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Biomedical subjects

R Sohaey

Publications and source records attributed to R Sohaey.

18 recordsLinked to original sources
PubMed1999

Sonohysterography: technique, endometrial findings, and clinical applications.

Transvaginal ultrasound-guided saline infusion sonohysterography (SHG) is a relatively new technique for evaluation of the uterine cavity. As new studies declare the clinical usefulness of this technique, SHG may quickly become part of the routine ultrasound evaluation of the female pelvis. In this article, the SHG procedure is described and normal findings are discussed. Common endometrial pathological findings such as atrophy, polyps, fibroids, hyperplasia, and carcinoma are reviewed. The newly touted roles of SHG for screening patients on long-term tamoxifen therapy and for evaluating patients with infertility are introduced. Finally, we present a practical ultrasound-based flow chart for the workup of menopausal and perimenopausal patients with abnormal uterine bleeding.

Endometrium↗
PubMed1998

Amniotic fluid and the umbilical cord: the fetal milieu and lifeline.

Amniotic fluid volume should be routinely assessed in every second and third trimester case. A review of amniotic fluid physiology and techniques for ultrasound evaluation of fluid volume is presented. The causes and significance of oligohydramnios and polyhydramnios are stressed. Umbilical cord abnormalities are often incidently observed at the time of amniotic fluid evaluation. The clinical significance of some common umbilical cord abnormalities such as a two-vessel cord and nuchal cord are discussed. Other, more uncommon entities such as cord mass lesions are also reviewed. Finally, the role of cord Doppler interrogation in determining fetal well-being is discussed.

Amniotic Fluid↗
PubMed1997

Postmortem fetal MR imaging: comparison with findings at autopsy.

OBJECTIVE: The purpose of this study was to prospectively compare findings from postmortem fetal MR imaging with findings at autopsy. SUBJECTS AND METHODS: Twenty-six fetuses were imaged on a 1.5-T MR scanner using two-dimensional and high-resolution three-dimensional fast spin-echo techniques immediately before autopsy. The MR images were reviewed independently by three radiologists who evaluated then for major and minor malformations. These findings were then compared with those at autopsy. RESULTS: The 26 subjects had 47 major and 11 minor malformations. All three radiologists correctly identified 37 of the major malformations on the MR images (detection rate, 79%), and at least one of the three reviewers correctly identified 43 of the abnormalities (detection rate, 91%). Only one of the 11 minor anomalies was identified by any reviewer. Reviewers made six false-positive diagnoses. In two cases, both with major CNS malformations, MR imaging was superior to autopsy in defining in situ relationships. CONCLUSION: Although autopsy remains the study of choice for evaluating causes of fetal death, MR imaging is an excellent alternative when autopsy is refused. Additionally, MR imaging may be a valuable adjunct to autopsy for fetuses with CNS anomalies.

Abnormalities, Multiple↗
PubMed1997

Polyhydramnios and fetal intrauterine growth restriction: ominous combination.

The purpose of this study was to evaluate the significance of polyhydramnios combined with intrauterine growth restriction. During a 6 year period, 39 fetuses were identified by prenatal sonography as having both polyhydramnios and intrauterine growth restriction. Polyhydramnios was defined as a four-quadrant amniotic fluid index of 24 or greater (mean 30.5, range 24 to 40). Intrauterine growth restriction was defined as estimated fetal weight less than the tenth percentile (Hadlock standards). The mean birth weight was 2213 g. Major anomalies were present postnatally in 92% (36 of 39) of fetuses. Among nine fetuses without sonographically detectable anomalies prenatally, six (67%) proved to have one or more anomalies at birth. Chromosome abnormalities were present in 38% (15 cases) including 10 fetuses with trisomy 18 and one with trisomy 13. The overall mortality rate was 59%. The combination of polyhydramnios and intrauterine growth restriction is ominous. The majority of fetuses have major anomalies or chromosome abnormalities, or both, even when other sonographic abnormalities are absent. Chromosome analysis and detailed fetal evaluation should be offered when polyhydramnios and intrauterine growth restriction are identified prenatally.

Abnormalities, Multiple↗
PubMed1996

First-trimester ultrasound: the essentials.

A review of first-trimester ultrasound findings is presented. The normal first trimester, including practical embryology and pregnancy dating, is first discussed. Abnormal first-trimester findings, including sonographic evaluation of the failing pregnancy, ectopic pregnancy, gestational trophoblastic disease, and first-trimester cystic hygroma, are then stressed. This report reviews the spectrum of findings encountered by sonographers while evaluating early pregnancy.

Female↗
PubMed1996

The fetal heart: a practical sonographic approach.

