Internal Medicine wards have progressively evolved into high-complexity clinical environments, increasingly managing patients with acute respiratory failure, hemodynamic instability, and multi-organ dysfunction. Within this scenario, point-of-care ultrasonography (POCUS) has emerged as a bedside imaging modality capable of supporting rapid diagnostic reasoning and real-time clinical decision-making. This narrative review aims to critically analyze the role of POCUS in High-Care Medical Areas of Internal Medicine, focusing on diagnostic applications, clinical monitoring, and ultrasound-guided procedures, while addressing limitations and training requirements. A narrative review of the literature was conducted, integrating evidence from international guidelines, observational studies, randomized trials, and expert consensus documents regarding the use of POCUS in acutely ill medical patients. Emphasis was placed on multimodal ultrasound approaches consistent with the holistic clinical framework of Internal Medicine. POCUS facilitates early identification of time-dependent conditions such as pulmonary embolism, acute coronary syndromes, acute heart failure, acute respiratory distress syndrome, and septic shock. Lung ultrasound, focused cardiac ultrasound, vascular, and abdominal ultrasound can be integrated to improve diagnostic accuracy and etiological characterization of shock and respiratory failure. Serial POCUS examinations enable dynamic monitoring of disease progression, treatment response, and fluid responsiveness. Furthermore, ultrasound guidance significantly improves the safety and effectiveness of bedside invasive procedures. POCUS represents a cornerstone of modern High-Care Internal Medicine, enhancing bedside diagnostic integration, clinical monitoring, and procedural safety. Its effectiveness depends on structured training, awareness of limitations, and appropriate clinical governance. Although evidence of direct mortality reduction remains limited, POCUS consistently improves diagnostic confidence, appropriateness of care, and patient-centered decision-making.
IgG4-related cholangitis (IgG4-SC) is often difficult to differentiate from cholangiocarcinoma (CCA) due to similar clinical and imaging presentations, yet their management and prognosis differ drastically. Accurate non-invasive distinction remains a significant clinical challenge. This study aimed to identify and compare the characteristic features of IgG4-SC and CCA on conventional ultrasound (US) and contrast-enhanced ultrasound (CEUS) to establish reliable imaging discriminators. We retrospectively analyzed clinical and imaging data from 14 patients with IgG4-SC and 26 with CCA. Two blinded physicians independently reviewed US and CEUS images to assess lesion characteristics, bile duct lumen visibility, wall thickening, and enhancement patterns. Statistical comparisons were performed using appropriate tests. On conventional US, a preserved bile duct lumen within the thickened segment was significantly more frequent in IgG4-SC (10/14, 71.4
Standardizing robotic breast ultrasound remains challenging in practice, particularly during near-lesion approach, where small nonlinearities can degrade imaging consistency and needle guidance. This study uses publicly available datasets to derive skill-informed motion primitives for an ontology-guided path-planning framework and to define a representative breast ultrasound workspace with lesion-oriented linear trajectories. BUSI-derived lesion information is used to generate image-informed scan paths in the imaging plane, while JIGSAWS kinematic sequences are used to initialize motion primitives and neuro-fuzzy inverse-kinematics rules. The proposed robotic ultrasound scan controller maps Cartesian targets to joint commands, and its parameters are subsequently refined using an ant colony optimization for continuous domains (ACOR) strategy. Performance is evaluated in terms of joint-angle error, forward-kinematics path tracking, motion smoothness measured by mean absolute jerk, and needle–heading alignment relative to the planned trajectory. Among the untuned variants, the controller initialized by data-driven clustering showed the strongest generalization across the evaluation workspace. ACOR-based refinement further reduced path-tracking error and markedly improved motion smoothness. Orientation alignment also improved relative to the baseline, although performance remained variable across test segments and the predefined success threshold was not achieved in all cases. The proposed knowledge-driven robotic ultrasound framework integrates ontology-guided linear path planning, neuro-fuzzy inverse kinematics, and metaheuristic parameter refinement to achieve accurate and smoother tracking in representative breast-imaging tasks. In the present proof-of-concept study, the image-based component is used primarily for lesion-informed trajectory generation and evaluation rather than full real-time visual servoing. These findings support the feasibility of standardized robotic ultrasound workflows and motivate future integration of explicit orientation costs, force regulation, and real-time image feedback.
