Journal of Medical Ultrasound最新文献

Cardiac myxoma, the most common primary cardiac tumor, is indeed rare, with an estimated incidence of 0.03% in the general population. Despite its rarity, it can lead to severe complications such as intracardiac obstruction, emboli, and constitutional symptoms. Surgical excision of myxomas is associated with excellent outcomes and low rate of recurrence. Herein, we will report a case where the lesion was discovered early by point-of-care ultrasound (POCUS), allowing for the quickest possible prompt intervention. A 45-year-old man presented with a 1-day history of dizziness, right-sided body weakness, and facial asymmetry, which led to a motorbike fall. POCUS performed noted mass-like lesions measuring 7 cm by 6 cm, moving freely in the left atrium and prolapsing through the mitral valve during each cardiac cycle. The lesion appears to originate from the septal rather than the atrial appendage, which gives rise to a higher suspicion toward the left atrial myxoma than the left atrial thrombus. Besides, there are areas of liquefaction seen within the mass. He underwent a sternotomy and excision of the left atrial myxoma within the same hospitalization. Histopathology examination of the excised lesion confirmed the diagnosis of atrial myxoma. Early detection and surgical intervention result in a favorable prognosis. Upon discharge, he was stable, ambulating independently with minimal residual facial asymmetry.

Parasitic fibroid is a rare benign pathology that can be negotiated because of its rarity. The etiology remains unknown following prior intervention related to uterine fibroids. The assessment of this rare disease is usually based on clinical features and imaging modalities. In addition, appropriate management should be individualized where appropriate. Herein, we report an uncommon case at our center and raise proper recognition for all gynecologists. Particularly, in low-and middle-income countries such as Vietnam, where the health-care system is insufficient to follow-up the long-term postoperation. A 40-year-old woman (gravida 3, para 2) presented to the gynecologic examination room due the abdominal pain and increased size of abdominal circumference. The patient had undergone laparoscopy involving the power morcellator without a contained-bag system for myomectomy at our hospital 6 years prior. The imaging diagnostic tools showed multiple hypoechoic disseminated masses in the abdominal cavity. The laparotomy intervention and histopathological endpoints confirmed completely the diagnosis of parasitic fibroid. Although an extremely rare occurrence, parasitic fibroids should be informed to all patients after laparoscopic intervention for uterine fibroids. In addition, the diagnosis of parasitic fibroid should be warranted among the patients presenting with abdominal pain after a history of fibroid resection. The power morcellation in the contained bag, uterine extraction in hysterectomy, as well as relieving the surgical specimen of uterine fibroids should be gently performed to minimize fibroid tissue disruption.

Cervical insufficiency poses risks for premature birth and neonatal outcomes. Preoperative sonography aids in the diagnosis and therapeutic considerations. Cervical cerclage is effective but carries risks. In our case series, 8 cases failed to complete emergent cerclage, leading to adverse outcomes. Analysis of preoperative images revealed thicker cervixes and cervical strictures may affect the surgical outcomes. Larger studies are needed to determine the reliable cutoff values. Preoperative assessment is crucial to inform treatment decisions.

Splenic injuries are common in abdominal trauma, as the spleen is one of the most often harmed organs. The treatment of splenic injuries underwent major changes during the past decades, shifting from a surgical approach to nonoperative management. This change of the proceedings results from a constantly growing awareness of the spleen's crucial hematological and immunological function and was possible owing to the advances in radiological techniques. In a setting of high-energy trauma in hemodynamically stable patients, computed tomography (CT) remains the gold standard. Where ultrasonography (US) is of major importance is in cases of unstable patients undergone high-energy trauma or in patients after low-energy trauma. Nevertheless, baseline US's sensitivity is not sufficient to detect splenic traumatic injuries; hence, a new method was developed involving ultrasound contrast agents (UCAs), called contrast-enhanced ultrasound (CEUS). In a low-energy trauma setting, it facilitates the diagnosis of abdominal lesions with a sensitivity close to that of CT, without the disadvantages of the latter. In addition, CEUS can be used in the follow-up of abdominal traumatic injuries. The fact that CEUS preserves CT's sensitivity while not carrying the risk of radiation-induced cancer makes it feasible for children and pregnant women. This review aims to discuss the technical aspects of CEUS, the limitations, and possibilities regarding this modality, present the appearance of both a healthy and injured spleen, and compare CEUS's effectiveness to that of CT through an analysis of retrievable studies.

Background: Point-of-care ultrasound (POCUS) has become a widely used diagnostic tool in emergency departments (EDs), and proper documentation is essential for both patient safety and reimbursement. POCUS is often underdocumented, and therefore, underbilled, by emergency medicine physicians. The absence of POCUS documentation can result in significant revenue loss for both providers and hospital administration.

