AimThe aponeurotic expansion of the supraspinatus tendon is a recognized but underappreciated anatomical structure of the shoulder. Its sonographic appearance may mimic or coexist with pathology of adjacent tendons, particularly the long head of the biceps tendon, creating diagnostic challenges. Although described in prior literature, many atypical variants remain insufficiently documented. This study aimed to characterize atypical sonographic manifestations of the aponeurotic expansion of the supraspinatus tendon and to propose new classifications based on its relationship with the supraspinatus tendon, its position within the rotator interval, and its association with the long head of the biceps tendon.Material and methodsBetween October 2018 and September 2025, a total of 3,600 shoulder ultrasound examinations were performed. Nineteen patients (15 women, four men; mean age 60.7 years, range 24–82 years) with pathologically altered aponeurotic expansions were retrospectively identified. Each case was evaluated for structural and positional changes in relation to the supraspinatus, long head of the biceps, and subscapularis tendons.ResultsThe most frequent supraspinatus–aponeurotic expansion relationship was minor intrasubstance tearing (31.6%), followed by complete supraspinatus tears with retraction (21.1%). At the rotator interval, subluxation was observed in 36.8% of cases. Regarding interactions with the long head of the biceps tendon, aponeurotic expansion dislocation with preserved intragroove biceps alignment was most common (31.6%). Several theoretical subtypes were not observed.ConclusionsUltrasound enables detailed assessment of the aponeurotic expansion of the supraspinatus tendon. The proposed classifications provide a structured framework for clinical practice and may guide future research into the diagnostic and functional significance of this complex region.

Adipose tissue of the extremities has been largely neglected in musculoskeletal ultrasound (US), beyond the assessment of superficial nodules or the exclusion of deep complications in superficial infections. Three developments have brought it to the fore: a more refined understanding of its anatomy and function − recognizing adipose tissue not merely as a passive fat store but as a metabolic and endocrine organ and a regulator of inflammation; advances in US technique; and the wider adoption of US across medical specialties, particularly dermatology and plastic surgery. Panniculitis refers to inflammation of the subcutaneous tissue and encompasses numerous disorders with considerable clinical overlap. Patients typically present with painful nodules in the extremities and often require histopathological confirmation. Histologically, panniculitides are classified according to the predominant site of involvement − septal, lobular, or mixed. US correlates strongly with these patterns. This review describes the principal sonographic appearances of the most frequent panniculitides and highlights key clinical and pathological features that help narrow the differential diagnosis. Entities that may mimic panniculitis on US are also discussed. Beyond diagnosis, ultrasonography supports disease assessment and monitoring, and it reliably guides targeted biopsy. Finally, the US features of inflammation in articular and periarticular adipose tissue are summarized, with emphasis on findings that should be considered during routine joint US examinations, as such involvement often accompanies internal derangement and may also represent the primary source of patient-reported symptoms.

AimTo evaluate the diagnostic accuracy and clinical utility of cranial ultrasound in detecting skull fractures in children with head trauma, with computed tomography as the reference standard, and to assess the impact of imaging findings on hospital admission and management decisions.Material and methodsThis retrospective single-center observational study included 619 pediatric patients (0–14 years) presenting with head trauma to a pediatric hospital between 2020 and 2025. All patients underwent cranial ultrasound, and a subset subsequently underwent computed tomography. Suspected fractures were analyzed as positive findings for diagnostic purposes. Diagnostic accuracy metrics were calculated using computed tomography as the reference. Associations between clinical variables and outcomes were analyzed using appropriate nonparametric and categorical tests.ResultsAmong 619 children, 62 ultrasound examinations were classified as positive or suspected for fracture. Computed tomography was performed in 13 cases, most frequently in preschool-aged children. When compared with computed tomography, ultrasound demonstrated 100.0% sensitivity, 63.6% specificity, 33.3% positive predictive value, and 100.0% negative predictive value. Overall, 101 patients were hospitalized, including all patients with ultrasound-confirmed fractures and most with suspected fractures. Admission was significantly associated with younger age and trauma mechanism. All patients were managed conservatively and discharged without complications.ConclusionsCranial ultrasound may serve as a safe, rapid, and accessible first-line imaging modality in the emergency setting for detecting skull fractures in children. Although specificity in this cohort was moderate, ultrasound showed a high negative predictive value, supporting its role in reducing unnecessary computed tomography scans and radiation exposure. Computed tomography should remain reserved for clinically ambiguous cases or those with persistent symptoms.

