Pub Date : 2019-11-01Epub Date: 2020-03-30DOI: 10.1055/a-1044-7237
Caroline Ewertsen
Dear Colleagues, Europe is severely hit by the virus SARS-CoV-2 and most countries report increasing numbers of people affected by COVID-19. WHO has declared it a pandemic, many countries have introduced severe restrictions on travelling and thousands of people around Europe are in quarantine. Currently, the most severely affected European country is Italy, which also experienced some of the first European cases.
{"title":"Editorial.","authors":"Caroline Ewertsen","doi":"10.1055/a-1044-7237","DOIUrl":"https://doi.org/10.1055/a-1044-7237","url":null,"abstract":"<p><p>Dear Colleagues, Europe is severely hit by the virus SARS-CoV-2 and most countries report increasing numbers of people affected by COVID-19. WHO has declared it a pandemic, many countries have introduced severe restrictions on travelling and thousands of people around Europe are in quarantine. Currently, the most severely affected European country is Italy, which also experienced some of the first European cases.</p>","PeriodicalId":44852,"journal":{"name":"Ultrasound International Open","volume":"5 3","pages":"E80"},"PeriodicalIF":3.2,"publicationDate":"2019-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/a-1044-7237","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37811565","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-11-01Epub Date: 2020-02-26DOI: 10.1055/a-1088-3569
Adeline Walter, Alexander C Engels, Andreas Heydweiller, Annegret Geipel, Ulrich Gembruch
Constantly improving ultrasound technologies facilitate prenatal detection of various fetal diseases, including low-incidence disorders that are typically diagnosed postnatally, such as testicular teratoma. These can appear as an unclear cystic intra-abdominal structure, caused by an undescended torqued testis. In the case of such uncertain cystic intra-abdominal lesions, a cryptorchidism could lead the investigator to narrow the possibilities to the urogenital tract. Herein, we report the second case of a prenatally detected cystic-solid lesion being a testicular teratoma by a torqued undescended testis and the seventh case of a prenatally seen testicular teratoma. In late gestation, a structured evaluation of the testes would be beneficial to detect such malformations.
{"title":"Prenatal Diagnosis of Teratoma in a Torqued Undescended Testis Masked as Unclear Intra-Abdominal Mass.","authors":"Adeline Walter, Alexander C Engels, Andreas Heydweiller, Annegret Geipel, Ulrich Gembruch","doi":"10.1055/a-1088-3569","DOIUrl":"https://doi.org/10.1055/a-1088-3569","url":null,"abstract":"Constantly improving ultrasound technologies facilitate prenatal detection of various fetal diseases, including low-incidence disorders that are typically diagnosed postnatally, such as testicular teratoma. These can appear as an unclear cystic intra-abdominal structure, caused by an undescended torqued testis. In the case of such uncertain cystic intra-abdominal lesions, a cryptorchidism could lead the investigator to narrow the possibilities to the urogenital tract. Herein, we report the second case of a prenatally detected cystic-solid lesion being a testicular teratoma by a torqued undescended testis and the seventh case of a prenatally seen testicular teratoma. In late gestation, a structured evaluation of the testes would be beneficial to detect such malformations.","PeriodicalId":44852,"journal":{"name":"Ultrasound International Open","volume":"5 3","pages":"E96-E97"},"PeriodicalIF":3.2,"publicationDate":"2019-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/a-1088-3569","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37687296","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Neuroblastoma is the most common malignant extracranial solid tumor in infancy with an incidence rate of 58 per million infants younger than one year old. It originates from the neural crest during fetal development and may arise from the sympathetic ganglia or the adrenal medulla (Gurney JG, et al. J Pediatr Hematol Oncol. 1997; 19: 428). Prenatal detection of neuroblastoma was first described in 1983 (Fenart D, et al. Journalde Radiologie 1983; 64: 359). In the majority of antenatally diagnosed cases, neuroblastomas are adrenal in origin and right-sided. Differentiating neuroblastomas from other fetal suprarenal masses such as extralobar pulmonary sequestration, congenital adrenal hyperplasia, renal duplication, urinoma, gastric duplication cyst, and splenic cyst may be very difficult. However, improvements in ultrasound technology have made early detection possible and, combined with fetal MRI, facilitate differential diagnosis. Finally, prenatal diagnosis of a neuroblastoma is associated with a better prognosis, as it can resolve spontaneously either in utero or shortly after birth (Maki E, et al. J Ultrasound Med 2014; 33:895–904). This is a case of a mixed cystic and solid suprarenal tumor that was identified during a routine antenatal visit in the third trimester of pregnancy and was diagnosed as an adrenal neuroblastoma. Case description A 27-year-old pregnant woman presented to the outpatient clinic of Alexandra Maternity Hospital in Athens, Greece during the third trimester of her pregnancy. The woman was Gravida 2 Para 0 (G2P0). The gestational age of the pregnancy was 38 weeks and 2 days. The woman’s past medical history was uneventful. During her pregnancy, she underwent prenatal testing including first trimester scan, anomaly scan, 3 rd trimester Doppler scan without any abnormal findings. During the initial ultrasound scan we detected one fetus in occiput anterior position. All growth parameters (biparietal diameter, head circumference, abdominal circumference, femur length, estimated fetal weight) and the amniotic fluid index were within normal range for the gestational age. During the scan a well circumscribed mass was detected over the left kidney ( Fig. 1 ). The mass appeared to have both cystic and solid areas and appeared to originate from the left adrenal gland ( Fig. 1 ). The anatomy of the left kidney was not altered. The mass measured 4.40 × 4.12 cm ( Fig. 2 ). Doppler evaluation did not reveal increased blood flow towards the mass nor a single feeding vessel ( Fig. 3 ). The right kidney and right adrenal gland appeared normal ( Fig. 4a and b). Extensive ultrasound examination of the fetus revealed no other abnormalities. After careful evaluation of the ultrasound appearance of the tumor, the diagnosis of adrenal neuroblastoma was suggested. Open in a separate window Fig. 1 The mass is well circumscribed with both cystic and solid areas and appears to originate from the left adrenal gland.
