Power Doppler imaging in preoperative planning and postoperative monitoring of muscle flapsLoh, Nyu‐nyu; Ch'en, Ian Y.; Olcott, Eric; Jeffrey,, R. Brooke; Hui, Kenneth C.; Persons, Barbara; Lineaweaver, William C.
doi: 10.1002/(SICI)1097-0096(199711/12)25:9<465::AID-JCU1>3.0.CO;2-Lpmid: 9350564
Purpose We assessed the utility of power Doppler imaging (PDI) in preoperative planning and postoperative evaluation of microvascular tissue transfers. Methods Twenty‐five PDI studies were performed on 23 patients using a 5–10‐MHz linear‐array transducer. Thirteen patients were assessed preoperatively for patency of the desired donor vessel; 8 of them had surgical scars overlying the desired vascular territory. Twelve patients (including 2 from the first group) were evaluated postoperatively for patency of the vascular anastomoses and adequacy of the blood supply to the transferred tissue. Results Twelve of the 13 patients assessed preoperatively had successful flap transfers. Four of the 8 patients with scars over the desired vascular territories had absent or aberrant arteries, necessitating a change in the operative plan. None of these patients had operative complications. Eight of the 12 patients scanned postoperatively had patent anastomoses. In 2 of these patients, impending surgery was averted when the adequacy of the tissue blood supply was established with PDI. In 4 patients, PDI showed arterial or venous compromise, which was confirmed at surgery. Conclusions PDI is a useful technique in microsurgical tissue transfer for assessing the patency of desired donor vessels preoperatively and for postoperative evaluation of blood supply. © 1997 John Wiley & Sons, Inc. J Clin Ultrasound 25: 465–471, 1997.
Gray‐scale and color flow sonography of pancreatic ductal adenocarcinomaYassa, Nabil A.; Yang, Jason; Stein, Sharon; Johnson, Meade; Ralls, Philip
doi: 10.1002/(SICI)1097-0096(199711/12)25:9<473::AID-JCU2>3.0.CO;2-Kpmid: 9350565
Purpose Current sonographic technology has enhanced imaging. This study analyzes the sonographic findings in a large series of patients with pancreatic ductal adenocarcinoma. Methods The sonograms of 62 patients with pathologically confirmed pancreatic ductal adenocarcinoma were retrospectively analyzed. Results Tumors were an average of 4.5 × 3.5 cm in cross section. The largest lesion was 14.0 × 9.0 cm, and the smallest was 1.8 × 1.1 cm. Forty‐three tumors (69%) were located in the head of the pancreas, 1 (2%) at the junction of the head and body, and 16 (26%) in the body or tail; 2 lesions (3%) were diffuse. Tumors were ovoid or spherical in 37 patients (60%) and irregular in 25 (40%). Forty tumors (65%) markedly deformed the shape of the gland. Six lesions (10%) caused no glandular contour abnormality and were visualized only because tumor echogenicity differed from that of the normal pancreas. Thirty‐four tumors (55%) were homogeneously hypoechoic compared with the normal pancreas, 2 (3%) were homogeneously hyperechoic, 1 (2%) was iso‐echoic, and 25 (40%) had heterogeneous echotextures. Many of the heterogeneous tumors were predominantly hypoechoic with areas of varied echogenicity. Calcifications were noted in 4 patients (6%) and small intratumoral cystic areas in 9 patients (15%). Postobstructive pseudocysts were found in 4 patients (6%). Color Doppler flow information was available for 19 patients; internal flow was detected in only 1 tumor (5%). Vascular occlusion was found in 3 patients and circumferential vascular encasement in 8; the tumors in these patients were unresectable. Tumors were noted to touch vessels in another 6 patients. Conclusions Current sonographic equipment allows the demonstration of new findings in pancreatic carcinoma. Color Doppler sonography can define tumor involvement of blood vessels and potentially affect clinical staging and treatment decisions. © 1997 John Wiley & Sons, Inc. J Clin Ultrasound 25: 473–480, 1997.
