Abstract
This small single-centre study found that in preterm deliveries at periviable gestational ages, there is poor correlation between estimated fetal weight using ultrasound and actual weight. Ultrasound significantly underestimates fetal weight regardless of maternal size. This may have an impact on management strategies.
Another small single-centre study investigated the value of performing carotid endarterectomy on symptomatic stenoses of less than 50% (using NASCET criteria) and had good outcomes in those with unstable plaque. This study seems to fit with the current thinking of earlier intervention way before development of stenoses above 70%.
This team from Egypt investigated over 1000 patients with portal hypertension to determine whether the intra-abdominal portion of the oesophagus could reveal information about the presence of oesophageal varices. They say oesophageal wall thickness may be a useful indicator for identifying high-risk varices but it is hard for me to see how they achieved accuracy to 1/100th of a millimetre using a 4-MHz transducer.
This team in South Korea investigated the feasibility of transmitting ultrasound clips produced by emergency technicians in ambulances to hospital-based physicians ahead of the patient’s arrival. It would make more sense to train the technicians to provide a clinical opinion rather than getting a doctor to judge second hand images but sadly this would constitute illegal medical practice in South Korea.
Unsurprisingly, this survey of UK practice found that there is a wide variation on the significance attributed to microlithiasis, follow-up and management. The authors state that the European Society of Urogenital Radiology is currently working on producing some guidelines. I have heard they are now complete, so let us hope they are published soon so that we can amend practice accordingly.
On the same theme, this study involving 2266 boys found one germ cell tumour in 87 cases of microlithiasis, and eight germ cell tumours in 2179 boys without microlithiasis. The authors conclude that there is no association between microlithiasis and germ cell tumours. Bring on those ESUR guidelines!
Here is a helpful educational refresher for practitioners already including the cardiac three vessel and trachea view (3VT) during the prenatal anomaly scan. For those trying to implement it, I like this paper for two reasons: it is well illustrated with lots of abnormal 3VT views and offers a nice summary of 10 practice points.
This team reports two cases where bedside ultrasound performed by a paediatric emergency medicine physician detected fractures in infants younger than 12 months. They suggest ultrasound may be a useful tool in cases of child abuse.
Still on the subject of the use of ultrasound for boney pathology, here is a study that investigated the ultrasound appearance of metastatic rib deposits in patients with either prostate or renal cell carcinoma. Different sonographic appearances may mean that ultrasound may be useful at characterising rib metastases once they have been found on a bone scan.
Not only does point-of-care ultrasound expedite diagnosis and management but it also improves patient–physician relationships. Maybe some of our more curmudgeonly medics should take it up.
This study of 253 examinations on 189 patients found that lung ultrasound on mechanically ventilated critically ill patients made a big difference to their management in nearly half of cases. In around 20% of cases, the ultrasound examination revealed findings which were not suspected by the physician.
By analysing TCD studies in 159 patients from multiple centres, this team concluded that a patent foramen ovale is unlikely to be a causative factor in people experiencing chronic headache.
A fascinating paper reminding us of the massive contribution made by diagnostic ultrasound within the fertility setting but beyond applications for humans.