Nitin Chaubal

Color Doppler and Duplex Sonography in 5 Patients With Thoracic Outlet Syndrome

To evaluate the use of color Doppler sonography in the diagnosis of thoracic outlet syndrome.

Sonography in Budd-Chiari Syndrome

Objective. The objective of this presentation is to provide an overview of sonographic manifestations of Budd‐Chiari syndrome (BCS). Methods. Patients were scanned with ultrasound systems using mainly a 2‐ to 5‐MHz curvilinear transducer and in some patients a 5‐ to 12‐MHz linear transducer. The patients were asked to fast from the previous night or for at least 6 hours. Color and spectral Doppler sonography was performed in all patients. Results. Commonly seen findings in BCS include inferior vena cava (IVC) webs and thrombi, IVC narrowing, hepatic venous thrombosis, enlarged caudate lobes, ascites, intrahepatic or extrahepatic collaterals, monophasic to absent flow in the hepatic veins, and high flow velocities in areas of stenosis in the IVC or hepatic veins. Inferior vena cava stents used in the treatment of BCS could also be seen. Conclusions. Budd‐Chiari syndrome is an uncommon disorder; outcome is poor in many cases; and the condition is often misdiagnosed or underdiagnosed. Sonography is a noninvasive and effective modality for diagnosis of BCS.

Sonographic and Color Doppler Findings in Aortoarteritis (Takayasu Arteritis)

Objective. To review the sonographic appearance of aortoarteritis. Methods. A pictorial review of cases is presented. Results. Sonography in conjunction with color and pulsed Doppler imaging is a valuable tool in the evaluation of aortoarteritis. We can accurately diagnose, grade, and follow the progress of the disease. The response to treatment can also be assessed. This presentation reviews the sonographic findings in aortoarteritis. Conclusions. Color‐coded Doppler sonography can facilitate an accurate diagnosis of Takayasu arteritis by the characteristic appearance. Associated organ involvement can also be assessed.

Dance of live adult filarial worms is a reliable sign of scrotal filarial infection.

Objective. To determine the value of the filarial dance sign as a diagnostic sign of scrotal filarial infection and to recognize unsuspected scrotal filariasis by this sign. Methods. Eight symptomatic patients in whom the filarial dance sign was shown on high‐resolution ultrasonography were studied, investigated, and followed after treatment with diethylcarbamazine citrate. Two patients underwent fine‐needle aspiration. Results. Multiple foci (nests) of motile (live) filarial worms were observed in most patients. Fine‐needle aspiration of the dilated lymphatic vessels in 2 patients confirmed the presence of microfilariae. Five of 8 patients had a favorable response to treatment with diethylcarbamazine citrate. Conclusions. High‐resolution ultrasonography is a useful technique for diagnosing scrotal filariasis in symptomatic patients and is very useful in the follow‐up period for assessing the response of worms to treatment.

Antenatal Detection of Idiopathic Arterial Calcification With Hydrops Fetalis

Idiopathic arterial calcification of infancy, or occlusive infantile arterial calcification, is a rare cause of arterial calcification. This condition is inherited as an autosomal recessive pattern, which is almost always fatal. In most of the 100 cases described in the literature, the diagnosis was made at autopsy; a few cases have been reported in which an antemortem diagnosis was made on the basis of radiographic or sonographic demonstration of arterial calcification. The clinical characteristics are extremely variable, and respiratory distress with cardiac failure is the most common finding. Hypertension that is refractory to treatment is present in most cases. Most infants die before the age of 6 months, and very few have survived for more than 1 year. Mortality in this condition is caused by myocardial ischemia due to coronary artery involvement or refractory cardiac failure. The purpose of this report is to describe the prenatal diagnosis of idiopathic arterial calcification. Fewer than 10 cases of antenatal detection of this condition have been reported in the literature. This case is 1 of 2 cases with the earliest diagnosis of this condition so far (Table 1).

Sonography of the gastrointestinal tract.

Objective. The purpose of this presentation is to provide an overview of sonographic manifestations of various gastrointestinal diseases. Methods. Patients were scanned with an HDI 3000 or HDI 5000 system (Philips Medical Systems, Bothell, WA) with both a 2‐ to 5‐MHz curvilinear transducer and a 5‐ to 12‐MHz linear transducer. The patients were asked to fast from the previous night. For accurate visualization of the stomach, a cup of water was given to patients thought to have stomach or upper gastrointestinal disease. Results. A satisfactory sonographic examination could be performed in all patients. Conclusions. With recent technical advances, the increasing use of sonography in initial evaluation of patients with abdominal pain may allow earlier detection of bowel disease.

Congenital left ventricular aneurysm: Prenatal sonographic diagnosis

congenital left ventricular aneurysm is a rare condition involving protrusion or outpouching of a portion of the ventricular wall with a broad connection to the ventricular cavity, which may or may not have paradoxical systolic expansion.1 We report a case of a left ventricular aneurysm diagnosed at 21 weeks’ gestation. After an extensive search of the literature, we concluded that this represented the earliest prenatal diagnosis of this condition.

Calcified meconium: an important sign in the prenatal sonographic diagnosis of cloacal malformation.

Cloacal malformation is a rare abnormality, characterized by direct communication between the gastrointestinal, urinary, and genital structures, resulting in a single perineal opening. Prenatal diagnosis is difficult because of nonvisualization of the communication. We report a case of prenatal diagnosis of this condition, in which the recognition of calcified meconium in the colon and urinary tract provided an important clue.

Juvenile polyposis of the colon: sonographic diagnosis.

Juvenile polyposis is an uncommon condition characterized by development of multiple juvenile polyps, predominantly in the colon but also in the rest of the gastrointestinal tract. The condition usually appears in childhood. The rarer and often fatal form, occurring in infancy, is typified by diarrhea, protein-losing enteropathy, bleeding, and rectal prolapse. The more common form of juvenile polyposis (affecting the colon, stomach, and small bowel) occurs in the first or second decade with rectal bleeding and anemia. We report a case of juvenile polyposis detected on sonography, which had been treated as severe anemia for 1 year.

Sonographically Guided Nerve Biopsy

Peripheral neural involvement in tuberculoid leprosy is a well-known entity. However, many times, an open nerve biopsy is performed for a final histopathologic diagnosis in this condition. Sonographically guided Tru-Cut nerve biopsy is a promising alternative to open nerve biopsy in cases of leprosy and other nerve-involving diseases in an emerging era of very minimally invasive sonographically guided nerve interventions.