Echo Density Research Articles

Data-driven room acoustic modeling via differentiable feedback delay networks with learnable delay lines

Over the past few decades, extensive research has been devoted to the design of artificial reverberation algorithms aimed at emulating the room acoustics of physical environments. Despite significant advancements, automatic parameter tuning of delay-network models remains an open challenge. We introduce a novel method for finding the parameters of a feedback delay network (FDN) such that its output renders target attributes of a measured room impulse response. The proposed approach involves the implementation of a differentiable FDN with trainable delay lines, which, for the first time, allows us to simultaneously learn each and every delay-network parameter via backpropagation. The iterative optimization process seeks to minimize a perceptually motivated time-domain loss function incorporating differentiable terms accounting for energy decay and echo density. Through experimental validation, we show that the proposed method yields time-invariant frequency-independent FDNs capable of closely matching the desired acoustical characteristics and outperforms existing methods based on genetic algorithms and analytical FDN design.

Efficacy Evaluation of a Hyaluronic Acid Dermal Filler Containing Mannitol: Clinical and Aesthetic Assessment Using High-Frequency Ultrasound.

Mannitol may be a good excipient for hyaluronic acid (HA) filler. This study aimed to assess the tolerability and effectiveness of a mannitol-containing HA filler for the improvement of nasolabial folds (NLFs). Thirty Middle Eastern participants aged 18 to 65 years with moderate-to-severe NLFs on the Wrinkle Severity Rating Scale (WSRS) received 1 to 2 mL of a HA filler containing mannitol in both NLFs. Wrinkle Severity Rating Scale; volume, depth, and area of NLFs; and ultrasound parameters were measured at baseline, Weeks 2, 12, and 24 after the injection. Adverse events and participants' satisfaction were recorded in all follow-up visits. Eighty-nine percent, 86%, and 61% of participants showed at least one grade improvement in WSRS, at Weeks 2, 12, and 24, respectively. The area and volume of NLFs significantly decreased compared with baseline (p-value < .01). In severe NLFs, echo density of the dermis significantly increased at Week 2. Participants reported great satisfaction with the treatment, and adverse events were mainly mild and transient. One patient had significant pain during injection, but this resolved without sequelae. The tested mannitol-containing HA filler showed to be effective in Middle Eastern participants. The safety will require a follow-up larger study.

Echo-aware room impulse response generation.

In real-time applications, like interactive virtual reality environments, there is a significant need for low-complexity simulation of room impulse responses in highly complex virtual scenes, but this remains a challenging issue. In particular, simulating late reverberation using physically based acoustic modeling requires much computational effort, contrary to the early reflections that can be modeled by simpler techniques, e.g., the image source method. To tackle this computational complexity issue, we propose a neural network-based hybrid artificial reverberation framework (Echo2Reverb) that generates late reverberation from given early reflections. The proposed model can control both temporal texture and frequency-dependent energy decay, i.e., echo density and spectral energy distribution, of the generated reverberations by extracting spectral and echo-related features and filtering sampled sparse sequences and Gaussian noises using estimated features. To support the end-to-end training with controlled echo density, a differentiable approximation of the normalized echo density profile is proposed. We train and test the model not only for nearly diffuse but also distinct echoes prominent in late reverberations, such as with flutter echoes in narrow corridors. Evaluation results demonstrate that the proposed model can accurately reproduce frequency-dependent energy decay and temporal texture of a room impulse response using only early reflections.

Dorsal wrist ganglion: clinical and imaging correlation in symptomatic population based on high-field MRI.

