ACR Appropriateness Criteria® Right Lower Quadrant Pain: 2022 Update.

This document focuses on imaging in the adult and pregnant populations with right lower quadrant (RLQ) abdominal pain, including patients with fever and leukocytosis. Appendicitis remains the most common surgical pathology responsible for RLQ abdominal pain in the United States. Other causes of RLQ pain include right colonic diverticulitis, ureteral stone, and infectious enterocolitis.

Prospective screening for blunt cerebrovascular injuries: analysis of diagnostic modalities and outcomes.

Objective: To prospectively examine outcomes associated with an aggressive screening protocol for blunt cerebrovascular injury (BCVI), and to compare the accuracy of computed tomographic angiography (CTA) and magnetic resonance angiography (MRA) versus conventional angiography with respect to BCVI diagnosis.

Summary Background Data: In the past 5 years, BCVI (carotid and vertebral arteries) has been recognized with increasing frequency. Initial studies described blunt carotid injuries and their associated morbidity, while more recent reports have established the devastating potential of blunt vertebral injuries.

Sonographic visualization of ovarian veins during the puerperium: an assessment of efficacy.

Objective: The purpose of this study was to determine the ability to visualize ovarian veins by sonography in postpartum patients as well as to assess the frequency of ovarian vein thrombosis in these patients.

Study Design: Seventy subjects were recruited from either the postpartum ward or labor and delivery unit after vaginal delivery between November 1, 2000, and March 1, 2001. Patients were excluded if they had a previous or current history of venous thrombosis or recently underwent cesarean delivery.

Fetal 'space-suit' hydrops in the first trimester: differentiating risk for chromosome abnormalities by delineating characteristics of nuchal translucency.

Detecting first trimester fetuses with pan-body hydrops, giving the appearance of a 'space-suit,' is associated with a marked increased risk for chromosome abnormalities. In 30 consecutive fetuses prospectively characterized by space-suit hydrops, detected at or before 13.9 weeks' gestation, 26 (86.

Prenatal diagnosis of genital anomalies.

Objectives: This is a report of five cases of abnormal fetal genitalia detected by routine prenatal ultrasound.

Methods: Retrospective review was conducted to identify all cases of abnormal fetal genitalia identified by routine obstetrical ultrasound at our institution in which postpartum follow-up was available.

Results: Five cases of prenatal sonographically diagnosed abnormal fetal genitalia were confirmed postnatally.

Remote real-time ultrasound interactive telediagnosis: putting it into practice.

Teleradiology, the practice of radiology over a distance via electronic transmission of radiologic images, has the potential to fundamentally alter the practice of radiology in the years to come. Different models for the practice of teleradiology include on-call reading, consultation and overreading, primary-reading teleradiology, and integration with picture archiving and communication system (PACS) and miniPACS. Remote real-time ultrasound telediagnosis represents a specialized subset of primary-reading teleradiology, specifically designed to involve the radiologist directly with sonographer in the performance of the ultrasound examination.

Isolated fetal choroid plexus cysts and trisomy 18: a review and meta-analysis.

Objective: Risk of trisomy 18 in a fetus with ultrasonographic diagnosis of choroid plexus cysts and no other anomalies is controversial. Using our data and current literature, we performed a meta-analysis and estimated the positive predictive value of isolated choroid plexus cysts for trisomy 18.

Study Design: Between Jan.

Clinical course and outcome of fetuses with isolated cystic nuchal lesions and normal karyotypes detected in the first trimester.

Objective: We assessed newborn outcome and infant development in cases of first-trimester fetal cystic nuchal lesion and normal karyotype.

Study Design: Information regarding newborn outcomes and infant growth and development was prospectively obtained from 32 consecutive pregnancies characterized by fetal cystic nuchal lesions detected in the first trimester (< or = 13.9 weeks' gestation) and normal karyotypes.

Severity of abnormality influences decision to terminate pregnancies affected with fetal neural tube defects.

We examined parental decision concerning pregnancy management in women having fetuses with neural tube defects (NTDs) to determine whether severity of defect or method of detection has an impact on the decision making process. Analysis of decisions by 50 women, whose pregnancies were affected by an isolated neural tube defect (NTD) and characterized by a singleton gestation at 24 gestational weeks or less with normal chromosomal complement (46,XX or 46,XY), were assessed. All 23 women carrying fetuses with anencephaly elected to terminate their pregnancies.

Significance of septations in isolated fetal cystic hygroma detected in the first trimester.

Recent reports have indicated an increased risk for fetal chromosome abnormalities, especially autosomal trisomy, in fetuses with isolated cystic hygroma, or prominent nuchal membranes, detected by ultrasonography during the first trimester. However, these reports present contradictory information regarding the prognostic significance of septations within the cystic hygroma. We evaluated, in blind fashion, 55 consecutive cases of isolated fetal cystic hygroma detected at or before 13.

Predicting pregnancy survival from a single first trimester vaginal ultrasonogram.

This retrospective study evaluates early first trimester FHR, gestational SACD, and CRL measurements as means to predict ultimate pregnancy outcome. Outcomes of 274 pregnancies were monitored a single time by transvaginal ultrasonography with measurements recorded between 5.0 and 9.

Predicting aneuploidy in fetuses with cardiac anomalies: significance of visceral situs and noncardiac anomalies.

