RESUMEN
Autologous breast reconstructive surgery with deep inferior epigastric artery (DIEA) perforator flaps has become the mainstay for breast reconstructive surgery. CT angiography and three-dimensional image post processing can depict the number, size, course and location of the DIEA perforating arteries for the pre-operative selection of the best artery to use for the tissue flap. Knowledge of the location and selection of the optimal perforating artery shortens operative times and decreases patient morbidity.
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Neoplasias de la Mama/cirugía , Arterias Epigástricas , Mamoplastia/métodos , Colgajo Perforante/irrigación sanguínea , Cuidados Preoperatorios/métodos , Pared Abdominal/irrigación sanguínea , Adulto , Femenino , Humanos , Imagenología Tridimensional , Persona de Mediana Edad , Tomografía Computarizada por Rayos X/métodos , Trasplante Autólogo/métodosRESUMEN
PURPOSE: This prospective study was performed to determine if the ratio of the middle cerebral artery (MCA) S/D ratio (ratio of peak systolic blood flow velocity to diastolic velocity) to the umbilical artery (UA) S/D ratio (MCA/UA S/D ratio) predicts the degree of neonatal morbidity in fetuses suspected of having intrauterine growth restriction (IUGR). METHODS: Sixty-one fetuses were identified prospectively by sonography as having an estimated fetal weight below the 10th percentile for gestational age. The 61 fetuses underwent Doppler sonography in the third trimester and then were stratified into 3 groups based on the MCA/UA S/D ratio: group A, MCA/UA S/D ratio > 1.0 (controls; n = 37); group B, MCA/UA S/D ratio < or = 1.0 (intracerebral blood flow redistribution; n = 16); and group C, reversed or absent UA diastolic flow (n = 8). Outcome variables assessed included gestational age at delivery, birth weight, UA pH, mode of delivery, respiratory distress syndrome requiring intubation, and intracranial hemorrhage. RESULTS: The mean MCA/UA S/D ratios in groups A and B were 1.69 + /- 0.61 and 0.59 + /- 0.24, respectively (p < 0.01). The mean gestational ages at delivery for groups A, B, and C were 34.7, 33.2, and 29.0 weeks, respectively. The mean birth weights were below the fifth percentile for age for groups B and C and significantly related to the severity of abnormal Doppler findings (p < 0.01) after correction for age. Mean UA pHs were 7.25 + /- 0.01, 7.19 + /- 0.01, and 7.14 + /- 0.13 for groups A, B, and C, respectively, with significant differences between groups A and B (p < 0.05) and groups A and C (p < 0.05). Respiratory distress syndrome and intracranial hemorrhage were not associated with abnormal Doppler findings after correction for gestational age. The interval between the abnormal Doppler examination and delivery (p < 0.001) and the occurrence of fetal distress requiring cesarean section (p < 0.001) were significantly related to the severity of Doppler findings. CONCLUSIONS: In fetuses with suspected IUGR, abnormal MCA/UA S/D ratios are strongly associated with low gestational age at delivery, low birth weight, and low UA pH. Abnormal MCA/UA S/D ratios are also significantly associated with shorter interval to delivery and the need for emergent delivery.
Asunto(s)
Retardo del Crecimiento Fetal/complicaciones , Arteria Cerebral Media/diagnóstico por imagen , Ultrasonografía Prenatal , Cordón Umbilical/diagnóstico por imagen , Adulto , Femenino , Edad Gestacional , Humanos , Recién Nacido de Bajo Peso , Recién Nacido , Masculino , Morbilidad , Valor Predictivo de las Pruebas , Embarazo , Resultado del Embarazo , Flujo Sanguíneo RegionalRESUMEN
The objective of this study was to evaluate the efficacy of endometrial arterial flow in the exclusion of ectopic pregnancy. From October 1997 to June 1999, 66 women with elevated beta-human chorionic gonadotropin titers and clinical indications of ectopic pregnancy were evaluated by endovaginal sonography. Women with a gestational sac containing an embryo, a yolk sac, or both were excluded from the study. Doppler ultrasonography was performed in the remaining cases when a definite intrauterine pregnancy could not be visualized. In all cases the thermal index was kept to less than 1.0, consistent with as-low-as-reasonably-achievable principles. Trophoblastic flow was defined as a resistive index of less than 0.6 within the endometrium. Statistical analysis was performed using a 2-tailed t test. Twenty women had ectopic pregnancies; 33 had spontaneous pregnancy losses; and 13 had normal intrauterine pregnancies. A total of 29 women had endometrial trophoblastic flow: 11 of 13 with intrauterine pregnancies, 1 of 20 with ectopic pregnancies, and 17 of 33 with spontaneous pregnancy losses. The negative predictive value for the presence of endometrial low-resistance flow for excluding ectopic pregnancy was 97%. The presence of low-resistance arterial endometrial flow can be a useful sign in diagnosing an early intrauterine pregnancy and decreasing the probability that an ectopic pregnancy is present, particularly in patients with otherwise normal ultrasonographic findings.
