Cerebrospinal fluid lactate dehydrogenase in neonatal intracranial hemorrhage.

Cerebrospinal fluid (CSF) lactate dehydrogenase (LDH) was measured in 54 neonates with intracranial hemorrhage and compared with 82 control, 27 traumatic lumbar puncture, seven meningitis, and 30 asphyxiated newborns. Hospital data, neonatal outcomes, and long-term neurodevelopmental follow-up results were reviewed. CSF LDH was not significantly affected by traumatic lumbar puncture but was elevated in proportion to the severity of CNS hemorrhage as scored by computerized tomography. LDH was also significantly associated with subsequent seizures and hydrocephalus and abnormal long-term developmental outcome.

The ultrasonographic evaluation of large cystic pelvic masses.

Thirty-six large cystic masses of pelvic origin were evaluated by means of gray-scale ultrasonography. The goal was to determine which sonographic criteria would help establish whether a lesion was malignant or benign, to further characterize it into ovarian neoplasms (cystadenoma, teratoma), inflammatory lesions (tuboovarian abscess), and blood-containing lesions (hematocolpos, hematoma). Eighty-three percent of the masses were benign, and 72% were of ovarian origin. Fifty-six percent of the masses were found in women 11 to 30 years old. Although no pathognomonic patterns were discovered, the application of certain sonographic criteria may narrow the differential diagnoses considerably.

Evaluation of the biliary tree: a comparison of percutaneous transhepatic cholangiography and ultrasonography.

After we examined 45 patients with jaundice, using both percutaneous transhepatic cholangiography and ultrasonography, our results suggest that ultrasound is useful as an early screening procedure in evaluating patients with jaundice.

Ultrasonography in the diagnosis of a type 1 choledochal cyst.

We have described an adult patient with a type 1 choledochal cyst and without jaundice. Ultrasonography demonstrated a cystic mass in the right upper quadrant and dilated bile ducts.

Ultrasonic diagnosis of obstructed renal duplication and ureterocele.

The diagnoses of complete obstruction in a duplicated renal collecting system and ureterocele can be made with a high degree of confidence by ultrasound. Two children presenting with abdominal masses were examined by gray scale ultrasonography which demonstrated large cystic masses dorsal to and displacing the lower pole of the kidney ventrally and laterally. In one patient the dilated ureter terminated in a ureterocele. Ultrasonography is the appropriate imaging modality for this disease process, though it generally becomes the complementary study to excretory urography in the diagnosis of an obstructed duplicated system. The dilated pelvis and ureter can be imaged to ultrasonography even when their presence is only implied on an excretory urogram. Finally, the cystic nature of a ureterocele, as well as its relationship to the ureter and bladder, makes ultrasonography an ideal technic for evaluating this anomaly.

Abdominal and obstetric applications of a dynamically focused phased array real time ultrasound system.

Abdominal and obstetric applications of a dynamically focused phased array real time ultrasonic system are described. This work was performed utilising both the Thaumascan (two-dimensional, high resolution, actual time, ultrasound, multi-element array scanner) and the first commercial unit based on this system, the Grumman RT-400. Examples of normal and pathological anatomy are presented from over 300 examinations performed to date, including a series of 28 abdominal aortic aneurysms studied with the RT-400. Following electronic alterations in the Thaumascan with resultant improvement in the grey scale, prospective analyses in 86 obstetric and 23 abdominal examinations were undertaken. These studies indicate that fetal, intra-uterine, and abdominal structures can be rapidly and consistently imaged. The value of real time ultrasonic scanning in obstetric and abdominal examinations is illustrated. The principles of dynamically focused phased arrays are described, and the merits and limitations of these systems are discussed.

Ultrasound patterns of disorders affecting the gastrointestinal tract.

A mass associated with the gastrointestinal tract was detected by sonography in 33 patients. Etiologies included primary or metastatic tumor; intussusception; inflammation secondary to bowel infarction, pancreatitis, or irradiation; and a dilated, fluid-filled gut related to retained gastric contents, obstruction, ileus, or an ileal bypass. Mesenteric or omental changes were identified with inflammation and frequently with metastatic disease. The diagnosis was confirmed by repeat sonography, abdominal radiography, barium examination of the small bowel, computed tomography, surgery, or autopsy. Ultrasound patterns are characteristic in tumor, intussusception, and inflammation; specific features allowing differentiation between tumor and inflammation are described. Colonic haustra, valvulae conniventes, or bowel contours and peristalsis on real-time sonography are helpful in identifying fluid-filled bowel loops.

Ultrasonic diagnosis of renal vein thrombosis in neonates.

Ultrasound findings in four neonates with renal vein thrombosis are described. Three of the patients had unilateral involvement and one had bilateral involvement. Gray scale ultrasonograms showed the affected kidney to be enlarged. Either medium level echoes were distributed evenly throughout the kidney, or there were distinct clumps of echoes randomly scattered within the kidney, sometimes surrounding echofree spaces. The ultrasound findings, combined with appropriate clinical findings, should allow diagnosis of renal vein thrombosis without requiring invasive vascular studies.

