Duplex sonography of the carotid arteries in patients with pure aortic regurgitation: pulse waveform and hemodynamic changes and a new indicator of the severity of aortic regurgitation.

PURPOSE: To determine the changes of multiple hemodynamic parameters and pulse wave contour in pure aortic regurgitation (AR) and to present a new indicator of the severity of AR (shrink ratio of proximal common carotid artery). MATERIAL AND METHODS: The sonograms of 42 patients (31 M, 11 F; 16-68 years) with pure AR and 18 control subjects (15 M, 3 F; 20-47 years) were assessed for velocities and indices, and change of pulse wave contour (bisferious pattern, zero level and retrograde diastolic flow) in each carotid artery. Shrink ratio (maximum diameter-minimum diameter/maximum diameter) of each proximal common carotid artery was calculated. RESULTS: Bisferious waveforms seen in patients with AR grade 1, grade 2, and grade 3-4 were 66%, 83%, and 88%, respectively. Diastolic reversed flow was determined in 7 (39%) of 18 patients with AR grade 3-4. Three patients (25%) with AR grade 2 and 4 patients (22%) with AR grade 3-4 had zero level diastolic flow in the common carotid artery. Statistically significant changes of decreased end-diastolic velocity, increased peak systolic velocity/end-diastolic velocity, resistivity index, and pulsatility index were revealed, especially in AR grade 3-4 compared to controls. Significantly increased shrink ratio was seen only in AR grade 3-4. CONCLUSION: Increased shrink ratio or changes in hemodynamics or pulse waveform can be used in recognition of AR.

Carotid and brachial intima-media thickness, arterial diameter and resistivity indices in aortic regurgitation.

PURPOSE: To evaluate signs of atherosclerosis in carotid and brachial arteries in patients with aortic regurgitation (AR). MATERIAL AND METHODS: The sonograms of 33 patients (24 M and 9 F, 16-67 years old) with pure AR and 20 control subjects (15 M and 5 F, 19-49 years old) were evaluated. Patients with AR and control subjects completed a questionnaire with SMART risk score based on pre-existing vascular disease and risk factors. AR patients and control subjects were assessed for intima-media thickness (IMT) of common carotid artery (CCA), IMT of brachial artery (BA), CCA diameter, and resistivity index (RI) of CCA and RI of internal carotid artery (ICA). RESULTS: There was no significant difference in the cardiovascular risk score between the patients with AR and control subjects. All measured parameters were statistically significantly greater in AR patients than in control subjects with P values 0.0233 for CCA IMT, 0.0034 for BA IMT, 0.0429 for CCA diameter, <0.0001 for CCA RI, and 0.0002 for ICA RI. CONCLUSION: AR is associated with signs generally considered to represent atherosclerosis, such as increased CCA and BA IMT, CCA diameter, and CCA and ICA RI.

Ultrasonographic evaluation of bilateral groins in children with unilateral inguinal hernia.

PURPOSE: The presence of hernia was investigated prospectively by US in both groins of children with clinically suspected or apparent unilateral inguinal hernia. MATERIAL AND METHODS: One hundred and twenty-eight (103 boys, 25 girls) were classified into three groups according to age: 0-2, 3-5 and 6-15 years. The widest diameter of the inguinal canal was measured in the longitudinal plane while the children were in the supine position and at rest. The patent processus vaginalis (PPV) values of 4 mm and higher were accepted as hernia. The groins diagnosed clinically and/or ultrasonographically as hernia were explored surgically. The clinical and US findings were compared with surgical results. The relations between hernia diameters and the age groups, sex, right/left and inguinal/scrotal hernias were analyzed statistically. RESULTS: In 128 children, 138 groins were treated with surgery. One hundred and eleven cases were unilateral hernia (73 right, 38 left) and 10 were bilateral. Seven cases were found to be normal. Ten cases with clinically unilateral hernia were bilateral at US and surgery. One hundred and thirty-one of 138 groins were correctly diagnosed by US. The accuracy, specificity and sensitivity of US were 94.9%, 85.7% and 95.4%, respectively. The accuracy of physical examination was 87.7%. There were no significant differences between hernia diameters and the age groups, sex and right/left side except the difference between inguinal and scrotal hernia diameters (p<0.0001). CONCLUSION: US can be used routinely in the pre-operative diagnosis of inguinal hernia in children. PPV values higher than 4 mm, with a high accuracy indicate hernia.

A thyroglossal duct cyst with calcification.

We report a thyroglossal duct cyst with calcification, the second case in the world literature. The ultrasound and CT findings are described and we highlight the differential diagnosis.

Scrotal gray-scale and color Doppler sonographic findings in genitourinary brucellosis.

PURPOSE: Brucellosis is an enzootic disease that is frequently transmitted from Brucella-infected animals and their products to humans through the gastrointestinal tract. Genitourinary complications are seen in 2-10% of cases. We used sonography to investigate such complications in patients from a Brucella-endemic area. METHODS: Between 1992 and 1996, 246 patients were clinically and serologically diagnosed as having brucellosis and were examined by sonography. RESULTS: Genitourinary complications were identified by sonography in 26 patients. Fifteen of these patients had unilateral epididymo-orchitis, 6 had diffuse orchitis, and 5 had a focal hypoechoic testicular lesion. An increase in the vascularity of the lesions was seen in the 14 patients who also underwent color Doppler examination. Spectral waveform analysis showed a decrease in the resistance index in 9 patients. After medical treatment, all but 1 of the lesions disappeared within 2 months; the last lesion persisted for 6 months. CONCLUSIONS: In areas in which brucellosis is endemic, when scrotal abnormalities are seen with gray-scale or color Doppler sonography, the possibility of genitourinary tract complications of brucellosis should be considered. Simple Brucella tests may prevent unnecessary surgery.