Posterolateral elbow ganglion cysts are extremely rare and have been previously documented almost exclusively on clinical and magnetic resonance imaging reports. Herein, we describe the rare case of a 38-year-old man presenting with an asymptomatic lateral elbow lump. High-resolution ultrasound obtained using high-frequency linear transducers demonstrated a well-defined anechoic cyst with a thin stalk extending toward the articular space, consistent with a posterolateral elbow ganglion. This case underscores the problem-solving role of high-resolution ultrasound in the evaluation of elbow lumps, enabling a prompt and accurate diagnosis of this entity despite its atypical and therefore unexpected location.
BACKGROUND:This study aimed to evaluate diaphragmatic muscle behavior via ultrasound in children over the course of invasive mechanical ventilation in a PICU. METHODS:An observational, longitudinal, quantitative study was conducted in a PICU, including children on IMV for more than 48 h. Ultrasound assessments were performed on the first, third, and seventh days of IMV. Measurements included inspiratory and expiratory diaphragmatic thickness, thickening fraction, diaphragmatic excursion, and diaphragmatic slope. RESULTS:A significant reduction in inspiratory thickness (Tdi), expiratory thickness (TDe), and diaphragmatic excursion (DE) was observed over the IMV period (p < 0.001), while the diaphragmatic thickening fraction (DTF) showed a progressive increase (p < 0.001). The diaphragmatic slope showed a downward trend, though not statistically significant (p = 0.06). Patients who received neuromuscular blocking agents (NMBA) exhibited lower DTF values, with a strong correlation (r = 0.79; p < 0.01). CONCLUSION:Diaphragmatic ultrasound demonstrated the ability to detect morphofunctional changes in the diaphragm during IMV in children throughout their PICU stay. The observed changes-particularly in diaphragmatic thickness, excursion, and thickening fraction associated with the use of NMBAs-reinforce the potential of ultrasound as a monitoring tool.
OBJECTIVE:To determine normative ultrasonographic dimensions, morphology, and visualization rate of the cavum septum pellucidum (CSP) in structurally normal singleton fetuses between 19 and 40 weeks of gestation and to assess correlations with gestational age and fetal biometric parameters. METHODS:This prospective cross-sectional study enrolled 600 consecutive singleton pregnancies with normal fetal anatomy at Beheshti Hospital, Isfahan, Iran (2024-2025). Transabdominal ultrasound was performed in standard ISUOG-recommended axial planes. CSP visualization status, morphology (rectangular, triangular, oval, square, or circular), length, and width were recorded together with biparietal diameter (BPD) and head circumference (HC). Data were analyzed using descriptive statistics, Pearson's and Spearman's correlations, and chi-squared tests. RESULTS:The CSP was visualized in 552 of 600 fetuses (92.0%). Mean CSP length was 8.27 ± 2.94 mm and mean width was 6.60 ± 2.74 mm, with rectangular morphology predominating (71.7%). Mean length increased modestly from 7.01 ± 2.62 mm (19-23 weeks) to 8.67 ± 2.98 mm (32-35 weeks) then stabilized, whereas width remained relatively stable. Weak positive correlations were observed between CSP length and gestational age (r = 0.132, p = 0.002) and HC (r = 0.156, p < 0.001); however, the small effect sizes indicate limited explanatory and clinical significance. No significant correlations were observed for width or morphology with biometric parameters. Nonvisualization (8.0%) occurred exclusively at or after 19 weeks. CONCLUSION:This study provides contemporary, population-specific normative data for fetal CSP in the second and third trimesters in an Iranian cohort. CSP length shows modest gestation- and HC-dependent growth, while width and morphology remain largely independent of standard biometry.
Obstructive total anomalous pulmonary venous connection (TAPVC) and ABCA3-related interstitial lung disease (ILD) rarely coexist. We report a neonate with TAPVC complicated by compound heterozygous ABCA3 variants (c.4180dup/p.V1394fs maternal, c.3446A>G/p.D1149G paternal). Overlapping neonatal respiratory symptoms mask the underlying surfactant disorder, easily causing misdiagnosis and delayed targeted management. This case highlights that the genetic screening for ABCA3 deficiency is mandatory for infants with persistent severe hypoxemia and ventilator dependence after complete TAPVC surgical repair. To our knowledge, this is the first documented co-occurrence of TAPVC and congenital ABCA3-related ILD.