{"title":"Prenatal Diagnosis of Adrenal Neuroblastoma - Differential Diagnosis of Suprarenal Masses in the Third Trimester of Pregnancy.","authors":"Alexandros Psarris, Michail Sindos, Anastasia Dimopoulou, Panagiotis Antsaklis, Antonios Psarakis, Thomas Kataras, Dimitrios Loutradis, Georgios Daskalakis","doi":"10.1055/a-1070-8651","DOIUrl":"https://doi.org/10.1055/a-1070-8651","url":null,"abstract":"Neuroblastoma is the most common malignant extracranial solid tumor in infancy with an incidence rate of 58 per million infants younger than one year old. It originates from the neural crest during fetal development and may arise from the sympathetic ganglia or the adrenal medulla (Gurney JG, et al. J Pediatr Hematol Oncol. 1997; 19: 428). \u0000 \u0000Prenatal detection of neuroblastoma was first described in 1983 (Fenart D, et al. Journalde Radiologie 1983; 64: 359). In the majority of antenatally diagnosed cases, neuroblastomas are adrenal in origin and right-sided. Differentiating neuroblastomas from other fetal suprarenal masses such as extralobar pulmonary sequestration, congenital adrenal hyperplasia, renal duplication, urinoma, gastric duplication cyst, and splenic cyst may be very difficult. However, improvements in ultrasound technology have made early detection possible and, combined with fetal MRI, facilitate differential diagnosis. Finally, prenatal diagnosis of a neuroblastoma is associated with a better prognosis, as it can resolve spontaneously either in utero or shortly after birth (Maki E, et al. J Ultrasound Med 2014; 33:895–904). \u0000 \u0000This is a case of a mixed cystic and solid suprarenal tumor that was identified during a routine antenatal visit in the third trimester of pregnancy and was diagnosed as an adrenal neuroblastoma. \u0000 \u0000Case description \u0000A 27-year-old pregnant woman presented to the outpatient clinic of Alexandra Maternity Hospital in Athens, Greece during the third trimester of her pregnancy. The woman was Gravida 2 Para 0 (G2P0). The gestational age of the pregnancy was 38 weeks and 2 days. The woman’s past medical history was uneventful. \u0000 \u0000During her pregnancy, she underwent prenatal testing including first trimester scan, anomaly scan, 3 rd trimester Doppler scan without any abnormal findings. During the initial ultrasound scan we detected one fetus in occiput anterior position. All growth parameters (biparietal diameter, head circumference, abdominal circumference, femur length, estimated fetal weight) and the amniotic fluid index were within normal range for the gestational age. During the scan a well circumscribed mass was detected over the left kidney ( Fig. 1 ). The mass appeared to have both cystic and solid areas and appeared to originate from the left adrenal gland ( Fig. 1 ). The anatomy of the left kidney was not altered. The mass measured 4.40 × 4.12 cm ( Fig. 2 ). Doppler evaluation did not reveal increased blood flow towards the mass nor a single feeding vessel ( Fig. 3 ). The right kidney and right adrenal gland appeared normal ( Fig. 4a and b). Extensive ultrasound examination of the fetus revealed no other abnormalities. After careful evaluation of the ultrasound appearance of the tumor, the diagnosis of adrenal neuroblastoma was suggested. \u0000 \u0000 \u0000 \u0000 \u0000Open in a separate window \u0000 \u0000 \u0000Fig. 1 \u0000 \u0000 \u0000The mass is well circumscribed with both cystic and solid areas and appears to originate from the left adrenal gland.","PeriodicalId":44852,"journal":{"name":"Ultrasound International Open","volume":"5 3","pages":"E93-E95"},"PeriodicalIF":3.2,"publicationDate":"2019-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/a-1070-8651","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37570105","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
M. Altersberger, P. Pavelka, A. Sachs, Michael Weber, M. Wagner-Menghin, H. Prosch
Abstract Background Learning ultrasound early in the medical school curriculum helps students to understand anatomy and pathology and to perform defined ultrasound standard views. Instructional videos are a potentially valuable tool for improving the process of learning ultrasound skills. It was the aim of the present study to investigate how students perceived instructional videos as a learning aid, compared to other learning opportunities, in preparation for an Objective Structured Clinical Examination (OSCE). Materials and Methods Eleven concise ultrasound videos were created and implemented in the 4th year at the Medical University of Vienna. The videos illustrate the predefined examination process, image optimization, and nine standardized ultrasound views. The videos were available to be used in preparation for the practical ultrasound examination, which was part of the objective structured clinical examination. The students’ perceptions of the instructional videos and other learning methods were surveyed using an online questionnaire. Results In total, 445 of 640 students (69.5% of the cohort) used the instructional videos. Of those students, 134 (30%) answered the questionnaire. Of this group, 88.9% rated the instructional videos as very helpful (49.6% as extremely helpful). An ANOVA revealed a significant difference between various learning materials in terms of helpfulness. Post hoc analysis showed that instructional videos were perceived as the second most helpful learning material after “self-execution and feedback.” Conclusion The study revealed that students use instructional videos frequently and appreciate them as an extra tool for effective studying.
