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2088694 Sonographic Findings of Various Diseases Causing Gallbladder Wall Thickening
S142
Ultrasound in Medicine and Biology
Objectives: To improve the diagnostic performance for renal nutcracker syndrome (NCS) through the imaging findings although the diagnostic criteria are not well defined, often causing delayed or misdiagnosis. To propose endovascular stenting of the renal vein as an alternative therapy, although surgical repair has been the standard of care. Methods: Nutcracker syndrome (NCS) is a rare condition characterized by the entrapment of the left renal vein (LRV) between the superior mesenteric artery (SMA) and the aorta resulting in elevated pressure in the left renal vein and hematuria due to development of collateral veins. This syndrome has also been reported in association with retroaortic course of the left renal vein between the aorta and the vertebral column and has been termed as posterior NCS. Results: Real time US and Doppler scanning: Measurement of the diameter and the peak velocities of the left renal vein at two points, i.e. at the renal hilum and at the superior mesenteric artery crossing point. MDCT: left renal vein stenosis with proximal distention and the presence of collateral pathways Left renal venography with measurement of the pressure gradient between the left renal vein and inferior vena cava. An alternative therapy: Endovascular stenting of left renal vein Conclusions: Diagnosis is based on history, physical examination, basic lab tests and imaging. Sequence of tests can be composed of Doppler ultrasound (DUS), computed tomography scan (CT scan) or magnetic resonance imaging study (MRI) and retrograde phlebography with pressure gradient to confirm the diagnosis. Management options include surveillance, intravascular and extravascular stenting procedures as well as open procedures. NCS is a rare condition that represents a challenge for radiologists in terms of accurate diagnosis and proper management. 2088694 Sonographic Findings of Various Diseases Causing Gallbladder Wall Thickening Yoon Young Jung, Radiology, Eulji General Hospital, Eulji University, Seoul, KOREA (THE REPUBLIC OF) Objectives: To illustrate the sonographic findings of various diseases causing gallbladder (GB) wall thickening. Methods: To illustrate the normal anatomy of the GB. To illustrate the sonographic and/or other imaging features of various diseases causing GB wall thickening and a brief review of the diseases. Results: GB wall thickening is a frequently detected finding on ultrasonography. GB wall thickening is caused by various diseases such as cholecystitis, acute hepatitis, hypoalbuminenia, congestive heart failure, GB cancer, and adenomyomatosis. To accurate diagnosis, it is important to be aware of the sonographic features of acute cholecystitis or other diseases causing GB wall thickening. Conclusions: Understanding the sonographic findings of diseases causing GB wall thickening helps to accurate diagnosis and proper treatment. 2088848 Acoustic Radiation Force Impulse Assessment of Hydronephrosis In Adults In An Out Patient Clinic Chau Ngan Tran, Hung Thien Nguyen, Hai Thanh Phan radiology, Medic medical center, Ho Chi Minh city, Viet Nam Objectives: Hydronephrosis in adults is caused by obstructive (stone, tumor of the ureter.) or non-obstructive (ureteropelvic junction obstruction [UPJO]) nephropathy . In our study, we compared the value of acoustic radiation force impulse ( ARFI) by measuring the shear wave velocities (SWVs) for hydronephrotic kidneys in adults to detect obstructive or non-obstructive nephropathy and take notice whether fibrotic process existing. Methods: A total of 63 mild hydronephrosis patients at Medic Center from August 2013 to August 2014, 33 patients with obstruction due to
Volume 41, Number 4S, 2015 ureteral stone and 30 patients with UPJO. We also had a control group of normal kidney of 36 cases. All 33 cases with ureteral stone underwent treatment: drug or surgery and followed – up. All 30 others were followed-up. We applied virtual touch tissue quantification (VTQ) on Siemens Acuson S2000 with 1-4 MHz convex probe, by measuring 3 positions of hydronephrotic kidney. Medcalc statictical software was used to compare the ARFI values of 2 groups. Results: The mean ARFI value was 2.73 6 0.39 m/sec for hydronephrotic kidneys due to ureteral stone (n533) and 1.66 6 0.16 m/sec for those with UPJO (n530) while 1.60 6 0.2 m/sec for normal kidneys (n536). With t-test, there are significant statistically differences between 2 groups of hydronephrosis (p , 0.0001); and between 2 groups of ureteral stone and normal kidneys (p,0.0001), but no significant statistically differences between 2 groups of UPJO and normal kidneys. Conclusions: This is our premilinary study of ARFI measurements of nephrohydrotic kidney in adults. These elastic velocities increased in obstructive group and help to take notice whether the fibrosis process existing. 