ULTRASOUND NEWS 2-2019

Conclusion In pediatric PVG patients of various ages and with different underlying diseases, the presence of intestinal pneumatosis limited to the large bowel and the absence of ascites were predictors of a benign prognosis. We did fnd that ultrasound, which can be easily performed at the bedside, may be helpful in predicting benign disease outcomes. However, PVG occurred in various diseases that required specifc treatment, such as surgical intervention. Therefore, the cause of PVG, such as necrotizing enterocolitis, volvulus, or pancreatitis, should be also carefully evaluated.

Fig 3. Point shear wave elastography (pSWE) of the patellar tendon along the longitudinal axis. The ROI corresponds to the box area placed 0.5-1.5 cm from the skin.

Sonographic Spectrum of Testicular Adrenal Rest Tumors AbstrAct Testicular adrenal rest tumors (TARTs) are benign testicular masses but can lead to infertility without medical attention. It is important to identify TARTs in childhood, as early diagnosis has been shown to have good success in preserving fertility. It is also important to differentiate TARTs from other testicular masses to avoid unnecessary orchiectomy. Ultrasound is the preferred imaging modality for the evaluation of TARTs; however, sonographic differentiation from testicular neoplasms can sometimes be very difficult. In this article, we review the spectrum of sonographic features of TARTs and propose a decision tree that relies on these features, with the goal of increasing clinician’s confidence in diagnosing TARTs. Keywords: Congenital adrenal hyperplasia, Testicular adrenal rest, Testicular mass,

Sonographic Spectrum of Testicular Adrenal Rest Tumors

CONCLUSION Ilthough there are no clinical guidelines for testicular imaging of males with CAH, the presence of TARTs in this population is significant. Sonography is the first-line approach to assess the presence of TART, and although salient features have been studied, it is important to review these features and how these features may separate TARTs from other diagnoses, including lymphoma and non-germ cell tumors, notably Leydig cell tumors. Furthermore, TARTs are often an incidental finding and clinical radiologists should be aware of this benign mass in the setting of CAH to help prevent unnecessary surgical procedures. The decision tree we have proposed summarizes all of the most salient and agreed on sonographic findings with the goal of increasingclinical confidence when diagnosing TARTs (Figure 4).

Abstract Objective: The objective of this study was to investigate the interobserver reliability when measuring the carotid intima media thickness (IMT) using superb microvascular imaging (SMI) and B-mode ultrasonography. Methods: Two sonologists were selected to scan the left common carotid artery and measure IMT first with B-mode and then with SMI on 20 patients. They were blinded to each other results. Intraclass correlation coefficients (ICCs) were calculated to estimate the inter-rater reliability using both the modes of scanning. Results: Interobserver agreement when using SMI, for both near wall and far wall, was almost perfect (ICC, 0.870; 95% confidence interval [CI], 0.700–0.946). Interobserver agreement when using B-mode was poor for near wall (ICC, 0.396; 95% CI, −0.048–0.708) and moderate for far wall (ICC, 0.474, 95% CI, 0.070–0.749). Conclusions: SMI proved to be a greatly reliable tool in the measurement of carotid IMT. Keywords: B-mode ultrasonography, Carotid artery, Interobserver reliability, Intima-media thickness, Superb microvascular imaging

Abstract Umbilical cord hemangiomas are rare tumors of the umbilical cord. Doppler ultrasound has been shown to be useful in the diagnosis of cord hemangioma and evaluation of arterial blood flow through the mass. In this study, we present a 28-year-old pregnant woman with an umbilical cord mass with solid and cystic components. She was followed with weekly umbilical artery (UA) Doppler ultrasound, but the fact that the umbilical vein (UV) ran in the wall of the mass was not noted prospectively. At the time of placental delivery, the cystic component of the mass ruptured tearing the UV causing significant bleeding. The case illustrates the importance of using Doppler ultrasound to both look for UA compromise and to map the UV location through the entirety of the cord.

ABSTRACT Objective: The objective of this study was to investigate the interobserver reliability when measuring the carotid intima media thickness (IMT) using superb microvascular imaging (SMI) and B-mode ultrasonography. Methods: Two sonologists were selected to scan the left common carotid artery and measure IMT first with B-mode and then with SMI on 20 patients. They were blinded to each other results. Intraclass correlation coefficients (ICCs) were calculated to estimate the inter-rater reliability using both the modes of scanning. Results: Interobserver agreement when using SMI, for both near wall and far wall, was almost perfect (ICC, 0.870; 95% confidence interval [CI], 0.700–0.946). Interobserver agreement when using B-mode was poor for near wall (ICC, 0.396; 95% CI, −0.048–0.708) and moderate for far wall (ICC, 0.474, 95% CI, 0.070–0.749). Connclusions: SMI proved to be a greatly reliable tool in the measurement of carotid IMT.

DECREASED BLOOD FLOW IN THE TESTIS: IS IT TESTICULAR TORSION Allison Forrest, Akshaar Brahmbhatt, Vikram Dogra

ABSTRACT The absence of blood flow in the testis on ultrasound examination is the gold standard for diagnosis of testicular torsion. This imaging finding is seen in the vast majority of patients with testicular torsion, except in patients with partial torsion. Patients with partial testicular torsion may have reversal of arterial diastolic flow on spectral Doppler, decreased amplitude of the spectral Doppler waveform (parvus tardus wave), or monophasic waveforms. However, it is important to consider that not all absence of blood flow or reversal of diastolic flow in testis represents testicular torsion, as other conditions may have a similar appearance, including rare detection of such a pattern in normal asymptomatic patients. Conditions that commonly mimic testicular torsion include incarcerated inguinal hernias and complications following hernia repair, thrombotic phenomena, vasculitis, complicated epididymo-orchitis, asymptomatic variants, and technical limitations of ultrasonography. It is important for a practicing radiologist to be familiar with such cases to avoid unnecessary surgical interventions. We present a pictorial essay of cases in which the absence of testicular blood flow on color flow Doppler or abnormal waveforms on spectral Doppler are identified, without the presence of testicular torsion. Keywords: Color flow Doppler, Ischemia, Testis, Torsion, Ultrasound