Volume 8 Issue 3 - Australasian Society for Ultrasound in Medicine

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Justin O’learyFigure 3 Figure 4confirmed moderate left ventricular impairment and mild tomoderate mitral regurgitation.The subcostal four-chamber view showed no evidenceof pericardial effusion or an interatrial septal defect, a normalsized IVC with normal respiratory collapse (RAP =5–1O mmHg).Figure 4dilatation, and mitral regurgitation confirmed by continuoswave Doppler as mild to moderate.Pulsed wave Doppler in the right upper pulmonary veindemonstrated a normal pulmonary vein signal with no evidenceof systolic blunting or flow reversal.Colour Doppler of the tricuspid valve showed trivialtricuspid regurgitation with a pressure gradient of 40mmHg,indicating mildly increased pulmonary pressures.Rotating the transducer to a two-chamber view againDiscussionThe echocardiogram revealed a mildly dilated left ventriclewith moderately impaired contraction in keepingwith global dysfunction. The ejection fraction obtainedfrom the Simpsons method was approximately 37%. Asthe impairment was diffuse the ejection fraction measuredfrom M-mode (Teicholtz method) correlated closely withthe Simpson method value. The right ventricle appearednormal in size with normal systolic function. The atria weremildly dilated. The cardiac valves showed mild to moderatemitral regurgitation, mild aortic regurgitation and mild tricuspidregurgitation. The estimated pulmonary pressure wasapproximately 50 mmHg (calculated from a resting atrialpressure of 10 mmHg plus the valve gradient of 40 mmHg). These findings are typical of a cardiomyopathy mostprobably not caused by ischemic heart disease. The patientwas commenced on Digoxin, Aldactone, a beta blocker andLasix. Major surgery for the renal tumour was postponedpending an adequate response to medical management.2005 DDU Part 1pass candidatesPhilip Aplin SAKristine Barnden NSWJacqueline Chua VicPhillipa Cuttance NZCyrus Edibam WAMartha Finn NTBrendan Flaim VicAlexandra Ivancevic NZSubodh Joshi VicVasundhara Kaushik NSWPatricia Lai NSWChristopher Lewis VicDMU and DDU ExaminationsJustin Mariani VicKristy Milward NSWKaren Mizia NSWCarl Muthu NZWendell Neilson NSWMark Page VicEmma Parry NZDeirdre Percy NSWChristine Russell SANasser Shehata NZMedha Sule UKGreg Sweetman WAJoseph Thomas SAKa-Kit Wong NSW2005 DDU Part 2pass candidatesThushari Alahakoon NSWNagesh Anavekar VicNatalia Andreianova NZNeil Athayde NSWTerry Chang NSWMarilyn Fooks VicAdrian Goudie WALisa Hui NSWAllan Kruger QldFrancis Ponnuthurai VicJillian Spilsbury NSWAmarendra Trivedi VicDavid Walters SAApril 30 2005 DMU DiplomaGeneralMr Christopher PowersMr Vishwant SandeepObstetricMiss Wendy GellelVascularMs Carol Duncan32 ASUM Ultrasound Bulletin 2005 August; 8 (3)
POLICIES and STATEMENTSGuidelines for the Performance ofFirst Trimester UltrasoundMay 1995, Revised October 1999, Revised October 2002, Revised July 2005Introduction and equipmentStudies should be performed using anabdominal and/or vaginal approach.A high frequency transducer shouldbe used and the equipment should beoperated with the lowest ultrasonicexposure settings capable of providingthe necessary diagnostic information.A vaginal transducer should alwaysbe available and a transvaginal scanshould be offered to the patient whenit is anticipated that this would resultin a more diagnostic study. The patientmay choose to accept or refuse this offerand undue persuasion is inappropriate.Reference should be made to theGuidelines for the Performance of aGynaecological Scan regarding thefacilities and preparation for such anexamination.ASUM policy on disinfectionof vaginal transducers should befollowed.HistoryEstimate gestation based on last menstrualperiod or time of conception.Document symptoms and, if possible,the result and date of any pregnancytest – Human Chorionic Gonado-trophin(HCG).Gestation sacThe gestation sac should usually bevisible from four and one half (4.5) tofive (5) weeks using high frequencytransvaginal ultrasound.When a gestation sac-like structureis seen but no live fetus demonstrated,it is important to attempt to ensurethat it is not a 'pseudo gestational sac'.Look for the echogenic trophoblastrim and the yolk sac, and ensure thatthe fluid in the gestation sac is echofree.If a gestation sac is not visiblein the uterus of a patient believed tobe pregnant, the adnexa should becarefully examined looking for evidencesuggesting the presence of anectopic pregnancy – most ectopicscan be suspected with high frequencytransvaginal ultrasound.In a patient with a positive