Can Chest Computed Tomography Be Replaced by Lung Ultrasonography With or Without Plain Chest Radiography in Pediatric Pneumonia?

PURPOSE: The purpose of this study was to answer the following question: can chest computed tomography (CT) requested by pediatricians be replaced by lung ultrasonography (US) with or without chest radiography in pediatric pneumonia? MATERIALS AND METHODS: A total of 98 children with suspected pneumonia who were referred by pediatricians for CT examinations were prospectively studied. Levels of agreement between CT findings and plain radiography, lung US, and chest radiography plus lung US results were investigated. RESULTS: CT defined pneumonia in 84 patients, among which 26 cases were complicated. κ values between radiography and CT findings were 0.82 in complicated cases, 0.67 in uncomplicated cases, and 0.72 overall. The corresponding values between US and CT findings were 1, 0.52, and 0.62, respectively, and between radiography plus US and CT findings were 1, 0.86, and 0.88, respectively. CONCLUSIONS: CT can be replaced by US when complex effusions are present in children with pneumonia. In case of an ambiguous diagnosis of pediatric pneumonia with or without complex effusions, a combination of chest radiography and US is a reliable surrogate for chest CT.

Normal Values of Spleen Length and Volume: An Ultrasonographic Study in Children.

We aimed to determine normal ultrasonographic limits of spleen length and volume in healthy Caucasian neonates and children. A total of 458 healthy cases (age, 1 d to 15 y; sex, 241 males and 217 females) with normal body measurements were included. Spleen length and volume were obtained ultrasonographically. The two genders were comparable for the mean spleen length and volume. Lower and upper normal limits were tabulated according to age and sex groups. Significant correlations (Pearson r > 0.80; p < 0.001) were present between spleen length/volume and age, height and weight. Two equations were created to estimate spleen length and volume by age. Normal spleen lengths and volumes and their lower and upper limits were obtained ultrasonographically in a large sample of Caucasian pediatric patients.

Vascular Doppler ultrasonographic indices in cirrhosis: a case-control study with emphasis on the common carotid arteries.

PURPOSE: To compare vascular Doppler waveform indices, particularly in the common carotid arteries, between cirrhotic and healthy subjects. MATERIALS AND METHODS: A total of 60 patients with Class-B cirrhosis and 60 healthy matched counterparts were enrolled in this prospective study. Vascular Doppler waveform parameters including resistance and/or pulsatility indices (RI and PI, respectively) were obtained from the common carotid, renal, celiac, superior mesenteric, femoral and brachial arteries. RESULTS: Compared to patients, healthy subjects had significantly higher mean PI and RI obtained from the common carotid (1.53 ± 0.20 vs. 1.43 ± 0.14, p = 0.03; 0.75 ± 0.02 vs. 0.72 ± 0.02, p < 0.001, respectively) and celiac arteries (2.00 ± 0.36 vs. 1.81 ± 0.34, p = 0.03; 0.80 ± 0.03 vs. 0.78 ± 0.02, p < 0.001, respectively). Both the mean PI and RI derived from the renal arteries, in contrast, were significantly higher in patients compared to that in controls (1.05 ± 0.13 vs. 1.11 ± 0.07, p = 0.03; 0.59 ± 0.03 vs. 0.63 ± 0.03, p < 0.001, respectively). The mean vascular impedance values obtained from the remaining arteries were comparable between the two groups. CONCLUSIONS: Blood flow increases in the common carotid and celiac arteries of Class-B cirrhotic patients with elevated renovascular impedance.

Arterial injuries in extremities trauma, angiographic findings.

At present, trauma is a common problem and regarded as the third cause of mortality in different societies. Significant part of injuries resulting from trauma is due to vascular damages. Tissue ischemia associated with vascular injuries is regarded as medical emergencies which can result in irretrievable ischemia if it continues for 6 h. Therefore, early diagnosis and quick treatment of vascular injuries are of high importance. In this cross sectional study, all trauma patients referred with possible vascular injury to angiography department of Tabriz Imam Khomeini Hospital from Apr. 2011 to Apr., 2012 underwent angiography. The results were compared with the similar studies conducted in other countries. Out of all patients, angiography detected vascular injury in 75 cases consisting of 93.7% of men and 5.3% of women. Motor vehicle (93.3%) especially motorcycles accidents were the most common cause of the damages. Leg was the most common site of trauma (62.2%) and associated fracture was seen in 86.7% of cases. Also, double fracture of leg was the most common associated fracture. Anterior tibial artery (36%) and complete arterial occlusion (62.7%) were the most common injured vessel and vascular injury, respectively. Vascular injuries are more common in young men (20-30 years old) mainly resulted from blunt trauma associated with motor vehicle especially motorcycle accidents. Leg and anterior tibial artery were introduced as the most common site and injured artery, respectively.