Small cell neuroendocrine carcinoma (SCNEC) is a rare high-grade malignant tumor associated with high-risk HPV infection. It is prone to early lymph node metastasis and distant metastasis. The main clinical manifestations are contact bleeding, pelvic masses, and abdominal pain. Conventional imaging examinations are not characteristic, but multimodal ultrasound can fully show the morphology, internal echoes, blood supply, tissue hardness, and other subtle characteristics of cervical neuroendocrine tumors.
BACKGROUND:To identify predictive ultrasonic factors and establish cutoff values for assessing sclerosis severity and selecting appropriate lymphatic vessels for lymphovenous anastomosis (LVA). METHODS:We enrolled 22 patients with extremity lymphedema undergoing LVA (53 lymphatic vessels). Sclerosis severity was determined preoperatively by ultrasonography and intraoperatively using a surgical microscope; the findings were stratified by NECST (normal, ectasis, contraction, and sclerosis type) classification. Demographic and ultrasonographic data, including lymphatic vessel inner and outer diameters (Id and Od, respectively), Id/Od ratio, and wall thickness, were analyzed. RESULTS:Although NECST classifications for ultrasonographic and surgical observations exhibited discrepancies, ultrasound findings showed high overall accuracy (71.7%), with strong correlation (r = 0.652) and moderate agreement (k = 0.554) with intraoperative results. For ultrasound-based classification, Id and Id/Od ratio of 0.43 mm and 34.1% were the suggestive values for predicting ectasis type, with the area under the curve (AUC) values of 0.843 and 0.842, respectively. For surgical evaluation-based classification, Id and Id/Od ratio of 0.269 mm and 41% were the suggestive values for predicting ectasis type, with both AUC values > 0.8. These results were significant (p < 0.05). CONCLUSION:Ultrasonographic parameters could help identify ectasis type of lymphatic vessels in patients with extremity lymphedema.
BACKGROUND:Many physicians assess left ventricular filling pressures (LVFP) with mitral Doppler before prescribing fluid infusion, in the hope of avoiding the occurrence of a deterioration of oxygenation. This work questions the merits of this practice. PATIENTS AND METHODS:Inclusion criteria were: adult patient receiving mechanical ventilation and vascular filling. Clinical and echocardiographic parameters were collected before and after volume expansion. Patients with increased LVFP (identified by at least one mitral Doppler criterion: E/E' > 10 or E/A ≥ 2 or deceleration time < 120 ms) were compared to those without increased LVFP. Primary endpoint was the frequency of a ≥ 15% decrease in the SpO2/FiO2 ratio. Secondary outcome was the response to volume expansion (a ≥ 15% increase in cardiac output). RESULTS:Eighty-seven patients were included in 3 centers with 26 (30%) having elevated LFVP. Only two (2%) patients, who had no increased LVFP, showed respiratory deterioration. The response to volume expansion was identical in patients with or without increased LVFP (25% and 23%, p = 0.8). CONCLUSION:This pragmatic but underpowered prospective study does not support the hypothesis that ultrasound assessment of LVFP by mitral Doppler is a reliable index to predict the respiratory and hemodynamic consequences of filling. Additional studies are required.
This color Doppler ultrasound image visualizes an ovarian sclerosing stromal tumor (OSST). The heterogeneous echo texture of the tumor is clearly depicted, while the color-coded blood flow signals (blue/red) reveal the vascular architecture within the lesion. Such ultrasonographic features are pivotal for characterizing the tumor's structural and hemodynamic properties, enabling accurate preoperative diagnosis and differential diagnosis among ovarian stromal tumors. This image exemplifies how advanced ultrasound techniques can uncover the distinct sonographic signature of OSST, thereby supporting precise clinical decision-making.
A 2-year-old boy initially misdiagnosed with dextro-Transposition of the Great Arteries (d-TGA) was accurately diagnosed with Berry syndrome-an extremely rare congenital heart defect-using multimodal imaging and 3D printing. Echocardiography and CTA revealed aortopulmonary window, anomalous origin of the right pulmonary artery, type A aortic arch interruption, and patent ductus arteriosus. A patient-specific 3D-printed model from CTA data significantly enhanced visualization of complex vascular anatomy. This case highlights the value of combining multimodal imaging and 3D printing for diagnosing Berry syndrome and improving surgical planning for complex congenital heart defects.
