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   Table of Contents - Current issue
Coverpage
October-December 2020
Volume 28 | Issue 4
Page Nos. 205-280

Online since Tuesday, December 22, 2020

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EDUCATIONAL FORUM  

Potential application of low intensity pulsed ultrasound in obstetrics p. 205
Yucheng Liu
DOI:10.4103/JMU.JMU_33_20  
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REVIEW ARTICLE Top

The role of the lung ultrasound in Coronavirus Disease 2019: A systematic review p. 207
Kiran Pillai, Savini Hewage, Amer Harky
DOI:10.4103/JMU.JMU_87_20  
The coronavirus disease 2019 (COVID-19) pandemic has now infected six million people and is responsible for nearly four hundred thousand deaths. We review the potential role of the lung ultrasound to evaluate its benefits and potential roles to compare it to the current gold standard of computed tomography. A literature search was carried out utilizing electronic search engines and databases with COVID-19. Keywords related to the lung ultrasound (LUS) were used to refine this search – only the relevant articles found are cited. This review showed that there exists a strong correlation between the CT and LUS scan in COVID-19. Prominent features include the vertical B-lines, thicker pleural lines, and subpleural consolidation. Potential roles include reducing transmission between health-care workers and monitoring the progress of the disease. However, the current research is scarce compared to well-established imaging modalities, and as such, there is a necessity for more research to confirm the findings of this review.
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ORIGINAL ARTICLES Top

