MyMedR

Ultrasound-Guided Retroclavicular Block (aka Posterior Approach Infraclavicular Block): Anatomical Variation of the Clavicle Limits Block Feasibility

Beh ZY, Hasan MS, Lai HY

Reg Anesth Pain Med, 2016 8 23;41(5):658-9.

PMID: 27547909 DOI: 10.1097/AAP.0000000000000456

Matched MeSH terms: Ultrasonography, Interventional

Fulltext Ultrasound evaluation of penile fractures

Kachewar S, Kulkarni D

Biomed Imaging Interv J, 2011 Oct;7(4):e27.

PMID: 22279504 DOI: 10.2349/biij.7.4.e27

This short case report discusses the various aspects of penile fracture, which is a rare entity. Nevertheless, the incidence of penile fractures is on the rise due to the increased use of performance-enhancing drugs. An individual with a penile fracture should seek immediate medical referral. Prompt diagnosis and management is necessary to prevent undesirable after-effects as discussed. Emphasis is made on how imaging with ultrasound enables a quick and complete assessment of this mishap.

Matched MeSH terms: Ultrasonography

The louder the bigger: A case of jugular phlebectasia in a child

Kandiah R, Mohamad I

Malays Fam Physician, 2019;14(3):77-79.

PMID: 32175047

Jugular phlebectasia has been increasingly recognised with the advent of non-invasive diagnostic methods. Phlebectasia differs from varix, as it is an abnormal outward dilatation of a vein without tortuosity. It presents as a soft, compressible mass, apparent upon straining or execution of the Valsalva maneuver. The differentials for neck masses are broad, but if the swelling appears on the Valsalva maneuver, the type of mass narrows down to a laryngocele, superior mediastinal mass or phlebectasia. A simple non-invasive investigation, such as ultrasonography, is used as a diagnostic tool. We report a case of jugular phlebectasia that was suspected clinically and confirmed via ultrasound to be a vascular lesion which changed its size upon straining.

Matched MeSH terms: Ultrasonography

Fulltext Leucocoria in a boy with Kawasaki disease: a diagnostic challenge

Che Mahiran CD, Alagaratnam J, Liza-Sharmini AT

Singapore Med J, 2009 Jul;50(7):e232-4.

PMID: 19644606

Retinoblastoma, the most common primary intraocular malignancy of childhood, usually presents in the first three years of life. Atypical presentation of retinoblastoma can masquerade as virtually any ocular or orbital pathology, which may lead to diagnostic dilemmas especially in the presence of other systemic diseases. We report a 20-month-old boy who was diagnosed with coronary aneurysm as a complication of Kawasaki disease, and presented with sudden left eye redness. His mother noticed the presence of white pupillary reflex three months earlier. Atypical acute ocular presentation secondary to Kawasaki disease was initially suspected, but the presence of multiple calcification and mild proptosis on imaging suggested characteristics of advanced retinoblastoma. Histopathological examination of the enucleated eye, which revealed a classical rosette pattern appearance, confirmed the diagnosis. Atypical presentations of retinoblastoma are usually associated with advanced disease. The presence of other systemic conditions further complicates the diagnosis. Early diagnosis is important to reduce the mortality and morbidity.

Matched MeSH terms: Eye/ultrasonography; Retinoblastoma/ultrasonography; Retinal Neoplasms/ultrasonography

Fulltext Delayed diagnosis of cervical pregnancy: management options

Sivalingam N, Mak FK

Singapore Med J, 2000 Dec;41(12):599-601.

PMID: 11296786

Cervical pregnancy is an uncommon variety of ectopic gestation. The aetiology is obscure. Diagnosis can be missed unless early evaluation is done by experienced personnel utilising pelvic ultrasonography. Three cases of cervical pregnancy managed at this hospital are described illustrating difficulties in early diagnosis and possible association with previous uterine scar and prior curettage of the uterus for retained products of conception. Treatment options vary according to the clinical state of the patient at the time of diagnosis. Non-surgical methods including systemic methotrexate administration in one and surgical evacuation of products of conception with subsequent cervical cerclage in another are discussed. Surgical interventions like total abdominal hysterectomy with internal iliac artery ligation to arrest life-threatening pelvic haemorrhage is also described. Other treatment options include potassium chloride (KCl) alone or in combination with methotrexate.

Matched MeSH terms: Pregnancy, Ectopic/ultrasonography*; Ultrasonography, Prenatal/methods

Fulltext The role of endovaginal ultrasonography and the value of endometrial biopsy in breast cancer patients on tamoxifen therapy

Sivalingam N, Pathmalingam A

Singapore Med J, 1999 Jun;40(6):402-4.

