ScholarWorks @ SeattleU (Seattle University)

Park, Kasydie

Seattle University 
ScholarWorks @ SeattleU 
Bachelor of Science in Diagnostic Ultrasound 
Projects College of Nursing 
6-1-2025 
The significance of sweeping through the apex to further 
investigate potential LV mural thrombi: A case report of a hidden 
mural thrombus 
Kasydie Park 
Seattle University 
Follow this and additional works at: https://scholarworks.seattleu.edu/dius-projects 
Recommended Citation 
Park, Kasydie, "The significance of sweeping through the apex to further investigate potential LV mural 
thrombi: A case report of a hidden mural thrombus" (2025). Bachelor of Science in Diagnostic Ultrasound 
Projects. 20. 
https://scholarworks.seattleu.edu/dius-projects/20 
This Article is brought to you for free and open access by the College of Nursing at ScholarWorks @ SeattleU. It 
has been accepted for inclusion in Bachelor of Science in Diagnostic Ultrasound Projects by an authorized 
administrator of ScholarWorks @ SeattleU. 
 1 
 
 
Journal of Diagnos.c Medical Sonography  
2025,  
Vol. __(__) ___-___ 
 
 
The significance of 
sweeping through the apex 
to further investigate 
potential  
LV mural thrombi: A case report of a  
hidden mural thrombus  
 
Kasydie Park 
 
Abstract 
This case study demonstrates a 70-
year-old male who presented with shortness 
of breath and was subsequently found to 
have a left ventricular mural thrombus. A 
full echocardiogram revealed hypokinesis of 
the apical and inferoseptal walls which 
produced an ejection fraction of 16%. With 
much sweeping and the use of Definity 
contrast, a mural LV apical thrombus was 
identified near the apex and measured 
approximately at 2.86 by 1.89 cm. This 
patient also underwent an electrocardiogram 
(EKG), Computed tonography (CT) scan, 
and fluoroscopy of multiple coronary 
arteries due to an non-ST elevation 
myocardial infarction (NSTEMI) diagnosis. 
The patient was put on anticoagulants to 
prevent and mitigate the risk of future 
thrombus forming. After monitoring the 
patient on anticoagulants, the patient was 
later discharged. With patients who have 
severely low function, it is crucial to sweep 
through the apex and use a contrast agent if  
available to rule out any thrombi that may be 
hidden. 
 
Keywords 
Mural Thrombus, Anticoagulants, NSTEMI, 
Aortic stenosis, Aortic regurgitation, 
Inferoseptal walls, Apex, Coronary 
atherosclerosis, Right coronary artery, Left 
anterior descending artery 
 
With this specific case, identifying where the 
mural thrombus is within the heart is crucial. 
A mural thrombus is a blood clot that adheres 
to the heart wall typically due to slow or 
stagnant blood flow. This patient also has 
several underlying cardiac conditions such as 
aortic stenosis (AS), aortic regurgitation (AI), 
and Non-ST elevation myocardial infarction 
(NSTEMI ) which can contribute to a mural 
thrombus being formed. Mural thrombi tend 
to develop when blood flow is impaired, 
particularly in areas where the heart muscle is 
not contracting effectively. The apical and 
inferoseptal wall were found to be 
hypokinetic which means that the walls had 
significantly reduced motion. The 
inferoseptal wall describes the 
interventricular septum that sits posteriorly. 
 2 
The apex on the echocardiogram is near the 
transducer and located at the top of the image 
(Seen in figure 1). From reduced motion, this 
can lead to blood pooling, especially at the 
bottom of the heart which is the apex. 
Prolonged hypokinesis can result in thinning 
of the heart walls (seen in figure 1) which 
would create the perfect environment for 
thrombi to form. 
Aortic stenosis (AS) happens when the aortic 
valve becomes calcified, and the orifice is 
narrowed. iWhen this occurs, it reduces the 
amount of blood ejected out of the heart to 
the rest of the body. Narrowing of this valve 
puts more workload and pressure onto the left 
ventricle, which leads to ventricular 
hypertrophy. The turbulent blood flow and 
regurgitation of blood back into the left 
ventricle with reduced wall motions and 
contractility can increase blood stasis even 
more. 
 
Aortic regurgitation (AI) is a result from the 
calcification of the valve or dilation of the 
ventricle, which causes the valve leaflets to 
grow apart and not close fully, prompting 
blood to be pushed back into the chamber 
behind. The backflow of blood increases the 
volume to the left ventricle which in result 
takes apart in the cause of a thrombi being 
formed. 
Additionally, coronary artery disease, as 
known as coronary atherosclerosis can also 
lead to partial or complete blockage of blood 
flow which is due to fatty deposits within the 
arteries. A condition known as NSTEMI or 
STEMI is a myocardial infarction without ST 
elevation or with ST elevation. This is caused 
by stenosis or total occlusion of coronary 
arteries. ii Since the inferoseptal walls and 
apex is hypokinetic, it can be presumed that 
the right coronary artery (RCA) and left 
anterior descending artery (LAD) can be 
occluded. iii With the disruption of blood 
supply to the myocardium ultimately impairs 
function and contributes to the formation of a 
thrombi.  
  
 
 
 
 
 
Case report or findings 
 
This patient is a 70-year-old male who has not seen a doctor in over 20 years. This 
patients daily life consists of smoking cigarettes a day and drinking a 6 pack of beer every 
night. They went to their local emergency department where he lives because one of their 
family members came home sick one day and shortly after he developed respiratory symptoms. 
Their local hospital then transferred him to a nearby hospital for higher level of care.  
Figure 1. The apical 4 chamber view in diastole which reveals 
enlarged atria, ventricles, and thin heart walls  with subtle 
trabecula;ons near the apex.  
 3 
Other tests besides the echocardiogram were done on the patient to further investigate 
the root cause of his shortness of breath (SOB).  A CT scan showed no pericardial effusions 
but bilateral pleural effusions. An electrocardiogram (EKG) was done on the patient and that 
showed a right bundle branch block which affects the electrical signal going to the right 
ventricle causing it to contract later than the left ventricle. Resulting in a slightly delayed 
heartbeat and an overall irregular heart rhythm. Having knowledge of his NSTEMI diagnosis, a 
fluoroscopy of multiple coronary arteries was done, and the left and right heart catheterization 
revealed mild coronary atherosclerosis however no percutaneous coronary intervention was 
done at that time.  
The echocardiogram showed regional 
and global wall motion abnormalities, the 
apex and inferoseptal walls were 
hypokinetic. The predicted  EF was to be less 
than 20%. There was a smoky like contrast 
on the echo that was seen which could 
indicate blood stasis which is when blood is 
stagnant due to low flow of blood. (See 
figure 1) Whenever there is blood stasis, the 
sonographer should be aware of a possible 
thrombus. The next step would be to sweep 
the apex. Even though there does not seem to 
be a thrombus in the LV it important to 
prove that. But in this case after doing a 
careful sweep of the apex a LV mural 
thrombus that measured out to be 2.86 by 
1.89 cm was found. (See figure 2) To be sure and to prove our findings there was a  
clot present, an ultrasound enhancing agent called 
Definity was used. After definity was used, the EF was 
calculated to be 16%. The echocardiogram also 
presented with the central venous pressure elevated, 
moderate pulmonary hypertension, a severely enlarged 
left atrium (LA), moderate to severe aortic stenosis and 
aortic regurgitation.  
This patients treatments were to be put on 
heparin which is an anticoagulant that limits the ability 
of the blood clotting. Changes in their lifestyle will 
have to be improved and that includes his amount of 
alcohol and cigarette usage. The daily use of alcohol 
and cigarettes can build up plaque in his coronary 
arteries and worsen his atherosclerosis.  
 
 
Discussion 
 
With patients presenting with cardiac conditions 
such as NSTEMI, it is critical to thoroughly interrogate 
Figure 2. This shows the hidden thrombus near the apex. Revealed 
by sweeping all the way through the apex without an ultrasound 
enhancing agent. 
 
