Complex renal cysts represent a clinical problem, since it is often difficult to exclude malignan... more Complex renal cysts represent a clinical problem, since it is often difficult to exclude malignancy. The Bosniak classification uses computed tomography (CT) to categorize cystic renal lesions. Category I and II are presumed to be benign, and III and IV potentially malignant. Category IIF cysts are lesions that may develop into malignancy. Studies exploring whether the IIF category solves the clinically important problem of differentiating between benign and malignant cysts are needed.
Almost all kidney stones are CT positive. Before a CT scan can be done a CT planning image (CTI) ... more Almost all kidney stones are CT positive. Before a CT scan can be done a CT planning image (CTI) is generated in order to select the exact scanning area. The CTI looks approximately like a normal kidney-ureter-bladder abdominal radiography (KUB) but with reduced quality. It has been used as a guide, assuming that if the kidney stone could be seen on the CTI the kidney stone also would be visible on a conventional plain KUB (radiopaque). From the perspective of diagnosis and treatment as well as follow-up it is of importance to know whether a kidney stone is radiopaque or not. The aim of this study was to evaluate whether the CTI actually can predict radiopacity. CT scans and corresponding KUB's were analysed in 76 consecutive kidney stone patients. The CT scan and the KUB were performed on the same day. All patients were examined with the same CT scanner (64 slice GE light speed VCT). Three radiologists evaluated the images in plenum. The following was recorded regarding the kidney stones: X-ray positive (radiopaque on KUB), CTI positive (radiopaque on CTI), location (a kidney, b upper two-thirds of ureter and c lower one-thirds of ureter including the bladder), size and Hounsfield units (HU). We also measured the patient's 'anterior-posterior depth' (APD) at the kidney stone level in axial plane, and whether the stone was homogeneous/inhomogeneous. 54 of the 76 patients (71%) had radiopaque stones on KUB. 43 (57%) of these also could be seen on the CTI, resulting in a positive predicting value (PPV) of 100% and a negative predictive value (NPV) of 67%. In the 54 KUB positive kidney stones the mean kidney stone diameter was 7 mm (2-30 mm), mean HU's 1,007 (294-1,782 HU), location: a:32, b:9 and c:13 patients. APD was mean 23.6 cm (13-39 cm). In the KUB positive and CTI negative kidney stones (11 patients) mean kidney stone diameter was 4 mm (2-9 mm), mean HU's 742 (294-1,253 HU), location: a:32, b:9 and c:13 patients. APD in this group was mean 26.1 cm (13-37 cm). If the kidney stone can be seen on the CTI it is also visible on a plain KUB (PPV 100%). The CTI do, however, underestimate the radiopacity of a stone on a plain KUB (NPV 67%). Kidney stone HU [ 742, stone location in the kidney and proximal ureter and APD \ 26 cm independently predict agreement between CTI and KUB with regard to radiopacity.
Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 2015
Focused emergency ultrasound is rapidly evolving as a clinical skill for bedside examination by p... more Focused emergency ultrasound is rapidly evolving as a clinical skill for bedside examination by physicians at all levels of education. Ultrasound is highly operator-dependent and relevant training is essential to ensure appropriate use. When supplementing hands-on focused ultrasound courses, e-learning can increase the learning effect. We developed an emergency ultrasound app to enable onsite e-learning for trainees. In this paper, we share our experiences in the development of this app and present the final product.
Complex renal cysts represent a clinical problem, since it is often difficult to exclude malignan... more Complex renal cysts represent a clinical problem, since it is often difficult to exclude malignancy. The Bosniak classification uses computed tomography (CT) to categorize cystic renal lesions. Category I and II are presumed to be benign, and III and IV potentially malignant. Category IIF cysts are lesions that may develop into malignancy. Studies exploring whether the IIF category solves the clinically important problem of differentiating between benign and malignant cysts are needed.
