An Inexpensive and Easy-to-Make Simulation Model of Biliary Ultrasound That Mimics Normal Anatomy and Abnormal Biliary Conditions
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Simulation training in sonography has been shown be an effective method of teaching and assessing user competency in image acquisition/interpretation and performance of procedures. Gallbladder simulation models that are currently commercially available are entire torso section phantoms, are generally expensive to obtain, and require maintenance. We have developed a sonographic gallbladder simulation model constructed using readily available and inexpensive materials. Models were created of normal gallbladder anatomy as well as various gallbladder pathologies such as cholelithiasis, biliary sludge, and thickening of the gallbladder wall. This model can be used to train users both to obtain and interpret sonographic images of the gallbladder. (Source: Journal of Diagnostic Medical Sonography...
Sonographic Evaluation of a Ruptured Ectopic Pregnancy
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Ectopic pregnancy is a life-threatening condition that warrants immediate treatment due to the risk of rupture and resultant hemorrhaging. Less than 1% of all pregnancies are ectopic; of these, 90% or more are located in the fallopian tubes. In a clinical setting, sonography can diagnose an ectopic pregnancy in conjunction with beta-human chorionic gonadotropin (B-hCG) levels above 1500 mIU. A case is presented in which the diagnosis of ectopic pregnancy was supported through sonographic features. Medication was given to terminate the ectopic pregnancy; however, surgery was later needed when the ectopic ruptured. (Source: Journal of Diagnostic Medical Sonography)
JDMS CME Article-SDMS CME Credit
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(Source: Journal of Diagnostic Medical Sonography)
Agenesis of the Ductus Venosus With Extrahepatic Umbilical Vein Connection Into the Right Atrium
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Agenesis of the ductus venosus is a rare anomaly that was first reported in literature within the past decade. Color/Doppler sonography is an important tool for mapping blood flow in determining this aberrant anastomosis. Careful observation of the fetus for signs of congestive heart failure can lead to a positive outcome. In the following case, cardiomegaly was detected and digoxin was introduced, which arrested progression into congestive heart failure. (Source: Journal of Diagnostic Medical Sonography)
The Case of the Wandering Spleen
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Wandering spleen is a condition that describes the movement of the spleen to an ectopic location inside the abdomen/pelvis as a result of weakened peritoneal ligaments. Wandering spleens are rare, with a less than 0.2% incidence being reported. Diagnosing a wandering spleen can be challenging because of the wide range of findings and the oftentimes vagueness of the patient’s symptoms. The most common ectopic location of the spleen is the left mid-abdomen. The most frequent treatment for wandering spleen includes splenopexy or splenectomy, depending on the complications associated with the condition. (Source: Journal of Diagnostic Medical Sonography)
IUD Perforation to the Urinary Bladder: Ultrasonographic Diagnosis
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Intrauterine contraceptive devices (IUD) are a popular method of birth control, typically with minimal side effects, and are used worldwide. Serious side effects such as uterine perforation are rare. Most often, a perforated IUD is found in the intraperitoneal space, although in rare instances, an IUD may perforate to the urinary bladder. In the case presented, a combination of 2D and 3D sonography was used to identify a missing IUD within the urinary bladder. The IUD was removed by cystoscopy without serious consequences to the patient. (Source: Journal of Diagnostic Medical Sonography)
Is the Pocket Ultrasound the "Phonendoscope" of the Urologist?
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The objective was to evaluate the utility of the "pocket ultrasound" in making clinical decisions in urologic emergencies. From May to September 2011, 105 patients were assessed for urologic emergencies: acute flank pain, macroscopic hematuria, urinary retention, and lower urinary tract symptoms. All patients underwent an ultrasonographic examination whereby the pocket ultrasound was used to evaluate the kidneys and bladder, followed by another appropriate diagnostic test to verify the suggested diagnosis. Urinary retention was diagnosed in 10 patients. Of 48 subjects with hematuria, 34 had an immediate diagnosis: there were 18 cases of a bladder tumor, 13 cases of urolithiasis, and 2 cases of renal cell carcinoma; one ureteral stent was detected. Of 30 patients referred with lower urinary...
Cross-Sectional Area of the Median Nerve Characterized by Ultrasound in Patients With Carpal Tunnel Syndrome Before and After the Release of the Transverse Carpal Ligament
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The objective of this study was to evaluate the cross-sectional area of the median nerve by ultrasonography before and after release of the transverse carpal ligament in patients with carpal tunnel syndrome. An additional goal was to correlate the cross-sectional area following surgery with clinical symptoms. Eighteen patients and 22 wrists were evaluated. All patients underwent Paine’s surgical technique for release of the transverse ligament. Cross-sectional area was calculated from sonograms taken at the pisiform bone level pre- and postsurgery. Postsurgical measurements were made at 4, 8, 12, and 96 weeks. Before surgery, the mean cross-sectional area was 19.7 mm2. The results following surgery were as follows: 4 weeks, 20.1 mm2; 8 weeks, 17.4 mm2; 12 weeks, 15.5 mm2; and 96 week...
JDMS CME Article-SDMS CME Credit
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(Source: Journal of Diagnostic Medical Sonography)
Investigation of the Potential Windows and Methods for Viewing the Tongue Using Diagnostic Medical Ultrasound
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This study investigates prospective windows sonography use to examine the tongue externally, lessening invasive measures currently used to diagnose and treat pathology. Based on results of this study, five of eight windows and methods tested were shown to have potential for evaluating the tongue externally. These were shown to be reproducible, acceptable windows for sonographers, providing a prospective means for sonographic evaluation of the tongue with hopes of developing a standardized protocol. (Source: Journal of Diagnostic Medical Sonography)
Corrigendum
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The JDMS CME article for "Focal Nodular Hyperplasia: Case Study, Imaging, and Treatment" by Chelsey N. McCann and Steven M. Penny contained an error in Question 4. (JDMS 2013;29(1):24-25) (Original DOI: 10.1177/8756479312474438) (Source: Journal of Diagnostic Medical Sonography)
Pancreatic Tuberculosis Diagnosed with Endoscopic Ultrasound-Guided Fine Needle Aspiration: Solid-Cystic Pancreatic Lesions in Endemic Areas
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We describe four cases with pancreatic tuberculosis mimicking carcinoma or pancreatic cyst on imaging. None of these patients was immunocompromised. Endoscopic ultrasound–guided fine needle aspiration demonstrated necrotizing granulomatous inflammation in these cases and acid-fast bacilli in two of them. We suggest that pancreatic tuberculosis should be included in the differential diagnosis of a pancreatic cystic or solid-cystic mass, especially in patients from a region where tuberculosis is endemic. (Source: Journal of Diagnostic Medical Sonography)
JDMS CME Article-SDMS CME Credit
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(Source: Journal of Diagnostic Medical Sonography)
Combined 2D and 3D Transthoracic and Transesophageal Echocardiography in the Evaluation of Nonobstructive and Obstructive Cor Triatriatum Sinister
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Cor triatriatum sinister is a rare congenital condition in which the left atrium is partitioned into two chambers by a fibromuscular membrane. Two-dimensional transthoracic echocardiography and 2D transesophageal echocardiography are the standard tests of choice for the assessment of function and physiology, although with complex pathology, evaluation of specific structures may be limited. We are reporting the additional use of 3D transesophageal echocardiography to delineate the anatomical features of the membrane in a comprehensive way not possible by conventional 2D imaging. (Source: Journal of Diagnostic Medical Sonography)
JDMS CME Article-SDMS CME Credit
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(Source: Journal of Diagnostic Medical Sonography)
The Role of Sonography in Renal Artery Stenosis Evaluation and Stent Placement
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A literature review has been conducted to demonstrate the role of duplex sonography in evaluating renal artery stenosis (RAS) as a screening method for patients prior to percutaneous transluminal renal artery stent (PTRAS) placement. The review also evaluates the role of ultrasound surveillance following PTRAS and establishes the overall influence of ultrasound on defining stent efficacy for managing hemodynamically significant renovascular disease. Recent studies have narrowed criteria for intervention through duplex sonographic assessment of RAS to better predict patient benefit and response to stent placement. Studies using sonographic parameters evaluating patients for renal artery stenosis, criteria-dependent stent placement, and postintervention follow-up have shown improved patient ...
Incidental Findings on Upper Gastrointestinal Endoscopic Ultrasonography
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Conclusions: Incidental findings on EUS are not uncommon in clinical practice and might be a clue to a significant pathology. The appropriate extent of evaluation of incidental findings noted during a standard EUS procedure warrants further research yet to be defined. (Source: Journal of Diagnostic Medical Sonography)
Body Mass Index and Abdominal Ultrasound Image Quality: A Pilot Survey of Sonographers
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The objective was to assess the consensus among sonographers that the quality of abdominal ultrasound (US) images is related to the patient’s body mass index (BMI). Fourteen sonographers completed a 12-item questionnaire to evaluate their experience with abdominal US imaging with respect to image quality in correlation with the patient’s adipose tissue. Of the sonographers sampled, 85.7% agreed that there is an association between the amount of adipose tissue on a patient’s abdomen and the quality of US image obtained; 85.7% also agreed that a normal BMI of 18.5 to 24.9 provides the best US image. However, only 28.6% agreed that normal amounts of adipose tissue produce poor image quality. There appears to be agreement among sonographers that BMI is a factor in obtaining g...
