Versatile,Reusable, and Inexpensive Ultrasound Phantom Procedural Trainers

We have constructed simple and inexpensive models for ultrasound‐guided procedural training using synthetic ballistic gelatin. These models are durable, leak resistant, and able to be shaped to fit a variety of simulation scenarios to teach procedures. They provide realistic tactile and sonographic training for our learners in a safe, idealized setting.     

A rare giant placental chorioangioma with favorable outcome: A case report and review of the literature

We describe a rare giant placental chorioangioma in a patient who had a favorable outcome with close prenatal surveillance in a 28‐year‐old primigravida who was referred to our clinic for ultrasound evaluation of a suspected placental mass at 23 weeks' gestation. A detailed ultrasound scan revealed a well‐circumscribed, echogenic lesion measuring 11.0 × 10.3 × 7.3 cm and protruding into the amniotic cavity. A diagnosis of placental chorioangioma was made and intensive prenatal surveillance was scheduled. A small‐for‐gestational age (2,325 g) but normal female neonate was delivered at 37 weeks by cesarean section and discharged from hospital on the second day of the delivery. A giant chorioangioma may not cause any adverse effect to the fetus and may not require any medication or invasive intervention. © 2014 Wiley Periodicals, Inc. J Clin Ultrasound 43 :254–256, 2015     

Comparison of Sonography and Magnetic Resonance Imaging for Spring Ligament Abnormalities

Objective. The purpose of this study was to determine whether sonography is as accurate as magnetic resonance (MR) imaging for depicting abnormalities of the spring ligament in patients with symptomatic posterior tibial tendon (PTT) dysfunction. Methods. Sixteen patients (18 ligaments) with symptomatic PTT dysfunction were prospectively evaluated with sonography and MR imaging. Results. Magnetic resonance imaging showed spring ligament tears in 8 of 18 feet, including 6 incomplete tears and 2 complete tears. Sonography showed spring ligament tears in 7 of 18 feet, including 6 incomplete tears and 1 complete tear. The findings of sonography and MR imaging were concordant in 17 of 18 feet (94%). Six of the 8 spring ligament tears on MR imaging were associated with posterior tibial tendinosis or tears. Conclusions. Sonography is an effective imaging option in assessing spring ligament abnormalities in patients with symptomatic PTT dysfunction.     

Feasibility and accuracy of Doppler echocardiographic estimation of pulmonary artery occlusive pressure in the intensive care unit

Mitral inflow and pulmonary vein inflow variables have been shown to relate to left ventricular filling pressures. However, the feasibility and accuracy of Doppler estimation of pulmonary artery (PA) occlusive pressure in the intensive care unit have not been previously assessed. Accordingly, 67 consecutive patients in intensive care units who had PA catheters underwent Doppler recordings of mitral inflow, pulmonary vein flow, and isovolumic relaxation time (IVRT). Thirty-six patients met Doppler inclusion criteria. Most exclusions were due to atrial fibrillation, merging of peak velocity during early diastole (E) and atrial contraction (A) mitral flow velocities, and inadequate recordings. Mean age (±SD) was 65 ± 12 years, ejection fraction varied between 19% and 80%, and 45% of patients were on mechanical ventilation. Doppler-derived variables were related to occlusive pressure (mean 16 ± 6 mm Hg, range 6 to 40), and the most significant variables were entered into a multiple linear regression analysis. The derived relation was tested in 30 repeat studies after a variety of hemodynamic interventions and in a prospective group of 32 additional patients (mean age 63 ± 11.6 years, pressure range 7 to 28 mm Hg). The highest correlations with occlusive pressure were observed with the E/A ratio (r = 0.75), IVRT (r = −0.55), atrial filling fraction (r = −0.65), and deceleration time (r = −0.50). Pulmonary venous recording could be obtained in only 16% of patients. The best model was with E/A and IVRT: PA occlusive pressure = 17 + (5.3 E/A) − (0.11 IVRT), r = 0.79. In the group with repeat studies, a significant correlation was observed between predicted and observed changes in occlusive pressure (r = 0.87), with a mean difference between pressure changes of 0.4 ± 3 mm Hg. Similarly, in the prospective group, a significant correlation was observed between measured and Doppler-derived occlusive pressures (r = 0.88). Of the total 112 patients screened, Doppler estimation of occlusive pressure could be performed in 63%. Estimation of PA occlusive pressure is therefore feasible by Doppler in approximately two thirds of adult patients in intensive care units and may significantly contribute to management of the critically ill patient.