ABSTRACT A 61‐year‐old woman presented with progressive chest tightness and dyspnoea 17 years after mechanical mitral valve replacement. Transthoracic echocardiography (TTE) showed an elevated transprosthetic velocity, raising suspicion of prosthetic valve stenosis. Further evaluation with live three‐dimensional transoesophageal echocardiography (3D TOE) using Philips Multivue imaging revealed restricted leaflet motion and a small irregular mass on the leaflet surface, findings suggestive of fibrotic pannus ingrowth. The diagnosis was confirmed intraoperatively, and the patient underwent successful redo mitral valve replacement. This case demonstrates that 3D TOE with Philips Multivue imaging can clearly visualise leaflet‐restricting pannus ingrowth without radiation and provide important clinical implications for guiding subsequent management. The technique provides added value over conventional 2D TOE and cine‐fluoroscopy, as it enables multiplanar reconstruction and en‐face views of the prosthetic valve, allowing detailed assessment of leaflet morphology and surface abnormalities that are often difficult to appreciate on 2D imaging, particularly in patients where CT is contraindicated or radiation exposure is a concern.
ABSTRACT Introduction Pneumonia remains a leading cause of morbidity and mortality in children worldwide. Diagnosis commonly relies on chest radiography or CT, which have limitations including radiation exposure, cost and availability. Lung ultrasonography (LUS) is a safe, portable bedside imaging technique. This study compared LUS findings between children with clinically diagnosed pneumonia and healthy controls. Methodology A prospective comparative study was conducted in Sudan from July to October 2022. Eighty children aged 3 months to 17 years were enrolled, including 50 with clinically diagnosed pneumonia and 30 healthy controls. Children with chronic lung disease, congenital abnormalities, or malignancy were excluded. LUS was performed using a 5–12 MHz high‐frequency transducer. Data were analysed using SPSS version 25.0 andassociations were assessed using the chi‐square test ( p < 0.05). Results Males accounted for 70% of pneumonia cases and fever was the most common symptom. Mean pleural thickness was significantly greater in pneumonia patients than controls (0.42 ± 0.17 mm vs. 0.30 ± 0.02 mm, p ≤ 0.0001). A‐lines were absent in 60% of pneumonia cases but present in all controls ( p ≤ 0.0001). More than three B‐lines were detected in 60% of pneumonia patients and none of the controls ( p ≤ 0.0001). Consolidation was observed in 10% of cases, most commonly in the left upper lung zone. Conclusion LUS demonstrated significant differences in pleural thickness, A‐lines and B‐lines between children with clinically diagnosed pneumonia and healthy controls, supporting its role as a safe and accessible imaging modality for paediatric pneumonia, particularly in resource‐limited settings.
ABSTRACT Background Shear wave elastography (SWE) was originally developed to assess the staging of fibrosis caused by chronic liver diseases, including chronic hepatitis B and C and metabolic dysfunction‐associated steatotic liver disease. However, it has not been previously used to evaluate traumatic liver injury. Case Presentation A 19‐year‐old seemingly healthy male was transferred to our emergency department due to multiple injuries caused by a motor vehicle accident. He was in shock due to hemothorax and a ruptured liver. He was treated with a massive blood transfusion followed by chest drainage, open abdominal surgery, and transcatheter arterial embolization (TAE). After closing the abdominal wounds, a series of abdominal ultrasounds including SWE were conducted on the unaffected lobe (Segment 5) adjacent to the destructed lobes (mainly Segments 7 and 8). On Day 48 of hospitalization, his abdominal ultrasound, using color Doppler, showed hepatofugal portal vein flow showing arterioportal shunts, which were embolized by another TAE. The portal vein flow then became hepatopetal on Day 80, indicating a successful embolization. After Day 70, the amount of ascites drastically decreased, and the liver enzymes, including aspartate aminotransferase (AST), alanine transaminase (ALT), and bilirubin, decreased gradually. However, the SWE values plateaued (above 1.8 m/s) during the follow‐up period (380 days after injury) despite normalization of the liver markers, Type IV collagen, and hyaluronic acid. Conclusion This case represents the first report of long‐term SWE findings following severe liver trauma. The observation of persistently elevated SWE values in unaffected parenchyma for more than 1 year raises important questions regarding post‐traumatic hepatic remodeling; however, further studies are needed to clarify the significance of these findings and the potential role of SWE in traumatic liver injury.
ABSTRACT Late cutaneous fistula secondary to dropped gallstones is an uncommon complication of laparoscopic cholecystectomy. We present a case with clinical manifestation several years after surgery, characterized by chronic cutaneous drainage of the abdominal wall. Multimodal imaging demonstrated a focus consistent with a retained gallstone within an inflammatory tract, without evidence of communication with the biliary tree. The pathophysiology is related to a chronic foreign body inflammatory reaction. Recognition of this entity and its correlation with surgical history are essential for timely diagnosis and to avoid unnecessary interventions, allowing appropriate clinical and surgical management.
