New Technologies help in Rare Ultrasound Case Studies

King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia

Abstract

Budd-Chiari syndrome (BCS) is associated with occlusion of hepatic venous outflow by thrombosis or structural compression at the level of the main hepatic vein or the extrahepatic segment of the inferior vena cava. Initial management of BCS is usually medical (non-operative/noninterventional), with the most common intervention for BCS not responsive to medical management being trans jugular intrahepatic portosystemic shunt (TIPSSS).

Internal Iliac Artery Aneurysm

Internal iliac artery aneurysms are rare and are not commonly imaged with ultrasound because most patients reporting acute symptoms are imaged primarily with computed tomography. In the case reported here, the patient presented first to the ultrasound department from the emergency department. As described in the following, sonography showed findings consistent with an iliac artery aneurysm, which prompted further emergent imaging.

Case presentation

Patient History: 3-year-old patient with bilateral iliac artery aneurysms, Kawasaki disease to check the size of aneurysms. Investigations: The patient was referred to the ultrasound department for an aorto-iliac examination to evaluate for possible recurrence internal iliac arteries. The examination was performed on a ACUSON Sequoia ultrasound system using a 5 MHz curvilinear transducer and 10 MHZ linear Transducer. Sonography showed a normal distal aorta and bilateral internal iliac artery aneurysm with moderate size intraluminal echogenicity in keeping with partially thrombosed bilateral internal iliac artery aneurysm.

Right internal iliac aneurysm measures 4.3*3.6 cm with neck measurement of 0.6cm (Fig. 2A) and the left internal iliac artery aneurysm shows 2.7*3.3 cm with neck measurement of 0.3 cm (Fig. 2B).

Abdominal aorta and internal iliac arteries are patent throughout with normal peak systolic velocity and waveform.

Internal iliac artery aneurysms are uncommon, and they are often found only when they have become large with a high attendant risk for rupture and significant resulting mortality. Early detection of these aneurysms is important for appropriate management. Sonography is the screening modality of choice in asymptomatic patients with multiple risk factors. The relatively high incidence of coexisting iliac artery aneurysms with abdominal aortic aneurysms makes sonographic investigation of the iliac artery system essential in the assessment and treatment of high-risk patients. This case demonstrates the appearance of an internal iliac artery aneurysm in a patient difficult to evaluate on physical examination because of large body habitus with acute rupture.

ACUSON Sequoia Auto flash artifact suppression technologies

The implications of patient and transducer motion in ultrasound, are significant. Up to 40% of abdominal ultrasound scans are repeat scans. Of those, 14% require additional follow-up exams, which may cost up to 8 billion dollars in additional tests. Image quality is a foremost concern, since even modest amounts of motion may be sufficient to reduce clinical confidence, resulting in longer scan times, increased keystrokes reach, and repeat scans. All of which can impact departmental efficiency as well as patient and referring physician satisfaction. Auto Flash Artifact Suppression eliminates the continual need to adjust sensitivity settings by automatically maintaining the best color sensitivity when little motion is detected. As motion increases, the degree of suppression automatically increases proportionally to provide an artifact-free image. Auto Flash Artifact Suppression is a Siemens Healthineers proprietary, technology that detects and prevents artifacts associated with transducer and patient motion and enhances color imaging sensitivity when no motion is detected. It is integrated into the platform architecture of the ACUSON Sequoia system and, as such, can support higher image quality and greater diagnostic certainty without adding additional steps to the clinician’s workflow. Auto Flash Artifact Suppression enables the use of very low filter settings without showing motion artifacts in color Doppler.

InFocus Coherent Image Formation and Auto TEQ

InFocus coherent image formation focuses the image at all depths and exploits high beamformer output capacity, which increases image uniformity compared to prior systems. More information is harvested from the usual transmit sequence, using massive overlapping multi-beam groups rather than individual or close parallel beam lines as in conventional systems. This secondary beamforming enabled with InFocus, physics-based delay, phase, and amplitude corrections can be made across transmit events to significantly sharpen the image and improve spatial resolution beyond what is typical for a given transducer frequency.

Workflow automation with Doppler AutoTEQ reduces user interaction and improves exam consistency.