Utility of Sonography for Evaluation of Clinical T1 and T2 Glottic Carcinoma

Objective. The aim of this study was to evaluate the prognostic impact of sonographically determined tumor features in relation to local control of clinical T1 and T2 glottic carcinoma treated by definitive radiation therapy. Methods. Between 1999 and 2005, 72 patients with T1 and T2 glottic carcinoma were evaluated by percutaneous sonography in terms of tumor detectability, maximum tumor dimension, involvement of the anterior commissure, presence of supraglottic, subglottic, or paraglottic spread, and thyroid cartilage invasion. Factor analyses for local control included clinical features, sonographic findings, and treatment factors. Results. Forty‐one lesions (57%) were detected as hypoechoic masses on sonography. For detectable T2 tumors, sonographic and laryngoscopic findings were in agreement in all cases with respect to spread to anatomic subsites. The 3‐year local control rate with radiation therapy alone was 82%. Univariate analysis of the sonographic characteristics revealed that the maximum tumor dimension and thyroid cartilage invasion predicted a loss of local control, whereas none of the clinical or treatment characteristics was significant. Multivariate analysis showed that thyroid cartilage invasion was an independent negative prognostic factor for local control. Conclusions. Sonography provides information about the likely outcome of radiation therapy for patients with clinical T2 glottic carcinoma, although its utility for T1 lesions is not proven. Thyroid cartilage invasion may be an independent negative predictor of the outcome.     

Sonographic approach to diagnosing pulmonary consolidation.

Thirty-nine consecutive patients with consolidated lung confirmed radiologically underwent sonography, and their sonograms were compared with results for 100 healthy subjects. The hyperechoic line of normal aerated lung and its air artifacts showed respiratory motions ("gliding sign," n = 100). Patients with pneumonia demonstrated distinct sonographic patterns. Strong linear echoes with characteristic air artifacts (air bronchogram) and anechoic tubular structures (fluid bronchogram) were visualized in 36 of 39 patients (92.30%). The superficial lung showed a homogeneous hypoechoic band termed "superficial fluid alveolograms" (n = 39) with respiratory motions in 35 of 39 patients. We conclude that sonography can evaluate pulmonary consolidation and may provide additional roentgenographic information, especially when fluid bronchograms are visualized.     

Sonographic findings of Zenker diverticula.

OBJECTIVE: The purpose of this study was to describe the sonographic findings of Zenker diverticula. METHODS: This study included 6 patients (age, 26-70 years; average, 55.3 years). Three cases were detected incidentally by thyroid sonograms, and 3 cases were transferred from other hospitals for aspiration of a thyroid nodule. All the sonograms and medical records were reviewed retrospectively. RESULTS: All 6 patients had no symptoms, and diverticula were incidentally detected by neck sonography. The masses were located on the posterolateral aspect of the left lobe in 5 patients and the right lobe in the remaining patient. All lesions were located in the upper and mid portions of the thyroid glands and showed echogenic foci similar to those of a microcalcification or an arc-shaped microcalcification. The sonographic findings of a Zenker diverticulum were seen as an isoechoic or a hypoechoic mass with internal or peripheral echogenic foci and a boundary hypoechoic zone at the posterior portion of the thyroid gland on sonography. All lesions appeared connected with the adjacent esophageal wall on sonography. In all cases, diagnoses were confirmed by esophagography. CONCLUSIONS: Zenker diverticula had several unique characteristics on sonography. We can, therefore, diagnose Zenker diverticula by careful thyroid sonography, avoiding unnecessary aspiration due to misdiagnosis of a Zenker diverticulum as a thyroid nodule.     

