American Institute of Ultrasound in Medicine <strong>Proceedings</strong> J Ultrasound Med 32(suppl):S1–S134, 20131537060 Comparative Analysis of Sonographic and Doppler Signsand Perinatal Outcomes in Patients With Twin-Twin TransfusionVariants and Selective Intrauterine Growth Restrictionof One of the Monozygote TwinsInessa Safonova, 1 * Irina Lukjanova, 2 Rizvan Abdullaev 11HMAPO, Kharkiv, Ukraine; 2 Pediatrics, Obstetrics, andGynecology Institute, Kiev, UkraineObjectives—Some complications of monochorionic (MH) multiplepregnancy, twin-twin transfusion syndrome (TTTS), twin anemiapolycythemiasequence (TAPS), acute intertwin transfusion, and selectiveintrauterine growth restriction (sIGR) of one of the twins, have differentperinatal prognoses and require differential tactics. Our objective was tocompare their sonographic and Doppler signs, sequences, and the perinatalresults.Methods—Nine cases of complicated diamniotic MH pregnancywere studied: with chronic progressive unimproved TTTS (4),TAPS (1), acute intertwin transfusion (2), and sIGR (2). Fetometry andfetal weight calculation were carried out. The amniotic fluid amount andDoppler of the umbilical artery, ductus venosus, and middle cerebral arterywere estimated.Results—The sequence of ultrasound signs and the perinatalresults in all cases have been described and compared. In 7 of 9 describedcases, the common sonographic feature turned out to be a discorded twin’sgrowth. In 8 of 9 cases, a volume asymmetry of the twin’s amniotic fluidwas observed. The worst perinatal outcomes and the most substantialweight differences were in women with natural flow of the TTTS, and all4 cases were accompanied by fetal bladder asymmetry and donor cardiomegaly.At birth, hematologic distinctions of the twins were the mostconsiderable with TAPS.Conclusions—Dynamic sonographic monitoring of an MHpregnancy should take into account several aspects, such as fetometric,amniometric, and Doppler as well as twin bladder symmetry and fetal cardiothoracicratio control.1537067 Transvaginal Sonographic Differential Diagnosis of theCauses of Postpartum Uterus Involution Slowdown:Clinical Experience of a Specialized Hospital DepartmentInessa Safonova, 1,2 * Yuri Paraschuk, 2,3 Roman Safonov 2,31HMAPO, Kharkiv, Ukraine; 2 Kharkiv Regional PerinatalCenter, Kharkiv, Ukraine; 3 Kharkov National Medical University,Kharkiv, UkraineObjectives—to compare the sonographic, clinical, and histopathologicresearch results in patients with slowing down of involution ofthe postpartum uterus.Methods—Transvaginal sonographic (TVS) examinationswere undertaken in 140 postpartum women receiving care in a specializedhospital department for treatment of postpartum complications. In 38of them, the uterine histopathology was studied.Results—The opportunities of TVS in the differential diagnosisof retained lochia, endometrial inflammation, and retained placentalfragments in the postpartum uterine cavity were defined. Some specificsonographic criteria of metritis after vaginal and operational births, as wellas retained unseparated placental fragments in the postpartum uterine cavitywere exposed.Conclusions—The diagnostic accuracy of most ultrasound criteriafor postpartum complications was not great. At the same time, TVShelped identify and differentiate the causes of uterine involution slowdownin some forms of endometritis and in women with unseparated placentalfragments in the uterine cavity.1537241 Unusual Anechoic Portal Vein Thrombosis and its Significancefor Predicting the Response to Anticoagulant TherapyShoichi Matsutani, 1,2 * Hideaki Muzumoto, 2 AkitoshiKobayshi, 2 Atsuyoshi Seki, 2 Takeshi Ando 2 1 Chiba PrefecturalUniversity of Health Science, Chiba, Japan; 2 Gastroenterology,Funabashi Municipal Medical Center, Funabashi,JapanObjectives—Acute portal vein thrombosis is still a challengingproblem in daily clinical practice. Ultrasonography usually contributes