S156 Ultrasound in Medicine and Biology Volume 35, Number 8S, 2009

vention. Sonograms provide a road map for additional imaging whererequired.Conclusions: Ultrasound is a very fast, non invasive and inexpensivemodality in the evaluation of commonly encountered symptoms in theemergency room. Understanding the finer points of image recognitionand interpretation is highly valuable in expedient patient management.

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Doppler Ultrasound (DUS) in Diagnosis of the Acute Scrotumfor Children in Emergency DepartmentWei-Hsi Chang, Department of Emergency, Tri-Service GeneralHospital, National Defense Medical Center, Taiwan

Introduction: The acute scrotum has signs of local inflammation suchas scrotal swelling, heat, redness, and pain. The acute scrotum has fourmost common cause including appendix testis torsion (ATT), epidid-ymitis, orchitis, and testicular torsion. An established treatment strat-egy is the immediate exploration of the scrotum in acute scrotumpatient to prevent testicular loss, whereas other authors recommend atherapeutic approach based on the findings of scrotal Doppler ultra-sound (DUS).Case Report: We describe a 10-year-old boy, student, and physicalexamination revealed tenderness of left swelling & reddish scrotum,because of suspected acute scrotum, and followed scrotal Dopplerultrasound that increased blood flow of left scrotum was noticed incomparison with the contralateral testicle. Because of epididymitis,then he received the treatment of antibiotics, and the symptom sub-sided.Discussion: The acute scrotum is common condition in emergencydepartment, and we must be careful to diagnose between surgical andnon-surgical condition. It is important that adequate treatment preventtesticular loss. Since the early 1990s, there has been an increased use ofDUS in the diagnosis of acute scrotum. Children with normal orincreased testicular blood flow should not undergo primary surgicalexploration, and decreased or missing testicular perfusion or unclearDUS indicates immediate surgical exploration. In children with persis-tent symptoms, despite conservative treatment, elective scrotal explo-ration should be considered. A comparison of the blood flow with thecontralateral testicle may have prevented misdiagnosis in these cases.

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Ruptured Congenital Sinus of Valsalva Aneurysm Complicatedwith Congestive Heart Failure in Real-Time EchocardiographyFu-Chung Chen, Division of Cardiovascular Center, Department ofMedicine, Show Chwan Memorial Hospital, Changhua, TaiwanShu-Man Cheng, Division of Cardiovascular Center, Department ofMedicine, Show Chwan Memorial Hospital, Changhua, Taiwan

Aneurysm of the sinuses of Valsalva is a rare congenital lesion causedby the separation of the aortic wall media from the valve ring tissue, butcan also be acquired in association with trauma, bacterial endocarditis,syphilis, or tuberculosis. Rupture of the aneurysm is the most frequentcomplication and causes clinical symptoms in adulthood.Prior to the advent of Doppler, contrast, and two-dimensional echocar-diography, sinus of Valsalva aneurysm posed a difficult diagnosticchallenge and could be confused with patent ductus arteriosus (PDA),coronary arteriovenous fistula, or ventricle septum defect (VSD) com-bined with aortic regurgitation (AR) by the clinician. We report ourexperience in the precise diagnosis of a continuous signal to confirmthe presence of a ruptured congenital sinus of Valsalva aneurysmcomplicated with congestive heart failure using real-time echocardiog-

raphy. Transthoracic echocardiography has reduced the need for

coronary contrast angiography and has become the principal diagnostictool over the last decade.

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Emphysematous Pyelonephritis in a Diabetic Patient Diagnosedby Emergency Department Ultrasound- A Case ReportHenry Kam-Hong Cheng, Mackay Memorial Hospital, TaiwanKuo-Song Chang, Mackay Memorial Hospital, TaiwanWen-Han Chang, Mackay Memorial Hospital, Taiwan

Emphysematous pyelonephritis is a severe acute necrotizing parenchy-mal renal infection caused by gas-forming bacteria. Diabetes mellitusand urinary tract obstruction are the two most predisposing factors. Theinitial diagnosis can only be made by emergent department ultrasoundand confirmed by abdominal CT scan. We reported a case of emphy-sematous pyelonephritis diagnosed by bedside emergency departmentultrasound allowing a more rapid diagnosis and subsequent treatment.A 84 years-old female patient, history of diabetics with insulin controland hypertension, was noted general malaise, poor appetite, high bloodsugar noted for about 1 week. Lab data showed WBC 18600 S93 B4Glu 248 BUN/Cr 65/3.0 CRP 43.09. KUB showed an opaque shadowin right flank, mottled appearance of right kidney shadow. A bedsideemergency department ultrasound was performed and showed rever-beration of air within the right kidney that obscured the entire kidneyshadow, right side pleural effusion and right liver cyst. An emergencyabdominal CT scan without contrast was done immediately and showedprominent air collection in right renal parenchyma and perirenal spacewith a big calcified stone in right renal pelvis, right liver cyst and rightpleural effusion. Finally urologist was consulted and operation hadarranged. Operation findings showed necrotic change of entire rightkidney with a lot of pus and right upper ureter stone. Right subcapsularnephrectomy was done.

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Diagnostic Value of Ultrasonography for the Assessment of NasalFractureHeung Cheol Kim, Dept. of Radiology, Hallym University Hospital,Chuncheon, Korea

Purpose: The aim of the study was to compare the sonographic and CTexamination of nasal fracture.Materials and Methods: 72 patients with nasal trauma were investi-gated retrospectively. All patients underwent US (5--12 MHz lineararray transducer) and CT (axial and coronal scans). The US and CTfindings were retrospectively review and compared with the finaldiagnosis, which was based on results from the clinical examinations,images and intraoperative findings.The results were analyzed by various statistical testing methods (forsensitivity, specificity, PPV, NPV, accuracy and ?2 test).Results: CT evaluation of nasal fractures yielded a sensitivity of 85%,a specificity of 100%, an accuracy of 87%, PPV of 100%, and NPV of50%, respectively. Ultrasound demonstrated satisfactory sensitivity(84%) and specificity (100%) when compared with CT results, andyielded an accuracy of 86%, PPV of 100% and NPV of 47%, respec-tively.The ?2 test showed no statistical significant difference was foundbetween US and CT in the investigation of the nasal bone fracture(p�0.239).Conclusion: Ultrasonic investigation of the nasal bone is a useful wayto demonstrate fracture that provides similar results to CT.Nasal US could be an alternative imaging method to CT to detect nasal

fracture.