Health Professions: Diagnostic Medical Sonography Senior Capstone Presentations
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Item Bezoar(Bryan College of Health Sciences, 2019-11) Klein, Randa; Julie Morbach, MA, RDMS, RVT, RT(R)Although uncommon, bezoars are a well-recognized accumulation of partially or completely undigested material present anywhere in the gastrointestinal tract. There are multiple types of bezoars, each classified according to their contents. In this case study, a female child presented to her primary care physician with generalized abdominal pain. Physical examination verified the presence of a palpable mass in the epigastric region. The primary care provider ordered an abdominal ultrasound examination, which was followed up with a computed tomography (CT) contrast exam. Comparison of the two imaging modalities resulted in the diagnosis of a gastric bezoar. Onset of bezoar symptoms does not occur until the mass becomes relatively large in size. Once symptoms are present it is important for doctors and healthcare professionals to diagnose and treat bezoars in an accurate and timely manner. Early detection provides the patient enough time to attempt noninvasive treatment options before the bezoar becomes life threatening.Item Dandy-Walker variant(Bryan College of Health Sciences, 2019-12-03) Heckathorn, Mikayla; Julie Morbach, MA, RDMS, RVT, RT(R)Fetal anatomy scans are one of the most important tools in evaluating a fetus for abnormalities. A primary focus of the fetal ultrasound is the brain. Ultrasound of the fetal brain can detect abnormalities in the brain like those with characteristics that fall under the dandy-walker complex. Detection of a brain abnormality can alert the obstetrics doctor and the imaging team that there may be abnormalities elsewhere in the body. Detecting abnormalities early can place the patient under a high-risk pregnancy flag and get the patient to maternal fetal medicine for further assessment and counseling. This case study looks at a pregnant patient coming to her initial 20-week fetal anatomy scan. Findings of an abnormal cerebellum and suboptimal views of the face and heart prompted a recommendation to the maternal fetal medicine clinic for a follow-up. Dandy-Walker malformation falls under the category of dandy-walker complex, it is the most common malformation of the cerebellum. After being referred to the maternal fetal medicine clinic the patient had a detailed fetal anatomy ultrasound. This confirmed the finding of an abnormal cerebellum consistent with dandy-walker variant. A hypoplastic or absent nasal bone was also discovered and because of the patient’s advanced maternal age raised the probability of the fetus having Down Syndrome. Following the referral to maternal fetal medicine, the team at MFM closely monitored the patient due to maternal factors that placed her in a high-risk category. Detection of this abnormality allowed the patient to receive many options and the level of care and counseling necessary following a diagnosis of dandy-walker variant and Down Syndrome.Item Invasive papillary breast carcinoma: A case study(Bryan College of Health Sciences, 2019-12-03) Hixson, Malerie; Julie Morbach, MA, RDMS, RVT, RT(R)Papillary breast carcinoma constitutes approximately 0.5% of invasive breast cancers (Pal et al, 2010). Patients are usually postmenopausal females, especially the age range of 40-75, who present with bloody nipple discharge, a palpable mass, or abnormalities on medical imaging such as mammography or ultrasonography. Histology reports show that distinguishing papillary carcinoma from other breast cancers can be determined by a proliferation of malignant papillary cells which do not contain an intact layer of myoepithelial cells within the papillae. Patients have a good prognosis, with a ten year survival rate of 86% (Schneider, 1989). There are several options for treatments including mastectomy, lumpectomy, or chemotherapy treatment.Item Incarcerated Left Inguinal Hernia(2019-11-08) Sedivy, Allison; Morbach, Julie, MA, RDMS, RVT, RT(R), Bryan College of Health SciencesThe patient of this case had undergone a unique experience as he had minimal risk factors for an inguinal hernia. He presented to the emergency department with a sudden onset of a severe left incarcerated inguinal hernia. After an ultrasound and CT imaging, he immediately was sent to surgery for a left-sided inguinal hernia repair. During surgery complications were discovered as some of the bowel had been incarcerated. Twelve days after the surgical procedure, the patient presented again to the emergency department with symptoms of a right inguinal hernia. After additional imaging, he was sent back for another surgical repair. With the proper imaging modalities of computed tomography and ultrasound available to evaluate his condition, he was able to receive necessary care for a good outcome.Item Sacrococcygeal teratoma(2019-11-19) Berkey, Holly; Morbach, Julie, MA, RDMS, RVT, RT(R), Bryan College of Health SciencesSacrococcygeal tumors are the most common congenital anomaly in fetuses. This presentation focuses on the pathogenesis of sacrococcygeal teratomas. In the case study presented, a pregnant female patient was referred to Maternal-Fetal Medicine following an abnormal ultrasound with her primary obstetric care office. Through a detailed examination of the fetus, it was determined that a mostly cystic sacrococcygeal teratoma was present. The fetus was then monitored weekly via ultrasound leading to delivery. The mass continued to increase in size leading to intrauterine growth restriction in the fetus. The fetus was delivered via cesarean section at 36 weeks and six days gestation and surgical intervention of the mass was performed. Early intervention from the healthcare team in this patient’s case was vital in creating a treatment plan that would result in a healthy mother and fetus. Appropriate imaging and procedures early in pregnancies like this are important so that the mother can evaluate all her options and so that surgical teams can develop proper treatment plans for the post-natal time period.