Figure 3. This image is showing Definity that is pushed with 
no sweeping done just yet. Dropout near the apex is 
indica;ng a LV mural thrombus. 
 4 
the apex with and without an ultrasound enhancing agent because with impaired blood flow and 
blockage of blood supply to the heart muscle, this increases the risk of a thrombi forming. iv vAs 
seen above, LV mural thrombi are not always apparent to the eye. These thrombi like to adhere 
to the walls of the heart especially at the apex where blood pools when there is low function. vi vii 
With sweeping through the apex, it is also imperative to use an ultrasound enhancing agent, in 
this case we utilized definity.viii With Definity, it is important to ensure that the contrast has 
reached the apex so that a proper interrogation of the suspected thrombus is done.  
 
It is known that contrast can prove the 
suspicions of a thrombi. The use of contrast in 
post-infarc<on pa<ents can detect LV thrombus 
and can help unmask ar<facts or myocardial 
structures. With contrast, trabecula<ons, 
myocardium, and thrombi can easily be 
differen<ated. 
 
Accurate iden<fica<on of mural thrombi is 
cri<cal because misdiagnoses and delayed 
detec<on runs the risk of severe consequences 
such as emboliza<on. ix With early detec<on, this 
allows for a treatment plan to be worked up such 
as being put on an<coagulants to mi<gate and 
reduce the risk of future thrombi. 
Thoroughly sweeping through the apex, both with and without Definity, is essential for a 
comprehensive assessment of the left ventricular cavity, as it ensures full visualization while 
maintaining clear delineation of the myocardial borders.  
 
 
 
Conclusion 
The patient's diagnosis was a LV 
mural thrombus near the apex with moderate 
to severe aortic valve stenosis and NSTEMI. 
He was to be switched to anticoagulants 
right before discharge to be managed at 
home. Changes in his lifestyle will have to 
be implemented since this patient 
experienced an NSTEMI. The coronary 
arteries are not totally occluded but are 
partially occluded which means the patient 
should refrain from ingesting alcohol or 
using cigarettes as that would increase the 
risk of total occlusion of the arteries. This 
patient should also keep up with their health 
and schedule annual appointments with their 
primary care provider and other specialists 
he needs to see. Keeping a close eye on this 
patient’s heart disease is crucial to ensuring 
health since this can get dangerous if matters 
become worse. Implementing exercise into 
their daily life can be vital for his recovery.  
 
 
Declaration of conflicting interest 
The author declares that there are no 
conflicts of interest with respect to the 
research, authorship, and/or publication of 
the article.  
 
 
Figure 4. This is showing the sweeping of the apex with 
definity pushed. The LV mural thrombus is now more 
apparent than seen in figure 2. 
 5 
Funding 
The author received no financial support for 
the research, authorship, and/or publication 
of this article 
 
Ethics Approval 
Ethical approval was not sought for the 
present study because the findings in this 
research study is strictly for educational 
purposes 
 
Informed consent 
 
Informed consent was not sought for the 
present study because all case data was de-
identified and/or aggregated and followed 
ethics committee or IRB guidelines 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 6 
 
 
 
 
 
 
 
 
 
 
 
References 
 
i Breathett K, Lewsey 
S, Brownell NK, Enright K, Evangelista LS, Ibrahim NE, Iturrizaga J, Matlock 
DD, Ogunniyi MO, Sterling MR, Van Spall HGC; American Heart Association Heart 
Failure and Transplantation Committee of the Council on Clinical Cardiology; Council 
on Cardiovascular and Stroke Nursing; Council on Lifestyle and Cardiometabolic 
Health; and Council on Quality of Care and Outcomes Research. Implementation 
Science to Achieve Equity in Heart Failure Care: A Scientific Statement From 
the American Heart Association. Circulation. 2024 May 7;149(19):e1143-e1163. 
doi: 10.1161/CIR.0000000000001231. Epub 2024 Apr 3. PMID: 38567497. 
 
 
ii Mitsis A, Gragnano 
F. Myocardial Infarction with and without ST-segment Elevation: a Contemporary 
Reappraisal of Similarities and Differences. Curr Cardiol Rev. 
2021;17(4):e230421189013. doi: 10.2174/1573403X16999201210195702. PMID: 
33305709; PMCID: PMC8762150. 
 
 
 
iii Shams P, Gul Z, Makaryus AN. Silent Myocardial Ischemia. 2024 Mar 7. In: StatPearls [Internet]. Treasure 
Island (FL): StatPearls Publishing; 2025 Jan–. PMID: 30725600. 
iv Daga LC, Kaul U, Mansoor A. Approach to STEMI and NSTEMI. J Assoc Physicians India. 2011 Dec;59 
Suppl:19-25. PMID: 22624277. 
 
 
 
v Elendu C, Amaechi DC, Elendu TC, Omeludike EK, Alakwe-Ojimba CE, Obidigbo B, Akpovona OL, Oros 
Sucari YP, Saggi SK, Dang K, Chinedu CP. Comprehensive review of ST-segment elevation myocardial 
infarction: Understanding pathophysiology, diagnostic strategies, and current treatment approaches. 
Medicine (Baltimore). 2023 Oct 27;102(43):e35687. doi: 10.1097/MD.0000000000035687. PMID: 37904413; 
PMCID: PMC10615529. 
 
 
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vi Bardooli F, Kumar D, Hasan J, Mengal N, Iqbal Bhatti K, Makwana D, Rai K, Maheswari L. Prognostic 
Significance of Electrocardiography, Echocardiography, and Troponin in Patients Admitted With Non-ST 
Elevation Myocardial Infarction. Cureus. 2023 Apr 16;15(4):e37629. doi: 10.7759/cureus.37629. PMID: 
37200672; PMCID: PMC10186068. 
 
 
 
vii Weinsaft JW, Kim J, Medicherla CB, Ma CL, Codella NC, Kukar N, Alaref S, Kim RJ, Devereux RB. 
Echocardiographic Algorithm for Post-Myocardial Infarction LV Thrombus: A Gatekeeper for Thrombus 
Evaluation by Delayed Enhancement CMR. JACC Cardiovasc Imaging. 2016 May;9(5):505-15. doi: 
10.1016/j.jcmg.2015.06.017. Epub 2015 Oct 14. PMID: 26476503; PMCID: PMC5104336. 
 
 
viii Abdelmoneim SS, Pellikka PA, Mulvagh SL. Contrast echocardiography for assessment of left ventricular 
thrombi. J Ultrasound Med. 2014 Aug;33(8):1337-44. doi: 10.7863/ultra.33.8.1337. PMID: 25063398. 
 
 
ix Stylianou VV, Tsampasian V, Pavlou M, Georgiou P, Patestos D, Kapetis L, Vassiliou VS, Eftychiou C, 
Tsielepis M, Bazoukis G. Left ventricular thrombus in a patient with recurrent ischemic stroke events-The 
role of echocardiography. Clin Case Rep. 2023 May 1;11(5):e7300. doi: 10.1002/ccr3.7300. PMID: 
37143461; PMCID: PMC10151600. 


The significance of
sweeping through the apex
to further investigate
potential
LV mural thrombi: A case report of a
hidden mural thrombus

Tang, Yan

Seattle University 
ScholarWorks @ SeattleU 
Bachelor of Science in Diagnostic Ultrasound 
Projects College of Nursing 
6-1-2025 
Case study: Bilateral Stenting- A Decade of Stability Followed by a 
Sudden Change 
Yan Tang 
Seattle University 
Follow this and additional works at: https://scholarworks.seattleu.edu/dius-projects 
Recommended Citation 
Tang, Yan, "Case study: Bilateral Stenting- A Decade of Stability Followed by a Sudden Change" (2025). 
Bachelor of Science in Diagnostic Ultrasound Projects. 25. 
https://scholarworks.seattleu.edu/dius-projects/25 
This Article is brought to you for free and open access by the College of Nursing at ScholarWorks @ SeattleU. It 
has been accepted for inclusion in Bachelor of Science in Diagnostic Ultrasound Projects by an authorized 
administrator of ScholarWorks @ SeattleU. 
 1 
Case study: Bilateral Stenting- A Decade 
of Stability Followed by a Sudden Change 
 
Abstract 
A 53-year-old female underwent an interven6on of bilateral renal artery stents 13 years prior, 
and an annual follow-up has been showing stable velocity of both stents for more than a decade 
un6l 2024. A sudden increase in velocity was observed at the right origin of the renal artery, 
despite the absence of symptoms, which suggests possible in-stent restenosis. Even though the 
results were concerning, the pa6ent's blood pressure and kidneys remained normal. This case 
highlights the importance of annual follow-up for pa6ents, as significant hemodynamic changes 
could occur even aGer years of stability. 
 