Screening COVID-19 patients using safe practice score system in non-COVID radiology departments p. 213
Kapoor Atul, Kapur Aprajita, Mahajan Goldaa
DOI:10.4103/JMU.JMU_127_20  
Background: A prospective study was designed to evaluate the role of safe practice score system (SPSS) for targeted screening of patients in the non-COVID radiology department with the objective to (a) determine the incidence of COVID-19 in patients visiting non-COVID facilities, (b) to determine the sensitivity and specificity with predictive value of SPSS system to identify high-risk COVID patients undergoing ultrasound and echocardiographic examinations, (c) determination of relative risk (RR) estimation for health-care staff and other visiting patients and attendants, and (d) overall impact of the use of SPSS in the prevention of spread of the disease in the society. Methods: The study comprised a cohort of 688 patients who initially presented as non-COVID patients for ultrasound and echocardiography tests to a non-COVID health-care facility. Patients were divided into low-, moderate-, and high-risk COVID-19 probability groups based on SPSS screening scores of 0–3, 4–6, and more than 6, respectively. All high-risk patients with SPSS of more than 6 were advised real-time polymerase chain reaction (RT-PCR) or plain high-resolution computed tomography chest for the presence of COVID-19 before the diagnostic test could be done and all results were analyzed statistically. Results: Four hundred and forty-four low-risk patients had a median score of 3, and all underwent their radiological examinations. One hundred and forty patients were in the moderate-risk group and had a median score of 5. Thirty-six patients had a score of 6, out of which 12 patients were upgraded to score 6. One hundred and four patients were in the high-risk category group. Out of these, 20 patients were screened as RT-PCR negative and got their ultrasound examinations. The sensitivity and specificity of SPSS in categorizing patients into low and high risk were 100% and 95%, respectively, with false positive and negative of 4% and 0% with a positive and negative predictive value of 77% and 100%, respectively. The use of SPSS reduced the RR ratio for health-care workers and other staff from 7.9 to 2.6 (P = 0.001). The overall incidence of COVID-19 disease in patients visiting non-COVID hospitals was 12% during this time period. Screening and detection by the use of SPSS had a positive epidemiological impact and saved 33,000 people from getting infected when calculated by the susceptible-exposed-infectious-recovered (SEIR) pandemic model in this period of 90 days. Conclusion: SPSS categorized patients in low-, moderate-, and high-risk pretest COVID-19 probability categories accurately with good sensitivity and specificity and was useful in preventing the spread of disease with reduced RR to 2.6 for medical staff and other hospital patients and also helped to contain spread in the society.
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Compatibility and validation of a recent developed artificial blood through the vascular phantom using doppler ultrasound color- and motion-mode techniques p. 219
Marwan Alshiplil, Mohannad Adel Sayah, Ammar A Oglat
DOI:10.4103/JMU.JMU_116_19  
Background: Doppler technique is a technology that can raise the predictive, diagnostic, and monitoring abilities in blood flow and suitable for researchers. The application depends on Doppler shift (shift frequencies), wherein the movement of red blood cells away from the probe is determined by the decrease or increase in the ultrasound (US) frequency. Methods: In this experiment, the clinical US (Hitachi Avious [HI] model) system was used as a primary instrument for data acquisition and test the compatibility, efficacy, and validation of artificial blood (blood-mimicking fluid [BMF]) by color- and motion-mode. This BMF was prepared for use in the Doppler flow phantom. Results: The motion of BMF through the vessel-mimicking material (VMM) was parallel and the flow was laminar and in the straight form (regular flow of BMF inside the VMM). Moreover, the scale of color velocity in the normal range at that flow rate was in the normal range. Conclusion: The new BMF that is being valid and effective in utilizing for US in vitro research applications. In addition, the clinical US ([HI] model) system can be used as a suitable instrument for data acquisition and test the compatibility, efficacy, and validation at in vitro applications (BMF, flow phantom components).
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Ultrasound-guided-fine-needle aspiration drainage and percutaneous ethanol injection for benign neck cysts p. 225
Li-Jen Liao, Chi-Te Wang, Tsung-Wei Huang, Po-Wen Cheng, Wu-Chia Lo
DOI:10.4103/JMU.JMU_111_19  
Background: Ultrasound-guided-fine-needle aspiration drainage (US-FNAD) and US-percutaneous ethanol injection (US-PEI) have been widely used in the management of benign neck cysts. However, the long-term results of US-FNAD and US-PEI are not well elucidated. Methods: We retrospectively collated patients under neck US examinations from March 2007 to December 2017 and investigated the recurrence after US-FNAD and US-PEI. Univariate and multivariate Cox regression analyses were used to assess significant risk factors for recurrence after US-FNAD. Results: A total of 1075 patients were recruited, and their age was 50 ± 15 (mean ± standard deviation) years. A total of 862 patients had thyroid cysts, 118 patients had thyroglossal duct cysts (TGDC), twenty patients had branchial cleft cysts, 64 patients had parotid sialocysts, and 11 patients had plunging ranulas. Majority of the patients (97%, 1037/1075) reported significant symptom improvement immediately. However, 38% of the patients had recurrence with a median 3-year follow-up period. In a multivariate Cox regression analysis with adjustment for age and gender, plunging ranula (hazard ratio [HR]: 2.44, 95% confidence interval [CI]: 1.19–4.99) and lateral dimension size ≥ 0.8 cm (HR: 1.32, 95% CI: 1.04–1.67) after US-FNAD were independent risk factors for recurrence. There were 15 male and 19 female patients who received US-PEI therapy after repeated US-FNAD, of whom 23 patients had thyroid cysts, 6 had plunging ranulas, 4 had TGDC, and one had a branchial cleft cyst. The overall success rate was 94% (32/34), with a median follow-up period of 1.6 years. Two recurrent symptomatic patients had plunging ranulas. Some patients stated mild pain (21%, 7/34) and swelling sensation (26%, 9/34) after the injection. No major complications, such as vocal fold paresis or airway compression, were found. Conclusion: US-FNAD is an effective tool in the management of benign neck cysts with a 38% recurrence rate. Plunging ranulas have the highest rate of recurrence after FNAD. US-PEI is effective for most recurrent neck cysts after repeated US-FNAD.
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Influence of breast density on patient's compliance during ultrasound examination: Conventional handheld breast ultrasound compared to automated breast ultrasound p. 230
Sara De Giorgis, Nicole Brunetti, Jeries Zawaideh, Federica Rossi, Massimo Calabrese, Alberto Stefano Tagliafico
DOI:10.4103/JMU.JMU_13_20  
Background: Our aim was to study the influence of breast density on patient's compliance during conventional handheld breast ultrasound (US) or automated breast US (ABUS), which could be used as adjunct screening modalities. Methods: Between January 2019 and June 2019, 221 patients (mean age: 53; age range: 24–89 years) underwent both US and ABUS. All participants had independently interpreted US and ABUS regarding patient compliance. The diagnostic experience with US or ABUS was described with a modified testing morbidity index (TMI). The scale ranged from 0 (worst possible experience) to 5 (acceptable experience). Standard statistics was used to compare the data of US and data of ABUS. Breast density was recorded with the Breast Imaging Reporting and Data System (BI-RADS) score. Results: The mean TMI score was 4.6 ± 0.5 for US and 4.3 ± 0.8 for ABUS. The overall difference between patients' experience on US and ABUS was statistically significant with P < 0.0001. The difference between patients' experience on US and ABUS in women with BI-RADS C and D for breast density was statistically significant with P < 0.02 in favor of US (4.7 ± 0.4) versus 4.5 ± 0.6 for ABUS. Patients' experience with breast density B was better for US (4.7 ± 0.4) versus 4.3 ± 0.6 for ABUS with P < 0.01. Pain or discomfort occurred during testing, especially in patients >40 years. Conclusion: Patient age (>40 years) is a significant predictor of decreased compliance to ABUS. Compliance of ABUS resulted lower that of US independently for breast density.
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Ultrasonographic features associated with diffuse hepatosteatosis among diabetic obese and normal body mass index patients p. 235
Mahjabeen Liaqat, Mehreen Fatima, Sajid Shaheen Malik, Syed Amir Gillani, Iqra Manzoor
DOI:10.4103/JMU.JMU_94_19  
Background: The purpose of the study is to evaluate and compare the changes associated with hepatosteatosis in diabetic obese versus diabetic normal-weight patients through ultrasonography. It is estimated that with the prevalence of about 30%–75% of obese individuals accordingto the body mass index (BMI) criteria are at increase risk of developing simple fatty live. Besides obesity, diabetes mellitus is also considered to be one of the important causes of hepatosteatosis. Methods: This prospective study was conducted in February 2015–December 2015 on a group of 181 diabetic patients, including 65 males and 116 females with an age range of 40–80 years. The patients were divided into two diabetic groups: those having a BMI ≥30 kg/m2 were included in the obese group (n = 116) and those with a BMI of 18.5–25 kg/m2 were included in the normal BMI group (n = 65). Ultrasound machine Esaote MyLab 50 equipped with a 3.5–5 MHz curvilinear multifrequency transducer was used to scan the liver. Independent samples t-test was performed to compare the liver span in the two groups. Chi-square tests were applied to compare the frequencies of fatty changes, border, and surface characteristics. Results: The presence of fatty changes among obese groups was statistically significant in the diabetic obese group compared to the normal-weight individuals with P < 0.0001. Similarly, hepatic spans were found to be significantly greater in the diabetic obese group than the diabetic normal BMI group on independent samples t-test with P < 0.0001. Females were seen to develop hepatosteatosis more frequently compared to males in all diabetic individuals with P = 0.02. Conclusion: It is concluded that diabetic obese patients are more prone to develop hepatosteatosis as compared to normal BMI diabetic individuals.
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Fetal epicardial fat thickness: Can it serve as a sonographic screening marker for gestational diabetes mellitus? p. 239
Sonay Aydin, Erdem Fatihoglu
DOI:10.4103/JMU.JMU_29_20  
Background: Gestational diabetes mellitus (GDM) is defined as the new onset of impairment in carbohydrate tolerance during pregnancy. The aim of the current study was to define fetal epicardial fat thickness (fEFT) changes that developed before 24 weeks of gestation, to evaluate the diagnostic effectiveness of fEFT in predicting GDM diagnosis, and to correlate fEFT values with hemoglobin A1C (HbA1C) values. Methods: The study included a total of 60 GDM patients and 60 control subjects. A record consisted of fEFT measurements, maternal body mass index, maternal subcutaneous fat thickness, and fetal subcutaneous fat thickness during sonographic screening performed at 18–22 gestational weeks. Fetal abdominal circumference (AC) values, estimated fetal weight (EFW), and fetal gender were also recorded. Results: The median fEFT measurement of the whole study population was 0.9 ± 0.21 mm; 1.05 ± 0.21 mm in the GDM patients, and 0.8 ± 0.15 mm in the control group. The median fEFT values of the GDM patients were significantly higher than those of the control group (P < 0.01). According to the correlation analysis results, a strong positive correlation was determined between the fEFT and HbA1C values (r = 0.71, P < 0.01), gestational week of the fetus (r = 0.76, P = P < 0.01), AC (r = 0.81, P < 0.01), and EFW (r = 0.71, P < 0.01). According to the receiver operating characteristic analysis results, a fEFT value of > 0.95 can predict GDM diagnosis with sensitivity of 65% and specificity of 88% (odds ratio = 13). Conclusion: fEFT values are increased in GDM cases, and the increase can be detected earlier than 24 weeks of gestation. fEFT values are positively correlated with HbA1C values and can serve as an early predictor for GDM diagnosis.
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BRIEF COMMUNICATION Top