{"title":"Student Perceptions of Instructional Ultrasound Videos as Preparation for a Practical Assessment","authors":"M. Altersberger, P. Pavelka, A. Sachs, Michael Weber, M. Wagner-Menghin, H. Prosch","doi":"10.1055/a-1024-4573","DOIUrl":"https://doi.org/10.1055/a-1024-4573","url":null,"abstract":"Abstract Background Learning ultrasound early in the medical school curriculum helps students to understand anatomy and pathology and to perform defined ultrasound standard views. Instructional videos are a potentially valuable tool for improving the process of learning ultrasound skills. It was the aim of the present study to investigate how students perceived instructional videos as a learning aid, compared to other learning opportunities, in preparation for an Objective Structured Clinical Examination (OSCE). Materials and Methods Eleven concise ultrasound videos were created and implemented in the 4th year at the Medical University of Vienna. The videos illustrate the predefined examination process, image optimization, and nine standardized ultrasound views. The videos were available to be used in preparation for the practical ultrasound examination, which was part of the objective structured clinical examination. The students’ perceptions of the instructional videos and other learning methods were surveyed using an online questionnaire. Results In total, 445 of 640 students (69.5% of the cohort) used the instructional videos. Of those students, 134 (30%) answered the questionnaire. Of this group, 88.9% rated the instructional videos as very helpful (49.6% as extremely helpful). An ANOVA revealed a significant difference between various learning materials in terms of helpfulness. Post hoc analysis showed that instructional videos were perceived as the second most helpful learning material after “self-execution and feedback.” Conclusion The study revealed that students use instructional videos frequently and appreciate them as an extra tool for effective studying.","PeriodicalId":44852,"journal":{"name":"Ultrasound International Open","volume":"1 1","pages":"E81 - E88"},"PeriodicalIF":3.2,"publicationDate":"2019-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89541335","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-11-01Epub Date: 2020-03-09DOI: 10.1055/a-1118-3974
Elisabeth Wrede, Alexander Johannes Knippel, Pablo Emilio Verde, Ruediger Hammer, Peter Kozlowski
Objective To investigate the clinical relevance of an isolated echogenic cardiac focus (iECF) as a marker for trisomy 21 using a large second-trimester collective including a low-risk subgroup. Materials and Methods We retrospectively evaluated 1 25 211 pregnancies from 2000-2016 and analyzed all iECF cases with regard to chromosomal anomalies. It consisted of an early second-trimester collective from 14+0-17+6 weeks (n=34 791) and a second-trimester anomaly scan collective from 18+0-21+6 weeks. Two a priori risk subgroups (high and low risk) of the latter were built based on maternal age and previous screening test results using a cut-off of 1:300. Likelihood ratios (LR) of iECF for the detection of trisomy 21, trisomy 13, trisomy 18 and structural chromosomal anomalies were estimated. Results In total, 1 04 001 patients were included. An iECF was found in 4416 of 1 02 847 euploid fetuses (4.29%) and in 64 of 557 cases with trisomy 21 (11.49%) giving a positive LR of 2.68 (CI: 2.12-3.2). The sensitivity was 11.5% at a false-positive rate of 4.29% (CI:4.17-4.42) with p≤0.01%. In the high-and low-risk subgroups, the prevalence of iECF was comparable: 5.08% vs. 5.05%. The frequency of trisomy 21 was 0.39%, 98/24 979 vs 0.16%, 69/44 103. LR+was 3.86 (2.43-5.14) and 2.59 (1.05-4). For both subgroups the association of iECF with trisomy 21 was statistically significant. The prevalence of structural chromosomal anomalies in the second-trimester anomaly scan collective was 0.08% (52/68 967), of which 2 showed an iECF. Conclusion The detection of an iECF at the time of 14+0-21+6 weeks significantly increases the risk for trisomy 21 in the high-risk and in the low-risk subgroups and does not statistically change the risks for trisomy 13/18 or structural abnormalitie.