Keywords 
Renal artery stent, renal artery stenosis (RAS), renal-to-aortic ratio 
  
Case study 
In this case, a 53-year-old female 
received bilateral renal artery stenting in 
2012 due to severe stenosis in bilateral renal 
arteries. Following the intervention, an 
annual Doppler ultrasound exam was 
performed to assess stent patency and 
velocity changes.  
The examination followed a 
protocol, beginning with B-mode imaging to 
obtain transverse and sagittal measurements 
of the proximal aorta as well as the 
maximum length measurements of both 
kidneys, with the liver and spleen in the 
lateral position, if possible. Following a 
color and spectral Doppler at 60 or 0 degrees 
to the vessel wall, measuring peak systolic 
velocity (PSV) and end-diastolic velocity 
(EDV). The Doppler assessment included 
the proximal aorta, bilateral renal arteries at 
the ostium, proximal, mid, and distal 
segments at the aorta level, as well as the 
upper, mid, and lower poles, hilum, and 
renal veins of both kidneys in the lateral 
position.  
The criteria for the stented renal 
artery velocity indicate a 60-99% stenosis 
range, with a peak systolic velocity (PSV) 
greater than 280 cm/sec with a renal-to-
aortic (AO) ratio equal to or greater than 
4.5. 
 
Figure 1: The right renal artery ostium 
shows elevated velocity at the stent. 
 
Figure 2. Proximal aorta velocity exceeds 
100 cm/s. 
 2 
The renal peak systolic velocity 
(PSV) at the stenotic site = 298 cm/s, 
indicating 60-99% stenosis. The renal-aortic 
ratio = 2.0. The renal-aortic ratio (RAR) 
does not meet the criteria for significant 
stenosis due to the elevated proximal aorta 
velocities exceeding 100 cm/s. The proximal 
aorta velocity was 151 cm/s, making the 
ratio unreliable. According to the Journal of 
Vascular Study, when the abdominal aorta 
velocity exceeds 100 cm/s, the RAR may 
not be a reliable diagnostic parameter, as it 
can result in false-negative findings.! 
The patient's right origin renal artery 
was stable for the past decade, from 2012 to 
2024. From 230 cm/s in 2022 to 286cm/s in 
2023 which indicates the borderline if 60-
99% stenosis to 298 cm/s last year, which 
indicates a hemodynamically significant 60-
99% stenosis.  
Figure 3. Right renal artery at the stent 
origin (2022) demonstrating normal flow 
velocities within the expected range for a 
stented vessel. 
Figure 4. Right renal artery at the stent 
origin (2023) 
Despite the findings indicating 
evidence of a hemodynamically significant 
stenosis at the origin of the right renal 
artery, the patient's blood pressure remains 
adequately controlled, and renal function 
remains normal. As a result, no acute 
intervention is necessary currently. 
However, the patient will need to continue 
to maintain normal blood pressure level and 
repeat the vascular study for follow-up. 
 
Discussion 
In normal physiology, the renal 
arteries supply oxygenated blood to the 
kidneys without obstruction. Renal stenosis 
restricts blood flow to the kidney, causing 
increased resistance, hypertension, and 
possible kidney damage. Mild stenosis may 
remain asymptomatic or hypertension, while 
severe stenosis may result in renal failure or 
kidney complication if not treated.  
Treatment for renal artery stenosis 
may include antihypertensive medication 
and lifestyle changes such as the DASH diet 
and reduced alcohol and smoking intake to 
manage blood pressure." In more severe 
cases, interventions like angioplasty with 
stenting, bypass surgery, or endarterectomy 
may be required. Regardless of the 
 3 
intervention, medical therapy remains 
essential for all patients. 
Restenosis could happen after 
stenting, especially if the original disease 
was not completely cured or if the vessel has 
changed over time. While the procedural 
success rate for percutaneous transluminal 
angioplasty (PTA) is over 90%, there is 
potential risk of restenosis, which requires 
consistent annual follow-up imaging and 
maintain adequate blood pressure.# 
Other imaging, such as CT or MRI 
angiography, ultrasound provides a non-
invasive, cost-effective tool for monitoring 
stent patency and early diagnosis of 
restenosis. 
 
Conclusion 
This case highlights the importance of 
consistent annual follow-up after renal 
artery stenting, even after many years of 
stability. Although the patient’s elevated 
velocities suggest in-stent stenosis, stable 
blood pressure and normal kidney function 
indicate there's no need for intervention, but 
careful monitoring will allow timely 
intervention if anything changes.  
 
Ethics Approval 
Ethical approval was not sought for the 
present study because it did not interfere 
with patient care. 
  
Informed Consent 
Informed consent was not sought for the 
present study because all case data was de-
identified and/or aggregated and followed 
ethics committee or IRB guidelines. 
  
Declaration of Conflicting Interests 
 The author declares that there are no 
conflicts of interest with respect to the 
research, authorship, and/ or publication of 
the article. 
  
 
Funding 
The author received no financial support for 
the research, authorship, and/ or publication 
of this article. 
  
Reference 
1. Arab, Sadiq F., et al. “Review of Renal 
Artery Stenosis and Hypertension: 
Diagnosis, Management, and Recent 
Randomized Control Trials.” Saudi 
Journal of Kidney Diseases and 
Transplantation: An Official Publication 
of the Saudi Center for Organ 
Transplantation, Saudi Arabia, vol. 33, 
no. 1, 2022, pp. 147–59. PubMed, 
https://doi.org/10.4103/1319-
2442.367807. 
 
2. Bax, Liesbeth et al. “Repeated 
intervention for in-stent restenosis of the 
renal arteries.” Journal of vascular and 
interventional radiology : JVIR vol. 
13,12 (2002): 1219-24. 
doi:10.1016/s1051-0443(07)61968-x 
 
3. Corriere, Matthew A., et al. “Restenosis 
after Renal Artery Angioplasty and 
Stenting: Incidence and Risk Factors.” 
Journal of Vascular Surgery : Official 
Publication, the Society for Vascular 
Surgery [and] International Society for 
Cardiovascular Surgery, North American 
Chapter, vol. 50, no. 4, Oct. 2009, pp. 
813-819.e1. PubMed Central,  
https://doi.org/10.1016/j.jvs.2009.05.019
. 
 
4. Edwards, Aurelie, and Vartan 
Kurtcuoglu. “Renal Blood Flow and 
Oxygenation.” Pflugers Archiv: 
European Journal of Physiology, vol. 
474, no. 8, Aug. 2022, pp. 759–70. 
PubMed, 
https://doi.org/10.1007/s00424-022-
02690-y 
 
 4 
5. Li J, Jiang Y, Zhang S, Wang L, Ouyang 
Y, Qi Z. Evaluation of renal artery 
stenosis with hemodynamic parameters 
of Doppler sonography. Journal of 
Vascular Surgery. 2008;48(2):323-328. 
doi:https://doi.org/10.1016/j.jvs.2008.03.
048 
 
6. Ozemek, Cemal, et al. “Impact of 
Therapeutic Lifestyle Changes in 
Resistant Hypertension.” Progress in 
Cardiovascular Diseases, vol. 63, no. 1, 
2020, pp. 4–9. PubMed, 
https://doi.org/10.1016/j.pcad.2019.11.0
12. 
 
7. Safian, Robert D. “Renal Artery 
Stenosis.” Progress in Cardiovascular 
Diseases, vol. 65, 2021, pp. 60–70. 
PubMed, 
https://doi.org/10.1016/j.pcad.2021.03.0
03. 
 
8. Theodoridis, Xenophon, et al. 
“Adherence to the DASH Diet and Risk 
of Hypertension: A Systematic Review 
and Meta-Analysis.” Nutrients, vol. 15, 
no. 14, July 2023, p. 3261. PubMed, 
https://doi.org/10.3390/nu15143261. 
 