Physiotherapeutic treatment for levator ani avulsion after delivery: A transperineal three-dimensional ultrasound assessment p. 245
Juliana Sayuri Kubotani, Edward Araujo Júnior, Andrea Silveira de Queiroz Campo, Jurandir Piassi Passos, Caroline Ferreira do Nascimento Neri, Miriam Raquel Diniz Zanetti
DOI:10.4103/JMU.JMU_43_20  
Background: Levator ani avulsion is defined as the interruption of the insertion of this muscle on the pubic bone. It is currently recognized as an important triggering factor for genital prolapse. Although surgical interventions are available, there are no conservative strategies for this muscular injury. Description: A 40-year-old female presented with urinary incontinence and levator ani avulsion, which was confirmed on transperineal three-dimensional ultrasound (3DUS). Upon referral for physiotherapy, she presented with incorrect and weak contractions of the pelvic floor. Her treatment comprised 13 sessions of intravaginal electrotherapy followed by pelvic floor muscle (PFM) exercises in different positions. At the end of the sessions, another transperineal 3DUS was performed, and it revealed rapprochement of the levator ani muscle. The avulsed levator ani muscle can be reinserted using physiotherapeutic interventions, especially a combination of electrotherapy and PFM exercises. Conclusion: Transperineal 3DUS is an important approach for the follow-up of conservative treatment until full recovery.
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CASE REPORTS Top