Asunto(s)
Endometrio/irrigación sanguínea , Embarazo Ectópico/diagnóstico por imagen , Ultrasonografía Doppler , Adulto , Arterias , Femenino , Humanos , Valor Predictivo de las Pruebas , Embarazo , Estudios Retrospectivos , Factores de Riesgo , Sensibilidad y Especificidad , Ultrasonografía Doppler en Color , Resistencia VascularRESUMEN
OBJECTIVE: We describe a new sign improving detection of pneumothorax in patients with giant bullous emphysema: air surrounding both sides of the bulla wall (the intrathoracic equivalent of the double-wall sign of pneumoperitoneum). We report the radiographic and CT appearances of the double-wall sign in seven patients with giant bullous emphysema, four of whom had pneumothorax. CONCLUSION: Recognizing the double-wall sign of pneumothorax should aid in the triage of patients with giant bullous emphysema.
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Neumotórax/diagnóstico por imagen , Enfisema Pulmonar/complicaciones , Radiografía Torácica , Adulto , Anciano , Anciano de 80 o más Años , Humanos , Pulmón/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Neumotórax/complicaciones , Enfisema Pulmonar/diagnóstico por imagen , Estudios Retrospectivos , Tomografía Computarizada por Rayos XRESUMEN
PURPOSE: To determine the transvaginal hysterosonographic appearances of benign and malignant endometrial disease. MATERIALS AND METHODS: From April 11, 1994, through August 1, 1996, a total of 88 women (age range, 25-81 years) underwent transvaginal hysterosonography and histopathologic evaluation of the endometrium after dilation and curettage or after hysterectomy. A benign appearance at transvaginal hysterosonography was defined as a thin endometrium, diffuse smooth endometrial thickening, or a smoothly marginated, homogeneously echogenic, pedunculated endoluminal mass. A suspicious appearance was defined as either irregular thickening of the endometrium or an inhomogeneous endoluminal mass. RESULTS: Of 88 women, 37 had a benign-appearing endometrium at transvaginal hysterosonography; at histologic examination, 16 had a proliferative endometrium, 12 had a secretory endometrium, six had polyps, two had an inactive endometrium, and one had carcinoma. Of the 51 women with suspicious endometrial appearances, eight had carcinoma, 24 had adenomatous polyps, five had hyperplasia, 11 had fibroids, and three had endometritis. For carcinoma, the sensitivity of transvaginal hysterosonography was 89%, specificity was 46%, positive predictive value was 16%, and negative predictive value was 97%. CONCLUSION: A thin endometrium or diffuse smooth endometrial thickening is predictive of benign endometrial histologic findings, but all women with endoluminal masses require further histologic evaluation to exclude malignant disease.