toan early diagnosis of portal vein thrombosis, which thus leads to appropriatetreatment. However, the response to anticoagulant therapy is somewhatunpredictable, and these situations trouble clinicians in themanagement of the disease. This report describes the unusual ultrasonographicappearance of acute portal vein thrombosis, which can predict apoor response to anticoagulant therapy.Methods—Sonographic changes in acute portal vein thrombiwere examined in 4 patients treated with anticoagulant therapy (heparinand vitamin K antagonist). The background diseases were acute colitis in2 patients, acute cholecystitis in 1 patient, and acute cholangitis in 1 patient.The thrombus was located in the right portal vein in 2 patients andin both the right and left portal veins in 2 patients. A Toshiba SSA 770Asystem with a 3.75-MHz convex probe was used for ultrasonography.Results—Two of the thrombi in the right portal vein (group A)completely recanalized with the disappearance of the thrombus in responseto anticoagulant therapy. However, 4 thrombi (group B) remained unrecanalizedwithout a response to the treatment. The group A thrombishowed echogenic material in the portal vein, which is a common sonographicappearance of thrombosis at the initiation of anticoagulant treatment.However, the group B thrombi were anechoic without any bloodflow signals at the initiation of the treatment, which was quite differentthan the sonographic appearance of group A. The thrombus in 2 patientsin group B, which had a 1-week interval before anticoagulation, showedechogenic material, which was similar to that seen in group A at the initialdiagnosis. However, these 2 thrombi became anechoic 1 week laterafter the initiation of the treatment. All portal veins with an anechoicthrombus became occluded and changed to a hyperechoic band.Conclusions—An unusual anechoic appearance of portal veinthrombosis may therefore indicate a poor response to anticoagulant therapy,although the mechanism of this kind of ultrasonographic appearanceof blood clots is undetermined.1537456 Sonographic Appearance of Cutaneous Basal Cell Carcinomasof the Head and NeckXimena Wortsman, 1 * Nelson Lobos 2 1 Radiology, Dermatology,Clinica Servet, Faculty of Medicine, 2 Health Sciences, Universityof Chile, Santiago, ChileObjectives—To assess the sonographic morphology of cutaneousbasal cell carcinomas of the head and neck.Methods—A retrospective review of cutaneous basal cell carcinomasof the head and neck sonographically diagnosed and confirmedby histology was performed (September 2009–July 2012). Postoperativecases and medically treated lesions were excluded from the analysis. Informationabout extension, location, blood flow, and deeper-layer involvementwas analyzed.Results—Forty-one lesions in 36 patients (55.6% female [n =20], 44.4% male [n = 16]; mean age, 65 years [range, 38–92 years]).Number of lesions per patient: 1, 86.1% (n = 31); 2, 8.3% (n = 3); 3, 2.8%(n = 1); ≥4, 2.8% (n = 1). One hundred percent of cases were hypoechoic.Location: 52% nose, 15% lower eyelid, 8% inner canthus, 5% scalp, 5%supraciliary, 2.5% nasal fold line, 2.5% infraorbitary, 2.5% frontal region,2.5% ear pinna, 2.5% other facial locations, 2.5% neck. Mean sizes: 7.79mm transverse (range, 0.3–21.9 mm), 2.73 mm depth (range, 0.1–13 mm),7.91 mm longitudinal (range, 0.5–31.1 mm). Mean area: 184.92 mm 2S95
American Institute of Ultrasound in Medicine <strong>Proceedings</strong> J Ultrasound Med 32(suppl):S1–S134, 2013(range, 0.01–2149 mm 2 ). Location of blood flow: 86.9% intralesional,7.9% peripheral, 2.6% sublesional, 2.6% mixed,. Type of vessels: 74.3%arterial, 5.2% venous, 20.5% mixed arterial and venous. Mean thicknessof vessels: 0.94 mm (range, 0.5–1.8 mm). Mean peak systolic velocity ofthe arterial vessels: 10 cm/s (range, 3.7–31 cm/s). One hundred percent ofarteries showed peak systolic velocity
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