness, flank pain, and heartburn), doctors and specialists in kidney and urinary tract surgery among consider XGP disease differential diagnoses in order to manage these patients well in the presence of kidney stones and positive urine culture and perform surgical procedures at the right time

An intricate vagina penetrating injury with a 22 cm cassava stick in situ for 6 months: a case report

BackgroundTrauma remains one of the major causes of morbidity and mortality and a threat to attainment of sustainable development goal 11. Genital urinary trauma is reported in about 10% of patients presenting with trauma worldwide, and in about 6.6% of patients in Sub-Saharan Africa. If not careful enough, one may miss the foreign body in the vagina and this may be associated with morbidity, and although rare, mortality.Case presentationWe report a case of a 7-year-old Black Ugandan that had suffered vagina trauma 6 months prior to presentation at our facility and presented with chronic vagina pus discharge for 6 months. Prior examinations had failed to recognize the foreign body and so did the two abdominal pelvic ultrasound scans. During examination under anesthesia, we were able to locate the cassava stick that had caused penetrating vagina injury and we were able to dislodge it. It was a blunt cassava stick with length of 22 cm and diameter of 2 cm. Although it had gone through the peritoneal cavity, we did not do a laparotomy.ConclusionThis case emphasizes the need for a thorough vaginal exam including the need to do it under anesthesia with good lighting even when ultrasound scan findings are normal. It presents an opportunity for one to manage penetrating peritoneal injury without a laparotomy in highly selected cases. Gynecologists should be keen as well to rule out child molestation.

Macrofollicular Architecture in Invasive Encapsulated Follicular Variant of Papillary Thyroid Carcinoma: A Pitfall in Thyroid Practice.

Predominantly macrofollicular architecture in invasive encapsulated follicular variant of papillary thyroid carcinoma (IEFVPTC-MF) is rare and often a cause of misinterpretation during pre-operative work-up and histopathology evaluation. We comprehensively evaluated the radiological, cytological, gross, microscopic, molecular and follow-up characteristics of four such cases, intending to increase its recognition and add our experience to the limited literature available. All such histopathologically-proven cases of IEFVPTC-MF were retrieved from the departmental archives. The clinical details, thyroid ultrasound, cytology and thyroid scan findings were reviewed. Allele-specific PCR for BRAF p.V600E, KRAS, NRAS, and HRAS mutations, and FISH assays for ETV6::NTRK3 fusion and RET fusions were performed. There were four cases of IEFVPTC-MF diagnosed between 2021 and 2022, involving two males and two females. The median age at presentation was 27years, and the duration of the disease was 1-10years. Thyroid ultrasound was TR1 (benign; n = 1), TR2 (not suspicious; n = 2), or TR4 (moderately suspicious; n = 1). Cytology was categorized as nondiagnostic (n = 1), benign (n = 1), andatypia of undetermined significance (n = 1). The three nodules with available cytology smears showed abundant colloid. Cells were arranged as sheets/microfollicles/clusters. Nuclei were predominantly round with minimal/focal elongation, membrane irregularity, and cellular crowding. On gross examination, cut surfaces of the tumors showed variable amounts of colloid. The tumors were solid-cystic. Histopathology revealed partially encapsulated multinodular tumors. There were prominent pseudopapillae projecting into the lumina of macrofollicles. Nuclei were predominantly round with variable nuclear atypia, including chromatin clearing and multifocal presence of nuclear grooves. Pseudoinclusions were identified in two. Molecular analysis revealed NRAS codon 61 mutation and ETV6::NTRK3 fusion in one case each. Two patients had cervical lymph node and hematogenous metastases. Post-radio-active iodine, the response was structurally incomplete (n = 2), indeterminate (n = 1) and excellent (n = 1). Macrofollicular architecture in invasive encapsulated follicular variant of papillary thyroid carcinoma is a major pitfall in thyroid oncology practice. Long-standing disease, and ultrasonographic and cytological features that overlap with benign disease, often lead to underdiagnosis during pre-operative evaluation. As patients may consequently develop distant metastases and have inadequate treatment response, there is a need for more vigilant understanding of the spectrum of macrofollicular thyroid disease for accurate diagnosis. ETV6::NTRK3 or other fusions, when found, present opportunities for targeted therapy.