2089044 The Relationship Between Hand Dominance And Peripheral Venous Access Sites In Intravenous Drug Using Patients Nicole Kaban,1 Turandot Saul,3 Nicholas Avitablile,2 Sebastian Siadecki,3 Resa E. Lewiss4 1 Emergency Medicine, Mount Sinai Beth Israel, New York, NY, United States, 2St. Barnabas Hospital, Bronx, NY, United States, 3Mount Sinai St. Luke’s Mount Sinai Roosevelt Hospital, New York, NY, United States, 4 University of Colorado Hospital, Aurora, CO, United States Objectives: Intravenous (IV) drug using patients often have damaged veins due to injection, making peripheral IV access difficult to obtain. We investigate the relationship between hand dominance and the presence of upper extremity (UE) veins in IV drug (IVD) using patients. We predicted that injection into the non-dominant UE vein would occur more frequently and the dominant UE would have relatively fewer damaged veins. Methods: Prospective convenience sample of adult patients with selfreported history of IVD use. Patients excluded for instability, UE amputations, or inability to consent or tolerate a tourniquet. Using a high frequency linear transducer, the volar aspect of each UE was examined in 3 areas to a depth of 2.2cm: anticubital crease, forearm, and proximal arm. Vein patency was assessed by compression. The number of fully compressible veins $ 1.8 mm in diameter was recorded. Descriptive information, history of IVD use, and hand dominance was then obtained. Results: The study was powered to detect a vein difference of -2. 19 patients were enrolled; average age was 53.4; 84% were male; 89% were right handed. Patients had an average of 14.6 years of IVD use (range 3-36) with an average of 20.9 years (range 0-276 months) since their last use. 90% of patients had a history of injecting heroin, 76% cocaine, 16% methamphetamine, with 68% reporting the use of more than one substance. 84% reported at least daily use while they were active. 79% stated they injected themselves 100% of the time; the other 4 patients had another person inject for them 20, 10, 5, and 1% of the time. Patients used their dominant hand to inject their non-dominant UE an average of 54% (range 0-100) of the time. The mean vein difference between the numbers of veins in the dominant versus the nondominant UE was -1.5789. At a 0.05 significance level, there was insufficient evidence to suggest the number of compressible veins between patients’ dominant and non-dominant arms is significantly different (p50.0872). Conclusions: There is significant variability in injection patterns among IVD using patients. The number of compressible veins visualized with ultrasound was not greater in the dominant UE as expected.
Ultrasound in Medicine and Biology
Objectives: To improve the diagnostic performance for renal nutcracker syndrome (NCS) through the imaging findings although the diagnostic criteria are not well defined, often causing delayed or misdiagnosis. To propose endovascular stenting of the renal vein as an alternative therapy, although surgical repair has been the standard of care. Methods: Nutcracker syndrome (NCS) is a rare condition characterized by the entrapment of the left renal vein (LRV) between the superior mesenteric artery (SMA) and the aorta resulting in elevated pressure in the left renal vein and hematuria due to development of collateral veins. This syndrome has also been reported in association with retroaortic course of the left renal vein between the aorta and the vertebral column and has been termed as posterior NCS. Results: Real time US and Doppler scanning: Measurement of the diameter and the peak velocities of the left renal vein at two points, i.e. at the renal hilum and at the superior mesenteric artery crossing point. MDCT: left renal vein stenosis with proximal distention and the presence of collateral pathways Left renal venography with measurement of the pressure gradient between the left renal vein and inferior vena cava. An alternative therapy: Endovascular stenting of left renal vein Conclusions: Diagnosis is based on history, physical examination, basic lab tests and imaging. Sequence of tests can be composed of Doppler ultrasound (DUS), computed tomography scan (CT scan) or magnetic resonance imaging study (MRI) and retrograde phlebography with pressure gradient to confirm the diagnosis. Management options include surveillance, intravascular and extravascular stenting procedures as well as open procedures. NCS is a rare condition that represents a challenge for radiologists in terms of accurate diagnosis and proper management. 2088694 Sonographic Findings of Various Diseases Causing Gallbladder Wall Thickening Yoon Young Jung, Radiology, Eulji General Hospital, Eulji University, Seoul, KOREA (THE REPUBLIC OF) Objectives: To illustrate the sonographic findings of various diseases causing gallbladder (GB) wall thickening. Methods: To illustrate the normal anatomy of the GB. To illustrate the sonographic and/or other imaging features of various diseases causing GB wall thickening and a brief review of the diseases. Results: GB wall thickening is a frequently detected finding on ultrasonography. GB wall thickening is caused by various diseases such as cholecystitis, acute hepatitis, hypoalbuminenia, congestive heart failure, GB cancer, and adenomyomatosis. To accurate diagnosis, it is important to be aware of the sonographic features of acute cholecystitis or other diseases causing GB wall thickening. Conclusions: Understanding the sonographic findings of diseases causing GB wall thickening helps to accurate diagnosis and proper treatment. 