Ultrasonographic evaluation of bowel wall thickness and intramural blood flow in ulcerative colitis.

Aim. This study aimed at assessing Doppler ultrasonographic findings of gut wall vessels and thickness in active and quiescent ulcerative colitis. Methods. Fifty patients with ulcerative colitis were studied using transabdominal grayscale and Doppler sonography of sigmoid, distal and middle parts of descending colon in different stages of the disease. Thickness of colon wall in the most involved site, number of color signals in each box, resistive index (RI), and pulsatility index (PI) were evaluated. Results. The median thickness of the colon wall in the most involved sites was 4.3 mm in acute phase and 4.4 mm in the inactive phase (P = 0.47). The median number of the color signals in the active phase at the most involved site, distal part of descending colon and sigmoid was higher than that of the color signals in the inactive phase (P = 0.0001). In the most involved site, the PI and RI were undetectable in the inactive phase. The median PI was 1.4 in the mild phase, 1.3 in the moderate phase, and 1.1 in the severe phase (P = 0.002). Conclusion. In contrast to the colon wall thickness, increased intramural blood flow reflected the clinical severity in ulcerative colitis patients.

Prevalence of significant carotid artery stenosis in Iranian patients with peripheral arterial disease.

BACKGROUND: Generalized screening for carotid artery stenosis with carotid duplex ultrasonography in patients with peripheral arterial disease is controversial. OBJECTIVES: The aim of the present study was to determine the prevalence of significant internal carotid artery (ICA) stenosis in a group of Iranian patients with peripheral arterial disease. METHODS: We prospectively screened 120 patients with a known diagnosis of peripheral vascular disease for carotid artery stenosis. Based on the angiographic assessment of abdominal aorta and arteries of the lower extremities, patients with stenosis greater than 70% in the lower extremity arteries were included. A group of healthy individuals aged ≥ 50 years was recruited as a control. Risk factors for atherosclerosis including smoking, diabetes mellitus, hyperlipidemia, ischemic heart disease, and cerebrovascular disease were recorded. Common carotid arteries (CCAs) and the origins of the internal and external arteries were scanned with B-mode ultrasonography. Significant ICA stenosis, > 70% ICA stenosis but less than near occlusion of the ICA, was diagnosed when the ICA/CCA peak systolic velocity ratio was ≥ 3.5. RESULTS: Ninety-five patients, with a mean age of 58.52 ± 11.04 years, were studied. Twenty-five patients had a history of smoking, six patients had a history of coronary artery disease, six patients had hypertension, and ten patients had diabetes mellitus. Significant ICA stenosis was present in four patients (4.2%) with peripheral arterial disease in one healthy individual (1%) of the control group (P > 0.05). In terms of the risk factors for atherosclerosis, no statistically significant relationship was found between individual atherosclerotic risk factors and significant ICA stenosis (P > 0.05). CONCLUSION: The prevalence of significant ICA stenosis in Iranian patients with peripheral arterial disease is low. In addition, there is no relationship between individual atherosclerotic risk factors and significant ICA stenosis.

Comparison of normal values of Duplex indices of vertebral arteries in young and elderly adults.

BACKGROUND: Considering the role of aging in brain atrophy and cerebral vascular demand, we carried out this study to clarify the role of aging in duplex indices of vertebral arteries. METHODS: From June 2005 to June 2006, 96 volunteers with age range of 20 to 95 years, were evaluated with color doppler for duplex indices of vertebral arteries. Sever hemodynamic stenosis was excluded in all of these patients. These volunteers were subdivided in two groups: younger and older than 60 year old. In all of these patients we measured diameter, peak systolic velocity (PSV), resistive index (RI), and flow volume (FV) of vertebral arteries in right and left sides. RESULTS: There was no significant difference in diameter, PSV, RI and FV between two groups. We have clarified that in patients younger than 60 year old, comparing right and left vertebral arteries, PSV and FV were higher in left side. CONCLUSION: Duplex indices of vertebral arteries are age independent in adults.