BackgroundLeprosy is the most common treatable peripheral nerve disorder worldwide with periods of acute neuritis leading to functional impairment of limbs, ulcer formation and stigmatizing deformities. Since the hallmarks of leprosy are nerve enlargement and inflammation, we used high-resolution sonography (US) and color Doppler (CD) imaging to demonstrate nerve enlargement and inflammation.Methology/Principal FindingsWe performed bilateral US of the ulnar (UN), median (MN), lateral popliteal (LP) and posterior tibial (PT) nerves in 20 leprosy patients and compared this with the clinical findings in these patients and with the sonographic findings in 30 healthy Indian controls.The nerves were significantly thicker in the leprosy patients as compared to healthy controls (p<0.0001 for each nerve). The two patients without nerve enlargements did not have a type 1 or type 2 reaction or signs of neuritis. The kappa for clinical palpation and nerve enlargement by sonography was 0.30 for all examined nerves (0.32 for UN, 0.41 for PN and 0.13 for LP). Increased neural vascularity by CD imaging was present in 39 of 152 examined nerves (26%). Increased vascularity was observed in multiple nerves in 6 of 12 patients with type 1 reaction and in 3 of 4 patients with type 2 reaction. Significant correlation was observed between clinical parameters of grade of thickening, sensory loss and muscle weakness and US abnormalities of nerve echotexture, endoneural flow and cross-sectional area (p<0.001).Conclusions/SignificanceWe conclude that clinical examination of enlarged nerves in leprosy patients is subjective and inaccurate, whereas sonography provides an objective measure of nerve damage by showing increased vascularity, distorted echotexture and enlargement. This damage is sonographically more extensive and includes more nerves than clinically expected.

No abstract

Imaging of the 4-chamber view is not adequat4 for detecting ventricular septal defects. The technique described in this presentation will illustrate movement of the transducer beam that sweeps the heart in longitudinal and transverse planes and using color/power Doppler ultrasound.

Four chamber view of fetal heart is the most important view in both fetal echocardiography as well as the standard second trimester anomaly scan. This view does not require specialized skills, it can be obtained in all fetal positions, at all gestational ages from 12 weeks to term. Also, this view identifies almost 60%-70% of cardiac anomalies that can be detected antenatally. This talk will discuss the technique of obtaining a good four chamber view, ascertaining the position and situs of fetal heart, its size, axis, normal sizes of all four chambers, the heart valves, their alignment and functioning and most important, the use of colour Doppler in fetal echocardioagraphy. The anomalies associated with abnormal sizes of each chamber as well as abnormal number of chambers, abnormalities of valves and the IVS (interventricular septum) will be discussed. It has been shown by many that a normal four chamber view does not always mean a normal fetal heart. There are anomalies such TOF, TGA etc which may be missed if one relies only on this view. This talk will further discuss the anomalies which are diagnosed if one goes beyond the four chamber view.

Left-sided obstructive lesions, particularly bicuspid aortic valve/valvar aortic stenosis and coarctation of the aorta, can be challenging to detect prenatally. In some cases, these lesions can progress, or may be associated with forms of HLHS. Hypoplastic left heart syndrome represents a spectrum of congenital heart abnormalities that share in common an inability of the mitral valve/left ventricle to provide adequate systemic cardiac output. This talk will review how to detect and evaluate left-sided heart lesions in fetal life, and will discuss management and prognosis, as well. While outcomes for HLHS have improved dramatically in recent years, single ventricle defects face potential complications throughout their lives. Insights into the spectrum of left-sided obstructive disease are important to consider when counseling pregnant patients with affected fetuses. Optimizing delivery and neonatal management provides the best way to optimize long-term quality of life and survival.