Ultrasound technology has developed to be a versatile and sustainable technology in new food processing and preservation methods. Ultrasound, which is based on the principles of acoustic cavitation and mechanical vibrations, can improve mass and heat transfer, ramping up processing times and improve the quality of products. The main application of low intensity ultrasound is the analytical and quality checks in food systems while high intensity ultrasound is more common in food systems for emulsification, extraction, homogenization, drying, freezing and microbial inactivation. As it is a nonthermal approach, ultrasound is safe for food systems to follow nutritional and sensory characteristics, making it a green processing technology versus conventional methods. Advances in ultrasonic equipment design and combined use with other elegant technologies like pulsed electric fields, high pressure processing and nanotechnology have led to a broader industrial application. Although the advantages are promising, aspects of scalability, energy efficiency, and uniform energy distribution are important areas for research moving forward. This review provides various applications, fundamental principles of ultrasound in food science with a focus on improving energy efficiency, product safety and sustainability.
Chorionic bumps are a rare first‑trimester ultrasound finding with uncertain prognostic significance. To estimate the risk of miscarriage in pregnancies with a chorionic bump compared with the institutional baseline miscarriage rate in our Early Pregnancy Unit (EPU). Retrospective cohort of consecutive pregnancies with a sonographically confirmed chorionic bump (January 2020–May 2025). Outcomes were benchmarked against the EPU’s baseline miscarriage rate derived from all attendances during the study period. Prespecified secondary analyses explored whether maternal age, subchorionic haematoma (SCH), or bump size predicted outcome. Among 151 pregnancies with a chorionic bump, 81 miscarried (53.6
Breast ultrasound (US) has often interpretation challenges (BIRADS 3-BIRADS 4 lesions), leading to a high demand for core needle biopsies (CNB). In this context, a computer-aided diagnostic (CAD) tool based on a machine-learning artificial intelligence, applied to images obtained with an automated breast ultrasound system (ABUS), could potentially provide more accurate diagnoses by instantly and automatically assessing the US lesion features and their level of suspicion. The aim of this study is to evaluate the diagnostic accuracy of a CAD applied to ABUS images for BIRADS 3–4 lesions. Fifty-four patients underwent ABUS, performed with three scans per side, reconstructing images in the axial, coronal, and sagittal planes. Two expert radiologists draw a region of interest (ROI) on the lesion to be assessed by CAD tool, reaching a consensus regarding the images. Only breast lesions classified as BIRADS 3–4 were included, for a total of 68 (32 BIRADS 3, 36 BIRADS 4). CAD results were compared with the histological findings from CNBs in all cases, calculating sensitivity (SE), specificity (SP), accuracy (AC), positive predictive value (PPV), and negative predictive value (NPV). Histology identified 40 positive lesions and 28 negative lesions. The CAD classified 38 suspicious lesions, with 6 false positives, 22 true negatives, and 2 false negatives. The values for SE, SP, AC, PPV, and NPV were 95, 79, 88, 86, and 92
To present a reproducible ultrasound-guided approach for the identification and injection of the long thoracic nerve (LTN) in patients with burning axillary pain. High-resolution ultrasound was used to visualize the LTN along its superficial course, from its emergence through the middle scalene muscle to its trajectory over the serratus anterior muscle. It is used a high-frequency linear transducer (10–18 MHz) with patients positioned supine or lateral decubitus with arm abduction. Under sterile conditions, it is performed perineural injections both proximal to the cervical spine and distally to the axilla, using the in-plane technique. The LTN was identified at both the supraclavicular and lateral thoracic levels. Ultrasound guidance allowed for accurate needle placement and perineural distribution of the injectate. The procedure has proven feasible, safe, and reproducible in the clinical setting. Ultrasound-guided injection of the long thoracic nerve is a precise and minimally invasive technique that combines precise diagnostic confirmation with lasting therapeutic benefit. It represents a valuable option in the management of long thoracic nerve neuropathy and may reduce the need for systemic medications. Further studies are needed to verify its long-term efficacy and define standardized protocols.
Accurate preoperative assessment of tumor size (T parameter) is crucial for surgical planning in breast cancer. This study aimed to compare the diagnostic performance of automated breast ultrasound (ABUS) and conventional handheld ultrasound (HHUS) in evaluating tumor size, using histopathology as the reference standard. Between September 2025 and March 2026, 43 patients with 46 invasive breast carcinoma lesions underwent preoperative evaluation with both HHUS and ABUS. Tumor diameters were measured by two experienced radiologists. Measurements obtained with each imaging modality were compared with histological findings. Statistical analysis included analysis of variance (ANOVA), paired Student’s t-tests, and inter-observer agreement using Cohen’s kappa coefficient. Mean tumor diameters were 12.82 mm for ABUS, 12.50 mm for HHUS, and 12.74 mm for histology. No statistically significant differences were observed between ABUS and HHUS measurements (p = 0.07), nor between either imaging modality and histology (ABUS vs. histology: p = 0.15; HHUS vs. histology: p = 0.86). Inter-observer agreement was excellent (κ = 0.88). Measurements obtained with ABUS showed a closer overlap with histological findings. Both ABUS and HHUS provide accurate preoperative assessment of tumor size in invasive breast cancer. However, ABUS demonstrates advantages in reproducibility, operator independence, and three-dimensional visualization, supporting its role as a valuable tool for surgical planning.
