Eugenio O. Gerscovich

Ultrasonographic evaluation of diaphragmatic motion.

To evaluate the technical feasibility and utility of ultrasonography in the study of diaphragmatic motion at our institution.

Appearance of Solid Organ Injury with Contrast-Enhanced Sonography in Blunt Abdominal Trauma: Preliminary Experience

OBJECTIVE The purpose of this study was to compare the detection rate of injury and characterize imaging findings of contrast-enhanced sonography and non-contrast-enhanced sonography in the setting of confirmed solid organ injury. SUBJECTS AND METHODS This prospective study involved identifying hepatic, splenic, and renal injuries on contrast-enhanced CT. After injury identification, both non-contrast-enhanced sonography and contrast-enhanced sonography were performed to identify the possible injury and to analyze the appearance of the injury. The sonographic appearance of hepatic, splenic, and renal injuries was then analyzed, and the conspicuity of the injuries was graded on a scale from 0 (nonvisualization) to 3 (high visualization). RESULTS Non-contrast-enhanced sonography revealed 11 (50%) of 22 injuries, whereas contrast-enhanced sonography depicted 20 (91%) of 22 injuries. The average grade for conspicuity of injuries was increased from 0.67 to 2.33 for spleen injuries and from 1.0 to 2.2 for liver injuries comparing non-contrast-enhanced with contrast-enhanced sonography, respectively, on a scale from 0, being nonvisualization, to 3, being high visualization. The splenic injuries appeared hypoechoic with occasional areas of normal enhancing splenic tissue within the laceration with contrast-enhanced sonography. Different patterns were observed in liver injuries including a central hypoechoic region. In some liver injuries there was a surrounding hyperechoic region. CONCLUSION Contrast-enhanced sonography greatly enhances visualization of liver and spleen injuries compared with non-contrast-enhanced sonography. Solid organ injuries usually appeared hypoechoic on contrast-enhanced sonography, but often a hyperechoic region surrounding the injury also was identified with liver injuries.

A radiologist's guide to the imaging in the diagnosis and treatment of developmental dysplasia of the hip. II. Ultrasonography: Anatomy, technique, acetabular angle measurements, acetabular coverage of femoral head, acetabular cartilage thickness, three-dimensional technique, screening of newborns, study of older children

Abstract Developmental dysplasia of the hip (DDH) has a broad spectrum of presentation with the minor findings resolving spontaneously and the most severe ones resulting in disability, if not diagnosed early in life. Diagnosis in the first few months of life allows conservative treatment with complete resolution in most cases. Suspicion of DDH is based on ethnic, family, and pregnancy history, and on physical examination of the newborn. Imaging assists in the diagnosis and follows the treatment. Different modalities have their own advantages and disadvantages. This article deals with ultrasonography.

Testicular microlithiasis: our experience of 10 years.

Testicular microlithiasis (TM) is characterized on sonography by multiple microprecipitates in the testes. The correlation between TM and testicular malignancies is variable. The purpose of this study was to review our 10‐year experience regarding the prevalence of TM and its association with testicular malignancies.

Osteomyelitis of the clavicle: clinical, radiologic, and bacteriologic findings in ten patients

Most lesions of the clavicle are traumatic and pose few diagnostic difficulties. Nontraumatic clavicular lesions, on the other hand, are rare and frequently present problems in diagnosis. This report reviews the clinical, radiologic, and bacteriologic findings in ten patients, six of whom were diagnosed as having acute osteomyelitis and four chronic osteomyelitis. The differential diagnosis of clavicular osteomyelitis is also discussed. The clinical duration of the infectious process in these patients ranged from 2 weeks to 1.5 years. All patients presented with pain; six had fever, three had localized swelling or a mass, and three had soft tissue abscesses. The radiographic findings also varied: the lesion was predominantly sclerotic in four patients, lytic in three, and mixed in two patients; in the one patient in whom magnetic resonance imaging was the only imaging study performed, these features could not be properly evaluated. Periosteal reaction was detected in three patients. Staphylococcus aureus was the causal organism in four patients, while in the remaining six patients different microorganisms were cultured, including Coccidioides immitis and Mycobacterium tuberculosis. Six patients required biopsy for final diagnosis. Although clavicular osteomyelitis is rare, particularly in adults, it should be considered in the differential diagnosis of a clavicular lesion. The final diagnosis often depends on the results of biopsy and cultures.