PMID: 10489508

Endometrial changes have been observed when tamoxifen is used as an adjuvant therapy for carcinoma of the breast in postmenopausal women with positive estrogen receptors status.

Matched MeSH terms: Endometrial Hyperplasia/ultrasonography; Endometrium/ultrasonography; Vagina/ultrasonography*

Fulltext Management of acute testicular pain in children: changing trends with improvements in scrotal ultrasonography over 18 years

Kyaw L, Choo CSC, Ong LY, Yap TL, Teo HJ, Nah SA

Singapore Med J, 2023 Apr;64(4):249-254.

PMID: 35196848 DOI: 10.11622/smedj.2022032

INTRODUCTION: Doppler scrotal ultrasonography (US) is the modality of choice in diagnosing testicular torsion. We aimed to evaluate the performance of scrotal US in diagnosing testicular torsion over the past 18 years in our institution and determine the factors contributing to the length of wait times for it.

METHODS: A retrospective review was conducted of boys who presented with acute scrotal pain from 2014 to 2015. US reports, operative findings, final diagnosis and key time points of the patients' journey (time to emergency department consultation, time to admission, time to US and time to operating theatre [OT]) were collected. US performance results were compared with those observed in a historical cohort from 1998 to 2004. Wait times were compared between operated and non-operated patients.

RESULTS: Data from 519 boys with a mean age of 9.15 years was collected. Of these, 438 (84.4%) boys had undergone initial scrotal US; of these scrotal US cases, 28 were surgically explored, with 23 confirmed to have torsion. Another five cases were explored without prior US, and all were confirmed to have torsion. Performance analysis of US showed a sensitivity of 100% and a specificity of 98.8%. There was no significant difference between wait times of operated and non-operated patients. Time to US (P < 0.0001, r = 0.96) and time to OT (P < 0.0001, r = 0.64) correlated significantly with the total time from presentation to surgery.

CONCLUSION: There has been an improvement in the diagnostic performance of scrotal US for testicular torsion over the past 18 years. Quality improvement programmes targeted at reducing wait times for patients presenting with acute scrotum should target time to US and time to OT.

Matched MeSH terms: Ultrasonography

Severe fetal growth restriction secondary to placental implantation on intrauterine synechiae

Hong J, Hong J, Thomas J, Kumar S

Ultrasound Obstet Gynecol, 2024 Jul;64(1):120-121.

PMID: 38197232 DOI: 10.1002/uog.27574

Matched MeSH terms: Ultrasonography, Prenatal

Point-of-Care Ultrasound Identification of Portal Vein Thrombosis in a Pediatric Patient

Ong YN, James V, Lau KS, Chor YK, Ong GY

Pediatr Emerg Care, 2022 Apr 01;38(4):183-186.

PMID: 34608058 DOI: 10.1097/PEC.0000000000002555

Abdominal pain is one of the most common presenting complaints encountered in the pediatric emergency department. The use of point-of-care ultrasonography by emergency physicians has been shown to expedite the diagnosis of a large variety of conditions and can be used to accurately identify intra-abdominal pathology in children. We describe the case of a pediatric patient who presented to the pediatric emergency department with acute abdominal pain, in whom point-of-care ultrasonography helped expedite the diagnosis of acute portal vein thrombosis and liver abscess.

Matched MeSH terms: Ultrasonography

Comments on "The Value of the Optic Nerve Sheath Diameter (ONSD) in Predicting Postdural Puncture Headache (PDPH): A Prospective Observational Study"

Suresh V, Magoon R, Sethuraman RM

Pain Physician, 2023 May;26(3):E243-E244.

PMID: 37192253

Matched MeSH terms: Ultrasonography

Update on the management of ovarian torsion in children and adolescents

Nur Azurah AG, Zainol ZW, Zainuddin AA, Lim PS, Sulaiman AS, Ng BK

World J Pediatr, 2015 Feb;11(1):35-40.

PMID: 25557598 DOI: 10.1007/s12519-014-0536-3

Ovarian torsion is commonly seen in young girls. Unfortunately it is often misdiagnosed because of its non-specific symptoms and lack of diagnostic modalities. This article focuses on the diagnostic challenge and also the changes in the management of ovarian torsion.

Matched MeSH terms: Ovarian Diseases/ultrasonography; Torsion Abnormality/ultrasonography

An automated technique for carotid far wall classification using grayscale features and wall thickness variability

Acharya UR, Sree SV, Molinari F, Saba L, Nicolaides A, Suri JS

J Clin Ultrasound, 2015 Jun;43(5):302-11.