Asunto(s)
Neoplasias Endometriales/diagnóstico por imagen , Endometrio/patología , Enfermedades Uterinas/diagnóstico por imagen , Adulto , Anciano , Anciano de 80 o más Años , Neoplasias Endometriales/patología , Femenino , Humanos , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Estudios Prospectivos , Sensibilidad y Especificidad , Ultrasonografía/métodos , Enfermedades Uterinas/patologíaRESUMEN
Echogenic fluid is an important extrauterine finding of ectopic pregnancy. The purpose of this study was to determine how accurately echogenic fluid correlates with hemoperitoneum at surgery. Transvaginal sonography was performed in 831 consecutive patients referred to rule out ectopic pregnancy over a 36 month period. Scans were retrospectively evaluated for the presence or absence and echogenicity of free pelvic fluid. Subsequently, 185 patients had a laparotomy or laparoscopy and had documentation of the presence or absence of hemoperitoneum. On transvaginal sonography 125 patients had echogenic fluid, 30 patients had anechoic fluid, and 30 patients had no fluid. Of the 125 patients with echogenic fluid, 122 (98%) patients had hemoperitoneum; none of the patients with anechoic fluid or no detected fluid had hemoperitoneum (0%). Echogenic fluid had a sensitivity of 100%, specificity of 95%, positive predictive value of 98%, and an accuracy of 98% for detecting hemoperitoneum. This study demonstrates that echogenic fluid detected by transvaginal ultrasonography accurately correlates with hemoperitoneum detected at surgery in patients with suspected ectopic pregnancy.
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Hemoperitoneo/diagnóstico por imagen , Embarazo Ectópico/diagnóstico por imagen , Adolescente , Adulto , Exudados y Transudados/diagnóstico por imagen , Femenino , Humanos , Pelvis/diagnóstico por imagen , Embarazo , Estudios Retrospectivos , UltrasonografíaRESUMEN
The development of color-flow imaging has made ultrasound the primary imaging modality for the evaluation of testicular pathology. The ability to distinguish between epididymo-orchitis and torsion is of great clinical significance in those patients with acute onset of pain. Not only does the appropriate treatment depend on the correct diagnosis, but the outcome following that treatment is also dependent on establishment of the diagnosis. Although it is of less importance in the evaluation of testicular neoplasms, color-flow imaging does provide adjunctive information that can aid in establishment of the proper diagnosis in confusing clinical situations. The diagnosis of varicocele depends on color-flow imaging, and the prediction of testicular viability following trauma is essential for proper treatment. More studies concerning the use of power Doppler for imaging of scrotal disorders are necessary to determine what its role will be.
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Enfermedades Testiculares/diagnóstico por imagen , Testículo/diagnóstico por imagen , Ultrasonografía Doppler en Color , Humanos , Masculino , Testículo/lesiones , Varicocele/diagnóstico por imagenRESUMEN
OBJECTIVE: Because the presence of echogenic fluid on transvaginal sonography has been shown to correlate well with hemoperitoneum in patients with possible ectopic pregnancy, the aim of this study was to compare echogenic fluid on sonography with the results of culdocentesis in predicting hemoperitoneum. MATERIALS AND METHODS: Free fluid on transvaginal sonography and the results of culdocentesis were correlated with the presence or absence of hemoperitoneum in 46 patients at surgery. Forty ectopic pregnancies and six nonectopic pregnancies were found. Echogenic fluid was the criterion used to establish hemoperitoneum on sonography. For statistical analysis, negative and nondiagnostic culdocentesis results were combined. The sensitivity, specificity, and positive and negative predictive values of each diagnostic technique were compared. RESULTS: In 40 of 46 patients with ectopic pregnancy, the sensitivity and specificity of echogenic fluid for establishing hemoperitoneum were 100% and 100%, respectively, compared with 66% and 80%, respectively, for culdocentesis. More important, the negative predictive value of a nondiagnostic culdocentesis was 25% compared with 100% for echogenic fluid in the ectopic subgroup of patients. In two patients with incomplete abortions, sonography failed to detect small amounts of hemoperitoneum at surgery performed 4 hr and 7 days after sonography. CONCLUSION: Sonography is more sensitive than culdocentesis in the detection of hemoperitoneum. Culdocentesis is invasive, and nondiagnostic results cannot be used to exclude hemoperitoneum. Culdocentesis should play no role in the evaluation of ectopic pregnancy except in the unusual circumstance in which high-resolution sonography cannot be readily performed.
