Preoperative sonographic prediction of intra-abdominal adhesions using sliding sign at repeat caesarean section at the University of Maiduguri Teaching Hospital, Nigeria: a prospective observational study

ObjectiveTo determine if the presence or absence of sonographic sliding sign preoperatively is a good predictor of the presence and type of intra-abdominal adhesions; and to determine the time taken to demonstrate this sign.DesignA prospective, observational, triple-blind study using tests of diagnostic accuracy.SettingSingle-centre tertiary health institution in north-east Nigeria.Participants67 women in the third trimester scheduled for repeat elective caesarean sections (CS) had transabdominal sonography to determine the absence or presence and degree of sliding sign. The time taken to make these decisions were noted. Surgeons blinded to the ultrasound findings graded adhesions intraoperatively and comparison between sonographic and intraoperative findings made. Women who were scheduled for emergency CS were excluded.Main outcome measuresAccuracy of preoperative ultrasound to determine no/mild, moderate and severe adhesions. Secondary outcomes were interobserver correlations and time taken to determine sliding.ResultsWhen classified as adhesion and no adhesion, the sliding sign demonstrated a sensitivity of 100.00% (CI95 85.18% to 100.00%), specificity of 100.00% (CI95 92.13% to 100.00%). In predicting presence of moderate intra-abdominal adhesions, a sensitivity of 65.0% (CI95 40.78% to 84.61%) and specificity of 82.98% (CI95 69.19% to 92.35%) was found. For predicting severe intra-abdominal adhesions, it had a sensitivity of 25.00% (CI95 0.63% to 80.59%) and specificity of 98.41 (CI95 91.47 to 99.96). Disease prevalence for mild, moderate and severe adhesions was 33.82% (CI95 22.79% to 46.32%), 29.85% (CI95 19.28% to 42.27%) and 5.97% (CI95 1.65% to 14.59%), respectively. Interobserver Cohen’s kappa coefficient and PPA were 0.58 (CI95 0.39 to 0.76) and 58.82 (CI95 52.82 to 64.82), respectively. The mean duration to determine sliding sign was 7.56±2.86 s.ConclusionThis study supports the role of transabdominal sliding sign in preoperative prediction of intra-abdominal adhesions in women with previous CS without significant increase in sonography duration. This information can encourage planning for CS by ensuring that surgeons of appropriate seniority are deployed to undertake anticipated complex operations.

Ovarian Clear Cell Carcinoma which Detected in Ascitic Fluid Smear

Objective: To report the case of ovarian clear cell carcinoma with involvement of both ovaries and metastatic to ascitic fluid and the label mass in the bladderMethod: Case Report Case: A 51 years old female presented with enlarging abdominal with gradual pain. The result of transabdominal sonography were multiple cysts with solid mass, suspected solid cystic ovarian neoplasm and ascites. The patient prepared for laparotomy; optimal debulking surgery, mass resection from bladder. Cytology examination was performed from ascitic fluid and it was confirmed by histopathology examination.Result: Microscopic features on cytology examination of ascitic fluid smear was suggest carcinoma. Histological examination was confirmed the diagnosis and the result was ovarian clear cell carcinoma. Discussion: Ovarian clear cell carcinoma is a rare subtype of epithelial ovarian cancer and comprises about 5-10% of ovarian carcinomas. Clear cell carcinoma tends to occur in the fifth to seventh decades. Cytology examination showed the cellular smear consists of groups of epithelial cells with large nucleus, hyperchromatic, pale-staining, vacuolated cytoplasm. There is also eosinophilic, extracellular substance. The presence of a tumor in ascitic fluid and the label mass in the bladder can categorize become IIB. This determined based on the FIGO’s ovarian tumor staging system.Keywords: ovarian clear cell carcinoma; ascitic fluid.

DIAGNOSTIC ACCURACY OF TRANSABDOMINAL ULTRASONOGRAPHY IN DETECTING MALIGNANT NATURE OF URINARY BLADDER MASS TAKING HISTO-PATHOLOGY AS GOLD STANDARD FOR CORRELATION- A PROSPECTIVE STUDY IN A TERTIARY CARE HOSPITAL OF EASTERN INDIA

Background: Bladder cancer is a highly lethal malignancy and its increasing trend is alarming in India, and thus, there is a strong need to identify and implement effective prevention and treatment strategies. Objective: To measure parameters of diagnostic accuracy of transabdominal ultrasound in detecting malignant features of urinary bladder masses in respect to histopathology taking it as gold standard. Methodology: We took 30 patients for transabdominal sonography(TAS) and recorded the ndings with corroborating them with histopathological ndings prospectively Results: Mostly affected were male with complaint of haematuria(90%) .After corroboration, we found the sensitivity was 96.43% but the specicity was 50% .The association of ndings of ultrasound with HPE were statistically signicant(p-0.011) Conclusions: We found transabdominal ultrasonography has an excellent diagnostic accuracy in detecting neoplastic nature of urinary bladder masses.

