Morton neuroma: sonographic evaluation

One hundred consecutive patients with symptoms suggestive of Morton neuroma were examined with sonography, and 134 intermetatarsal masses were demonstrated. Forty-five patients underwent surgical exploration, which revealed Morton neuromas. The typical sonographic appearance is that of an ovoid, hypoechoic mass oriented parallel to the long axis of the metatarsals. Most masses were between the second and third or third and fourth metatarsals and seemed to produce symptoms when reaching a diameter of 5 mm.     

Shoulder impingement syndrome: sonographic evaluation

A method of shoulder sonography in which lateral and anterior elevation of the arm is used during scanning was demonstrated to be effective in cases of suspected impingement syndrome. The value of the method lies in its ability to demonstrate fluid collection in the subacromial-subdeltoid bursal system, with gradual distention of the bursa and lateral pooling of fluid to the subdeltoid portion while the arm is elevated. In 102 of 381 patients studied, surgical diagnosis was available for correlation. Among this group there were seven false-negative and three false-positive sonographic findings. A comparison of sonographic with surgical findings demonstrated a sensitivity of 81% and a specificity of 95% in stages I-III, and a sensitivity of 71% and a specificity of 96% in early stages I and II of the impingement syndrome. The results of dynamic shoulder sonographic examination with fluoroscopic radiography provide valuable information in patients with suspected early-stage impingement syndrome.     

Dynamic sonographic evaluation of peroneal tendon subluxation

OBJECTIVE: Peroneal tendon subluxation is a major cause of posttraumatic lateral ankle pain. Because peroneal subluxation often occurs only when the foot is dorsiflexed and everted, findings on static imaging studies may appear to be normal. We therefore evaluated the effectiveness of sonography in revealing peroneal tendon subluxation in patients performing stress maneuvers. MATERIALS AND METHODS: From June 2001 to June 2003, 13 consecutive patients (10 females and three males; mean age, 30.4 years; age range, 16-66 years) in whom peroneal tendon subluxation was clinically suspected were scanned with a high-frequency linear array transducer by an experienced sonologist. The ankles in 10 asymptomatic volunteers were also scanned. Sequential axial and longitudinal sonograms of the peroneus longus and peroneus brevis tendons at rest were obtained and evaluated for tendinitis and tendon tears. Real-time axial sonograms were then obtained while the foot was dorsiflexed and everted. Of the 13 patients, 12 had sonographic findings of peroneal tendon subluxation and underwent surgical exploration. The sonographic and surgical reports of these 12 patients were compared. RESULTS: All 12 patients with sonographic findings of peroneal tendon subluxation were subsequently found to have subluxation at surgery. The positive predictive value of dynamic sonography for peroneal tendon subluxation was therefore 100%. Sonography revealed peroneus brevis tendon tears in five patients and a peroneus longus tear in one; all findings were confirmed at surgery, with no false-positive sonograms. Only four of the 20 asymptomatic ankles showed subluxation, and none had any other tendon abnormalities. CONCLUSION: Sonography is an effective technique for diagnosing peroneal tendon subluxation, as well as associated tears of the peroneal tendons.     

Second-generation sonographic contrast agents in the evaluation of renal trauma

PURPOSE: The purpose of this study was to define the indications, diagnostic accuracy and limitations of second-generation sonographic contrast agents in the evaluation of patients with renal trauma. MATERIALS AND METHODS: Between March 2004 and April 2005, 277 patients with blunt abdominal trauma were evaluated. Twenty-eight out of 277 patients had renal lesions, the severity of which was graded according to the organ injury severity scale of the American Association for the Surgery of Trauma (AAST). All the patients enrolled in the study had minor trauma and were evaluated with baseline ultrasound (US), contrast-enhanced US after injection of a second-generation contrast agent (SonoVue) and, if positive, with multiphasic multidetector computed tomography (MDCT). RESULTS: Five out of 28 traumatic parenchymal lesions with perirenal fluid collection were identified at baseline US. All 28 renal parenchymal lesions, with or without perirenal or retroperitoneal haematoma, were identified at contrast-enhanced US. Multiphase MDCT confirmed all the cases that were positive at contrast-enhanced US and demonstrated the integrity of the urinary tract in the delayed phase. CONCLUSIONS: Our experience confirmed the diagnostic accuracy of second-generation sonographic contrast material both for diagnosis and for appropriate patient management. In particular, contrast-enhanced sonography proved to be a reliable technique for the evaluation and follow-up of low-grade renal injuries. Its main advantage is reduced radiation exposure, as fewer MDCT examinations are needed, whereas its limitation is the high cost of the technique if used in unselected patients.     

