Objective: The aim of this quality improvement study was to determine whether adding a transverse coronal (TC) duplex Doppler view to the conventional long-axis sagittal (SAG) approach improves the detection and quantification of reflux at the saphenofemoral junction (SFJ) in patients with clinical evidence of chronic superficial venous insufficiency. Materials and Methods: This quality improvement study evaluated 64 limbs from 33 patients undergoing lower extremity venous duplex examinations at 4 private cardiovascular practice offices. All patients had a documented history and clinical signs or symptoms of superficial venous insufficiency and an SFJ diameter greater than 5 mm. Each limb was examined in reverse Trendelenburg using both the conventional SAG approach and an additional TC approach. Color and spectral Doppler were used to evaluate reflux direction, intraluminal flow pattern, and reflux duration during a Valsalva maneuver. Pathologic reflux was defined as retrograde flow lasting at least 500 ms. Reflux detection rates were compared using McNemar exact test, and paired reflux-duration measurements were compared using a paired Student t test. Results: Reflux was detected in 63 of 64 limbs (98.4%) using the TC approach and in 44 of 64 limbs (68.8%) using the SAG approach. Among the 63 TC-positive limbs, the SAG approach failed to detect reflux in 19 limbs, corresponding to a relative false-negative rate of 30.2%. The difference in paired detection rates was statistically significant ( P = .0000038). Mean reflux duration was 2417.3 ms with the TC approach compared with 1605.1 ms with the SAG approach. The mean paired increase was 812.2 ms, representing a 50.6% increase in measured reflux duration with the TC approach ( P < .001). The TC view facilitated visualization and sampling of eccentric reflux jets that were incompletely demonstrated in the sagittal plane. Conclusion: There may be value to adding a TC duplex Doppler view to the conventional SAG examination for chronic venous insufficiency significantly increased SFJ reflux detection and produced longer reflux-duration measurements in this patient population. The conventional sagittal approach may underestimate or fail to detect clinically relevant venous reflux when the reflux jet is eccentric, low flow, or poorly aligned with the Doppler beam. The TC view may be a useful adjunct when sagittal findings are negative, borderline, or discordant with the clinical presentation.
Objective: Necrotizing enterocolitis (NEC) is a destructive infantile disease with the highest mortality, which requires surgery. This study investigated and compared the diagnostic accuracy of abdominal radiography (AR), bowel ultrasonography (BUS), and Doppler for infants with suspected NEC stages I-III. Materials and Methods: Eighty-four infants with risk factors for NEC were enrolled and categorized into suspected (stage I) and final diagnostic (stages II-III) patient groups, based on Bell’s criteria. Gray-scale sonography and Doppler diagnostic findings were analyzed using Faingold’s criteria and compared with AR. The descriptive characteristics, such as maternal factors, and infant mortality, were recorded. Results: Most of the study neonates were males (59.5%) and had suspected NEC (57.1%). Of the 48 infants with suspected NEC, 20 were reclassified as definite NEC based on sonographic findings. Eighteen patients (21.4%) died, predominantly in the definite NEC group (72.2%, P = .005). All AR and BUS findings, except fluid collections, differed significantly between groups ( P < .05). Bowel loop dilatation showed 60% to 65% diagnostic accuracy, 50% to 52% specificity, and 80% sensitivity. Pneumatosis intestinalis, portal venous gas, and pneumoperitoneum had similar diagnostic accuracy but different sensitivities and specificities. Doppler was used to identify avascular loops in 18 patients, all with a final diagnosis of NEC ( P < .001), with 74.3% diagnostic accuracy, 66.6% specificity, and 83.7% sensitivity. Conclusion: In this cohort of patients, gray-scale sonography, Doppler, and AR parameters had acceptable diagnostic accuracy, although sensitivity and specificity varied.