pregnanttest but either:■ no gestational sac is seen withinthe uterus or elsewhere in the pelvis■ an apparent sac is seen but no fetalstructures (including yolk sac) orheart movements are visibleconsider the following:■ pregnancy not as advanced asthought (e.g. delayed ovulationand conception in that cycle)■ ectopic pregnancy■ failed pregnancy including completemiscarriageInterpretation of the scan may bemore accurate if the result of the quantitativeHCG levels is known.There is more than one acceptedlaboratory standard for reporting HCGlevels. The units for the local serviceshould be taken into account whencorrelating sac development and HCGlevel. In general when the level is >2000 IU/1 a gestation sac should beseen in the uterus on transvaginalscanning. If no sac is visible an ectopicmust be considered.If the level is < 1000 IU/1 thenfurther follow up by serial HCG isappropriate and/or a repeat scan if thediagnosis is uncertain.Gestational ageThis is most accurately assessed in thefirst trimester. The earlier the crownrump length (CRL) is measured, themore accurate is the assessment of gestationalage. The CRL can be measuredfrom six weeks gestation. The compositeCRL chart in the ASUM Policiesand Statements Folder is recommended.From eleven (11) weeks multiparameterassessment can be used. Biparietal diameter(BPD) is the most often used secondmeasurement.Fetal heart movementsWith a high resolution vaginal transducer,fetal heart movements are oftenvisible from five (5) to six (6) weeks(i.e. CRL = 2 mm), but may not beseen until CRL = 3–4 mm (See paragraphon pregnancy failure).Fetal numberThe diagnosis of a multiple pregnancyrequires the visualisation of multiplesacs prior to six (6) weeks and subsequentlyvisualisation of multipleembryos.The first trimester is the optimumtime to determine chorionicity of thefetuses. The chorionicity of the fetusesshould be stated in the report.The presence of separate sacs and thethickness of the intervening membraneand the shape of its junction with theplacenta should be assessed. Be awarethat early in the first trimester anintervening amnion may not be visiblein diamniotic, monochorionic twins.Later in the first trimester the numberof placentas can be evaluated.Pregnancy failureAn experienced operator using highquality transvaginal equipment maydiagnose pregnancy failure undereither or both of the following circumstances:1 When no live fetus is visible ina gestation sac and the mean sacdiameter is 2.0 cm or greater.2 When there is a visible fetus witha CRL of 6 mm or more but nofetal heart movements can be demonstrated.The area of the fetalheart should be observed for aprolonged period of at least thirty(30) seconds to ensure that there isno cardiac activity.In situations where pregnancy failureis suspected by an operator whoeither does not have extensive experiencein making the diagnosis or doesnot have access to high quality equipmentor if there is any doubt about theviability of the fetus, a second opinionor a review scan in one week should berecommended in the report 1 .ASUM Ultrasound Bulletin 2005 August; 8 (3)33
Page 1 and 2: ISSN 1441-6891Volume 8 Number 3 Aug
Page 3 and 4: PresidentDr David RogersImmediate P
Page 5 and 6: ientific Meeting of ASUMe r 2005 Ad
Page 7 and 8: ASM 2005 PROFFERED PAPERSFriday 30t
Page 9 and 10: THE EXECUTIVEPresident’s messageD
Page 11 and 12: THE EXECUTIVEAdelaide ASMLooking ah
Page 13 and 14: The DMU (Asia) will deliver high te
Page 15 and 16: THE EXECUTIVEMember ServicesSonogra
Page 17 and 18: ASUM Ultrasound Bulletin 2005 Augus
Page 19 and 20: D Fauchon, S Watson and R Benzieor
Page 21 and 22: ASUM Ultrasound Bulletin 2005 Augus
Page 23: Fetal upper abdominal masses; a pre
Page 26 and 27: RP Davies, T McClymont and D Boshel
Page 28 and 29: RP Davies, T McClymont and D Boshel
Page 30 and 31: CASE REPORTASUM Ultrasound Bulletin
Page 32 and 33: HS Wong, K Burns, L Strand and S Pa
Page 36 and 37: POLICIES and STATEMENTSFetal struct
Page 38 and 39: SOCIAL SCREENINGDraft of a letter s
Page 40 and 41: SOCIAL SCREENINGSonographerMelbourn
Page 42 and 43: THE SOCIETYSUMCertified ISO 9001:20
Page 44 and 45: THE SOCIETYDiploma of Medical Ultra
Page 46 and 47: EDUCATIONExamination dates for 2005
Page 48 and 49: THE SOCIETYThe 2004 Beresford Butte
Page 50 and 51: OBITUARYJames Robert Syme MD, FRACP
Page 52 and 53: THE SOCIETYCorporate Members 2005Au
Page 54 and 55: CALENDARContact Byung Ihn Choi MDCo
Page 56: ASUM ULTRASOUND BULLETIN VOLUME 8 N

Volume 8 Issue 3 - Australasian Society for Ultrasound in Medicine

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