J D Bowie

The Case for Immediate Pyeloplasty in the Neonate with Ureteropelvic Junction Obstruction

The 99mtechnetium-diethylenetriaminepentaacetic acid renal scan allows differentiation of ureteropelvic junction obstruction from multicystic kidney in most instances. Although renal function usually will improve at least a little after relief of obstruction, the young infant is privileged and more improvement can be expected than occurs usually in older children. Since an operation is as safe and results of pyeloplasty are as good in the neonate as in older infants or children early correction of ureteropelvic junction obstruction is advocated in otherwise healthy infants as soon as the diagnosis is established.

Ultrasound of the postpartum uterus. Prediction of retained placental tissue.

We reviewed ultrasound images an 53 postpartum patients referred for possible retained products of conception and correlated specific ultrasound patterns with clinical and pathologic follow‐up. The most common finding in patients with retained placental tissue was an echogenic mass in the uterine cavity, seen in 9 of 11 patients with pathologically proven retained placental tissue. In the remaining 2 patients with pathologically confirmed retained placenta, a heterogeneous mass was seen in the uterine cavity at some point during the course of serial sonography. Retained placental tissue was unlikely when ultrasound demonstrated a normal uterine stripe (n = 18), endometrial fluid (n = 6), or hyperechoic foci in the uterine cavity without an associated mass (n = 17). The latter finding was often associated with recent uterine instrumentation. The sonographic appearance of retained placental tissue is variable, but detection of an echogenic mass in the uterus strongly supports the diagnosis. A heterogeneous mass is sometimes caused by retained placenta, but can also be secondary to blood clots or infected or necrotic material in the absence of placental tissue. Sonographic evaluation for retained products of conception is best done before uterine instrumentation to avoid confusion with iatrogenically introduced air.

Ultrasound in the staging of lymphoma.

Ultrasonography of the abdomen and pelvis was performed in 16 patients with lymphoma who underwent clinical and pathologic staging. The results of the ultrasound examinations were correlated with the pathological findings as were the results of gallium-67 scans, inferior vena cavagrams and lymphangiograms obtained in the same group. Analysis of the data indicated accuracies in the 80-90% range and specificities of greater than 90% for ultrasound. The sensitivity of ultrasound was somewhat lower, in the 60-70% range. These findings compare favorably with those of the other diagnostic procedures evaluated and indicate the usefulness of ultrasound in the staging of lymphoma.

What is the upper limit of normal for the common bile duct on ultrasound: how much do you want it to be?

Conventionally, the upper limit of normal for the common bile duct as measured by ultrasound is considered to be 6 mm. This review is a somewhat personalized account of how that number became the convention and cautions the reader to avoid being slavish in the use of this number. Two specific cautions are not to apply this limit to older patients and to consider where in the common bile duct the measurement was taken, as measurements taken closer to the pancreas may be larger than ones closer to the liver.

Fetal choroid plexus lesions: relationship of antenatal sonographic appearance to clinical outcome

The sonograms and clinical outcomes of 31 fetuses with antenatally detected choroid plexus lesions were retrospectively reviewed. Lesions were classified as simple cysts in 22 cases (71%) and complex lesions in 9 (29%). Simple cysts tended to be smaller in size than the complex lesions and no adverse sequelae were attributed to the sonographic detection of simple cysts. Although complex choroid plexus lesions appeared to be an incidental finding in seven of nine cases (78%), one of the remaining fetuses developed ventriculomegaly with focal cerebral cortical thinning and in utero viral infection was suspected in the other. Amniocentesis was performed in nine patients (five with simple cysts and four with complex lesions) and no chromosomal abnormalities were detected during the study period, although after these data were collected we encountered a fetus in which bilateral large complex choroid plexus lesions were associated with trisomy 18. These findings suggest that antenatally detected choroid plexus lesions are more variable in appearance than previously recognized. We consider fetuses with small simple cysts and otherwise normal sonograms to be at relatively low risk for developing adverse sequelae and recommend repeat sonography in 1 to 2 months to confirm the benign nature of the process. The presence of large and/or complicated lesions is of more concern, although the majority of these lesions (78%) also represented an incidental finding. We suggest consideration of amniocentesis, TORCH titers, and close sonographic follow‐up of pregnancies with large or complex choroid plexus lesions.