AimSarcopenia, a key component of frailty, is a known risk factor for postoperative morbidity and mortality. This study aimed to assess ultrasonographic features of aging muscles and their association with frailty, as determined by the comprehensive geriatric assessment, in patients undergoing elective surgery. As a secondary objective, we evaluated the utility of muscle ultrasound in predicting postoperative complications.Material and methodsPatients were assessed upon admission to the Department of General Surgery at the University Hospital in Krakow. The study enrolled 84 surgical patients aged 65 years and older. They underwent ultrasound examination of the right rectus femoris muscle and the comprehensive geriatric assessment. Preoperative findings were correlated with data on the postoperative course, including length of hospitalization and occurrence of adverse events.ResultsFrail patients had smaller rectus femoris muscles with higher echogenicity than fit patients. Muscle size parameters significantly correlated with muscle strength, and rectus femoris cross-sectional area emerged as an independent predictor of handgrip strength in the regression model. Increased rectus femoris echogenicity was associated with higher odds of frailty, while reduced rectus femoris muscle thickness was linked to probable sarcopenia. Notably, associations between muscle measurements and physical performance were stronger in men than in women. No strong correlations were observed between ultrasonographic muscle measurements and the occurrence or severity of postoperative complications.ConclusionsUltrasound-based muscle measurements showed weak to moderate associations with strength and physical fitness, but had limited predictive value for postoperative outcomes. While potentially complementary to the comprehensive geriatric assessment, the clinical utility of ultrasound remains uncertain and warrants validation in larger studies.

AimThe aim of the study was to train, evaluate, and optimize machine learning models for classifying focal lesions in the thyroid gland as benign or malignant based on their features.Material and methodsA dataset of 841 focal thyroid lesions described by 17 features (ultrasonographic and patient characteristics) was considered. Using the Python programming language, statistical and then exploratory data analyses were conducted using the libraries, including the generation of graphs and heat maps of correlations between the considered features. Binary classification models were selected to categorize the focal lesion on the basis of their characteristics into one of two classes (benign lesion, malignant lesion). The following models were used: logistic regression-based, support vector machine-based, k-nearest neighbor model, Random Forest model, and decision tree classifier. We applied formulas to select those focal lesion features that most contributed to the models’ classification decisions. The final dataset consisted of 841 focal thyroid lesions described by seven ultrasonographic features and histopathological assessment of malignancy (benign or malignant). Classifiers were validated using 10-fold cross-validation. Model performance was evaluated using sensitivity, accuracy, measure-F, precision, area under the ROC curve, PPV, NPV, specificity.ResultsThe best-performing model (in term of sensitivity) was the classifier based on a support vector machine: sensitivity = 71.17%, accuracy = 83.24%, area under the ROC curve = 84.86%, measure f1 = 69.13%, precision = 68.85%, PPV = 68.49%, NPV = 89.06%.ConclusionsThe study demonstrates the usefulness of data science methods in predicting the malignant nature of focal lesions in the thyroid gland. It proves that classification decisions made by the studied models are based on specific ultrasonographic features associated with increased or reduced risk of malignancy.

Soft tissue hematomas are frequently encountered in both emergency and outpatient settings and often present a diagnostic challenge due to their variable ultrasound appearance and overlapping features with other soft tissue pathologies. Ultrasound is the first-line imaging modality for their evaluation, offering real-time, radiation-free assessment. The sonographic appearance of hematomas is influenced by the stage of evolution, etiology, and anatomical location, which can complicate their differentiation from other entities, particularly when clinical history is unclear or imaging findings are atypical. This article provides a comprehensive review of the sonographic features of hematomas, categorized by etiology (spontaneous, iatrogenic, traumatic), and supported by a series of illustrative clinical cases. These cases highlight key imaging patterns and clinical scenarios that commonly arise in routine practice and underscore the importance of correlating ultrasound findings with clinical evolution and patient a history, especially in diagnostically ambiguous presentations. Diagnostic workflows, practical scanning tips, and key features for differential diagnosis are reviewed, including abscesses, seromas, soft tissue sarcomas, and ruptured Baker’s cysts. Emphasis is also placed on integrating clinical context with imaging findings, particularly in anticoagulated or immunocompromised patients. Recognizing subtle sonographic signs and applying a structured approach can greatly improve confidence in diagnosis. This review aims to equip radiologists, sonographers, and clinicians with a structured, practical framework for the ultrasound evaluation of soft tissue hematomas, promoting diagnostic accuracy and optimal patient care.

