Journal of Diagnostic Medical Sonography

Contrast two-dimensional (2D) echocardiography using peripheral venous injections of agitated saline provides useful clinical information not available with standard 2D Doppler and color flow imaging techniques. Intraor extracardiac right-to-left shunting in patients with atrial or ventricular septal defects and patent ductus arteriosus can be identified in this manner, and the relative degree of shunt can be assessed. Other conditions, such as left superior vena cava to the coronary sinus or pulmonary arteriovenous malformation, are accurately detected only when contrast 2D echo is incorporated during the noninvasive examination. Recent work has also demonstrated that venous injections of agitated saline can be used to enhance continuous wave Doppler recordings of tricuspid regurgitant jet envelopes when poorly defined, or with color flow imaging to characterize the jet area. Twodimensional visualization of the needle placed in the pericardial sac for drainage of pericardial effusion may be difficult. Injection of agitated saline through the needle may be used to verify proper location in the pericardial sac and not in the ventricular chambers. The role of contrast 2D echocardiography with new agents has been used to assess myocardial perfusion. All of these applications of contrast echo contribute to standard echocardiographic techniques to provide a better characterization of flow dynamics not seen with color flow imaging.

Women with preexisting diabetes mellitus are at higher risk than others to give birth to an infant with congenital anomalies. Sonographic examination aids in the detection of these anomalies during pregnancy. The fetal anomalies associated with preexisting diabetes, including anencephaly, holoprosencephaly, occipital encephalocele, spina bifida, cardiac defects, situs inversus, duodenal atresia, anal atresia, and femoral hypoplasia, are reviewed. The sonographic appearance of several of the anomalies is illustrated.

Behqet's disease is today considered a chronic multisystem disorder. The sequela of this disease depends on the particular organs involved. A nonspecific vasculitis, however, is a common trait found in patients afflicted with vascular Behqet's disease. Trauma to a vessel affected by Behset's disease can lead to aneurysmal formation. Duplex ultrasound examination has proved a useful diagnostic tool in patients who are clinically suspect for vascular lesions. Diagnostic information from invasive procedures must be weighed against the potential to cause aneurysms. A case report of a man with a pseudoaneurysm of the carotid artery and the subsequent diagnosis of Behqet's disease is presented.

The presence of a pelvic spleen is an exceedingly rare occurrence. Correct diagnosis, which is essential for appropriate management, can be suggested by sonographic evaluation and confirmed with the use of computed tomography. The case presented here demonstrates the necessity of examination of the entire abdomen by sonography when a pelvic mass of unknown etiology is encountered.

A case of an allantoic cyst of the umbilical cord with urinary tract involvement was detected in a fetus by sonographic examination. The pregnancy was followed to term, and a healthy infant was born. Embryologic development of the umbilical cord, clinical significance, and differential diagnosis of cystic lesions of the cord are discussed.