To determine whether the risk of aneuploidy in fetuses with cardiac anomalies is affected by abnormal visceral situs or coexisting noncardiac anomalies (NCA), were reviewed 125 cases in which a structural cardiac anomaly was detected by prenatal sonography. Forty-three of the 125 fetuses (34%) had an abnormal karyotype (31 autosomal trisomies, 12 other). None of the 13 fetuses with abnormal visceral situs had an abnormal karyotype, whereas an abnormal karyotype was present in 43 of 112 with normal visceral situs (P < 0.

Transvaginal chorionic villus sampling using transabdominal ultrasound guidance: a new technique for first-trimester prenatal diagnosis.

Transvaginal chorionic villus sampling (CVS) using concurrent transabdominal ultrasound guidance was performed in 20 women who desired CVS but could not be offered transcervical or transabdominal approaches because of uterine position and placental location. Satisfactory amounts of chorionic villi were obtained in all 20 cases with no maternal discomfort, an occurrence that contrasts with our experience in transvaginal CVS using endovaginal ultrasound guidance. We believe that transvaginal CVS using concurrent transabdominal ultrasound guidance warrants consideration as an alternative technique for first-trimester CVS in selected patients.

[A forceps for the bile ducts].

The authors suggest and use in the practice an original forceps for the bile ducts. With its application the stump of the cystic duct is intubated in minimal time and with less damage in operations on the bile ducts. The design and use of the suggested forceps are described.

High frequency of cytogenetic abnormalities in fetuses with cystic hygroma diagnosed in the first trimester.

Objective: The purpose of this study was to evaluate the association between fetal cystic hygroma detected in the first trimester and fetal cytogenetic abnormalities.

Methods: Visualization of a prominent (2.5 mm or larger) anechoic or hypoechoic separation of the fetal skin line from the posterior body wall led to the diagnosis of fetal cystic hygroma; presence or absence of septations within the cystic hygroma was documented in each patient.

Diagnostic efficacy of endovaginal color Doppler flow imaging in an ectopic pregnancy screening program.

The authors compared the diagnostic yield of endovaginal color and pulsed Doppler ultrasound (US) in conjunction with endovaginal sonography with that of endovaginal sonography alone in patients prescreened to be at increased risk for ectopic pregnancy. Pelvic structures were evaluated for overall vascularity and for the presence of characteristic pulsed Doppler US velocity waveforms. The diagnostic sensitivity of the initial endovaginal sonographic examination increased with the addition of color and pulsed Doppler US, from 71% to 87% for ectopic pregnancy, from 24% to 59% for failed intrauterine pregnancy, and from 90% to 99% for viable intrauterine pregnancy.

Transvaginal chorionic villus sampling using transabdominal ultrasound guidance.

Transvaginal chorionic villus sampling (CVS) using concurrent transabdominal ultrasound guidance was performed in six women who desired CVS but could not be offered transcervical or transabdominal approaches because of uterine position and placental location. Satisfactory amounts of chorionic villi were obtained in all six cases with no maternal discomfort, an occurrence that contrasts with our experience in transvaginal CVS using endovaginal ultrasound guidance. We believe that transvaginal CVS using concurrent transabdominal ultrasound guidance warrants consideration as an alternative technique for first-trimester CVS in selected patients.

Serial endovaginal sonography of ectopic pregnancies treated with methotrexate.

Methotrexate therapy is a newly established treatment modality for ectopic pregnancy. We performed this study to determine the time frame for resolution of the sonographically identifiable mass during such therapy and to determine the role of sonography in the management of these patients. Eighteen patients treated with methotrexate for laparoscopically proven ectopic pregnancy consented to long-term follow-up with endovaginal sonography.

Diagnosis of early embryonic demise by endovaginal sonography.

To determine the embryonic size at which cardiac activity is always seen in a normal early pregnancy, 398 endovaginal sonograms were evaluated in which the gestational sac contained a yolk sac and/or embryo of less than or equal to 12 mm in crown-rump length (CRL). In the 99 sonograms in which there was a yolk sac but no identifiable embryo, cardiac activity was absent in 75; 58 of these pregnancies progressed normally. Of the 299 sonograms where there was an identifiable embryo with CRL less than or equal to 12 mm, cardiac activity was absent in 31; 29 of these were proven to be failed pregnancies.

Anomalous systemic and pulmonary venous pathways diagnosed in utero by ultrasound.

Anomalies of systemic and pulmonary venous return are found as either isolated lesions or as part of a complex cardiac malformation. Specifically, these venous pathway malformations are associated frequently with the cardiac defects in asplenia or polysplenia. This report describes the prenatal ultrasound diagnosis of both anomalous pulmonary and systemic venous drainage in three late gestation fetuses with a splenic syndrome and complex congenital heart disease.

Ultrasound of the fetal thymus.

A prospective study was performed in 340 obstetric sonograms to evaluate the sonographic characteristics of the fetal thymus. The thymus was identified as a homogeneous structure in the anterior fetal mediastinum in 251 cases (74%). The thymus was categorized as either hyperechoic, isoechoic, or hypoechoic relative to fetal lung.

The peripheral hypoechoic rim of the fetal heart.

The purpose of this study is to determine the origin of the hypoechoic rim around the fetal heart; this rim has been noted previously but there is disagreement as to its origin. Of 314 fetuses scanned, a four-chamber view was obtained in 290; a hypoechoic rim was present in 94% of these. In all cases in which a short-axis view could be obtained, the rim continued circumferentially through the ventricular septum.