Methods: This study is a follow-up study to the manuscript published by Lahham et al. and primarily examines POCUS documentation rates for a 15-month billing period following the initial intervention of a personalized e-mail reminder. Data included rates of documented and phantom scans from three separate 11-day periods (April 2019, July 2019, and July 2020) after the performance feedback intervention in March 2019.

Results: Documentation rates steadily declined from April 2019 to July 2020 following the intervention, with the highest success rate being immediately after the e-mail intervention.

Conclusion: This study demonstrates that there is limited durability to a single e-mail reminder as an intervention to improve POCUS documentation in the ED and suggests that there is a need for repeated interventions to prevent deterioration of documentation rates.

Background: Isosexual precocious puberty (PP) is defined as the appearance of secondary sexual characteristics before the age of 8 years in girls and before the age of 9 years in boys. The aim of this study was to evaluate the association of ovarian volume and bone age measurements with the number of symptoms in female patients diagnosed with PP.

Methods: The dataset includes pelvic ultrasound and bone age tests from 96 girls diagnosed with PP who presented to a tertiary hospital's pediatric outpatient clinic with signs and symptoms of early puberty between January 1, 2020, and January 1, 2021. The study included 96 healthy ladies of the same age as a control group.

Results: A total volume >2.75 was shown to predict the existence of pubertal pre with 79.2% sensitivity and 90.6% specificity (area under the curve [AUC]: 0.903; P = 0.001). A total volume of >3.25 predicted the existence of 2 or more symptoms in patients with PP, with a sensitivity of 72.1% and a specificity of 98.1% (AUC: 0.917; P = 0.001).

Conclusion: To the best of our knowledge, no study has been published that investigates the relationship between the number of symptoms at the time of presentation and ovarian volume and bone age in girls with PP. Our investigation, which involved 192 female participants (96 patients and 96 controls), revealed a statistically significant correlation between the frequency of symptoms indicating early puberty and a rise in both ovarian capacity and bone age.

Background: Stuve-Wiedemann syndrome (SWS) is a rare skeletal abnormality with extensive postnatal literature but limited prenatal studies. Our group had published a diagnostic algorithm to identify prenatal cases, yet, the challenge continues, especially when there is no family history of a similar condition.

Methods: We retrospectively analyzed our experience of prenatal diagnosis of SWS over an 8-year period with ethical approval. Literature review of articles published until July 30, 2023 from PubMed, GeneReviews, and Genetics Home Reference using search parameters, "SWS," "prenatal," and "ultrasound" was conducted.

Results: Three cases (diagnosed during the routine anomaly scan) were identified from our institutional review, and 11 cases from six studies from the literature review. Eight out of these 11 cases had a positive family history. SWS was recognized without positive family history in two patients from literature review and the three patients in the current study. The consistent findings that helped in reaching the suspicion were the typical pattern of long bone involvement (bowing of tibia > femora, relative sparing of the fibula and upper limb bones, normal scapulae, and clavicles), and the presence of camptodactyly. Despite the lack of sonographic evidence of narrow thorax, SWS is highly lethal, due to dysautonomic symptoms.

Conclusion: In SWS, accurate ultrasound diagnosis is crucial to provide prognostic information as the lethality does not depend on pulmonary hypoplasia. Examination of the hands looking for camptodactyly is crucial in skeletal dysplasias to distinguish SWS from other bent bone osteochondrodysplasias, namely, campomelic and kyphomelic dysplasias. This prenatal distinction has important implications for prognosis.

Background: Reliable quantification of stroke volume (SV) and left ventricular ejection fraction (LVEF) is essential for point-of-care assessment in hemodynamically compromised patients. Handheld echocardiography (HHE) equipment has entered the market a few years ago and is now available for clinical use. However, the performance of HHE for SV and LVEF quantification in comparison to cardiac magnetic resonance (CMR) imaging as golden standard is yet unknown.

Methods: Twenty volunteers were scanned with HHE, standard echocardiography (SE), and CMR. LVEF and SV were measured with each modality, and their accuracy and precision were evaluated.

Results: Bias and limits of agreement (LOA) between HHE and CMR were -0.21% (-2.89: 2.48) and 11.24% (-15.79: 15.59) for LVEF and 29.85 ml (22.13: 37.57) and 32.34 ml (-15.01: 44.86) for SV, respectively. Bias and LOA between SE and CMR were -0.60% (-3.74:2.55) and 13.16% (-18.85:18.26) for LVEF and 32.08 ml (24.61:39.54) and 31.34 ml (-11.29:43.37) for SV, respectively.

Conclusion: HHE versus CMR showed comparable accuracy and precision compared to SE versus CMR.