Almost all kidney stones are CT positive. Before a CT scan can be done a CT planning image (CTI) ... more Almost all kidney stones are CT positive. Before a CT scan can be done a CT planning image (CTI) is generated in order to select the exact scanning area. The CTI looks approximately like a normal kidney-ureter-bladder abdominal radiography (KUB) but with reduced quality. It has been used as a guide, assuming that if the kidney stone could be seen on the CTI the kidney stone also would be visible on a conventional plain KUB (radiopaque). From the perspective of diagnosis and treatment as well as follow-up it is of importance to know whether a kidney stone is radiopaque or not. The aim of this study was to evaluate whether the CTI actually can predict radiopacity. CT scans and corresponding KUB's were analysed in 76 consecutive kidney stone patients. The CT scan and the KUB were performed on the same day. All patients were examined with the same CT scanner (64 slice GE light speed VCT). Three radiologists evaluated the images in plenum. The following was recorded regarding the kidney stones: X-ray positive (radiopaque on KUB), CTI positive (radiopaque on CTI), location (a kidney, b upper two-thirds of ureter and c lower one-thirds of ureter including the bladder), size and Hounsfield units (HU). We also measured the patient's 'anterior-posterior depth' (APD) at the kidney stone level in axial plane, and whether the stone was homogeneous/inhomogeneous. 54 of the 76 patients (71%) had radiopaque stones on KUB. 43 (57%) of these also could be seen on the CTI, resulting in a positive predicting value (PPV) of 100% and a negative predictive value (NPV) of 67%. In the 54 KUB positive kidney stones the mean kidney stone diameter was 7 mm (2-30 mm), mean HU's 1,007 (294-1,782 HU), location: a:32, b:9 and c:13 patients. APD was mean 23.6 cm (13-39 cm). In the KUB positive and CTI negative kidney stones (11 patients) mean kidney stone diameter was 4 mm (2-9 mm), mean HU's 742 (294-1,253 HU), location: a:32, b:9 and c:13 patients. APD in this group was mean 26.1 cm (13-37 cm). If the kidney stone can be seen on the CTI it is also visible on a plain KUB (PPV 100%). The CTI do, however, underestimate the radiopacity of a stone on a plain KUB (NPV 67%). Kidney stone HU [ 742, stone location in the kidney and proximal ureter and APD \ 26 cm independently predict agreement between CTI and KUB with regard to radiopacity.
Percutaneous drainage proved to be successful in managing a renal subcapsular haematoma that was ... more Percutaneous drainage proved to be successful in managing a renal subcapsular haematoma that was causing acute renal failure and hypertension in a 74-year-old woman. The patient presented with oliguria, nausea and malaise 2 days after a ureteronephroscopic procedure with biopsies of a suspected urothelial neoplasm in the right renal pelvis. The left kidney had recently been removed due to renal cell carcinoma. At admission, the patient's blood pressure and plasma creatinine levels were massively elevated. Ultrasonography revealed a moderate right-sided renal subcapsular haematoma. When the patient did not respond to antihypertensive treatment, Page kidney was suspected. A pigtail catheter was placed in the haematoma and, shortly after drainage, the diuresis resumed and plasma creatinine together with blood pressure decreased. This condition had previously been managed by open surgery, but recent case reports have described successful management by laparoscopy-assisted and radiol...
Purpose To evaluate moderately complex renal cysts of Bosniak category IIF. Materials and methods... more Purpose To evaluate moderately complex renal cysts of Bosniak category IIF. Materials and methods The regional ethics committee approved the study. In the period 2003-2009, radiological CT reports of 8,402 CT examinations of the kidneys were analysed retrospectively by one radiologist. All complex cystic lesions in the kidney (n=550 in the same number of patients) were reclassified according to the Bosniak classification by two radiologists in consensus. If a patient had more than one lesion, only the highest Bosniak category was recorded. All Bosniak IIF lesions with ≥2-year follow-up were included in the study. Results Thirty-two Bosniak IIF lesions were found. Five lesions (16 %) were upgraded during follow-up and the patients were offered surgery. Pathology of three lesions showed papillary carcinoma, clear cell renal carcinoma and chronic inflammation, respectively. Due to comorbidity the remaining two patients were followed with CT without intervention. Ten lesions (31 %) with follow-up periods >5 years had no further radiological changes and clinical follow-up was stopped. Conclusion The use of Bosniak category IIF is clinically applicable, resulting in an overall surgical nephron-sparing approach to complex renal cysts. Teaching Points • The Bosniak classification is used to categorise complex renal cystic masses • BIIF cysts behave mostly as benign lesions • Radiological progression in complexity occurs in only 16 % of cases • BIIF category seems promising for clinical application, potentially avoiding unnecessary surgery Keywords Kidney neoplasms . Renal cystic masses . Multidetector computed tomography Abbreviations HU Hounsfield units PACS Picture-archiving communication system DLP Dose length product mSv Millisievert mA Milliampere
Hydronephrosis in pregnancy is common in the second and third trimester. Only a few cases are sym... more Hydronephrosis in pregnancy is common in the second and third trimester. Only a few cases are symptomatic, caused by a ureteric stone or by the pregnancy itself. The clinical dilemma is when to treat and when not to treat. We propose a multidisciplinary management based on renal ultrasonography to verify hydronephrosis and renography to diagnose obstructive hydronephrosis. Obstruction with a high intra-renal pressure must be treated to avoid kidney dysfunction. Patients with pyonephrosis need immediate treatment.
