Ultrasonography greatly improves the ability of clinicians to diagnose psoriatic arthritis Kuo-Lung Lai Journal of Medical Ultrasound 2019 27(4):167-168

Transrectal doppler sonography of benign prostatic enlargement in Nigerian Men Olubukola Olayinka Fanimi, Christianah Mopelola Asaleye, Abdulkadir Ayo Salako, Oluwagbemiga Oluwole Ayoola, Tewogbade Adeoye Adedeji, Bukunmi Michael Idowu Journal of Medical Ultrasound 2019 27(4):169-176 Background: Transrectal ultrasonography (TRUS) is the best route for examining the prostate gland because of transducer proximity, elaboration of zonal anatomical details, and Doppler assessment of prostatic arteries' hemodynamics. Materials and Methods: This was a cross-sectional study of 300 men with benign prostatic enlargement (BPE) and 300 healthy age-matched controls. The resistive index (RI) of the left capsular, right capsular and urethral arteries were assessed by TRUS and correlated with these parameters: maximum urine flow rate (Qmax), total prostatic volume (TPV), transitional zone volume (TZV), transitional zone index (TZI), presumed circle area ratio, and the International Prostatic Symptoms Score (IPSS). Results: The RI of capsular and urethral arteries correlated significantly with Qmax, TPV, TZV, TZI, and IPSS. Of the three different RIs evaluated, the RI of UA showed the strongest correlation with Qmax(r =- 0.51; P < 0.0001). The RIs were significantly higher in obstructive BOO than the non-obstructive group (Qmaxof <15 ml/sec and ≥15 ml/sec, respectively). The mean RI values were 0.73 ± 0.05 vs. 0.63 ± 0.04 for the RCA; 0.73 ± 0.05 vs. 0.62 ± 0.04 for the LCA; and 0.73 ± 0.06 vs. 0.62 ± 0.05 for the UA in the BPE and controls, respectively (P < 0.001). The TPV values were 52.36 ± 28.67 and 18.28 ± 4.26 in BPE and controls, respectively (P < 0.001).Conclusion: Prostatic artery RIs are elevated in BPE. Increase in RI correlated with increase in TPV, TZV and TZI, urinary symptoms' severity, poor QOL, and the severity of BOO.

Skin-liver distance and interquartile range-median ratio as determinants of interoperator concordance in acoustic radiation force impulse imaging Shu Su, Wayland Wang, David Nadebaum, Amanda Nicoll, Siddharth Sood, Alexandra Gorelik, Jeffrey Lai, Robert Gibson Journal of Medical Ultrasound 2019 27(4):177-180 Context and Aims: The accuracy of acoustic radiation force impulse (ARFI) ultrasound compared to liver biopsy is higher when there is concordance between F-scores of two or more operators. We hypothesized that when the first operator interquartile range/median-velocity ratio (IMR) is <0.3 and skin-liver distance (SLD) is <2.5 cm, there is greater interoperator concordance and a second operator is not necessary. Subjects and Methods: Two-operator ARFI ultrasound measurements (F-score, SLD, and IMR) were recorded for 927 consecutive patients. Chi-squared testing compared interoperator concordance for SLD <2.5 cm versus SLD ≥2.5 cm and IMR <0.3 versus IMR ≥0.3 when SLD <2.5 cm, in each of the F-score groups of 0/1, 2, 3, and 4. Results: Statistically significant differences were demonstrated between SLD <2.5 cm and SLD ≥2.5 cm groups for F-scores 0/1 or 4 (P = 0.005) and F-scores 2 or 3 (P < 0.001). Concordance, when SLD measured <2.5 cm, was more than 85% for all F-score groups. In the SLD <2.5 cm group, concordance fell below 85% when IMR ≥0.3, for all F-scores except F2. Specifically, P values comparing IMR <0.3 and IMR ≥0.3 in the various first operator F-score groups were P = 0.040 for F0/F1, P = 0.580 for F2, P = 0.342 for F3, and P < 0.001 for F4. Conclusions: ARFI measurements from one operator can be considered acceptable when SLD <2.5 cm and IMR <0.3. Otherwise, adding a second operator can improve confidence in the result.

