Australasian Journal of Ultrasound in Medicine最新文献

Background

A 27-year-old nulliparous woman with a history of subfertility presented to a routine dating scan at 13 + 1 weeks gestation with a history of left-sided abdominal pain.

Key Findings

Both standard transabdominal ultrasound and handheld point-of-care ultrasound (POCUS) identified a probable abdominal ectopic pregnancy (AEP), confirmed by MRI. Intraoperative findings revealed a live pregnancy encapsulated by the omentum with associated haemoperitoneum. Active haemorrhage necessitated conversion from laparoscopy to laparotomy, culminating in a left salpingo-oophorectomy.

Discussion

This case highlights the potential role of handheld POCUS in diagnosing a rare and life-threatening condition. The device enabled immediate, bedside imaging and facilitated rapid decision-making. To our knowledge, this is the first documented case of an abdominal ectopic pregnancy diagnosed using handheld POCUS, emphasising its potential to improve maternal outcomes through early detection and intervention.

Introduction

Point-of-care ultrasound (POCUS) can be very useful in low-resource settings, where access to radiology is often limited. The PEARLS (POCUS in Emergency and Acute care in Resource-Limited Settings) program is a scalable, innovative approach to POCUS training for clinicians in low- and middle-income countries (LMICs), where access to imaging modalities is frequently limited.

Methods

A review of the PEARLS program was conducted using participant data that were gathered from participants in Vanuatu, Tonga, and Papua New Guinea (PNG), tracking the number and type of scans uploaded and overall engagement with the training. The PEARLS program begins with a three-day in-person course focused on hands-on practice using portable ultrasound devices. Clinicians are provided with devices and guided on how to store images securely online. After the course, each participant is paired with an experienced coach who offers ongoing remote support through regular image reviews and a series of follow-up lectures. One year later, the program team revisits the site, and selected participants are transitioned into faculty roles to help train others in a train-the-trainer model.

Results

Across 40 participants, a total of 576 scans were uploaded following training. The extended FAST exam was the predominant modality, followed by critical care echocardiography and first-trimester pregnancy assessments. Although remote mentoring maintained high levels of engagement, only one participant achieved the full competency benchmark of 25 uploaded scans.

Discussion

These findings illustrate that a longitudinal training model with remote mentorship can improve POCUS proficiency in LMIC settings. However, challenges such as inconsistent internet access and equipment sharing persist, potentially limiting sustained competency.

Conclusion

The PEARLS program presents a scalable, sustainable framework for POCUS education in resource-limited environments, fostering local expertise and enhancing acute care diagnostics.

Introduction

Ulnar-sided wrist pain is a common clinical problem, which can be difficult to diagnose, manage and treat. Ultrasound imaging can be used to identify structural changes which may contribute to the pain. Knowledge of the associated relative anatomy and intertwining structures which form the triangular fibrocartilage complex (TFCC) and distal radio-ulnar joint (DRUJ), sonographic techniques to image these structures and their normal and abnormal appearances can be underappreciated and are required.

Methods

A literature search was conducted to review the current knowledge related to sonographic assessment of the TFCC and DRUJ.

Results

The intertwining components of the DRUJ and TFCC which can be demonstrated sonographically are unpacked with clear supporting figures and videos.

Discussion

The components of the TFCC, which include the disc proper, meniscus homologue, extensor carpi ulnaris (ECU) sub-sheath, palmar-sided ulno-carpal ligaments and the palmar and dorsal distal radio-ulnar ligaments, can all be individually demonstrated sonographically, in addition to structures which comprise the DRUJ. Normal sonographic images are presented.

Conclusion

Improved understanding of the sonographic anatomy, technique and normal imaging appearances of ulnar-sided wrist structures can enhance the quality of imaging and subsequently the diagnosis of structural causes of pain, which can guide patient management.

Background

Ultrasound diagnosis of fetal skeletal conditions remains challenging. MYH3 is a gene that encodes the embryonic myosin heavy chain; it is important for skeletal and muscular development and is strongly expressed during fetal development. Variants in MYH3 are involved in distal arthrogryposes 2A and 2B3 and in spondyocarpotarsal synostosis syndrome with contractures and pterygia, contractures of proximal and distal joints, variable spine anomalies and vertebral, carpal and tarsal fusions.

Key Findings

We describe a case in which prenatal ultrasonography detected abnormal bone density in the fetal spine. The fetus showed abnormal spinal segmentation, characterised by demineralisation and lacunar morphological tracts. x-rays and histological examination confirmed the ultrasonographic findings. We describe a unique ultrasonographic phenotype of fetal spine that has not yet been described in the literature. This is likely associated with two MYH3 variants. Therefore, we believe that abnormal spinal segmentation should be considered a relevant ultrasound finding.

Discussion

Fetal ultrasound, together with radiological investigations, clinical examination of the fetal phenotype and histological investigations are essential in directing molecular genetic testing to identify rare diseases. We review the literature and describe a prenatal case with abnormal bone density in the spine. Whole-exome sequencing (WES) analysis in the fetus was performed to explore variants compatible with ultrasound signs.