Differences in Pain Perceptions between Automated Breast Ultrasound and Digital Screening Mammography
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A prospective single-site survey was performed to gauge perceived pain during automated breast ultrasound (ABUS) and digital x-ray mammography (XRM). Patients also described differences in duration of the exams, provided their bra size, and indicated whether they would recommend ABUS to a friend. Pain was measured on a Likert-type visual analog scale (1–10). Participants were 199 female volunteers who also participated in the prospective, multicenter, nationwide clinical research study SOMO•INSIGHT. There was a mean pain and/or discomfort score of 6.41 (± 2.41) for XRM and a mean score of 1.86 (± 1.24) for ABUS (P = .001). Bra size and perceived examination duration played no role in determining patient pain and/or discomfort. One hundred percent of patients who pa...
Role of Endoscopic Ultrasonography in Patients With Thickened Wall Stomach by CT Scan
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The usefulness of endoscopic ultrasonography (EUS) in patients who have gastric wall thickening in computed tomography (CT) is not clear. All patients referred for EUS due to thickened gastric folds on CT were included in this study. Esophagogastroduodenoscopy (EGD) followed by EUS was performed on all patients. Twenty-eight patients were enrolled in the study. The mean ± SD age was 50.8 ± 15.9 years, and 60.7% were male. Most patients (78.6%) had symptoms, and 10 patients (35.7%) were ultimately diagnosed with a gastric neoplasm. In all patients with a normal EGD (11 patients), the EUS was normal. Accuracy, specificity, sensitivity, positive predictive value, and negative predictive value of EUS for detecting a lesion in thickened wall stomach on CT were 89.3%, 88.8%, 90.0%,...
Does Gallbladder Wall Thickening of Cirrhotic Patients Increase the Risk of Formation of Gallstones?
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In conclusion, gallbladder wall thickening in cirrhotic patients does not significantly add any risk for the formation of gallstones. (Source: Journal of Diagnostic Medical Sonography)
Incidental Finding of Urothelial Cell Carcinoma in a Young Patient During an Early Obstetrical Sonogram
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Bladder cancer is a rare finding in young adults. This case demonstrates a 17-year-old female with an incidental bladder mass seen during a first-trimester obstetrical sonogram. Sonographic examination revealed a nonmobile, echogenic mass in the inferior portion of the patient’s bladder. The patient subsequently went to surgery at 18 weeks’ gestation where a cystoscopic resection was performed. The tumor was found to be a low-grade papillary urothelial cell carcinoma. The patient delivered at term without further complications. Early diagnosis of this bladder carcinoma led to prompt diagnosis and treatment for the patient. This diagnosis may not have been possible without the bladder being fully distended. (Source: Journal of Diagnostic Medical Sonography)
Sonography of Portal Vein Tumor Thrombus Associated With HCC
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Portal vein tumor thrombus (PVTT) is a complication of liver disease, specifically hepatocellular carcinoma (HCC). It occurs secondary to direct invasion of tumor into the portal venous system. PVTT is associated with a poor prognosis, therefore identification and differentiation of malignant from benign thrombus is very important in the treatment of the patient. Sonography can be a useful tool in the detection of malignant thrombus. (Source: Journal of Diagnostic Medical Sonography)
Complicated Acute Pyelonephritis With Extrarenal Manifestations: Diagnosis With Sonography
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Discussion places a focus on the imaging spectrum and clinical significance of the extrarenal manifestations. The hepatobiliary findings of APN appear to signify accompanying sepsis and gravity of the condition, and gallbladder wall thickening must not be misdiagnosed as acute cholecystitis. (Source: Journal of Diagnostic Medical Sonography)
Sialolithiasis: Sonographic Detection of Salivary Duct Stones
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Sialolithiasis is a rare condition characterized by the presence of stones within the salivary gland or duct. Salivary duct stones have an incidence of 1% at autopsy, but only 50 in 1,000,000 present symptomatically per year. Possible signs and symptoms include an upper neck or jaw mass that enlarges and recedes following meals and xerostomia, or dry mouth. Sonography has been used along with a number of other imaging modalities to diagnose this condition. The use of real-time sonographic imaging allows for identification and confirmation of the presence of stones within the salivary gland. Treatment of sialolithiasis generally begins conservatively but can result in surgery if not resolved. This case report demonstrates the use of sonography as an effective method of diagnosing sialolithi...
Detection of a Unilateral Mucinous Borderline Ovarian Tumor With Sonography and Magnetic Resonance Imaging
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Various modalities of diagnostic imaging have been proven to be adequate in the characterization and diagnosis of ovarian neoplasms. This case study investigates a unique form of mucinous borderline ovarian tumor consisting of both intestinal and Müllerian types. Borderline tumors are considered an intermediate form of neoplasm between the benign and malignant form. Shortly after sonographic and magnetic resonance imaging, the large tumor was removed and the patient was determined to have an excellent prognosis. The utilization of sonography in diagnosing this tumor is discussed, demonstrating the significance of the technology. (Source: Journal of Diagnostic Medical Sonography)
Page Kidney: Hypertension Secondary to Extra-Renal Compression
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Page kidney refers to the development of secondary hypertension due to compression of the kidney by an external source, most commonly a subcapsular hematoma. Compression of the renal parenchyma results in hypoperfusion and microvascular ischemia leading to activation of the renin-angiotensin system and elevation of blood pressure. Until the last decade, Page kidney was primarily diagnosed in young men with unexplained hypertension and a history of sports-related trauma and imaging studies demonstrating a subcapsular hematoma. Treatment varies from conservative, medical management to a nephrectomy, depending on how the patient’s blood pressure responds to treatment. (Source: Journal of Diagnostic Medical Sonography)
JDMS CME Article-SDMS CME Credit
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(Source: Journal of Diagnostic Medical Sonography)
Focal Nodular Hyperplasia: Case Study, Imaging, and Treatment
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Focal nodular hyperplasia (FNH) is the second most common benign hepatic mass. The primary purpose of this article is to provide a relevant case study and offer a review of the recent literature related to FNH with a discussion of both the clinical and imaging findings of this classically benign hepatic lesion. Although magnetic resonance imaging is considered the gold standard of FNH imaging, the sonographic and computed tomography appearance also is offered in this article. Furthermore, contrast-enhanced ultrasound, which boasts a 96% success rate at differentiating FNH from other hepatic tumors, is analyzed. The historical treatment options, including medical and possible surgical intervention, are provided as well. Last, this article offers an analysis of the prognosis for the patient ...
JDMS CME Article-SDMS CME Credit
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(Source: Journal of Diagnostic Medical Sonography)
Retroaortic Left Renal Vein
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A retroaortic left renal vein (RLRV) is an uncommon condition in which the left renal vein passes posterior to the abdominal aorta and anterior to the vertebrae. Retroaortic left renal vein may lead to left renal vein hypertension syndrome, also known as the nutcracker syndrome, a condition in which extrinsic compression of the left renal vein causes hypertension within the vessel. Retroaortic left renal vein and nutcracker syndrome are vascular anomalies considered to be of clinical importance, particularly during surgical procedures involving the renal vasculature directly or, in many cases, the abdominal aorta. (Source: Journal of Diagnostic Medical Sonography)
Transperineal Sonography Evaluation of Muscles and Vascularity in the Male Pelvic Floor
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Idiopathic chronic male pelvic pain is difficult to diagnose and treat. Currently, diagnosis relies on subjective symptoms; objective measures of neuromuscular mechanisms have not been investigated. Sonographic imaging has been used to investigate these neuromuscular mechanisms in the female pelvic floor, but neither research nor books describe sonography evaluation of the male pelvic floor. The purpose of this study was to develop and evaluate a perineal sonographic technique for the examination of the male pelvic floor muscles. Anatomic landmarks were identified with images collected from two subjects, one with intermittent reports of pelvic pain and one with no history of pain in the pelvic region. A description of the equipment settings, the examination protocol, and the resulting comp...