The sonolucent placenta in high-risk obstetrics.

Placental sonolucency has been reported to be a normal sonographic finding after 36 weeks' gestation. To further characterize this acoustic phenomenon, 15 placentas from previously scanned high-risk obstetric patients were studied in vitro. Placentas were obtained at delivery, and were washed, weighed, sonographically imaged in a water bath, x-rayed by xerography, and pathologically examined. Placental sonolucency occurred as early as 31 weeks' gestation and corresponded anatomically to cotyledons. The degree of septal calcification appeared to correlate best with the degree of sonolucency, and no unusual gross or microscopic placental features could be identified. Intrauterine growth retardation or intrauterine fetal death occurred in 8 of the 10 patients in whom there were sonolucent changes.

Intraabdominal abscess: current concepts in radiologic evaluation.

Forty patients with suspected abdominal abscess had computed tomography (CT) and plain film examinations; 15 also had ultrasound study. CT was found to be the most consistently accurate examination, both for the detection of abscess and evaluation of its extent. Ultrasound was positive in a high percentage of cases in which it was used. Although plain films correctly suggested the presence of an abscess in over half the proven cases, confirmatory evidence from CT or ultrasound was often required to persuade clinicians of the presence of an abscess and to provide detailed information regarding its extent and configuration.

Comparison of gray-scale ultrasonography and computed tomography in the evaluation of macrocrania in infants.

Head scans in 27 infants were done to compare the value of ultrasonography and computed tomography (CT) in the evaluation of macrocrania and encephalocele. Ultrasonography and CT correlated well with regard to anatomical information, especially in the assessment of the lateral and third ventricles. However, unlike CT, ultrasonography uses no ionizing radiation, is less expensive, eliminates sedation, and reduces artifacts due to motion and metal clips. In conjunction with an initial CT examination, ultrasonography is useful for serial evaluation of the lateral and third ventricles. It can also be helpful in assessing extraventricular fluid collections and suspected encephaloceles.

Type II choledochal cyst: ultrasonographic appearance.

The ultrasonic findings in a rare Type II choledochal cyst are described. In patients with a right upper quadrant mass in whom the clinical, ultrasonic, or radiographic findings are atypical for other etiologies, this diagnosis should be considered.

Applications of real-time ultrasound in obstetrics: the linear and dynamically focused phased arrays.

Real-time ultrasound is a dynamic imaging technique that allows in utero orientation to the fetus. It permits rapid and efficient examination of fetal anatomy and provides a dynamic assessment of fetal well-being. The energy dissipation can be comparable to that in conventional ultrasonic B-mode scanning. We have used both linear and dynamically focused phased arrays for fetal examinations in conjunction with conventional gray scale B-mode scanners. The sophisticated phased-array real-time systems have demonstrated higher resolution and an improved gray scale as compared with the linear arrays. Applications of real-time ultrasound in obstetrics are discussed, and appropriate clinical examples are cited that illustrate the value of the technique for study of both normal and abnormal fetal development. We believe that this technique is the most sensitive method of detecting intrauterine fetal demise. The relative advantages and disadvantages of linear and dynamically focused phased arrays in obstetric evaluation are considered.

Ultrasonic imaging of the amniotic and chorionic cavities.

This paper presents two cases illustrating separate chorionic and amniotic sacs at 5 to 6 weeks of estimated gestational age. With higher resolution scanning units and higher-frequency transducers, the delineation of the amniotic membrane can be seen before it fuses with the chorionic membrane; this should not be interpretated as an abnormality.

Computed tomography in the diagnosis of intra-abdominal abscesses.

The diagnosis of intra-abdominal abscess by radiographic means often relies on combining the results of several different imaging modalities. Computed tomography (CT) has been shown to be a safe, accurate and rapid diagnostic method of diagnosing these abscesses. Five patients with a variety of intra-abdominal abscesses are presented in whom the CT scan alone provided the correct diagnosis. The various imaging modalities available for the radiologic diagnosis of intra-abdominal abscess are described and are compared to CT diagnosis regarding their pitfalls.

Principles and applications of a dynamically focused phased array real time ultrasound system.

The physical principles and clinical applications of a high-resolution, dynamically focused phased-array real time ultrasound are described. Advantages of the real time technique include rapid survey capability, efficient selection of an appropriate tomographic plane, identification of pulsating structures, and dynamic studies. The capabilities of a high resolution phased array with extended dynamic focusing to a range of 15-20 cm are demonstrated in vascular, abdominal, and obstetric imaging. Appropriate clinical examples showing normal and pathological anatomy are presented. Comparisons with conventional B scans are illustrated.

Computerized tomographic diagnosis of massive hydronephrosis of duplicated system in an adult.

A case of massive hydronephrosis of the upper portion of a duplicated collecting system in a middle-aged male is presented. Computerized tomographic examination of the abdomen provided the most precise information and led to a correct preoperative diagnosis, whereas both urography and ultrasound did not.