Journal of Clinical Ultrasound最新文献

Objective: To evaluate the clinical manifestations and ultrasonographic characteristics of glomus tumors under the nails and other subcutaneous soft tissues.

Methods: A retrospective analysis was performed on 45 patients with pathologically confirmed glomus tumors who underwent ultrasonographic examination at our institution between October 15, 2019, and April 8, 2025. Twenty tumors were in subungual and 25 were in extrasubungual subcutaneous tissue. Clinical parameters and ultrasonographic findings by a linear transducer (15-18 MHz) were systematically documented.

Results: Among the 45 glomus tumors, the maximum tumor diameter ranged from 0.2 to 2.8 cm. Ultrasonographic features showed that 93.3% of lesions were hypoechoic, 88.9% exhibited regular shapes, 84.4% displayed well-defined borders, 73.3% showed rich vascularity, and 59.1% featured a perilesional "vascular stalk sign." Eighty percent of subungual glomus tumors presented with adjacent osseous involvement.

Conclusion: The characteristic ultrasonographic presentation of subcutaneous glomus tumors comprises a hypoechoic mass with regular contours, distinct margins, and abundant internal vascular flow. Perilesional osseous changes can usually be observed in subungual glomus tumors.

Objectives: The widespread use of ultrasound in prenatal care raises concerns about fetal safety due to acoustic exposure. This study compared the thermal index (TI), mechanical index (MI), and scan duration between Doppler and B-mode examinations, while identifying the clinical indications for the use of Doppler.

Methods: A cross-sectional study was conducted on 264 pregnancy ultrasound examinations performed at one educational hospital and two private clinics. Certified radiologists and gynecologists performed all scans. Data were collected using a structured checklist. Scan modality, gestational age, TI, MI, scan duration, and clinical indications were recorded. Convenience sampling was used. Statistical analysis was performed using SPSS version 26, with significance set at p < 0.05.

Results: Doppler scans comprised 23.5% of all examinations and were primarily indicated for intrauterine growth restriction (IUGR) and maternal hypertension. TI values were significantly higher in Doppler scans, while MI values exceeded the recommended threshold (0.4) across both modalities, especially in B-mode scans. Scan durations were longer for B-mode during later gestational weeks. No significant differences in safety indices were observed across imaging centers or ultrasound systems.

Conclusion: Although TI values remained within recommended safety ranges, persistently elevated MI values emphasize the need for vigilance. Doppler should not be routinely restricted but reserved for clinically justified cases. Sonographers should actively monitor TI and MI values during scans and minimize exposure time, adjusting scan duration according to gestational age and modality to ensure fetal safety.

Polypoid ganglioneuroma in the descending colon is rare and typically confined to the mucosa and submucosa. This report presents a pediatric case initially detected by ultrasonography as descending colon intussusception with significant bowel wall thickening. The tumoriform pathological lead point was identified during ultrasound-guided hydrostatic reduction, which was ultimately confirmed by postoperative pathology as an atypical polypoid ganglioneuroma infiltrating the muscular layer. We discuss the clinical value of ultrasonography and the risks associated with deep infiltration. Furthermore, we summarize the sonographic features of the lesion, which manifest as a broad-based, hypovascular solid mass accompanied by bowel wall thickening.

Abdominal pain is a common presenting complaint in the pediatric emergency department. Here, we present a three-year-old boy with acute on chronic abdominal pain found on point of care ultrasound (POCUS) to have cholelithiasis in a choledochal cyst on POCUS. This is the first case of a choledochal cyst on POCUS in the medical literature, and led to early and definitive treatment. This case highlights the potential utility of POCUS as a diagnostic tool in all cases of pediatric abdominal pain, emphasizing its role in early detection and intervention.

Pentasomy 49,XXXXY is a rare sex chromosomal abnormality characterized by three extra X chromosomes in a male fetus. This condition is not related to maternal age, and phenotypic representations are non-specific. Prenatal diagnosis of this condition is challenging with very few antenatally diagnosed cases. This case report discusses the prenatal diagnosis of 49,XXXXY using thickened nuchal fold as a pointer in the second trimester of a first-trimester low-risk pregnancy. Amniocentesis with fluorescence in situ hybridization (FISH) and karyotyping confirmed the diagnosis. This case highlights the significance of prenatal markers and their utility as a broader tool for other chromosomal anomalies beyond Trisomy 21, including sex chromosomal anomalies and the importance of a targeted anatomical survey for other signs of such anomalies. This approach would aid in patient counseling, genetic testing, and early decision-making.

Venous air embolism is a rare but clinically significant complication of hyperbaric oxygen therapy (HBOT), which is widely used in the treatment of conditions including carbon monoxide poisoning, decompression sickness, and wound healing. We report a case of systemic venous air embolism following HBOT in an 85-year-old woman treated for carbon monoxide poisoning. The patient had syncope, dizziness and nausea. Abdominal CT revealed multiple venous air bubbles. This case highlights a scarcely reported complication of HBOT and the importance of recognizing imaging findings and potential clinical effects after HBOT. Increased awareness may improve monitoring and safety in patients undergoing HBOT.