Objective: To compare the detection capability and reported diagnostic indicators of Doppler ultrasonography (DUS) and contrast-enhanced ultrasound (CEUS) to detect neovascularisation in Achilles tendinopathy, as well as assess the diagnostic relevance in relation to symptoms and treatment outcomes. Materials and Methods: A systematic literature search was conducted using the EBSCO host databases for studies published between 2004 and 2024, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies involving adults with Achilles tendinopathy assessed with DUS and/or CEUS were included. Data extraction was performed using a structured form, and study quality was evaluated using the Critical Appraisal Skills Programme (CASP) tool. Due to methodological heterogeneity, a narrative synthesis was executed. Results: Eight studies met the inclusion criteria, all using DUS, with two additionally incorporating CEUS. The CEUS appeared to demonstrate greater detection capability for microvascular flow compared to DUS, particularly in complex clinical cases. The DUS remained more accessible and clinically feasible. Evidence linking neovascularisation with symptom severity was inconsistent, although some studies reported vascular changes following treatment. Conclusion: Both DUS and CEUS have been shown to detect neovascularisation in Achilles tendinopathy. Based on published evidence, CEUS provides enhanced microvascular assessment, while DUS remains a practical primary diagnostic tool. The diagnostic role of neovascularisation as a clinical biomarker remains uncertain.
Objective: This scoping review aimed to summarize the cardiopulmonary implications of long COVID in young adults (ages 18-25) utilizing lung and cardiac sonography to identify subclinical abnormalities. Materials and Methods: A comprehensive literature search was conducted across six databases (PubMed, MEDLINE, Embase, CINAHL, Scopus, and Web of Science) from 2020 to August 2024, following Preferred Reporting Items for Systematic Review and Meta-Analysis Extension for Scoping Review (PRISMA-ScR) guidelines. The search strategy included terms related to “echocardiography,” “ultrasonography,” and “post-acute COVID-19 syndrome.” Studies were screened using Covidence software, focusing on young adults with confirmed COVID-19 who underwent sonographic evaluation in the post-acute phase. Of 583 articles identified, six met the inclusion criteria. Results: Included studies varied in design, comprising case series and prospective observational studies. Pulmonary findings include ventilatory inefficiency in athletes despite preserved exercise capacity, and pleural thickening and fragmentation were present. Echocardiographic evaluations showed constriction-like features, impaired left atrial strain, and reduced global longitudinal strain, in individuals with mild infections. Conclusion: Sonography can play a crucial role in identifying subclinical abnormalities in young individuals with long COVID. These findings underscore the need for routine imaging assessments to guide clinical management and inform rehabilitation strategies. Longitudinal studies are warranted to establish standardized imaging protocols and to better understand the long-term implications of COVID-19.
Objective: Fetal sonography is a cornerstone of prenatal care, enabling noninvasive monitoring of fetal growth and early detection of congenital anomalies. Despite its clinical value, its effectiveness can be limited by operator dependency, subjective interpretation, and variability in image quality. To address these issues, researchers have suggested using deep learning (DL) models as a maneuver to assist sonographers. Materials and Methods: A search of the current literature was conducted using PubMed, IEEE Xplore, SpringerLink, and Scopus, to create a targeted and current review on the use of DL in obstetric sonography. These platforms are renowned for their high-quality, peer-reviewed publications in both medical imaging and artificial intelligence. The timeframe is selected between 2019 and May 2025, which aligned with the period that DL experienced rapid expansion, into clinical applications. Results: The systematic review found that DL has numerous therapeutic uses in prenatal imaging, including classifying aberrant and normal anatomy and measuring fetal biometry. This review consolidated recent developments in the application of DL such as classification, segmentation, and automation in obstetric processes. Conclusion: Deep learning has a great potential to guide future diagnostic directions for sonographers, clinicians, and researchers involved in fetal sonography.
Left ventricular outflow tract (LVOT) obstruction (LVOTO) after transcatheter mitral valve replacement (TMVR) continues to be a major concern and carries a high risk of mortality. Patients undergoing valve-in-valve (ViV) procedures are at increased risk of LVOTO with hemodynamic compromise. The combination of laceration of the anterior mitral leaflet to prevent outflow obstruction (LAMPOON) and balloon-assisted translocation of the mitral anterior leaflet (BATMAN) procedures to prevent LVOTO has proven to be successful. However, the presentation on echocardiography during TMVR implantation and surveillance imaging may be complicated or unfamiliar to those with limited structural heart imaging experience. This case study provides a successful two-phase intervention for ViV TMVR utilizing echocardiography during alcohol septal ablation, LAMPOON, and BATMAN procedures. In addition, it describes the ViV implantation posttreatment results demonstrating improved mitral valvular function and successful prevention of LVOTO. These diagnostic findings highlight the essential role of echocardiography in treating high-risk patients and underscore the value of these advanced interventional techniques.