 
 
 


Case study: Bilateral Stenting- A Decade
of Stability Followed by a Sudden Change

Tran, Kelsea

Seattle University 
ScholarWorks @ SeattleU 
Bachelor of Science in Diagnostic Ultrasound 
Projects College of Nursing 
2025 
Case Study: Umbilical Hernia 
Kelsea Tran 
Follow this and additional works at: https://scholarworks.seattleu.edu/dius-projects 
Case Study: Umbilical Hernia  
 
Kelsea Tran   
  
Abstract  
Umbilical hernias are a condition that can affect children and adults. It is more commonly seen 
in children than adults. In adults, it is a break in the abdominal wall caused by weakened 
abdominal wall muscles from surgery, obesity, or pregnancy. This case study examines the 
abdominal hernia ultrasound procedure done on a 33-year-old mother of four, who has been 
experiencing umbilical pain and bulging. The ultrasound showed a large partially reducible 
umbilical hernia. The sonographic findings are examined and compared with the normal 
presentation of abdominal walls. Lack of childcare was a health care access barrier that the 
patient faced while trying to get a diagnosis and treatment for her pain, and this case study 
highlights a common obstacle to getting access to healthcare   
  
Keywords: Umbilical hernia, Obstructed, Abdominal wall, Valsala, Healthcare access.  
  
Introduction  
The patient is a 33-year-old mother of four, 
experiencing pain in her umbilical area for 
the past 6 months after a work injury. The 
pain would worsen and radiate up to the 
epigastric region when the patient would 
exercise or lift heavy objects, and her 
bellybutton visibly bulged out. Hernias are 
cause by weakened abdominal wall muscles 
and it most often affects multiparous women 
and obese people2 Umbilical hernias make 
up ten percent of all hernias for adults. They 
are more common in women who have had 
children because pregnancy can weaken the 
abdominal wall muscles. In people over 60 
years old it is equally common between men 
and women.3 The patient had no prior 
imaging, and she had an appointment for an 
abdominal ultrasound three weeks prior but 
cancelled it due to lack of childcare.   
  
Case report  
The patient had no previous imaging or lab 
results prior to the ultrasound. The GE logiq 
ultrasound equipment and a linear probe 
were used to evaluate the hernia. The 
protocol for imaging umbilical hernia’s is 
images and cines of the hernia at rest and 
then with Valsalva, and neck and L x W x H 
measurements for both. The hernia volume 
was 5.7cc at rest and increased to 7.5cc with 
Valsalva.  Valsalva is when the patient bears 
down and tightens their abdominal muscles; 
the pressure in the abdomen can cause the 
hernia to herniate and get larger, which was 
what happened in this case.   
The protocol also includes additional images 
with color doppler to see if there is 
vascularity and compression. The hernia was 
avascular, it only contained fat, and no 
bowel was seen within the hernia. When 
compression was applied to the hernia, the 
hernia was partially reducible meaning the 
hernia did not fully go back into the 
abdomen. The plan for the patient was to get 
a hernia repair surgery where they fixed the 
weak spot in the abdominal wall. While the 
patient was waiting for the surgery, she was 
prescribed Advil for the pain and told to not 
do any strenuous activity. The patient got 
surgery two months after her ultrasound and 
the surgeon decided to put a mesh in. The 
mesh was placed right beneath the hernia 
site and sutured to stronger tissue 
surrounding the 
hernia.  
Figure 1. sagittal umbilical area at rest  
 
Figure 2. Transverse umbilical area at rest  
  
 
 
Measurements at Rest 
• Hernia: 2.7 x 2.9 x 1.4cm  
• Neck: 0.97 x 0.98cm  
 
Figure 3. Sagittal umbilical area with Vals  
 
Figure 4. Transverse umbilical area with 
Vals  
  
 
Measurements With Valsalva 
• Hernia: 3.0 x 2.8 x 1.7cm 
• Neck: 1.1 x 1.3cm   
 
 
Discussion  
The appearance of a normal abdominal wall 
is an echogenic line running across the 
entire abdomen in sagittal and transverse. 
With hernias, the abdominal wall is weak, 
and there is a break in the echogenic line 
and abdominal contents coming out. Most 
commonly hernia’s contain fat, but bowel 
can also herniate out of the break in the 
abdominal wall. Children are most likely to 
get umbilical hernias because the hole in 
their abdominal wall that allows the 
umbilical cord to pass through doesn’t fully 
close. Usually in children, the hernia will 
close and repair itself and they are only 
treated if they are larger than 2 cm or if it 
has not closed after 4 years old.6 In adults, 
around 65% require surgical repair8 or it 
could become problematic. The times when 
a hernia would be problematic would be 
when it becomes incarcerated which means 
it can't be pushed back into the abdomen or 
strangulation which is when the bowel 
becomes trapped and loses the blood supply, 
which will cause pain and potential 
complications. The treatment for a hernia 
would be surgery to fix the weak spot in the 
abdominal wall. The surgeon can either put 
a mesh in or they can suture the muscles 
back together. The mesh repair has a smaller 
percent reoperation rate compared to the 
open sutured repair.7 The prognosis for 
umbilical hernias is good because for the 
most part it is not serious or life threatening.  
 Ultrasound is a common method for 
evaluating hernias because it gives real time 
imaging which is something other imaging 
modalities do not offer. With ultrasound, 
radiologists are able to look at the cines of 
patients doing Valsalva. One downside of 
ultrasound for evaluating umbilical hernias 
is that it is not able to see complex things 
like strangulation in obese patients.2 Some 
other imaging modalities that could be used 
to evaluate hernias are CT and MRI. They 
are good for giving a more comprehensive 
evaluation of hernias when the hernia is 
complex and to see potential complications 
such as obstructions or strangulation. The 
primary risk of CT and MRI is the exposure 
to ionizing radiation. It is important to keep 
that exposure amount as low as possible, 
which is one reason why the use of 
ultrasound is commonly used to evaluate 
hernias. Some patients may also have 
allergic reactions to the contrast dye used 
during the CT scan to enhance the visibility 
of certain structures or abnormalities.  
  
Conclusion  
Lack of childcare was the reason for the 
patient missing her first appointment, and it 
is a common healthcare access barrier that 
many parents face. High cost and need for 
childcare is one of the most common 
barriers to accessing healthcare. And in a 
survey given to veterans more than half the 
people said childcare issues caused them to 
miss appointments.4 One suggestion for 
improvement is to decrease the cost of 
childcare. It is well known that childcare is 
very expensive it should be made more 
affordable so that everyone has access to it. 
Another suggestion is to integrate childcare 
into healthcare services. Hospitals and 
clinics can have a playground or daycare 
area where parents can drop off their 
children for their doctors' appointments. 
And my last suggestion is to offer more 
evening and weekend availability because 
patients might have more childcare options 
during those times  
  
Ethical statements  
Ethics Approval: Ethical approval was not 
sought for the present study because the 
information provided is for medical and 
educational purposes.  
Informed consent: Informed consent was not 
sought for the present study because all case 
data were de-identified and/or aggregated 
and followed ethics committee or IRB 
guidelines  
Declaration of conflicting interests: The 
authors declared no potential conflicts of 
interest with respect to the research, 
authorship, and/or publication of this 
article.  
Funding: The authors received no financial 
support for the research, authorship, and/or 
publication of this article.  
 
 
 
 
 
 
 
 
 
 
 
  
  
