Transient intussusception - What the sonographer needs to know.

Intussusception is typically considered an acute emergency; however, the increased utilisation of medical imaging has revealed that intussusceptions can also be transient, asymptomatic and possibly physiologic. Sonographers should be aware of three categories of intussusceptions: (i) persistent intussusceptions resulting in acute abdomen and requiring urgent intervention, (ii) transient symptomatic intussusceptions which may be amenable to a 'wait-and-see' strategy and (iii) transient asymptomatic intussusceptions which almost always involve the small bowel. In particular, the incidental discovery of enteroenteric intussusceptions in children should not be confused with acute pathology. In adults, sonographers should be mindful of the frequent presence of pathological lead points and further investigations may be warranted. In this literature review, we provide an overview of transient intussusceptions, highlight important differences between children and adults and describe sonographic appearances of various intussusceptions and their mimics.

Do radiologists need to review abdominal ultrasound examinations reported as 'normal' by the sonographer?

INTRODUCTION: Sonographers demonstrate a high standard of diagnostic performance and work with a considerable degree of professional independence. In Australasia, sonographers typically generate a preliminary report which is reviewed by the radiologist who issues a final report. The aim of this study was to determine whether radiologist's review is required in cases reported as normal by the sonographer. METHODS: This study was a retrospective review of 1000 abdominal US examinations considered normal by sonographers that were subsequently reported by radiologists. Any findings reported by radiologists that were not reported by sonographers were analysed and separated into errors or discrepancies according to commonly accepted definition. RESULTS: The 1000 abdominal examinations included 244 complete abdominal, 200 hepatobiliary, 506 urinary tract and 50 other abdominal examinations. Patients' age ranged from < 1 to 94 years (mean = 35 years, median = 32 years). US examinations were performed by any one of 14 sonographers with 1-21 years (mean = 6 years, median = 7 years) of clinical experience. Two diagnostic errors were made by sonographers and two errors by radiologists. In no single case did the radiologist uncover a case of an acute or serious illness, illness requiring admission or urgent clinical review, nor did the radiologist identify the cause for the presenting symptoms. Eighteen discrepancies were found, but these were of trivial nature and most were rated by specialist clinicians as irrelevant. CONCLUSION: Sonographers are accurate in distinguishing normal abdominal US examinations. The involvement of a radiologist in a second reading of normal abdominal US examinations is unnecessary.