Journal of Diagnostic Medical Sonography

A novel diagnostic test, named the PREW© score, was formulated to predict the known liver disease status of a purposive sample of 500 patients (304 cases and 196 controls) referred for abdominal sonograms. The score was defined by (P R E)/W, where P = portal vein pressure gradient (mm Hg), R = ratio between the observed mean portal vein diameter in the patient (mm) and the mean diameter in healthy subjects (mm), E = echogenicity of liver parenchyma (ECHO grade scale), and W = hepatic venous waveform (1 = monophasic to 3 = triphasic). Cases with PREW scores >50 were about 480 times more likely than the controls to be diagnosed with cirrhosis/ascites. Cases with PREW scores of 16 to 50 were about 6 to 15 times more likely than the controls to be diagnosed with hepatitis and about 15 to 120 times more likely to be diagnosed with cirrhosis/ascites. It was not possible to clearly discriminate between a diagnosis of hepatitis and cirrhosis/ascites if the PREW score was less than 50. The likelihoods of patients with PREW scores >25 being diagnosed with nonalcoholic fatty liver disease/steatohepatitis (NAFLD/NASH) or gallbladder (GB) disease were not statistically significant. A PREW score greater than 25 identified cases diagnosed with hepatitis/cirrhosis/ascites but eliminated diagnoses of NAFLD/NASH/GB. The clinical implication is that a PREW score >50 may help to facilitate the diagnosis of cirrhosis without confirmation by liver biopsy.

A preclinical study of 15 Macaca fascicularis monkeys was conducted to determine (1) the ability of detecting median mononeuropathy (MMN) within the median nerve after a work intervention and (2) the relationship between the layers of the median nerve during an acute inflammatory process by using sonography in conjunction with magnetic resonance imaging (MRI). Cross-sectional areas (CSAs) were imaged using MRI and sonography proximal to the carpal tunnel inlet (defined by the most distal portion of the radius) and further distal into the carpal tunnel (defined by the most proximal portion of the pisiform) at the prework exposure stage. CSAs measured on the outer edge of the median nerve were obtained from both modalities, at both anatomical locations. An intermodality t test demonstrated no statistical differences between the two sets of measurements (radius, P ≤ .15; pisiform, P ≤ .46). At the postwork exposure stage, sonographic measurements were obtained on the outer and inner borders of the median nerve at both anatomical levels. A two-tailed t test showed statistically significant differences within the carpal tunnel comparing pre- and postwork CSA measurements (radius, P ≤ .01; pisiform, P ≤ .297). The epineurial layer area was then determined as the difference between outer-border and inner-border CSAs. Pearson correlations between the epineurial layer and overall median nerve CSA within the carpal tunnel demonstrated a strong positive correlation that was statistically significant (r = 0.97; P ≤ .01) after postwork exposure. Possible factors contributing to this acute phase of MMN could be hyperemia within the layers of the nerve and the development of Renault bodies. This work would need to be translated to human studies for further confirmation of the anatomic and clinical significance of this effect.

A pregnancy developing in the cornu is rare and accounts for less than 1% to 4% of ectopic pregnancies. This case describes a cornual heterotopic gestation occurring as a first pregnancy where both gestational sacs were anembryonic. Presented are subsequent 2D and 3D sonographic findings with laboratory changes following treatment in an ectopic systemic methotrexate protocol.

This case study describes a newborn male infant with cat eye syndrome, found to have a rare constellation of congenital defects, which included an interrupted aortic arch, type B₂ (with aberrant right subclavian artery), aortic valve atresia, aorto-pulmonary window, left coronary artery to pulmonary artery fistula, ventricular septal defect, atrial septal defect, and a restrictive patent ductus arteriosus.

A 48-year-old woman presented with fatigue and vaginal spotting and was subsequently diagnosed with squamous cell cancer of the cervix. Computed tomography and positron emission tomography scans suggested widespread disease including possible involvement of the right ventricle. A 2D echocardiogram with Doppler showed a large right ventricular mass obstructing the tricuspid valve inflow. This report demonstrates the use of echocardiography and Doppler ultrasound in the diagnosis of a rare case of cardiac metastasis from cervical cancer.

Aneurysms of the major veins are rare, and those involving the inferior vena cava (IVC) are extremely rare. The etiology of IVC aneurysms remains unknown, and they can have variable presentation. Although many aneurysms are found incidentally, others are diagnosed after complications develop. Thrombosis is a frequent presentation, and serious sequelae, such as lethal pulmonary embolism and Budd-Chiari syndrome, may result. Therapeutic alternatives range from watchful waiting to surgical management. Development of complications such as rupture has been described and may require surgery. In this article, we report the discovery of an IVC aneurysm in a patient who had chronic renal failure associated with renal hypoperfusion and severe cardiac insufficiency.

Eccrine spiradenoma is a well-recognized benign tumor arising from the intradermal straight portion of the eccrine or merocrine sweat glands. It is usually a small, solitary lesion in the cutis and the subcutaneous tissues. As with other lesions in the cutis and the subcutaneous tissue, few cases describing the sonographic findings of eccrine spiradenoma have been reported. This case study demonstrates these sonography findings in a case of eccrine spiradenoma distributed in the right thigh.

A 43-year-old South Korean male presented to urgent care with pain free jaundice and weight loss. An abdominal ultrasound was ordered and demonstrated a 2.5 cm irregularly contoured ampullary mass that was obstructing the common bile duct (CBD). Endoscopic biopsy demonstrated ampullary villous adenoma with high grade dyspasia. Villous adenoma is a type of polyp typically found in the colon, but it is rarely seen at the ampulla of Vater. To our knowledge this is the first documented case found by transabdominal sonography.

Iniencephaly is a rare defect caused by improper closure of the neural tube. The incidence is 0.1-10 per 10,000 live births. The head is disproportionately large as compared to the body and displays excessive retroflexion. The neck is absent with the face directed upward. Prenatal sonography is an accurate means of identifying this anomaly.

Appendicitis is a surgical emergency that can mimic many other abnormalities. Early diagnosis is critical to reduce the risk of perforation and potentially life-threatening complications. The use of sonography has proven to aid in accurately diagnosing an inflamed appendix without adversely affecting the rate of perforation. However, the accuracy of sonography is highly operator dependent. This case demonstrates the classic clinical presentation of appendicitis with the incorporation of sonographic findings to support the diagnosis.

The JDMS CME Article for “Fetal Anasarca” by Karen Having and Stephani Bullock contained an error in Question 8. (JDMS 2011;27(1):26) (Original DOI: 10.1177/87564793110270010501)