To implement, execute and evaluate a quality assurance test protocol for clinical ultrasound transducers that is software-based, user-independent, inexpensive, easily repeatable, and does not require tissue phantoms. The test protocol is based on in-air reverberation images. The software test tool generates uniformity- and reverberation profiles to monitor system sensitivities and signal uniformities that provide a sensitive analysis of transducer status. Whenever a transducer was suspected to be damaged validating tests were conducted using the Sonora FirstCall test system. A total of 21 transducers from five ultrasound scanner systems were included in the study. Tests were performed every other month for a total of 5 years. Each transducer was tested on average 11.7 times. Testing a transducer required a total of 2.75 hours annually. The ultrasound quality assurance test protocol detected an average annual fail rate of 10.7%. The test protocol provides a reliable approach for monitoring transducer lens status of clinically used ultrasound transducers. The ultrasound quality assurance test protocol may potentially find deviations in diagnostic quality before being noticed by the clinicians. Thus, the ultrasound quality assurance test protocol holds the ability to reduce the risk of undiscovered image quality degradation hereby minimizing the danger of diagnostic errors.

Congenital teratomas are rare with less than 10% found in the cervical region. When they do occur in the neck, they are usually identified during the third trimester and, due to their location, they are associated with polyhydramnios. Cervical teratoma was identified at 32 weeks gestation during a routine scan of a 33-year-old female expecting dichorionic diamniotic twins. Only one twin was affected and referral to a specialist hospital allowed a care plan to be arranged to ensure safe delivery followed by immediate treatment and surgery. To date, both twins are thriving. Cervical teratomas usually occur in the third trimester and are not always detected prenatally. Although usually benign, their size and location may cause polyhydramnios as well as increasing the risk of neonatal asphyxiation and death. It is therefore essential to assess the foetal neck when polyhydramnios is noted at any third trimester scan, to maximise detection and ensure appropriate multidisciplinary healthcare can be organised to optimise postnatal survival. Antenatal detection of a rare cervical teratoma was pivotal in the management and survival of this infant. Ultrasound practitioners must consider the possibility of a neck teratoma in the presence of third trimester polyhydramnios and therefore evaluate carefully foetal head, neck and chest anatomy as part of their examination.

The prenatal detection of an intrathoracic cyst during the first trimester of pregnancy is an exceedingly rare condition. In this report, we describe a case of first-trimester intrathoracic cyst causing cardiac dextroposition, which resolved by 24 weeks' gestation. A 5-mm intrathoracic cyst causing cardiac dextroposition was detected during the routine sonographic scan performed at 12 weeks + 2 days. The cyst remained stable in size until 20 weeks and was no longer identified during focused fetal echocardiography at 24 weeks. Our case demonstrates that a first-trimester intrathoracic cyst can have a benign course, either by remaining stable in size or even undergoing complete resolution during the second trimester. A focused sonographic examination should therefore be undertaken as follow-up to determine the final prognosis of these lesions. The etiology of intrathoracic cysts detected in the first trimester is unclear and could represent a resolving pericardial cyst.

The aim of the study was to evaluate the diagnostic potential of placental shear wave elastography in predicting preeclampsia at 16 to 20 weeks of gestation. A total of 230 pregnant women between 16 and 20 weeks of gestation were observed for the study. These women underwent shear wave elastography ElastPQ (Philips Healthcare, Bothell, Washington, USA) of the placenta. The mean value of placental shear modulus was obtained for each participant. These participants were followed up for the development of preeclampsia and were divided into two groups; group A included those who developed preeclampsia and group B included those who remained normotensive until delivery. The elasticity values of the two groups were compared, and the ROC curve was drawn to obtain the best cut-off value that would predict the onset of preeclampsia. Placental shear modulus varied from 1.03 kPa to 7.4 kPa at 16 to 20 weeks of gestation with an average of 2.74 ± 0.87 kPa. There was a statistically significant difference in the mean value of elasticity between two groups, being 4.61 kPa in group A and 2.51 kPa in group B. Maximum diagnostic accuracy was obtained at 2.9667 kPa with area under the curve 0.970, sensitivity 92%, specificity 91.71%, positive predictive value 57.5% and negative predictive value 98.9%. Stiffness of placenta, quantitatively measured by SWE at 16 to 20 weeks of gestation, is higher in the women who develop preeclampsia and hence may be used for predicting preeclampsia.