Pulmonary Invasive Fungal Disease: Ultrasound and Computed Tomography Scan Findings.

The importance of ultrasound in diagnosing pulmonary invasive fungal diseases (IFD) has yet to be assessed. Thus, this study aimed to evaluate the frequency of sonographic findings in patients suspected of an invasive pulmonary fungal infection. This prospective longitudinal study examined all patients with lung lesions in imaging modalities and suspected IFDs referred to Dr. Sheikh and Akbar pediatric hospitals from 2019 to 2022. Considered variables were the halo sign in the computed tomography (CT) scan; the target sign in the ultrasound and contrast-enhanced CT scan; the cavity; wedge-shaped consoli- dation; and pleuritis and extrapulmonary invasion to the chest wall or subdiaphragmatic invasion in both modalities. All patients who underwent lung CT scans and ultrasounds until the final diagnosis were followed up. The degree of agreement between ultrasound and CT scan findings and the sensitivity, specificity, and diagnostic accuracy of these signs were assessed. This study involved 40 patients with an average age of 7.16 ± 4.23 years. Acute leukemia was the commonest underlying dis- ease detected in 17 (42.5%) cases. The target sign in ultrasound (61.9%) and the halo sign in CT scan (71.4%) had the highest frequency among the variables in patients with IFD. Cohen's kappa coefficient agreement in both modalities was 0.5 for the cavity, with significant relation (P = .02). The Cohen's kappa was less than .17 for other findings (P > .05). The diagnostic criteria in the simultaneous examina- tion of the fungus target in ultrasound and halo in CT scan showed a sensitivity of 82.4% and specificity of 76.5%, respectively. Combining the characteristic findings of ultrasound and CT-scan provides a higher value in diagnosing pulmonary invasive fungal disease.

Ultrasound for suspected Baker's cyst: A test of limited clinical value?

Patients with posterior knee swellings are commonly encountered in clinical practice with the vast majority referred for an ultrasound scan to assess for a clinically suspected Baker's cyst. Our aim was to determine the incidence of different pathologies in patients investigated for a posterior knee swelling of a clinically suspected Baker's cyst using ultrasound. We also wanted to investigate the incidence of significant pathologies in the popliteal fossa to assess whether the ultrasound scan findings influenced patient management. Retrospective analysis was performed on all patients who underwent an ultrasound scan for a suspected Baker's cyst or posterior knee swelling at our institution, between January 2017 and December 2018. Patient demographics, ultrasound findings, further imaging investigations and histopathology were recorded. Patient records were followed up for a minimum period of 3 years after ultrasound. A total of 680 patients had a posterior knee ultrasound scan. Of that, 51% (347/680) had a Baker's cyst and 40% (273/680) had a normal ultrasound scan. Sixty (9%) patients had other abnormalities identified within the popliteal fossa. Four patients had significant findings on ultrasound that required a change of management. No malignancies identified. This study confirms the high incidence of Baker's cysts in patients presenting with a posterior knee swelling. In the absence of red flag symptoms, ultrasound of the posterior knee for a clinically suspected Baker's cyst is of limited clinical value.

Premenopausal and Postmenopausal Uterine Lipoleiomyoma; A Report of Two Cases

Background: Uterine lipoleiomyoma are extremely rare variants of leiomyoma. Postmenopausal women frequently develop these types of tumors. but we also have a case of pre-menopausal woman. Ultrasound and CT scan findings may be nonspecific, but The use of MRI prior to surgery can be beneficial in detecting fatty tissue in the lesion, but diagnosis is usually confirmed postoperatively through histopathological examination. Methods: Two cases were reported. A 60 years old postmenopausal woman with mass in the abdomen presented at Jinnah Hospital Lahore with differential diagnosis of Ovarian teratoma, Leiomyoma sarcoma, non-teratomatous, lipomatous ovarian tumor, pelvic sarcoma, and lipomatous malignancy. Another case was reported involving a premenopausal woman who was 53 years old and presented with pelvic pain, irregular bleeding, and a mass in the lower abdomen. Result: Postoperative excision biopsy report showed a rare pathology of Lipoleiomyoma. Conclusions: Lipoleiomyomas are clinically rare with most common occurrence in uterine corpus. They have excellent prognosis and but a long-term follow- up of patients is required to observe its potential for coexisting malignancies and metabolic disorders.