Acute cholecystitis is generally caused by the incarceration of a gallstone. This patient case report provides an extremely rare case of acute cholecystitis caused by an impacted viable cholesterol polyp. Typically, cholesterol polyps are connected to the gallbladder mucosa by a fine filamentous stalk. They are reported to disappear or decrease in size occasionally without symptoms. This process is usually attributed to detachment and subsequent devascularization, leading to degenerative changes and tissue necrosis. It is hypothesized that acute cholecystitis could be caused by a viable cholesterol polyp that arises only under specific circumstances. In this patient, the cholesterol polyps originated in the gallbladder neck and became impacted in situ, leading to acute cholecystitis before any histopathologically degenerative changes could have occurred.
The aim of this systematic review and meta-analysis was to analyze the accuracy of three ultrasound elastography-based techniques: two-dimensional shear wave elastography, point shear wave elastography, and transient elastography. These sonographic techniques were used to provide liver fibrosis staging, compared with liver biopsy. An additional goal was to evaluate the factors that might contribute to diagnostic variations, which could harm reliability, affect early detection, and delay management of liver fibrosis. This systematic review and meta-analysis was conducted in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. The literature search was performed across multiple search engines to curate published evidence, based on studies published between 2015 and 2025. An additional criterion was that these studies had to include both liver biopsy and sonography assessments, to be included. This review is based on 29 studies with a total of 4552 patients. The findings indicated that ultrasound elastography demonstrated superior diagnostic performance, with an area under the curve of 0.931, a sensitivity of 88.8%, and a specificity of 89.2%. As liver fibrosis progressed, the accuracy of predicting cirrhosis was increased. Variability in results was primarily attributed to operator expertise, a body mass index greater than 30 kg/m², the presence of hepatic steatosis, and the underlying cause of liver disease. The elastography methods demonstrated comparable performance, indicating their applicability in clinical settings, despite some data heterogeneity. Ultrasound elastography was found to have high accuracy in staging liver fibrosis, particularly in detecting advanced fibrosis and cirrhosis, and therefore may reduce the need for invasive liver biopsies. However, standardization remains challenging in obese patients and in cases of acute inflammation. Protocol harmonization and standardized operator training should be prioritized in future multicenter studies, to minimize variability. Addressing these gaps will result in elastography having the potential to transform liver disease management through earlier and more accurate diagnoses.
Objective: Artificial intelligence (AI) has emerged as a transformative tool in ultrasound imaging enhancing the accuracy and efficiency of carotid plaque characterization. In addition, AI-driven models facilitate automated analysis reducing interobserver variability and enhancing reproducibility in plaque assessment. Materials and Methods: A systematic review process is outlined that provides an observational study curated from the available results from 1165 unique studies and were screened based on their titles and abstracts. Results: This review is based on 11 studies that satisfied all eligibility requirements and were included in the final review synthesis. The summative results highlighted the current state-of-the-art applications of AI in sonography, as well as providing early detection and risk stratification of carotid atherosclerotic plaques. The review also addressed emerging technologies, limitations, and future directions in AI-driven vascular imaging. Conclusion: With continued advancements, AI has the potential to revolutionize carotid sonography, enabling early intervention and reducing the global burden of stroke and cardiovascular diseases.
