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Re: 'Terrifying Sonogram' Dilemma: patient with single (new) 'soft marker' -- all other screens normal From: art fougner, md (evsono@pipeline.com) Sat May 24 10:39:09 2003 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Adalberto Perez Rojas: "Conservative treatment in placenta accreta and percreta" Previous message: RBurns: "Re: 'Terrifying Sonogram' Dilemma: patient with single (new) 'soft" In reply to: Dave Berck: "Re: 'Terrifying Sonogram' Dilemma: patient with single (new) 'soft marker' -- all other screens normal" to image the nasal bone, the angle definitely is important. i have seen the nasal bone literally disappear by varying the angle of the beam. as far as the case in question - i would look again at follow- up studies. Though the nasal bone promises to be a powerful marker more powerful than nuchal fold, it's still the new kid on the block and it pays to be conservative. also ethnic variation plays a role in the presence or absence of the nasal bone, too. keep your fingers crossed. also the Filly editorial on terrifying ultrasounds is - J Ultrasound Med 2000 Jan;19(1):1-5 Obstetrical sonography: the best way to terrify a pregnant woman. Filly RA. art At Fri, 23 May 2003, Dave Berck wrote: > >Nicolaides Lancet paper about 18 months ago describes >the proper way to image the nasal bone in the 2nd >trimester. Like NT measurements, if you don't know >what you're doing, you'll definitely do a bad job. I >would suggest that there are few radiologists who have >any idea of how to measure a NB properly. > >Furthermore, the finding of a soft marker should not >cause you to throw the screening results out of the >window. You have to consider them in aggregate. > >Lastly, I would suggest that the finding of an absent >nasal bone is actually NOT a soft marker, but rather a >marker that greatly increases the risk of DS, more >along the lines of an AV Canal defect or omphalocele. > >Does anyone agree? > >--- RBurns <bito02@aol.com> wrote: >> This "may" communication is my error, not an error >> in the report. The >> actual report indicates that "they are concerned >> about the development >> of the nasal bone." In the original Level II u/s, >> the nasal bone appears >> present; in the subsequent Level I, it is absent. >> Thus, they are >> suggesting that there is something concerning about >> the development of >> the nasal bone itself. >> >> But I surely agree; Levels are only as good as the >> sonographers >> performing the screen -- >> >> Does that clarify things? >> >===== >David J. Berck, MD, MPH -- art fougner, md ich bin ein New Yorker Next message: Adalberto Perez Rojas: "Conservative treatment in placenta accreta and percreta" Previous message: RBurns: "Re: 'Terrifying Sonogram' Dilemma: patient with single (new) 'soft" In reply to: Dave Berck: "Re: 'Terrifying Sonogram' Dilemma: patient with single (new) 'soft marker' -- all other screens normal"

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