To determine prevalence in the symptomatic population of dorsal mucoid cysts centered on dorsal capsuloscapholunate septum (DCSS) using high-field magnetic resonance imaging (MRI) for anatomoclinical and epidemiological correlations. This single-center retrospective study analyzed all 3-Tesla MRIs consecutively performed for painful wrists in 295 patients. Two blinded readers performed measurements. The protocol included T1 spin echo and 3D proton density sequences with fat saturation. Inter-observer reliability was assessed using kappa and intra-class correlation coefficients for cyst detection and volumetry, respectively. Disagreements concerning cyst detection were resolved by a consensus reading. Cyst size, relationship to extrinsic and scapholunate ligaments (SL), continuity of SL, minimum distance to the posterior interosseous nerve (PIN), cyst communication with joint, and anatomical classifications of cysts were analyzed. Correlation tests were performed to assess associations. Two-hundred ninety-five patients (mean age 39.6 +/- 15.6 (standard deviation), 161 males) were evaluated for detection of dorsal wrist cysts identified in 150/295. In this subgroup, the mean age was 38.7 years (15-75), the sex ratio of 0.6 (59% women), and the median volume cyst of 8.7 mm3 (0.52-2555). Cyst detection, volume, and major axis measurements showed very high agreement between observers, respectively, 0.89, 0.96, and 0.91. 42 patients had dorsal SL pain. A weak negative correlation was found between distance to PIN and dorsal SL pain (r = -0.2415; p < 0.05) and a weak positive correlation between Guérini's classification and dorsal SL pain (r = 0.2466; p < 0.05). High-field MRI is the modality of choice for the detection, anatomical, and volumetric assessment of dorsal cysts. Preoperative assessment will be aided by the proposed revised anatomical classification. High-field MRI is the modality of choice for the anatomical study of dorsal ganglion cysts. It allows the radiologist to accurately describe the anatomical relationships, size, and visibility of the pedicle, essential information for the surgeon's preoperative assessment. Dorsal mucoid wrist ganglion is a condition for which prevalence remains to be determined. High-field MRI is a reproducible imaging modality for the detection and assessment of dorsal wrist cysts. High-field MRI has a key role in the preoperative management of dorsal mucoid cysts.

Early Morbidities of Hypoxia-Ischemic Encephalopathy in Term Neonates With a Resistive Index as a Prognostic Indicator.

Background Acidosis, hypoxemia, and hypercarbia are symptoms of a syndrome known as perinatal asphyxia that occurs during the first and second stages of labor and shortly after delivery due to poor gas exchange. The Doppler technique is a non-invasive way to assess the risk of neurodevelopment damage in hypoxic-ischemic encephalopathy (HIE) that may be done at the patient's bedside without disturbing them. The study aims to evaluate cranial ultrasound findings in HIEand investigate the role of resistive index (RI) values assessed by color Doppler transcranial ultrasonography in predicting early morbidities in neonates with HIE within 72 hours of life. Methodology Prospective observational research was carried out at the north Karnataka region's tertiary newborn critical care unit. The study included 54 infants with HIE in total. The male-to-female ratio was 1.7:1, with 34 (63%) male and 20 (37%) female newborns. Results About 32 instances had grade I HIE, 8 had grade II HIE, and 14 had grade III HIE. In 35 instances (64.81%), the RI was normal; in 19 cases (35.19%), it was abnormal. Increased periventricular density and cerebral parenchyma echo density were common Doppler ultrasonography findings. Roughly 93% of people survived, and 7% of people died from HIE. Seizures (12.96%) and acute renal damage (33.33%) were the most frequent consequences. Conclusion In instances of HIE, the RI was revealed to be a favorable predictive indicator for newborn prognosis. Counselingand educating parents about early morbidities, anticipated long-term consequences, and the need for follow-up will all benefit from it. Additionally, color Doppler is a practical and secure diagnostic method for determining a newborn's level of HIE.

Tolerability and efficacy assessment of an oral collagen supplement for the improvement of biophysical and ultrasonographic parameters of skin in middle eastern consumers.

Topical skin care products often do not reach the deeper layers of the skin, and oral hydrolyzed collagen is one of the newest and most popular systemic supplementations for skin rejuvenation. However, there are limited information in case of Middle Eastern consumers OBJECTIVE: The purpose of this study was to evaluate the tolerability and efficacy of an oral collagen supplement for improvement of skin elasticity, hydration, and roughness in Middle Eastern consumers. It was a 12-week, before-after clinical study, conducted on 20 participants (18 women and 2 men) aged 44.15 ± 5.36 years with skin type III-IV. Skin elasticity parameters (R0, R2, R5, and R7), skin hydration and friction, as well as the thickness and echo density of the dermis, were measured after six and 12 weeks daily intake of the study product, as well as 4 weeks after stopping its use (week 16). Participants' satisfaction was assessed on the basis of their answers to the standard questionnaire, and tolerability of the product was assessed by monitoring the adverse effects. A significant improvement was detected in R2, R5, and skin friction at week 12 (p-values 0.041, 0.012 and <0.01, respectively). At week 16, the values remained at an increased level, which indicates the persistence of the results. The increase of dermis density in week 16 was also significant (p-value=0.03). Moderate overall satisfaction was reported with the treatment, and a few gastrointestinal complications were reported. The study demonstrated that oral collagen peptides could significantly improve the skin elasticity, roughness, and dermis echo density, and they also proved to be safe and well-tolerated.

