Ectopic pregnancies are implanted outside the normal location within the uterus; mostly (about 95%) within the fallopian tube but might also rarely be seen within abnormal locations in the uterus, in the ovaries, peritoneal cavity, or even retroperitoneally. These pregnancies are particularly challenging to diagnose. The outcome in most ectopic pregnancies is guarded unless an early diagnosis is made and dealt with by an experienced multidisciplinary team. The management of rare ectopic pregnancies is further complicated by difficulties in diagnosis, delay in diagnosis, and greater risk of bleeding. This paper describes the rare ectopic pregnancies that the authors have seen in their practice, the presentation, pitfalls in diagnosis, the clues that might lead to the correct diagnosis, and the outcomes in these cases are discussed. An algorithmic approach is presented that might improve the diagnostic accuracy.

Our objective was to evaluate the ultrasonography sliding sign with enhanced reliability using an inter-observer approach, with the aim of predicting standardized intra-abdominal adhesions before cesarean section. Between January 2022 and January 2024, this retrospective cross sectional study included 350 individuals who underwent cesarean section. Data from 198 participants who met the inclusion criteria were analyzed. Analyzes were made with SPSS 26.0. The Mann-Whitney U test was employed to assess variables that were not normally distributed. Chi-square test and Fisher precision test were employed in the categorical data analysis. These were presented as counts and percentages (%). An inter-rater reliability analysis was performed for ultrasonography sliding sign finding. For this purpose, the Cohen's Kappa was calculated. Receiver operating characteristic analysis was used to determine the area under the curve, which indicates the average sensitivity of ultrasonography sliding sign finding. There was a 95% confidence interval for the results. A p value of less than 0.05 was deemed statistically significant. To assess sliding signs, all pregnant participants received transabdominal ultrasonography. The study achieved triple masking: both sonographers were unaware of the surgical findings, the surgeon remained unaware of the ultrasound findings, and the data analyst was unaware of both sonographic and surgical findings. According to the Nair's modified scoring system, the cases were classified as Group 1 (adhesions present [Grade ≥ 1]; n = 107, 54%) and Group 2 (no adhesions [Grade 0]; n = 91, 46%). The diagnostic value of transabdominal ultrasonography sliding sign for detecting the presence of intra-abdominal adhesion (according to the modified Nair's scoring system) yielded 84.6% specificity and 58.9% sensitivity. A Nair's score ≥ 2 was identified as the cut-off point, with the sliding sign finding being statistically significant, resulting in 70% specificity and 54% sensitivity. This research validates the use of a sliding sign during transabdominal ultrasonography in pre-cesarean evaluation in patients with previous cesarean section. It has been shown that applying the adhesion scoring system categorically as well as using it numerically makes a difference by analyzing the cut-off point of Nair's score as 2. From this perspective, the reliability of the sliding sign finding in transabdominal ultrasound will be better demonstrated.

The purpose of this research was to quantitatively evaluate the vascular supply and tissue stiffness of the salivary glands-namely, the submandibular and parotid glands-in pregnant individuals throughout the three trimesters, employing superb microvascular imaging (SMI) and shear wave elastography (SWE). A longitudinal prospective study was executed involving 35 healthy pregnant women. Salivary gland ultrasonography was conducted during each trimester. The vascularization index (VI) was quantified using the two-dimensional SMI VI (2DcSMIVI) mode by manually delineating the glandular parenchyma. Glandular elasticity was measured through SWE in kilopascals (kPa) and meters per second (m/s). Statistical evaluations incorporated repeated measures ANOVA and the Friedman test (p < 0.05). Submandibular gland stiffness showed significant trimester-based variations, with kPa values peaking in the second trimester and declining in the third (F(2,68) = 5.31, p < 0.05, η2 = 0.13). Likewise, m/s values were elevated in the second trimester relative to the third (X2 = 7.79, p < 0.05). In contrast, the stiffness and VI values of the parotid gland exhibited consistency across trimesters (p > 0.05). The dynamic shifts in submandibular gland stiffness, highlighted by a rise in the second trimester followed by a decrease in the third, most likely signify the hormonal and hemodynamic adaptations that come with pregnancy. These findings underscore the importance of monitoring salivary gland function in pregnant women and pave the way for future investigations into the diagnostic and prognostic implications of these changes. To the best of our knowledge, this represents the inaugural study demonstrating normative stiffness and vascularity parameters of salivary glands across each trimester of pregnancy.

This report documents the first serial sonographic progression of ganglionic eminence (GE) anomalies in pyruvate dehydrogenase complex deficiency (PDCD) from 12 to 28 weeks. Ultrasound revealed bilateral anterior hypoechoic foci (12 weeks), progressing to solid-cystic GE cavitations (22 weeks) and periventricular germinolysis-type pseudocysts (28 weeks). MRI confirmed concurrent callosal dysgenesis and cerebellar hypoplasia. A pathogenic PDHA1 variant (c.581A>G, p.Y194C) provided definitive molecular diagnosis after exclusion of common etiologies. This continuum serves as an early PDCD imaging indicator, guiding prenatal diagnosis of this lethal disorder.