Severe nonimmune hydrops fetalis: sonographic evaluation

Reported survival rates in nonimmune hydrops fetalis vary considerably. Among 27 fetuses exhibiting severe sonographic features of nonimmune hydrops fetalis, 33% survived the neonatal period. For five of the nine survivors, the prognosis remains uncertain or poor. On the basis of sonographic features alone neither prognosis nor potential survivors were reliably predicted.     

Amyotrophic lateral sclerosis: sonographic evaluation of dysphagia

Purpose

The authors sought to determine the role of video ultrasonography (VUS) in the diagnostic assessment of dysphagia in patients with amyotrophic lateral sclerosis (ALS).

Materials and methods

Nine patients underwent simultaneous static and dynamic VUS examination and videofluoroscopy (VFS) of swallowing.

Results

At the static phase, VUS showed 5/9 patients had lingual atrophy. Abnormal bolus position was observed in 6/9 patients at VUS and 3/9 at VFS. Both techniques identified an inability to keep the bolus in the oral cavity in 4/9 patients. At the dynamic phase, reduced lingual movement was observed in 5/9 patients at VUS and 2/9 at VFS. Disorganised tongue movement was seen in 3/9 patients at VUS and in 2/9 at VFS. Fragmented swallowing was only visualised at VUS. Stagnation of ingested material was never visualised at VUS, whereas it was clearly depicted in 2/9 patients at VFS.

Conclusions

VUS can be integrated into the diagnostic protocol for evaluating swallowing in patients with ALS, as it has higher sensitivity than VFS in assessing the dynamic factors that represent the early signs of dysphagia.     

Visualization of the uterus on evaluation of transplanted kidneys

A vascular blush was noted in the pelvis during flow studies in two women with kidney transplants. The vascular structure was noted to be due to the uterus. In one patient, the activity in the area of the uterus could have been mistaken for excretion of agent into the bladder.     

Significance of membrane thickness in the sonographic evaluation of twin gestations

A retrospective study of 55 twin pregnancies was performed to determine the role of sonography in distinguishing between dichorionic and monochorionic diamniotic gestations solely by evaluating the thickness of the membrane between the fetuses. The presence of a thick dividing membrane indicated a dichorionic diamniotic gestation in 38 (90%) of 42 cases in which it was identified. Inability to identify a membrane between dichorionic diamniotic twins occurred most commonly during the third trimester. A thin membrane indicated monochorionic diamniotic twinning and was seen in three (25%) of 12 cases. Membrane thickness was indeterminate in one case. Therefore, on the basis of the thickness of the dividing membrane imaged by sonography, dichorionic diamniotic gestations can be distinguished from monochorionic diamniotic gestations. Inability to show a separating membrane by sonography, however, can occur with any form of twin gestation, particularly in the third trimester. Membrane thickness should be used in conjunction with other sonographic criteria to predict the amnionicity and chorionicity of twin gestations.     

Breast masses. Mammographic and sonographic evaluation.

Asymmetric breast tissue can nearly always be distinguished from a true mass by means of mammographic evaluation. Stellate masses from early invasive breast cancer are often extremely subtle so that optimal technique and meticulous interpretation are essential. Benign stellate masses such as post-biopsy scarring and fat necrosis frequently have a characteristic appearance. A radial scar is usually indistinguishable from malignancy on the mammogram. Nearly all circumscribed masses are benign and are usually cysts, fibroadenomas, or intramammary lymph nodes. A few circumscribed masses represent in situ or invasive carcinoma or both. Characteristics that may allow a definitively benign diagnosis for a circumscribed mass include the presence of fat and certain calcification patterns on the mammogram and features of a simple cyst on the sonogram. Management decisions for other circumscribed masses will depend on characteristics such as shape, margins, calcification, multiplicity, size, stability, and sonographic features as well as patient age and risk factors. Most nonspecific circumscribed masses should be followed rather than biopsied as they are commonly present on mammograms and have a change of malignancy of less than 5%. Even when biopsied on the basis of interval change, most small circumscribed cancers will not have metastasized to the regional nodes. For palpable breast masses, selection of mammography or ultrasonography as the primary imaging modality will depend on patient's age and risk factors.     