Structural abnormalities of the heart are a fairly common problem, affecting more than 8 of 1,000 newborns annually in the United States. Therefore, sonographic detection of these anomalies in utero is important. It is possible to detect a high percentage of fetal cardiac anomalies through proper sonographic examination using three central views of the heart: (1) the four-chamber view; (2) the aortic outflow tract view; and (3) the pulmonary output tract view. Although average sonologists may not be able to provide a precise diagnosis for a cardiac abnormality, they are able to recognize such abnormalities in a high percentage of cases by using these three views and by answering the following questions: (1) Is the heart in a normal position? (2) Is the heart size normal? (3) Are the ventricles equal in size? (4) Is there a septal defect? (5) Are the atrioventricular valves in a normal position? and (6) Is there any abnormality of the endocardium, myocardium, or pericardium? This article presents a practical approach to the detection of fetal cardiac anomalies using the four-chamber and outflow tract views. Examples of normal anatomy and cardiac pathology are provided as well as a listing of differential diagnoses that should be reviewed when certain abnormalities are visualized.

Diagnosis, Differential↗
PubMed1996

The fetal thorax: noncardiac chest anomalies.

Fetal thoracic anomalies often lead to pulmonary hypoplasia with subsequent fetal or neonatal demise. Therefore, in utero sonographic identification of these anomalies is important. Unlike cardiac anomalies, most noncardiac thoracic abnormalities are easily detected with ultrasound. An unusually small thorax is usually obvious to the experienced sonographer, and thoracic masses are commonly observed on the routinely obtained four-chamber view of the heart. This article reviews the many causes of pulmonary hypoplasia with an emphasis placed on thoracic masses. Many examples of pathological fetal thoracic conditions are provided as well as a listing of differential considerations with regard to sonographic appearances of chest masses.

Bronchopulmonary Sequestration↗
PubMed1996

Fetal gastrointestinal anomalies.

A review of fetal gastrointestinal anomalies is presented. Normal abdominal development and anatomy, including basic embryology and recommended ultrasound techniques, are first outlined. Next is a more detailed discussion of the abnormal examination, including abdominal wall defects and intra-abdominal abnormalities. The goal of this work is to present a practical approach to the abnormal fetal abdominal examination enabling the sonographer and sonologist to suggest precise differential diagnoses.

Abdominal Muscles↗
PubMed1995

Hepatic ultrasonic changes in workers exposed to perchloroethylene.

OBJECTIVE: To determine if subclinical hepatotoxicity is associated with exposure to perchloroethylene at concentrations commonly experienced in the workplace, and whether surveillance with serum hepatic transaminase activity underestimates such effects. METHODS: Hepatic parenchymal echogenicity on ultrasonography and serum hepatic transaminase activity were compared in 29 community based dry cleaning operators exposed to perchloroethylene, and a control group of 29 non-exposed laundry workers. Perchloroethylene exposure was assessed by work history and air monitoring. RESULTS: Mean hepatic transaminase activities were minimally increased in dry cleaners compared with laundry workers. Increased alanine aminotransferase activities, between 1.0 and 1.5 times the normal limits, were found in five of 27 (19%) dry cleaners compared with one of 26 (4%) laundry workers. In contrast, diffuse parenchymal changes in echogenicity, as determined by hepatic ultrasonography, were increased nearly twofold in dry cleaners, occurring in 18 of 27 (67%) dry cleaners compared with 10 of 26 (39%) laundry workers (P < 0.05), and were most strongly associated with increased perchloroethylene exposure in older dry to dry or wet transfer operations (odds ratio 4.2, 95% confidence interval 1.1-15.3). Mean eight hour time weighted average perchloroethylene exposure for dry cleaners was 16 ppm, which is less than the permissible exposure limit of 100 ppm in the United States. CONCLUSIONS: It was concluded that mild to moderate hepatic parenchymal changes occur more frequently in workers exposed to perchloroethylene than in populations not exposed to chemical solvents, and that these effects are underestimated by serum hepatic transaminase activity.

Adult↗
PubMed1995

Sonographic diagnosis of peritoneal inclusion cysts.

Peritoneal inclusion cysts have not received the attention they merit in the imaging literature. We present a series of peritoneal inclusion cysts and describe their sonographic features. Our findings lead us to encourage more conservative therapies. All seven patients in our series had pelvic pain and had undergone surgery previously. An ovary surrounded by septations and fluid was the most common finding by transvaginal sonography. Doppler examination showed low resistive flow in the septations. Conservative therapy was used in five cases with excellent results. We found that a confident diagnosis of peritoneal inclusion cysts is possible with ultrasonography. This diagnosis should encourage the use of more conservative therapy.

Adolescent↗
PubMed1994

Idiopathic polyhydramnios: association with fetal macrosomia.