Ultrasound detection of blunt splenic injury

The purpose of this study was to determine the sensitivity of emergency ultrasound (US) for the detection of blunt splenic injury (BSI), and to describe sonographic parenchymal patterns. Over 3 years, 2138 emergency US were performed, and 162 patients had BSI. CT was performed for 76 patients, and there were 86 laparotomies. Seventy patients (43%) had concomitant intraabdominal injuries. Ultrasound detected free fluid in 109 patients (67%), and parenchymal injury in 31 patients (19%). There were 48 false negative US (30%). Sonographic patterns included a diffuse heterogeneous appearance, hyperechoic and hypoechoic perisplenic crescents, and discrete hypoechoic or hyperechoic areas within the spleen. Overall sensitivity of US for detection of BSI was 69%, but was 86% for grade III or higher injuries. Ultrasound is most sensitive for the detection of grade III or higher BSI based on the presence of haemoperitoneum. Ultrasound may also identify BSI on the basis of parenchymal abnormality, with a diffuse heterogeneous pattern most commonly encountered. Sonographic evaluation for both free fluid and parenchymal injury improves sensitivity of US.

Differentiation of Ovarian Endometriomas from Hemorrhagic Cysts at MR Imaging: Utility of the T2 Dark Spot Sign

PURPOSE To determine sensitivity and specificity of the T2 dark spot sign in helping to distinguish endometriomas from other hemorrhagic adnexal lesions. MATERIALS AND METHODS This HIPAA-compliant, institutional review board-approved retrospective study, with informed consent waived, included 56 women (mean age, 38.8 years; range, 18-66 years). With a radiology database search of pelvic magnetic resonance images from December 16, 2002, to July 24, 2012, 74 cystic hemorrhagic adnexal lesions with hyperintense signal on T1-weighted images were identified. Lesions were excluded if they had solid enhancing components. Final diagnosis was established with pathologic analysis for all endometriomas and neoplasms. Hemorrhagic cysts were diagnosed with pathologic analysis (n = 7), follow-up imaging (n = 13), or prior ultrasonography (n = 5). Two radiologists independently reviewed cases and recorded the presence or absence of T2 shading and T2 dark spots. T2 dark spots were defined as discrete, well-defined markedly hypointense foci within the adnexal lesion on T2-weighted images. Sensitivity, specificity, and positive and negative predictive values of the T2 dark spot sign in distinguishing endometriomas from nonendometrioma hemorrhagic lesions were calculated. RESULTS Sixteen of 45 endometriomas (36%), zero of 25 hemorrhagic cysts, and two of four neoplasms (50%) (all serous cystadenomas) demonstrated T2 dark spots. Forty-two of 45 endometriomas (93%), 12 of 25 hemorrhagic cysts (48%), and four of four neoplasms (100%) demonstrated T2 shading. Sensitivity, specificity, positive predictive value, and negative predictive value of T2 dark spots for differentiating endometriomas from other hemorrhagic cystic ovarian masses were 36% (95% confidence interval [CI]: 19.8, 51.3), 93% (95% CI: 83.9, 100), 89% (95% CI: 63.9, 98.1), and 48% (95% CI: 34.8, 61.8), respectively, and for T2 shading, they were 93% (95% CI: 84.0, 100), 45% (95% CI: 27.8, 61.9), 72% (95% CI: 58.9, 83.0), and 81% (95% CI: 53.7, 95.0), respectively. CONCLUSION The T2 dark spot sign has high specificity for chronic hemorrhage and is useful to differentiate endometriomas from hemorrhagic cysts. The T2 shading sign is sensitive but not specific for endometriomas. Online supplemental material is available for this article.

A radiologist's guide to the imaging in the diagnosis and treatment of developmental dysplasia of the hip. I. General considerations, physical examination as applied to real-time sonography and radiography.

Abstract Developmental dysplasia of the hip (DDH) has a broad spectrum of presentation with the minor findings resolving spontaneously and the most severe ones resulting in disability, if not diagnosed early in life. Diagnosis in the first few months of life allows conservative treatment with complete resolution in most cases. Suspicion of DDH is based on ethnic, family, and pregnancy history, and on physical examination of the newborn. Imaging assists in the diagnosis and follows the treatment. Different modalities have their own advantages and disadvantages. This article deals with the description of the disease, risk factors, statistics, the physical examination as applied to real-time sonography, and imaging (plain radiography, arthrography, computed tomography, and magnetic resonance imaging).

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

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

High resolution ultrasound in the diagnosis of heterotopic pregnancy: combined transabdominal and transvaginal approach

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