Congratulations to the 2011 Kenneth R. Gottesfeld Award Winners
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(Source: Journal of Diagnostic Medical Sonography)
Corrigendum
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The JDMS CME Article for "Fetal Anasarca" by Karen Having and Stephani Bullock contained an error in Question 8. (JDMS 2011;27(1):26) (Original DOI: 10.1177/87564793110270010501) (Source: Journal of Diagnostic Medical Sonography)
Elimination of Sonographer Musculoskeletal Injury in a Hospital-Based Cardiovascular Sonography Laboratory Following Implementation of Ergonomic Guidelines
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(Source: Journal of Diagnostic Medical Sonography)
Duplex Assessment of Mesenteric Arteries Within a Targeted Negative Gallbladder Sonogram: A Pilot Protocol Study
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(Source: Journal of Diagnostic Medical Sonography)
Sonographic Evaluation of Acute Appendicitis
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Appendicitis is a surgical emergency that can mimic many other abnormalities. Early diagnosis is critical to reduce the risk of perforation and potentially life-threatening complications. The use of sonography has proven to aid in accurately diagnosing an inflamed appendix without adversely affecting the rate of perforation. However, the accuracy of sonography is highly operator dependent. This case demonstrates the classic clinical presentation of appendicitis with the incorporation of sonographic findings to support the diagnosis. (Source: Journal of Diagnostic Medical Sonography)
Prenatal Sonographic Diagnosis of Iniencephaly: A Case Report
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Iniencephaly is a rare defect caused by improper closure of the neural tube. The incidence is 0.1-10 per 10,000 live births. The head is disproportionately large as compared to the body and displays excessive retroflexion. The neck is absent with the face directed upward. Prenatal sonography is an accurate means of identifying this anomaly. (Source: Journal of Diagnostic Medical Sonography)
Villous Adenoma With High Grade Dysplasia of Ampulla of Vater: Sonographic Appearance and CT Correlation
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A 43-year-old South Korean male presented to urgent care with pain free jaundice and weight loss. An abdominal ultrasound was ordered and demonstrated a 2.5 cm irregularly contoured ampullary mass that was obstructing the common bile duct (CBD). Endoscopic biopsy demonstrated ampullary villous adenoma with high grade dyspasia. Villous adenoma is a type of polyp typically found in the colon, but it is rarely seen at the ampulla of Vater. To our knowledge this is the first documented case found by transabdominal sonography. (Source: Journal of Diagnostic Medical Sonography)
Eccrine Spiradenoma of the Thigh: Sonographic Findings and Review of the Literature
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Eccrine spiradenoma is a well-recognized benign tumor arising from the intradermal straight portion of the eccrine or merocrine sweat glands. It is usually a small, solitary lesion in the cutis and the subcutaneous tissues. As with other lesions in the cutis and the subcutaneous tissue, few cases describing the sonographic findings of eccrine spiradenoma have been reported. This case study demonstrates these sonography findings in a case of eccrine spiradenoma distributed in the right thigh. (Source: Journal of Diagnostic Medical Sonography)
Combined Aneurysm and Infrahepatic Stenosis of the Inferior Vena Cava
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Aneurysms of the major veins are rare, and those involving the inferior vena cava (IVC) are extremely rare. The etiology of IVC aneurysms remains unknown, and they can have variable presentation. Although many aneurysms are found incidentally, others are diagnosed after complications develop. Thrombosis is a frequent presentation, and serious sequelae, such as lethal pulmonary embolism and Budd-Chiari syndrome, may result. Therapeutic alternatives range from watchful waiting to surgical management. Development of complications such as rupture has been described and may require surgery. In this article, we report the discovery of an IVC aneurysm in a patient who had chronic renal failure associated with renal hypoperfusion and severe cardiac insufficiency. (Source: Journal of Diagnostic Med...
Cervical Cancer With Cardiac Metastasis
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This report demonstrates the use of echocardiography and Doppler ultrasound in the diagnosis of a rare case of cardiac metastasis from cervical cancer. (Source: Journal of Diagnostic Medical Sonography)
Interrupted Aortic Arch With Aortic Valve Atresia, Aorto-Pulmonary Window, Left Coronary Artery to Pulmonary Artery Fistula, and Cat Eye Syndrome
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This case study describes a newborn male infant with cat eye syndrome, found to have a rare constellation of congenital defects, which included an interrupted aortic arch, type B2 (with aberrant right subclavian artery), aortic valve atresia, aorto-pulmonary window, left coronary artery to pulmonary artery fistula, ventricular septal defect, atrial septal defect, and a restrictive patent ductus arteriosus. (Source: Journal of Diagnostic Medical Sonography)
JDMS CME Article-SDMS CME Credit
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(Source: Journal of Diagnostic Medical Sonography)
3D Volume Assessment of a Cornual Heterotopic Double Anembryonic Gestation and Response to Methotrexate Treatment
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A pregnancy developing in the cornu is rare and accounts for less than 1% to 4% of ectopic pregnancies. This case describes a cornual heterotopic gestation occurring as a first pregnancy where both gestational sacs were anembryonic. Presented are subsequent 2D and 3D sonographic findings with laboratory changes following treatment in an ectopic systemic methotrexate protocol. (Source: Journal of Diagnostic Medical Sonography)
Utilization of Sonography Compared With Magnetic Resonance Imaging in Determining the Cross-Sectional Area of the Median Nerve in a Sample of Working Macaca fascicularis: A Preclinical Study
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A preclinical study of 15 Macaca fascicularis monkeys was conducted to determine (1) the ability of detecting median mononeuropathy (MMN) within the median nerve after a work intervention and (2) the relationship between the layers of the median nerve during an acute inflammatory process by using sonography in conjunction with magnetic resonance imaging (MRI). Cross-sectional areas (CSAs) were imaged using MRI and sonography proximal to the carpal tunnel inlet (defined by the most distal portion of the radius) and further distal into the carpal tunnel (defined by the most proximal portion of the pisiform) at the prework exposure stage. CSAs measured on the outer edge of the median nerve were obtained from both modalities, at both anatomical locations. An intermodality t test demonstrated n...
JDMS CME Article-SDMS CME Credit
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(Source: Journal of Diagnostic Medical Sonography)
The Prediction of Liver Disease Status Using a Combination of Sonographic and Doppler-Derived Observations of the Portal Venous System
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A novel diagnostic test, named the PREW© score, was formulated to predict the known liver disease status of a purposive sample of 500 patients (304 cases and 196 controls) referred for abdominal sonograms. The score was defined by (P R E)/W, where P = portal vein pressure gradient (mm Hg), R = ratio between the observed mean portal vein diameter in the patient (mm) and the mean diameter in healthy subjects (mm), E = echogenicity of liver parenchyma (ECHO grade scale), and W = hepatic venous waveform (1 = monophasic to 3 = triphasic). Cases with PREW scores >50 were about 480 times more likely than the controls to be diagnosed with cirrhosis/ascites. Cases with PREW scores of 16 to 50 were about 6 to 15 times more likely than the controls to be diagnosed with hepatitis and about 15 ...
The Sonography Research Institute
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(Source: Journal of Diagnostic Medical Sonography)
Continuing Medical Education for Sonographers: A Brief History and an Update
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The requirement for continuing medical education in health care originated in the early 1900s when several investigators in the United States determined that the training physicians were receiving was woefully inadequate. The Flexner Report, which was based on an extensive analysis of how the early medical schools were educating physicians, proposed several radical changes in physician instruction, including a recommendation for postgraduate training. Now known as continuing medical education (CME), this obligation is practically universal in the medical and allied health fields including sonography. Although there are many options for the diagnostic medical sonographer to earn CME credits, the Society of Diagnostic Medical Sonography (SDMS) instituted a unique program for sonographers to ...
Bizarre Scrotal Sonogram: Atypical Hematoma Mimicking Testis
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A 48-year-old male who had undergone left inguinal orchidectomy for testicular tumor 10 days previously presented with left inguinal and scrotal swelling. The scrotal sonogram showed what appeared to be two testes, with a mass within the left testicular area. Real-time scanning revealed that the left "testis" was thick fluid/hematoma with a more organized hematoma within. (Source: Journal of Diagnostic Medical Sonography)
Intrauterine Myocardial Infarction in a Twin Gestation Complicated by Twin-to-Twin Transfusion Syndrome
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Twin-to-twin transfusion syndrome (TTTS) is a known complication of 10% to 15% of monochorionic/diamniotic twin gestations. It is also known that the "recipient" twin in these pregnancies is at higher risk for cardiac abnormalities. Early identification of TTTS and recognition of changes in fetal cardiac function can reduce fetal morbidity and mortality. This case describes intrauterine myocardial infarction developing in the recipient twin of a monochorionic/diamniotic twin gestation complicated by TTTS. (Source: Journal of Diagnostic Medical Sonography)
Intra-abdominal Umbilical Vein Varix Thrombus: From Diagnosis to Delivery
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Fetal intra-abdominal umbilical vein varix (FIUVV) is an uncommon finding with poorly understood clinical significance. Numerous fetal complications are associated with this anomaly. This case report demonstrates FIUVV in which thrombus develops leading to early induction of labor for successful delivery. The literature regarding FIUVV is reviewed and discussed with implications for sonographic follow-up during pregnancy and patient management. (Source: Journal of Diagnostic Medical Sonography)
Prenatal Diagnosis of VACTERL Association
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VACTERL syndrome is a multisystem congenital anomaly. The potential findings include vertebral, anorectal, and cardiac anomalies; tracheoesophageal fistula/esophageal atresia; and renal and limb anomalies. This case report presents a pregnant woman in her early 30s presenting with multiple fetal anomalies suggesting this diagnosis. (Source: Journal of Diagnostic Medical Sonography)
Larsen Syndrome: Sonographic Findings
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Larsen syndrome is a rare inherited disorder of collagen formation with multiple joint dislocations, cardiac abnormalities, short stature, talipes equinovarus, short and broad fingertips, spatula-like thumbs, supernumerary ossification center in the calcaneus, hearing loss, neurologic impairment, cryptorchidism, and characteristic craniofacial abnormalities. The sonographic prenatal findings in a case of Larsen syndrome at 26 weeks’ gestation, which demonstrated joint dislocations, hypertelorism, frontal bossing, micrognathia, and upper and lower limb shortening and confirmed at both 29 and 30 weeks’ gestation, are presented and discussed. When evaluating patients with a positive family history of Larsen syndrome, sonographers should carefully scan and meticulously assess the f...