Airway Management: Difficulty of Intubation and Range of Movement of the Thyroid Cartilage

PurposeDifficult endotracheal intubation has been associated with a number of anatomic factors. According to our experience, the range of movement of thyroid cartilage can be used as a useful test to determine the difficulty in endotracheal intubation. The aim of this study was to evaluate the association between the range of movement of thyroid cartilage and difficulty in intubation.DesignCross-sectional study.MethodsThis study was carried out on 400 patients at (Shohada Ashayer Hospital, Khorramabad). After obtaining consent letters from the patients who were between 18 and 60 years of age, the patients underwent general anesthesia. The participants were evaluated by Mallampati and other evaluating tests. The range of movement of thyroid cartilage from the midline was measured and recorded.FindingsThere were significant correlation between the range of movement of thyroid cartilage and thyromental distance. In addition, in patients with Cormack-Lehane class 1, the mean range of movement of thyroid cartilage was significantly more than the patients with Cormack-Lehane class 3 and 4.ConclusionsThe outcomes of our study indicate that the range of movement of thyroid cartilage can be used for predication of difficult intubation. However, further randomized trials should be conducted in this regard.     

Sonographic diagnosis of thyroid metastasis from hepatocellular carcinoma

Metastasis to the thyroid is very rare in hepatocellular carcinoma (HCC) and only a few cases have been reported. Herein, we report a rare case of metastatic HCC to the thyroid in a 63-year-old man and discuss the various radiologic findings. Computed tomography (CT) revealed a heterogeneous enhancing mass that had invaded the thyroid cartilage in the left upper thyroid, compressing the airway. Ultrasonography (US) showed a heterogeneous hypoechoic mass with increased vascularity in the peripheral portion. The mass showed focal intense uptake on positron emission tomography-computed tomography (PET-CT). The patient underwent US-guided core needle biopsy and the final diagnosis was metastatic HCC.     

Emergent Right Upper Quadrant Sonography

Objective. The purpose of this presentation is to review the sonographic spectrum of disease entities evaluated by right upper quadrant (RUQ) sonography on an emergent basis. Methods. Right upper quadrant sonography was performed on an emergent basis in patients who came to the emergency department with signs and symptoms suspicious for or simulating acute cholecystitis or diseases of the liver and biliary tree. Results. A wide gamut of acute and chronic cholecystitis and diseases of the liver and biliary tree were visualized on RUQ sonography. Several other entities in addition to hepatic and biliary disease were also suspected on sonography and further evaluated by computed tomography. Conclusions. Right upper quadrant sonography is the first line of imaging in patients with signs and symptoms of hepatic, gallbladder, or biliary disease as well as RUQ pain. Patient triage or additional imaging may be obtained on the basis of emergent RUQ sonographic findings.     

支气管内光学相干断层成像技术评估兔创伤性气道狭窄类型的诊断价值

目的 使用支气管内光学相干断层成像技术（EB-OCT）获得兔创伤性气道狭窄模型的图像,评估EB-OCT在判断良性气道狭窄类型中的诊断价值。方法 建立黏膜破坏联合软骨破坏的兔创伤性气道狭窄模型,建模成功12只,获取12只气道狭窄兔术后2、4、6和8周支气管镜、EB-OCT图像特点和气管组织病理学图像,测量EB-OCT和病理图像匹配部分软骨层及非软骨层的厚度,并比较两者的相关性。结果 12只建模成功的气道狭窄兔的EB-OCT图像特点：低信号反射的软骨层结构,从断裂、不连续到软骨膜逐渐修复;EB-OCT诊断气管结构层次：黏膜破坏3例,黏膜破坏及软骨破坏9例,与组织病理学比较,差异无统计学意义（P > 0.05）。EB-OCT和病理图像匹配部分软骨层及非软骨层的厚度呈线性正相关,相关曲线分别是：软骨层Y = 3.7498+0.9717X,r = 0.9992（P < 0.01）;非软骨层Y = -9.4328 + 0.9935X,r = 0.9999（P < 0.01）。结论 EB-OCT可以很好地观察到良性气道狭窄中气管黏膜破坏和/或软骨破坏以及两者的破坏程度,具有病理组织学的诊断优势。     

Testicular epidermoid cysts: sonographic features with histopathologic correlation