Objective: Hepatitis B virus (HBV) and hepatitis C virus (HCV) infections remain major global health challenges. Rwanda faces a disproportionately high HCV burden, with a prevalence of 6.7%, nearly ten times the global average of 0.7%, while HBV prevalence stands at 2.1%. Therefore, the aim was to identify sonographic liver patterns among hepatitis B and C patients and assess their association with sociodemographic factors. Materials and Methods: A cross-sectional study was conducted among 240 patients with viral hepatitis (120 HBV and 120 HCV). Sonographic findings were analyzed for associations with type of hepatitis and demographic variables using Fisher's exact test and chi-square analysis. Results: The 240 participants had a mean age of 52.7 +/- 17.9 years, and 57.1% were male. The most frequent liver sonographic findings were patterns of chronic liver alteration, which was suggestive of fibrosis (21.7%), fatty liver (8.8%), liver size abnormalities (14.6%), and suspicious nodules (5.0%). Fibrotic patterns were more commonly associated with HCV compared with HBV (14.2% vs 7.5%, p = .010), with HCV showing nearly double the cirrhosis rate (6.7 vs 3.3%). Fibrotic patterns were strongly associated with older age (p < .001) and being female (p = .014). Conclusion: Sonography revealed distinct liver morphological changes among hepatitis B and C patients, more frequent in HCV, older participants, and females, suggesting differences in infection duration or health care-seeking behavior. Sonography can be a practical diagnostic tool for identifying and monitoring liver changes in resource-limited practice setting.
Right-sided infective endocarditis (IE) is rare, with most cases involving the tricuspid valve; isolated pulmonary valve endocarditis (PVE) is very rare. Due to the nonspecific clinical presentation, when there is a clinical suspicion of IE, heightened awareness of possible isolated PVE is necessary for timely diagnosis. This case study underscores the importance of a meticulous exploration of the pulmonary valve during transthoracic echocardiography (TTE), utilizing all possible imaging views to identify PVE. Transthoracic echocardiography plays a vital role in the diagnosis of IE by facilitating the identification of vegetations and complications.
Objective: It is unknown whether novice point-of-care ultrasonography (POCUS) users can interpret a lung sonogram (LS) for the presence of pulmonary edema. The aim was to evaluate novice POCUS users' ability to differentiate between A- and B-line artifacts that could indicate pathology on a LS. Materials and Methods: A survey featuring 40 LS videos taken from an emergency medicine department's sample of patients that contained either normal lungs or pulmonary edema and those were distributed to POCUS experts and novice POCUS users. Responses were analyzed for primary outcomes of accuracy, sensitivity, and specificity, compared with the diagnostic gold standard and inter-rater agreement within groups. Results: Twenty-five novice POCUS users and 25 expert surveys were included in analysis. Compared with the diagnostic gold standard, novices yielded a sensitivity of 86.8% and a specificity of 81.8%. Experts yielded a sensitivity of 98.4 and a specificity of 99.2. There was a significant difference between experts and novices for median accuracy 90% versus 100% (p < .001). Fleiss' kappa revealed a near-perfect agreement in the expert group and moderate agreement in the novice POCUS users' group. Conclusion: In this study, the POCUS experts' interpretation of LS findings was more accurate than that of the novices for the presence or absence of B-lines, although both groups performed well. The high performance of this group of novice POCUS users rivaled previously published results. This would suggest that it may be feasible for novice POCUS users to provide some level of LS interpretation.
Objective: To explore the psychological impact, coping strategies, and healthcare experiences of African women undergoing a sonographic diagnosis of uterine fibroids, guided by the Lazarus Stress and Coping Theory and the Engel Biopsychosocial Model. Materials and Methods: Semi-structured interviews were conducted with 20 Nigerian women aged 26 to 50 years, purposively recruited from public and private patient waiting rooms (e.g., 6 awaiting initial diagnosis; 14 in surveillance). Data were analyzed inductively using reflexive thematic analysis. Results: Three themes captured women’s experiences. (1) Psychological distress and threat appraisal: anxiety, fear, reduced self-esteem, and fertility concerns, most acute during initial diagnosis. (2) Adjustment and coping strategies: reliance on religious belief, family/partner support, lifestyle modifications, and complementary therapies, with ambivalence toward surgical treatment largely driven by concerns about potential effects on infertility. (3) Healthcare encounters and information gaps: inconsistent communication and counseling that led women to rely on informal sources of information. Conclusion: A diagnosis of uterine leiomyomas can be marked by substantial emotional burden, influenced by cultural beliefs, fertility expectations, and variable healthcare communication.