The study objectives were to develop standard charts for fetal renal artery blood flow to define normal ranges and to assess the reliability of the measurements. This prospective, longitudinal study reviewed 72 low-risk singleton pregnancies who had serial ultrasound examinations. Pulse wave Doppler was used to obtain the resistivity and pulsatility indices of the fetal renal arteries. Standard charts of the fetal renal arteries were created using mixed effects modelling and the intra- and interobserver reliability for the renal blood flow measurements was analysed. Standard charts of the normal ranges of the renal artery resistive index (RI) and pulsatility index (PI) of the fetal renal arteries were created. The 3rd, 5th, 10th, 50th, 90th, 95th and 97th centiles were calculated. The intraclass correlation coefficient was acceptable for intraobserver reliability (RI = 0.66, PI = 0.88) and poor for interobserver reliability (RI = 0.11, PI = -0.56). These novel charts demonstrate the change of the fetal renal artery blood flow during pregnancy. These may be used in clinical practice to detect variations from these normal ranges and be useful in future studies of kidney function projection.

A chorionic bump is an increasingly recognized ultrasound finding in first-trimester scans, which has been associated with early pregnancy loss. In ongoing second-trimester pregnancies, however, chorionic bumps usually resolve over time with no deleterious effect on the fetus. In this report, we describe the incidental ultrasound detection of a chorionic bump in early pregnancy and its progression to a subamniotic hematoma in the second trimester of pregnancy that persisted as such until delivery. A round, echogenic mass protruding from the choriodecidual surface measuring 13 × 11 × 8 mm was first identified during a transvaginal scan at 6.3 weeks' gestation. Subsequent follow-up scan at 8.3 weeks revealed an increase in the size of the chorionic bump to 25 × 20 × 19 mm, which remained stable as determined by the routine late first-trimester scan. At the second-trimester scan, a subamniotic hematoma was identified in the surface of the placenta, close to the insertion of the umbilical cord. Subsequently, the pregnancy proceeded uneventfully. The etiopathology and clinical significance of a chorionic bump remain unclear. The case herein reported demonstrates that a chorionic bump can grow considerably without having a deleterious effect on the early embryo and, occasionally, can persist throughout pregnancy as a subamniotic hematoma. A chorionic bump can occasionally progress to a subamniotic hematoma from the second trimester onwards. This observation further supports the hypothesis that a chorionic bump is the result of choriodecidual bleeding. An alternative explanation for the development of subamniotic hematomas is proposed.

IntroductionThis systematic review investigates which image appearances are most common when diagnosing lower limb stress fractures using ultrasound imaging, with the aim of outlining an image critique guideline for operators to support confident diagnoses.MethodA comprehensive literature search of medical databases and handsearching was undertaken to identify relevant studies. All studies were critically examined for quality using the CASP critical appraisal tool. Results from eight studies were combined and interpreted using a narrative synthesis.FindingsA clear outline of common stress fracture appearances using ultrasound were identified in a combined total of 119 participants. Each finding was ranked according to its popularity. Periosteal thickening (78/119) and cortical disruption/irregularity (83/119) were noted in all eight studies. Hypervascularity of the periosteum visualised by colour Doppler imaging (66/119) was reported in six of the eight studies. Soft tissue hypervascularity (13/119), bony callus formation (5/119) and cortical break (22/119) were seen in three studies.ConclusionsBased on the findings, we offer a guideline of the most significant preliminary image findings to be utilised by operators when examining athletes suspected of having lower limb stress fractures. The results show a gap in research for evaluating changes in appearance depending on the injury severity. Further research into distinguishing stress fractures from pathological involvement may in future reduce reliance on plain film radiography.

Ultrasound is the modality of choice in the evaluation of neonates and young children with suspected adrenal lesions including adrenal haemorrhage and congenital adrenal hyperplasia. It is also the initial imaging modality in children presenting with an upper abdominal mass, which may be adrenal in origin. Topic discussion: This paper shows adrenal anatomy and demonstrates how the sonographic features change with age. It reviews the imaging features of congenital adrenal lesions, as well as benign and malignant conditions affecting the adrenal gland in childhood. Discussion and Conclusion: Ultrasound is a useful primary imaging modality in the assessment of the adrenal gland in children. Knowledge of the changes of the adrenal gland with age is important when assessing the adrenal gland. Ultrasound is also useful for assessing abdominal masses. However, it cannot differentiate adrenal masses, therefore correlation with biochemical findings, multimodality imaging, and histology is usually required.

The use of ultrasound is becoming more widespread in anaesthesia. In this review, we discuss the use of ultrasound in various aspects of paediatric anaesthesia and how it can be used to assist diagnostic and therapeutic interventions and the evidence available. We explore the use of ultrasound as an adjunct for regional anaesthesia, vascular access, airway management, bedside cardiac, pulmonary and abdominal imaging and intracranial pressure monitoring.