Ultrasonography is particularly useful in children because it can be repeated without ionizing radiation and can be adapted to the clinical question during the examination. A 10-year-old boy with right lower quadrant pain, right leg pain, and a limp was referred with suspected acute appendicitis. A comprehensive diagnostic ultrasound examination of the abdomen demonstrated a normal appendix and an enlarged lymph node corresponding to the site of right lower quadrant tenderness. During the examination, conversation with the patient and his mother disclosed household cat ownership, frequent exposure to cat fleas, and multiple flea bites. The abdominal findings, exposure history, and pre-existing right leg symptoms were shared with the clinical team. At the physician's request, additional ultrasound evaluation of the right popliteal region demonstrated a second enlarged, tender lymph node. Superb microvascular imaging showed nonspecific vascular signals predominantly near the hila of both nodes. Serologic and molecular testing for Bartonella henselae was not performed; therefore, cat-scratch disease remained a clinical suspicion rather than a confirmed diagnosis. After azithromycin treatment, the symptoms improved and both lymph nodes decreased in size on follow-up ultrasonography. This case does not establish an ultrasonographic diagnosis of cat-scratch disease. Rather, it illustrates how ultrasonography provided anatomic correlates for symptoms at two sites, complemented the information available from clinical assessment alone, and supported noninvasive follow-up.
BACKGROUND:Placenta accreta spectrum (PAS) disorders are life-threatening obstetric complications associated with significant maternal morbidity and mortality. Early diagnosis and risk stratification are critical for optimal management. This study aimed to estimate the incidence of abnormally invasive placentas (AIPs) in singleton pregnancies and evaluate the correlation between AIP scores and estimated blood loss (EBL) in PAS cases. METHODS:This retrospective cohort study was conducted at tertiary center in south India, from January 2019 to March 2024. Singleton pregnancies diagnosed with PAS were included. The AIP score, based on ultrasonographic features, was used to categorize patients into moderate (score < 8) and high risk (score 8-12) groups. Maternal and neonatal outcomes, including EBL, hysterectomy rates, and ICU admissions, were analyzed. Statistical analysis included Spearman's correlation, chi-square tests, and logistic regression. RESULTS:Among 52 041 deliveries, 84 PAS cases were analyzed (incidence: 1.6 per 1000 births). The high-risk AIP group (n = 73, 86.9%) had significantly higher EBL (median: 4500 vs. 2500 mL, p = 0.012), transfusion requirements (median: 6 vs. 2 units, p = 0.02), and hysterectomy rates (88%). AIP score correlated moderately with EBL (ρ = 0.403, p < 0.001). Placenta percreta was associated with higher AIP scores (p < 0.001). CONCLUSION:The AIP scoring system effectively predicts the risk of massive hemorrhage and surgical complexity in patients with PAS. High AIP scores predict worse maternal outcomes, underscoring the importance of multidisciplinary care at tertiary centers.
OBJECTIVE:To establish gestational age (GA)-specific reference ranges for fetal parieto-occipital sulcus (POS) depth and angle using the transcranial high axial plane at 20-30+6 weeks of gestation. METHODS:This cross-sectional study enrolled 357 normal singleton fetuses. Five cases were excluded owing to suboptimal image quality caused by maternal obesity, unfavorable fetal presentation, anterior placenta and oligohydramnios. Finally, 352 fetuses were included for analysis, yielding a POS visualization rate of 98.6% (352/357). Gestational age (GA) was established based on first-trimester crown-rump length (CRL) measurements. The morphology of the POS was assessed, and its depth and angle were measured to establish relevant reference ranges. Intra- and inter-observer reproducibility was evaluated. RESULTS:POS depth showed a linear increase with advancing gestational age (GA), whereas POS angle presented a linear decrease. The regression equations were: POS depth (mm) = -16.41 + 0.85 × GA (R2 = 0.853, p < 0.01) and POS angle (°) = 389.06-11.82 × GA (R2 = 0.855, p < 0.01). Reference ranges for POS depth and angle were established. Excellent reproducibility was observed, with all intraclass correlation coefficients (ICCs) > 0.850, and more than 95% of data points lying within the 95% limits of agreement (LoA) on Bland-Altman plots. CONCLUSION:Quantitative measurements of POS depth and angle on the transcranial high axial plane offer a simple, feasible, and reproducible complementary method to evaluate fetal cerebral cortical development during 20-30+6 weeks of gestation.
Mitral valve blood cysts are rare, benign lesions in adults. A 52-year-old female presenting with acute ischemic stroke was found on echocardiography to have a thin-walled, mobile, 1.2 × 2.4 cm cystic mass on the posterior mitral leaflet, along with hypertrophic obstructive cardiomyopathy. Although transesophageal echocardiography detected the mass, differentiating it from solid tumors or caseous calcifications remained challenging. Noncontrast cardiac magnetic resonance imaging showed that the cyst's internal signal was isointense with the left ventricular blood pool throughout the cardiac cycle. This distinct dynamic signature definitively ruled out solid neoplasms and caseous mitral annular calcification, confirming a blood-filled cavity.