Congenital adrenal hyperplasia (CAH) is an autosomal recessive disorder. It can be observed with varied clinical symptoms. It can be diagnosed with the help of biochemical tests, radiologic imaging, and genetic testing. Sonography can be helpful in identification of bilateral adrenal gland enlargement. A case is presented of a 13-day-old female neonate, who was brought to the radiology department for detailed screening, due to the presence of ambiguous genitalia. She was incidentally found to have bilateral adrenal gland enlargement. The sonographic findings revealed enlarged bilateral adrenal glands. The remainder of the diagnostic findings were deemed to be normal, except for the incidental finding of a uterus-like structure. Hence, the neonate was further evaluated for CAH hormonal and genetic evaluations. This patient case reinforces the need for a multidisciplinary approach involving radiology, endocrinology, and genetics, to provide an early diagnosis, intervention, and improved outcomes associated with CAH. This case also highlights the importance of clinician's awareness and family counseling.
Antenatal intracranial hemorrhage (ICH) is an uncommon but serious finding, particularly in the setting of fetal growth restriction (FGR). This report describes a case of severe early-onset FGR complicated by extensive fetal ICH, highlighting the sonographic findings and pathophysiological relationship between the two conditions. A 28-week growth-restricted fetus with reversed umbilical artery end-diastolic flow and reduced fetal movements underwent detailed sonographic evaluation, including Doppler studies of the umbilical artery, middle cerebral artery (MCA), and ductus venosus. Sonography of the fetal cranial structures demonstrated progressive supratentorial and infratentorial hemorrhages, later confirmed by postmortem magnetic resonance imaging and examination. FGR is a recognized risk factor for antenatal ICH, likely related to chronic hypoxia and altered cerebrovascular autoregulation. The presence of cerebral hyperechogenicity, ventriculomegaly, or elevated MCA peak systolic velocity in a growth-restricted fetus should prompt targeted sonography of the fetal cranial structures and Doppler evaluation.
Objective: Transesophageal echocardiogram (TEE) is a useful diagnostic tool for cardiologists. Despite its widespread use, studies addressing safety concerns are limited. The aim was to evaluate the safety profile of TEEs at the host institution and decide whether postprocedural EGD (esophagogastroduodenoscopy) was necessary to assess possible patient injury.Materials and Methods: This was a single-center, retrospective study of patients who underwent TEE in both inpatient and outpatient settings in a community hospital in New York. Data was collected on all adult patient visits from January 1, 2019, to May 30, 2024. Incidence of injury was calculated based on information from procedural reports and documentation in the health systems' electronic medical record (EMR).Results: A total of 441 patients were included in this study. Only one patient (0.23%) had significant complications associated with TEE (i.e., esophageal perforation). The complication rate, based on this review, for the host hospital appeared lower than the rate of gastrointestinal complications seen in other studies (e.g., 0.51%).Conclusion: This study demonstrated this hospital's relative safety of performing TEE, due to the low rate of complications. While some health centers may perform postprocedural endoscopies to assess injury, it may be important for labs to replicate this type of review and confirm the overall safety of their performance of TEEs. This has the potential to negate further endoscopic evaluation for injury is not warranted unless clinical signs raising suspicion of injury manifest.