Color Doppler imaging of paragangliomas in the neckJansen, Jeroen C.; Baatenburg de Jong, Robert J.; Schipper, Jaap; van der Mey, Andel G. L.; van Gils, Adrian P. G.
doi: 10.1002/(SICI)1097-0096(199711/12)25:9<481::AID-JCU3>3.0.CO;2-Jpmid: 9350566
Purpose In this study, we describe the color Doppler imaging findings in carotid body tumors and vagal body tumors. Methods B‐mode and color Doppler imaging were performed on 17 patients who had a total of 25 previously diagnosed paragangliomas (14 carotid body tumors and 11 vagal body tumors). Results Nineteen of 25 tumors were depicted. Five small vagal body tumors in the region of the nodose ganglion and 1 carotid body tumor could not be depicted. With B‐mode imaging, paragangliomas appeared as well‐defined, solid, hypoechoic masses. With color Doppler imaging, hypervascularity with a low‐resistance flow pattern was demonstrated in all but 1 of the 19 tumors. Conclusions The use of color Doppler imaging in the workup of an ambiguous neck mass is advocated. © 1997 John Wiley & Sons, Inc. J Clin Ultrasound 25: 481–485, 1997.
Detection of congenital müllerian duct anomalies using three‐dimensional ultrasoundWu, Meng‐Hsing; Hsu, Chao‐Chin; Huang, Ko‐En
doi: 10.1002/(SICI)1097-0096(199711/12)25:9<487::AID-JCU4>3.0.CO;2-Jpmid: 9350567
Purpose The purpose of this study was to assess the value of 3‐dimensional sonography in the diagnosis of congenital müllerian duct anomalies, which cause infertility, preterm labor, and first trimester abortion. Methods A prospective study was undertaken in which 40 patients with histories of repeated spontaneous abortions or infertility were first examined using conventional 2‐dimensional sonography or hysterosalpingography. Three‐dimensional transvaginal sonography was then performed. Results Twenty‐eight women had müllerian duct abnormalities, and 12 women had normal uterine anatomy. Müllerian duct defects detected in this study were unicornuate uterus (3), bicornuate uterus (3), complete or partial septate uterus (12), arcuate uterus (9), and didelphic uterus (1). The diagnosis of müllerian duct anomalies in these patients was confirmed by laparoscopic and/or hysteroscopic examinations. Three‐dimensional sonography demonstrated all congenital uterine abnormalities with a sensitivity and specificity of 100%. Separate uterus and bicornuate uterus could be correctly diagnosed using 3‐dimensional sonography in 11 (92%) of 12 cases and 3 (100%) of 3 cases, respectively. These 2 abnormalities were commonly confused with each other using hysterosalpingography and conventional sonography. Conclusions Three‐dimensional sonography with image reconstruction is less expensive and less invasive than hysterosalpingography for the assessment of uterine anatomy and diagnosis of müllerian duct abnormalities. The ability to visualize both the uterine cavity and the myometrium on a 3‐dimensional scan facilitates the diagnosis of uterine anomalies and enables the differentiation of septate from bicornuate uteri for preoperative surgical planning. © 1997 John Wiley & Sons, Inc. J Clin Ultrasound 25: 487–492, 1997.
Clinical significance of echogenic foci in fetal lungsPetrikovsky, Boris; Schneider, Elizabeth P.; Klein, Victor R.; Gross, Beth
doi: 10.1002/(SICI)1097-0096(199711/12)25:9<493::AID-JCU5>3.0.CO;2-Ipmid: 9350568
Purpose We reviewed our experience with echogenic foci in fetal lungs. Methods During the period January 1991 through December 1995, 16,292 patients underwent comprehensive ultrasound examinations between 16 and 42 weeks of pregnancy. Echogenic foci in the lungs were identified in 8 fetuses. All 8 underwent karyotyping, fetal echocardiography, screening for infectious agents, and follow‐up sonography. The neonatal outcome was obtained in each case. Results The 5 fetuses in whom echogenic foci in the lungs were the only abnormal finding all had normal outcomes. One fetus had echogenic foci identified in 1 lung and the abdomen. This fetus tested positive for cytomegalovirus, and the pregnancy was terminated. Two fetuses with echogenic foci in the lungs had associated anomalies: 1 had an omphalocele, and the other had cerebral ventriculomegaly. Both of these pregnancies were terminated. Conclusions In our series, isolated echogenic pulmonary foci were rare findings that carried a good prognosis. When echogenic foci in the lungs are identified, careful evaluation for associated abnormalities is warranted. © 1997 John Wiley & Sons, Inc. J Clin Ultrasound 25: 493–495, 1997.
