Re: 'Terrifying Sonogram' Dilemma: patient with single (new) 'soft marker' -- all other screens normal
From: Terry J DuBose (tjdubose@juno.com)
Fri May 23 08:05:39 2003
Dr. Worrall, I agree. I think Filly's article was "I'll see your level
II and raise you III.", meaning the exam is only as good as the
operator... "levels" don't mean anything without proper experience and
education. It was the JUM, but at this time I don't have the reference
in front of me. Terry J DuBose
On Thu, 22 May 2003 22:42:34 -0500 "Allen Worrall" <jworrall@alaska.net>
writes:
> 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!
> >
>
