2089631 Correlation Of Sonographic Measured Optic Nerve Sheath Diameter and Lumbar Puncture Opening Pressure In Emergency Department Headache Patients

Abstracts Results: After participation in this exhibit, learners should be able to recognize and differentiate the common emergent causes of abdominopelvic pain related to the GU tract based on sonographic evaluation. Conclusions: Ultrasound is a fast, convenient, cost-effective, and radiation-free modality for evaluating the genitourinary (GU) tract in the emergent setting. Recognizing the key sonographic findings in common emergent causes of abdominopelvic pain is essential for making accurate diagnoses and for efficiently facilitating appropriate management. 2089631 Correlation Of Sonographic Measured Optic Nerve Sheath Diameter and Lumbar Puncture Opening Pressure In Emergency Department Headache Patients Richard Gordon,2 Matthew Lyon,1 Joshua Wyatt3 1 Emergency Medicine, Georgia Regents University, Martinez, GA, United States, 2Emergency Medicine, Georgia Regents University, August, GA, United States, 3Medical School, Georgia Regents University, Augusta, GA, United States Objectives: To identify the best optic nerve sheath diameter (ONSD) cutoff among emergency department patients presenting with nontraumatic headache who require urgent intervention for the treatment of elevated intracranial pressure. Methods: A retrospective chart review was performed on 252 charts going back 2.5 years. Charts were extracted from the Emergency Department ultrasound database specifically searching patients who had ONSD measurements over the 2.5-year study period. Ultimately, 34 patients met criteria for inclusion in the study. Inclusion criteria consisted of patients 18 years of age, presented to the emergency department with headache, no documented recent history of head trauma, ONSD measured, and lateral decubitus lumbar puncture opening pressure recorded for the same visit. The patient records were reviewed for emergency department intervention and operative intervention. Discharge summary and clinic notes were reviewed for final diagnosis and outpatient management. Bilateral sonographic ONSDs were averaged and recorded for comparison to opening pressure and outcome. A receiver operator characteristic (ROC) curve was built to compare ONSD with patients who had elevated ICP requiring immediate intervention. Results: In our group of 34 patients, 9 were found to have elevated ICP requiring immediate intervention. 8 patients had idiopathic intracranial hypertension and 1 patient had venous sinus thrombosis. Among the immediate intervention group the average opening pressure was 46 cm H2O with an average ONS diameter of 6.2mm. The 5.0mm ONSD cutoff had a sensitivity of 100% and specificity of 46%. The 5.5mm ONSD cutoff had a sensitivity of 89% and specificity of 85%. The 6.0mm cutoff had a sensitivity of 67% and a specificity of 100%. Conclusions: For Emergency Department patients presenting with headache a sonographic ONSD greater than 5.5mm is both sensitive and specific for elevated intracranial pressure requiring urgent intervention. Providers should consider further workup to evaluate for elevated intracranial pressure in headache patients with ONSD greater than or equal to 5.5mm. 2089644 Psoas Origin: Another Possible Vertebral Level Landmark For Spinal Canal Sonography Michael DiPietro, Page Wang Radiology, University of Michigan, Ann Arbor, MI, United States Objectives: Psoas muscle origin is usually drawn as occurring at L1 in anatomy books. This study was undertaken to verify that the vertebral level origin of the psoas muscle is L1 and what variation exists. Recognizing the psoas origin on sonography would allow it to be used as another marker of vertebral level during spinal canal sonongraphy, such as evaluation for tethered spinal cord. Methods: Total spine MRs (65) and CTs (7) in 72 patients already undergoing those studies for assorted reasons were reviewed to determine

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at which vertebral level the psoas originates. Only total spine studies were used so that we could use the odontoid to definitely assign vertebral level and so that transitional vertebra will be recognized. Since total spine studies are uncommon in infants we had no age restriction. Ages were 1 year to 85 years with 23 subjects under 18 years. Median age of that under 18 years subgroup was 8 years. Results: Levels of psoas origin demonstrated no age related distribution and were: T12: 5 subjects T12-L1: 19 subjects L1: 40 subjects L1-L2: 8 subjects Conclusions: Psoas origin is T12-L1 or L1 with a few variations originating at T12 or L1-L2. Identification of psoas origin on sonography will be demonstrated and can be considered essentially as L1. It can be considered with other indicators of vertebral level already used: lowest rib right and left, lumbosacral junction, and caudal end of thecal sac. 2089805 Sentinel Lymph Node (SLN) Melanoma Micrometastasis Managed Conservatively: Sonography (US) Patterns Of Recurrence Orlando Catalano,1 Corrado Caraco’,3 Antonio Nunziata,2 Nicola Mozzillo,3 Antonella Petrillo1 1 Radiology, National Cancer Institute Fondazione Pascale, Naples, Naples, Italy, 2Radiology, CEDISA, Salerno, Italy, 3Department of skin tumors surgery, National Cancer Institute ‘‘Fondazione Pascale’’, Naples, Italy Objectives: Patients treated conservatively for lymph node melanoma micrometastasis are at risk of recurrence and require a close, longterm follow-up. We have employed US to prospectively monitor melanoma patients having not undergone completion lymphadenectomy after a SLN biopsy (SLNB) diagnosis of micrometastasis. We now report on the timing, location, and features of recurrence as detected by US. Methods: As a part of an ongoing multicenter study, we managed conservatively, without completion lymphadenectomy, 40 melanoma patients with a SLNB diagnosis of micrometastasis. These subjects were evaluated three-monthly with physical examination, LDH sampling, chest x-ray, and US with color Doppler of the pericicatricial area, superficial lymphatic stations, and liver. PET was carried out sixmonthly. Lymph-nodes were regarded as suspicious in the following circumstances: L/T diameter ,1.5 and hypoechoic internal echotexture; L/T diameter ,1.5 and non-hilar vascularization; hypoechoic internal echotexture and non-hilar vascularization; diffuse cortical thickening and non-hilar vascularization; asymmetrical cortical thickening; focal cortical nodule. In-transit metastasis was defined as hypoechoic cutaneous/subcutaneous nodules with flow signals. Results: US detected tumor recurrence in 15 patients (4 now alive with disease and 11 dead of disease). Mean time for recurrence was 14 months (range 4-30 mo.). US detected melanoma recurrence as intransit metastasis in 7/15 cases, regional lymphadenopathy in 6/15 cases, and liver metastasis in 3/15 (one patient had two recurrence sites simultaneously). There was no nodal relapse in non-regional stations. Conclusions: Melanoma recurrence of micrometastasis diagnosed at SLNB and treated conservatively is frequent. US proves effective in the detection of locoregional recurrence. Tumor recurrence may develop as an in-transit metastasis, a lymph-node metastasis, or a deep metastasis. Knowledge of the timing and location of recurrence is relevant, allowing to focus on higher risk settings. 2089885 Uneventful Pregnancy and Cesarean Delivery After Successful Robotic Surgical Repair of a Vaginal-Birth-AfterCesarean Section (VBAC) Created Uterine Fistula in The Scar Makiko Tokawa,2 Kenneth Levy,2 Victor Douek,2 Ana Monteagudo,1 Ilan E. Timor-Tritsch1 1 Ob/Gyn, NYU School of Medicine, New York, NY, United States, 2NYU School of Medicine, New York, NY, United States