Peripheral polyneuropathy associated with COVID-19 in two patients: A musculoskeletal ultrasound case report p. 249
Steven B Soliman, Chad L Klochko, Manmeet K Dhillon, Naomi R Vandermissen, Marnix T van Holsbeeck
DOI:10.4103/JMU.JMU_150_20  
As coronavirus disease 2019 (COVID-19) spreads, we are encountering multiple different symptoms and related complications. Although the vast majority of literature is focused on its pulmonary manifestations, recent reports have mentioned neurologic manifestations but typically those related to the central nervous system and diagnosed utilizing magnetic resonance imaging. We present two cases of COVID-19–associated peripheral polyneuropathy diagnosed utilizing musculoskeletal ultrasound (US), which to our knowledge is the first such case report. US is an instrumental portable modality that can be used for COVID-19 patients in isolation. As this virus continues to spread, understanding and recognizing these COVID-19 related complications and their sonographic findings are crucial.
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Point-of-care ultrasound in lingual hematoma p. 253
Roshan Mathew, Prakash Ranjan Mishra, VT Amrithanand, Sanjeev Bhoi
DOI:10.4103/JMU.JMU_118_19  
Isolated tongue hematoma following direct trauma to face is not a common finding. It can cause life-threatening airway obstruction and needs prompt diagnosis and early intervention. We report the case of a 40-year-old male who presented to our hospital with a large tongue swelling after a fall. Bedside point-of-care ultrasound (POCUS) of the tongue revealed a hematoma. This case highlights the use of POCUS for early diagnosis of tongue hematomas.
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A rare case of choledochal cyst presented as sudden and severe abdominal pain p. 256
Lung-Huang Lin
DOI:10.4103/JMU.JMU_27_20  
We report a pediatric case of Type 1C choledochal cyst presented as acute biliary colic pain. Choledochal cyst is an abnormal expansion of the biliary tract. The Type 1 choledochal cyst is the cystic dilation of the common bile duct. The Type Ic choledochal cyst is the fusiform dilatation of the common bile duct with an anomalous pancreaticobiliary junction. Patients with choledochal cysts may have the formation of cholelithiasis due to chronic biliary stagnation and repeated inflammation. Cholelithiasis may fall into the common bile duct to cause biliary colic. Abdominal sonography can be used as a preliminary examination.
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One-year-old boy with gallbladder stone: A case report and literature review p. 260
King Jun Koh, Lung Huang Lin
DOI:10.4103/JMU.JMU_28_20  
Gallstone is a rare disease in children. It might cause complications such as cholecystitis, cholangitis, and gallstone pancreatitis due to obstruction of biliary duct or secondary infection. We report a case of a 1-year, 7-month-old boy with incidental finding of gallbladder stone, who received ceftriaxone treatment after diagnosing with Salmonella enterocolitis. Herein, we review the incidence, etiology, risk factors, and management of ceftriaxone-related gallstones in children. In conclusion, these patients are suggested to receive expectant management with close follow-up instead of surgical intervention.
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To evaluate and explain the occurrence of recurrent ectopic pregnancy after ipsilateral salpingectomy, using the ultrasound p. 264
Ashraf Talaat Youssef
DOI:10.4103/JMU.JMU_113_19  
The current case report evaluated a female patient with a history of right salpingectomy subsequent to right tubal ectopic pregnancy that was presented with amenorrhea followed by vaginal bleeding and lower abdominal severe pain. The transvaginal ultrasound examination revealed the presence of ipsilateral right interstitial ectopic pregnancy. The patient was subjected to cornual wedge resection and uterine repair. The pathology report of the excised specimen revealed decidua, chorionic villi, and blood. Recurrent interstitial ectopic pregnancy after previous ipsilateral tubal ectopic pregnancy managed with salpingectomy is very rare, with only a few cases described in the literature. The current study was to evaluate and explain the occurrence of recurrent ectopic pregnancy after ipsilateral salpingectomy using the ultrasound.
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LETTERS TO EDITOR Top