Necrotizing Fasciitis of Breast: A Rare but Fatal Entity

Necrotising fasciitis is a rapidly developing, fatal bacterial infection of deep subcutaneous tissues. It may occur at any site in the body; breast being a rare site. We describe a case of necrotizing fasciitis in the breast that was diagnosed on the basis of ultrasound and CT scan findings.

Stratifying risk of malignancy in cystic lateral neck lumps: a multivariant analysis of demographic, radiological and histological investigation factors and the development of a patient-centred risk-predictive tool for malignancy.

Management of lateral cystic neck masses with no apparent upper aerodigestive tract primary tumour in adults is controversial. Imaging modalities and fine needle aspiration cytology often struggle to distinguish the presence of malignancy. This study entailed a multicentre retrospective review of all patients with isolated lateral cystic neck masses from 2012 to 2018 in three Welsh health boards, utilising demographic data and first-line investigations (ultrasound scanning and fine needle aspiration cytology) to develop an evidence-based predictive tool for risk of malignancy. It was found that 29.1 per cent of cystic lesions were malignant on final histology. Age, male gender, non-benign ultrasound scan findings and fine needle aspiration cytology were significant risk factors on univariate analysis. The final multivariate analysis predicted a risk of malignancy ranging from 2.1 to 65.0 per cent depending on the covariate pattern. Smoking status was non-significant. A rigorous, risk-stratified approach to the management of these patients should aid the clinician in minimising morbidity and optimising resources.

Performance of comprehensive first trimester fetal anatomy assessment.

Ultrasound assessment of the fetal anatomy and fetal echocardiography are feasible in the first trimester of pregnancy. This study was designed to assess the performance of a comprehensive fetal anatomy assessment in a high-risk population at a tertiary fetal medicine unit. A retrospective review of high-risk patients undergoing comprehensive fetal anatomy ultrasound assessment between 11weeks and 13+6weeks of gestation was conducted. Findings of the early anatomy ultrasound scan were compared with those of the second trimester anatomy scan, and birth outcomes or post-mortem results. Early anatomy ultrasounds were performed in 765 patients. The sensitivity of the scan for detecting fetal anomalies compared to the birth outcome was 80.5% (95% CI 73.5-86.3) and specificity was 93.1% (95%CI 90.6-95.2). Positive and negative predictive values were 78.5% (95% CI 71.4-84.6) and 93.9% (95% CI 91.4-95.8), respectively. The most missed and overdiagnosed abnormalities were ventricular septal defects. The second trimester ultrasound had sensitivity of 69.0% (95% CI 55.5-80.5) and specificity of 87.5% (95% CI 84.3-90.2). In a high-risk population, early assessments had similar performance metrics as the second trimester anatomy ultrasound. We advocate for a comprehensive fetal assessment in the care of high-risk pregnancies.

Menopausal status, ultrasound and biomarker tests in combination for the diagnosis of ovarian cancer in symptomatic women.

Menopausal status, ultrasound and biomarker tests in combination for the diagnosis of ovarian cancer in symptomatic women.