540. Impact on Clinical Decision Making of Microbial Broad Range Metagenomic Cell-Free DNA at a Single Academic Medical Center, a Retrospective Study

Abstract Background Broad-range metagenomic cell-free DNA testing (Karius®) can identify a variety of pathogens from a single blood sample to help in diagnosis of deep seated and bloodstream infections. Few studies have evaluated the impact of Karius testing on clinical decision making when compared to more conventional diagnostic methods. Methods We performed a retrospective cohort study of adult patients who had Karius tests at University of Iowa Hospitals and Clinics between 01/2020 and 10/2021. Chart review was conducted to obtain patient characteristics and clinical course including patient age, immunocompromising conditions, involvement of Infectious Disease (ID) consultant, reason for the test, and final diagnosis. Results of the Karius tests and conventional tests were compared for concordance. Clinical impact and change in management due to Karius testing were determined using previously established criteria outlined by Hogan et al.(Clin Infect Dis. 2021 Jan 27;72(2):239-245) Results Out of 26 patients who had Karius testing, 20 patients (77%) had an immunocompromising condition, the most common of which was hematologic malignancy (17 patients, 65%). Twenty-four patients (92%) had received a formal ID consultation prior to the test. The most common finding prior to testing was the presence of pulmonary infiltrates on imaging (20 patients, 77%). Karius testing was positive in 18/26 cases (69%). Organisms detected by Karius and conventional testing were concordant in 9/18 cases (50%). Karius test result had a positive clinical impact in 3 cases (12%), an indeterminant impact in 1 case (3%) and no impact in 22 cases (85%). Reasons for a positive impact are as follows: 1 case with initiation of antituberculosis therapy due to earlier diagnosis of tuberculosis, 1 case with de-escalation of antifungal therapy based on negative Karius results, and 1 case of clearance for urgent lung transplantation based on negative Karius results in the setting of mobile echo density on echocardiogram in the absence of other stigmata of endocarditis. Conclusion The impact of Karius testing on patient management appears limited. Further studies will be needed to identify patient populations or disease factors in which this testing have clinical impact. Disclosures All Authors: No reported disclosures.

143: THE BROKEN AND CLOTTED HEART: A CASE OF TAKOTSUBO CARDIOMYOPATHY WITH LEFT VENTRICULAR THROMBUS

Introduction: Takotsubo cardiomyopathy is a rare heart disease characterized by systolic dysfunction and ballooning of the left ventricle (LV). It is triggered by intense physical or emotional stress and causes symptoms similar to myocardial infarction. Even though rarely associated with complications, 1-2% of patients may develop LV thrombi. Description: A 39-year-old female with a history of gastric bypass surgery, anorexia nervosa, laxative abuse, and depression presented with vomiting, diarrhea, generalized weakness, and chest pain. She had a blood pressure of 75/45 mmHg, heart rate of 130/min, respiratory rate of 18/min, and SpO2 of 95%. Physical examination showed a semi-responsive female with poor peripheral pulses and cyanotic lips. EKG showed sinus tachycardia, left anterior fascicular block, and nonspecific ST changes. Laboratory results were significant for white count of 14.1 K/uL, BNP of 1560 pg/dL, troponins of 5.11 ng/ml, creatinine of 1.47 mg/dL and lactate of 4.8 mmol/L. The patient was transferred to the intensive care unit, resuscitated with fluids, and started on a heparin infusion, norepinephrine, and broad-spectrum antibiotics for suspected infection. An echocardiogram showed globally reduced ejection fraction (EF) of 30-35%, evidence of partial noncompaction of the LV apex and a mobile echo density near the mid anterior lateral wall which was later confirmed on cardiac magnetic resonance imaging. Coronary angiography revealed no flow limiting disease. The patient was managed supportively and continued on a heparin infusion with a plan to start goal directed medical therapy as tolerated for heart failure. A follow up transesophageal echocardiography two days later showed EF of 50-55% and a persistent mass in the LV apex with multiple lobes and various echogenicity. A final diagnosis of takotsubo cardiomyopathy complicated by LV thrombus was made. Discussion: Takotsubo cardiomyopathy is a rare cause of myocardial injury which is reversible in a few months. Reported incidence of LV thrombus is 1-2% with cardioembolic complications observed in 1.3% of patients. Timely diagnosis remains challenging due to nonspecific clinical picture. Appropriate treatment of LV thrombus is pivotal to ensure prevention of long-term neurological sequelae.