Heterotopic pregnancy (HP) is a rare condition with an incidence of about 1 in 30 000 in natural conceptions and 1 in 100 in cases involving assisted reproductive techniques (ART). The diagnosis can be challenging and often underdiagnosed due to the presence of an intrauterine pregnancy. We aim to present a rare case of HP, characterized by the presence of intrauterine twin implantation. This case highlights the importance of maintaining a high index of suspicion for HP even in the presence of a viable intrauterine twin gestation, particularly following ovulation induction with clomiphene citrate.

Accurate evaluation of left ventricular (LV) dysfunction and infarct localization in acute myocardial infarction (AMI) remains challenging due to subjective variability in conventional echocardiographic analysis. This study validates an artificial intelligence (AI)-driven automated strain framework for standardized quantification of myocardial deformation and its correlation with clinical biomarkers. A retrospective cohort of 102 first-onset ST-elevation AMI patients and 90 age-/sex-matched controls underwent 2D speckle-tracking echocardiography. A modified ResNet-18 architecture processed standardized apical views (112 × 112 pixels, 25-frame cycles) through dual-task learning: global/regional longitudinal strain (LPSS) quantification and infarct localization. Training employed a two-phase optimization-myocardial tracking followed by strain regression and infarct classification. Real-time augmentation included speckle noise and cardiac-phase variations. Statistical analyses assessed correlations between strain parameters, LV ejection fraction (LVEF), cardiac troponin T (cTnT), and ST-segment elevation. AI-derived global LPSS strongly correlated with LVEF (r = -0.609; p < 0.001), outperforming the wall motion score index (r = 0.291). Infarct-zone LPSS demonstrated the strongest associations with cTnT (r = 0.671; p < 0.001) and ST elevation (r = 0.321; p = 0.001). Remote myocardium exhibited compensatory hyperkinesis (LPSS = -17.93%). Bland-Altman analysis confirmed reproducibility (intra-observer bias: 0.7% ± 1.2%; interobserver: 1.1% ± 3.1%). AI-driven strain analysis standardized LV functional assessment in AMI, providing quantitative correlations with enzymatic and electrophysiological injury markers. Its ability to localize infarcts and detect compensatory mechanisms supports clinical decision-making, bridging gaps between echocardiography and advanced imaging.

We present a rare fetal case of aortopulmonary window (APW) accompanied by severe growth restriction and a complex chromosomal abnormality involving two pathogenic 15q copy number variants encompassing the IGF1R gene. Fetal echocardiography at 28 weeks confirmed the APW and a perimembranous ventricular septal defect. This co-occurrence suggests a more complex relationship between 15q aberrations and APW and warrants further study. Moreover, this case expands the phenotypic spectrum of 15q imbalances and underscores the need for integrated prenatal evaluation combining advanced cardiac imaging with genomic analysis, particularly in congenital heart disease accompanied by significant growth disturbance.

We present a case of a very rare benign ovarian tumor, a sclerosing stromal tumor (SST). In addition, we performed a review of the literature to describe the spectrum of sonographic findings of this tumor. Our case was a 43 year-old woman, referred for pelvic endometriosis evaluation. Transvaginal ultrasound showed a solid tumor with a maximum diameter of 30 mm arising from external pole of the right ovary. Color Doppler assessment showed a moderate/abundant vascularity. A diagnosis of presumed ovarian surface serous borderline tumor was established. Surgery was performed with tumor removal. Definitive histological diagnosis was benign sclerosing stromal ovarian tumor. In the literature review, we identified 81 cases describing sonographic findings of this tumor. This spectrum was wide, with most tumors reported as purely solid or predominantly solid with cystic areas (86.7%) and few cases were reported as multilocular-solid, unilocular-solid, multilocular and unilocular. Echogenicity was heterogeneous in 96.9% of the cases. When vascularity was described, 61% of the cases had moderate/abundant vascularization. Calcification and shadowing were rare. Ascites was reported in 16.0% of the cases. In conclusion, the spectrum of findings of SSTs may vary, but most cases were solid tumors. Our case fits this pattern.

We report a rare case of dual ductal-dependent systemic perfusion in type C interrupted aortic arch. Despite imaging confirmation, ductal closure led to cardiopulmonary failure, and surgery was declined. This case underscores the critical need for prenatal diagnosis and coordinated perinatal management to enable timely intervention.

This study investigates the blood supply distribution in pituitary macroadenomas with cavernous sinus invasion using dynamic contrast-enhanced MRI (DCE-MRI). Data from 44 patients treated between May 2018 and December 2021 were collected. DCE-MRI was conducted preoperatively. As a result, tumors in the sella turcica and cavernous sinus were distinguished based on cavernous sinus wall continuity on T2WI coronal views. Time-signal intensity curves were generated from DCE-MRI using a postprocessing workstation. Analysis revealed no significant difference (p > 0.05) in curve types between sella turcica and cavernous sinus tumor tissues. However, the volume transfer constant, reflux rate constant, and rT2WI in the sella turcica tumor tissue were significantly higher than those in the cavernous sinus (p < 0.05). Extracellular space volume fraction and initial area under the curve showed no significant difference (p > 0.05). Pituitary adenomas in the sella turcica and cavernous sinus share the same blood supply artery. However, the tumor tissue in the sella turcica displays richer blood flow and microvascular generation than that in the cavernous sinus.