{"title":"Isolated Echogenic Cardiac Focus: Assessing Association with Trisomy 21 by Combining Results from a Prenatal Center with a Bayesian Meta-Analysis.","authors":"Elisabeth Wrede, Alexander Johannes Knippel, Pablo Emilio Verde, Ruediger Hammer, Peter Kozlowski","doi":"10.1055/a-1118-3974","DOIUrl":"https://doi.org/10.1055/a-1118-3974","url":null,"abstract":"<p><p><b>Objective</b> To investigate the clinical relevance of an isolated echogenic cardiac focus (iECF) as a marker for trisomy 21 using a large second-trimester collective including a low-risk subgroup. <b>Materials and Methods</b> We retrospectively evaluated 1 25 211 pregnancies from 2000-2016 and analyzed all iECF cases with regard to chromosomal anomalies. It consisted of an early second-trimester collective from 14+0-17+6 weeks (n=34 791) and a second-trimester anomaly scan collective from 18+0-21+6 weeks. Two a priori risk subgroups (high and low risk) of the latter were built based on maternal age and previous screening test results using a cut-off of 1:300. Likelihood ratios (LR) of iECF for the detection of trisomy 21, trisomy 13, trisomy 18 and structural chromosomal anomalies were estimated. <b>Results</b> In total, 1 04 001 patients were included. An iECF was found in 4416 of 1 02 847 euploid fetuses (4.29%) and in 64 of 557 cases with trisomy 21 (11.49%) giving a positive LR of 2.68 (CI: 2.12-3.2). The sensitivity was 11.5% at a false-positive rate of 4.29% (CI:4.17-4.42) with p≤0.01%. In the high-and low-risk subgroups, the prevalence of iECF was comparable: 5.08% vs. 5.05%. The frequency of trisomy 21 was 0.39%, 98/24 979 vs 0.16%, 69/44 103. LR+was 3.86 (2.43-5.14) and 2.59 (1.05-4). For both subgroups the association of iECF with trisomy 21 was statistically significant. The prevalence of structural chromosomal anomalies in the second-trimester anomaly scan collective was 0.08% (52/68 967), of which 2 showed an iECF. <b>Conclusion</b> The detection of an iECF at the time of 14+0-21+6 weeks significantly increases the risk for trisomy 21 in the high-risk and in the low-risk subgroups and does not statistically change the risks for trisomy 13/18 or structural abnormalitie.</p>","PeriodicalId":44852,"journal":{"name":"Ultrasound International Open","volume":"5 3","pages":"E98-E106"},"PeriodicalIF":3.2,"publicationDate":"2019-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/a-1118-3974","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37726562","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-03-01Epub Date: 2019-03-15DOI: 10.1055/a-0853-2002
Kristoffer Lindskov Hansen, Peter Møller Hansen, Caroline Ewertsen, Lars Lönn, Jørgen Arendt Jensen, Michael Bachmann Nielsen
Abstract Purpose Stenosis of the superficial femoral artery (SFA) induces complex blood flow with increased velocities. Disease assessment is performed with Doppler ultrasound and digital subtraction angiography (DSA), but Doppler ultrasound is limited by angle dependency and DSA by ionizing radiation. An alternative is the vector flow imaging method based on transverse oscillation (TO), an angle-independent vector velocity technique using ultrasound. In this study, flow complexity and velocity measured with TO were compared with DSA for the assessment of stenosis in the SFA. Materials and Methods The vector concentration, a measure of flow complexity, and the velocity ratio obtained from the stenosis and a disease-free adjacent vessel segment, were estimated with TO in 11 patients with a total of 16 stenoses of the SFA. TO data were compared with the corresponding stenosis degree percentage obtained with DSA. Results The correlation between the vector concentration and DSA was very strong (R=0.93; p<0.001; 95% confidence interval (CI): 0.81–0.98), while only moderate for velocity ratio and DSA (R=0.50; p<0.07; 95% CI: 0.00–0.80). The correlation coefficients that were found were significantly different (p<0.005) without overlapping CI. Conclusion The study indicated that flow changes in the SFA induced by stenosis can be quantified with TO, and that stenosis grading may be improved by estimation of flow complexity instead of velocity ratio. TO is a potential diagnostic tool for the assessment of atherosclerosis and peripheral arterial disease.