First trimester fetal cardiac activity. Sonographic documentation of a progressive early rise in heart rate.

The heart rates of 124 first trimester fetuses were determined with real‐time sonography and were analyzed with regard to gestational age. The mean embryonic heart rate increased from 101 beats per minute (bpm) at 5 to 5.95 menstrual weeks to 143 bpm at 8 to 8.95 weeks. After nine weeks, the rate reached a plateau, ranging from 137 to 144 bpm. Slower heart rates are normal early in the first trimester and should not be misinterpreted as an abnormal finding or mistaken for maternal pulsations.

Ultrasonographically guided manual compression of femoral artery injuries.

To determine the success and complication rates of ultrasonographically guided manual compression in patients with femoral arterial injuries after femoral arterial catheterization, we performed 53 sonographically guided compression repairs in 51 patients. Ultrasonographically guided compression repair was performed on 40 pseudoaneurysms in non‐anticoagulated patients, seven pseudoaneurysms in anticoagulated patients, four arteriovenous fistulas on non‐anticoagulated patients, and one pseudoaneurysm combined with an arteriovenous fistula. One pseudoaneurysm underwent two separate ultrasonographically guided compression repairs: once when the patient was anticoagulated and once after anticoagulants were withheld. Ultrasonographically guided compression repair was successful in 37 of 48 pseudoaneurysms (77%). Of the 40 pseudoaneurysms in non‐anticoagulated patients, ultrasonographically guided compression repair was successful in 36 (90%). This repair technique failed in all seven pseudoaneurysms in anticoagulated patients. Ultrasonographically guided compression repair was successful in 13 of 16 (81%) multilobulated pseudoaneurysms but failed in all arteriovenous fistulas and the one case of pseudoaneurysm combined with an arteriovenous fistula. Ultrasonographically guided compression repair is a safe and effective alternative to surgery for the repair of pseudoaneurysms, including multilobulated pseudoaneurysms. The procedure does not appear to be effective in the anticoagulated patient or in patients with an arteriovenous fistula.

The in utero findings in twin pentalogy of Cantrell.

The antenatal sonographic diagnosis of omphalocele is well documented, 1 but because it has a verv strong association with other congenital anomalie~. the sonographer must be fully aware of these so that an accurate evaluation can be made. !!: A case of identical twins with secundum atrial septal defects, cleft sternums, abse nce ofventral diaphragms, diaphragmatic pericardia] defects, and omphalocele (Cantrells pentalogy)l forms the basis for this report. To our knowledge Cantrells pentalogy in twins has never been reported. The antenatal sonagraphic findings, obstetric approach . and postmortem findings are reported and a discussion of the literature is included.

The changing sonographic appearance of fetal kidneys during pregnancy.

One hundred consecutive women between 11 and 40 weeks of gestation were studied to evaluate the changing appearances of the fetal kidneys. In the first trimester, the kidney was never positively identified. Between 15 and 26 weeks it was seen but was difficult to distinguish from surrounding tissue. In the early third trimester, either an echogenic border or increased echogenicity of the renal sinus was observed; in the late third trimester this increased echogenicity was observed in both areas. It is thought that the echogenicity is the result of fat deposition in the pararenal space and in the renal sinus.

Gray-Scale Ultrasonography in the Diagnosis of Polycystic Kidney Disease

Five patients with polycystic disease of the kidney were examined with gray-scale ultrasonography. It was found that bilateral involvement may be demonstrated by ultrasound even when it cannot be seen on excretory urography. It is suggested that this technique be used in screening families in whom a history of polycystic kidney disease has been shown.