Exencephaly With Ectopia Cordis: A Rare Finding in a Twin Pregnancy
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Ectopia cordis is an anomaly of embryonic cell growth that causes the heart to form outside the chest cavity during fetal development. Other birth defects are often present with ectopia cordis as well. It is usually a fatal condition, commonly associated with pentalogy of Cantrell, and occurs in 5.5 to 7.9 children per one million live births. Exencephaly is the exposure of a well-developed and differentiated brain outside the skull during the embryonic period. It is the second of three phases in the development of anencephaly and is a lethal neural tube defect with only a small number of cases reported in the literature. Sonographically, it appears as a bilobed-shaped head termed the "Mickey Mouse" head with a relatively large amount of brain tissue present floating in the amniotic fluid....
JDMS CME Article-SDMS CME Credit
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(Source: Journal of Diagnostic Medical Sonography)
Comparison of Endobronchial Ultrasound and Computed Tomography With Fluoroscopy in the Guidance of Lung Cancer Biopsies: A Literature Review
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Open lung biopsy is the gold standard for diagnosing lung cancer, but it is an invasive approach. There have been several noninvasive methods developed to biopsy the lung. This literature review compares the use of endobronchial ultrasound (EBUS) and computed tomography with fluoroscopy (CTF) guidance in the biopsy of lung nodules. Computed tomography with fluoroscopy has a higher diagnostic yield than endobronchial ultrasound but has more postprocedural complications. Endobronchial ultrasound guided lung biopsy is effective when the lesions are located in the right middle lobe of the lung, and overall EBUS has a low rate of complications when compared to CTF. (Source: Journal of Diagnostic Medical Sonography)
JDMS CME Article-SDMS CME Credit
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(Source: Journal of Diagnostic Medical Sonography)
A Case-Control Study to Compare the Likelihood of Detecting Liver Disorders Using Coincident Measures of Doppler-Derived Portal Vein Pressure Gradients, Hepatic Venous Waveforms, and the Echogenicity of Liver Parenchyma
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A case-control study based on the records of 465 adult patients receiving abdominal sonograms predicted the likelihood of liver damage, as detected by serum biomarkers, biopsy, and/or endoscopy, to increase systematically with respect to (a) an increase in echogenicity from grade 1 (odds ratio [OR] = 2.94) through 2 (OR = 10.50) to 3 (OR = 14.91) coincident with (b) a dampening of the hepatic venous waveform (HVW) from biphasic (OR = 1.66) to monophasic (OR = 3.68) and (c) a simultaneous elevation in the portal vein pressure gradient, adjusted for portal vein diameter (PVPG) from level 1 (OR = 1.85) through 2 (OR = 3.23) to 3 (OR = 3.35). Echogenicity consistently exhibited higher sensitivities but lower specificities than the HVW and PVPG. The lowest specificities were found among patient...
Exposing the Gap Between What Is Possible and What Is Acceptable: How M-Learning Can Make a Contribution to Sonography Education
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This article defines the differences between electronic learning (e-learning) and m-learning, illustrates a few of the many opportunities this application holds to offer its stakeholders, and challenges sonography educators to begin using its value as an educational tool in their established curriculums. (Source: Journal of Diagnostic Medical Sonography)
Aberrant Origin of the Superior Thyroid Artery
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Variation in the origin of arteries is a fairly common occurrence. Some of these variations are considered inconsequential, whereas others can have serious implications for medical procedures. The authors present an unusual case demonstrating an anomalous branching of the superior thyroid artery from the distal common carotid artery. (Source: Journal of Diagnostic Medical Sonography)
Ectopic Abdominal Uterine Leiomyoma, an Unusual Consequence of Uterine Artery Embolization
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This case report demonstrates an unusual, vascularized solid mass in the right upper abdomen of a female patient ultimately identified as a uterine leiomyoma (fibroid). The patient’s past medical history was significant, having had a prior uterine artery embolization (UAE) procedure for symptomatic uterine fibroids. (Source: Journal of Diagnostic Medical Sonography)
Trisomy 5p Syndrome
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Trisomy 5p syndrome is a rare chromosomal abnormality with about 40 documented cases. This abnormality is a result of a duplication of the short arm of chromosome 5. Most Trisomy 5p cases are the result of an unbalanced translocation between the duplicated material of chromosome 5 and another chromosome. This case study demonstrates the sonographic features found on a fetus affected with trisomy 5p. It also discusses how genetics play a role in fetuses affected by chromosome abnormalities and why it is important for sonographers to be aware of the contributing factors that can lead to anomalies. (Source: Journal of Diagnostic Medical Sonography)
Directional Color Doppler Aids the 2D and 3D Prenatal Diagnosis of Cleft Lip and Palate With Antenatal Single-Shot Fast-Spin Echo Magnetic Resonance Imaging Confirmation
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Standard 2D sonography has variable success in the prenatal diagnosis of cleft lip combined with cleft palate. A case is presented that demonstrates the added value of 3D sonography plus color Doppler imaging in confirming this diagnosis. Additional techniques such as the flipped-face view, the reverse-face view, and the oblique-face view are discussed as further enhancements to the prenatal sonographic study of the fetal palate. (Source: Journal of Diagnostic Medical Sonography)
Fetal Oral Mass
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A case report is presented of a sonographic examination at 39 weeks’ gestation that showed a nonvascular fetal oral mass. The patient was transferred to a tertiary referral hospital where an ex utero intrapartum treatment (EXIT) procedure was planned; however, delivery was subsequently completed without the need of this procedure. The neonate underwent marsupialization of the mass with the final diagnosis of a ranula or lymphangioma. This case report emphasizes identification of a fetal oral mass, appropriate diagnostic tools to evaluate oral masses, and treatment options for these patients. (Source: Journal of Diagnostic Medical Sonography)
Abnormal Fetal Umbilical Cord Doppler? What Should I Do Next? A Case Study Demonstrating Corroboration of Umbilical Cord Doppler and Middle Cerebral Doppler
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For the fetus at risk for intrauterine growth restriction (IUGR), umbilical cord Doppler provides the clinician valuable information about fetal circulation. When the cord Doppler is abnormal, spectral analysis of the middle cerebral artery (MCA) gives additional information about perfusion to the fetal brain. This case report describes a 31-week gestational age fetus referred for a biophysical profile and umbilical cord Doppler because of an abnormal nonstress test. (Source: Journal of Diagnostic Medical Sonography)
Ultrasonographic Findings in Anterior Chest Wall Abscess: Empyema Necessitatis Due to Staphylococcus epidermidis
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Empyema necessitatis is a rare complication of empyema, in which the pleural infection spreads outside of the pleural space to involve the soft tissues of the chest wall, and is difficult to diagnose with sonography alone. In the case presented, sonography to evaluate a focal anterior chest wall pain in a patient resulted in findings consistent with an abscess and prompted additional workup. Further testing included sonography-guided aspiration and computed tomography scan to establish the diagnosis followed by surgical debridement. (Source: Journal of Diagnostic Medical Sonography)
JDMS CME Article-SDMS CME Credit
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(Source: Journal of Diagnostic Medical Sonography)
Splenic Abscess Detection and Monitoring Using Sonography
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The finding of a splenic abscess is rare, with only 500 to 600 cases ever having been reported internationally. Prior to the advent of sonography and computed tomography, the survival rate for an individual with a splenic abscess was 0%. Present-day real-time imaging with sonography allows for accurate diagnosis of an abscess in the spleen versus rupture, hematoma, splenomegaly, or cyst within the spleen or left kidney. Until recently, the prescribed treatment was splenectomy. The increased understanding of splenic abscess etiology and advancements in pharmacology have allowed the treatment to progress from surgical removal of the entire spleen to draining the abscess using fine-needle aspiration with the use of strong broad-spectrum intravenous antibiotics. (Source: Journal of Diagnostic ...
JDMS CME Article-SDMS CME Credit
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(Source: Journal of Diagnostic Medical Sonography)
Using Automated Breast Sonography as Part of a Multimodality Approach to Dense Breast Screening
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This study was performed as part of a multimodality approach to histologically proven breast lesions classified as categories 4 and 5 according to the American College of Radiology Breast Imaging, Reporting, and Data System (BI-RADS). Comparable diagnostic reliability (kappa values between 0.95 and 0.98) was observed between automated breast sonography and MRI in differentiating benign from malignant breast lesions based on similar morphologic criteria. This preliminary study offers automated breast sonography as a promising cost-effective adjunct diagnostic modality to MRI in the evaluation women with increased breast density by digital mammography. (Source: Journal of Diagnostic Medical Sonography)
Diagnostic Imaging of Late-Stage Breast Cancer
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Diagnostic imaging has proven to be a beneficial tool in the screening, diagnosis, and prognosis of breast cancer. Most cancers are found early with breast screening methods, such as mammography. In some instances, breast cancer will go unidentified or untreated up to the point that the cancer becomes more advanced. This case study investigates a form of breast cancer that was diagnosed within a month after the patient’s first meeting with her physician. The breast cancer was examined with x-ray, computed tomography, and sonography. The role of sonography is discussed in detail with the aim of illustrating the usefulness of this technology in identifying cancerous breast tissue. (Source: Journal of Diagnostic Medical Sonography)
Main Pulmonary Artery Aneurysm Described by Transthoracic Echocardiography in an Adult Without Pulmonary Stenosis or Pulmonary Hypertension
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Aneurysm of the main pulmonary artery is a rare finding in adults. This case presents the finding of an asymptomatic 4.6-cm pulmonary artery aneurysm in a woman in her early 60s detected on routine transthoracic echocardiography. All pertinent data are presented, and the clinical significance of the pulmonary artery aneurysm is discussed. The case emphasizes the importance of following a complete and thorough echocardiographic examination protocol. A limited study is likely to miss significant incidental findings such as is reported here, particularly if it involves the right heart. (Source: Journal of Diagnostic Medical Sonography)
Intravascular Sonography Assessment of a Type III Endoleak of an Aortic Endograft
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Abdominal aortic aneurysm (AAA) is a common disease in today’s older population. When AAAs grow large, the risk for rupture becomes high, and the AAA should be treated. It can be treated in one of two ways: open or endovascular repair. With endovascular repair, an endograft is placed within the aorta using angiographic guidance to exclude the AAA. Intravascular sonography (IVUS) can be used as an adjunct to angiography for the endovascular repair. The endograft must then be routinely followed for complications such as endoleak. This case report identifies a symptomatic type III endoleak and describes how IVUS is used in conjunction with computed tomography and angiography to treat type III endoleaks. (Source: Journal of Diagnostic Medical Sonography)
Sister Vascular Anomalies in the Nongravid Uterus: Arteriovenous Malformation Versus Arteriovenous Fistula
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Uterine arteriovenous malformation and arteriovenous fistula are rare vascular lesions that have only recently been described in literature. They are two differentials in reproductive-age women with acute onset of abnormal vaginal bleeding. The sonographic and clinical presentation of these two pathologies can be both varied in appearance and impossible to distinguish from each other. However, a detailed history along with specific sonographic investigation using color and pulse-wave Doppler, as well as a transvaginal scanning technique, can lead to strong suspicion of these vascular malformities. A successful sonogram can provide essential evidence to justify further investigation with a more invasive angiography procedure. This will not only confirm a diagnosis but also give important in...