References:  
1. The abdominal wall and hernia. In: 
O. James Garden  Rowan W. 
Parks  and Stephen J. Wigmore, eds. 
Principles and practices of surgery, 
eighth edition. The abdominal wall 
and hernia - ClinicalKey  
2. Dynamic Ultrasound of Hernias of 
the Groin and Anterior Abdominal 
Wall. In: Alison M. Savicke, & 
Deborah Levine, eds. Diagnostic 
Ultrasound Sixth Edition. 
Philadelphia Elsevier. Dynamic 
Ultrasound of Hernias of the Groin 
and Anterior Abdominal Wall - 
ClinicalKey  
3. Nancy Strand, Mark Malangoni, 
Brian Heniford. Adult umbilical 
hernia. ACS. April 2016. Accessed 
May 12, 2025. 
https://www.facs.org/for-
patients/the-day-of-your-
surgery/adult-umbilical-
hernia/#:~:text=Ten%20percent%20
of%20all%20hernias%20in%20adult
s%20are%20umbilical.&text=They
%20are%20three%20times%20more
,abdominal%20muscles%20start%20
to%20weaken.  
4. Shepherd-Banigan M, Cannedy S, 
Rodriguez A, et al. Veteran 
caretaker perspectives of the need 
for childcare assistance during 
health care appointments. Women’s 
Health Issues. 2024; Veteran 
Caretaker Perspectives of the Need 
for Childcare Assistance During 
Health Care Appointments - 
ScienceDirect  
5. Jain, S., Higashi, R. T., Salmeron, 
C., & Bhavan, K (2024). The 
intersection of childcare and health 
among women at a U.S. saftey-net 
health system during the COVID-19 
pandemic: a qualitative study. Health 
Equity, 8(1), 32-38. 
https://doi.org/10.1089/heq.2023.006
8   
6. Abdominal Hernias and Gastric 
Volvulus. In: Mark Feldman, 
Lawrence S. Friedman, and 
Lawrence J. Brandt. Gastrointestinal 
and livaer disease, eleventh edition. 
2021 by Elsevier. Abdominal 
Hernias and Gastric Volvulus - 
ClinicalKey  
7. Abdominal wall reconstruction. In: 
David H. Song, Joon Pio Hong. 
Plastic Surgery, Volume four: Lower 
Extremity, Trunk, and Burns. Fifth 
Edition. Copyright © 2024, Elsevier. 
Abdominal wall reconstruction - 
ClinicalKey  
8. Holt AC, Bamarni S, Leslie SW. 
Umbilical Hernia. In: StatPearls. 
Treasure Island (FL): StatPearls 
Publishing; February 27, 2024. 
Umbilical Hernia - PubMed  
 
  
 


Case Study: Umbilical Hernia

Flaming, James

Fragments 
Volume 65 Lust Article 9 
2023 
Volatile 
James Flaming 
Seattle University 
Follow this and additional works at: https://scholarworks.seattleu.edu/fragments 
Recommended Citation 
Flaming, James (2023) "Volatile," Fragments: Vol. 65, Article 9. 
Available at: https://scholarworks.seattleu.edu/fragments/vol65/iss1/9 
This Poetry is brought to you for free and open access by the Seattle University Journals at ScholarWorks @ 
SeattleU. It has been accepted for inclusion in Fragments by an authorized editor of ScholarWorks @ SeattleU. 
Volatile	
By	James	Flaming 
Touch	is	the	kind	of	drug	that	turns	me	volatile 
Love	me	with	caution,	sudden	movements	have	been	known	to	be	volatile 
  
Hidden	in	a	canopy	of	green;	bark	and	book	in	child	hands	 
Paper	thin	comforts	are	best	when	the	work	waxes	quickly	volatile	 
  
Buzzing,	dripping	neon	with	too-bright	headlights	while	 
Flipping	through	day-night	dreams,	can’t	you	see?	My	attention	is	volatile 
  
Doormat	greetings	can	be	chipped	away	by	tone 
Flint-sharp	words	behind	anger’s	key,	volatile 
  
And	James!	Halt	dissociation.	5,	4,	3,	2,	1,	spark	wires,	reconnecting	to	
eroding	rivers,	 
emotion.	Now	let	me	be	free,	volatile.	
	 	


Volatile

Stipkovits, Caleb

El-Sherbeeny, Abdullah

Seattle University 
ScholarWorks @ SeattleU 
The Spectator Online Newspapers 
5-28-2025 
2025-05-28 Pride Funding Deficits Emphasize Importance of 
Community 
Caleb Stipkovits 
Abdullah El-Sherbeeny 
Follow this and additional works at: https://scholarworks.seattleu.edu/spectator-online 
The Spectator • May 28, 2025 • https://seattlespectator.com/2025/05/28/pride-funding-deficits-
emphasize-importance-of-community/
Pride Funding Deficits
Emphasize Importance of
Community
Caleb Stipkovits and Abdullah El-Sherbeeny
For 50 years, Seattle’s Pride Month festivities have been
some of the city’s most iconic staples. Each year, hundreds
of thousands of people join in to celebrate through parades,
events and even reviewing Pride merchandise. But with
Pride Month just a few days away, this year’s celebrations
might look different.
April articles published in the Seattle Times and The
Stranger reported that the city’s two largest Pride
organizers, Seattle PrideFest and Seattle Pride, are
struggling to gather sponsorship funding this year. Seattle
PrideFest, which throws events in Capitol Hill and Seattle
Center, reported being short one-third of its sponsorship
funding—a $75,000 deficit. Seattle Pride, who organizes
the Seattle Pride Parade and several other events, is
$350,000 short of its $1.5 million budget.
The funding deficits have many Seattle University students feeling unsurprised, including Fourth-year Communication and Media
Major Kevin Rocha.
“I was expecting this, if I’m being honest. With the current administration and so many companies like Target pulling out of their DEI
initiatives, it’s not surprising for a city like Seattle… [to be] losing their supporters, especially with a lot of the supporters and donors
being big companies and corporations,” Rocha said.
Zam Ortega
There are a few reasons that Pride event sponsorships have decreased this year. As Rocha mentioned, several corporate sponsors
have pulled out as a result of Diversity, Equity and Inclusion (DEI) rollbacks. This hasn’t completely diminished funding for the two
organizations, but it is one of the leading factors. 
Third-year Criminal Justice and Forensic Psychology Major Masee Anderson believes that corporate sponsors pulling out this year
shows that their previous support was performative.
“Them pulling out shows that while they were ‘committed to DEI’ under the Biden administration… it was all performative, and that
none of this was long-lasting,” Anderson said. “None of this did anything that truly mattered for the community that I’m in because
they completely flipped the script.”
Anderson first heard of the corporate cuts in class, which was not surprising to her. She cited the rollback of DEI policies as the
reason she expected Seattle’s Pride celebrations to be affected, and also pointed out that Pride events all over the country have lost
funding.
While a loss of corporate sponsorships doesn’t tell the full story of why Pride organizers are strapped for cash, it certainly is a major
contributor to the deficit. Another reason for the shortfall can be tied to the organizers themselves—Pride event planners have
been more selective with their sponsors this year. 
Seattle Pride vetted potential 2025 sponsors based on LGBTQ+-friendly workplace policies, political donations, relationships with
Immigration and Customs Enforcement (ICE) and other factors. As a result, the organization cut ties with sponsors that didn’t meet
its ethical codes.
This has led to Seattle Pride parting with major sponsors, including Washington aerospace giant Boeing. Seattle Pride will still
receive funding from major companies such as Alaska Airlines, Starbucks, QFC and Pokémon. 
Other sponsors, notably smaller companies and businesses, have pulled out due to financial constraints and the presumed impacts
of President Donald Trump’s tariff policies. While sponsorship shortfalls aren’t predicted to impact this year’s events, they could
affect future Pride celebrations as early as 2026.
While 2025’s celebrations are facing budget deficits, both Seattle PrideFest and Seattle Pride hope to make up ground through
individual donations. Seattle PrideFest has set up a GoFundMe to raise back some of the $75,000 they are short of this year. As of
publication, the fundraiser has brought in over $13,000.
Rocha worries that current DEI rollbacks could further affect Pride celebrations in the future.
Ahmed Abdirashid-Abdullah
“It’s the [Trump administration’s] first summer, there’s still three more to go,” Rocha said. “I just wonder what else they could do, and
there’s plenty they could do to make this worse.”
For some, recent Pride sponsorship cuts don’t just signal a setback to the events themselves, but to inclusivity as a whole. Anderson
believes this speaks to President Trump’s policies and intentions.
“In my mind, the whole plan is to finish [Project 2025], which would create a non-inclusive America, a non-inclusive USA. And I’m
not saying we’re 100% inclusive, we have our problems. But this will make it where homophobia, transphobia [and] LGBTQ+ hate is
much more prevalent than it already is,” Anderson said.
Several policies that Trump’s administration has implemented have been criticized for being anti-LGBTQ+, notably a ban on
transgender people serving in the military. Trump also enacted an Executive Order stopping passports from reflecting a trans
person’s gender, among other restrictions.
Seattle U responded to Trump’s military ban in support of its transgender students. In a January email sent to Seattle U students,
faculty and staff, President Eduardo Peñalver and Senior Vice Provost Tamara Herdener wrote that any ROTC student affected by
the legislation would have their scholarships honored by the school.
Close to campus at Cal Anderson Park this weekend, political tensions boiled over when a rally organized by right-wing group
Mayday USA was met by a wave of counter-protesters, leading to several arrests. The rally and counterprotests made national
headlines, putting Seattle at the forefront of the national conflict surrounding trans issues and reproductive rights.
The rally incident, Pride event funding issues, and new policies have been difficult for many LGBTQ+ Seattleites. The current
political climate has also left a mark on many students, and Seattle U’s clubs and organizations are starting to take notice.
Collin Durfee is a fourth-year political science major and the event coordinator of the Triangle Club, which provides a safe space for
LGBTQ+ students and allies. Although he isn’t sure if Trump’s rhetoric has prevented students from attending meetings, he has
noticed a trend in attendance.
“What we have seen is that a lot of queer students seem afraid to come to us for our meetings… I don’t know if that’s out of fear [of]
backlash over homophobic students finding out they’re going to [Triangle Club] meetings, or if it’s something else entirely, but I have
noticed that compared to meetings last year, we get about half the amount of people,” Durfee said.
Despite uneasy feelings about the current political landscape and what the national defunding of Pride events could entail, student
Annabelle DeGuzman-Carino
groups and school organizations hope to make a difference.
One of those organizations is Seattle U’s MOSAIC Center, which offers several resources for LGBTQ+ students. The Center
operates the Pride Link, located on the third floor of the Student Center, a space that supports LGBTQ+ students. MOSAIC also
runs the Gender Affirmation Support and Products Program, which provides care products and other resources to Trans and non-
binary students through appointments. The Center also partnered with the Social Work Department to host Trans solidarity
workshops for staff and faculty and a name and gender marker change clinic, also in collaboration with the law school. Tacadena
said the Social Work Department spearheaded both of those efforts.
As for future ways MOSAIC can continue to support LGBTQ+ students, Assistant Director Brandon Tacadena has some ideas.
“I think further collaboration with community org[anization]s  is important, because we’re near Capitol Hill… there’s a lot of queer
nonprofits that are set [up] here. I think we should be in relationship with these folks, and be able to share these resources and
[make] sure that students are supported,” Tacadena said.
The Triangle Club is also planning for the future. Durfee shared that the organization is planning to ramp up operations next school
year to better serve Seattle U’s LGBTQ+ community.
“We’re hoping that next year we’re going to hold a lot more meetings, and hopefully more people will have the opportunity to check
us out, and [we want to start] earlier in the year too so we get a solid base to support Triangle Club as it moves forward,” Durfee said.
Fourth-year Communication and Media Major Avani Koganti called upon the LGBTQ+ community and its allies to make the change
they want to see.
“The administration is what it is right now, but correcting it and being active in your community on a local level will make those
larger impacts,” Koganti stated.
While Pride may look smaller this year, the reduction in corporate sponsorship and administrative support for the LGBTQ+
community does not negate the celebration of Pride in Seattle. Parades will still march through downtown Seattle and LGBTQ+
friendly local organizations will continue to uplift the queer community throughout June and beyond.