Genetic burden and outcome of cystic hygromas detected antenatally: Results of 93 pregnancies from a single center in the Northern Region of Turkey Huri Sema Aymelek, Gönül Oğur, Miǧraci Tosun, �mmet Abur, Engin Altundaǧ, Handan Çelik, Emel Kurtoǧlu, Erdal Malatyalıoǧlu, Ömer Salih Akar, Tayfun Alper Journal of Medical Ultrasound 2019 27(4):181-186 Objective: Genetic burden, fetal malformations, and fetal outcomes of 93 fetuses with cystic hygroma (CH) are reported from a single center in Turkey. Patients and Methods: Pregnancies, having a diagnosis of fetal CH, detected between January 2010 and October 2016, were included in the study except fetuses having increased nuchal translucency. Fetal age/gender, maternal age, the age of pregnancy, types of fetal malformations, karyotype, and outcomes were evaluated. Results: The average gestational age was 16.2 weeks. Nearly 47% of the pregnancies had multiple congenital anomalies, of which 58% had a chromosomal anomaly. Chromosomal anomaly rate was 68.2% in patients with hydrops fetalis. Aneuploidies were major chromosomal defects. All trisomies were of regular type except one with Robertsonian translocation (46, XY, +13, rob[13;14][q10;q10]). Seventy-four percentage pregnancies were terminated due to either fetal/karyotype anomaly. Conclusion: Characteristics of fetal CH were similar in different ethnical backgrounds. Aneuploidy is the dominant chromosomal constitution of fetal CH. Little information was known about the genes involved. Gene dosage effect implies that fetal CH is a complex genetic situation involving multiple genes interactions. For proper genetic counseling, each fetus with CH should be karyotyped, and fetal ultrasound examination should be performed. In the case of normal chromosome set, application of aCGH should be considered.

A comparison of internal jugular vein cannulation by ultrasound-guided and anatomical landmark technique in resource-limited emergency department setting Meenhas Oravil Kunhahamed, Siju Varghese Abraham, Babu Urumese Palatty, S Vimal Krishnan, Punchalil Chathappan Rajeev, Vivek Gopinathan Journal of Medical Ultrasound 2019 27(4):187-191 Background and Objectives: Central venous catheter placement is a frequently performed procedure in emergency medicine as well as critical care unit. We aimed to compare real-time ultrasonography (USG)-guided and the traditional anatomical landmark (AL) technique for the insertion of internal jugular vein (IJV) catheters in an emergency department (ED) setting. Materials and Methods: Patients requiring IJV catheterization were prospectively recruited over a period of 1 year at a single center. Cannulation was done either by the AL or USG technique, according to ED physician's discretion. A preset pro forma was completed for each central line placed. Variables were compared using the independent t-test, Fisher's exact test, and the nonparametric Mann–Whitney U-test. Results and Discussion: Seventy patients were enrolled, of which 35 patients underwent IJV cannulation by USG-guided technique (USG group) and 35 patients by the AL technique (AL group). There were a 100% success rate (35/35) for cannulation in the USG group and a 91.4% success rate (32/35) in the AL group. The catheter was placed on the first attempt in 17 (48.6%) patients in the AL group and 32 (91.4%) patients in the USG group. In th AL group, there were three failed cannulation attempts in comparison to the USG group. The mean start to flash time for the AL technique was 16.59 s (±10.67) and 4.86 s (±2.18) in the USG group. The mean cannulation time was 305.88 s (±66.84) in the AL group and 293.03 s (±71.15) in the USG group. A total of seven acute complications were noted, of which 2 (5.7%) in the USG group and 5 (14.3%) in the AL group. Conclusion: The real-time USG guided technique significantly reduces the number of attempts to cannulate, has a higher first-pass success rate, a quicker flash time, and fewer complications when compared to the AL technique. In EDs equipped with USG, insertion of IJV catheters under real-time USG guidance should become the standard of care.

Prognostic value of ultrasonography in predicting therapeutic outcome for carpal tunnel syndrome after conservative treatment: A retrospective long-term follow-up study Xue Deng, Lai-Heung Phoebe Chau, Suk-Yee Chiu, Kwok-Pui Leung, Yong Hu, Wing-Yuk Ip Journal of Medical Ultrasound 2019 27(4):192-197 Purpose: This study aimed at investigating prognostic values of different ultrasound variables in predicting therapeutic outcome of the patients with carpal tunnel syndrome (CTS) after conservative treatment in a long-term follow-up data. Materials and Methods: One hundred and three participants with 162 affected hands were enrolled in this retrospective study. Records of baseline clinical information, nerve conduction studies (NCSs), and ultrasound assessment were retrieved. A structured telephone interview was conducted for acquiring patients' response to recovery after treatment. Multinomial logistic regression analysis was used to estimate the odds ratio and 95% confidence interval of individual ultrasound variable, adjusted for age, gender, and other confounding factors. Results: Perimeter at wrist (W-P), ratio of cross-sectional area of wrist over one-third distal forearm (R-CSA), changes of CSA from wrist to the one-third distal forearm (△CSA), and changes of perimeter from wrist to one-third distal forearm (△P) were negatively and significantly associated with “improved” and “no change” categories relative to reference category (“deteriorated” category). After adjustment for age, gender, affected hand side, surgical history, and comorbidity, for one unit increase of W-P/△CSA/△P, the odds of “improved” category versus “deteriorated” category decreased by 89.1%/56%/95.2%, whereas the odds of “no change” relative to “deteriorated” category decreased by 77.8%/54.6%/84.9% should one unit increase in the correspondent individual ultrasound variable. Conclusion: Ultrasound variables can significantly predict therapeutic outcome in CTS after conservative management in a long-term follow-up. Further studies may be required to assess whether a combination of clinical, NCS, and ultrasound variables can better predict the therapeutic outcome.

