Diagnostic ultrasound in otolaryngology.
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Biomedical subjects
Publications and source records attributed to M Miskin.
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Diagnostic ultrasounds is a simple, rapid, harmless and painless method to visualize intrascrotal contents. It may provide information that is difficult to obtain on clinical examination. Abnormalities such as testicular neoplasms, inflammation and hydroceles are discussed herein.
We evaluated the efficacy of combining B-scan bistable and gray-scale ultrasound with needle aspiration cytology in assessing and managing solitary hypofunctioning solid and cystic nodules. Of the 150 cases surveyed, 90 had surgical follow-up histology for comparison to preoperative aspiration cytology results. Overall neoplasm rate in these 90 cases was 66%, increasing to 93% if colloid nodules were included. Adequate material for cytology preoperatively was obtained in 83 (92%). In cases with adequate preoperative needle aspiration cytology, there were 66 solid and 17 cystic or mixed lesions. Overall accuracy for differentiating benign from malignant nodules for solid lesions was 63 of 66 (95%), compared to 15 of 17 (88%) for predominantly cystic or mixed lesions. Of the 17 cases of proven carcinoma, correct preoperative cytology diagnosis for malignancy was obtained in 12 (71%). Malignancy was most often correctly diagnosed for solid papillary and metastatic cancer lesions. No false-positives were noted and atypical adenomas and Hürthle-cell adenomas have been correctly diagnosed. The simplicity and safety of these diagnostic procedures justify their use for "selective" surgery and particularly for those cases that have been initially assigned to conservative, nonsurgical therapy.
Conventional radiography is now complemented by a large range of newer radiologic diagnostic techniques, involving both roentgenographic and non-roentgenographic modalities. It is the purpose of this presentation to present these new roentgenographic modalities in graphic form, and demonstrate their application to otolaryngic diagnosis. The major roentgenographic modalities which will be stressed are: xeroradiography, angiography, and computerized tomographic scanning.
Newer forms of radiologic diagnostic imaging now include non-roentgenographic modalities such as ultrasound, nuclear medicin, and thermography, all of which can be applied to otolaryngology. It is the purpose of this presentation to demonstrate these modalities, and indicate their clinical application, yet in its earliest stages, to otolaryngology.
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The radioisotope scanning, ultrasonic and angiographic findings in 16 patients with congenital cystic liver disease are described. Radioisotope scans are useful in determining the size, location and number of lesions. Ultrasonography is of value in differentiating solid from fluid-filled lesions, thus narrowing the differential diagnosis. At angiography, cysts produced well-defined avascular areas in the hepatogram in all 14 patients examined, enhanced by a well-defined "rim sign" in seven. This sign is considered pathognomonic of a cystic lesion (hydatid or congenital). Two had a "honeycomb" pattern at angiography, pathognomonic of congenital polycystic liver disease.
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The primary challenge in the management of nodular goitre is to establish which thyroid nodules are malignant. Since selection of patients for operation on the basis of palpation of nodules alone gives a low yield of malignant disease, physicians have sought criteria for selection that combine the information obtained from special laboratory procedures with thoughtful clinical appraisal. Such special procedures, which include radioisotope scintiscanning, echography by B-mode ultrasonography, and either large- or fine-needle aspiration and cytologic examination of the aspirate, are considered valuable in a proposed clinical approach to the management of thyroid nodules.
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Four hundred fifty cases of thyroid enlargement were studied by B-mode ultrasonography. Specific ultrasonographic patterns could be established for cyst, solid tumors, multinodular goiter, cystadenoma, and thyroiditis. Benign and malignant tissue could not be differentiated. In 155 cases, tissue diagnosis was established usually by operation but also by aspiration cytology. One hundred forty-two were hypofunctioning solitary nodules. The reliability of ultrasonographic diagnosis was 94 percent. It permitted safe aspiration of cysts, early operation of solid lesions, and avoidance of radiation hazard in the management of pregnant and pediatric patients. Our operative series showed the following incidences: cancer 16 percent, cyst 20 percent, and neoplasm 62 percent.
Ultrasound has proven to be helpful in the assessment of the thyroid gland and in particular of solitary hypofunctioning thyroid nodules. In 94% of cases differentiation can be made between solid and cystic lesions. This information is of importance to the clinician in deciding on the course of therapy. The ability to accurately measure thyroid gland size, the size of individual nodules, and to follow these with serial measurements during therapy, is also useful. Gray scale ultrasound may provide the additional benefit of differentiating between benign and malignant thyroid tumore. More study of this new technique is necessary before any final conclusions can be drawn as to its accuracy in the diagnosis of thyroid carcinoma.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.