Editorial

Welcome to the November 2014 issue of Ultrasound. This issue brings a great mix of original research papers, some high-quality review papers with excellent educational value and some quite unusual case reports. We begin with a prospective study by Mortensen et al. of the incidence and appearances of the pyramidal lobe of the thyroid. Over 20% of 416 patients studied were found to have a pyramidal lobe in various forms. The pyramidal lobe can be affected by the same pathologies as the rest of the thyroid and the authors recommend that the presence of this variant is reported if thyroid surgery is likely, to ensure complete resection. The second research article, by Joy et al., is something completely different and describes the design of a computer-controlled system that measures the lateral resolution of ultrasound imaging systems at a range of depths. The measurements are carried out with little user interaction and are then combined to generate a single figure of merit to describe the quality of the beam.

The first of four review papers is by Adlan and Freeman and describes the role of ultrasound in managing scrotal injuries. Such injuries can quickly lead to serious complications, and the authors show that ultrasound has a pivotal role in the accurate triage of such patients, assessing injuries and testicular perfusion to inform decisions on surgical management. Paliwalla and Park provide a practical guide to the assessment of the urinary tract in children. The authors begin with some very useful advice on gaining the cooperation of a child in preparation for scanning. They list some general scanning protocols and then consider a comprehensive range of urinary tract pathologies, giving practical advice and describing a systematic approach to scanning for each. The third review article is entitled: ‘My patient’s got abdominal pain: identifying biliary problems’. This article, by Woo et al., is the next in the long-running PoCUS series and describes the use of ultrasound by emergency physicians to identify cholelithiasis or cholecystitis as the cause of right upper quadrant pain and to determine if the biliary system might be the source of infection, where there are symptoms of sepsis. Abe et al. review the literature on ultrasound of the muscles of the upper extremity and trunk. In particular, they review studies of the relationships between ultrasound muscle thickness and muscle morphology, i.e. cross-sectional area and muscle volume. Muscle thickness is much easier to measure with ultrasound than area or volume and they conclude that muscle thickness measurements may reflect muscle area and volume for these individual muscles. The evidence linking muscle thickness to muscle function was less convincing, however.

In the first of three case studies, Greenall et al. describe the ultrasound features of a solitary fibrous tumour of the cheek. This unusual presentation was difficult to diagnose and they conclude that ultrasound imaging alone was limited in reaching a diagnosis, but was helpful for ultrasound-guided biopsy. The definitive diagnosis was only made by a histological analysis following surgery. Hannon presents an unusual case report of renal artery stenosis identified on duplex ultrasound in a patient with a history of IVC filter placement following a DVT. Follow-up CTA images suggested that a displaced leg of the filter was impinging on the renal artery and perforating the IVC. Open surgical intervention was required to disentangle the filter legs and relieve the impingement. The final case report by Vohra et al. describes the ultrasound appearances of a rare unilateral twin ectopic pregnancy from a spontaneous conception. Cardiac activity was demonstrated in both embryonic poles using ultrasound imaging, colour Doppler and M-mode.

I do hope that our readers appreciate the excellent content of this November issue and I look forward to seeing many of you at the forthcoming BMUS Annual Scientific Meeting in Manchester. If you are presenting a paper or poster, please do consider writing up your work and submitting it for publication in Ultrasound.