Acta radiologica (Stockholm, Sweden : 1987), Jan 28, 2015
Ultrasonography of the testis is a well-established diagnostic tool in detection of testicular mi... more Ultrasonography of the testis is a well-established diagnostic tool in detection of testicular microlithiasis (TML). Operator-dependent diagnostic variation related to skill, knowledge, and operator consistency are factors that influence detection of TML. To determine inter- and intraobserver agreement for detection of TML using ultrasonography for a group of physicians with no or limited experience compared to a group of experience senior radiologists. Between May and September 2014 a total of six observers evaluated 34 patients scrotal ultrasonography recorded from September to December 2013. The observers were blinded to patient history and previous ultrasonography. Three of the observers had no or limited experience with detection of TML, and three of the observers had more than 15 years of experience. Each observer reviewed all the scrotal ultrasonography recordings twice with a time interval of 3 months. The inter-observer agreement showed substantial agreement and up to almos...
For minimal invasive treatment of small renal masses, cryoablation has gained popularity. Treatme... more For minimal invasive treatment of small renal masses, cryoablation has gained popularity. Treatment success is defined as absence of contrast enhancement on postoperative imaging of the cryoablated lesion, but contrast enhancement does not necessary equal treatment failure. This present study investigates the proportion of spontaneous resolutions after initial contrast enhancement in relation to cryoablation. Data were collected from a prospectively maintained clinical database containing all patients treated with primary laparoscopic and percutaneous cryoablation between August 2005 and December 2013. All images were evaluated with regard to PADUA-score, cryolesion size, contrast enhancement pattern and tissue density. A total of 107 patients with a biopsy verified malignant tumor were included in the study. On postoperative imaging 33 (31%) patients presented with contrast enhancement. Spontaneous resolution was observed in 15 (45%) patients after a mean follow-up time of 14 months. Patients with cryolesions that resolved spontaneously were found to have less anatomical complex tumor compared to patients with treatment failure (PADUA 7.8 vs. 9.5, p<0.01). A total of 7 patients with a PADUA-score ≥ 10 and contrast enhancing cryolesions were diagnosed as treatment failure. No association was found between BMI, histology, treatment modality, enhancement pattern, number of applied cryoprobes and resolution. Postoperative contrast enhancement is commonly observed after cryoablation and a large portion of these lesions often resolve spontaneously, thus not representing treatment failure. In patients with a high preoperative PADUA score and postoperative contrast enhancement of the cryolesion, treatment failure or recurrent disease should be suspected.
To create a state-of-the-art overview of the new and expanding role of ultrasonography in clinica... more To create a state-of-the-art overview of the new and expanding role of ultrasonography in clinical decision-making, intervention and management of the upper and lower airways, that is clinically relevant, up-to-date and practically useful for clinicians. This is a narrative review combined with a structured Medline literature search. Ultrasonography can be utilised to predict airway difficulty during induction of anaesthesia, evaluate if the stomach is empty or possesses gastric content that poses an aspiration risk, localise the essential cricothyroid membrane prior to difficult airway management, perform nerve blocks for awake intubation, confirm tracheal or oesophageal intubation and facilitate localisation of tracheal rings for tracheostomy. Ultrasonography is an excellent diagnostic tool in intraoperative and emergency diagnosis of pneumothorax. It also enables diagnosis and treatment of interstitial syndrome, lung consolidation, atelectasis, pleural effusion and differentiates...
A 72-year-old man was admitted to the emergency department due to fever and cough. Nine days prio... more A 72-year-old man was admitted to the emergency department due to fever and cough. Nine days prior he had had an open cholecystectomy performed due to acute cholecystitis. Biochemical analysis showed leucocytosis (15×10 9 /L); all other parameters were normal. Chest X-ray showed bilateral pneumonia, and treatment with intravenous isotonic saline and antibiotics was initiated. A bladder catheter was placed to monitor the effect of fluid resuscitation. The catheter only produced 150 mL of urine within the first few minutes. Since the catheter produced urine shortly after being placed it was presumed as being placed correctly. Urine was tested (chemical stix test) and showed minor microscopic haematuria without signs of infection.
Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 2015
Focused emergency ultrasound is rapidly evolving as a clinical skill for bedside examination by p... more Focused emergency ultrasound is rapidly evolving as a clinical skill for bedside examination by physicians at all levels of education. Ultrasound is highly operator-dependent and relevant training is essential to ensure appropriate use. When supplementing hands-on focused ultrasound courses, e-learning can increase the learning effect. We developed an emergency ultrasound app to enable onsite e-learning for trainees. In this paper, we share our experiences in the development of this app and present the final product.
The Bosniak classification was originally based on computed tomographic (CT) findings. Magnetic r... more The Bosniak classification was originally based on computed tomographic (CT) findings. Magnetic resonance (MR) and contrast-enhanced ultrasonography (CEUS) imaging may demonstrate findings that are not depicted at CT, and there may not always be a clear correlation between the findings at MR and CEUS imaging and those at CT. To compare diagnostic accuracy of MR, CEUS, and CT when categorizing complex renal cystic masses according to the Bosniak classification. From February 2011 to June 2012, 46 complex renal cysts were prospectively evaluated by three readers. Each mass was categorized according to the Bosniak classification and CT was chosen as gold standard. Kappa was calculated for diagnostic accuracy and data was compared with pathological results. CT images found 27 BII, six BIIF, seven BIII, and six BIV. Forty-three cysts could be characterized by CEUS, 79% were in agreement with CT (κ = 0.86). Five BII lesions were upgraded to BIIF and four lesions were categorized lower with CEUS. Forty-one lesions were examined with MR; 78% were in agreement with CT (κ = 0.91). Three BII lesions were upgraded to BIIF and six lesions were categorized one category lower. Pathologic correlation in six lesions revealed four malignant and two benign lesions. CEUS and MR both up- and downgraded renal cysts compared to CT, and until these non-radiation modalities have been refined and adjusted, CT should remain the gold standard of the Bosniak classification.
Complex renal cysts represent a clinical problem, since it is often difficult to exclude malignan... more Complex renal cysts represent a clinical problem, since it is often difficult to exclude malignancy. The Bosniak classification uses computed tomography (CT) to categorize cystic renal lesions. Category I and II are presumed to be benign, and III and IV potentially malignant. Category IIF cysts are lesions that may develop into malignancy. Studies exploring whether the IIF category solves the clinically important problem of differentiating between benign and malignant cysts are needed.
Almost all kidney stones are CT positive. Before a CT scan can be done a CT planning image (CTI) ... more Almost all kidney stones are CT positive. Before a CT scan can be done a CT planning image (CTI) is generated in order to select the exact scanning area. The CTI looks approximately like a normal kidney-ureter-bladder abdominal radiography (KUB) but with reduced quality. It has been used as a guide, assuming that if the kidney stone could be seen on the CTI the kidney stone also would be visible on a conventional plain KUB (radiopaque). From the perspective of diagnosis and treatment as well as follow-up it is of importance to know whether a kidney stone is radiopaque or not. The aim of this study was to evaluate whether the CTI actually can predict radiopacity. CT scans and corresponding KUB's were analysed in 76 consecutive kidney stone patients. The CT scan and the KUB were performed on the same day. All patients were examined with the same CT scanner (64 slice GE light speed VCT). Three radiologists evaluated the images in plenum. The following was recorded regarding the kidney stones: X-ray positive (radiopaque on KUB), CTI positive (radiopaque on CTI), location (a kidney, b upper two-thirds of ureter and c lower one-thirds of ureter including the bladder), size and Hounsfield units (HU). We also measured the patient's 'anterior-posterior depth' (APD) at the kidney stone level in axial plane, and whether the stone was homogeneous/inhomogeneous. 54 of the 76 patients (71%) had radiopaque stones on KUB. 43 (57%) of these also could be seen on the CTI, resulting in a positive predicting value (PPV) of 100% and a negative predictive value (NPV) of 67%. In the 54 KUB positive kidney stones the mean kidney stone diameter was 7 mm (2-30 mm), mean HU's 1,007 (294-1,782 HU), location: a:32, b:9 and c:13 patients. APD was mean 23.6 cm (13-39 cm). In the KUB positive and CTI negative kidney stones (11 patients) mean kidney stone diameter was 4 mm (2-9 mm), mean HU's 742 (294-1,253 HU), location: a:32, b:9 and c:13 patients. APD in this group was mean 26.1 cm (13-37 cm). If the kidney stone can be seen on the CTI it is also visible on a plain KUB (PPV 100%). The CTI do, however, underestimate the radiopacity of a stone on a plain KUB (NPV 67%). Kidney stone HU [ 742, stone location in the kidney and proximal ureter and APD \ 26 cm independently predict agreement between CTI and KUB with regard to radiopacity.
Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 2015
Focused emergency ultrasound is rapidly evolving as a clinical skill for bedside examination by p... more Focused emergency ultrasound is rapidly evolving as a clinical skill for bedside examination by physicians at all levels of education. Ultrasound is highly operator-dependent and relevant training is essential to ensure appropriate use. When supplementing hands-on focused ultrasound courses, e-learning can increase the learning effect. We developed an emergency ultrasound app to enable onsite e-learning for trainees. In this paper, we share our experiences in the development of this app and present the final product.
Complex renal cysts represent a clinical problem, since it is often difficult to exclude malignan... more Complex renal cysts represent a clinical problem, since it is often difficult to exclude malignancy. The Bosniak classification uses computed tomography (CT) to categorize cystic renal lesions. Category I and II are presumed to be benign, and III and IV potentially malignant. Category IIF cysts are lesions that may develop into malignancy. Studies exploring whether the IIF category solves the clinically important problem of differentiating between benign and malignant cysts are needed.
Almost all kidney stones are CT positive. Before a CT scan can be done a CT planning image (CTI) ... more Almost all kidney stones are CT positive. Before a CT scan can be done a CT planning image (CTI) is generated in order to select the exact scanning area. The CTI looks approximately like a normal kidney-ureter-bladder abdominal radiography (KUB) but with reduced quality. It has been used as a guide, assuming that if the kidney stone could be seen on the CTI the kidney stone also would be visible on a conventional plain KUB (radiopaque). From the perspective of diagnosis and treatment as well as follow-up it is of importance to know whether a kidney stone is radiopaque or not. The aim of this study was to evaluate whether the CTI actually can predict radiopacity. CT scans and corresponding KUB's were analysed in 76 consecutive kidney stone patients. The CT scan and the KUB were performed on the same day. All patients were examined with the same CT scanner (64 slice GE light speed VCT). Three radiologists evaluated the images in plenum. The following was recorded regarding the kidney stones: X-ray positive (radiopaque on KUB), CTI positive (radiopaque on CTI), location (a kidney, b upper two-thirds of ureter and c lower one-thirds of ureter including the bladder), size and Hounsfield units (HU). We also measured the patient's 'anterior-posterior depth' (APD) at the kidney stone level in axial plane, and whether the stone was homogeneous/inhomogeneous. 54 of the 76 patients (71%) had radiopaque stones on KUB. 43 (57%) of these also could be seen on the CTI, resulting in a positive predicting value (PPV) of 100% and a negative predictive value (NPV) of 67%. In the 54 KUB positive kidney stones the mean kidney stone diameter was 7 mm (2-30 mm), mean HU's 1,007 (294-1,782 HU), location: a:32, b:9 and c:13 patients. APD was mean 23.6 cm (13-39 cm). In the KUB positive and CTI negative kidney stones (11 patients) mean kidney stone diameter was 4 mm (2-9 mm), mean HU's 742 (294-1,253 HU), location: a:32, b:9 and c:13 patients. APD in this group was mean 26.1 cm (13-37 cm). If the kidney stone can be seen on the CTI it is also visible on a plain KUB (PPV 100%). The CTI do, however, underestimate the radiopacity of a stone on a plain KUB (NPV 67%). Kidney stone HU [ 742, stone location in the kidney and proximal ureter and APD \ 26 cm independently predict agreement between CTI and KUB with regard to radiopacity.
