Journal of Clinical Ultrasound最新文献

Vesicovaginal reflux (VVR) is a functional disorder seen in girls and women. It may be asymptomatic or cause incontinence and dribbling symptoms. It is often associated with high body mass index (BMI) and infrequent voiding or abnormal voiding position. It is important to be aware of this entity as it can be mistaken for a vesicovaginal or urethrovaginal fistula or hydrocolpos on imaging all of which require surgical treatment. The fluid collecting in the vagina in VVR is urine which refluxes during micturition via the introitus from the urinary bladder into the vagina and can leak out later. In a typical case, urocolpos is seen as an anechoic fluid collection in the vagina during transabdominal sonography of the pelvis with a full bladder. It usually diminishes in size and can disappear when the patient is reassessed after voiding the urine completely. Knowledge of this entity in a patient with the classical body habitus is helpful in preventing an unnecessary imaging odyssey and causing anxiety to the patient. Treatment of VVR is by modification of toileting behavior and weight loss.

The third-trimester ultrasound diagnosis in two fetuses with isolated testicular torsion is described. Pregnancy courses were uneventful and routine second-trimester scans had shown no structural anomalies. Antenatal ultrasound performed at 32 + 3 and 33 + 0 weeks' gestation showed signs consistent with the diagnosis of isolated left spermatic cord torsion in both cases (absent flow across the testicular artery, hyperechogenic small rounded mass in the hemiscrotum representing the twisted testes, and hydrocele). Although testicular torsion may occasionally occur in utero, these acute events have been scanty reported in the prenatal literature. As a consequence of the ischemic injury, the rate of salvage of the affected testis is extremely low.

Traditionally, computed tomography angiography has been considered the gold standard for diagnosing renal arteriovenous malformation (AVM). Despite the sensitivity of ultrasound in detecting AVM through Doppler techniques, it often lacks the ability to provide detailed insights into the lesion. In this narrative, we present a case of unexplained hematuria accompanied by flank pain, which was conclusively diagnosed as congenital renal AVM via multimodal ultrasound. The pivotal contributions of color Doppler ultrasound and contrast-enhanced ultrasound are that they are instrumental in enabling an early and markedly precise diagnostic pathway.

Giant cell tumor of soft tissue (GCT-ST) is an extremely rare phenomenon in the breast. Herein, a case involving a 75-year-old female with a painless lump and bloody discharge from the nipple of her left breast is reported. A diagnosis of malignant tumor was arrived at by observing the location of the tumor, interior echo, margins, vascular distribution, hardness, and microvascular density on preoperative multimodal ultrasonography. However, no evidence of malignancy was found on ultrasonography-guided nuclear needle biopsy or rapid intraoperative pathological examination. Subsequently, an excisional biopsy was performed, and GCT-ST coincident with high-grade ductal carcinoma in situ were confirmed using histopathology and immunohistochemistry. Accordingly, the patient underwent left-sided mastectomy and sentinel lymph node biopsy. This case emphasizes the complexity of the clinical and pathological diagnosis of GCT-ST in the breast and may raise the awareness of clinicians and sonographers to the advantages of multimodal ultrasound imaging in the diagnosis of GCT-ST in the breast. Pathologists should consider the possibility of GCT-ST when encountering a giant cell-rich mass in the breast.

A 40-year-old woman presented with chronic left anterior shoulder, upper arm, and axillary pain following a routine mammogram 3 years prior. Despite multiple interventions, her pain persisted significantly affecting her quality of life. Ultrasound examination revealed fascicular edema in the medial brachial cutaneous nerve (MBCN), intercostobrachial cutaneous nerve (ICBN), and a positive sono-Tinel. Ultrasound-guided hydrodissection of these nerves provided complete axillary pain relief and significant improvement in anterior arm pain, sustained for 6 months. This case highlights the diagnostic challenges of cutaneous nerve entrapment syndromes, often overlooked and misdiagnosed, especially without a clear inciting injury. Ultrasound proves superior to electrodiagnostic studies in visualizing nerve pathology, particularly in small cutaneous nerves. Incorporating ultrasound into the diagnostic process for nerve entrapments can reduce the need for more expensive tests like magnetic resonance imaging (MRI) with the added benefit of therapeutic intervention. Moreover, routine mammography should be considered a cause for ICBN and MBCN neuropathy, a rare but significant condition. Neuromuscular ultrasound offers distinct advantages in diagnosing and treating such neuropathies, exemplified by the successful management of our patient's condition.