Pediatric Gastrointestinal Tumors
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This report details the initial sonographic findings and the follow-up studies that had initially suggested a pediatric GIST of malignant potential but, upon further outside consultation, suggested a benign pediatric GIST. (Source: Journal of Diagnostic Medical Sonography)
Unilateral Type II Schizencephaly: Prenatal Diagnosis and Review
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Schizencephaly is a rare developmental disorder of the brain that is characterized by abnormal clefts within the cerebral hemispheres. Infants with this disorder commonly have developmental delay, delay in speech and language, partial or complete paralysis, poor muscle tone, and seizures. The manifestations and severity of the disease are related to the size and location of the clefts. The authors report a case of type II (open-lipped) schizencephaly diagnosed in the second trimester by sonography. Early prenatal diagnosis of fetal type II (open-lipped) schizencephaly allows time for patient counseling and discussion of options and preparation. (Source: Journal of Diagnostic Medical Sonography)
JDMS CME Article-SDMS CME Credit
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(Source: Journal of Diagnostic Medical Sonography)
A Selective Review of Commonly Used Sonography-Guided Hyperthermic Ablative Technologies for Malignant Lesions of the Liver
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This article analyzes the differences between these two technologies and discusses the circumstances in which one method may be preferred over the other for hepatic malignancies. (Source: Journal of Diagnostic Medical Sonography)
JDMS CME Article-SDMS CME Credit
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(Source: Journal of Diagnostic Medical Sonography)
Sister Mary Joseph Nodule: A Cohort Study of an Unusual Umbilical Mass
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This report demonstrates the capability of sonography to evaluate soft tissue periumbilical masses, describes their sonographic appearance, and evaluates the utility of sonography to accurately locate the SMJN for biopsy. (Source: Journal of Diagnostic Medical Sonography)
Letter to the Editor
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(Source: Journal of Diagnostic Medical Sonography)
The Sonographer's Role in Meaningful Use
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On January 24, 2009, newly sworn-in President Obama uttered a bold promise: "To lower health care cost, cut medical errors, and improve care, we’ll computerize the nation’s health records in five years, saving billions of dollars in health care costs and countless lives" (http://www.healthmu.org/radiology/index.php). It’s those words that marked the beginning of health care reform. In February 2009, the American Recovery and Reinvestment Act was passed. Within this bill was the HITECH (Health Information Technology for Economic and Clinical Health) Act. With it came a large number of dollars to incentivize the move toward electronic health records and the use of health information technology. The Continuing Extension Act of 2010 included language that removed outpatient f...
A Pilot Study: Exposing Novice Medical and Nursing Students to Point-of-Care Sonography Skills
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Point-of-care sonography is a valuable tool used in medical practice. A free health clinic was the venue for the authors’ approach to hands-on training for medical and nursing students. Students were surveyed before and after the event regarding their experience and their ability to successfully perform six targeted sonographic skills. The primary outcome was the change presurvey to postsurvey in the students’ assessment of their ability to perform scans on patients and identify the anatomic structures in the six skill areas. An experienced sonographer monitored each scan and confirmed skill application. One hundred nineteen sonograms were performed. Most students (23/29) did not report competence in any of the six assessed skills prior to the study. On average, students develo...
Sonographic Evaluation of Non-Hodgkin Lymphoma
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Non-Hodgkin lymphoma requires an early diagnosis for optimal survival rates. If a diagnosis and treatment are too late, the malignancy has the probability of spreading to extranodal regions. A diagnosis of non-Hodgkin lymphoma may present itself unexpectedly to the young adult patient, as well as the examining sonographer. With a comparable case and images, this case study can aid sonographers, radiographers, and radiologists in making an accurate diagnosis of this malignancy for the most favorable patient treatment and outcome. (Source: Journal of Diagnostic Medical Sonography)
Sonographic Findings in a Case of Crohn Disease
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Crohn disease is an incurable inflammatory bowel disease that can involve the large or small bowel but typically is located at the terminal ileum. The disease ranges from mild inflammation to bowel obstruction, fistula, and abscess formation and is typically diagnosed during adolescence or the early 20s. Patients with Crohn disease undergo multiple follow-up imaging examinations for the disease during the course of their lives. Sonographic findings in an adolescent patient diagnosed with Crohn disease are discussed. Sonography is emerging not only as an effective imaging modality for long-term disease follow-up but also, with the addition of hydrosonography and improved transducer technology, as a primary diagnostic tool. (Source: Journal of Diagnostic Medical Sonography)
JDMS CME Article-SDMS CME Credit
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(Source: Journal of Diagnostic Medical Sonography)
Three-Dimensional Sonography, Tomographic Sonography Imaging, and the OmniView Algorithm: New Imaging Modality in the Prenatal Diagnosis of Congenital Dacryocystocele
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The prenatal diagnosis of congenital dacryocystocele has been reported using 2D sonographic imaging, but there are very few reports of the use of 3D sonography for this diagnosis. Two cases are presented in which 3D and Doppler sonography was helpful in determining the prenatal diagnosis. The embryologic basis of this obstruction of the nasolacrimal duct is discussed along with techniques for the prenatal diagnosis, including the potential value of 3D sonography in limiting the necessity of other prenatal testing. The importance of establishing the differential diagnosis is also discussed, as there is the possibility of the dacryocystocele being secondary to a sinonasal tumor. (Source: Journal of Diagnostic Medical Sonography)
JDMS CME Article-SDMS CME Credit
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(Source: Journal of Diagnostic Medical Sonography)
Neuroblastoma: Sonography's Major Role in Its Diagnosis and Treatment
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Neuroblastoma is a common malignancy of infancy and early childhood. The difference in the outcomes for patients with these neoplasms is striking. Infants younger than one year have a good prognosis, even in the presence of metastatic disease, whereas older patients with metastatic disease fare poorly even when treated with aggressive therapy. The noninvasive nature of diagnostic sonography has allowed it to play a major role in the early detection and treatment of neuroblastoma. This early sonographic detection, in conjunction with early postnatal surgical intervention, has greatly improved the prognosis of infants born with neuroblastoma. (Source: Journal of Diagnostic Medical Sonography)
Traditional Peripheral Arterial Doppler Waveform Descriptors: Are They Still Worth Teaching?
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This study emphasizes the contribution of sonographers in arterial Doppler waveform categorization and underscores the need for standardization and education. (Source: Journal of Diagnostic Medical Sonography)
Nonalcoholic Fatty Liver Disease: An Abnormal Appearance
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Nonalcoholic fatty liver disease (NAFLD) is an accumulation of extra fat in the liver cells not caused by alcohol consumption. This disease is an increasingly common condition and the most common cause of abnormal liver function tests among adults. NAFLD is an array of liver diseases ranging from simple hepatic steatosis (fatty liver) to nonalcoholic steatohepatitis (NASH). A liver biopsy is the gold standard for determining hepatic fat content and staging fibrosis. However, the invasiveness of this approach can be a contraindication in certain patients. Noninvasive imaging modalities such as ultrasound, computed tomography (CT), and magnetic resonance (MR) can also detect hepatic fat content. (Source: Journal of Diagnostic Medical Sonography)
Intraductal Papilloma of the Extraglandular Segment of the Stensen Duct: A Sonographic Diagnosis and Pathological Correlation
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This report depicts the sonographic diagnosis of intraductal papilloma of the extraglandular segment of the Stensen duct. The sonographic and histological appearances of this rare entity are illustrated. (Source: Journal of Diagnostic Medical Sonography)
A Rare Diagnosis of Common Symptoms: Vascular Sonography in Takayasu Arteritis
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Vascular sonography combined with other modalities has established the diagnosis of Takayasu arteritis. This case presents an East Indian woman who presented with right upper extremity pain, coldness, and numbness. Sonography remained the basis of intervention evaluation. (Source: Journal of Diagnostic Medical Sonography)
Natural Breast Augmentation or Fat Transfer: The Mammographic and Sonographic Correlation
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Natural breast augmentation, or fat transfer, involves taking fat cells from one area of the body and injecting them into another area, such as the breast. This can be done for cosmetic reasons after a lumpectomy or other surgical procedures that affect the shape of the breast. Breast augmentation is also being used electively by some women to enhance the appearance of their breasts. Defects such as asymmetry, sagging, or indentations have been improved with fat transfers. The changes of the breast tissue from the reaction to the new fat can also change the outcome of mammograms and sonograms. The interpreting radiologist might recommend a biopsy to exclude the possibility of missing a malignant lesion. These two case reports give sonographers an idea of what additional questions they may ...
