S6 Ultrasound in Medicine and Biology Volume 35, Number 8S, 2009

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Sonographically Detected Caesarean Section Defects andMenstrual IrregularityValeria Lanzarone, Nepean Hospital Penrith, Sydney, AustraliaTalat Uppal, Northern Beaches Health, Sydney, AustraliaMax Mongelli, Nepean Hospital Penrith, Sydney, Australia

Caesarean section defects may contribute to irregular menstrual bleed-ing. We performed a prospective audit of 300 women referred to ourunit for pelvic scans, aged between 20-45years, during the periodOctober 2007 –May 2008. The women completed a questionnaire todetermine the history of caesarean section and irregular bleeding.During the pelvic ultrasound examination, if a caesarean section scardefect was noted, images of the size were recorded. A review of theindications for the scans, a history of irregular bleeding and any otherrelevant pathology detected on gynae scans was recorded. A total of300 pelvic scans were assessed. 80 women had a history of caesareansections, and 27 of these had a visible uterine defect. 20 had a mea-surable scar defect in the absence of any other uterine pathology.13 ofthese women also reported prolonged periods or intermenstrual bleed-ing. Caesarean section scar defect may be the cause of menstrualabnormalities, particularly intermenstrual or post menstrual spotting.

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Shoulder Ultrasound with MRI CorrelationBill Breidahl, Perth Radiological Clinic, Australia

Objectives: - to understand the complex anatomy of the rotator cuff asit pertains to US and MRI images- to recognize common pathologies of the rotator cuff on US and MRI- to appreciate potential pitfalls of diagnostic shoulder USTendon pathologyTendonopathy results in focal or diffuse tendon thickening and on- USappears as inhomogeneous, predominantly hypoechoic echotexturePartial thickness tears -US appear as 1. Defined hypoechoic or mixed hypoechoic and hypere-choic defects seen in both longitudinal and transverse planes incom-pletely traversing the tendon2. A contour deformity NOT extending as far medial as the head/neckjunction of the humerus.Full thickness tears -US 1. Absent tendon2. Hypoechoic defect or non-fibrillar tissue extending from the articularto bursal surface.3. Contour defect extending medial to the head/tuberosity junction.There are a number of secondary signs of rotator cuff tears. Whilst notspecific, the presence of any of these findings should prompt carefulreview for rotator cuff tear. This includes:1. Contour deformity2. Cartilage Interface Sign3. Cortical Irregularity4. Combined effusions within both the subacromial subdeltoid bursaand the glenohumeral jointPotential pitfalls in the diagnosis of rotator cuff tendon pathologyinclude:A. AnisotropyB. Rotator cuff interval - small hypoechoic area on transverse imagesbetween the supraspinatus and LHB.C. Large rotator cuff tearsD. Subscapularis tendon tears.E. Attritional Rotator Cuff Tears - instead of the rotator cuff tearoccurring in a swollen tendonopathic tendon, the tear occurs as exten-

sive longitudinal tearing of the tendon along its long axis at the deep

surface, resulting is extensive tendon thinning. This occurs most fre-quently within subscapularis.F. Thickened Subacromial Subdeltoid Bursa - the thickened bursaconforms to the shape of the defect within the tendon and is of similarechogenicity to tendon. This can be a real problem! Helping confirmthe soft tissue is bursa includes:i. Lack of fibrillar patternii. Compressibilityiii. Extension peripheral to the greater tuberosity

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Pre - Surgical Appraisal of Shoulder Ultrasound and Follow Upon PatientsLisa Briggs, Premiere Orthopaedics, Australia

The shoulder is a very complex joint consisting of four structuralregions that all contribute to shoulder joint pathology.1. Bone,2. Soft tissue - rotator cuff.Biceps tendon,Subscapularis tendon,Supraspinatus tendon,Infraspinatus tendon and Teres major.3. Capsule4. Labrum.This presentation is designed to demonstrate the complexity of thisjoint and how ultrasound is used to provide information for eithersurgery or management. High frequency ultrasound is used to demon-strate the soft tissue of the shoulder - namely the rotator cuff. This typeof examination is very operator dependant and a thorough knowledgeof how this joint works is imperative. Each of the above mentionedregions of the shoulder can be visualised by ultrasound and clinicalexamination. The clinical examination of the shoulder will be demon-strated to assist you in your diagnosis of the shoulder complaint. Allthese clinical appraisals will be explored and statistics will be discussedon how to diagnose a shoulder problem. If the supraspinatus tendon iscompromised, you as the sonographer/sonologist must demonstrate anddescribe whether the tendon is partially torn, if so what side of thetendon in torn, bursal or articular, is the tendon frayed? To whatpercentage. The supraspinatus muscle belly is a very important struc-ture to evaluate particularly if surgery is the only option. When issurgery the only option? Ultrasound imaging of before and after sur-gery will be demonstrated. Appraisal of sutures, anchors, tendon foot-prints and vascularity will also be discussed during this presentation.

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Carotid Interpretation Criteria. How to Choose What You UsePhilip Walker, University of Queensland, Department of VascularSurgery, RBWH, Australia

The first criteria for estimation of carotid stenosis were developed bythe Strandness group at the University of Washington in the 1980s.Others proposed different criteria around the same time. The majorcarotid surgery trials of the 1990s (NASCET, ECST and ACAS)prompted the development of CDUS criteria to match the 70% and60% ICA diameter reducing stenosis cut-offs used in these trials. It isto be remembered that these trials used differing methods for estimat-ing stenosis. B mode measurement of stenosis has improved substan-tially on modern duplex scanners. In 1988 Gray-Weale proposed aclassification of carotid plaques on the basis of their echogenicity.Recently interest has returned to plaque characterization with measure-ment of Gray scale median and other features in an attempt to identifythe “vulnerable carotid plaque” and better select asymptomatic patients

who might benefit from intervention. The diagnosis of ICA occlusion