2088848 Acoustic Radiation Force Impulse Assessment of Hydronephrosis In Adults In An Out Patient Clinic Chau Ngan Tran, Hung Thien Nguyen, Hai Thanh Phan radiology, Medic medical center, Ho Chi Minh city, Viet Nam Objectives: Hydronephrosis in adults is caused by obstructive (stone, tumor of the ureter.) or non-obstructive (ureteropelvic junction obstruction [UPJO]) nephropathy . In our study, we compared the value of acoustic radiation force impulse ( ARFI) by measuring the shear wave velocities (SWVs) for hydronephrotic kidneys in adults to detect obstructive or non-obstructive nephropathy and take notice whether fibrotic process existing. Methods: A total of 63 mild hydronephrosis patients at Medic Center from August 2013 to August 2014, 33 patients with obstruction due to
Volume 41, Number 4S, 2015 ureteral stone and 30 patients with UPJO. We also had a control group of normal kidney of 36 cases. All 33 cases with ureteral stone underwent treatment: drug or surgery and followed – up. All 30 others were followed-up. We applied virtual touch tissue quantification (VTQ) on Siemens Acuson S2000 with 1-4 MHz convex probe, by measuring 3 positions of hydronephrotic kidney. Medcalc statictical software was used to compare the ARFI values of 2 groups. Results: The mean ARFI value was 2.73 6 0.39 m/sec for hydronephrotic kidneys due to ureteral stone (n533) and 1.66 6 0.16 m/sec for those with UPJO (n530) while 1.60 6 0.2 m/sec for normal kidneys (n536). With t-test, there are significant statistically differences between 2 groups of hydronephrosis (p , 0.0001); and between 2 groups of ureteral stone and normal kidneys (p,0.0001), but no significant statistically differences between 2 groups of UPJO and normal kidneys. Conclusions: This is our premilinary study of ARFI measurements of nephrohydrotic kidney in adults. These elastic velocities increased in obstructive group and help to take notice whether the fibrosis process existing. 2089044 The Relationship Between Hand Dominance And Peripheral Venous Access Sites In Intravenous Drug Using Patients Nicole Kaban,1 Turandot Saul,3 Nicholas Avitablile,2 Sebastian Siadecki,3 Resa E. Lewiss4 1 Emergency Medicine, Mount Sinai Beth Israel, New York, NY, United States, 2St. Barnabas Hospital, Bronx, NY, United States, 3Mount Sinai St. Luke’s Mount Sinai Roosevelt Hospital, New York, NY, United States, 4 University of Colorado Hospital, Aurora, CO, United States Objectives: Intravenous (IV) drug using patients often have damaged veins due to injection, making peripheral IV access difficult to obtain. We investigate the relationship between hand dominance and the presence of upper extremity (UE) veins in IV drug (IVD) using patients. We predicted that injection into the non-dominant UE vein would occur more frequently and the dominant UE would have relatively fewer damaged veins. Methods: Prospective convenience sample of adult patients with selfreported history of IVD use. Patients excluded for instability, UE amputations, or inability to consent or tolerate a tourniquet. Using a high frequency linear transducer, the volar aspect of each UE was examined in 3 areas to a depth of 2.2cm: anticubital crease, forearm, and proximal arm. Vein patency was assessed by compression. The number of fully compressible veins $ 1.8 mm in diameter was recorded. Descriptive information, history of IVD use, and hand dominance was then obtained. Results: The study was powered to detect a vein difference of -2. 19 patients were enrolled; average age was 53.4; 84% were male; 89% were right handed. Patients had an average of 14.6 years of IVD use (range 3-36) with an average of 20.9 years (range 0-276 months) since their last use. 90% of patients had a history of injecting heroin, 76% cocaine, 16% methamphetamine, with 68% reporting the use of more than one substance. 84% reported at least daily use while they were active. 79% stated they injected themselves 100% of the time; the other 4 patients had another person inject for them 20, 10, 5, and 1% of the time. Patients used their dominant hand to inject their non-dominant UE an average of 54% (range 0-100) of the time. The mean vein difference between the numbers of veins in the dominant versus the nondominant UE was -1.5789. At a 0.05 significance level, there was insufficient evidence to suggest the number of compressible veins between patients’ dominant and non-dominant arms is significantly different (p50.0872). Conclusions: There is significant variability in injection patterns among IVD using patients. The number of compressible veins visualized with ultrasound was not greater in the dominant UE as expected.