{"title":"Vector Flow Imaging Compared with Digital Subtraction Angiography for Stenosis Assessment in the Superficial Femoral Artery - A Study of Vector Concentration, Velocity Ratio and Stenosis Degree Percentage.","authors":"Kristoffer Lindskov Hansen, Peter Møller Hansen, Caroline Ewertsen, Lars Lönn, Jørgen Arendt Jensen, Michael Bachmann Nielsen","doi":"10.1055/a-0853-2002","DOIUrl":"https://doi.org/10.1055/a-0853-2002","url":null,"abstract":"Abstract Purpose Stenosis of the superficial femoral artery (SFA) induces complex blood flow with increased velocities. Disease assessment is performed with Doppler ultrasound and digital subtraction angiography (DSA), but Doppler ultrasound is limited by angle dependency and DSA by ionizing radiation. An alternative is the vector flow imaging method based on transverse oscillation (TO), an angle-independent vector velocity technique using ultrasound. In this study, flow complexity and velocity measured with TO were compared with DSA for the assessment of stenosis in the SFA. Materials and Methods The vector concentration, a measure of flow complexity, and the velocity ratio obtained from the stenosis and a disease-free adjacent vessel segment, were estimated with TO in 11 patients with a total of 16 stenoses of the SFA. TO data were compared with the corresponding stenosis degree percentage obtained with DSA. Results The correlation between the vector concentration and DSA was very strong (R=0.93; p<0.001; 95% confidence interval (CI): 0.81–0.98), while only moderate for velocity ratio and DSA (R=0.50; p<0.07; 95% CI: 0.00–0.80). The correlation coefficients that were found were significantly different (p<0.005) without overlapping CI. Conclusion The study indicated that flow changes in the SFA induced by stenosis can be quantified with TO, and that stenosis grading may be improved by estimation of flow complexity instead of velocity ratio. TO is a potential diagnostic tool for the assessment of atherosclerosis and peripheral arterial disease.","PeriodicalId":44852,"journal":{"name":"Ultrasound International Open","volume":"5 2","pages":"E53-E59"},"PeriodicalIF":3.2,"publicationDate":"2019-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/a-0853-2002","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37069737","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
scattered tight pattern of hyperechoic areas (▶Fig. 3). The etiology of the phenomenon is still unknown and various hypotheses have been discussed: intestinal formation of unsheathed gas, bubble fusion or gas bubble pooling (Caruso G et al. Radiol Med (Torino) 2007; 112: 56–63; Shimada T et al. Ultrasound Med Biol 2012; 38: 1317–1323; Cui XW et al. Ultraschall Med 2014; 35: 246– 252). In all reported cases except one, the patients remained free of symptoms and liver enzymes were not reported to be altered. One patient experienced “general discomfort and a transient skin rush” during the infusion of the contrast media, before the appearance of PHLE (Tana C et al. Ultrasound Med Biol 2013; 39: 2214). After days, the US image of the liver is normal again in all patients. In the few patients that received a second portion of US contrast media days later, the phenomenon did not reappear. From the case series estimations, the incidence rate seems to be somewhere around 0.01–0.8 % of CEUS examinations. These rates are questionable and do not quite match the results from a recent oral survey among experienced German medical doctors, each having performed more than 1 000 CEUS investigations. Most of them were not aware of this side effect of contrast media.
高回声区域的分散紧密模式(▶图。3).该现象的病因尚不清楚，并讨论了各种假设:肠内形成无鞘气体，气泡融合或气泡池化(Caruso G et al.)。放射医学(都灵)2007年;112: 56 - 63;Shimada等。2012;38: 1317 - 1323;崔小伟等。Ultraschall Med 2014;35: 246 - 252)。在所有报告的病例中，除一例外，患者均无症状，肝酶未见改变。在PHLE出现之前，一名患者在输注造影剂期间经历了“全身不适和短暂的皮肤冲动”(Tana C等)。超声医学，2013;39: 2214)。几天后，所有患者的肝脏图像恢复正常。在少数接受第二部分美国造影剂几天后，这种现象没有再出现。从病例序列估计，发生率似乎在超声造影检查的0.01 - 0.8%左右。这些比率值得怀疑，与最近在经验丰富的德国医生中进行的口头调查结果不太相符，每位医生都进行了1 000多次超声造影检查。他们中的大多数都没有意识到造影剂的这种副作用。