PURPOSE: To determine the relationship between idiopathic polyhydramnios and fetal macrosomia in the absence of maternal diabetes. MATERIALS AND METHODS: Idiopathic polyhydramnios was studied with ultrasound (US) in 99 consecutive normal fetuses of nondiabetic women. Birth weights and estimated fetal weights were compared with those of postnatal and prenatal control groups, respectively. RESULTS: The mean birth weight for the study (polyhydramnios) group was 3,771 g +/- 572 (standard deviation) compared with 3,476 g +/- 444 for the postnatal control group (P < .001). Birth weights in the 90th percentile or greater occurred in 28.2% of the study group versus 9.3% of the postnatal control group (P < .001) with a relative risk of 3.0 and a 95% confidence interval of 1.9, 4.9. The mean percentile of estimated fetal weight obtained with US was also significantly greater for the study group (79.3 +/- 23.7) than for the prenatal control group (51.5 +/- 32.7) (P < .001). CONCLUSION: Idiopathic polyhydramnios is associated with large-for-gestational-age fetuses and macrosomia independent of maternal diabetes.

Birth Weight↗
PubMed1994

Pelvic lymphangioleiomyomatosis. Atypical precursor to pulmonary disease.

A 22-year-old woman presented with left pelvic pain and mass. Ultrasonography confirmed a multilocular left adnexal mass containing cysts of varying sizes. The patient had no pulmonary symptoms at the time of presentation. The mass was surgically excised and pathologic diagnosis of lymphangioleiomyomatosis (LAM) was made. Subsequently, she developed hemoptysis and pleural effusion. High-resolution computed tomography of the chest showed findings consistent with LAM. Early diagnosis and treatment for LAM was possible in this atypical case.

Adult↗
PubMedDate not supplied

Congenital uterine malformations.

With the advent of newer imaging techniques, the radiologist is now able to make very precise and accurate diagnoses of congenital uterine malformations and their complications. Because these anomalies are associated with reproductive dysfunction, they are often discovered during an infertility evaluation. By imaging parallel to the long axis of the uterus, the external contour can be evaluated, obviating laparoscopy for differentiating septate from bicornuate uteri. Obstructed uterovaginal anomalies (e.g., hematometros, hematometrocolpos), an important complication of abnormal müllerian duct development, can occur at any time from the newborn period to adulthood. Determining the site of obstruction is imperative for planning the proper surgical approach. To understand these malformations better, we review the relevant embryology. The most widely accepted classification scheme is discussed in detail, with an emphasis on diagnosis, prognosis, and therapeutic options.

Adolescent↗
PubMedDate not supplied

The spectrum of first-trimester ultrasound findings.

A wide spectrum of sonographic findings can be seen in the first trimester of pregnancy. One must have an appreciation of embryology to recognize normal and abnormal early pregnancy development. In this article we emphasize discriminatory criteria for identification of normal structures, as well as ultrasound findings in threatened abortion, failing pregnancy, multiple gestations, ectopic pregnancy, and trophoblastic disease. Sonoembryology, the identification of embryonic anatomy, is discussed, as are examples of early identification of anomalies.

Abortion, Threatened↗
PubMedDate not supplied

Infected aortic aneurysms: CT appearance.

Three patients with infected (mycotic) aortic aneurysms were diagnosed primarily by CT. In two patients findings included the presence of a saccular aneurysm with an irregular lumen, perianeurysmal fluid, gas and/or hematoma, osteomyelitis in adjacent vertebral bodies, and disruption of intimal calcification. In one patient with sepsis there was rapid development of an aortic aneurysm. Computed tomography is of substantial benefit in the identification and characterization of infected aortic aneurysms. Certain features may strongly suggest the diagnosis without use of aortography.

Aged↗
PubMedDate not supplied

Endometriosis: radiologic-pathologic correlation.

Endometriosis is an important gynecologic disorder primarily affecting women during their reproductive years. Pathologically, it is the result of functional endometrium located outside the uterus. It may vary from microscopic endometriotic implants to large cysts (endometriomas). The physical manifestations are protean, with some patients being asymptomatic and others having disabling pelvic pain, infertility, or adnexal masses. Symptoms do not necessarily correlate with the severity of the disease. Ultrasonographic (US) features are variable and can mimic those of other benign and malignant ovarian lesions. Low-level internal echoes and echogenic wall foci are more specific US features for endometriomas. Magnetic resonance imaging improves diagnostic accuracy, with endometriotic cysts typically appearing with high signal intensity on T1-weighted images and demonstrating "shading" on T2-weighted images. The ovaries are the most common sites affected, but endometriosis can also involve the gastrointestinal tract, urinary tract, chest, and soft tissues. Small implants and adhesions are not well evaluated radiologically; therefore, laparoscopy remains the standard of reference for diagnosis and staging. Both medical and surgical treatment options are available depending on the patient's specific case.

Diagnosis, Differential↗