Journal of Medical Ultrasound最新文献

Cancer therapy-related cardiac dysfunction (CTRCD) presents a significant challenge for both oncology and cardiology, necessitating a comprehensive understanding of its pathophysiology, risk factors, diagnostic modalities, and pharmacological interventions. The pathophysiology of CTRCD is multifactorial, and various cancer therapies exert cardiotoxic effects through distinct but overlapping mechanisms, highlighting the need for more personalized preventive and therapeutic interventions. In addition to conventional clinical risk factors, baseline echocardiographic evaluation also plays a critical role in the risk stratification of CTRCD, and numerous studies have demonstrated that baseline left ventricular ejection fraction, global longitudinal strain, and diastolic dysfunction are all predictive of the development of cardiotoxicity. Moreover, continuous surveillance of cardiac function throughout the course of cancer therapy is also paramount. A multimodal diagnostic approach, including cardiac biomarkers, echocardiography, cardiac magnetic resonance imaging, and computed tomography, may facilitate early detection of subclinical myocardial injury and enables timely interventions that may mitigate irreversible cardiac damage. Finally, several pharmacologic strategies have demonstrated promising data in reducing cardiotoxic effects and preserving cardiac function. With these advancements, clinicians can now take a more proactive role in integrating cardio-oncology strategies into treatment protocols, thereby optimizing patient outcomes while minimizing unplanned interruptions in oncologic therapy.

A biloma is defined as an abnormal collection of bile in an intrahepatic or extrahepatic location secondary to a rupture of the biliary system, either spontaneous or posttraumatic. It can lead to significant morbidity and mortality if timely diagnosis and management is not done. We will be discussing a case of a 70-year-old male who presented to the hospital with pain in the right hypochondriac region and fever. Clinical examination and laboratory tests were nonspecific. Ultrasonography was carried out, which revealed an intrahepatic hypoechoic cystic lesion with internal echoes and debris in the right lobe of the liver. A provisional diagnosis of hepatic abscess was made. However, pigtail catheter insertion and magnetic resonance cholangiopancreatography performed later on identified the correct diagnosis, which was biloma.

Organs and tissues comprising the perianal area include the caudal segments of the digestive system and reproductive system, the perianal soft tissues, and the terminal part of the spinal cord. Diseases originating in one part of the perianal region may have connections with others. Incomprehensive and disorganized ultrasound (US) scanning may lead to insufficient diagnostic information, potentially impacting the effectiveness of subsequent treatment. The purposes of this paper are (a) to describe our technique of performing US of perianal area; and (b) to explore the diagnostic strategy of US in infant perianal diseases by outlining the sonographic characteristics of these conditions.

Ritodrine hydrochloride, a beta-adrenergic tocolytic agent, can rarely cause acute noncardiogenic pulmonary edema, particularly in patients with multiple gestations or comorbidities. We report a case of a 28-year-old woman with twin pregnancy, type 1 diabetes, and hyperthyroidism that developed acute respiratory distress following ritodrine infusion. Imaging showed pulmonary edema, and point-of-care ultrasound (POCUS) revealed diffuse bilateral B-lines, preserved left ventricular function, and no signs of right heart strain or inferior vena cava plethora. These findings supported a diagnosis of noncardiogenic pulmonary edema. Emergency cesarean section was performed at 31^+6/7 weeks. Postoperatively, the patient's respiratory status improved, and both neonates had favorable outcomes. This case demonstrates the utility of POCUS as a rapid, radiation-free diagnostic tool for differentiating types of pulmonary edema in pregnant patients, enabling timely intervention and potentially improving maternal and neonatal outcomes. It also underscores the importance of vigilant monitoring when using beta-mimetic tocolytics in high-risk pregnancies.

Kawasaki disease (KD) is an etiology-unknown but with a generalized inflammatory disorder of multiple organs and systems in childhood. The basic pathologic changes are panvasculitis of the small and medium-sized arteries, mainly the coronary arteries. It is now the leading cause of acquired heart disease during childhood in developed countries and has led to the early development of angina pectoris, myocardial ischemia/infarction, and even sudden cardiac death in early adulthood. Although there is no definitive diagnostic test for KD, the accurate diagnosis is dependent on the clinical presentations to meet the diagnostic criteria. Echocardiography is a well-known noninvasive tool to detect structural abnormalities and evaluation of cardiovascular function. It has been reported to detect accurately the early and late cardiovascular abnormalities, including perivascular brightness, lack of tapering, dilatation, and aneurysmal formation of coronary arteries as well as the mitral/aortic regurgitation, pericardial effusion, and myocardial functional changes in KD. In cases of incomplete form of KD and patients whose clinical manifestations did not meet the diagnostic criteria, abnormal echocardiographic findings of coronary artery may provide the assistance for early diagnosis of KD. Long-term periodic echocardiographic follow-up is the basic and essential study for patients of KD with initial coronary arterial abnormalities. Ninety nine articles that studied echocardiographic findings of KD had been reviewed and will be discussed.

Genital tuberculosis (female genital tuberculosis [FGTB]) continues to be an essential underdiagnosed cause of infertility and reproductive morbidity, most significantly in resource-limited settings. Diagnostic laparoscopy and hysteroscopy have become crucial for assessing suspected FGTB cases, mainly when supported by molecular and histopathological tests. This systematic review has evaluated these modalities' diagnostic utility, sensitivity, specificity, and clinical outcomes for predicting FGTB. A comprehensive systematic review was performed with the help of the PECOS framework and PRISMA guidelines. Studies were identified by running Boolean operators and MeSH terms on seven databases: PubMed, Embase, Scopus, Web of Science, Cochrane Library, CINAHL, and Google Scholar. Cohort and cross-sectional designs were considered, focusing on clinically relevant outcomes such as sensitivity, specificity, prevalence, and procedural findings obtained from diagnostic laparoscopy and hysteroscopy. Data extraction was done using a standardized template, and bias was assessed using ROBINS-I and AXIS tools. The certainty of evidence was evaluated using the GRADE framework, and sensitivity analyses were performed to assess the robustness of the findings. Thirteen studies involving 2201 participants were included in the review. Tubal beading, adhesions, and hydrosalpinx were the constant findings of diagnostic laparoscopy, with sensitivities and specificities varying between 33% and 85.71% and 22.8% and 100%, respectively. Hysteroscopy revealed intrauterine fibrosis in up to 48.48% of cases. Adhesions and synechiae were seen in 46% and 18%, respectively. Molecular diagnostics GeneXpert and tuberculosis-polymerase chain reaction (TB-PCR) showed high sensitivity (up to 100%) and varied specificity (33% to 100%). The prevalence of FGTB ranged from 6.73% to 45%, with conception rates improved by 39% postantitubercular therapy. Sensitivity analyses revealed lower heterogeneity (I² <40%) in studies applying combined diagnostic modalities compared to single-method approaches. This systematic review showed that integrating diagnostic laparoscopy and hysteroscopy with molecular tools such as GeneXpert and TB-PCR improves the predictive and therapeutic approach to FGTB. These modalities effectively identify structural abnormalities and correlate the findings with molecular and histopathological results. Standardized protocols and more extensive multicenter studies will be required to reduce heterogeneity and further refine diagnostic accuracy.