Comparison of Single Versus Multiple Echogenic Foci in the Fetal Heart Regarding Risk of Aneuploidy

Objective. The purpose of this study was to investigate whether multiple echogenic cardiac foci (ECF) are associated with an increased risk of fetal trisomy 21 in our patient population. Methods. During a span of 38 months, all women found to have an ECF on obstetric sonography were identified as study patients and grouped into single‐ and multiple‐ECF groups. Age‐ and race‐matched patients were identified as a control group. Fetal anatomic sonographic examinations were assessed for other markers of aneuploidy and major abnormalities. The baseline risk for trisomy 21 was assessed by maternal serum screening or age alone if no serum screening had been performed. Trisomy 21 was assessed by amniocentesis or clinically at birth. Both univariate and multivariate analyses were used to assess for associations with trisomy 21. Results. Six of 71 patients (8.5%) with multiple ECF and 1 of 171 patients (0.6%) with a single ECF had trisomy 21. One of 242 control patients (0.4%) had trisomy 21. Logistic regression found multiple ECF (P < .008), the presence of a major finding or multiple minor findings (P = .0012), and a baseline risk for trisomy 21 of greater than 1 in 100 (P = .003) as independent associations with trisomy 21. Conclusions. Our results suggest that finding multiple ECF is a stronger predictor of trisomy 21 than what is described for a single ECF.     

Methamphetamine use can mimic testicular torsion

We report the case of a patient presenting with the classic clinical appearance of testicular torsion. Ultrasound showed testicular ischemia supporting the clinical diagnosis, but the lack of visualization of spermatic cord torsion was of concern. An attempt of clinical detorsion was considered unsuccessful and the patient was explored. No torsion was found. On postoperative review of the patient's medical history, we found methamphetamine use, with a positive urine test at the time of his emergent consultation for the scrotal pain episode. The use of amphetamines has been previously reported as the cause of ischemia of multiple organs, but we could not find previous reports of involvement of the testis mimicking torsion. © 2013 Wiley Periodicals, Inc. J Clin Ultrasound 41 :461–463, 2013     

Spinal sonography and magnetic resonance imaging in patients with repaired myelomeningocele: comparison of modalities.

The goals of this study were to evaluate the feasibility of using ultrasonography of the spine in the follow-up evaluation of patients with repaired myelomeningocele at birth and to compare sonography with the accepted modality of magnetic resonance imaging. Over a period of 4 years we performed 165 sonographic studies in 101 patients; 107 sonographic studies had MR imaging results for comparison. We collected our data prospectively. The quality of the sonograms was good in 110 of 129 studies, acceptable in 17 of 129, and poor in two of 129. The sonographic examinations failed in 33 of 165 studies (20%). Concordant information was obtained between ultrasonography and magnetic resonance imaging in the following percentage of studies: level of the distal end of the cord in 82%, position of the cord in the canal in 59%, presence of hydromyelia in 63%, cord duplication in 96%, adhesions in 16%, intradural mass in 37%, cord measurements in 85%, and dural sac measurements in 83%. At the lumbosacral level, we saw no cord pulsation in 57% of the studies in patients with cord adhesions and in 20% of those without adhesions. At the lower thoracic level, we saw no pulsation in 35% of the studies in patients with cord adhesions and in 7% of those without adhesions. Postoperative studies of cord release surgery in eight patients showed varied findings. We conclude that in those patients who have a spinal defect or interlaminar space allowing proper visualization of the lumbosacral spinal canal, ultrasound can provide fairly similar information to that obtained with magnetic resonance imaging of that area with no need for sedation and at a reduced cost. Ultrasonography seems more sensitive than magnetic resonance imaging in the detection of cord adhesions, which is particularly relevant in the diagnosis of tethering.     

Endometrial microcalcifications detected by ultrasonography: clinical associations, histopathology, and potential etiology.

Endometrial microcalcifications are uncommon, with alleged clinical implications ranging from innocuous to ominous. We reviewed the histopathologic slides from 29 patients who had endometrial echogenic foci on pelvic ultrasound and found many endometrial microcalcifications. The extent of microcalcifications in each specimen was graded on a semiquantitative scale from 0 to 3. The mean patient age was 54 years (range, 34-81 years). The specimens included endometrial biopsies, curettages, and hysterectomies. Most of the patients had presented with abnormal vaginal bleeding. Fifteen patients (51.7%) were postmenopausal, 10 (34.5%) were premenopausal, and the rest were perimenopausal. The most frequent endometrial types were atrophic (39.5%), inactive (23.3%), and proliferative (14%). Six specimens (14%) showed benign endometrial polyps. One patient had well-differentiated endometrioid carcinoma of the endometrium without myometrial invasion. Specimens from 16 patients (55.2%) had microcalcifications. The patients with calcifications were older than those without calcifications (mean age, 60 vs. 47 years, respectively; P = 0.017). The extent of microcalcifications positively correlated with the presence of endometrial polyps (P = 0.00076), postmenopausal state (P = 0.004), atrophic endometrium (P = 0.002), and hormone replacement therapy (P = 0.013). The microcalcifications were concentric or amorphous, intraglandular or stromal. They were focally associated with minute papillary epithelial projections or with degenerated endometrial glands. Follow-up was available on 26 patients (89.7%). Except for the patient with endometrioid carcinoma, none has developed uterine, adnexal, or peritoneal malignancy. In summary, endometrial microcalcifications are histologically heterogeneous and are associated with older patient age, postmenopausal state, atrophic endometrium, and endometrial polyps. Those found incidentally by means of pelvic ultrasonography, in our experience, did not portend malignancy.     

Sonographic appearance of a dermoid cyst (mature cystic teratoma) of the spleen

Splenic dermoids are rare, with few published case reports and no ultrasound images in the English literature. We report the case of a 57‐year‐old woman with that diagnosis and illustrate it with ultrasound, CT, and pathology images. We discuss the differential diagnosis of solid splenic lesions. © 2014 Wiley Periodicals, Inc. J Clin Ultrasound, 43 :132–134, 2015     

Imaging of subcapsular hepatic and renal hematomas in pregnancy complicated by preeclampsia and the HELLP syndrome

The purpose of this report is to provide an illustrative case of spontaneous hepatic and renal hematomas that occurred during a pregnancy complicated by preeclampsia and the HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome. The sonographic and computed tomographic findings included intrahepatic, subcapsular hepatic, and extracapsular perihepatic hematomas in addition to a large subcapsular renal hematoma. Since hepatic and renal hematomas that occur in association with preeclampsia and the HELLP syndrome are rare but potentially life‐threatening complications, prompt laboratory and radiologic evaluations are essential and may reduce the associated morbidity and mortality. © 1999 John Wiley & Sons, Inc. J Clin Ultrasound 27:35–40, 1999.