Primary non-hodgkin's lymphoma of the duodenum: An uncommon location p. 267
Reddy Ravikanth, Pooja Majumdar
DOI:10.4103/JMU.JMU_100_19  
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Sonological appearance of a tailgut duplication cyst (retrorectal cystic hamartoma) in a neonate p. 269
Reddy Ravikanth
DOI:10.4103/JMU.JMU_16_20  
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Ultrasonography-guided erector spinae plane nerve block may not always contribute to enhanced recovery after spine surgery p. 271
Varun Suresh
DOI:10.4103/JMU.JMU_17_20  
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IMAGING FOR RESIDENTS – ANSWER Top

A female patient with right anterior hip pain: A paralabral cyst of the hip p. 273
Ke-Vin Chang, Wei-Ting Wu, Wen-Ting Lin, Chih-Peng Lin
DOI:10.4103/JMU.JMU_88_19  
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IMAGING FOR RESIDENTS – QUIZ Top

Abnormal fetal profile at first-trimester ultrasound scan complicated by severe polyhydramnios at the second half of pregnancy p. 275
Ana Portela Carvalho, Catarina Estevinho, Maria Coelho, Juliana Rocha, Carla Marinho, Graça Rodrigues
DOI:10.4103/JMU.JMU_102_19  
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An often missed finding in ultrasonographic shoulder examination p. 278
Ève Boissonnault, Min Cheol Chang, Mathieu Boudier-Reveret
DOI:10.4103/JMU.JMU_39_20  
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CME TEST Top

CME Test p. 280
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INDEXES Top

Author Index p. 281
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Kayword Index p. 284
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Title Index p. 286
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