Testicular epidermoid cysts are rare, accounting for 1% of all testicular tumors. We present the sonographic appearances of epidermoid cysts in 3 cases, together with the histopathologic correlation. In case 1, sonography showed an intratesticular hypoechoic mass with a well-defined echogenic rim; the mass measured 1.8 x 1.5 x 1.5 cm, and there was no evidence of calcification. In case 2, sonography showed a well-circumscribed mass measuring 1.3 x 1.3 x 1.0 cm, with alternating hypoechoic and hyperechoic rings (onion-ring appearance) and no calcifications. In case 3, sonography showed a 2.4- x 2.3- x 2.3-cm, well-circumscribed, oval mass with a heterogeneous echotexture and an outer hypoechoic halo. The mass contained plaque-like regions of increased echogenicity, with peripheral acoustic shadowing from refraction artifact. Hypoechoic clefts were visualized posterior to the plaque-like areas. The triad of findings-sonographic appearance of an onion ring, avascularity on Doppler sonography, and negative results of tumor marker studies-is highly suggestive of an epidermoid cyst.     

A comparison of paediatric airway anatomy with the SimBaby high-fidelity patient simulator

Background

The SimBaby high-fidelity patient simulator is a widely used paediatric simulator for the training of standard and critical airway management scenarios. Furthermore this simulator is frequently used for the evaluation of different airway devices and techniques. However, the anatomic structures of the SimBaby have not been compared to actual patients’ anatomy.

Methods

The CT radiographic measures of the upper airway anatomy of two SimBaby simulators were compared to MRI images of the upper airway of 20 children aged 1-11 months who underwent routine MRI scans under sedation for diagnostic purposes. Various distances of the tongue, soft palate and pharynx, cross sectional areas and volumes of anatomic structures of the upper airway including the retroglossal airspace were compared.

Results

The SimBaby's retroglossal airspace volume greatly differed from the measurements in patients (SimBaby 5.3 ± 0.4 vs. 1.9 ± 0.8 cm³ in infants, p < 0.01). Furthermore the distance from the alveolar process of the mandible to the posterior pharyngeal wall was larger in the SimBaby than in infants (5.8 ± 0.1 vs. 4.5 ± 0.5 cm, p < 0.001) and dimensions of the epiglottis and pharynx were larger in the Simbaby.

Conclusion

The anatomic features of the SimBaby do not adequately simulate the upper airway anatomy of infants. These results imply inadequate realism of this simulator for airway training and compromise the validity of comparative trials of different airway devices with the SimBaby as airway model.     

Maternal Obesity Limits the Ultrasound Evaluation of Fetal Anatomy

Objective. The purpose of this study was to evaluate the effect of maternal habitus on adequate visualization of fetal anatomy during a standard second‐trimester ultrasound examination. Methods. This was a retrospective cohort study of singleton pregnancies at 18 to 24 weeks that underwent sonography over a 5‐year period. Pregnancies complicated by an indication for targeted sonography were excluded. Standard ultrasound examinations were performed according to American Institute of Ultrasound in Medicine criteria. Ten anatomic components were evaluated for adequacy of visualization: atria of the cerebral ventricles, posterior fossa, midline face, 4‐chamber view of the heart, spine, ventral wall, umbilical cord vessels, stomach, kidneys, and bladder. The body mass index (BMI) was based on the patient's weight at the first prenatal visit. Results. Of 10,112 women who underwent a standard ultrasound examination, 2% were underweight; 38% were of normal weight; 34% were overweight; and 26% were obese. Visualization of fetal anatomy decreased significantly with increasing maternal BMI for the complete survey as well as for each individual component with the exception of the fetal bladder (all P < .001). Among those with a normal or underweight BMI, an overweight BMI, and class 1, 2, and 3 obesity, all 10 anatomic components were adequately visualized at the initial examination in 72%, 68%, 57%, 41%, and 30% of cases, respectively (P < .001). Conclusions. Increasing maternal BMI limits visualization of fetal anatomy during a standard ultrasound examination at 18 to 24 weeks. In obese women, the fetal anatomy survey could be completed during the initial examination in only 50% of cases. Counseling may need to be modified to reflect the limitations of sonography in obese women.     