BACKGROUND:The detection of myocardial ischemia in coronary artery disease (CAD) patients who lack regional wall motion abnormality (RWMA) at rest remains a clinical challenge. Two-dimensional speckle-tracking echocardiography (2D-STE) provides a quantitative and sensitive means of evaluating myocardial function, whereas stress echocardiography (SE) is a well-validated modality for identifying myocardial ischemia. Using the Gensini score (GS), this study intended to assess the diagnostic utility of combining these two techniques in evaluating coronary lesion severity in the aforementioned patient population. METHODS:A cohort of 128 patients undergoing coronary angiography (CAG) without resting regional wall motion abnormality (RWMA) was enrolled in the study. Regadenoson stress echocardiography was performed in all patients. Apart from conventional echocardiographic parameters, two-dimensional strain parameters were measured at both resting and peak stress states. According to the GS, patients were categorized into two groups: a nonsignificant stenosis group (GS ≤ 38) and a significant stenosis group (GS > 38). RESULTS:No statistically significant differences were identified between the two groups in any conventional echocardiographic parameters or strain parameters measured at rest (p > 0.05). Significant intergroup differences in global longitudinal strain (GLS), GLS change from rest to stress (ΔGLS), global circumferential strain (GCS) change from rest to stress (ΔGCS), and wall motion score index (WMSI) were detected between the significant stenosis group and the nonsignificant stenosis group during regadenoson stress (all p < 0.05). In contrast, GCS, global radial strain (GRS), and GRS change from rest to stress(ΔGRS) failed to show significant between-group disparities (p > 0.05). Receiver operating characteristic (ROC) curve analysis demonstrated that ΔGLS exhibited the optimal diagnostic performance for identifying severe CAD (AUC = 0.928). Furthermore, a logical combination of ΔGLS and stress WMSI was employed to derive two diagnostic indicators with distinct clinical applicability. CONCLUSION:Parameters obtained from 2D-STE combined with regadenoson SE demonstrate favorable diagnostic value for identifying severe CAD in patients without RWMA at rest. This approach may be particularly useful for special populations who are unable to undergo exercise stress testing or have chronic respiratory diseases and warrants further validation as a potential screening tool for significant coronary artery lesions in this patient cohort. Furthermore, the logical diagnostic combination based on ΔGLS and stress WMSI shows preliminary promise, although larger studies are needed to confirm its clinical applicability across diverse scenarios.
OBJECTIVES:To establish normative reference ranges for diencephalon diameter, falx cerebri length, and the diencephalon/falx (D/F) ratio between 11 + 6 and 13 + 6 weeks of gestation and to evaluate their relationship with crown-rump length (CRL). METHODS:This prospective observational study included 676 fetuses during routine first-trimester screening; three fetuses were excluded from this study with major cerebral anatomical defects. Using a standardized mid-sagittal plane, the diencephalon (maximum anteroposterior distance) and falx cerebri were measured. The D/F ratio was calculated, and quantile regression was used to generate 5th, 50th, and 95th percentile curves associated with CRL. RESULTS:Diencephalon diameter increased progressively with CRL, while falx cerebri length showed modest growth. The D/F ratio demonstrated a slight inverse relationship with CRL. Two cases of midline defects (agenesis of the corpus callosum) were identified; the D/F ratio was abnormal in one case but remained within normal limits in the second. CONCLUSIONS:Diencephalon and falx measurements are reproducible during the first trimester. While the proposed quantile-based nomograms provide a robust normative framework, the isolated use of the D/F ratio may have limitations in detecting certain midline anomalies. These landmarks should be regarded as adjunctive markers and should be interpreted as part of a comprehensive first-trimester fetal neurosonographic assessment.
Renal vein aneurysm (RVA) is an exceptionally rare vascular anomaly and an unusual cause of hydronephrosis. We report an asymptomatic 17-year-old male with persistent right hydronephrosis and preserved renal function. Serial ultrasonography demonstrated progressive pelvic dilatation, while repeat examination raised suspicion of an atypical extrapelvic component. Multimodal imaging, including ultrasonography, MAG3 scintigraphy, and computed tomography angiography, identified a right RVA, subsequently confirmed by laparoscopy and treated by aneurysmorrhaphy. Postoperative follow-up showed resolution of hydronephrosis. This case highlights the pivotal role of ultrasonography within a multimodal imaging approach for diagnosing rare vascular causes of persistent unexplained hydronephrosis.
