Abdominal ultrasound examinations can include investigation of not only the digestive organs but also the urinary and reproductive organs. As such, Senior Medical Sonographers must have clinical knowledge of both urology and obstetrics/gynecology as well as advanced examination skills. People tend to think that Senior Medical Sonographers do not need to have any knowledge of obstetrics, but there are patients with an abdominal bulge who visit internists without knowing that they are pregnant, suggesting that an overall knowledge of obstetrics and gynecology may be necessary. The relevant organs of obstetrics and gynecology are mainly the uterus and adnexa (ovaries, fallopian tubes). The most frequently encountered diseases in obstetrics and gynecology are uterine fibroids and ovarian cysts. Both diseases may sometimes grow to navel height, in which case they may be incidentally detected by abdominal ultrasound. Uterine fibroids generally present as a circle or egg-shaped solid mass with lower echogenicity than normal uterine myometrium. Most ovarian tumors are recognized as a cystic mass, and the possibility of malignancy needs to be investigated when a solid part is observed inside a cystic mass. The histopathology of ovarian tumors includes benign, borderline malignant, and malignant. Senior Medical Sonographers need to have knowledge of ultrasonographic findings of common ovarian tumors such as endometrial cyst, mature cystic teratoma, and suspected malignant ovarian tumor. The purpose of obstetrics ultrasound is to investigate fetal growth and fetal well-being. Sonographers need to be able to measure the estimated fetal body weight and the amniotic fluid volume. Knowledge of detailed screening of the fetus is not necessary for Senior Medical Sonographers.

View full abstract

Purpose: Left ventricular ejection fraction (LVEF) is commonly measured by echocardiography to evaluate LV function. However, LVEF does not necessarily reflect actual LV function. In fact, half of patients with heart failure have normal LVEF. On the other, plasma brain natriuretic peptide (BNP) is high in those patients and reflects the prognosis. The levels of plasma BNP are also reported to increase with age in subjects with normal LVEF. Therefore, we evaluated whether global function index (GFI)=E/E′/S′ changes with age like plasma BNP, and what factors contribute to the levels of GFI in subjects with normal LVEF. Subjects and Methods: The study group included 770 patients with normal echocardiography (no organic abnormality). We measured GFI in addition to parameters measured in the routine study, and compared the value of GFI in each decade. Furthermore, we determined the independent factors affecting the levels of GFI by multivariable analysis. Results: GFI increased with age like BNP (r=0.567, p<0.001). Multivariable analysis revealed that the high level of GFI was associated with left atrium size (odds ratio 1.050, 95%confidence interval(CI) 1.020-1.090), age (every 10 years) (odds ratio 2.650, 95%CI 2.070-3.410), male (odds ratio 0.386, 95%CI 0.249-0.598), hypertension (odds ratio 1.730, 95%CI 1.070-2.800), and diabetes mellitus (odds ratio 1.660, 95%CI 1.020-2.700). Conclusion: These results suggest that GFI reflects the changes in LV function in subjects with preserved LVEF. Further study will be needed to clarify the importance of increased GFI with preserved LVEF.

View full abstract

Hepatic inflammatory pseudotumor (IPT) is a rare benign disorder with non-specified image findings that depend on the inflammatory stage. Here, we report a case of hepatic IPT with contrast-enhanced ultrasonography (CEUS) findings that changed over time. The female patient in her 40s was referred to us for close examination of a new lesion appearing in hepatic segment 5 on contrast-enhanced computed tomography (CT) during follow-up for a solitary necrotic nodule in hepatic segment 6. Ultrasonography revealed a 13-mm hypoechoic solid lesion with an ill-defined border in her liver. At the first visit, the new hepatic nodule showed a strong homogeneous enhancement pattern in the arterial phase of CEUS, while it showed a prolonged enhancement pattern in the portal phase of CEUS. In the post-vascular phase, the nodule showed an enhancement defect. Six months after these initial findings, the contrast enhancement pattern in the portal phase had changed into a washout pattern. The nodule showed a washout pattern in both the portal and equilibrium phases of contrast-enhanced CT. As dedifferentiation of hepatocellular carcinoma was not ruled out, laparoscopic partial hepatectomy was performed. The resected specimen clearly showed a distinct tumor without a capsule. Pathological findings showed an increased number of spindle cells and small blood vessels with infiltration of inflammatory cells including plasma cells in the tumor. The nodule was diagnosed as IPT. This case suggested that follow-up with CEUS might be useful to diagnose IPTs for hypoechoic solid lesions with ill-defined borders.

View full abstract