2025-05-28 Pride Funding Deficits Emphasize Importance of Community

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Scott, Tristan

2025-03-12 Superheroes Storm Seattle as Emerald City Comic Con Returns

Bunker, Leila

Seattle University 
ScholarWorks @ SeattleU 
The Spectator Online Newspapers 
6-4-2025 
2025-06-04 Saying a Beloved Goodbye to Graduating Spectator 
Editors 
Leila Bunker 
Seattle University 
Follow this and additional works at: https://scholarworks.seattleu.edu/spectator-online 
Recommended Citation 
Bunker, Leila, "2025-06-04 Saying a Beloved Goodbye to Graduating Spectator Editors" (2025). The 
Spectator Online. 1547. 
https://scholarworks.seattleu.edu/spectator-online/1547 
This Article is brought to you for free and open access by the Newspapers at ScholarWorks @ SeattleU. It has been 
accepted for inclusion in The Spectator Online by an authorized administrator of ScholarWorks @ SeattleU. 
The Spectator • June 4, 2025 • https://seattlespectator.com/2025/06/04/saying-a-beloved-goodbye-to-
graduating-spectator-editors/
Saying a Beloved Goodbye to
Graduating Spectator Editors
Leila Bunker, News Editor
The Spectator is the result of the work of dedicated editors,
designers and photographers week after week. Every year
brings a new set of uniquely talented and dedicated
individuals who work to make The Spectator more
excellent. With the excitement of a new Editorial Board
every year, a bittersweet goodbye must follow. 
So, to the graduating members of our team, we bid you
farewell.
Tyra Okuda, Graduating Copy Chief & Online Editor
Tyra has been The Spectator’s secret weapon for the past
two years. Her keen eye for detail and meticulous fixation
on removing Oxford commas, which is arguably the most
devastating punctuation rule in AP Style, though, for her,
it’s having to omit the use of “on” before a date, is the
reason why The Spectator is as polished as it is. Despite a
heavy hand in editing for technicality, Tyra is a gentle, warm person
whose laughter is contagious. Her calm demeanor is a constant
reminder that everything will be alright. 
Her advice to those who may be considering joining The Spectator
but are hesitant, or to those who have taken on assignments in the
past but were unfulfilled with their experience, is not to entirely
rule it out. 
“I would say try it once and if you don’t like it, try it again, because
every week is so different and every article is so different
depending on what you pick up, and it can actually be really fun.”
Tyra will be moving back home and returning to school at the
University of Hawaii to pursue a second bachelor’s degree in civil
engineering. 
Daniel Truog, Graduating Sports & Opinion Editor
Daniel possesses an intelligent wit and a passion for storytelling. His humor underscores both his writing and conversations, as he
Sasha Volovnikov
The graduating members of the editorial board prepare for the
journey ahead.
Sasha Volovnikov
consistently makes others laugh with his jokes and clever prose. Don’t be fooled by his comedy, though; Daniel is a deeply thorough
journalist who is committed to excellence. 
He has also (probably) increased our readership this year by going up to people he doesn’t know, insisting they take a copy of the
print on distribution days—a testament to his excitement about what he, amongst many others, produces at The Spectator. 
“It is so special that every week we have something you can hold in your hands as a representation of the creativity, passion [and]
effort that everyone put into this one piece of paper, well, several pieces of paper… I’m gonna miss everybody a lot.”
Daniel will be attending Oregon State University in the fall as a graduate research assistant, pursuing a master’s degree in fish,
wildlife and conservation science. But before then, he may be painting the radio tower in Capitol Hill. If you go to Trader Joe’s on
Madison Street amid a summer day, be sure to look up. 
Madi Oswalt, Graduating Social Media Manager
One of our most fashionable editors, Madi is the face behind The Spectator’s social media accounts. Madi is a calming presence with
a sense of humor that is both humble and encompassing. A distinctive voice both in writing and in cadence, Madi is a unique
individual who brings her love for pop culture, arts and fashion thoughtfully into every conversation.
Having been a part of The Spectator in multiple different roles throughout her three years, from staff designer to arts &
entertainment editor, she is well-versed in many facets of student journalism. She encourages any students on the fence about
joining The Spectator to give it a try. 
“Don’t be afraid to come check us out. We’re all really nice. I know it can feel intimidating and look like on the outside that everyone
is already a group, but we’ll welcome you with open arms, and everyone is happy to teach you and we’re all learning together.”
After graduation, Madi will be returning to her hometown of Spokane, Wash. She’s excited to take on the world of strategic
communication and marketing. 
Austin Harper, Graduating Director of Photography
Often elusive due to his employment in the Air Force, as he may be
deployed spontaneously to a random state or country, when Austin
does make an appearance, he brings a passion for team building. With
over 10 years of experience as a broadcast journalist in the military,
Austin possesses a multifaceted wheelhouse that he is eager to share.
As the king of unsolicited yet wise advice, he is always looking to
bring the best out of others. His commitment to fostering community
has significantly strengthened The Spectator’s sense of identity this
year. 
Austin encourages student journalists to be brave enough to make
mistakes and remain open to the possibilities that can arise from
them. 
“Don’t assume that because something’s been done a particular way for a long time that that’s the way it has to be done. Be willing
to try. Be willing to fail. College journalism is a really great place to get your wiggles out.” 
Austin will be temporarily relocating to San Angelo, Texas, for further military training, but will return to Seattle to work as a police
officer at the Port of Seattle. 
Caleb Stipkovits, Graduating Managing Editor 
Caleb’s commitment to journalism is a result of his tenacious spirit. His kindness and ¾ zips may lead some to paint him as an
everyday guy, but Caleb has a sharp judgment and ambition not commonly found. Caleb’s charisma is rivaled only by his deep
haterness. Caleb does not discriminate in his dispenses of critique—pickleball, rival NBA teams and people who try to take down the
press. 
Caleb’s advice to aspiring journalists is to trust their instincts and also prioritize their well-being.
Sasha Volovnikov
“If you’re younger, if you’re a freshman, if it’s your first quarter, it’s OK to take some time before you come here. I know for me
personally, that’s what worked best for me, but understand that you can’t wait forever.”
He brings an endearing charm to every space he enters, which is a quality that can’t be taught, can’t be bought and can’t go unseen
by anyone who has the pleasure of crossing his path. Caleb will be heading to Kennewick, Wash., to begin his career as an on-air
reporter. KVEW will be lucky to have a dedicated and skilled media personality in their presence. 
Zam Ortega, Graduating Lead Designer 
Zam has a calm and collected nature, as well as a unique ability to bring people together through their passion for design. A sharp
sense of humor complements her gentle demeanor, often inspiring moments of spontaneous laughter. 
Something so special about working with Zam is the moment when you first see what they’ve been cooking up for the week’s
designs. Scientists recently discovered a new color. Here at The Spectator, Zam’s been inventing new colors all year with their
stunning designs. 
Not only will she miss the feeling of holding a fresh printed copy of The Spectator every week, but also the other designers who also
made the plethora of this year’s editions possible.
“I love the community. Being able to produce something that we can all hold in our hands, and just the appreciation of print media, is
so amazing… I think the design team is so gold, and part of that comes with the appreciation of their growth… I’ve been able to look
at their work from the beginning of the year and see who they are today and know that they’re going to continue to do great things
without me here.”
After graduation, Zam will be moving back to their hometown and preparing for the next chapter.
Chloe Platt, Graduating Editor-in-Chief
Chloe has a special ability to not only see the beauty in everything and everyone, but also show others how even mundanity can be a
gift. Her approach to journalism is characterized by empathy and a curiosity to understand what makes a person, place or thing
unique. She genuinely believes that everyone has a story to tell and that there can be profound lessons to be learned from simply
listening to others—a minute fraction of her wisdom that all members of The Spectator have benefited from. 
As her tenure as editor-in-chief will soon come to an end, Chloe reflected on what she learned in her role.
“Everyone has just as much to give as the next person. You just need to find a way to encourage it out of them, and everyone needs a
different type of space to express themselves in. This year, especially, I’ve learned a lot about how to adapt, to give people the space
to contribute the beautiful things that we all have to contribute.”
Aspiring to become a professor, Chloe will be applying to graduate school during the fall for English and creative writing.


