Journal of Clinical Ultrasound

In order to determine normal echocardiographic values for older subjects, we studied 136 adults (78 men and 58 women, 20 to 97 years of age) without evidence of cardiovascular disease. When patients were subdivided into six age groups, progressive changes were found in mean normal values for various parameters. Specifically, when the oldest group (over 70 years) was compared with the youngest group (21–30 years), significant (p < 0.01) increases in aortic root (22 percent) and left atrial (16 percent) dimensions, in ventricular septal (20 percent) and left ventricular free‐wall (18 percent) thicknesses, and in estimated left ventricular mass (15 percent) were noted. In addition, a significant (p < 0.01) decrease in mean mitral E‐F slope (43 percent) and slight decreases in mean left ventricular systolic and diastolic internal dimensions (5 and 6 percent, respectively; p < 0.05) were noted. Left ventricular ejection fraction and percentage fractional shortening were found to be independent of age. These data have been used to derive regression equations that are related to both age and body surface area. The regression equations can be used to calculate mean normal values and 95 percent prediction intervals for echocardiographic measurements in adults.

Conventional signal processing and display of information obtained by ultrasonic scanning results in the loss of low level information which may be diagnostically valuable by demonstrating the internal structure of organs. The use of grey scale echography preserves this information, allowing visualization of the normal tissue patterns and the minimal deviations from these which can indicate early pathology. This technique supplements radioisotope scanning since it has greater resolution. The method may be particularly valuable in evaluating the effect of therapy on liver metastases.

The widespread use of modern diagnostic imaging techniques, especially computed tomography and sonography, has led to the detection of an increasing number of serendipitous renal neoplasms, with no signs nor symptoms related to the neoplastic renal disease. In the last 4 years, 54 consecutive patients (20 females and 34 males) with renal cell carcinoma were reviewed. In 26 patients (48.15 per cent) the diagnosis was made as an incidental finding by an abdominal ultrasound examination. Clear signs and symptoms related to the neoplastic disease were present in 28 cases (51.85 per cent). The pathologic type of each neoplasm was categorized, and each carcinoma was staged. In the patients not surgically treated, the stage was determined on the basis of the diagnostic imaging reports. The results of this study suggest that the incidentally detected tumors are of a significantly lower stage than the symptomatic tumors (Wilcoxon rank sum test: P < 0.0073 and X² test: P < 0.013). Early detection of renal tumors may improve the prognosis and the overall survival of patients with renal cell carcinoma and allow one to plan radical or partial nephrectomy, since local extension has a considerable impact on the operative strategy. Our experience emphasizes the role of ultrasound in the increased early detection of renal cell carcinoma.

In the course of doing routine echocardiograms on patients with mitral prosthetic valves, we observed peculiar intracavitary echoes within the left ventricle. Of the 36 valves studied in 31 different patients, 14 echocardiograms demonstrated the abnormal intracavitary echoes and 22 did not. The presence of mitral insufficiency, atrial fibrillation, systemic emboli and warfarin sodium (Coumadin) therapy were roughly equal in the two groups. A higher percentage of abnormal intracavitary echoes occurred in patients with a hemoglobin less than 11 gm/100 ml, other prosthetic valves, cloth covered valves, low platelets, and functional class III–IV. Although this study does not clarify the origin of these abnormal echoes, it is possible that they originate from particulate matter such as tiny fibrin clots or fibers from the cloth covering of the valve.

The benign cystic ovarian teratoma (dermoid) has distinctive ultrasonic features that differentiate it from other adnexal masses. The most frequent sign is the presence of highly reflective irregular solid components within a fluid‐conentaining adnexal mass. In vitro scans of surgical specimens have shown that the strongly reflective echo pattern is caused by the hair and sebum within the dermoid. Calcium is often sparse or absent. Acoustic shadowing from the hair may totally obscure the back wall of a large, clinically evident mass; hence the term “tip of the iceberg” sign. Recognition of this sign reduces the possibility of a false negative interpretation and confusion with a “bowel gas pattern.”

Experience with B scan ultrasound in the study of a series of patients admitted to the Johns Hopkins hospital for suspected occult hematomas has been reviewed. Patients included in this report acquired hematomas primarily as the result of medical or surgical therapy. The ultrasonic appearance in most patients is that of a cyst, due to unclotted or homogeneously clotted blood which generates no internal echoes. As soon as fragmentation of the clot occurs, internal echoes are usually found. B scanning was of value in detection, localization and follow‐up of hematomas and was the only diagnostic test used in seven of eleven cases.

The advantage of this technique for diagnosis and follow‐up are related to the simplicity of the procedure, its lack of sideeffects and low cost.

Gray scale ultrasonography has made it possible to identify hepatic and portal venous structures. Single sector sweep scanning is important in depicting these structures. Identification of venous structures is discussed as well as methods for distinguishing large veins from pathologic structures.