Cricoid cartilage on sonography in pediatric patients mimics a thyroid mass.

OBJECTIVE: The purpose of this study was to describe the sonographic appearance of the uncalcified cricoid cartilage in pediatric patients and illustrate how this can be easily confused with a thyroid mass or residual thyroid tissue after thyroidectomy. METHODS: We retrospectively reviewed the sonographic and computed tomographic examinations performed on 4 adolescent patients. Two patients had either thyroid cancer or thyroid nodules, and 2 healthy patients were reviewed to show normal anatomy. Results were compared with the clinical and surgical findings in each patient. RESULTS: Computed tomographic and sonographic examinations showed the normal anatomic relationships and imaging appearance of the cricoid cartilage. Findings from a follow-up sonographic examination on a patient with treated thyroid cancer were initially interpreted as residual thyroid tissue, but another examination revealed that this tissue was actually uncalcified cricoid cartilage. Another patient who had intraoperative sonography verified these findings. CONCLUSIONS: Uncalcified cricoid cartilage in a pediatric patient appears on sagittal sonography as a round or ovoid structure with variable echogenicity, located posteromedial to the thyroid gland. Awareness of this structure's sonographic appearance should prevent unnecessary biopsy or surgery.     

Breast and Scrotal Sparganosis

Objective. Sparganosis is caused by the tapeworm larva of the geneus Spirometra. Because sparganosis usually manifests as a migrating subcutaneous mass, sonography can play an important role in its diagnosis. Methods. In this series, we investigated 4 cases of subcutaneous sparganosis and focused on the sonographic findings. Three of the cases involved the breast, and the other involved the scrotum, as confirmed by surgery. Results. The characteristics of subcutaneous sparganosis included a poorly defined hyperechoic lesion with internal serpiginous tubular structures, anechoic serpiginous tubular structures with a surrounding hyperechoic lesion, and an elongated hyperechoic mass with a hypoechoic nodular lesion in the central portion. Conclusions. We suggest that a mass combined with a hypoechoic tubular structure should raise the suspicion of subcutaneous sparganosis.     

上气道超声表现及其生理径线测值

目的 探讨上气道的超声表现及其生理径线测值。方法 对218名正常成人行上气道超声检查,获得上气道四个解剖断面:鼻咽、口咽、喉咽、喉部的超声显像及其生理径线的测量,并进行统计学分析。结果 鼻咽、口咽、喉咽及喉部水平上气道的显示率分别为96.79%(211/218)、100%(218/218)、86.24%(188/218)和85.32%(186/218)。在声像图上,上气道呈左右径较前后径大的管腔(P<0.01),不同解剖断面的上气道呈不同形状的强回声。结论 超声可显示上气道,其声像图表现及生理测值的建立将有助于上气道及相关疾病的研究与诊断。     

Sonography of Fat Necrosis Involving the Extremity and Torso With Magnetic Resonance Imaging and Histologic Correlation

Objective. The purpose of this study was to describe the sonographic appearance of pathologically proven isolated fat necrosis involving the extremities or torso with magnetic resonance imaging (MRI) correlation. Methods. A query of the Department of Pathology database at our institution for the diagnosis of fat necrosis resulted in 1539 cases. Review of the cases and medical records excluded cases without sonographic imaging, those involving the breast, and those within or adjacent to a primary process, including masses or prior surgery, which resulted in a total of 5 cases of primary fat necrosis, 2 of which were evaluated with MRI. Sonograms were reviewed by 2 musculoskeletal radiologists and characterized with regard to location, echogenicity, shadowing, posterior through‐transmission, a hypoechoic rim or halo, definition of borders, homogeneity, a mass effect, and vascularity. The patient medical records, histologic results, and MRI findings were also reviewed. Results. Of the 5 cases of isolated fat necrosis, 2 involved the torso and 3 the lower extremities. On sonography, all were located in the subcutaneous fat; 2 were isoechoic; 3 were hyperechoic; 2 had a hypoechoic halo; none showed shadowing or posterior through‐transmission; 2 were well defined; 3 were masslike; 4 were heterogeneous; and 2 showed increased flow on color or power Doppler imaging. Magnetic resonance imaging showed an intermediate signal and either diffuse or ring enhancement. Conclusions. Isolated fat necrosis of the extremities and torso had 2 sonographic appearances, which included a well‐defined isoechoic mass with a hypoechoic halo and a poorly defined hyperechoic region in the subcutaneous fat.     