Meckel-Gruber Syndrome with Multiple Congenital Anomalies- A Rare Lethal Case

Meckel-Gruber Syndrome (MGS), a rare autosomal recessive malformation syndrome with incidence of one per 13,250-140,000 live birth. It is a classical triad of occipital encephalocele, infantile polycystic kidneys and postaxial polydactyly with associated multiple congenital anomalies. It leads to the death of foetus in utero or shortly after birth. Most important diagnostic tools for MGS are antenatal ultrasonography and chromosomal study. A 3.14 kg dead female foetus was delivered from 19-year-old primigravida on the first visit to hospital with full term pregnancy. Sonography revealed no cardiac activity of the foetus in utero. Termination of pregnancy was done by the decision of obstetrician and consent of patient. Gross multiple anomalies along with microanatomical changes were noticed in foetus. Typical triad of polycystic kidney resulted to oligohydramnios, protrusion of meninges with brain tissue resulted to occipital encephalocele and limb anomalies might be hereditary or due to mutational changes. Histological changes were supportive of gross anatomical changes and ultrasound scan findings. Major changes as multiple cystic lesions in kidney, non functional alveoli in lungs and fibrous tissues with deranged hepatocytes in foetal liver were noticed. Concluding through all investigations and family history might confirm the diagnosis and help in further treatment or termination of pregnancy timely and directs for further genetic and chromosomal counselling.

Green Synthesis of Purslane Seeds-Selenium Nanoparticles and Evaluate its Cytokines Inhibitor in Lead Acetate Induced Toxicity in Rats

Lead is a heavy metal that produces toxicity in both humans and animals due to oxidative stress. The aim of this study was to synthesize through green channel and evaluate hepatoprotective effect of purslane seeds-selenium nanoparticles (PS-Se NPs) against lead acetate-induced liver toxicity. The PS-Se NPs were made and their particle size and zeta potential were measured. In addition, the IC50 of SP-Se NPs against the HepG-2 liver cancer cell line as well as and LD50 in rats were determined. The PS-Se NPs had a mean particle size of around 54.70 ± 4.55 nm, a negative zeta potential of +17.25 and the observed shape of the nanoparticle was spherical. Also, the IC50 of PS-Se NPs against HepG-2 liver carcinoma cell line is 92.66 μg/mL and the LD50 is 1695 mg/kg b.w. Daily oral administration of PS-Se NPs at concentrations of 33.9 and 84.75 mg/kg b.w. for 30 days to rats treated with lead acetate (0.6 mg/kg b.w.) resulted in significant improvements in ALT, AST, ALP, TNF-α, Bcl-2, P53 and MDA. In contrast, oral administration of PS-Se NPs increased the levels of SOD, GPx and GSH in the liver tissue of lead acetate-treated rats. Furthermore, PS-Se NPs almost normalized these effects in histoarchitecture and ultrasound scanning examination of liver tissue. The PS-Se NPs have protective activity against lead acetate-induced liver tissue injury in rats, according to the biochemical, histological and ultrasound scanning findings.

P-BN20 An evaluation of the accuracy of sonography for the measurements of gallbladder polyps across 3 UK hospital trusts: should the surveillance guidelines be revised?

Abstract Background Transabdominal ultrasound scan (USS) is recommended for surveillance of gallbladder polyps (GBP), this is to stratify risk for premalignant potential. European Society of Gastrointestinal and Abdominal Radiology make recommendations based on increases of as small 2mm during sequential USS surveillance. Our aim is to determine the accuracy of USS in diagnosis and measurement of GBP. Methods Measurement data for all GBPs were gathered for three hospital trusts across a 12 year period and retrospectively reviewed. USS findings (diagnosis of GBP and GBP size) were compared with histological diagnosis and measurements, when both reports were available, in those patients who had underwent cholecystectomy at the time of data collection. Results For the first two hospital trusts, 778 USS were reviewed which identified patients with GBP. 78 patients had undergone cholecystectomy at time of data collection. Only 17/78 of patients had histological evidence of GBP. Of those without GBP, 37/61 had gallstones. For the third hospital trust, 41 GBP histological reports were identified, 20 could be directly compared with USS. Collectively 29 USS reports were directly compared with GBP histology reports. Only, 31% had results which were in agreement to within 1mm. The mean measurement discrepancy between both modalities was 5.41mm. Conclusions USS does not provide an accurate diagnosis of GBP, it is likely that USS misdiagnoses gallstones as GBP. Moreover, when comparing USS measurements with histological data, there is 31% accuracy of measurement to within 1mm in this cohort. Current guidelines recommend cholecystectomy if there is an interval change of 2mm or more; this data shows a measurement error of more than this.