Preoperative localisation of non-palpable lymph nodes remains challenging, particularly in previously treated oncological patients. Current localisation techniques may require ionising radiation, dedicated detection systems or complex logistical support. We report the first application of an UltraCor™ ultrasound-visible marker for ultrasound-only localisation of a cervical lymph node in suspected relapsed Hodgkin lymphoma. A 22-year-old man with previous stage IIIB nodular sclerosis Hodgkin lymphoma presented with constitutional symptoms and a suspicious non-palpable supraclavicular lymph node detected on computed tomography. Initial ultrasound-guided fine-needle aspiration was non-diagnostic. Due to persistent clinical suspicion and the need for accurate surgical localisation, an UltraCor™ marker was deployed within the lymph node under real-time ultrasound guidance. Intraoperative ultrasound enabled accurate localisation and targeted surgical excision. Histopathological examination confirmed recurrent nodular sclerosis Hodgkin lymphoma. UltraCor™ localisation may represent a feasible radiation-free alternative for ultrasound-guided selective surgical targeting of non-palpable cervical lymph nodes.
To assess the clinical value of VExUS-guided volume management in patients following CPB surgery. A single-center, prospective, randomized controlled trial was performed. All adult patients undergoing CPB surgery between January 2024 and October 2025 were consecutively enrolled and randomly allocated in a 1:1 ratio to either a VExUS-guided intervention group or a conventional control group. Baseline demographics, intraoperative surgical parameters, serial postoperative fluid and transfusion metrics, and clinical outcomes were compared between the two cohorts. Intergroup comparisons were conducted using two-tailed statistical tests, with a significance level of P < 0.05. A total of 89 eligible participants completed the study, including 46 in the VExUS group and 43 in the control group. Baseline clinical profiles and all intraoperative variables showed no statistically significant intergroup differences (all P > 0.05). At 12 h and 24 h postoperatively, the median albumin transfusion volume was 0 g in both groups; however, the VExUS-guided cohort exhibited broader data distribution and a larger proportion of patients receiving high-dose albumin administration, with significant between-group differences (P = 0.007 and P = 0.015, respectively). The median postoperative hospital stay was markedly shorter in the VExUS group (15 days vs. 19 days, P = 0.027). No significant differences were observed in intensive care unit (ICU) or total mechanical ventilation time. Although the cumulative net fluid balance did not reach statistical significance between groups, the VExUS-guided group demonstrated a more prominent negative fluid balance trend at 48 h postoperatively, reflecting greater systemic decongestion. VExUS-directed volume management optimizes personalized fluid therapy and shortens postoperative hospital stay in patients undergoing CPB surgery.
The biceps femoris long head (BFlh) has a complex architecture, posing challenges for accurately assessing its fascicle length. This study compared four 3D ultrasound (3DUS)-based methods for estimating mid-belly BFlh fascicle length in human cadavers (n = 6 legs). Method 1 and Method 2 assumed straight fascicles within a single longitudinal plane, aligned with the muscle axis and oriented perpendicular to either proximal or distal aponeurosis. Method 3 represented multiplanar trajectory using two connected straight segments, whereas Method 4 further incorporated local in-plane curvature within each segment. Agreement relative to the direct measurement of fascicle length by dissection using Bland–Altman bias and 95
To characterize longitudinal changes in axillary-pouch capsular thickness and clinical outcomes after ultrasound-guided hydrodilation with corticosteroid injection in patients with post-stroke adhesive capsulitis, and to examine associations between structural and clinical changes. In this longitudinal observational study, 20 patients underwent clinical and ultrasonographic assessment before the first procedure (T0) and at follow-up (T1), separated by a median of 5.7 months. All participants also received conventional neurorehabilitation. Paired changes in pain measured using the Numeric Rating Scale (NRS), range of motion (ROM), strength, muscle tone, disability, quality of life, and capsular thickness were assessed using Wilcoxon signed-rank or exact McNemar tests. Associations between within-participant changes were explored using Spearman correlations. Median movement-evoked pain decreased by 4 NRS points during flexion and abduction and by 5 points during external rotation (all p < 0.001). Active and passive ROM improved across all assessed movements (all p ≤ 0.001). Median affected-side capsular thickness decreased from 3.7 to 2.45 mm, with a median within-participant reduction of 1.4 mm (p < 0.001). The proportion meeting the ultrasonographic criteria for adhesive capsulitis decreased from 20/20 at T0 to 4/20 at T1. Capsular-thickness changes were not significantly associated with changes in any clinical outcome (all |ρ|≤ 0.35; all p ≥ 0.13). In this uncontrolled cohort, hydrodilation with corticosteroid injection, delivered alongside neurorehabilitation, was followed by reduced movement-evoked pain, improved shoulder mobility, and axillary-pouch capsular thinning. Capsular thickness should be interpreted as a complementary structural marker rather than a surrogate for clinical recovery.