Objective: This quasi-experimental study investigated whether acupuncture would reduce median nerve crosssectional area (CSA) in carpal tunnel syndrome (CTS) patients, assessed by ultrasonography, and compared findings with nerve conduction velocity (NCV) for diagnostic concordance. Materials and Methods: This cohort study was conducted in a teaching hospital in Iran, where 16 patients were evaluated for CTS and acupuncture treatment for CTS. The cohort provided 26 affected wrists (e.g., six unilateral and ten bilateral) and the patients were aged 24-63 years. This group was compared with a comparison group of 12 patients (e.g., 12 wrists) who did not receive acupuncture treatment. The diagnosis of CTS was confirmed by both clinical symptoms and NCV testing results. Sonography was used to evaluate the carpal tunnel (proximal, inlet, and outlet), pre-and post-treatment of ten acupuncture sessions. Patients were further grouped by NCV severity (e.g., mild: n = 10, moderate: n = 7, severe: n = 9). The Wilcoxon test was used to compare CSA changes, and McNemar's tests assessed color Doppler shifts. Due to potential correlation within bilateral cases, a sensitivity analysis was performed on a subset of 16 independent wrists. Results: The series of acupuncture treatments significantly reduced CSA in the treatment group (p < .001) across all regions, unlike the comparison group (p > .05). Reduction in nerve swelling was noted for mild cases at the proximal/ inlet site, the moderate cases across all regional sites, and severe cases at the inlet/outlet. A sensitivity analysis of 16 independent wrists confirmed the primary diagnostic findings (p < .01). Color Doppler indication of nerve inflammation decreased from 14/20 to 6/20 (p = .01). The NCV testing demonstrated a reduction in severity for the treatment group (p < .001). The treatment group's responses to the Boston Carpal Tunnel Questionnaire improved from a mean of 3.2 +/- SD 0.8 to 2.1 +/- SE 0.6 (p = .01). Conclusion: In this cohort, acupuncture reduced median nerve CSA and improved CTS outcomes, particularly for those who had mild/moderate CTS. In this study, sonography aligned with NCV for monitoring CTS, however, longterm surveillance is recommended.
Objective: This retrospective study using a causal-comparative design addressed the question: Can clusters of prenatally detected defects be identified, based on a sample of fetal sonographic reports, for maternal patients that reside in rural and urban regions across five counties in the San Joaquin Valley of California? Materials and Methods: The fetal defects were identified by advanced perinatology sonography students and graduates who retrospectively reviewed a purposeful sample of 8667 obstetrical sonographic or fetal echocardiographic reports between October 30, 2024, and April 30, 2025. The reports were based on those maternal patients who were examined and resided in the counties of Fresno, Kings, Madera, Merced, and Tulare, California. Results: A total of 414 structural fetal defects (e.g., cardiac, ventral, cerebral/central nervous system (CNS), skeletal, renal, growth restriction, masses/tumors) were reported. Based on the record review, fetal cardiac abnormalities were the most frequently identified (229/414, 55.3%). Chromosomal (57/327, 17.4%) and multiple fetal abnormalities (89/395, 22.5%) were also commonly reported. The standardized incidence ratio of fetal defects in the sampled region of the San Joaquin Valley (414/8667, 4.8%) was greater than the national average incidence rate of birth defects (3.0%). The approximate prevalence rates of fetal defects in the populations of the San Joaquin Valley (2.0% in urban regions and 6.3% in rural regions) were greater than the global prevalence rate of congenital birth defects (1.57%). Conclusion: Clusters of fetal defects were identified, specifically in the urban regions of Fresno and Tulare counties. Further research is recommended to evaluate the effects of multiple potential factors (e.g., maternal age, race/ethnicity, socioeconomic status, delays in detection, environmental exposure to agricultural/industrial chemicals, contaminated water or air, and drug abuse) to explain this cohort of fetal defects that developed in the San Joaquin Valley.
Ovarian clear cell carcinoma (OCCC) represents an uncommon and aggressive form of epithelial ovarian cancer, often diagnosed, due to its relation to endometriosis. This case report is centered on a 63-year-old postmenopausal patient with no history of endometriosis or pertinent risk factors but diagnosed with stage IC3 ovarian clear cell carcinoma. It was initially identified through transabdominal and transvaginal sonography. Sonographic findings of a large cystic pelvic mass with internal vascularized solid nodules led to further imaging and surgical intervention. Histopathology confirmed OCCC coinciding with intraoperative rupture and malignant peritoneal washings. This case emphasizes the pivotal role of sonography in detecting suspicious adnexal masses, particularly when biomarkers like CA-125 are only slightly elevated. Early and accurate diagnostic imaging is crucial for prompt diagnosis and treatment, especially given OCCC's poor response to chemotherapy, at more advanced stages.