391 Routine Hatobiliary Iminodiacetic Acid Scan of All Suspected Cases of Acute Cholecystitis

Cholecystitis is the second-most common surgical admission from emergency departments and represents a large health burden. Different imaging modalities are utilized to evaluate this disease while hepatobiliary iminodiacetic acid (HIDA) scans are reported to be more sensitive and specific for acute cholecystitis because it is a functional evaluation of the gallbladder and can demonstrate cystic duct obstruction. Most emergency departments obtain a HIDA scan when the clinical diagnosis is equivalent. At our center, the primary general surgery group requires routine HIDA scans on all suspected cases of acute cholecystitis before deciding operative management. The purpose of this study was to perform a retrospective review of all HIDA scans performed in 2018 among emergency department cases of suspected cholecystitis. The specific aim was to evaluate the agreement between ultrasound (US) and HIDA scan findings and their association with operative decision-making. Secondary objectives were to evaluate discrepancies, insurance status, age, sex, ED length-of-stay, operative outcomes, and costs. HIDA scans were identified from our imaging record system from January 1, 2018 to December 31, 2018. An abnormal US (US+) was defined as the presence of gallstones plus either of the following: gallbladder wall thickening, pericholecystic fluid, sonographic Murphy’s, or common bile duct dilatation. An abnormal HIDA (HIDA+) scan was defined as cystic duct obstruction and/or failure to visualize the gallbladder. Qualitative reviews of specific cases were summarized. STATA (College Station, TX) was used for statistical analysis. N = 550 patients who received both HIDA scan and gallbladder US. There were 348 cases of US+ and 234 cases of HIDA+. There was a 59.3% agreement between US and HIDA findings. n = 169 of US+ and HIDA- and n = 55 of US- and HIDA+. Pairwise correlation 0.236 (p<0.001). There was a net decrease in operative care of 114 cases by adding HIDA. 550 HIDA scans have an estimated aggregate charge of $773,300 whereas 114 fewer laparoscopic cholecystectomies would have an aggregate savings of $2,101,932. This is the largest single-center study of comparison between HIDA and US in emergency department patients. The use of HIDA scans suggested 49% of patients with US+ findings may not require urgent surgery whereas 27% of patients with non-diagnostic US demonstrated the need for surgical intervention. The routine use of HIDA scans may have a significant impact on costs and reimbursements for this common etiology. The clinical suspicion is the main driver of resource utilization and routine HIDA scans increase immediate costs, ED length-of-stay, and can result in a net decrease of costs for urgent operative care.

ROLE OF ULTRASOUND SCANNING IN DIAGNOSIS OF CONDITIONS OF KNEE JOINT SOFT TISSUES IN ACUTE AND CHRONIC INJURY IN FOOTBALL PLAYERS

Traumatic injuries of the knee joint are one of the main factors resulting in the loss of mobility among football players. According to the reports of many researchers, the damage to the soft tissues predominates in the structure of traumatic injuries of the knee joint; therefore, such diagnostic technique as ultrasound scanning is very helpful in determining the nature and extent of injuries and in making decision on the necessity of the surgical intervention. The aim of this study is to investigate and systematize ultrasound criteria for various types of traumatic injuries of the soft tissues of the knee joint in acute and chronic trauma in football players. The analysis of the findings of ultrasound scan of the knee joints in 36 football players with sports injury was carried out. The following echographic data were assessed: homogeneity, echogenicity, integrity of the tendon contours, the presence of effusion in the bursae and tendon sheaths, the number of vascular signals in the affected area. In the first group of patients, the analysis of ultrasound signs revealed the following structural changes: separate meniscus ruptures were diagnosed in 6 (27, 3%) athletes; combined lesions of the menisci and ligamentous apparatus – in 9 (40, 9%) with signs of damage to the menisci and ligaments characteristic of acute trauma; separate ligament ruptures were diagnosed in 7 (31, 8%) athletes. In the second group of the patients, sonography confirmed suffered meniscus tears in 3 (21, 4%) athletes; combined lesions of the menisci and ligaments in 7 (50,1%) footballers; rupture of the ligamentous apparatus in 4 (28,5%) individuals. Fresh injuries to the menisci and ligaments against the background of previous ruptures were not diagnosed during past ultrasound examinations and resulted in the impairment of the ratio of the load distribution on the limb that could provoke repeated trauma to the menisci and ligaments. Ultrasound scanning for acute and chronic injury of the knee joint in football players can be considered a reliable informative imaging technique, which allows assessing the severity of damage to the menisci, ligaments, soft tissues and makes it possible to choose the proper tactics of further treatment.