PMID: 24909942 DOI: 10.1002/jcu.22183

To test a computer-aided diagnostic method for differentiating symptomatic from asymptomatic carotid B-mode ultrasonographic images.

Matched MeSH terms: Carotid Arteries/ultrasonography*; Atherosclerosis/ultrasonography*

Urinary bladder characteristics via ultrasound as predictors of acute urinary retention in men with benign prostatic hyperplasia

Ho CC, Ngoo KS, Hamzaini AH, Rizal AM, Zulkifli MZ

Clin Ter, 2014;165(2):75-81.

PMID: 24770808 DOI: 10.7471/CT.2014.1680

OBJECTIVE: To determine the clinical utility of urinary bladder and prostate characteristics measured by ultrasound scan in predicting acute urinary retention (AUR) for men with bladder outlet obstruction with an underlying benign prostate hyperplasia (BPH).
MATERIALS AND METHODS: Consecutive men aged ≥50 years presenting with lower urinary tract symptoms (LUTS) or AUR were prospectively recruited in this cross-sectional study. International prostatic symptom score (IPSS) and serum prostate-specific antigen (PSA) were recorded. High-resolution ultrasound was used to measure bladder detrusor thickness (DT, mm), prostatic volume (PV, cm3), intravesical prostatic protrusion (IPP, mm), bladder wall thickness (BWT,mm), intravesical volume and bladder radius. The latter two parameters were used to estimate bladder weight (UEBW, g), assuming a spherical bladder.
RESULTS: Among selected patients, thirty had AUR while 32 men presented with LUTS only. There were significant differences between those with and without AUR in their age (70.5 vs 66.0, p=0.017), IPSS (24.0 vs 18.5, p=0.009), serum PSA (6.18 vs 1.77, p=0.002), PV (56.7 vs 32.4, p=0.006), BWT (5.0 vs 4.4, p=0.034) and UEBW (39.1 vs 25.0, p=0.0003). Multivariate analysis revealed high IPSS and UEBW to be predictors for AUR. UEBW was the strongest predictor of AUR: area under ROC curve was 0.767, with sensitivity and specificity of 63.3% and 87.5%, respectively, at cut-off point of 35 g. The likelihood ratio for AUR was also best with UEBW≥35 g.
CONCLUSIONS: Combined with IPSS, ultrasound determined bladder characteristic, particularly UEBW, is a useful tool in predicting AUR in men with BPH.

Matched MeSH terms: Urinary Bladder/ultrasonography*; Prostatic Hyperplasia/ultrasonography*

A randomised controlled trial of expectant management versus surgical evacuation of early pregnancy loss

Nadarajah R, Quek YS, Kuppannan K, Woon SY, Jeganathan R

Eur J Obstet Gynecol Reprod Biol, 2014 Jul;178:35-41.

PMID: 24813099 DOI: 10.1016/j.ejogrb.2014.02.021

To show whether a clinically significant difference in success rates exists between expectant and surgical management of early pregnancy loss.

Matched MeSH terms: Abortion, Spontaneous/ultrasonography; Abortion, Incomplete/ultrasonography

Irreversible blindness following intravenous streptokinase

Peyman M, Subrayan V

JAMA Ophthalmol, 2013 Oct;131(10):1368-9.

PMID: 23929315 DOI: 10.1001/jamaophthalmol.2013.4489

Matched MeSH terms: Blindness/ultrasonography; Eye Hemorrhage/ultrasonography

Endoscopic ultrasound-guided injection therapy for hepatobiliary disease

Ponnudurai R, Sachithanandan S, George A

J Hepatobiliary Pancreat Sci, 2011 May;18(3):311-8.

PMID: 21468788 DOI: 10.1007/s00534-010-0354-5

Endoscopic ultrasound (EUS)-guided injection therapy is the new frontier in the management of patients with hepatobiliary disease. Celiac plexus block/neurolysis was the first form of injection therapy and has been validated in many subsequent trials. Cyst ablation therapy, fiducial insertion, angiography, portal hypertensive therapy, endoscopic portosystemic shunt creation, portal vein embolization and injection of chemotherapeutic/biologic agents for antitumor therapy are more recent uses and will be discussed. Celiac plexus neurolysis is currently well established in providing adjunct pain control in patients with advanced malignancy. There are limited data available for its use in benign conditions. EUS-guided ablative therapy for pancreatic cysts remains an area for future research but seems to have a role for small thin-walled non-septated cysts. EUS-guided implantation of fiducials is technically feasible but its exact impact on tumor regression is unknown. Several case reports have documented EUS-guided alcohol and thrombin injection into pseudoaneurysms and cyanoacrylate and coil embolization for variceal therapy. Injection of viral vectors and immunomodulating cell cultures as antitumor therapy has been described but the evidence is still preliminary and further data are awaited.