Prenatal diagnosis and immediate successful management of isolated fetal epignathus Mohamed ElSherbiny Hamed, Mohamed Hassan Naser El-Din, Ibrahim A Abdelazim, Svetlana Shikanova, Bakyt Karimova, Sakiyeva Kanshaiym Journal of Medical Ultrasound 2019 27(4):198-201 Epignathus or enigmatic teratoma is rare congenital tumor, arising from the sphenoid region of the palate or pharynx. A 30-year-old pregnant woman presented at 34 weeks + 2 days' gestation with a well-defined solid mass measuring 6.47 cm × 5.7 cm arising from the fetal oral cavity. The color flow mapping showed that the mass was well vascularized, especially in its center, and its blood supply was originated from the fetal oral cavity. The newborn has no chromosomal abnormalities or other associated anomalies and/or intracranial extension immediately and successfully managed after delivery to highlight the importance of prenatal diagnosis and the importance of multidisciplinary team management.

Sonographic findings in superficial angiomyxoma of the vulva in a perimenopausal female Lu Chen, Li Chen, Jing Ling Wang, Cai Hu, Zhi Xing Liu, Xin Chun Yuan, Jian Xin He Journal of Medical Ultrasound 2019 27(4):202-204 Superficial angiomyxoma (SAM) is an extremely rare soft tissue tumor. It is especially rare in the vulva, with only a few such cases reported in the medical literature. Here, we report a case of SAM of the vulva that was initially suspected to be a Bartholin gland cyst. The patient underwent local excision of the vulvar cyst under lumbar anesthesia. Clinical manifestations and B-scan ultrasonographic features are similar between SAM and cysts. Echoes in the mass are uneven and exhibit low echoes and punctate hyperechoic floating. Thus, increasing sonographers' awareness of the high-frequency ultrasonography findings associated with this rare tumor could broaden their knowledge base.

A rare case of fetal meconium peritonitis developing coagulopathy in utero Yusuke Kobayashi, Takahiro Nakano, Nobuhiro Hidaka, Kiyoko Kato Journal of Medical Ultrasound 2019 27(4):205-207 Hydrops fetalis in association with meconium peritonitis is a rare condition, and the mechanism underlying hydropic changes has not been fully recognized. We present a case of fetal meconium peritonitis with hydrops and coagulopathy. Clinically, the cause of fetal disseminated intravascular coagulation is considered to be a consequence of a systematic inflammatory response based on progressive, but mild fetal anemia without other apparent triggers, thrombocytopenia, elevated white blood cell count and serum C reactive-protein, hypoalbuminemia, and increased vascular permeability. The infant was born at 32 weeks of gestation and survived after postnatal multidisciplinary treatment. Our experience suggests that recognition of this rare condition will enable early diagnosis and better clinical management for fetuses with meconium peritonitis.

Imaging of lactating adenoma: Differential diagnosis of solid mass lesion in a lactating woman Reddy Ravikanth, Kanagasabai Kamalasekar Journal of Medical Ultrasound 2019 27(4):208-210 Lactating adenoma is an uncommon palpable breast lesion occurring in the late pregnancy or lactation period and is commonly found in young primiparous women in the second or third decade of life. Although a benign condition, sometimes, core biopsy is required to exclude malignancy. Approximately 3% of all breast cancers occur in women who are pregnant; and hence, a breast mass in this group of women must be investigated. The main differential diagnosis for a palpable solid breast mass is lobular hyperplasia which is a normal physiological event, fibroadenoma, focal mastitis, lactating adenoma, tubular adenoma, phyllodes tumor, and breast carcinoma. Here, we present a case of lactating adenoma of the breast at 6 months' postpartum in a 24-year-old primiparous woman.