The Tortoiseshell Pattern in One or Both Sides of the Submandibular Glands in Mucosa‐Associated Lymphoid Tissue Lymphoma Is Related to Chromosomal Aberrations and the Disease Extent

Objective. Lesions of mucosa‐associated lymphoid tissue (MALT) lymphoma in the submandibular glands are localized or a part of systemic involvement in association with chromosomal aberrations. This series was undertaken to investigate the sonographic features of MALT lymphoma in the submandibular glands and their relationships with chromosomal aberrations and the disease extent. Methods. A total of 5 patients with MALT lymphoma without Sjögren syndrome in the submandibular glands were enrolled in this series. Patients underwent sonography of the submandibular glands with a high‐resolution transducer before surgical biopsy of the main lesion. Sonographic characteristics of the lesions were described for their location, presence of a posterior echo, texture, and presence of an internal echo. Results. Sonography in all cases showed hypoechoic and solid masses with increased posterior echo enhancement. There was an arrangement of hypoechoic small compartments demarcated by hyperechoic contour lines, which had a tortoiseshell pattern. This pattern was classified into 2 types according to its location: a lesion in the right or left side and lesions in both sides of the submandibular glands, found in 3 and 2 patients, respectively. The latter 2 cases had chromosomal aberrations of t(11;18)(q23;q23) and t(12;18)(q22;q21), respectively, and were revealed as secondary organ involvement. Conclusions. The sonographic appearance of MALT lymphoma in the submandibular glands was characterized by the tortoiseshell pattern in both primary and secondary lesions. Detection of this pattern in both sides of the submandibular glands can be an indicator of chromosomal aberrations and systematic involvement of the disease.     

Performance of Endotracheal Intubation and Rescue Techniques by Emergency Services Personnel in an Air Medical Service

Background. Literature spanning the last two decades has identified potential harm associated with out-of-hospital endotracheal intubation performed by ground paramedics. Previous researchers have reported intubation success rates of 66% to 97% in the air medical setting. Objective. To examine the success of endotracheal intubation and rescue techniques performed by air medical personnel during the first eight years of operation of the air ambulance service. Methods. This study was a retrospective survey of health records utilizing data from LifeFlight of Maine's airway procedure quality review database, covering the first eight years of system encounters. Results. During the study period, 369 intubation encounters occurred. Rapid-sequence intubation medications were administered in 345 (93.5%) cases. Flight personnel successfully performed endotracheal intubation in 340 (92.1%) encounters. Unsuccessful intubations were managed with an alternative definitive airway, rescue airway, or bag–valve–mask. Laryngeal mask airway (n = 11) was the most commonly used rescue airway device. Conclusions. During the first eight years of operation of this air medical transport system, flight personnel were able to successfully perform endotracheal intubation in 92.1% of cases.     

Follicular Thyroid Carcinoma With an Eggshell Calcification

Objective. The purpose of this series is to report 3 cases of follicular thyroid carcinoma with an eggshell calcification along with their imaging findings. Methods. Imaging findings on gray scale and power Doppler (PD) sonography (n = 3), computed tomography (CT; n = 3), and integrated fluorodeoxyglucose F 18 (¹⁸F‐FDG) whole‐body positron emission tomography (PET)/CT (n = 1) were assessed. Results. Of the 3 cases, two 75‐year‐old women had bone metastasis, and one 54‐year‐old woman had a thyroid incidentaloma on sonography. All 3 cases had a spherical mass with an interrupted eggshell calcification on gray scale sonography and CT; 2 revealed intranodular vascularity on PD sonography, and 1 showed intense hypermetabolism (maximum standardized uptake value, 7.9 g/mL) on integrated ¹⁸F‐FDG whole‐body PET/CT. Conclusions. Follicular carcinoma should be considered in the differential diagnosis of a thyroid nodule with an eggshell calcification.     