This study describes a standardized ultrasound-guided double-needle lavage technique for acute calcific periarthritis of the hand and reports its technical feasibility and preliminary clinical outcomes. Five consecutive patients underwent ultrasound-guided percutaneous lavage. Clinical characteristics, affected joint, calcification size, sonographic features, complications, and visual analog scale (VAS) scores at baseline, 1 week, and 1 month were recorded. Four cases involved the metacarpophalangeal joints, whereas one involved the interphalangeal joint. Mean calcification size was 14.4 ± 6.0 mm. All deposits were mature and showed no posterior acoustic shadowing. Mean VAS decreased from 8.8 ± 1.8 at baseline to 0.4 ± 0.5 at 1 week and 0.2 ± 0.4 at 1 month, corresponding to mean pain reductions of 94.2
Testicular metastasis from gastric adenocarcinoma is rare, and serial ultrasonographic evolution of this process has seldom been documented. We report a 79-year-old man with gastric adenocarcinoma who presented with progressive left-dominant scrotal enlargement. Initial scrotal ultrasonography showed bilateral hydroceles, greater on the left, with septation but no definite intratesticular lesion. One month later, repeat ultrasonography demonstrated heterogeneous left testicular echotexture with multiple small solid nodules and mildly increased vascularity, indicating interval parenchymal involvement. Pelvic magnetic resonance imaging showed bilateral suspicious testicular and epididymal abnormalities with septal enhancement and diffusion restriction. Histopathology confirmed metastatic adenocarcinoma involving the left testis and left tunica vaginalis, with CDX-2 and SATB2 positivity supporting gastrointestinal differentiation. Biopsy of the right tunica vaginalis showed hydrocele without evidence of malignancy; therefore, the contralateral abnormalities remained radiologically suspicious but were not pathologically confirmed. Follow-up ultrasonography demonstrated destructive progression of the left testis and epididymis with chaotic vascularity. This case highlights the value of serial scrotal ultrasonography for recognizing interval progression from apparently benign hydrocele-dominant findings to metastatic testicular-epididymal involvement. In older patients with known extratesticular malignancy, evolving scrotal swelling should prompt careful reassessment of testicular parenchyma and vascularity on follow-up ultrasound.
Peripheral nerve ultrasound in the pain medicine clinic remains largely non-standardized. The purpose of this technical note is to propose a structured point-of-care ultrasound protocol for systematic peripheral nerve evaluation in the interventional pain medicine setting. The Peripheral Nerve Assessment Protocol (PNAP) was developed based on the existing peripheral nerve ultrasound literature, established point-of-care ultrasound models, and clinical experience in interventional pain medicine. The protocol targets 10 nerves across four anatomical regions using a four-step assessment sequence: static survey, dynamic provocation, Doppler interrogation, and contralateral comparison. Sonographic diagnostic criteria and a three-tier clinical decision framework are presented to guide same-visit treatment planning. The protocol integrates diagnostic assessment with procedural decision-making within a single clinical encounter. The PNAP provides a reproducible methodology for peripheral nerve assessment in the interventional pain medicine clinic that may serve as a foundation for future validation studies.
Image-guided thermal ablations are nowadays increasingly used to provide a minimally invasive treatment to patients with thyroid nodules, with reported good clinical results and a low complication rate. Different ablative techniques can be applied, each with specific advantages and disadvantages according to the clinical situation. Moreover, percutaneous ablation of thyroid nodules might be complex in cases where there is limited access for image guidance or a close proximity to critical structures, which can be unintentionally injured during treatment. In the present paper we offer an overview of the most commonly used ablative techniques and of the most important manoeuvres that can be applied to enhance the safety and effectiveness of percutaneous image-guided thyroid ablations. Emphasis is given to preoperative evaluation, the different technical aspects of ablation, operating room setting, image guidance, and some tips and tricks for a safe and effective treatment are presented.
Fontan-associated liver disease (FALD) may progress to portal hypertension, ascites, and nodular liver remodelling. Two-dimensional shear wave elastography (2D-SWE) can be performed in patients with ascites, but its reliability in this setting remains uncertain. We report two post-Fontan patients with ascites and nodular liver morphology on B-mode ultrasound who showed markedly discordant liver stiffness values. The pediatric patient had high stiffness (median 24.25 kPa; IQR/median 3.4
