This study is both a retrospective and prospective evaluation of the clinical usefulness of shoulder sonography. Ninety-eight patients suspected of having rotator cuff tears underwent sonography of both shoulders. Sixty-two patients underwent double-contrast arthrography performed on the same day as sonography, and 38 patients underwent surgery after sonography. A comparison of the results from ultrasound and arthrography, using published diagnostic criteria, demonstrated a sensitivity of 75% and a specificity of 43% for detection of a rotator cuff tear. In this study, use of more restricted criteria, a subset of the published criteria, yielded a sensitivity of 68% and a specificity of 90%. A comparison of sonography with surgery, using this study's criteria, demonstrated a sensitivity of 57% and a specificity of 76%. This report shows that shoulder sonography is less reliable than previously reported and appears to have a very limited role in the evaluation of rotator cuff injuries.

This study confirms the accuracy and reliability of sonographic assessment of renal dimensions when meticulous scanning techniques are employed. Sonographic renal dimensions are smaller than those obtained by radiography, since there is neither the geometric magnification nor the change in size related to an osmotic diuresis from iodinated contrast material. Sonographically, with patients in the prone position, the mean right renal length was 10.74 cm (+/- 1.35 SD) and the mean left renal length was 11.10 cm (+/- 1.15 SD). A prospective sample demonstrated the mean depth (ventral-dorsal dimension) to be approximately 4.5 cm when the transducer was angulated for the lie of the kidney.

Over a period of 1 year we diagnosed central pontine myelinolysis (CPM) in five patients all of whom survived, two of them with complete functional recovery despite extensive lesions on cranial computerized tomography and magnetic resonance imaging. Diagnosis was based upon the combination of an acute brainstem dysfunction with typical neuroradiological features; a history of chronic alcoholism or a preceding hyponatremia may serve as a diagnostic hint. The spectrum of symptoms ranged from severe tetraplegia and cranial nerve palsies to latent signs of pyramidal tract lesions and discrete ocular motor abnormalities. In two patients pontine and extrapontine manifestations of demyelination were confirmed neuroradiologically; in one patient a solely extrapontine manifestation was present. Thus it is reasonable that: (1) the incidence of comparatively mild forms of CPM as well as extrapontine manifestations are more frequent than hitherto assumed, (2) the clinical outcome of the syndrome is better than expected from earlier fatal case reports and is quite independent of the extent of the lesion as it appears with brain imaging methods.

Intra-abdominal meconium calcifications in the fetus can be detected with sonography.t-3 Fetal peritoneal calcifications are usually related to meconium peritonitis secondary to bowel perforation; intraluminal calcifications (enterolithiasis) are relatively rare but are often associated with bowel obstruction. 2.3 Sonographic characteristics clearly reveal the presence of calcified meconium and may distinguish intraluminal from peritoneal foci. The following is a report of two cases of prenatal detection of calcified intraluminal meconium associated with anorectal atresia. Sonographic signs useful in the antenatal diagnosis of enterolithiasis are described. To our knowledge, these have not been previously reported. CASE REPORTSCase 1 A multiparous 37-year-old woman without significant medical history presented to the obstetrics service with a 2-day history of dysuria and lower abdominal cramping. Sonography demonstrated a 30-week gestation and oligohydramnios. Fetal survey revealed a small thorax, right hydrone- phrosis, nonvisualization of the left kidney, and a dilated loop of bowel in the midabdomen. The bowel loop "mass" contained multiple coarse, highly reflective foci, 4-to 6-mm in diameter, compatible with calcifications (Fig. 1). Peristalsis in this segment was present. Four days later the patient delivered a 1,575-g girl with Apgar scores of 4 and 6. Delivery was com• plicated by breech presentation and amnionitis. The baby was noted to have multiple congenital anomalies and expired 5 hours postpartum. Postmortem examination demonstrated imperforate anus, bilateral renal hypoplasia with right uretero~ pelvic junction obstruction, Potter's facies, choledochal cyst, imperforate vagina, urachal cyst, and a colon that ended blindly against the dorsal aspect of the latter. Several mesenteric bands surrounded a distal loop of dilated sigmoid colon. Specimen radiographs of the meconium within the loop demonstrated scattered calcifications. No connection between the urachal sac and colon was identified. The infant's karyotype was 46,XX. An abdominal radiograph performed after expiration identified scattered left hemiabdominal calcifications confined to a focally dilated loop of colon (Fig. 2).Case 2 A 33~year-old gravida 1, para 0 woman with no significant medical history was suspected of carrying a growthretarded fetus. Sonography demonstrated a 32-week gestation. The fetal abdomen contained multiple coarse hyperechoic foci within dilated loops of bowel (Fig. 3). Active peristalsis of these loops was observed. A fetal sonogram 3 weeks later demonstrated normal interval growth and multiple coarse intra-abdominal calcifications confined to the dilated bowel that measured 4.5 em in diameter in the periphery of the fetal abdomen. A 2,296-g boy was delivered by cesarean section following a nonreactive stress test. Apgar scores were 9 and 9. Neonatal evaluation demonstrated imperforate anus, hypospadias, rectovesical fistula, malpositioned thumbs, and mul-

Isolated levocardia with situs inversus, or ILSI, is a rare anomaly with a reported incidence of 1:22,000 in the general population and from 0.4% to 1.2% of all patients with congenital heart diseases. It is commonly associated with both congenital heart disease and splenic abnormalities, either asplenia or polysplenia. The prognosis is poor, and only about 5% to 13% of patients survive more than 5 years. The case described here, which had computed tomographic findings, is the first case reported with multiple malignancies associated with ILSI. This patient, at 73 years of age, is the second longest survivor reported in the literature.