A Rare Multiple-Gestation Anomaly: Thoraco-Omphalopagus
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This report discusses a case of female thoraco-omphalopagus twins who share a single cardiac system. (Source: Journal of Diagnostic Medical Sonography)
JDMS CME Article-SDMS CME Credit
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(Source: Journal of Diagnostic Medical Sonography)
Morphologic Characterization of Intraneural Flow Associated With Median Nerve Pathology
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A prospective cohort of 47 symptomatic patients who reported for nerve conduction studies and 44 asymptomatic controls was examined with sonography to evaluate the median nerve. Doppler studies of the median nerve were collected with handheld sonography equipment and a 12-MHz linear broadband transducer. Strict inclusion criteria were established for assessing 435 waveforms from 166 wrists. Two sonographers agreed that 245 waveforms met the a priori criteria and analyzed the corresponding data. Spectral Doppler waveforms provided direct quantitative and qualitative data for comparison with indirect provocative testing results. These Doppler data were compared between the recruitment groups. No statistical difference existed in waveforms between the groups (P < .05). Trending of the over...
The Role of Transabdominal Sonography in Facilitating Successful Brachytherapy Outcomes in Cervical Cancer
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This article discusses the etiology, diagnosis, and treatment of cervical cancer. This article further explains the importance of the brachytherapy technique, the role of transabdominal sonography, and how both can lead to a successful outcome for the patient. (Source: Journal of Diagnostic Medical Sonography)
The 2010 Gottesfeld Award Winners
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(Source: Journal of Diagnostic Medical Sonography)
Amyand Hernia Diagnosed With Sonography: A Case Study
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Individually, inguinal hernias and acute appendicitis are common, but the combination of the two, acute appendicitis within an inguinal hernia or Amyand hernia (AH), is rare. The overwhelming majority of AH cases are in males and discovered during surgery. To date, only three case reports in the literature of this pathology have been diagnosed with sonography. This is a report of an AH diagnosed in a woman with sonography. (Source: Journal of Diagnostic Medical Sonography)
Sonographic Patterns of Testicular Torsion
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The objective of this study was to determine the sonographic patterns of the testes in patients with testicular torsion. Clinical data of 46 patients with testicular torsion confirmed by surgical exploration or manual detorsion were reviewed, and sonographic patterns of testicular torsion were categorized according to the sonographic characteristics of the testes, and their relation to the pathologic changes were analyzed. The sonographic appearances of testicular torsion were categorized into six patterns, reflecting pathologic changes of testicular torsion. Sonography of testicular torsion has different patterns, and recognition of these patterns may help the examiner establish a diagnosis and subsequently manage the patient. (Source: Journal of Diagnostic Medical Sonography)
Diagnosis of Lower Gastrointestinal Tumors by Transvaginal Sonography
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Sonography plays a primary role in the diagnosis of gynecological diseases. A retrospective review of incidental findings report by transvaginal sonography (TVS) was performed to evaluate the ability of TVS to visualize rectosigmoid carcinoma. The authors performed a retrospective review of 450 women who were referred for TVS because of suspected gynecological indications to evaluate those with incidental findings. Of these, 15 with incidental findings were subsequently diagnosed with rectosigmoid carcinoma. The sonographic properties and clinical findings were systematically evaluated. TVS findings included solid nonhomogeneous lesions (mean diameter of 4 cm; range, 1.6–8 cm), distended rectal walls, and gas inside the gastrointestinal lumen in 53% (n = 8) of the cases. Total wall i...
Subclavian Steal Syndrome: Diagnostic Imaging Correlations and Review of Literature
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Duplex sonography of extracranial arteries is one of the best tools for identifying stenoses and other diseases of the carotid, vertebral, and subclavian arteries. Abnormal Doppler waveforms in vertebral arteries could be evidence of subclavian steal syndrome. The difference of 15 to 20 mm Hg or more in systolic bilateral brachial arterial blood pressure measurements provides important clinical information in patients with subclavian steal syndrome. Complementary to duplex sonographic scanning, radiologists use computerized tomography angiography, magnetic resonance angiography, and digital subtraction angiography for preoperative planning. (Source: Journal of Diagnostic Medical Sonography)
JDMS CME Article-SDMS CME Credit
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(Source: Journal of Diagnostic Medical Sonography)
Safety Practices of Sonographers and Their Knowledge of the Biologic Effects of Sonography
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Diagnostic medical sonography is viewed as a safe imaging modality. However, bioeffects research has yet to define the effects of exposure to sonography in humans. Therefore, sonographers must be aware of potential risks and practice ALARA ("as low as reasonably achievable") routinely. This research explores sonographers’ ability to answer basic questions about the bioeffects of sonography, as well as their knowledge and use of the safety indices called the mechanical index (MI) and thermal index (TI). Members of the Society of Diagnostic Medical Sonographers, a southwestern sonographers’ society, and a sonography community on Facebook 2010 were surveyed. There is a low level of bioeffects knowledge and minimal safety practices among sonographers in this survey. No significant ...
Lab Accreditation and Credentials in Sonography: A Demographic Assessment of Facilities Receiving Federal Reimbursements
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There is an increasing demand for sonographer credentials and facility accreditation associated with federal reimbursement of sonography examinations. Therefore, a national survey was conducted to identify the education/certification status of sonographers currently performing studies that receive federal reimbursement. The survey, addressed to sonography administrators, also investigated the sonography laboratory accreditation status. Results indicated that approximately 12% of the sonographers were reported to have no sonography-specific credentials. The primary age range of this group was 25 to 34 years, and 64% were graduates of a two-year (minimum) allied health education program other than sonography. Forty-two percent indicated their sonography lab was not accredited. Should the Cen...
Sonographic Demonstration of Dermatofibrosarcoma Protuberans: An Uncommon Soft Tissue Neoplasm
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This case study presents the sonographic features of recurrent dermatofibrosarcoma protuberans, an uncommon soft tissue neoplasm. The original primary tumor presented five years earlier and was surgically excised. The current presentation demonstrates sonographic evaluation of several superficial left lower quadrant masses suspicious for tumor recurrence. This was confirmed by core needle biopsy and was followed by wide surgical excision. No evidence of metastasis was found, and no chemo or radiotherapy was offered. (Source: Journal of Diagnostic Medical Sonography)
Pseudothrombosis of the Subclavian Vein
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A woman in her late 20s presented one week after an abdominoplasty surgical procedure to the emergency room complaining of shortness of breath and chest pain. A chest computed tomography angiogram (CTA) pulmonary embolism protocol (PE) was ordered to rule out acute PE. The CTA study was negative for PE, but an incidental finding of complete obstruction of the right subclavian vein was noted. (Source: Journal of Diagnostic Medical Sonography)
Normal Transvaginal Sonography Endometrial Thickness Measurements Associated With Endometrial Cancer in the Symptomatic Postmenopausal Patient
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Carcinoma of the endometrium is a difficult abnormality to diagnose with sonography alone. In this case, a transvaginal sonogram resulted in unremarkable findings to evaluate a postmenopausal patient with vaginal bleeding. Further testing went on to establish a diagnosis of grade 1 endometroid adenocarcinoma. (Source: Journal of Diagnostic Medical Sonography)
Defibrillator Wire Leads Traversing an Atrial Septal Defect
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An implantable cardioverter defibrillator (ICD) is placed in the chest wall of patients who have reduced cardiac function and recurrent episodes of ventricular tachycardia or fibrillation. The purpose of the ICD is to detect life-threatening arrhythmias with subsequent cardioversion to a normal rhythm. Standard positioning of ICD leads are isolated to the right atrium and right ventricle, respectively. This case report documents an incidental but rare finding of an ICD lead traversing a suspected atrial septal defect in a patient with worsening dyspnea and a history of pulmonary embolism. Transthoracic echocardiography revealed what appeared to be a looped right atrial lead within the left atrium traversing the atrial septum, demonstrating an unusual ring appearance artifact. Subsequent im...
Comparative Assessment of Patient Satisfaction With Obstetric Sonography Between Missionary and Government Hospitals in Southeastern Nigeria
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Patient satisfaction with obstetric sonography may indicate the quality of services rendered in the sonographic suite. A comparative assessment of the quality of services between government and missionary hospitals in southeastern Nigeria is not known. The aim of this study was to compare the satisfaction rating during obstetric sonography between government and missionary hospitals in Nigeria. Seven hundred pregnant mothers who had obstetric sonography at least twice in both missionary and government hospitals were recruited for the study between January and June 2010. Questionnaires completed by patients were designed to obtain information on demographic variables, as well as patient satisfaction ratings of some indices of satisfaction that the sonographer and the managers of health inst...