2025-06-04 Saying a Beloved Goodbye to Graduating Spectator Editors

Gonzalez, Diego

Seattle University 
ScholarWorks @ SeattleU 
The Spectator Online Newspapers 
1-29-2025 
2025-01-29 The State of Higher Education in 2025 
Diego Gonzalez 
Follow this and additional works at: https://scholarworks.seattleu.edu/spectator-online 
The Spectator • January 29, 2025 • https://seattlespectator.com/2025/01/29/the-state-of-higher-
education-in-2025/
The State of Higher Education in
2025
Diego Gonzalez, Volunteer Reporter
There have been a lot of issues surrounding colleges and
universities—collectively known as higher education—
across the nation. Undergraduate enrollment rates are
down, impacting universities’ financial health who rely on
them for constant revenue, leaving some institutions
uncertain of their future. 
The drop is due to multiple reasons, including but not
limited to the demographic cliff, Free Application for
Federal Student Aid (FAFSA) issues and the financial
perception of a college education. 
According to Seattle University’s InformSU data, requested
by The Spectator, first-time first-year enrollment has
decreased by 5.1% from a decade ago. While applications
are down from last year—a high for the university—in the
long run, they are up 12.5% from 2014. Overall, since 2010,
Seattle U’s total undergraduate enrollment has only decreased by 4.7%. 
Seattle U is doing comparatively well nationally as U.S. undergraduate college enrollment continues to decrease since its peak in
2010, by around 14.9% since then, according to Education Data Initiative. 
At its most extreme, enrollment declines can lead to layoffs or school closures and mergers, as seen in the University of New
Orleans and Eastern Nazarene College. The state of higher education impacts us all as students as it could lead to budget problems
for Seattle U, which could lead to changes in what the university can provide its students in faculty, resources, facilities, etc.
Zam Ortega
Demographic Cliff
Problems with the FAFSA
The “demographic cliff” or “enrollment cliff” is a term used by experts in the higher education field to refer to the lowering college-
eligible population due to the 2008 recession.
Birth rates declined due to the recession, according to Pew Research, which means that there are fewer high school students,
resulting in fewer college applicants. The impact will be felt following 2025 as that is when the traditional aged high school students
would be applying and enrolling to universities across the nation. The trend is said to continue for a decade at least, till 2035.
James Miller, associate provost and dean of admission, is hopeful for Seattle U, even at the edge of this demographic cliff. In an email
to The Spectator, he described how his hope resides in Seattle U’s faculty, staff, and academic programs to allow the university to
compete with other universities for students. 
“Our ability to better communicate the value of what already exists in considerable measure in terms of quality programs and
support will drive good outcomes in this challenging market,” Miller wrote.
Provost Shane Martin similarly wrote to The Spectator about his confidence in Seattle U’s ability to withstand the declining
enrollments. He noted how universities in the Pacific Northwest will not be as impacted as other regions of the country. Martin
mentioned that the university is expanding marketing and recruitment efforts to a wider range of potential students, in anticipation
of the demographic cliff. 
He also explained how Seattle U is uniquely positioned as a private Jesuit university to acclimate to the changing environment of
higher education. 
“Seattle University, like all institutions of higher education, regularly evaluates its academic programs using a number of metrics. As
a private institution, we are particularly well positioned to grow and adapt to the changing educational needs of society in
alignment with our mission,” Martin wrote.
In an email to The Spectator, Monica Ingram, vice provost for enrollment management, acknowledged how the FAFSA negatively
impacted enrollment for this academic year, leading to fewer enrolled students than anticipated. 
Ingram also noted that some changes to the FAFSA negatively impacted prospective and current students.
“The recent changes to the FAFSA also resulted in families with multiple children in college no longer being able to have that
consideration in determining unmet need, though the financial challenge to those families remained. Consequently, this year, when
possible, [Seattle] U increased aid awards to offset that additional need; however, our aid resources are limited,” Ingram wrote. 
Graph made by Diego Gonzalez with InformSU data provided to The Spectator
Perception of College Education
Seattle University’s Future
FAFSA impacts enrollment as, without the FAFSA, students are ineligible for some financial aid which increases their net cost of
attendance.
According to a survey from the National Association of Independent Colleges and Universities, 43% of private, non-profit
universities reported a smaller incoming class due to the FAFSA. Seattle U seems to fit within this statistic as the university
experienced a 14.7% decrease in first-time first-year students. 
This is a point of concern for the university as financial cost is the main barrier to obtaining a degree. A report from the Gallup and
Lumina Foundation found that 85% of adults cited the cost of the degree as a reason for not enrolling or for dropping out.
Martin stated that college affordability was a major concern for the university. He also provided some information on how the
university intends to support current and prospective students in the coming years when it comes to costs.
“Increasing support for student scholarships will be a major goal in our next Capital Campaign. We are also involved in initiatives to
lower the cost of instructional materials which is led by Seattle University faculty librarians,” Martin wrote.
There is an underlying issue within American society impacting higher education that is much more difficult for universities to
overcome: a decreasing confidence in higher education.
It appears that Americans do not trust that higher education is worth the ever-growing price tag. A report from the Pew Research
Center found that only one in four Americans believe that a four-year degree is needed for a well-paying job today, indicating that
people are searching elsewhere for a way to get a job.
In the podcast “Changing Higher Ed,” Robert Massa, co-founder of Enrollment Intelligence Now and vice president emeritus for
enrollment and college relations at Dickinson College, spoke about issues with enrollment. 
 “A combination of the increasing list price and a decline in the perception of the value of a college degree… has resulted in a decline
in the percentage of high school graduates going on to college,” Massa said. 
Miller critiques this argument against higher education as around 97% of Seattle U students find job placement only six months
after graduation. Furthermore, Miller states that Seattle U is rated highly in terms of return on investment, while graduates say that
they are highly satisfied with their experience. Miller disagrees with the growing sentiment that a college is not worth it anymore.
“In short, every view of current early career, mid-career, and lifelong earnings, well-being, and happiness are clear: there is no better
lifetime social mobility accelerator than earning a bachelor’s degree,” Miller wrote.
All of the previously mentioned factors play a role in decreasing enrollment, some more than others. The main concern for
universities across the nation is how they are going to deal with the changes in enrollment financially. According to Chief Financial
Officer Chris Malins, Seattle U is going into the upcoming unprecedented years with a plan. 
Malins noted how overall, revenue and enrollment have increased over time. The main issue according to him is expenses outpacing
revenue. He noted how Seattle U anticipated decreasing enrollment as they planned for a deficit between expenses and revenue,
yet he states this is the last year of deficits for the university.
Malins listed multiple ways the university is looking to decrease the deficit. One way is through targeted expense reductions, such
as selective staff hiring slowdown. He says that the university is committed to ensuring that those reductions do not negatively
impact the student experience. Malins also notes how changes to faculty and programs may be on the way, in an attempt to reduce
the deficit.
“We are addressing this longer-term challenge in part, as President Peñalver has discussed with the campus community, by aligning
our student-to-faculty ratio with our peer institutions and reviewing program offerings,” Malins wrote.
Malins is referring to President Penalver’s presidential town hall where he mentioned how. through natural attrition, the university
intends to increase the student-to-faculty ratio to better align with our fellow Jesuit universities. 
Yet, despite the uncertainty of higher education, some people’s hopes stay unwavering.
According to Miller, there are many reasons to be hopeful for Seattle U’s future. He notes how from the pandemic each first-year
class has been progressively bigger. Miller also points out how Seattle U is even doing better than other private institutions of
higher education.
“We are the most ethnically and socioeconomically diverse selective university in the State of Washington. Our outcomes for the
neediest students are nearly as good as those for the general student body, which is unusual at private universities,” Miller wrote.
As Seattle U heads into 2025, it continues to tread into unforeseen times with unexpected surprises. While the university is dealing
with a budget deficit and decreasing enrollment, it is also receiving a $300 million art donation and could welcome around 400 new
students in a possible Cornish College of the Arts merger.
Due to an amalgam of social and financial factors, the state of higher education is in a deeply transitory period, of which Seattle U is
no exception.