{"title":"The ‘Disappearing’ Liver on CEUS: Nothing to Worry About","authors":"T. Müller, F. Posnien, C. Sarrazin","doi":"10.1055/a-1005-7459","DOIUrl":"https://doi.org/10.1055/a-1005-7459","url":null,"abstract":"scattered tight pattern of hyperechoic areas (▶Fig. 3). The etiology of the phenomenon is still unknown and various hypotheses have been discussed: intestinal formation of unsheathed gas, bubble fusion or gas bubble pooling (Caruso G et al. Radiol Med (Torino) 2007; 112: 56–63; Shimada T et al. Ultrasound Med Biol 2012; 38: 1317–1323; Cui XW et al. Ultraschall Med 2014; 35: 246– 252). In all reported cases except one, the patients remained free of symptoms and liver enzymes were not reported to be altered. One patient experienced “general discomfort and a transient skin rush” during the infusion of the contrast media, before the appearance of PHLE (Tana C et al. Ultrasound Med Biol 2013; 39: 2214). After days, the US image of the liver is normal again in all patients. In the few patients that received a second portion of US contrast media days later, the phenomenon did not reappear. From the case series estimations, the incidence rate seems to be somewhere around 0.01–0.8 % of CEUS examinations. These rates are questionable and do not quite match the results from a recent oral survey among experienced German medical doctors, each having performed more than 1 000 CEUS investigations. Most of them were not aware of this side effect of contrast media.","PeriodicalId":44852,"journal":{"name":"Ultrasound International Open","volume":"24 1","pages":"E78 - E79"},"PeriodicalIF":3.2,"publicationDate":"2019-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90541772","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Blunt pancreatic injuries are rare as they only comprise 1–5% of abdominal trauma, and half of the cases are seen in combination with multiple injuries. More than 60% of pancreatic injuries are located in the body and tail of the gland (Krige JE et al. Pancreatology. 2017;17(4):592–598). Pancreatic trauma often entails severe lesions with a high morbidity and mortality if treatment is delayed or inadequate (Mohseni S et al. Injury. 2018;49(1):27–32). Treatment is controversial and depends on whether the main pancreatic duct has been injured. Grade I and II trauma is usually managed conservatively, while grade III to V trauma is generally managed operatively either with drainage or resection of major parts of the gland (Ho VP et al. J Trauma Acute Care Surg . 2017;82(1):185–99). However, an increasing number of studies suggest that non-operative management with drainage alone rather than resection may provide acceptable outcomes (Menahem B et al. Hepato Biliary Surg Nutr. 2016;5(6):470–77). We present an acute case with a grade III lesion of the pancreatic neck in an adult treated with surgical drainage and subsequent drainage of a pseudocyst with a lumen-apposing metal stent (LAMS) with conservation of the gland. Case presentation A 27-year-old healthy female suffered a grade III lesion of her pancreas after she fell from a bicycle and landed on the handlebar. At a local hospital a pancreatic contusion was found on a trauma CT scan, and the patient was referred to a level 1 trauma center with specialized HPB function. A reassessment of the CT scan revealed complete rupture of the pancreatic neck with a retroperitoneal hematoma without signs of other abdominal injuries. An MRCP confirmed rupture of the main duct with a diastasis measuring 2 cm ( Fig. 1 ). A conservative approach was chosen, and the patient was treated with a nasogastric tube with continuous suction, intravenous proton pump inhibitor (pantoprazole 40 mg b.i.d.), subcutaneous octreotide 100 microgram t.i.d., intravenous cefuroxime 1500 mg t.i.d., metronidazole 1500 mg q.d. and parenteral nutrition. On the third day of admission an endoscopic retrograde cholangiopancreatography (ERCP) with papillotomy of the pancreatic duct was performed to ease the flow to the duodenum and diminish the leakage from the severed duct. Due to the considerable diastasis of the duct ends and the large hematoma with displacement of the fractured parts, an attempt to insert a bridge prosthesis over the contused area was not attempted. On the fourth day the patient’s condition deteriorated with increasing abdominal pain, inflammatory parameters and on free intraperitoneal fluid seen on ultrasonography. A laparotomy was performed with removal of 2000 ml ascites, but the surgeon refrained from resection of the distal part of the gland due to a large retroperitoneal hematoma in the retroperitoneal space. Instead two external 18 Fr tubes were placed along the superior and inferior pancreatic border, r