Percutaneous drainage proved to be successful in managing a renal subcapsular haematoma that was ... more Percutaneous drainage proved to be successful in managing a renal subcapsular haematoma that was causing acute renal failure and hypertension in a 74-year-old woman. The patient presented with oliguria, nausea and malaise 2 days after a ureteronephroscopic procedure with biopsies of a suspected urothelial neoplasm in the right renal pelvis. The left kidney had recently been removed due to renal cell carcinoma. At admission, the patient's blood pressure and plasma creatinine levels were massively elevated. Ultrasonography revealed a moderate right-sided renal subcapsular haematoma. When the patient did not respond to antihypertensive treatment, Page kidney was suspected. A pigtail catheter was placed in the haematoma and, shortly after drainage, the diuresis resumed and plasma creatinine together with blood pressure decreased. This condition had previously been managed by open surgery, but recent case reports have described successful management by laparoscopy-assisted and radiol...
Purpose To evaluate moderately complex renal cysts of Bosniak category IIF. Materials and methods... more Purpose To evaluate moderately complex renal cysts of Bosniak category IIF. Materials and methods The regional ethics committee approved the study. In the period 2003-2009, radiological CT reports of 8,402 CT examinations of the kidneys were analysed retrospectively by one radiologist. All complex cystic lesions in the kidney (n=550 in the same number of patients) were reclassified according to the Bosniak classification by two radiologists in consensus. If a patient had more than one lesion, only the highest Bosniak category was recorded. All Bosniak IIF lesions with ≥2-year follow-up were included in the study. Results Thirty-two Bosniak IIF lesions were found. Five lesions (16 %) were upgraded during follow-up and the patients were offered surgery. Pathology of three lesions showed papillary carcinoma, clear cell renal carcinoma and chronic inflammation, respectively. Due to comorbidity the remaining two patients were followed with CT without intervention. Ten lesions (31 %) with follow-up periods >5 years had no further radiological changes and clinical follow-up was stopped. Conclusion The use of Bosniak category IIF is clinically applicable, resulting in an overall surgical nephron-sparing approach to complex renal cysts. Teaching Points • The Bosniak classification is used to categorise complex renal cystic masses • BIIF cysts behave mostly as benign lesions • Radiological progression in complexity occurs in only 16 % of cases • BIIF category seems promising for clinical application, potentially avoiding unnecessary surgery Keywords Kidney neoplasms . Renal cystic masses . Multidetector computed tomography Abbreviations HU Hounsfield units PACS Picture-archiving communication system DLP Dose length product mSv Millisievert mA Milliampere
Hydronephrosis in pregnancy is common in the second and third trimester. Only a few cases are sym... more Hydronephrosis in pregnancy is common in the second and third trimester. Only a few cases are symptomatic, caused by a ureteric stone or by the pregnancy itself. The clinical dilemma is when to treat and when not to treat. We propose a multidisciplinary management based on renal ultrasonography to verify hydronephrosis and renography to diagnose obstructive hydronephrosis. Obstruction with a high intra-renal pressure must be treated to avoid kidney dysfunction. Patients with pyonephrosis need immediate treatment.
Acta radiologica (Stockholm, Sweden : 1987), Jan 28, 2015
Ultrasonography of the testis is a well-established diagnostic tool in detection of testicular mi... more Ultrasonography of the testis is a well-established diagnostic tool in detection of testicular microlithiasis (TML). Operator-dependent diagnostic variation related to skill, knowledge, and operator consistency are factors that influence detection of TML. To determine inter- and intraobserver agreement for detection of TML using ultrasonography for a group of physicians with no or limited experience compared to a group of experience senior radiologists. Between May and September 2014 a total of six observers evaluated 34 patients scrotal ultrasonography recorded from September to December 2013. The observers were blinded to patient history and previous ultrasonography. Three of the observers had no or limited experience with detection of TML, and three of the observers had more than 15 years of experience. Each observer reviewed all the scrotal ultrasonography recordings twice with a time interval of 3 months. The inter-observer agreement showed substantial agreement and up to almos...