Femoral artery pseudoaneurysm: Doppler sonographic features predictive for spontaneous thrombosisSamuels, D.; Orron, D. E.; Kessler, A.; Weiss, J.; Kaufman, B.; Miller, H.; Graif, M.
doi: 10.1002/(SICI)1097-0096(199711/12)25:9<497::AID-JCU6>3.0.CO;2-Ipmid: 9350569
Purpose The objective of this prospective study was to evaluate whether Doppler imaging characteristics can be used to predict spontaneous thrombosis of femoral artery pseudoaneurysms (PAs). Methods Eleven post‐cardiac catheterization PAs were monitored with color Doppler sonography. Total volume of the lesion, volume filled with free‐flowing blood, length and width of the neck of the PA, and its anatomic position were evaluated. Results All of the PAs in our series underwent spontaneous thrombosis. PAs with necks 0.9 cm or longer underwent spontaneous thrombosis in 9.8 days on average, while PAs with necks shorter than 0.9 cm required an average of 52 days to thrombose. Conclusions PAs with longer neck lengths are more likely to thrombose in a shorter period than are those with shorter necks. It may thus be worthwhile to await spontaneous resolution when the aneurysmal neck length is 0.9 cm or more. © 1997 John Wiley & Sons, Inc. J Clin Ultrasound 25: 497–500, 1997.
Unilateral testicular microlithiasis associated with a seminomaVrachliotis, Thomas G.; Neal, David E.
doi: 10.1002/(SICI)1097-0096(199711/12)25:9<505::AID-JCU8>3.0.CO;2-Rpmid: 9350571
Unilateral testicular microlithiasis is an uncommon entity that is important because of its association with malignancy. We describe a case in which the initial clinical presentation was that of metastatic cervical lymphadenopathy. Subsequent sonographic examination of the testes revealed right testicular microlithiasis and a small, hypoechoic, ill‐defined mass, which proved to be a seminoma. Since testicular microlithiasis is highly associated with testicular malignancy, it cannot be considered a benign condition. Sonographic follow‐up examinations are warranted in patients with testicular microlithiasis to detect the possible development of malignancy. © 1997 John Wiley & Sons, Inc. J Clin Ultrasound 25: 505–507, 1997.
Klinefelter's syndrome associated with testicular microlithiasis and mediastinal germ‐cell neoplasmAizenstein, Robert I.; Hibbeln, John F.; Sagireddy, Babureddy; Wilbur, Andrew C.; O'Neil, Howard K.
doi: 10.1002/(SICI)1097-0096(199711/12)25:9<508::AID-JCU9>3.0.CO;2-Rpmid: 9350572
Klinefelter's syndrome is a genetic disorder of male sexual differentiation characterized by an XXY karyotype. Although considered a benign condition, it is associated with several types of malignancies, including mediastinal germ‐cell neoplasm. In addition, Klinefelter's syndrome has been rarely associated with testicular microlithiasis. Whereas patients with Klinefelter's syndrome have an increased incidence of extragonadal germ‐cell neoplasms, patients with testicular microlithiasis have a predisposition to testicular germ‐cell neoplasms. To our knowledge, an extragonadal germ‐cell neoplasm has not been previously described in association with testicular microlithiasis. We present a patient with 2 unusual conditions, both of which are independently associated with Klinefelter's syndrome: mediastinal germ‐cell neoplasm and testicular microlithiasis. © 1997 John Wiley & Sons, Inc. J Clin Ultrasound 25: 508–510, 1997.