Hot Tips – Gallbladder “Rolling Stones” Sign on Ultrasound

One of the most common pitfalls in gallbladder sonography is confusing the proximal duodenum for an abnormal gallbladder.  Sonographers also struggle to demonstrate gallstones when they are located in close proximity to the GB neck. Theresa Jorgensen, RDMS, RDCS, RVT will discuss the  “rolling stones” sign to help demonstrate non-obstructed true-luminal gallstones to accurately distinguish between the gallbladder and GI tract.

For more educational information like this, check out our upcoming abdominal hands-on ultrasound seminars at Gulfcoast Ultrasound Institute.

TIPS benefits most cirrhotic patients with portal vein thrombosis

TIPS benefits most cirrhotic patients with portal vein thrombosis

SAN DIEGO — Most patients with cirrhosis and portal vein thrombosis experienced either complete recanalization or marked improvement after placement of a transjugular portosystemic shunt in a study presented at the American College of Gastroenterology Annual Scientific Meeting.

In a single-center, retrospective cohort study, researchers evaluated 50 adult patients with cirrhosis who underwent transjugular portosystemic shunt (TIPS) between 2000 and 2010, with follow-up of 18 ± 6 months after the procedure. The cohort had a mean age of 55.3 ± 11 years at the time of TIPS. All participants had portal vein thrombosis (PVT) prior to receiving TIPS, and received serial Doppler vascular ultrasound every 3 months until death or liver transplantation. The most frequent indications for TIPS were refractory ascites (45% of cases) and variceal bleed (41%).

Upon undergoing TIPS, 68% of participants experienced complete portal vein recanalization, 20% indicated marked improvement (more than 50% patency in a previously thrombosed portal vein), and 12% experienced no improvement. Factors associated with complete recanalization included a short interval between the initial appearance of thrombosis and TIPS placement (HR=2.63, 1.17-7.5), less severe PVT (HR=3.13, 1.9-8.9) and the absence of ascites (HR=2.28, 1.5-10.2). Persistent PVT following the procedure was linked with esophageal variceal bleeding prior to TIPS (HR=1.9, 1.4-8.5) and the presence of alcoholic liver disease (HR=1.3, 1.1-6.2) (95% CI for all).

“This study has brought up new ideas in the field of PVT treatment,” researcher Modaresi Esfeh, MD, Cleveland Clinic, told “There are a lot of discrepancies in regard to PVT treatment. Unfortunately, there is no established management algorithm for PVT in cirrhotic patients. We showed that TIPS might be an answer to this unclear clinical entity.” Esfeh added that the investigators plan to continue to follow the study population in order to determine whether complete PVT resolution can improve survival or reduce the time to liver transplantation.

Disclosure: The researchers report no relevant financial disclosures.

For more information:

Esfeh JM. #44: Effects of the Transjugular Intrahepatic Portosystemic Shunt on Portal Vein Thrombosis in Patients with Liver Cirrhosis. Presented at: The American College of Gastroenterology Annual Scientific Meeting; Oct. 11-16, San Diego.


Maternal cardiac function may predict outcomes in preeclampsia

Maternal cardiac function may predict outcomes in preeclampsia

By: BIANCA NOGRADY, Family Practice News Digital Network


SYDNEY, AUSTRALIA – Women at high risk of early preeclampsia who show signs of abnormal hemodynamic function earlier in pregnancy may be more likely to have adverse pregnancy outcomes, new data suggest.

A prospective cohort study in 36 women at high risk for early preeclampsia (at less than 34 weeks’ gestation) showed that those who experienced adverse outcomes had significantly higher total peripheral resistance at 14 weeks (1,710 vs. 1,307 dyne/sec/cm–5, P = .02), 24 weeks (1,564 vs. 1,305 dyne/sec/cm–5, P less than .001), and 30 weeks (1,603 vs. 1,323 dyne/sec/cm–5, P = .002) of gestation, compared with high-risk women who had normal outcomes.

Ms. Kate Russo
Ms. Kate Russo

According to data presented at the International Society of Ultrasound in Obstetrics and Gynecology world congress, cardiac output also was significantly lower at 14 weeks (4.41 vs. 5.18 L/min, P = .04) and 30 weeks (4.79 vs. 5.36 L/min, P = .04) of gestation in women who experienced adverse outcomes.

The results suggest that women at high risk for early preeclampsia and a subsequent adverse pregnancy outcome show signs of abnormal cardiac function as early as 14 weeks’ gestation, the researchers said.

Researcher Kate Russo said the results could help to differentiate between those who are likely to have a normal outcome and those who may develop an adverse outcome, in women who have already been identified as high risk through preeclampsia screening.

“We want to reduce the 10% false-positive rate of this screening, which has a 90% detection rate for early-onset preeclampsia,” said Ms. Russo, a sonographer and Ph.D. candidate in the fetal medicine unit at the Royal Prince Alfred Hospital in Sydney.

“Performing a maternal echocardiogram in high-risk women is an easy, well-tolerated examination that can be utilized for the assessment of the women’s hemodynamic profile,” she said.

The adverse outcomes, observed in 15 (42%) of the women enrolled in the study, included preeclampsia (11%), gestational hypertension (14%), low birth weight (14%), and preterm birth (3%).

Being able to identify women who were at greater risk of adverse pregnancy outcomes might help reduce the anxiety of some women deemed at high risk of early preeclampsia, as well as guide treatment, Ms. Russo said in an interview.

“You know who to look at, and potentially, if women develop hypertension, you can target their antihypertensive medication depending on their hemodynamic profile,” she said.

The study is continuing to recruit participants, with the aim of comparing the hemodynamic profiles of women with early-onset preeclampsia, late-onset preeclampsia, and small-for-gestational-age babies.

No conflicts of interest were declared.