钝性胰腺损伤是罕见的，因为它们只占腹部创伤的1-5%，一半的病例合并多重损伤。超过60%的胰腺损伤位于腺体体和尾部(Krige JE et al.)。Pancreatology。2017;17(4):592 - 598)。如果治疗延迟或不充分，胰腺创伤通常会导致严重病变，发病率和死亡率都很高(Mohseni S等)。受伤。2018;49(1):新)。治疗是有争议的，取决于主胰管是否受损。I级和II级创伤通常采用保守治疗，而III至V级创伤通常采用手术治疗，要么引流，要么切除腺体的主要部分(Ho VP等)。创伤急症护理外科。82(1): 185 - 2017; 99)。然而，越来越多的研究表明，单纯引流而非切除的非手术治疗可能会提供可接受的结果(Menahem B等)。肝胆外科杂志，2016;5(6):470-77。我们报告了一个急性病例与III级胰腺颈部病变的成人治疗手术引流和随后的假囊肿引流管旁金属支架(LAMS)与腺体保存。病例介绍一名27岁的健康女性从自行车上跌落并落在车把上后，胰腺出现III级病变。在当地一家医院，在创伤CT扫描中发现胰腺挫伤，并将患者转至具有专门HPB功能的一级创伤中心。重新评估CT扫描显示胰腺颈部完全破裂伴腹膜后血肿，无其他腹部损伤迹象。MRCP证实主导管破裂，并伴有2厘米的转移(图1)。选择保守入路，给予鼻胃管持续抽吸，静脉注射质子泵抑制剂(泮托拉唑40 mg b.i.d)，奥曲肽100微克皮下滴注，头孢呋辛1500 mg t.i.d，甲硝唑1500 mg q.d，肠外营养。入院第3天行内镜逆行胰管造影(ERCP)并行胰管乳头切开术，以缓解流向十二指肠的血流，减少切断胰管的渗漏。由于导管末端有相当大的转移和骨折部分的大血肿移位，没有尝试在挫伤区域插入桥式假体。第4天，患者病情恶化，腹痛加重，超声检查发现炎症参数增加，腹腔内积液增多。开腹手术切除了2000毫升腹水，但由于腹膜后间隙有大的腹膜后血肿，外科医生没有切除腺体的远端部分。相反，在胰腺上下边界分别放置两根18fr外置管，并关闭腹部。病人的一般情况迅速好转，不再需要止痛药，全身炎症反应减少，她开始正常饮食，由于液体量减少，一根腹腔插管被停止。在剩余的试管中，淀粉酶为10,000 U/l，液体水平稳定在200 ml/d左右。患者于第16天出院，每周在门诊随访1次，间歇性回拉引流管，直到皮肤形成瘘管，8周后拔出引流管。取下引流管两周后，瘘管的分泌物停止，患者主诉不适和腹痛加剧。CT扫描显示假性囊肿4.6×3.1×2.6 cm(图1)，MRCP和MR血管造影显示切断的胰管直径为6mm，腺体两侧动脉灌注(图2)。超声内镜检查后，在胃和囊肿之间置入10×10 mm HOT AXIOS TM支架(Boston scientific, Marlborough, MA)(图3和图4)。4)。治疗性宾得超声内窥镜(EG-3870UTK;宾得，东京，日本)和日立超声工作站(EUB 7500, HI Vison Preirus;使用日立医疗公司，日本东京)。在EUS控制下，使用Hot AXIOS支架尖端的电灼丝穿刺标本。一旦装置在囊肿内被满意地定位，支架的远端法兰在EUS控制下展开。然后将该装置拉回，直到远端法兰紧贴腔壁变形。在内镜直接控制下，将近端凸缘放置在管腔侧。当天晚上，患者可以正常进食，腹痛停止，第二天出院。5周后，CT扫描显示囊肿塌陷，植入支架9周后，常规胃镜检查取出支架。 取出支架两周后，CT扫描显示囊肿没有复发，胰管仍有6毫米长，两半胰腺都有血液供应。患者表现良好，无吸收不良或糖尿病迹象，随访结束，但仍与我科保持公开联系。图1 CT扫描显示胰腺颈部创伤，头部和身体之间有2厘米的转移，伴腹膜后外渗。
{"title":"Endoscopic Ultrasound-Guided Drainage of a Pancreatic Pseudocyst after a Bicycle Trauma","authors":"H. Grossjohann, T. Kristensen, C. Hansen","doi":"10.1055/a-0948-5620","DOIUrl":"https://doi.org/10.1055/a-0948-5620","url":null,"abstract":"Blunt pancreatic injuries are rare as they only comprise 1–5% of abdominal trauma, and half of the cases are seen in combination with multiple injuries. More than 60% of pancreatic injuries are located in the body and tail of the gland (Krige JE et al. Pancreatology. 2017;17(4):592–598). \u0000 \u0000Pancreatic trauma often entails severe lesions with a high morbidity and mortality if treatment is delayed or inadequate (Mohseni S et al. Injury. 2018;49(1):27–32). Treatment is controversial and depends on whether the main pancreatic duct has been injured. Grade I and II trauma is usually managed conservatively, while grade III to V trauma is generally managed operatively either with drainage or resection of major parts of the gland (Ho VP et al. J Trauma Acute Care Surg . 2017;82(1):185–99). However, an increasing number of studies suggest that non-operative management with drainage alone rather than resection may provide acceptable outcomes (Menahem B et al. Hepato Biliary Surg Nutr. 2016;5(6):470–77). \u0000 \u0000We present an acute case with a grade III lesion of the pancreatic neck in an adult treated with surgical drainage and subsequent drainage of a pseudocyst with a lumen-apposing metal stent (LAMS) with conservation of the gland. \u0000 \u0000Case presentation \u0000A 27-year-old healthy female suffered a grade III lesion of her pancreas after she fell from a bicycle and landed on the handlebar. At a local hospital a pancreatic contusion was found on a trauma CT scan, and the patient was referred to a level 1 trauma center with specialized HPB function. A reassessment of the CT scan revealed complete rupture of the pancreatic neck with a retroperitoneal hematoma without signs of other abdominal injuries. An MRCP confirmed rupture of the main duct with a diastasis measuring 2 cm ( Fig. 1 ). A conservative approach was chosen, and the patient was treated with a nasogastric tube with continuous suction, intravenous proton pump inhibitor (pantoprazole 40 mg b.i.d.), subcutaneous octreotide 100 microgram t.i.d., intravenous cefuroxime 1500 mg t.i.d., metronidazole 1500 mg q.d. and parenteral nutrition. On the third day of admission an endoscopic retrograde cholangiopancreatography (ERCP) with papillotomy of the pancreatic duct was performed to ease the flow to the duodenum