AimThe aim of this study was to evaluate left ventricular function in hypoxic neonates undergoing therapeutic hypothermia using echocardiography.Materials and methodsThis multicenter, prospective, case-control, observational study involved 113 neonates, including 55 in the hypothermic group and 58 nonhypothermic controls. Echocardiographic measurements were taken by two neonatologist (NB and RB) during therapeutic hypothermia and after rewarming using various techniques.ResultsThere was a significant difference between the study group and controls in mean blood pressure (p <0.001) and heart rate (p = 0.004) during therapeutic hypothermia. Significantly higher post-rewarming heart rate was observed in the study group compared to controls (p <0.001). Significantly lower mean A-wave (A mv) (p = 0.04) and E-wave (E mv) (p = 0.003) mitral valve velocities, as well as reduced mitral annular plane systolic excursion (p <0.001), cardiac output (p <0.001), and left ventricular internal diameter in diastole (p <0.001) were observed in the study group compared to controls during therapeutic hypothermia. The mean left ventricular myocardial performance index was significantly higher in the study group (p = 0.006). Tissue Doppler imaging showed significantly lower left ventricular E’ velocity (p <0.001) and E’/A’ ratio during therapeutic hypothermia in the study group compared to controls. Left ventricular A’ (p = 0.006), E’ (p <0.001), and S’ (p = 0.003) velocities were significantly lower, while myocardial performance index (p <0.001) was significantly higher in the study group during therapeutic hypothermia than after rewarming.ConclusionsHypothermic neonates exhibit more severe global impairment compared to healthy controls. This is reflected in higher myocardial performance index values and lower E’/A’ ratio, which indicates diastolic dysfunction.

Spontaneous biliary perforation in neonates is a rare but potentially life-threatening condition with nonspecific clinical presentation. Early diagnosis is challenging due to nonspecific clinical signs, yet it is critical for appropriate management. Our objective is to present two etiologically distinct cases of neonatal spontaneous biliary perforation and to review the literature, with a focus on imaging findings, particularly the role of ultrasound (US) in diagnosis. Abdominal US was the initial imaging modality. Indirect ultrasound signs, such as fluid collections near the gallbladder extending towards the duodenum, the porta hepatis, and further into the abdomen, gallbladder wall thickening, and bile duct abnormalities, helped raise suspicion of spontaneous biliary perforation. US findings can be nonspecific, and the direct sign – the so-called ‘hole sign’ – is rarely observed. The final diagnosis was confirmed using magnetic resonance cholangiopancreatography, hepatobiliary iminodiacetic acid scanning, and intraoperative cholangiography. A literature review was conducted focusing on the role of imaging in 23 neonatal cases of spontaneous biliary perforation reported since 1995. Ultrasound was the initial diagnostic tool in 19 cases. In eight cases (42%), US findings raised suspicion of spontaneous biliary perforation, including two cases with direct and six with indirect signs. Hepatobiliary iminodiacetic acid scanning and magnetic resonance cholangiopancreatography served as confirmatory methods. In 65.2% of cases, the diagnosis was ultimately confirmed surgically. Ultrasound plays an important role in the early diagnosis of spontaneous biliary perforation in neonates, mostly through recognition of indirect signs, highlighting the importance of familiarity with this entity.

AimUltrasound is the favorite method for follow-up of urachal remnants when conservative management is chosen instead of surgical resection. However, the success of conservative management depends on the type of urachal anomaly, and the agreement between sonographic and pathoanatomic diagnoses has not yet been assessed.Material and methodsWe retrospectively included all minors treated for a urachal anomaly at two German pediatric surgical centers between January 2008 and December 2020. Ultrasound examinations were conducted by specialized pediatric radiologists and compared with pathoanatomic reports following resection of the urachal anomaly, with respect to its type.ResultsWe included 15 patients with a median age of 0.2 years. The crude agreement between ultrasound and pathoanatomic diagnosis was 70%, and Cohen's κ was 0.66 (95% confidence interval: 0.3 – 1, z = 3.83, p <0.001).ConclusionsUltrasound identified the type of urachal anomaly with sufficient accuracy in this cohort; however, these findings should be corroborated by a substantially larger study.