Objectives

The condition known as pre-eclampsia (PE) is characterised by hemodynamic changes that can impact the ophthalmic artery, a branch of the internal carotid artery. In this study, we aimed to compare the ophthalmic artery resistance in pregnant participants with PE to those with normal blood pressure.

Materials and Methods

In this cross sectional study, the hemodynamic changes of the maternal ophthalmic artery were analysed using spectral Doppler ultrasound. The research included 50 normotensive pregnant participants matched for gestational age with 50 pregnant participants with PE. The study measured peak systolic velocity (PSV), end-diastolic velocity (EDV), S/D ratio, Resistance Index (RI) and Pulsatility Index (PI) to determine any differences between the two groups.

Results

A comparison of PSV parameters in two groups did not reveal any statistically significant difference (p > 0.05). However, Doppler findings were significantly lower for pregnant participants with PE than those with normal blood pressure in terms of RI (p = 0.008), PI (p < 0.001) and S/D ratio (p = 0.002). Conversely, EDV was higher for pregnant participants with PE (p = 0.032).

Conclusion

This study found significant differences in the ophthalmic artery Doppler indices between pregnant participants with PE and those with normal blood pressure. Specifically, lower RI, PI and S/D ratio, as well as a higher EDV, were observed in the PE group. These findings suggest altered blood flow dynamics in PE. Clinically, spectral Doppler ultrasound of the ophthalmic artery could be a useful, non-invasive tool for detecting and monitoring haemodynamic changes in PE. Given its accessibility and repeatability, it could help identify PE earlier, especially in settings where more advanced diagnostic tools are unavailable.

Introduction

The effect of hypercapnia on cardiac function in adults resuscitated after cardiac arrest is not well understood. We investigated the effects of mild hypercapnia (PaCO₂ 50–55 mmHg) compared to normocapnia (PaCO₂ 35–45 mmHg) on left ventricular (LV) systolic function using global longitudinal strain (GLS) in resuscitated out-of-hospital cardiac arrest (OHCA) patients.

Methods

We performed a pre-planned single-centre, prospective, exploratory sub-study of the Targeted Therapeutic Mild Hypercapnia After Resuscitated Cardiac Arrest (TAME) trial. Two transthoracic echocardiograms were performed in mild hypercapnia and normocapnia groups – first, within 24 h during intervention and second, 24–72 h after return of spontaneous circulation. The GLS was compared between and within the groups.

Results

We studied 13 TAME patients—six in the mild hypercapnia and seven in the normocapnia group. The GLS was low in both groups during and after the intervention period. During hypercapnia, the mild hypercapnia group had worse median GLS compared to the normocapnia group [−10.2% (Q1–Q3: −11.5 to −8) vs. −14.2% (Q1–Q3: −15.2 to –11.2), P = 0.046]. The median GLS did not improve significantly after restoring normocapnia in the mild hypercapnia group [−10.2% (Q1–Q3: −11.5 to –8) to −11.6% (Q1–Q3: −12.1 to –7.8); P = 0.63]. Repeated measures mixed-effects regression showed no significant worsening of GLS due to hypercapnia [−2.7% (95% CI: −0.7 to 6.03), P = 0.12].

Conclusion

In this exploratory sub-study, adults resuscitated after OHCA had persistent LV dysfunction even after the cessation of mild hypercapnia. Mild hypercapnia did not significantly impair LV systolic function, although mild persistent LV systolic dysfunction cannot be ruled out in this small study.

Background

Dextro-transposition of the great arteries (d-TGA) can be difficult to diagnose antenatally. Standardised cardiac screening protocols may improve detection rates.

Aims

The objective of this study was to examine rates of antenatal diagnosis of d-TGA in regional and metropolitan Brisbane over a 10-year period and assess if a targeted antenatal screening education programme had an impact on detection rates.

Materials and Methods

A retrospective cohort study was conducted. Data were collected for infants diagnosed with d-TGA in Queensland between January 2008 and December 2017. Infants were divided into two cohorts to assess antenatal detection rates in both regional and metropolitan areas Queensland pre- and post implementation of a targeted sonographer education programme between 2008 and 2011.

Results

A total of 126 infants were identified with a diagnosis of d-TGA. The overall antenatal detection rate was 63.5% across the 10-year study period. Prior to the educational intervention, the detection rate was 51% (2008–2011 n = 23/45), which increased significantly to 70% post educational intervention (2012–2017, n = 57/81) (p = 0.035). Regional Queensland (n = 60) detection rates increased from 44% to 63% (p = 0.192) and metropolitan (n = 66) detection rates increased from 60% to 76% (p = 0.24) post educational intervention.

Conclusions

Rates of antenatal diagnosis of d-TGA in Queensland compare favourably with internationally published rates, although difficulty in consistently diagnosing this congenital heart defect remains. A targeted educational programme of sonographers performing antenatal screening, particularly in regional areas, appears to increase rates of prenatal diagnosis and improve outcomes.

