Journal of Diagnostic Medical Sonography

Sonographic examination of the lower extremity arterial system can be time-consuming and arduous if performed in its entirety on every patient who is referred to the vascular sonography laboratory. In fact, most patients can benefit from a tailored noninvasive arterial examination that integrates clinical, physiological, and imaging/Doppler modalities in answering the referring physician s questions. This study provides an algorithm for assessing the type and level of information needed for most patients arriving in the sonography suite with known or suspected peripheral arterial disease.

Transcranial Doppler (TCD)is a common test used for cerebrovascular diseases. Typically, TCDs are done blindly, with no angle correction for any of the intracranial arteries. The authors measured the angle of the middle cerebral artery (MCA), as seen from the middle temporal sono-graphic window, on computed tomography (CT) scans of the brain. The head CT scans of 100 random adult patients were studied. The angles were measured once on each side by two blinded readers, with 200 measurements per reader, for a total of 400 measured angles. The mean angle of the MCA, as seen from the middle temporal window, is 33.9 degrees. There was no statistical difference between readers. When interrogating the MCA with TCD via the middle temporal sonographic window, it seems appropriate to use a 30-degree angle correction. More research needs to be done to determine the clinical utility of this finding.

In preliterate times, information was transmitted orally from person to person. The usefulness of this information relied on the accuracy and completeness of its transmission. The way to verify the quality of the material (and therefore its usefulness) was to obtain it from a speaker or speakers whose accuracy was personally known to the listener or whose reliability was vouched for by other knowledgeable sources. When published scientific and medical journals came into being, similar safeguards were adopted, summarized in the form of the bibliography. The role of the journal is to provide an environment for the dissemination of ideas while giving the reader reasonable assurance that the material is genuine, correct, and uninfluenced by the author's financial interests. The purpose of the scientific journal bibliography is to document the author s sources of information while establishing its validity and trustworthiness to the reader

Although work-related musculoskeletal disorders (MSDs) are now well recognized and documented, tests to diagnose and quantify these disorders are not well developed. Late presentation of MSDs is believed to equate to poor outcomes, and lack of reliable monitoring of treatment may lead to an inappropriate return to work. The authors report on a study to quantify “normal” muscle activity in volunteers. Subjects were randomly divided into control and intervention (exercise) groups. Using sonography, the authors measured the diameters of the selected soft tissue twice daily over a period of a week, with an extra measurement after exercise in the intervention group. Results indicated that there was no statistically significant difference between the intervention and control groups over any of the time frames or in dominant and nondominant sides. However, results indicated there was a day-to-day and diurnal difference in muscle size, indicating that muscles do not remain static in size.

Cardiac resynchronization therapy (CRT) is achieved by implanting a biventricular pacemaker (BiV) into patients suffering from congestive heart failure secondary to a dilated cardiomyopathy. Congestive heart failure patients are first treated with standard heart failure drug therapy; however, if this therapy is not sufficient and the patients meet specific criteria, they can be selected for CRT. This therapy can create vast cardiac and symptomatic improvements in a relatively short time. This case report discusses the characteristics of a dilated cardiomyopathy before and after CRT and the associated cardiac improvements. Sonography continues to play an important role in diagnosing dilated cardiomyopathies, as well as congestive heart failure, and monitoring the progression after treatment.

Fryns syndrome is an autosomal recessive genetic disorder characterized by craniofacial, thoracic, limb, genitourinary, gastrointestinal, and central nervous system abnormalities. This case demonstrates the role of sonography in detecting this entity in a fetus that demonstrated normal maternal serum screening and amniocentesis. In this case, there was no family history of this defect, the parents were not consanguineous, and an autopsy was unavailable.

The case presented is that of a man in his late 60s who experienced an acute anterior myocardial infarction. A complete 2D echocardiogram with color flow and Doppler imaging had been performed on the patient's first hospital day. On day 2 of his hospitalization, a follow-up limited study was performed to reevaluate left ventricular function. Cardiac function was essentially unchanged from the prior day's study. However, color flow Doppler was performed, and a distal septal ventricular septal defect was detected incidentally, only in the final apical view while using the full-height color sector box. This study demonstrates the value of using the full-size color sector box as a screening tool when performing color flow Doppler. Current high-capacity (256 channel and above) equipment assists the sonographer with image optimization and decreases the need to use the truncated color flow box.

The author describes two cases in which the presence of thick amniotic bands is identified and followed throughout the course of each pregnancy. The etiology of these bands is preexisting uterine synechiae, which is substantiated in the first case by a pathology report indicating the presence of smooth myometrial muscle tissue within the band. The identification of thick bands in pregnancy should not be confused with the more serious sequelae of amniotic band syndrome, which is a phenomenon directly related to embryogenesis and gestational sac development.

Arteriovenous fistulae (AVF) are the result of communication occurring between an artery andan adjacent vein. The etiology of an arterio-venous fistula can be either acquired or congenital in nature. They may occur anywhere in the body where arteries and veins are in proximity to each other. This case report involves an iatrogenic arteriovenous fistula discovered by sonographic examination in a female breast. Because of the potential for complications, which may occur with arteriovenous fistulae, it is important to investigate and supervene when patients are suspected of having these lesions.

A twin ectopic pregnancy is rare. A monochorionic, monoamniotic twin pregnancy is also rare. The authors present a case of an ectopic monochorionic, monoamniotic twin pregnancy diagnosed by the presence of a single yolk sac. The characteristics and diagnosis of monoamniotic twin pregnancies during the first trimester are discussed.