Contracture of the deltoid muscle: sonographic evaluation with MRI correlation

OBJECTIVE: This article evaluates the sonographic features of deltoid contracture (DC) with MRI correlation. MATERIAL AND METHODS: Two reviewers evaluated the imaging features in 22 painful shoulders of 20 patients with a sonographic diagnosis of DC and a subsequent confirming MRI study. The sonographic and MRI findings with regard to the lesion extent (assessed by a 3-point scale: 1 = less than or equal to one third of the longitudinal deltoid length involved, 2 = greater than one third and less than or equal to two thirds involved, and 3 = greater than two thirds involved), transverse lesion morphologic appearance, and maximal transverse diameter measured were compared with kappa statistics and Wilcoxon's signed rank test, respectively. RESULTS: Compared with MRI, there were two false-positive diagnoses of DC on sonography. Among the 20 true-positive diagnoses, sonography showed good agreement with MRI in assessing the lesion extent (kappa = 0.796, p < 0.001). Three sonographic lesion morphologic patterns for hyperechoic lesions (I = with multiple < 8-mm hypoechoic spots, II = heteroechoic lesions with predominant 8-15-mm hypointense areas, and III = > 15-mm calcified nodules, respectively) showed excellent agreement with three MRI lesion patterns (I = multiple < 8-mm hypointense spots, II = predominant 8-15-mm hypointense areas, and III = > 15-mm hypointense nodules, respectively) (kappa = 0.921, p < 0.001). However, the maximum lesion diameters appeared significantly larger on sonography than on MRI (2.8 +/- 0.6 cm vs 2.0 +/- 0.8 cm, mean +/- SD; p < 0.001), which was plausibly ascribed to the better sonographic delineation of hyperechoic immature fibrotic tissues. CONCLUSION: Sonography is helpful for evaluating DC and correlates well with MRI.     

A review of sonographic evaluation of renal transplant complications

In this article, we present an overview of renal transplantation with its complications and discuss the abilities and limitations of ultrasound in evaluating these complications. We included renal transplants performed at our institution between 1993 and 2006 and gathered data on more than 1,000 patients who developed graft dysfunction. We analyzed the ultrasound findings in different posttransplant complications and compared our findings with those in published literature. We present this review article that elaborates and categorizes various transplant complications from an ultrasound perspective. Based on imaging evaluation, the complications of renal transplantation can be divided into four major categories: peri-renal, renal parenchymal, renal collecting system, and renal vascular complications. Common complications included acute tubular necrosis, graft rejection, drug nephrotoxicity, hematoma, lymphocele, urinoma, hydronephrosis, and vascular complications. Ultrasound has a key role in identification and management of most of these complications. However, some parenchymal complications may only be diagnosed on renal biopsy. Ultrasound is a very powerful screening tool to assess renal transplant dysfunction and has a primary role in early diagnosis and management of structural and vascular complications, which may need surgical intervention to save the graft.     

Sciatic nerve: sonographic evaluation and anatomic-pathologic considerations

Sonographic analysis of the sciatic nerve was performed in vitro (anatomic specimen), in vivo (healthy volunteers), and in 16 patients with suspected peripheral sciatic nerve lesions. The ultrasound (US) examinations were performed with standard and high-resolution US equipment with linear-array configuration. The normal nerve displayed an echogenic fibrillar texture with round cross-sectional structure on both in vitro and in vivo sonograms. Satisfactory delineation of the nerve was obtainable in all cases. Nerve displacement was the main sonographic finding in cases of extrinsic compression. The lesion displayed variable echotexture, ranging from hypoechogenicity or mixed echogenicity in hematomata to hyperechogenicity in cases of fibrosis. Primary nerve tumors (neurofibroma) or infiltrating tumors (desmoid) caused clear disruption of the nerve structure. Use of sonography enabled assessment of the continuity of the nerve margins with the interposed graft in a case of reconstructive surgery. The potential to image sciatic nerve lesions noninvasively may have an important impact on diagnosis, treatment, and prognosis in symptomatic patients.