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Hemoperitoneo/diagnóstico por imagen , Paracentesis , Embarazo Ectópico/diagnóstico por imagen , Ultrasonografía Prenatal , Vagina/patología , Aborto Incompleto/diagnóstico , Aborto Incompleto/diagnóstico por imagen , Adolescente , Adulto , Apendicitis/diagnóstico , Apendicitis/diagnóstico por imagen , Femenino , Estudios de Seguimiento , Predicción , Hemoperitoneo/diagnóstico , Humanos , Quistes Ováricos/diagnóstico , Quistes Ováricos/diagnóstico por imagen , Valor Predictivo de las Pruebas , Embarazo , Embarazo Ectópico/diagnóstico , Estudios Retrospectivos , Sensibilidad y Especificidad , Vagina/diagnóstico por imagenRESUMEN
OBJECTIVE: The number of women seeking medical attention for peri- and postmenopausal bleeding (PMB) has been increasing. Determining the cause of PMB is essential in planning appropriate therapy. In these women, transvaginal sonography (TVS) is a sensitive means for diagnosing the causes of such bleeding, yet endometrial biopsy (EMB) is still preferred as the first diagnostic test. We prospectively compared TVS with aspiration biopsies of the endometrium in the examination of women with PMB. SUBJECTS AND METHODS: Between mid April 1994 and December 1995, 329 consecutive perimenopausal women underwent EMB. Of these EMBs 302 had negative results. We prospectively obtained TVS in 259 of these 302 women within 1 month of EMB (range, 10 days to 2 months) when the results of biopsy were negative. Forty-three patients were lost to follow-up. In 59 women who had endometrial thickening greater than 5 mm, dilatation and curettage, hysteroscopy, or hysterectomy was performed. Ninety-four of the 130 women who were found at TVS to have fibromyomata or diffusely enlarged uteri underwent hysterectomy for pathologic confirmation. The remaining 36 women with fibromyomata or diffusely enlarged uteri had no pathologic confirmation of their TVS findings. Twenty-one of 64 women with endometria thinner than 5 mm underwent dilatation and curettage, and 43 of these women were lost to follow-up. RESULTS: In 259 patients who underwent TVS, 57 patients who had an endometrium thicker than 5 mm and an endoluminal mass on hysterosonography had false-negative results on aspiration biopsies. Of the 18 patients who had malignancies in this series, 12 had false-negative results on biopsies. In the 94 patients with an enlarged uterus and negative EMB results who underwent hysterectomy, we found 87 with fibroids, three with adenomyosis, and four with sarcomas. Of the 64 women with endometria thinner than 5 mm seen on TVS, 21 had negative results from dilatation and curettage. CONCLUSION: EMB alone is not sufficient for screening women for PMB. TVS appears to be more sensitive than is EMB for the detection of abnormalities, particularly those outside the endometrium. For these reasons, TVS should be the initial screening test when examining women with PMB.
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Biopsia con Aguja , Endometrio/patología , Posmenopausia , Premenopausia , Hemorragia Uterina/diagnóstico por imagen , Útero/diagnóstico por imagen , Reacciones Falso Negativas , Femenino , Humanos , Persona de Mediana Edad , Estudios Prospectivos , Sensibilidad y Especificidad , Ultrasonografía , Hemorragia Uterina/etiología , Hemorragia Uterina/patología , Neoplasias Uterinas/complicaciones , Neoplasias Uterinas/diagnóstico , Neoplasias Uterinas/diagnóstico por imagenRESUMEN
PURPOSE: Visualization of an intrauterine pregnancy with transvaginal ultrasound virtually excludes an ectopic pregnancy. However, findings that might lower patients' risk for ectopic pregnancy have not been extensively investigated. We prospectively performed transvaginal color flow/image-directed Doppler imaging of the endometrium to determine the predictive value of endometrial blood flow for excluding ectopic pregnancy. MATERIALS AND METHODS: From April 1994 to August 1995, 211 consecutive women underwent transvaginal ultrasound examination to exclude an ectopic pregnancy. Color flow/image-directed Doppler imaging of the endometrium was performed on each patient. Flow was considered to be present only if a Doppler signal could be obtained with the cursor located completely within the endometrium. All Doppler imaging parameters were optimized for each patient. Resistive indices were obtained if arterial signal was present, and receiver operator characteristic curves were constructed for RI and peak systolic velocity. Findings were correlated with surgical and pathology results. RESULTS: Of 211 total patients, there were 55 ectopic pregnancies (52 diagnosed for a sensitivity of 95%), 89 incomplete spontaneous abortions, 40 completed spontaneous abortions, and 27 intrauterine pregnancies. Of 55 ectopic pregnancies diagnosed with real time imaging, 9 had areas of endometrial blood flow (6 venous, 3 arterial), and 46 did not. Of the 156 patients that did not have an ectopic pregnancy, 107 had arterial blood flow within the endometrium, and 49 had no flow. Using only cases with arterial signal, the negative predictive value of endometrial blood flow for excluding an ectopic pregnancy was 97% (107/107 + 3). The optimal cutoff values (5% false-positive rate) for peak systolic velocity and refractive index (RI) were 15 cm/s and 0.55. CONCLUSIONS: Arterial blood flow within the endometrium lowers the risk for ectopic pregnancy even when other findings that might indicate a high risk are present. Venous flow within the endometrium does not exclude an ectopic pregnancy.
