Echoes

Quality assessment of the detailed anomaly ultrasound scan. Souka AP, Pilalis A, Papastefanou I, et al. J Maternal-Fetal Neonatal Med 2019; 32(4): 666–670.

This prospective investigation from Greece of 940 single pregnancies found that there was suboptimal visualisation of the fetus due to lie or maternal weight in 34% of anomaly scans. However, the examination was completed at the first attempt in 75%. The researchers recommend at least 30 minutes scanning time. The UK NHS Fetal Anomaly Screening Programme recommends a 30-minute appointment, but all tasks including introductions, consent and reporting are included within that timeframe.

Three-dimensional printed cardiac models for focused cardiac ultrasound instruction. Ochoa S, Segal J, Garcia N, et al. J Ultrasound Med September 2018. DOI: 10.1002/jum.14818 [Epub ahead of print].

Twenty medical students with no point-of-care ultrasound experience were randomly assigned either to a workshop with access to a 3D printed heart model or to a traditional lecture. They were knowledge tested at 0 and 3 months and also had to acquire images at 3 months. Perhaps surprisingly, there was no significant difference in their performance.

Residual vein obstruction in patients diagnosed with acute isolated distal deep vein thrombosis associated with active cancer. Dentali F, Barco S, Pegoraro S, et al. J Thromb Thrombol 2018; 46(3): 404–408.

In this study of 153 patients with below knee deep vein thrombosis (DVT), post-hoc analysis showed that the female sex and obesity had the strongest association with residual vein obstruction. Furthermore, the risk of recurrent DVT was twice as likely if the patient had residual vein obstruction.

Suspected testicular torsion in children: Diagnostic dilemma and recommendation for a lower threshold for initiation of surgical exploration. Abbas TO, Abdelkareem M, Alhadi A, et al. Res Rep Urol 2018; 10: 241–249.

The titular dilemma is when to surgically explore. This retrospective study of 52 youngsters found that the most common clinical symptom for torsion was pain, and the most common radiological sign for excluding torsion was an enlarged epididymis on ultrasound. However, predictability by any single factor is unreliable, so the message here is to gather maximum information in a very timely manner.

The growth-restricted fetus: Risk of mortality by each additional week of expectant management. Pilliod RA, Page JM, Sparks TN, et al. J Maternal-Fetal Neonatal Med 2019; 32(3): 442–447.

Here, a large retrospective study of over 1.6 million pregnancies, of which 6.7% (n = 110,748) were growth restricted, concluded that at 38 weeks the mortality risk of expectant management exceeded the risks associated with delivery across all growth-restricted cohorts regardless of the degree of growth restriction.

Role of chest ultrasound in neonatal lung disease: A review of current evidences. Sharma D and Farahbakhsh N. J Maternal-Fetal Neonatal Med 2019; 32(2): 310–316.

The usefulness of lung ultrasound compared with computed tomography and chest radiographs of the neonate is the subject of this review. The authors conclude ultrasound has good sensitivity and specificity when it comes to all common causes of neonatal distress including pneumothorax, pneumonia, transient tachypnea and respiratory distress syndrome.

Can renal and bladder ultrasound replace computerized tomography urogram in patients investigated for microscopic hematuria? Tan WS, Sarpong R, Khetrapal P, et al. J Urol 2018; 200(5): 973–980.

This multicentre prospective observational study of over 3500 adults concluded that ultrasound may safely replace computed tomography (CT) for those with microscopic haematuria. However, those with macroscopic haematuria still need CT, not least because ultrasound is poor at detecting stones and upper tract urothelial tumours. Furthermore, cystoscopy remains the gold standard for detecting bladder cancer.

Fetal myelomeningocele surgery: Only treating the tip of the iceberg. Alrefai A, Drake J, Kulkarni AV, et al. Prenatal Diagn December 2018. DOI: 10.1002/pd.5390.

Over a 10-year period, this retrospective investigation found that 91 out of 158 fetuses with myelomeningocele were eligible for repair in utero, a technique which has been shown to improve infant neurological outcomes but can cause obstetric complications such as uterine dehiscence. Actual uptake for surgery was only 15% (n = 14). Such small numbers support the rationale for expert centres.

Presence of chromosomal abnormalities in fetuses with isolated ventriculomegaly on prenatal ultrasound in China. Zhao D, Cai A, Wang B, et al. Mol Genet Genom Med September 2018. DOI: 10.1002/mgg3.477 [Epub ahead of print].

This prospective study investigated the incidence of chromosomal abnormalities in two groups: fetuses with isolated ventriculomegaly and fetuses born to women ≥ 35 years of age. Those in the former group had a significantly greater incidence (p < 0.001) of chromosomal abnormalities.

Comparing the Hadlock fetal growth standard to the NICHD racial/ethnic standard for the prediction of neonatal morbidity and small for gestational age. Blue NR, Beddow ME, Savabi M, et al. Am J Obstetr Gynecol August 2018. DOI: 10.1016/j.ajog.2018.08.011 [Epub ahead of print].

This retrospective study of over 1500 deliveries concluded that, despite its age, the Hadlock fetal growth standard is still valid and is superior to the National Institute of Child Health and Human Development standard for predicting small babies and neonatal morbidity.

Ultrasonographic-based predictive factors influencing successful return to racing after superficial digital flexor tendon injuries in flat racehorses: A retrospective cohort study in 469 thoroughbred racehorses in Hong Kong. Alzola R, Easter C, Riggs CM, et al. Equine Veterinary J 2018; 50(5): 602–608.

This Anglo-Chinese collaboration described six ultrasonic features relating to superficial digital flexor tendon injuries in racehorses at initial presentation that were predictive of the animal making a successful return to racing. The researchers anticipate that their work may enable earlier decisions on these horses’ prognosis.