Ultrasound

The aim of this article is to document the incidence and appearances of the pyramidal lobe of the thyroid gland, and discuss the clinical relevance of this entity in sonographic practice. A prospective study was undertaken over a period of 10 months. A total of 416 consecutive patients attending head and neck ultrasound lists were scanned by a single experienced radiologist or an advanced practitioner sonographer. At the time of reporting, the presence of a pyramidal lobe was recorded. The anatomical morphology was classified into five subgroups devised for the purposes of the study. Appearances were documented in both normal and pathological glands. Of the total number of patients scanned, 90 patients were found to have pyramidal lobes, giving an overall incidence of 21%. In all, 51% were found to originate from the right of the isthmus, 46% from the left and 2% from the midline. One patient had two pyramidal lobes. A significant number of patients having routine neck ultrasounds have an incidental finding of a pyramidal lobe. Ultrasound is an effective modality for the demonstration and classification of the pyramidal lobe, as well as identification of pathology. It is important for radiologists to be aware of this normal variation, as it may be the site of primary or recurrent thyroid pathology. Radiologists should report it where relevant to ensure adequate surgical treatment of pathological glands.

Quality assurance of medical ultrasound imaging systems is limited by repeatability, difficulty in quantifying results, and the time involved. A particularly interesting approach is demonstrated in the Edinburgh pipe phantom which, with an accompanying mathematical transformation, produces a single figure of merit for image quality from individual measurements of resolution over a range of depths. However, the Edinburgh pipe phantom still requires time-consuming manual scanning, mitigating against its routine use. This paper presents a means to overcome this limitation with a new device, termed the Dundee dynamic phantom, allowing rapid set-up and automated operation. The Dundee dynamic phantom is based on imaging two filamentary targets, positioned by computer control at different depths in a tank of 9.4% ethanol–water solution. The images are analysed in real time to assess if the targets are resolved, with individual measurements at different depths again used to calculate a single figure of merit, in this case for lateral resolution only. Test results are presented for a total of 18 scanners in clinical use for different applications. As a qualitative indication of viability, the figure of merit produced by the Dundee dynamic phantom is shown to differentiate between scanners operating at different frequencies and between a relatively new, higher quality system and an older, lower quality system.

Traumatic injuries to the scrotum are uncommon but, when they do occur, frequently lead to serious complications. Early complications include testicular infarction, necrosis and abscess formation; in the longer-term trauma may result in testicular atrophy and subfertility. Early surgical intervention in patients with testicular rupture can significantly improve the clinical outcome and reduce the need for delayed orchidectomy. However, clinical examination of the scrotum following trauma is difficult and frequently inaccurate; this may result in incorrect triage of patients for surgical exploration. Scrotal ultrasound can reliably assess scrotal injuries and diagnose testicular rupture with a high level of accuracy. Additionally, ultrasound can provide important information regarding testicular perfusion, which can further inform decisions on surgical management. This article reviews the sonographic findings that may be encountered in patients with scrotal trauma, with an emphasis on blunt trauma. It describes the pivotal role that ultrasound can play in the accurate triage of these patients to surgical or conservative management.

The aim of this review article is to equip the sonographer with the necessary knowledge to perform a detailed and clinically relevant assessment of the urinary tract in a child. Many of the techniques and principles used in the imaging of the urinary tract in adults can be applied to children. There are, however, notable differences with which the sonographer should be familiar. There is often a certain amount of trepidation when asked to image a child, but there are a number of simple steps that can make the process easier and more fulfilling. This article begins with advice on how to maintain cooperation in a child and the differences in the technical aspects of imaging of children. This is followed by a detailed review of the different pathologies that may be encountered, as well as highlighting information that is particularly relevant to the clinician looking after the child.

Right upper quadrant and epigastric abdominal pain are common presenting complaints in the emergency department. With increasing access to point-of-care ultrasound, emergency physicians now have an added tool to help identify biliary problems as a cause of a patient’s right upper quadrant pain. Point-of-care ultrasound has a sensitivity of 89.8% (95% CI 86.4–92.5%) and specificity of 88.0% (83.7–91.4%) for cholelithiasis, very similar to radiology-performed ultrasonography. In addition to assessment for cholelithiasis and cholecystitis, point-of-care ultrasound can help emergency physicians to determine whether the biliary system is the source of infection in patients with suspected sepsis. Use of point-of-care ultrasound for the assessment of the biliary system has resulted in more rapid diagnosis, decreasing costs, and shorter emergency department length of stay.

Unless a subject’s muscle is relatively small, a single image from a standard ultrasound can only measure muscle thickness (MT). Thus, it is important to know whether MT is related to morphological and functional characteristics of individual muscles of the extremity and trunk. In this review, we summarize previously published articles in the upper extremity and trunk demonstrating the relationships between ultrasound-measured MT and muscle morphology (cross-sectional area, CSA and muscle volume, MV) and muscular or respiratory function. The linear relationship between MT and muscle CSA or MV has been observed in biceps brachii, triceps brachii, pectoralis major, psoas major, and supraspinatus muscles. Previous studies suggest that MT in the upper arm and trunk may reflect muscle CSA and MV for the individual muscles. Unfortunately, few studies exist regarding the functional relationship with ultrasound MT in the upper extremity and trunk. Future research is needed to investigate these findings further.

This case report discusses the unusual presentation and ultrasound features of a solitary fibrous tumour of the face. Solitary fibrous tumour is an uncommon form of soft tissue tumour which, although seen predominantly within the lung pleura, can occur throughout the body in sites such as the peritoneum, mediastinum and head and neck. Ultrasound is an excellent imaging modality in the assessment of soft tissue masses in the head and neck. The ultrasound features demonstrated by this example of solitary fibrous tumour are reviewed. This report also highlights that ultrasound alone is ultimately limited in reaching a definitive diagnosis. The roles of other investigations such as ultrasound-guided biopsy and cross-sectional imaging are discussed.

We present a case study of renal artery duplex findings for new onset of hypertension in a young woman with a history of inferior vena cava filter placed a year prior and failed percutaneous retrieval. Duplex ultrasound showed significantly elevated velocities in the mid-right renal artery, consistent with renal artery stenosis. Computed tomography angiography images suggested that a leg from the inferior vena cava filter was impinging on her right renal artery, with perforation through the vena cava possibly into the wall of her duodenum. Open surgical intervention was required to disentangle the filter legs from the wall of the duodenum and relieve impingement on the right renal artery with thrombolysis of clot found within the right renal artery.

The incidence of ectopic pregnancy has increased in recent years and now is around one in 100 pregnancies. However, the incidence of live twin ectopic pregnancy in a spontaneous conception is still quite rare. A 34-year-old gravida 3, para 0 presented in the Early Pregnancy Unit with a positive pregnancy test, lower abdominal pain and vaginal spotting. Her quantitative serum Beta hCG was high, and the transvaginal scan revealed an empty uterine cavity with a twin ectopic pregnancy in the left adnexa with cardiac activity in both embryos. The patient was taken for laparoscopic surgery and a left ampullary twin pregnancy was confirmed. She underwent a left salpingectomy and is well on a one-year follow-up. This case report discusses the incidence, diagnoses and treatment of ectopic pregnancies in general.