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Endometrio/irrigación sanguínea , Embarazo Ectópico/diagnóstico por imagen , Ultrasonografía Doppler en Color/métodos , Adolescente , Adulto , Velocidad del Flujo Sanguíneo , Diagnóstico Diferencial , Endometrio/diagnóstico por imagen , Endometrio/patología , Endosonografía , Reacciones Falso Negativas , Femenino , Humanos , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Embarazo , Embarazo Ectópico/fisiopatología , Estudios RetrospectivosRESUMEN
OBJECTIVE: We undertook this study to evaluate whether sonographic imaging of an intrauterine chorionic rim or arterial flow can help diagnose an early intrauterine pregnancy. MATERIALS AND METHODS: One hundred sixty-nine women with early intrauterine pregnancies and 69 women with ectopic pregnancies underwent pelvic sonography. All sonograms were examined for a chorionic rim (an echogenic rim bordering an intrauterine fluid collection) or a double decidual sac. Of these 238 patients, 126 also underwent Doppler examination for endometrial arterial flow. RESULTS: The chorionic rim and double decidual sac had sensitivities for intrauterine pregnancy of 80% and 64%, respectively, and specificities of 97% and 100%, respectively. Intrauterine arterial flow with either peak systolic velocity greater than or equal to 15 cm/sec or resistive index less than or equal to 0.55 had a sensitivity of 70% and a specificity of 95%, Combining these two signs led to sensitivities and specificities of approximately 90%. Similar test performance was observed in patients having intrauterine pregnancies that lacked an embryo, yolk sac, or amniotic remnant. CONCLUSION: The chorionic rim and low-impedance endometrial arterial flow can indicate an intrauterine pregnancy even when the double decidual sac is not seen. These two signs are particularly useful for patients with intrauterine pregnancies that show no other sonographic findings.
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Corion/diagnóstico por imagen , Pruebas de Embarazo , Útero/irrigación sanguínea , Aborto Incompleto/diagnóstico por imagen , Adolescente , Adulto , Decidua/diagnóstico por imagen , Femenino , Humanos , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Embarazo , Curva ROC , Flujo Sanguíneo Regional , Sensibilidad y Especificidad , Factores de Tiempo , Ultrasonografía , Útero/diagnóstico por imagenRESUMEN
PURPOSE: Little has been written regarding the ultrasound imaging features that might allow prediction of fetal viability in abdominal pregnancies. Toward this goal, we present our experience with a series of 11 abdominal pregnancies. MATERIALS AND METHODS: From 1981 to 1993, 11 patients presented to Universidad Catolica, Santiago, and Universidad de Austral, Valdivia, Chile, with third trimester abdominal pregnancies. Five had complete ultrasound examinations, and these five patients were managed expectantly. The other six women presented as acute abdominal emergencies and underwent emergent surgery. RESULTS: Four of five fetuses that survived had a complete placental attachment to the uterus, and one surviving neonate had a partial attachment of the placenta to the uterus. Three fetuses died prior to delivery, and all three had a complete mesenteric placental attachment. Two died in the early neonatal period. One had a complete uterine placental attachment, and the other had a partial attachment. CONCLUSIONS: The survival rate of abdominal pregnancies may be better than is generally believed. Placental attachment to the uterus appears to be a factor related to fetal survival and maternal morbidity. More cases are necessary to determine the feasibility of managing women with abdominal pregnancies expectantly.