Gossypiboma, or retained surgical sponge, is a rare post-surgical complication with very few reported cases due to medico-legal purposes. Diagnosis is very challenging due to the myriad of clinical presentations and imaging features. We present the case of a gossypiboma detected in a 72-year-old female with a recent history of vaginal hysterectomy. We describe the imaging findings in detail with the step-wise use of X-rays and ultrasound in raising suspicion and computed tomography (CT) and magnetic resonance imaging (MRI) to rule out other differentials and finally come to the diagnosis of gossypiboma, which was confirmed surgically.

Objective: This study aimed to evaluate the association between ophthalmic artery (OA) Doppler indices and adverse neonatal outcomes in women with pregnancies complicated by preeclampsia (PE).

Methods: A prospective cross-sectional study involving 110 pregnant women who were diagnosed with PE in the first 24 h of hospitalization was conducted at three hospitals in southeastern Brazil from April 2020 to December 2022. The ophthalmic parameters analyzed were the resistance index (RI), pulsatility index (PI), first peak systolic velocity (PSV1), second peak systolic velocity (PSV2), ratio of PSV2 to PSV1 (PSV ratio or the peak ratio [PR]), and end-diastolic velocity (EDV). The outcome measures were neonatal death (during hospitalization), neonatal intensive care unit (ICU) admission, gestational age at delivery < 32 weeks, birth weight < 1500 g, birth weight < 10th percentile, the presence of comorbidities associated with prematurity, the use of invasive mechanical ventilation, an Apgar score at the 5th minute < 7.0, and signs of neurological impairment.

Results: Pregnant women with severe features of PE showed higher values of systolic (152.8 ± 20.7 vs. 136.3 ± 11.9, p = 0.000) and diastolic (98.1 ± 12.8 vs. 88.1 ± 10.8, p = 0.000) blood pressure values and lower gestational age at admission (31.5 ± 3.8 vs. 33.7 ± 4.3, p = 0.009) than PE without severe features. No significant differences were found between the mean values of the OA Doppler indices when comparing the presence or absence of neonatal outcomes in the women with PE.

Conclusions: OA Doppler, while valuable for the prediction, diagnosis, and evaluation of adverse maternal outcomes, does not independently predict adverse neonatal outcomes in women with severe features of PE.

Objective: The aim of this study was to compare prenatal ultrasound markers and perinatal outcomes in newborns with simple and complex gastroschisis.

Methods: A retrospective cohort study was performed on pregnant women with gastroschisis fetuses and their respective newborns between 2009 and 2019. Binary logistic regression was used to determine the best prenatal ultrasound markers of complex gastroschisis and adverse perinatal outcomes.

Results: After delivery, 36 gastroschisis were classified as simple and 10 as complex. Newborns with complex gastroschisis had a higher prevalence of early neonatal death compared to newborns with simple gastroschisis (30.0% vs. 2.8%, p = 0.007). The abdominal wall defect diameter became a significant prenatal ultrasound marker of neonatal sepsis [X2: 6.31 (1), OR:0.92, CI 95% (0.85-0.98), p = 0.020]. The presence of complex gastroschisis [X2: 7.33 (1), OR: 23.25, CI 95% 1.92-280.77, p = 0.013] was the only significant predictor of early neonatal death, and the presence of complex gastroschisis increased the risk of early neonatal death by 23.25 times. There was no significant effect of the type of gastroschisis in relation to gestational age, amniotic fluid index, intra-abdominal intestinal dilation, extra-abdominal intestinal dilation, and thickness of the intestine diameter.

Conclusion: Abdominal wall defect diameter was a significant prenatal ultrasound marker of adverse perinatal outcomes in newborns with simple and complex gastroschisis. Complex gastroschisis was a significant predictor of early neonatal death.

Peripheral nerve sheath tumors of the hand are rare occurrences. Among them, schwannomas are benign tumors originating from peripheral nerves. In this case report, we presented a patient with schwannomas in the palm, examined using ultrasound for preoperative assessment and was confirmed by pathological specimen. By highlighting the utility of ultrasound in detecting this condition, we aimed to enrich existing literature and ultimately enhance patient outcomes.