Prenatal diagnosis of persistent cloaca accompanied by uterus didelphys: A case report.

Persistent cloaca is a rare abnormality that occurs usually in females and is characterized by direct communication between the gastrointestinal, urinary, and genital structures resulting in a single perineal opening. We report a case of persistent cloaca accompanying uterus didelphys that was diagnosed antenatally with fetal ultrasonography. A gravida 3, para 2, 35-year-old women at 22 weeks of gestation was referred to our hospital with a diagnosis of moderate pyelectasis of the fetal kidneys and fetal diffuse intestinal dilation. Detailed ultrasound scan findings were reported as a small thick-walled septated cystic pelvic mass of 5.2×5.5 cm size seen at the level of the fetal pelvic region. The target sign could not be visualized, it was considered as anal atresia. In the following weeks, the patient, who was evaluated together with meconium on the uterine septum, and monitoring of the neighboring bladder and anal atresia, was diagnosed as having persistent cloaca. Ultrasound findings showed that it could be persistent cloaca accompanying uterus didelphys. The fetus postnatally manifested persistent cloaca. On the first day after vaginal delivery, pelvic ultrasound in the neonatal intensive care unit showed bilateral 2nd-degree hydronephrosis, presacral enlarged bowel loops, uterus didelphis, vaginal septum, direct contact between urethra and vagina, proximal end in the rectum compatible with atresia. On the second day, colostomy was performed. Her renal condition continued to be stable. She is now waiting for definitive surgery for cloaca. Persistent cloaca should be considered in any female fetus presenting with hydronephrosis and a cystic pelvic mass lesion as diagnosed by ultrasound. Prenatal diagnosis allows time for parental counseling and delivery planning at a tertiary hospital for neonatal intensive care and pediatric surgery.

Lung Ultrasound Findings Compared to Chest CT Scan in Patients with COVID-19 Associated Pneumonia: A Pilot Study

Introduction: Lung US has been reported to be as useful as a chest CT scan and much better than a chest x-ray for the evaluation of pneumonia. Objective: This study aimed to compare the findings of lung ultrasound (US) and chest CT scan of patients with COVID-19-associated pneumonia in the Emergency Department (ED). Methods: This retrospective observational pilot study was carried out on confirmed COVID-19 patients in the isolation corona ward of the Imam Hussein Hospital ED from March 15 to March 22, 2020. After obtaining demographic data, the patients underwent a pulmonary bedside US examination, with the patients in the sitting position, turning their back to the examiner. A 10-point lung US was performed. Each lung was divided into two areas: posterior (three zones) and lateral (two zones). The patients’ lung ultrasound and chest CT scan as the standard imaging were blindly reviewed and recorded. The clinical value of ultrasound was evaluated with different severity of lung involvement according to CT severity score. Results: Nineteen patients (38 zones), including 13 males, were evaluated with a mean age of 62.5±16.8 years. B2 lines and consolidation observed in the US examinations were significantly correlated with ground-glass opacity and consolidation observed in CT scan examinations, respectively (p &lt;0.0001). US sensitivity and specificity of finding B2 lines were 90% and 100%, respectively. Also, the sensitivity and specificity of US in identifying consolidation were 82% and 100%, respectively. In the lungs with moderate and severe lobar involvement, US findings were significantly correlated (p &lt;0.05) with CT scan findings. Conclusions: Ultrasound evaluation is a safe, fast, and rapid technique for the evaluation of patients with moderate to severe COVID-19-associated pneumonia. It is a reproducible procedure and can be implemented by the operator after a short course of training.