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Resultado del Embarazo , Embarazo Abdominal/diagnóstico por imagen , Ultrasonografía Doppler , Ultrasonografía Prenatal , Peso al Nacer , Parto Obstétrico , Femenino , Humanos , EmbarazoRESUMEN
Transvaginal sonography is a highly sensitive method for detecting endometrial thickening. In the postmenopausal woman such thickening is non-specific and can be due to hyperplasia, polyps, submucosal endoluminal fibroids, or carcinoma. In such cases, transvaginal sonography combined with transvaginal hysterosonography may assist in the workup of these endometrial processes. We compared the combination of transvaginal sonography and transvaginal hysterosonography to aspiration endometrial biopsy in the evaluation of women with postmenopausal bleeding. We prospectively performed transvaginal sonography in 148 women within 1 month (range, 10 days to 2 months) after having had an aspiration endometrial biopsy. Transvaginal hysterosonography was then performed in 81 of these women who had endometrial thickness greater than 5 mm. In these 81 patients, transvaginal hysterosonography confirmed 45 lesions: 23 pedunculated endometrial masses and 22 inhomogeneous sessile lesions. Women with positive transvaginal hysterosonography examinations then underwent hysteroscopy or hysterectomy, whereas women with negative examinations were followed conservatively. Forty-one of the 45 cases with endoluminal masses on transvaginal hysterosonography had false-negative aspiration biopsies. Of the five (11%) lesions that were malignant, three resulted in false-negative biopsies, one biopsy revealed hyperplasia, and only one biopsy was true positive. All 36 women with negative transvaginal hysterosonography examinations also had negative biopsy findings. We conclude that the combination of transvaginal sonography and transvaginal hysterosonography is more sensitive in the detection of endometrial pathologic lesions than is endometrial biopsy, and that transvaginal sonography or transvaginal hysterosonography should be included in the evaluation of women with postmenopausal bleeding.
Asunto(s)
Biopsia con Aguja , Endometrio/diagnóstico por imagen , Posmenopausia , Hemorragia Uterina/diagnóstico por imagen , Útero/diagnóstico por imagen , Adulto , Anciano , Anciano de 80 o más Años , Carcinoma/diagnóstico por imagen , Carcinoma/patología , Hiperplasia Endometrial/diagnóstico por imagen , Hiperplasia Endometrial/patología , Neoplasias Endometriales/diagnóstico por imagen , Neoplasias Endometriales/patología , Endometrio/patología , Reacciones Falso Negativas , Femenino , Estudios de Seguimiento , Humanos , Histerectomía , Histeroscopía , Leiomioma/diagnóstico por imagen , Leiomioma/patología , Persona de Mediana Edad , Estudios Prospectivos , Ultrasonografía , Enfermedades Uterinas/diagnóstico por imagen , Enfermedades Uterinas/patología , Hemorragia Uterina/patología , Útero/patología , VaginaAsunto(s)
Arterias Cerebrales/fisiología , Diástole , Resultado del Embarazo , Sístole , Arterias Umbilicales/fisiología , Femenino , Humanos , Recién Nacido , EmbarazoRESUMEN
Transvaginal sonography is highly sensitive for detecting endometrial mass lesions, but it is nonspecific. Biopsies performed on patients with abnormal findings seen on TVS often are negative. We performed transvaginal hysterosonography prospectively on 48 consecutive patients with endometrial thickness demonstrated on TVS to be between 5 and 10 mm to assess whether this technique would be useful in the evaluation of such patients. TVHS is a simple, painless technique that is performed by placing a small catheter into the endometrial canal and infusing a small amount of saline solution under sonographic visualization. Of 48 suspected lesions, TVHS confirmed only 19 endoluminal masses: 11 fibroids and eight polyps. Polyps tended to be homogeneously echogenic and to have a pedunculated attachment to the uterine wall without interruption of the endometrial lining. Fibroids showed more heterogeneous echogenicity and had a more sessile attachment. Four patients in our series had false-negative biopsy results prior to having had endometrial mass lesions depicted on TVHS. TVHS may prevent unnecessary biopsies in those patients who appear to have abnormalities on TVS. By depicting the nature of the attachment of endoluminal masses to the uterine wall more clearly, TVHS also may help direct subsequent biopsy procedures.