Scapular winging (SW) describes abnormal scapular mechanics from weak stabilizing muscles or altered neural innervation. While electromyography (EMG) helps differentiate between myo- or neuropathic SW etiologies and determine the extent of muscle involvement, pediatric EMG may be limited due to the high risk of surrounding structures, small body habitus, and pain tolerance. Herein is a case of pediatric SW following anterior neck lymphadenopathy resection in which EMG was limited. Neuromuscular ultrasound (NMUS) showed asymmetric trapezius thinning and hyperechogenicity, revealing more expansive involvement than was previously known. NMUS is a painless, validated tool to augment the diagnostic capability of EMG and clarify the extent of neuromuscular involvement in SW from both a prognostic and rehabilitation point of view.

Background: Bronchopulmonary dysplasia (BPD) is a risk factor for late respiratory diseases (LRD). Lung ultrasound (LUS) is a useful, radiation-free tool for predicting BPD, but data linking LUS to late respiratory diseases is limited.

Objective: To assess the predictive value of the modified lung ultrasound score (mLUS) for late respiratory diseases in premature infants.

Methods: We retrospectively reviewed data from 140 premature infants born before 32 weeks of gestation, treated for atelectasis due to LRD in our ICU from December 2023 to January 2025. LRD was defined as a composite endpoint with operational criteria: (1) Worsening BPD (need for ≥ 10% FiO₂ increment or reinitiated mechanical ventilation, per 2018 NICHD definition); (2) Bronchiolitis (tachypnea/wheezing + positive RSV RT-PCR or LUS/X-ray peribronchial thickening); (3) Pneumonia (fever > 38°C + CRP > 20 mg/L + LUS/X-ray consolidation); (4) Asthma/reactive airway disease (RAW, ≥ 3 bronchodilator-responsive wheezing episodes); (5) Respiratory-related hospitalizations (unplanned admissions for respiratory symptoms). Diagnosis was based on ICD-10 codes, emergency notes, medication records, and imaging. Sample size calculation was performed with α = 0.05, power = 80%, confirming 140 cases and 48 controls met requirements. Missing data (< 3%) were handled via multiple imputation (5 datasets), with complete-case sensitivity analyses.

Results: Multivariable logistic regression (adjusted for gestational age, birth weight, mechanical ventilation duration) showed mLUS independently predicted LRD (adjusted OR: 1.25, 95% CI: 1.10-1.42, p < 0.001), as did traditional LUS (adjusted OR: 1.19, 95% CI: 1.04-1.36, p = 0.012). Model fit was good (Hosmer-Lemeshow χ² = 7.23, p = 0.495). The median mLUS score was 15 (IQR 9-21) in infants with LRD versus 11 (IQR 4-16) without (p < 0.001); traditional LUS was 12 (IQR 6-16) versus 7 (IQR 4-9) (p < 0.001). The mLUS had an area under the receiver operating characteristic (ROC) curve (AUC) of 0.789 (95% CI 0.731-0.847), sensitivity 78.5%, specificity 57.2% (cutoff: 14). DeLong test confirmed mLUS AUC was higher than traditional LUS (0.726, 95% CI 0.658-0.794; p = 0.032). Spearman correlation between scores was 0.82 (p < 0.001), and mLUS improved net reclassification improvement (NRI = 0.28, p = 0.002). Component analysis: mLUS AUC for worsening BPD was 0.812, bronchiolitis 0.765, respiratory hospitalizations 0.793; excluding asthma/RAW (sensitivity analysis) gave AUC = 0.795 (p = 0.891).

Conclusion: The modified lung ultrasound score is significantly linked to advanced respiratory disease in premature infants, demonstrating important clinical relevance.

Snowstorm appearance of the placenta warrants a differential diagnosis among placental mesenchymal dysplasia, partial molar pregnancy and dichorionic twin pregnancy with a complete mole in one sac. Albeit sharing the "unusual" appearance of the placenta, the three conditions differ in terms of management and prognosis as well as serum biochemistry and association with structural and genetic fetal anomalies. In our experience, the expert sonographic assessment of fetal anatomy best performs in differentiating the conditions as early as the first trimester. We present a case in which placental assessment and serial biochemistry were suspicious for placental mesenchymal dysplasia, but the early detection of a cono-truncal cardiac abnormality shifted the diagnostic hypothesis toward partial molar pregnancy, which was confirmed by an invasive procedure.

Objectives: Budd-Chiari syndrome (BCS) is characterized by hepatic venous outflow obstruction, from hepatic veins to the junction of the inferior vena cava (IVC) and the right atrium. Accurate diagnosis of BCS is essential for patient prognosis and management. This study aims to compare the diagnostic efficacy of ultrasound (US) and computed tomography venography (CTV) in diagnosing BCS.

Materials and methods: A retrospective analysis was conducted, of which 250 suspected BCS patients underwent both US and CTV examinations from January 2010 to December 2021. Diagnostic criteria were based on imaging signs of venous narrowing or occlusion. Statistical analyses were performed using SPSS 25.0 software.

Results: Both US and CTV exhibited high diagnostic accuracy for BCS, with sensitivities of 87% and 86%, specificities of 72% and 78%, positive predictive values (PPV) of 95% and 96%, negative predictive values (NPV) of 48% and 48%, and accuracies of 85% and 85%, respectively. Subgroup analysis revealed that CTV outperformed US in diagnosing type I BCS, while US demonstrated superior diagnostic accuracy for type II BCS. No significant difference was observed between US and CTV in diagnosing type III BCS.

Conclusion: Both US and CTV demonstrate high diagnostic accuracy for BCS, with distinct advantages across BCS subtypes. US is favored for its non-invasiveness and ease of use, especially in pediatric patients. Further multicenter prospective studies are warranted to validate these findings and explore additional non-invasive imaging options.