Matched MeSH terms: Bile Duct Diseases/ultrasonography; Liver Diseases/ultrasonography

Calcaneal quantitative ultrasound value for middle-aged and elderly Malaysian Chinese men and its association with age and body anthropometry

Chin KY, Ima-Nirwana S, Isa Naina M, Norazlina M, Ahmad Nazrun S, Norliza M, et al.

J Clin Densitom, 2012 Jan-Mar;15(1):86-91.

PMID: 22169197 DOI: 10.1016/j.jocd.2011.09.004

Quantitative ultrasound (QUS) is a relatively easy, reliable, and safe method for bone status assessment, but reference data for Asian males remain scarce. Our study aimed to determine the values for one QUS parameter, the speed of sound (SOS) at the calcaneus, in Malaysian Chinese men and to determine the association between the SOS and several demographic characteristics, such as age, weight, height, and body mass index. Three hundred forty-eight Malaysian Chinese men aged 40 yr and older were recruited, and their calcaneal QUS value was determined using the CM-200 densitometer (Furuno Electric, Nishinomiya City, Japan). The results indicated a significant correlation between SOS and age, and multiple stepwise regression analysis indicated that age and height were important predictors of SOS. A significant reduction in SOS value was observed when men 60 yr and older were compared with men aged 40-49 yr. Compared with the reference data for Japanese males, Chinese men in Malaysia showed higher SOS values across all the age groups studied. In conclusion, there is an age-related decrease in SOS values in Malaysian Chinese men, and the SOS values established in this study can be used as a reference for future studies.

Matched MeSH terms: Calcaneus/ultrasonography*; Osteoporosis/ultrasonography*

Primary corneal myxoma

Soong T, Soong V, Salvi SM, Raynor M, Mudhar H, Goel S, et al.

Cornea, 2008 Dec;27(10):1186-8.

PMID: 19034139 DOI: 10.1097/ICO.0b013e31817a5d0b

Primary corneal myxoma is extremely rare. It has only been reported on 2 previous occasions. Secondary corneal myxomas are more common, arising from corneal diseases such as infective keratitis, keratoconus, and bullous keratopathy. Myxomas occur commonly in other soft tissues such as the heart, paranasal sinuses, and muscles but can rarely present in periocular structures including the conjunctiva, orbit, and eyelid. Ours is only the third case of primary corneal myxoma reported in the literature and illustrates several unusual features. These include an inferonasal location between the corneal epithelium and Bowman layer and with no relationship to the corneal stroma, rapid tumor growth over a 3-month period, and no previous ocular trauma or conjunctival pathology. The histology of this lesion has an important part to play in the management of this condition as it determines the cellular origin, establishes a benign or malignant state, and helps with treatment and prognosis. One reported case of primary corneal myxoma recurred within 2 months after local resection. This was treated with bandage soft contact lens, and no recurrence had been reported since. Our case is now 12 months post op and has had no recurrence.

Matched MeSH terms: Corneal Diseases/ultrasonography; Eye Neoplasms/ultrasonography

Intrapancreatic gastric duplication cyst-a rare cause of chronic abdominal pain in childhood

Lee CL, binti Che Daud CZ, binti Ismail R

J Clin Ultrasound, 2014 Jan;42(1):42-4.

PMID: 23303464 DOI: 10.1002/jcu.22029

We report a rare case of a gastric duplication cyst in the tail of the pancreas in a child presenting with chronic abdominal pain which was cured by excision of the cyst and adjacent pancreas. This case report highlights the role of sonography as an excellent imaging tool for depiction of the bowel wall and, hence, in aiding diagnosis even when clinical picture and findings of other modalities are nonspecific.

Matched MeSH terms: Choristoma/ultrasonography*; Pancreatic Cyst/ultrasonography*

Influence of anterior vaginal mesh with concomitant mid-urethral sling surgery on stress urinary incontinence: clinical and sonographic outcome

Lo TS, Tan YL, Cortes EF, Lin YH, Wu PY, Pue LB

Aust N Z J Obstet Gynaecol, 2015 Dec;55(6):593-600.

PMID: 26299981 DOI: 10.1111/ajo.12397

To clinically and sonographically evaluate the influence of anterior vaginal mesh (AVM) surgery with concomitant mid-urethral sling surgery (MUS) for stress urinary incontinence (SUI).

Matched MeSH terms: Urinary Incontinence, Stress/ultrasonography*; Pelvic Organ Prolapse/ultrasonography*

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