For minimal invasive treatment of small renal masses, cryoablation has gained popularity. Treatme... more For minimal invasive treatment of small renal masses, cryoablation has gained popularity. Treatment success is defined as absence of contrast enhancement on postoperative imaging of the cryoablated lesion, but contrast enhancement does not necessary equal treatment failure. This present study investigates the proportion of spontaneous resolutions after initial contrast enhancement in relation to cryoablation. Data were collected from a prospectively maintained clinical database containing all patients treated with primary laparoscopic and percutaneous cryoablation between August 2005 and December 2013. All images were evaluated with regard to PADUA-score, cryolesion size, contrast enhancement pattern and tissue density. A total of 107 patients with a biopsy verified malignant tumor were included in the study. On postoperative imaging 33 (31%) patients presented with contrast enhancement. Spontaneous resolution was observed in 15 (45%) patients after a mean follow-up time of 14 months. Patients with cryolesions that resolved spontaneously were found to have less anatomical complex tumor compared to patients with treatment failure (PADUA 7.8 vs. 9.5, p<0.01). A total of 7 patients with a PADUA-score ≥ 10 and contrast enhancing cryolesions were diagnosed as treatment failure. No association was found between BMI, histology, treatment modality, enhancement pattern, number of applied cryoprobes and resolution. Postoperative contrast enhancement is commonly observed after cryoablation and a large portion of these lesions often resolve spontaneously, thus not representing treatment failure. In patients with a high preoperative PADUA score and postoperative contrast enhancement of the cryolesion, treatment failure or recurrent disease should be suspected.
To create a state-of-the-art overview of the new and expanding role of ultrasonography in clinica... more To create a state-of-the-art overview of the new and expanding role of ultrasonography in clinical decision-making, intervention and management of the upper and lower airways, that is clinically relevant, up-to-date and practically useful for clinicians. This is a narrative review combined with a structured Medline literature search. Ultrasonography can be utilised to predict airway difficulty during induction of anaesthesia, evaluate if the stomach is empty or possesses gastric content that poses an aspiration risk, localise the essential cricothyroid membrane prior to difficult airway management, perform nerve blocks for awake intubation, confirm tracheal or oesophageal intubation and facilitate localisation of tracheal rings for tracheostomy. Ultrasonography is an excellent diagnostic tool in intraoperative and emergency diagnosis of pneumothorax. It also enables diagnosis and treatment of interstitial syndrome, lung consolidation, atelectasis, pleural effusion and differentiates...
A 72-year-old man was admitted to the emergency department due to fever and cough. Nine days prio... more A 72-year-old man was admitted to the emergency department due to fever and cough. Nine days prior he had had an open cholecystectomy performed due to acute cholecystitis. Biochemical analysis showed leucocytosis (15×10 9 /L); all other parameters were normal. Chest X-ray showed bilateral pneumonia, and treatment with intravenous isotonic saline and antibiotics was initiated. A bladder catheter was placed to monitor the effect of fluid resuscitation. The catheter only produced 150 mL of urine within the first few minutes. Since the catheter produced urine shortly after being placed it was presumed as being placed correctly. Urine was tested (chemical stix test) and showed minor microscopic haematuria without signs of infection.
Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 2015
Focused emergency ultrasound is rapidly evolving as a clinical skill for bedside examination by p... more Focused emergency ultrasound is rapidly evolving as a clinical skill for bedside examination by physicians at all levels of education. Ultrasound is highly operator-dependent and relevant training is essential to ensure appropriate use. When supplementing hands-on focused ultrasound courses, e-learning can increase the learning effect. We developed an emergency ultrasound app to enable onsite e-learning for trainees. In this paper, we share our experiences in the development of this app and present the final product.
The Bosniak classification was originally based on computed tomographic (CT) findings. Magnetic r... more The Bosniak classification was originally based on computed tomographic (CT) findings. Magnetic resonance (MR) and contrast-enhanced ultrasonography (CEUS) imaging may demonstrate findings that are not depicted at CT, and there may not always be a clear correlation between the findings at MR and CEUS imaging and those at CT. To compare diagnostic accuracy of MR, CEUS, and CT when categorizing complex renal cystic masses according to the Bosniak classification. From February 2011 to June 2012, 46 complex renal cysts were prospectively evaluated by three readers. Each mass was categorized according to the Bosniak classification and CT was chosen as gold standard. Kappa was calculated for diagnostic accuracy and data was compared with pathological results. CT images found 27 BII, six BIIF, seven BIII, and six BIV. Forty-three cysts could be characterized by CEUS, 79% were in agreement with CT (κ = 0.86). Five BII lesions were upgraded to BIIF and four lesions were categorized lower with CEUS. Forty-one lesions were examined with MR; 78% were in agreement with CT (κ = 0.91). Three BII lesions were upgraded to BIIF and six lesions were categorized one category lower. Pathologic correlation in six lesions revealed four malignant and two benign lesions. CEUS and MR both up- and downgraded renal cysts compared to CT, and until these non-radiation modalities have been refined and adjusted, CT should remain the gold standard of the Bosniak classification.
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Papers by Ole Graumann