Although we tend to suspect torsion only in cases where there is ovarian enlargement, cyst, etc., there are a number of studies that show these are not reliable (sensitive or specific) indicators of torsion. Radiology reports often seem to hedge and note that ovarian torsion is a clinical diagnosis because the test characteristics of ultrasound are not that great even when you include flow, adnexal size, free fluid, and other factors in combination.
Children (<15 years old) are at greater risk of torsing normal ovaries (up to 50% of torsion cases), but even in women of childbearing age 8-19% of cases are associated with normal ovaries. Doppler flow has demonstrated great sensitivity and specificity for torsion by some authors but was much less valuable in this retrospective study.
In this recent study, abnormal ovarian location, abnormal flow and free fluid were the best predictors of torsion; ovarian mass or cyst actually didn’t help rule in or out the diagnosis.
Bottom line: normal ovaries do not rule out torsion. Doppler flow may not be sensitive or specific enough either. So use (dare we say it?) clinical judgement.
The Mount Sinai Department of Emergency Medicine hosted its annual ultrasound CME conference held on March 22 at the Stern Auditorium.
Faculty, fellows and PAs from a number of institutions took part in our eighth annual conference.
The course was directed by Bret Nelson, MD and topics included ultrasound physics (Leila PoSaw, MD, MPH) and assessment of airway and breathing (Jim Tsung, MD, MPH), circulation (Daniel Singer, MD), disability/trauma (Phil Andrus, MD) and procedure guidance (Danny Duque, MD).
Great lectures by Sinai’s Emergency Ultrasound faculty were followed by an intensive hands-on scanning session.
The AIUM recently announced a initiative to increase awareness of ultrasound as the first imaging modality to be considered when radiation exposure and cost are factors. If you are a fan of the Image Gently campaign from the Alliance for Radiation Safety in Pediatric Imaging, you’ll like this ultrasound-centric vision even more. More information below, including the AIUM’s press release.
April 1, 2012:
Researchers presented exciting new data on the use of extremely low-frequency ultrasound for the bedside diagnosis of a wide range of pathology.
“We’re very excited by the technique,” remarked Bret Nelson as he described a method he has used for many years. With conventional ultrasound, sound waves above the range of human hearing transmitted from a transducer into the patient. These waves are then reflected back to the transducer, creating an image on the ultrasound screen.
“By using sound waves within the range of human hearing, we have been able to create an image directly into the mind of the operator. This obviates the need for special equipment, and does not require the use of gel.” Dr. Nelson demonstrated the technique:
“So what brings you here today?” At this point, sound waves were transmitted from Dr. Nelson into the patient.
“I’m having an allergic reaction.” New sound waves were then transferred from the patient to Dr. Nelson.
“Why do you say that?” The cycle repeats with a new pulse.
“I’m allergic to shrimp, and I ate some shrimp, and now I have a rash.”
“I agree. You seem to be having an allergic reaction.” Diagnosis confirmed! Now treatment can begin.
The research team warned that this technique is quite operator dependent, and can often involve multiple cycles before the diagnosis is confirmed. But they hope that someday this technique can augment information gained from traditional ultrasound, CT scan, and MRI.
This year AIUM is hosting its annual conference at the JW Marriott Desert Ridge Resort and Spa in Phoenix, AZ. The first offering by the Emergency and Critical Care Community of Practice was a great success. The conference proper hasn’t even started yet and the sessions have already started off with a bang.
Moderator Bret Nelson organized the session which was attended by Emergency Physicians, Intensivists, Sonographers, Perinatologists, and Primary Care physicians:
Point-of-care ultrasound in the evaluation and treatment of the unstable patient
- Bret Nelson
- Introduction- Ultrasound for airway, breathing and circulation
- Srikar Adhikari
- Ultrasound assessment of airway anatomy and intubation
- Eitan Dickman
- Thoracic ultrasound: Beyond pneumothorax
- Anthony Dean
- Basic cardiac assessments
- Chris Moore
- Advanced cardiac assessments
- Robert Arntfield
- Transesophageal echo- practical utility in the critical patient
- Rajesh Geria
- Vascular assessment- IVC (volume assessment), aorta (AAA, dissection)
- Betty Chang
- Ultrasound guidance for bedside procedures
- Jerry Chiricolo
- Putting it all together- ultrasound use in Resuscitation
- All Faculty
- Panel Discussion and wrap up
Many of our lectures reference the same pantheon of literature on ultrasound in the acutely hypotensive patient. For ease of reference here they are, with appropriate links to the original publications:
- UHP protocol
- Trinity Protocol
- RCT of ultrasound in hypotension
- FATE:Focused Assessed Transthoracic Echocardiography
- FEER:Focused Echocardiographic Evaluation in Resuscitation
- CAUSE:Cardiac Arrest Ultrasound Exam
- RUSH: Rapid Ultrasound in Shock and Hypotension
- ACES:Abdominal and Cardiac Evaluation with Sonography in Shock
- RUSH: Rapid Ultrasound in Shock
Congratulations to Sinai’s own Dr. Jim Tsung, who recently coauthored a major evidence-based consensus guideline on point-of-care lung ultrasound. The manuscript is the result of a multi-national effort by pioneering clinician-sonographers, and was just published in the journal Intensive Care Medicine:
International evidence-based recommendations for point-of-care lung ultrasound.
Volpicelli G, Elbarbary M, Blaivas M, Lichtenstein DA, Mathis G, Kirkpatrick AW, Melniker L, Gargani L, Noble VE, Via G, Dean A, Tsung JW, Soldati G, Copetti R, Bouhemad B, Reissig A, Agricola E, Rouby JJ, Arbelot C, Liteplo A, Sargsyan A, Silva F, Hoppmann R, Breitkreutz R, Seibel A, Neri L, Storti E, Petrovic T; International Liaison Committee on Lung Ultrasound (ILC-LUS) for the International Consensus Conference on Lung Ultrasound (ICC-LUS).
Intensive Care Med. 2012 Mar 6. [Epub ahead of print]
- PMID: 22392031