2025-01-29 The State of Higher Education in 2025

Leyden, Henry

Seattle University 
ScholarWorks @ SeattleU 
The Spectator Online Newspapers 
3-5-2025 
2025-03-05 Grab a Putter! It’s Time to Smash. 
Henry Leyden 
Seattle University 
Follow this and additional works at: https://scholarworks.seattleu.edu/spectator-online 
Recommended Citation 
Leyden, Henry, "2025-03-05 Grab a Putter! It’s Time to Smash." (2025). The Spectator Online. 1534. 
https://scholarworks.seattleu.edu/spectator-online/1534 
This News Article is brought to you for free and open access by the Newspapers at ScholarWorks @ SeattleU. It 
has been accepted for inclusion in The Spectator Online by an authorized administrator of ScholarWorks @ 
SeattleU. 
The Spectator • March 5, 2025 • https://seattlespectator.com/2025/03/05/grab-a-putter-its-time-to-
smash/
Grab a Putter! It’s Time to
Smash.
Henry Leyden, Volunteer Reporter
Over 15
years ago,
in the
midst of a
global
financial
crisis that
saw
buildings
vacated
across the
country, a
“gonzo”
interactive art exhibit was born. Half sport, half mixed-material sculpture making, a warehouse on the corner of E Madison Street
and 10th Avenue, just outside the confines of our university campus, would be the first to host this eclectic project. 
The alcohol-infused spectacle? Smash Putt. Here, mini golf melded with the vision of local Seattle artists from various disciplines to
create a stunningly unique display. Each hole is its own thematic creation where the goal isn’t to win, but rather to investigate and
play with the artistic piece before you—sometimes even to the point of breaking it (an accepted externality of the business). 
Over the next decade, Smash Putt became a staple of the Seattle art scene under creator Jeremy Franklin-Ross and the collective
effort of others. Flitting from venue to venue for a few months out of the year, constantly changing out old holes for new ones while
retaining the classics—a sort of golf-ball-gatling-gun, where the goal is simply firing your ball at objects that make a loud noise, has
been a feature at every Smash Putt iteration since.
Unfortunately, Smash Putt in its first form came to an end in 2017 following what seemed to be  general fatigue and a desire to
move on to new creative enterprises. Former attendees mourned. 
But an idea as good as Smash Putt will always be the perfect candidate for a revitalization effort. 
Henry Leyden
One of Smash Putt’s VIP rooms, available for parties and private
events.
The “green” on one of Smash Putt’s more
shocking holes requires you to putt past
this wall. (Henry Leyden)
Eight years later, the ephemeral production is back under new management. Nick Ferderer, the founder and creative director of
Base Camp Studios 2, in what was formerly Bergman Luggage’s Belltown location, has been hosting Smash Putt in his studio space
since mid-February.
Ferderer got inspired to do Smash Putt after talking to an artist from Base Camp’s first gallery show at the Bergman location.
“The neon guy, he’s like, dude, you should do Smash Putt. I was like,
what’s Smash Putt? And he’s like, it’s miniature golf on acid. I was like,
say no more,” Ferderer said.
Despite the long hiatus, the chaotic yet highly collaborative nature of
Smash Putt is still flourishing. 39 artists have collaborated across the
11 current holes.
“[We would] propose a hole with the guidance being like, what’s the
craziest, kookiest thing that you can think of? And then the kookiest
ones, you’re like, yeah, let’s go,” Ferderer explained.
He wasn’t kidding, there is a diverse range of artistic expression
represented at Smash Putt. Some holes have impressive techy rigs
with virtual golf balls and lasers, while another features realistic
penises jutting out from a line of bathroom stall doors, each furnished
with a glory hole. You finish by putt-ing your ball into a toilet full of
fake feces. 
Smash Putt’s university ties don’t start and end with its beginnings in a Lark-adjacent warehouse.
One of the standout pieces, “Floor is Lava,” was created by Base Camp Operations Director Paul Nunn, a former Seattle U Master of
Fine Arts (MFA) graduate. Nunn explained that his primary motivation for the piece was to provide a space for golfers to climb and
have fun, harkening back to elementary school playground days. 
The hole features a three-story wooden structure that must be climbed in order to place your ball onto an intricate metal ramp
system that eventually dispenses onto the green. Be careful not to touch the ground when going to putt your ball in; it’s lava. 
The Smash Putt team also features some current Seattle U scholars. Madi
Stephens and Danielle Librera have both been working on the Smash Putt project
as interns while attending Seattle U’s MFA program for art leadership.
Stephens has helped to develop Smash Putt’s brand identity, as well as curate
special event nights. Her favorite thing to work on was creating a run of poster ads
with sexual innuendos revolving around the “smash” in Smash Putt. One of her
favorites was “it’s not cheating if it’s smashing,” others were too explicit for this
article. All were effective attention grabbers. 
Librera has been helping the Base Camp team by copywriting while also reaching
out to media contacts to promote the event. Having lived in Belltown for the last
fourteen years, Librera said Base Camp’s second location was a welcome surprise
for a community devastated by the pandemic, and a motivator to intern with
them. 
Once inside the operation, her gratitude for what was being created there only
grew.
“I’ve seen interactive exhibits before and participated in them, but not one at this
level… they’re actually, like, inviting you to beat the hell out of this art. I think it’s
kind of ballsy of the artists to welcome that,” Librera said. 
It’s precisely this kind of vulnerability that lets Smash Putt be a space for rich artistic creation, and a fun consumer product. If you
This hole, Floor is Lava, encourages golfers to commit
to a small climb. (Henry Leyden)
The “Quantum Putt” hole was
unfortunately unavailable due to previous
rough usage. (Henry Leyden)
find yourself looking for a night out that you won’t forget anytime soon, head to Smash Putt—but don’t wait too long, just like the
Smashers of the 2010s, the run-time is unspecified and certainly temporary.


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