Effects of Ascorbic Acid Intake on the Intima-Media Thickness and Blood Flow Velocities of the Carotid Artery in Patients With Sickle Cell Anemia
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This study aims to investigate and compare the effects of six-week oral vitamin C supplementation on blood velocities, intima-media thickness, and cross-sectional diameter (CSD) of the common carotid artery of sickle cell anemia (SCA) and non–sickle cell anemia (NSCA) subjects using sonography. Results showed that the CSD and end-diastolic velocity were significantly higher (P < .002 and P < .001, respectively) in the SCA subjects than in the NSCA subjects in the presupplementation phase. Calculated resistivity index (RI) was significantly lower in the SCA subjects (P < .003). Vitamin C supplementation had a slight effect on all the measured parameters in the NSCA subjects but caused a significant increase in peak systolic velocity (PSV) (P < .02) and RI (P < .01) in S...
JDMS CME Article-SDMS CME Credit
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(Source: Journal of Diagnostic Medical Sonography)
The Attempt to Standardize Technical and Analytic Competence in Sonography Education
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This study researched the implementation of using an objective structured clinical examination (OSCE) for diagnostic medical sonography students. The examination consisted of two components: (1) image analysis and (2) scanning. This examination involved first- and second-year sonography students. The results indicated that an objective assessment of technical and analytic skills could play an integral role in the evaluation process for sonography education. The objectives of this study were to determine (1) the reliability of the OSCE to test sonography students, (2) the validity of the OSCE in measuring the performance of sonography students at different levels in their education, and (3) the usefulness of the information received from this test. (Source: Journal of Diagnostic Medical Son...
Legislation Approaching Sonography
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This article will attempt to describe the process of occupational licensure as well as provide an overview of recent legislative activities at the state and federal levels. (Source: Journal of Diagnostic Medical Sonography)
Burkitt Lymphoma of the Heart: Echocardiographically Documented Improvement With Chemotherapy
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The incidence of non-Hodgkin lymphoma has increased over the past 10 years, particularly in association with human immunodeficiency virus (HIV) infection. Burkitt lymphoma is a highly aggressive non-Hodgkin lymphoma that involves the heart in up to a third of cases. This case describes an HIV-positive patient with cardiac involvement of Burkitt lymphoma who presented with atrial flutter and heart failure with pulmonary edema. Transthoracic echocardiography showed extensive heterogeneous lymphomatous infiltration of the heart (including the right atrium), with associated wall motion abnormalities. Within a day of starting chemotherapy, the patient had converted to normal sinus rhythm. His heart failure rapidly improved, and a repeat echocardiogram performed on day 5 of chemotherapy showed a...
Heterotopic Pregnancy in a Patient Not on Fertility Treatment
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Heterotopic pregnancy is a combination of an intrauterine pregnancy and an ectopic pregnancy. This is a rare event but has increased in incidence as in vitro fertilization becomes more common. This type of pregnancy is challenging to image and diagnose with sonography. This case reports a heterotopic pregnancy involving a woman in her late 20s who presented to the emergency room with acute abdominal pain, vomiting, and decreased blood pressure. The ectopic pregnancy was not visualized on an earlier dating scan. This case study discusses the etiology, diagnosis, sonographic appearance, and treatment of heterotopic pregnancy. (Source: Journal of Diagnostic Medical Sonography)
Neuroendocrine Tumor (Carcinoid) of the Appendix With Mucocele: Sonographic and Pathological Findings
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Acute right lower quadrant pain is a common emergency department presentation. Medical imaging has a main role to rule out appendicitis. Distinguishing between appendicitis and the other two major appendix pathologies, mucocele and carcinoid tumors, is not easy, but it is important for medical and surgical management planning. Appendix mobility is not usually assessed during sonography, but is it helpful? When comparing sonography and computerized tomography with histopathology findings to distinguish appendiceal pathologies, appendix mobility was found to be a key component. Appendix diameter, wall thickness, hyperemia, and surrounding echogenic fat are signs of an inflammatory process that will fix the appendix. Appendiceal carcinoids and mucoceles, on the other hand, will not initially ...
Prenatal Diagnosis of Cornelia de Lange Syndrome by 2D and 3D Sonography
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Cornelia de Lange syndrome, also known as Brachmann–de Lange syndrome, is a congenital condition characterized by pre- and postnatal growth deficiency, limb deformities, typical face features, hirsutism, behavioral problems, cognitive delay, and failure to thrive after birth. This developmental genetic disorder ranges from mild to fatal with unknown etiology. The sonographic prenatal findings in a case of Cornelia de Lange syndrome at 22 weeks’ gestation, which demonstrated facial dysmorphism, upper and lower limb abnormalities, growth retardation, and cardiac abnormality and confirmed at 32 weeks and 2 days of gestation and at autopsy, are discussed. Fetal karyotyping was normal. Because 2D sonography is the primary imaging modality for evaluating the growing fetus, it is poss...
Raine Syndrome
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Raine syndrome is a lethal, osteosclerotic bone dysplasia. There is a generalized increase in bone density, but the increased ossification in the skull results in a unique "fish-like" appearance to the face. Specific characteristics include a prominent forehead, exophthalmos, midfacial hypoplasia with hypoplastic nose, triangular-shaped mouth, and gum hyperplasia. Fewer than 20 cases have been reported in the literature with survival times varying from minutes to weeks. A retrospective review of the sonographic findings in the presented case documents the unique facial phenotype associated with this rare syndrome. (Source: Journal of Diagnostic Medical Sonography)
Role of Hydrocolonic Sonography in the Detection of Colonic Neoplastic Lesions
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This article evaluates the role of hydrocolonic sonography in the study of colon neoplastic lesions in daily gastroenterology practice. Consecutive patients referred for optical colonoscopy were randomly and prospectively enrolled to hydrocolonic sonography. All patients went through hydrocolonic sonography (HS) before optical colonoscopy (OS). In total, 108 patients (57 men), with an average age of 68.9 years, participated in the study. Indications for colonoscopy were colorectal cancer screening (50.0%), unspecific abdominal symptoms (45.4%), and liver metastasis or suspicious lymph nodes (4.6%). Inspection of the entire colon was possible in 86.8% of patients by OC and 89.6% of patients by HS. Globally, the sensitivity and specificity of HS in polyp detection were 24.2% and 99.7%, respe...
JDMS CME Article-SDMS CME Credit
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(Source: Journal of Diagnostic Medical Sonography)
Echocardiographic Findings in Fetuses With Vascular Lesions or Malformations
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Fetal vascular lesions or malformations such as sacrococcygeal teratomas, cervical teratomas, chorioangiomas, and vein of Galen aneurysms are associated with an increased risk of fetal death due to cardiac failure and hydrops. Large vascular lesions have the potential to result in increased cardiac output and volume overload on the fetal heart. As the heart compensates for the increasing blood flow, cardiovascular changes, demonstrable on fetal echocardiography, are likely to occur in the fetus. In the current era of fetal intervention and surgery, it is important to characterize these changes as a means of recognizing cardiac dysfunction and selecting patients for fetal intervention and management. This retrospective study characterizes the echocardiographic findings in fetuses with vascu...
Information for Authors
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(Source: Journal of Diagnostic Medical Sonography)
Appendicitis in the Deep Pelvis
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Sonography is an excellent tool to identify the appendix in patients with abdominal pain. If a normal appendix is identified, then a search for alternative pathology can be pursued. Identifying the appendix can be challenging: the location varies, overlying bowel gas interferes, and patient size can affect the resolution. Specific sonographic findings can help identify when an appendix is inflamed. A positive appendicitis may present with varying sonographic characteristics, and the tip of the appendix may present in atypical locations. The classic location of the appendix originates off the cecum with the tip draping over the iliac vessels in the right lower quadrant. This case report describes a case of appendicitis in the deep pelvis. Sonography of the appendix bears enormous responsibi...
Using Sonography to Characterize Renal Cell Carcinoma: Case Study of a Large Renal Mass
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This article presents a case study of a woman in her 60s diagnosed with late clear cell RCC with multiple metastases. It also addresses recent literature regarding outcomes for this disease. (Source: Journal of Diagnostic Medical Sonography)
Incidental Findings: A Case Study of Benign Liver Masses
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This article presents a unique case study with multiple benign liver masses: hemangiomas, focal nodular hyperplasias (FNHs), and liver cell adenomas (LCAs). Most hemangiomas have a characteristic echogenic appearance on sonography and need no further workup. FNH may be difficult to visualize sonographically because it is composed of normal hepatocytes in an abnormal arrangement. LCAs and liver adenomatosis are more serious, requiring medical intervention and monitoring. (Source: Journal of Diagnostic Medical Sonography)
Infantile Hemangioendothelioma of the Parotid Gland: A Sonographic Diagnosis
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Infantile hemangioendothelioma is the most common parotid gland tumor of infancy. It typically presents between two and four months of age as a rapidly growing mass. It is a benign condition that undergoes spontaneous regression and does not warrant intervention. Imaging plays a vital role in making an accurate diagnosis, thus helping to avoid biopsies in these young patients. In the appropriate clinical setting, sonography alone can assist in making a confident diagnosis, and magnetic resonance imaging is often reserved for atypical and/or complicated cases. The following case of hemangioendothelioma of the parotid gland was made based on characteristic sonographic features. No biopsy was performed, and it showed spontaneous regression during a one-year follow-up. (Source: Journal of Diag...
