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Re: 'Terrifying Sonogram' Dilemma: patient with single (new) 'soft marker' -- all other screens normal From: Allen Worrall (jworrall@alaska.net) Thu May 22 22:41:58 2003 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Terry J DuBose: "Re: 'Terrifying Sonogram' Dilemma: patient with single (new) 'soft marker' -- all other screens normal" Previous message: RBurns: "'Terrifying Sonogram' Dilemma: patient with single (new) 'soft marker' -- all other screens normal" Maybe in reply to: RBurns: "'Terrifying Sonogram' Dilemma: patient with single (new) 'soft marker' -- all other screens normal" Next in thread: Terry J DuBose: "Re: 'Terrifying Sonogram' Dilemma: patient with single (new) 'soft marker' -- all other screens normal" Is the radiologist specially trained or experienced in nasal bone imaging? Why is there uncertainty about the presence of absence of the nasal bone? Is this the same as saying the nuchal translucency MAY be increased, or the nuchal fold MAY be increased? If I got that kind of report from someone, I would assume they know almost nothing about nuchal translucency or nuchal fold, and I would not pay much attention to that part of their report. I am totally unfamiliar with imaging the nasal bone, but I suspect in some ways it presents the same problems as the nuchal translucency: you have to have a midsagittal view, and that is not always available. If I cannot do the nuchal translucency, I say so in my report and suggest the patient come back in a few days for another try, in the hopes the baby's position is more favorable. If I get widely differing nuchal translucency measurements during the same scan, I just keep scanning until I make up my mind what I am going to report. I do not say "the nuchal translucency MAY be increased." Can you obtain a targeted ultrasound examination from someone else with experience in imaging the fetal nasal bone? If so, that might be a good thing to do. It would also be good to make sure the patient understands the dilemma. Can the radiologist tell you what he or she means when they say the nasal bone MAY be absent? Incidentally, Dr. Filly also wrote a famous paper about levels of ultrasound exams. I do not know the title exactly, but something about your level I, my level II, I'll raise you one. -- Allen Worrall Joseph A Worrall MD RDMS OB/GYN Ultrasound at the Fairbanks Clinic Fairbanks, Alaska, USA jworrall@alaska.net http://www.obgynsono.com >----- Original Message ----- From: "RBurns" <bito02@aol.com> To: "Multiple recipients of list ULTRASOUND" <ultrasound@mail.medispecialty.com> Sent: Thursday, May 22, 2003 5:53 PM Subject: 'Terrifying Sonogram' Dilemma: patient with single (new) 'soft marker' -- all other screens normal > I rarely post to this board, but I followed with some interest your > discussion regarding Filly's article about sonography and soft markers. > > I will share with you my dilemma -- which also raises concerns regarding > the "new" soft marker -- the nasal bone. > > My patient is 36 years old and 25wks pregnant with partial previa. She > had the NT screen which yielded 1:809 risk for ds; her AFP results were > 1:420. On the basis of this, we did not strongly advise her to have an > amnio and instead, scheduled her for a Level II. > > At my patient's level II, no abnormalities were found (though we did > discover the previa) -- no soft markers, etc. > > Thereafter, at her 25wk previa follow-up u/s, the radiologist identified > what MAY be an absent or short nasal bone -- the famous and uncertain > "marker" in an otherwise low-risk patient. It is not clear whether or > not the nasal bone was seen in the Level II or indeed, if it was > screened. > > As Filly so aptly described, we are in a dilemma. We are inclined to > believe that our patient continues to be at extremely low risk of ds and > we are very cognizant of her already anxious state, given the previa. At > the same time, we are also concerned that we give our patient > appropriate follow up recommendations. On the basis of this screening > picture, would you recommend amnio? A follow up Level II? > > Regards and debate away! > Next message: Terry J DuBose: "Re: 'Terrifying Sonogram' Dilemma: patient with single (new) 'soft marker' -- all other screens normal" Previous message: RBurns: "'Terrifying Sonogram' Dilemma: patient with single (new) 'soft marker' -- all other screens normal" Maybe in reply to: RBurns: "'Terrifying Sonogram' Dilemma: patient with single (new) 'soft marker' -- all other screens normal" Next in thread: Terry J DuBose: "Re: 'Terrifying Sonogram' Dilemma: patient with single (new) 'soft marker' -- all other screens normal"

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