The Sonographic Appearance of Seminal Megavesicles, an Association With Autosomal Dominant Polycystic Kidney Disease: A Series Review

Megavesicles are an uncommon diagnostic finding during sonography of the bladder, especially when the examination is performed transabdominally. Although megavesicles are more likely seen with transrectal ultrasonography, computed tomogram (CT), vesiculography, or magnetic resonance imaging (MRI), it has been noted during transabdominal sonography for patients suffering from autosomal dominant polycystic kidney disease (ADPKD). When seminal vesicles become dilated, they are often visualized during transabdominal sonography. Two patient cases are provided of seminal megavesicles, associated with ADPKD and have documented sonographic findings. Both patient cases of megavesicles were discovered incidentally during the course of a renal sonogram. The importance of these diagnostic findings and the possible pathogenesis are provided.

Contrast enhanced ultrasound (CEUS) with parametric imaging after irreversible electroporation (IRE) of the prostate to assess the success of prostate cancer treatment

AIM: The aim of this study was to assess the success of irreversible electroporation (IRE) in prostate cancer and to differentiate between reactive changes and tumor. MATERIAL AND METHODS: This is a retrospective pilot study of 50 patients after irreversible electroporation (IRE) in prostate cancer between 50–79 years (mean age 65 years). Each patient received a transabdominal sonography using a 1–6 MHz convex matrix probe. Contrast-enhanced ultrasound (CEUS) was performed after i.v. bolus injection of 2.0 ml sulphur hexafluoride microbubbles. DICOM loops were continuously stored up to one minute. Parametric images were calculated by integrated perfusion analysis software. A comparison was drawn to a follow-up MRI six months after ablation. RESULTS: While 13 patients showed local recurrence, 37 patients were successfully treated, meaning no local recurrence within six months after ablation. 18 patients showed signs of prostatitis after IRE. Tumorous changes were visually characterized by dynamic early nodular hypervascularization with fast and high wash-in. Correspondingly, nodular red and yellow shades were seen in parametric imaging. All patients with remaining tumor were correctly identified with CEUS and parametric imaging. After IRE there is a relevant decrease in tumor microcirculation in all patients, as seen in more purple shades of the prostate. The sensitivity for detecting residual tumor with CEUS compared to MRI was 76 %, the specificity was 81 %. The corresponding positive predictive value (PPV) was 73 % and the negative predictive value (NPV) was 83 %. CONCLUSION: CEUS and parametric imaging enable a critical analysis of post-ablation defects after IRE for prostate cancer even with a transabdominal approach. Remaining tumor can be detected with the help of pseudo-colors.

Hypoplastic left heart syndrome with endomyocardial fibroelastosis diagnosed in first trimester: A case report

Background Report a case of hypoplastic left heart syndrome (HLHS) with endomyocardial fibroelastosis (EFE) diagnosed in the first trimester. Case presentation We detected a balloon shaped left ventricle, a narrowed reverse blood stream signal in the aortic arch and widened blood stream signals in the pulmonary artery (2.2 mm) and the ductus arteriosus when performing echocardiographic screen with transabdominal sonography in a 31-year-old pregnant woman (gravida 2, para 1) who presented to our department for routine fetal ultrasonography at 11+2 weeks’ gestation. Based on these findings, a diagnosis of HLHS with EFE was suspected. The findings from autopsy confirmed the diagnosis. Conclusion Ultrasound screening in the first trimester may be helpful in early diagnosis of HLHS.

Sonographic Diagnosis of a Mature Cystic Teratoma Resulting in Acute Torsion

Mature cystic teratomas are benign germ cell tumors and, depending on the size, may be at risk for torsion. These ovarian masses can cause the ovarian vasculature to twist upon itself and inhibit blood flow, resulting in partial to complete torsion. If detection and treatment are not prompt, a salpingo-oophorectomy may be needed impeding future fertility. This case describes a young woman with acute left adnexal pain where sonography aided in the diagnosis of ovarian torsion caused by a large mature cystic teratoma. Transabdominal sonography was used, aided by extended field-of-view technology for characterization of the mass. The sonographic attributes of mature cystic teratomas vary, but careful evaluations can lead to an accurate diagnosis to aid in surgical procedures. The patient underwent an exploratory laparotomy, which resulted in a left ovary oophorectomy and excision of the mass.

Adding trans-abdominal elastography to the diagnostic tool for an ileal gastrointestinal stromal tumor: a case report

Background Diagnosis of gastrointestinal stromal tumors (GISTs) in the distal small intestine is difficult by endoscopic ultrasound. This is the first reported case of an ileal GIST, which is diagnosed by transabdominal sonography and strain elastography. Case presentation A 75 y/o woman presented with tarry stool and dizziness. No definite bleeder could be identified by esophagogastroduodenoscopy and colonoscopy. The transabdominal sonography revealed a large heterogeneous tumor involving the muscular layer of the ileum. Strain elastography showed the strain ratio was 6.51. Strain histogram was skewed to the blue side, and mean color value was 230.5, signifying a stiff tumor. GIST was highly suspected. The patient underwent laparoscope-assisted tumor excision and the histological examination confirmed a malignant GIST. The patient was discharged without postoperative event. Conclusion Transabdominal strain elastography could play a role to discriminate small bowel GISTs and other submucosal tumors, especially in the location with difficulty in endoscopic ultrasound.