Sonography of subacute thyroiditis: changes in the findings during the course of the disease

Fifteen patients with subacute thyroiditis were studied with thyroid sonography. There were local hypoechoic areas in all patients during the active phase of the disease. Among 6 patients who underwent follow-up studies during the course of treatment, 3 had recurrence or aggravation of clinical symptoms such as painful swelling of the thyroid region, which was associated with, and sometimes preceded by, spread or reappearance of the sonographic abnormality. All 6 patients showed complete disappearance of the hypoechoic area when they were in remission. The thyroid sonography is useful not only for the initial diagnosis but also for the follow-up of these patients during the course of the disease.     

定量CT对比观察轻-中度慢性阻塞性肺疾病及哮喘

目的 观察稳定期轻-中度慢性阻塞性肺疾病（COPD）与哮喘患者近端气道结构及CT肺功能的差异。方法 对30例轻-中度COPD患者（mtmCOPD组）、30例轻-中度哮喘患者（mtmAs组）及30名健康对照者（健康对照组）行低剂量呼吸双相CT扫描及定量分析，比较其近端气道参数、肺气肿及空气潴留指数的差异。结果 mtmCOPD组与mtmAs组近端气道平均管腔面积（LA）/体表面积（BSA）分别为（10.93±2.58）mm²/m²和（10.81±3.20）mm²/m²，均小于健康对照组的（12.56±2.98）mm²/m²，mtmAs组与健康对照组差异有统计学意义（P=0.04）；mtmCOPD组和mtmAs组平均管壁面积百分比（WA%）分别为（63.02±2.34）%和（63.85±2.48）%，均大于健康对照组的（61.55±3.54）%，mtmAs组与健康对照组差异有统计学意义（P<0.01）。mtmCOPD组呼吸双相VI_-910（%）及VI_-950（%）均大于健康对照组（P均<0.01），呼气相平均肺密度（MLD）绝对值、呼气相VI_-856（%）及MLD E/I均大于健康对照组（P均<0.05）。mtmCOPD组与mtmAs组气道结构参数、肺气肿及空气潴留指数差异均无统计学意义（P均>0.05）。结论 轻-中度COPD及哮喘患者近端支气管管腔面积较健康对照者均有缩小，近端气道管壁面积百分比较健康对照者均有增大，且轻-中度哮喘患者更加明显。轻-中度COPD患者存在明显肺气肿及空气潴留。     

超声多因素分析预测甲状腺髓样癌

目的 筛选超声独立预测甲状腺髓样癌（MTC）征象，并分析其诊断效能。方法 选取经病理证实的24例MTC（29个病灶）及同期45例甲状腺良性结节患者（49个病灶），回顾性分析患者性别及超声征象，包括病灶形态、单发与多发、双侧与单侧、边缘、内部回声、内部成分、微钙化、纵横比及血流状况。采用单因素和多因素Logistic回归分析筛选MTC的独立预测因素，计算比值比（OR）及其95%置信区间（CI）。绘制受试者工作特征（ROC）曲线，计算MTC与甲状腺良性结节之间差异有统计学意义因素的曲线下面积（AUC）。结果 多发结节、双侧发病、结节纵横比>1在MTC与甲状腺良性结节之间差异均无统计学意义（P均>0.20）；甲状腺结节血流丰富、低回声、内部微钙化为MTC独立危险预测因素（P均<0.05）。AUC值显示低回声、血流状况、形态不规则、微钙化、边缘不规则诊断MTC效能中等，其中低回声的诊断效能相对较好[AUC=0.77，95%CI（0.68，0.89）]。结论 不同超声征象对MTC的诊断效能不同，甲状腺结节血流丰富、低回声、内部微钙化可作为鉴别诊断MTC与甲状腺良性结节的参考。