INTRODUCTION:The skeletal dysplasias pose a particular diagnostic challenge due to their rarity, phenotypic overlap, and the dynamic evolution of sonographic features across gestation. OBJECTIVE:To evaluate the relative prevalence of skeletal dysplasia (SD) and delineate antenatal ultrasound markers aiding diagnosis of SD in cases with short femur. METHOD:The records of targeted ultrasound of fetuses with suspected SD from 2021 to 2025 were reviewed. Femur length was expressed as standard deviations below mean and associated visceral and skeletal abnormalities were recorded among diagnosed and undiagnosed cases. RESULTS:A total of 76 cases were fully followed; the mean gestational age was 28.2 ± 6.6 weeks. Majority of the cases were detected in the late second or early third trimester. More than two-third of them were suspected to have SD, whereas the rest were either FGR or constitutionally small fetus. The ultrasound findings guided us to distinguish FGR and constitutionally small fetuses from SD cases. It was a valuable tool in determining lethality. The molecular testing could be done in only one third of the suspected SD cases. Apart from ultrasound findings such as severely short femur, polydactyly, poor mineralization and fractures, the bending of femur, narrow thorax, micrognathia, and visceral anomalies helped in pinning the clinical diagnosis of SD in many cases. The FL/AC and TC/AC ratio individually had less sensitivity and high specificity for the prediction of lethality, but had 100% sensitivity for lethality prediction if both were abnormal. Fetal growth restriction was diagnosed in 17/76 (22.4%), familial short stature in 4/76 (5.3%). SD was suspected in 55/76 (72.3%). Among them, the genetically diagnosed, clinically suspected, and undiagnosed cases were 19/55 (34.5%), 24/55 (43.6%), and 12/55 (21.8%). Bent femur was most common anomaly (29/55, 52.7%), followed by narrow thorax (20/55, 36.4%). Renal anomaly was the commonest visceral anomaly (5/55, 9.1%). The diagnosis of SD was made in 40/76 (52.6%). Ciliopathies were the largest group (12/40, 40%), followed by osteogenesis imperfecta (11/40, 27.5%). CONCLUSION:The study highlights the importance of structured ultrasound assessment and pattern recognition in skeletal dysplasia along with genetic testing for improved clinical decision-making and parental counseling.
BACKGROUND:Urinary bladder paraganglioma (UBPGL) is a rare neuroendocrine tumor. Exophytic variants can mimic gynecological or mesenchymal pelvic masses, posing diagnostic challenges. Accurate preoperative recognition is crucial to avoid perioperative complications, especially in functional cases. CASE:A 22-year-old asymptomatic woman presented with a slowly enlarging pelvic mass. Transrectal contrast-enhanced ultrasound (CEUS) revealed rapid, intense homogeneous early enhancement with late peripheral rim enhancement. MRI showed a markedly T2-hyperintense parauterine mass with vivid enhancement and restricted diffusion. The mass was intraoperatively confirmed to originate from the posterior bladder wall. Partial cystectomy was performed, and histopathology confirmed paraganglioma with malignant potential. CONCLUSION:Exophytic UBPGL can mimic common pelvic tumors. Multimodality imaging, including CEUS and MRI, plays a key role in characterizing vascularity and guiding surgical planning, though diagnosis ultimately relies on histopathology and clinical correlation.
Epidermal cysts are common benign cutaneous lesions that may occur on anybody skin surface, with a predilection for hair follicles, and generally demonstrate a favorable prognosis with few complications. In comparison, breast epidermal cysts are extremely rare. Given the unique anatomical and glandular features of breast tissue, these lesions are more susceptible to infection, rupture, and malignant transformation than epidermal cysts occurring at other cutaneous sites. This study analyzed the multimodal ultrasonographic findings of one case and reviewed relevant literature to summarize its clinical and imaging features, aiming to improve diagnostic awareness and accuracy for this rare breast lesion.
In a postoperative cardiac neonate undergoing bedside hemodynamic assessment for suspected venous congestion, point-of-care ultrasound performed by a pediatric intensivist unexpectedly revealed hepatic portal venous gas. This finding prompted immediate abdominal reassessment and urgent radiography, which demonstrated pneumoperitoneum. Exploratory laparotomy revealed terminal ileal perforations with ischemic changes and fecal peritonitis. Although the examination was performed for hemodynamic purposes, careful assessment of the portal venous system disclosed a clinically important abnormality unrelated to congestion. This case highlights the importance of recognizing sonographic signs suggestive of necrotizing enterocolitis and intestinal perforation during bedside POCUS to facilitate timely diagnostic escalation.