Testicular Sarcoidosis: Sonographic Findings
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Testicular sarcoidosis is a rare but benign entity. It is often mistaken for testicular neoplasm, leading to orchiectomy. It is, therefore, extremely important to identify and correctly diagnose testicular sarcoidosis on sonography to avoid unnecessary orchiectomy. This case study reports a young patient who had a prior history of unilateral orchiectomy for cryporchidism and presented with testicular lesions on the contralateral testis. He was later found to have skin lesions and chest symptoms that led to a diagnosis of sarcoidosis. (Source: Journal of Diagnostic Medical Sonography)
A Sonographer's Perspective: Quintero Staging System for Twin-to-Twin Transfusion Syndrome in Monochorionic Twins
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Sonography remains the cornerstone in the assessment of twin-to-twin transfusion syndrome in monochorionic twin pregnancies. Twin-to-twin transfusion is a common complication in monochorionic pregnancies, resulting in high perinatal morbidity and mortality rates. A disproportionate placental interconnection leads to hypovolemia and oligohydramnios in the donor twin and hypervolemia and polyhydramnios in the recipient twin. Ruben A. Quintero and his associates developed a staging system with definite sonographic criteria necessary for prognosis and management of these pregnancies. Quintero staging criteria consist of the following: stage 1, bladder of donor twin still visible; stage 2, bladder of donor twin no longer visible, no critical abnormal Doppler; stage 3, critical abnormal Doppler ...
Potential for Using 3D Technology to Image the Origins of the Coronary Arteries
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When young patients present to the echocardiography laboratory with chest pain, one consideration is that there may be an anomalous coronary artery. For this reason, it is critical that the sonographer evaluate the origins of the coronary arteries and map them with color Doppler flow to ensure that the blood is going in the correct direction. Although this may sound simple, not all sonographers have been trained to image the coronary arteries in detail and map them as far as possible. This pilot study investigated the feasibility of using volume acquisition from the parasternal short-axis and apical views. The results demonstrated that coronary artery origins can be successfully identified in adults using reconstruction of 3D volume data sets without adding significant time to the examinat...
JDMS CME Article-SDMS CME Credit
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(Source: Journal of Diagnostic Medical Sonography)
The Potential Value of Adding Colonic Sonography to Routine Abdominal Protocol in Patients With Active Pain
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Abdominal sonography examinations include evaluation of solid intra-abdominal organs but do not routinely include assessment of the colon. The focus of this study was to determine the utility of colonic sonography in addition to abdominal imaging in the prospective evaluation of patients with nonspecific acute or subacute abdominal symptoms. Patients referred for abdominal sonography for investigation of abdominal pain were evaluated by performing routine abdominal sonography followed by a detailed colonic sonographic examination. Final diagnosis was established by a clinical history questionnaire. Twelve colon (46%) or colon-related pathologies were identified, occurring in the cohort of 26 patients with a mean age of 23 years (range, 18—77 years). Sonographic findings included norm...
Information for Authors
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(Source: Journal of Diagnostic Medical Sonography)
Errata
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(Source: Journal of Diagnostic Medical Sonography)
Antiphospholipid (Anticardiolipin) Syndrome Leading to Budd-Chiari Syndrome and Anomalous Hepatic Vein Collateral Formation
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Most cases demonstrating extrahepatic venous collateral formation are the result of extensions of the portal venous system. This provides an outlet for venous drainage from the congested liver, usually in cases of portal hypertension. The case presented here, in a patient with systemic lupus erythematosus, antiphospholipid syndrome, and Budd-Chiari syndrome, is a demonstration of extrahepatic venous collateral formation originating from the hepatic veins in the liver. This rare case has features that are easily demonstrated using color and pulsed-wave Doppler sonography. (Source: Journal of Diagnostic Medical Sonography)
Sonographic Representation of Bifid Median Nerve and Persistent Median Artery
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Bifid median nerve and persistent median arteries are natural anatomic variants that exist in a small percentage of the population. This case describes a young woman who was referred for electrodiagnostic (EDX) testing of her right upper extremity because of a one-year history of numbness, tingling, and discomfort in her right upper extremity consistent with carpal tunnel syndrome. Careful sonographic scanning (gray scale and power Doppler) and dynamic investigation revealed a bifid median nerve and associated persistent median artery (PMA). The awareness of a bifid median nerve and PMA is important when evaluating patients sonographically for diagnosis of upper extremity pathology, including enlargement due to carpal tunnel syndrome. Furthermore, as musculoskeletal sonography increases in...
Ultrasonographic Appearance of Lung Sliding in a Patient With a Bronchopleural Fistula on a High-Frequency Oscillator Ventilator
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The patient with a bronchopleural fistula and acute respiratory distress syndrome can present a therapeutic challenge for the treating clinician. In this case, the authors describe the use of bedside thoracic sonography to show real-time improvement in a pneumothorax after initiation of high-frequency oscillatory ventilation. Sonography may have a role in the evaluation of ventilator strategies in the future, although validation of this application is still needed. (Source: Journal of Diagnostic Medical Sonography)
Portal Venous Gas Secondary to Gangrenous Gallbladder and Mirizzi Syndrome Diagnosed by Gray-Scale Sonography but Not on 64-Slice MDCT: A Case Report and Literature Review
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Portal venous gas is a rare entity that is associated with many fatal and nonfatal conditions. Its exact etiology remains unclear. Computed tomography (CT) has been described as a sensitive and primary imaging tool for detecting this condition, but there are only a few case reports in the literature where portal venous gas was not detected on CT scan but was found by sonography. This case reports portal venous gas developing secondary to gangrenous gallbladder with Mirizzi syndrome which was diagnosed by sonography but remained undetected on 64-slice MDCT. (Source: Journal of Diagnostic Medical Sonography)
JDMS CME Article-SDMS CME Credit
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(Source: Journal of Diagnostic Medical Sonography)
Echocardiographic Evaluation of Diastolic Function
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This article aims to review the components of diastolic filling and ventricular performance, as well as discuss the techniques used for the assessment of left ventricular diastolic function. (Source: Journal of Diagnostic Medical Sonography)
Sonographic Evaluation of Aortic Endografts
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The selective use of endovascular devices to repair abdominal aortic aneurysms was introduced in the early 1990s. Although placement of an aortic endograft offers patients a less morbid alternative to surgical repair, this procedure is not without complications. Persistent perfusion of the residual aneurysmal sac via endoleaks may place the patient at risk for aneurysmal enlargement and subsequent rupture. Historically, serial computed tomographic angiography has been used as the primary modality for assessment of aortic endografts. In recent years, sonography has been shown to provide a valued tool for ongoing surveillance of aortic endografts and identification of endoleaks, increasing aneurysmal size, hemodynamic disorders, and graft migration and/or kinking. Standardization of the sono...
Errata
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(Source: Journal of Diagnostic Medical Sonography)
Collaborative Learning and the Importance of the Discussion Board
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This article describes the various aspects a discussion board can lend to enhance the sense of a learning community. (Source: Journal of Diagnostic Medical Sonography)
Obstinate Choledocholithiasis
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Obstinate choledocholithiasis occurs when an obstructing common duct stone is large in size and does not easily respond to simple endoscopic or laparoscopic removal techniques. Such stones increase the risk of complications from causing biliary obstruction and from requiring more invasive methods of extraction. Sonography combined with computed tomography can confirm the presence, size, and position of common duct stones under ideal conditions before deciding if and how to treat choledocholithiasis. The sonographer must often battle bowel gas and difficult body habitus to image common duct stones, but it is crucial to document them when possible for proper diagnosis and management. (Source: Journal of Diagnostic Medical Sonography)
Spontaneous Hepatic Rupture Associated With HELLP Syndrome
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Hepatic rupture is a rare complication of severe preeclampsia with few cases having been reported in the literature. Most liver hematomas with subcapsular rupture occur antenatally but can occur in the postpartum period as well. Liver hematomas are a serious complication of severe preeclampsia but can be managed conservatively if the patient is stable. Hepatic rupture is a medical emergency and can be fatal if not properly diagnosed and treated. Sonography is an effective means of aiding in the diagnosis. Surgical intervention with delivery of the fetus and hepatic repair is essential for survival. (Source: Journal of Diagnostic Medical Sonography)
Umbilical Endometriosis
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Endometriosis is a common clinical disorder in which endometrial tissue is found outside the uterus. Although it is most commonly confined to the pelvis, it can present extra-pelvic. This case highlights one of the unusual locations of extra-pelvic endometriosis, the umbilical area, and the importance of including it in a differential diagnosis of any umbilical mass. When found at the umbilicus, sonographers should consider examining the pelvis for endometriomata and the abdomen and pelvis for any underlying malignancies. (Source: Journal of Diagnostic Medical Sonography)
Fetal Parvovirus B19 Infection Presenting With Nonimmune Hydrops Fetalis
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Parvovirus B19 is an easily transmitted virus that is common in young children but can infect gravid women if they do not have immunity. If this virus crosses the placenta and becomes a fetal infection, it can be potentially fatal to the fetus. This case report depicts the diagnosis and subsequent treatment of a fetus infected with parvovirus B19. (Source: Journal of Diagnostic Medical Sonography)