Introduction

Necrotising enterocolitis (NEC) is a life-threatening intestinal disease of the newborn characterised by ischaemia, inflammation and bowel necrosis. Due to the lack of biochemical markers and nonspecific clinical signs in early NEC, bowel ultrasound has gained popularity as a diagnostic tool. This survey aimed to investigate the opinions of neonatal clinicians on the practice of point-of-care bowel ultrasound for the diagnosis of NEC.

Methods

This quantitative study utilised a cross-sectional online single-invitation survey sent to neonatal clinicians using point-of-care ultrasound across Australia, New Zealand and Singapore. We aimed to explore the barriers to, and facilitators of the clinical practice of bowel ultrasound in NEC using the survey responses.

Results

The survey results indicate a clear need for a dedicated training module in Australasia to equip neonatal clinicians with the skills for point-of-care bowel ultrasound assessment. Most (95%) of neonatal clinicians practising point-of-care ultrasound agreed that performing a bowel ultrasound in the suspected diagnosis of NEC is helpful or may be helpful, with 87% expressing interest in undertaking training.

Conclusion

The study's findings reveal a strong interest among neonatal clinicians in Australia and New Zealand to learn point-of-care bowel ultrasound for NEC diagnosis. This interest not only sets the stage for a collaborative approach in planning and developing a training programme but also has the potential to significantly improve NEC diagnosis and patient outcomes in clinical practice.

Objective

Extracranial vertebral artery (VA) stenosis represents an important aetiology of ischaemic vascular events in the posterior circulation. Nevertheless, it remains insufficiently investigated. Ethnic differences might be related to VA stenosis. In this regard, Egyptian studies are scarce. We aimed to investigate the frequency and predictors of extracranial VA stenosis in a sample of Egyptian patients.

Methods

We enrolled consecutive patients who were referred to our neurovascular ultrasonography laboratory for routine clinical indications. Extracranial VA stenosis was diagnosed and graded using ultrasound.

Results

We included 528 patients in our study. Significant extracranial VA stenosis ≥ 50% was found among 10.4% (n = 10/96) of patients with ischaemic vascular events in the posterior circulation and 4.2% (n = 18/432) of patients without (p = 0.01). One patient received stenting for VA origin stenosis. Carotid atherosclerosis was present in 82.1% (n = 23/28) of patients with significant extracranial VA stenosis in comparison with 47.6% (n = 238/500) of those without (p < 0.001). In an age- and sex-adjusted multivariate binary logistic regression, the following factors predicted significant extracranial VA stenosis: age > 60 years (OR 2.68, 95% CI 1.08–6.66, p = 0.03), significant common/internal carotid artery (CCA/ICA) stenosis ≥ 50% (OR 4.81, 95% CI 1.89–12.29, p = 0.001) and ischaemic vascular events in the posterior circulation (OR 2.78, 95% CI 1.17–6.65, p = 0.02).

Conclusions

The frequency of extracranial VA stenosis seems to be lower among Egyptians in comparison with Western cohorts. Among patients with carotid atherosclerosis or significant CCA/ICA stenosis and/or ischaemic vascular events in the posterior circulation, meticulous ultrasound examination of the VA is warranted to detect possibly underlying extracranial VA stenosis.

Introduction/Purpose

The 2016 consensus statement from the International Deep Endometriosis Analysis group (IDEA) outlined a transvaginal ultrasound (TVUS) approach specific for the sonographic assessment of endometriosis (eTVUS). However, eTVUS remains a nonroutine sonographic examination, and the reasons for this are not fully understood. This study aimed to explore the current performance of eTVUS among Australian sonographers and the barriers and facilitators encountered when learning and implementing eTVUS into routine practice.

Methods

An online cross-sectional survey was disseminated to Australian sonographers. Quantitative and qualitative questions were asked regarding demographic information, eTVUS performance and experiences encountered when learning and implementing eTVUS. Statistical and thematic analyses were performed.

Results

In total, 127 responses were analysed, with 47.8% of respondents performing a full or partial eTVUS routinely. When a gynaecological ultrasound is referred, 18.4% of participants reported performing a full assessment of eTVUS, and 29.8% reported performing a partial assessment of eTVUS. When a partial eTVUS was performed, respondents indicated this mostly included an assessment of the sliding sign (94.6%) and ovarian mobility (97.3%), rather than a search for endometriotic nodules. Only 41.5% of all participants reported confidence in performing eTVUS.

The main barriers that limited the uptake of eTVUS were limited supervision/mentors (42.3%), limited reporting of eTVUS (39.6%) and its steep learning curve (38.7%). The main facilitators included sonographers' desire to answer the clinical question for suspected endometriosis (84.0%), external education (38.7%), local department protocols (30.7%) and colleagues who perform eTVUS (30.7%).

Conclusion

While eTVUS, or aspects of it, are being performed in most imaging practices, inconsistency exists for the anatomical structures assessed as part of an eTVUS. Although barriers exist, more education surrounding eTVUS for sonographers, reporting doctors, and referrers could help increase uptake into routine practice.