and diminish the leakage from the severed duct. Due to the considerable diastasis of the duct ends and the large hematoma with displacement of the fractured parts, an attempt to insert a bridge prosthesis over the contused area was not attempted. On the fourth day the patient’s condition deteriorated with increasing abdominal pain, inflammatory parameters and on free intraperitoneal fluid seen on ultrasonography. A laparotomy was performed with removal of 2000 ml ascites, but the surgeon refrained from resection of the distal part of the gland due to a large retroperitoneal hematoma in the retroperitoneal space. Instead two external 18 Fr tubes were placed along the superior and inferior pancreatic border, r","PeriodicalId":44852,"journal":{"name":"Ultrasound International Open","volume":"87 1","pages":"E75 - E77"},"PeriodicalIF":3.2,"publicationDate":"2019-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75410125","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Purpose: Thyroid lymphoepithelial cysts (TLECs) are rare, and detailed ultrasonography (US) findings have not been reported. This study aimed to examine in detail the US findings for 32 TLECs and to clarify the diagnostic problems associated with them.
Materials and methods: We examined 32 TLECs resected from 21 patients at the Kuma hospital between January 2008 and April 2018. All patients underwent US before resection. From the patients' medical records, we retrospectively assessed US reports and photographs of TLECs.
Results: The following four types of TLECs were classified: cystic, mixed solid and cystic, pseudo-solid, and pseudo-calcified types. The incidences were 50.0%, 12.5%, 12.5%, and 25.0%, respectively. Among the four types, pseudo-calcified TLECs were the smallest in size (mean: 7.1 mm). Of 24 nodules that had been interpreted in US reports, 11, 9, 1, 2, and 1 were benign, very low, low, intermediate, and high, respectively. Calcification and intramural solid growth were not identified by histological examination.
Conclusion: We should be aware that approximately half of TLECs do not exhibit US appearances typical of simple cysts, and TLECs may mimic calcified or solid nodules on US, although the reason remains unknown.
{"title":"Thyroid Lymphoepithelial Cysts Mimicking Calcified or Solid Nodules on Ultrasonography.","authors":"Yukie Tsutsuura, Mitsuyoshi Hirokawa, Ayana Suzuki, Hisashi Ota, Maki Oshita, Mitsuhiro Fukushima, Kaoru Kobayashi, Akira Miyauchi","doi":"10.1055/a-0943-6553","DOIUrl":"https://doi.org/10.1055/a-0943-6553","url":null,"abstract":"<p><strong>Purpose: </strong>Thyroid lymphoepithelial cysts (TLECs) are rare, and detailed ultrasonography (US) findings have not been reported. This study aimed to examine in detail the US findings for 32 TLECs and to clarify the diagnostic problems associated with them.</p><p><strong>Materials and methods: </strong>We examined 32 TLECs resected from 21 patients at the Kuma hospital between January 2008 and April 2018. All patients underwent US before resection. From the patients' medical records, we retrospectively assessed US reports and photographs of TLECs.</p><p><strong>Results: </strong>The following four types of TLECs were classified: cystic, mixed solid and cystic, pseudo-solid, and pseudo-calcified types. The incidences were 50.0%, 12.5%, 12.5%, and 25.0%, respectively. Among the four types, pseudo-calcified TLECs were the smallest in size (mean: 7.1 mm). Of 24 nodules that had been interpreted in US reports, 11, 9, 1, 2, and 1 were benign, very low, low, intermediate, and high, respectively. Calcification and intramural solid growth were not identified by histological examination.</p><p><strong>Conclusion: </strong>We should be aware that approximately half of TLECs do not exhibit US appearances typical of simple cysts, and TLECs may mimic calcified or solid nodules on US, although the reason remains unknown.</p>","PeriodicalId":44852,"journal":{"name":"Ultrasound International Open","volume":"5 2","pages":"E60-E64"},"PeriodicalIF":3.2,"publicationDate":"2019-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/a-0943-6553","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37398048","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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