Abstract 15627: Inferior Vena Cava Filter Strut Fracture and Migration to the Right Ventricle in Post-COVID Patient With Intractable Cough

Background: Inferior vena cava (IVC) filter fracture and migration of the fractured strut is a rare but potentially dangerous complication. We report a case of fractured IVC strut migrated to the right ventricle (RV) in a patient who was evaluated for persistent cough. Clinical Case: A 69-year-old male presented to his primary care physician for the evaluation of intractable cough and shortness of breath. Past medical history was significant for recurrent unprovoked deep vein thromboses treated with an IVC filter 15 years ago. He had COVID19 infection six months prior to current presentation. A computed tomography (CT) scan of the chest was ordered to screen for underlying pulmonary disease. CT scan showed no pulmonary process, but revealed a linear radiopaque foreign body in the RV of the heart. His cough was considered to be a sequela of his prior COIVD19 infection. Decision-making: To better characterize this foreign body in RV, a transesophageal echocardiogram was performed. This showed a prominent linear echo density on the tricuspid valve chord in the RV. On careful review of the CT scan of the chest and comparison with prior CT scans, it was found that one of the IVC filter strut at 9 o’ clock position was missing. The ‘foreign body’ in the RV had the same size as the remaining struts of the IVC filter. Given that the patient did not have any symptoms or complications from the incidentally found fractured strut, decision was made to not retrieve it with a percutaneous or surgical intervention. Conclusion: Significant variations in the intra-abdominal pressure may contribute to metal fatigue potentially leading to IVC filter strut fracture and migration to the RV. This underscores the importance of timely removal of IVC filters. Uncomplicated migrated IVC filter struts may be left unretrieved and patients can be followed clinically.

Abstract 14050: A Giant Free-Floating Ball Thrombus or a Tiny Fibroelastoma: Which Causes Multiple Strokes?

Background: Left atrial (LA) thrombus is not rare in patients with mitral valve stenosis, but in patients with nonvalvular atrial fibrillation on anticoagulation, the formation of a "ball thrombus" in the LA is uncommon. Case: A 73-year-old man with nonvalvular atrial fibrillation on eliquis presented with frequent syncope and slurred speech. .The appearance of the infarcts on brain MRI and involvement of different vascular territories suggests embolic phenomena as the cause. On transthoracic echo a large, highly mobile echo density in the left atrium was noted. Transesophageal echo revealed smoke in the left atrium and the left atrial appendage. A large round mobile echo density mass measuring 4.7 cm X 3.6 cm was seen in left atrium with no attachment to left atrium. A mobile round density measuring 0.7x0.7 cm was seen on the right coronary cusp. Absence of perfusion, no enhancement, and high signal intensity on T1 and T2 weighted images on cardiac MRI was suggestive organized clot in left atrium. Decision-making: Both masses were removed successfully. Pathology confirmed a large intact spherical organized clot from the LA and a small fibroelastoma attached to the aortic leaflet. Conclusion: This was a rare case of giant round-shaped left atrium thrombus, which occurred in a patient with nonvalvular atrial fibrillation on anticoagulation. An aortic fibroelastoma was also discovered by transesophegeal echo as another potential cause of stroke. The left atrial thrombus is thought to have developed from a small mural thrombus caused by prolonged blood stagnation, which gets rounded by the sculpting impact of multiple complex encounters with the atrial wall. This may then detach from the LAA and form a floating "ball thrombus.

Detection of skin thickness and density in healthy Chinese people by using high-frequency ultrasound.

Due to a recent development of high-frequency ultrasound (HFUS) systems, it is easier to realize high-resolution in vivo imaging of the biological tissues. The object of this study was to map the thickness and echo density of skin layers in healthy Chinese people and assess the influence of gender, age, and region on it. A total of 189 volunteers (85 male, 104 female) with age range of 22-75-year old (mean age of 41.2-year old) were enrolled. The thickness and density of the epidermis and dermis layer were detected by high-frequency (22 or 75MHz) ultrasonography at 13 different anatomical sites, including the forehead, cheeks, flexor and extensor forearms, flexor and extensor upper arms, inner and outer legs, inner and outer thighs, back, and abdomen. The thickness and density of epidermis/dermis between different anatomical sites were statistically significant (p<0.05). The epidermis thickness of the face and trunk were less than that of the limbs, whereas the thicknesses of the dermis were on the contrary. The density of the epidermis/dermis of the face and trunk were less than that of the limbs. The thickness of dermis in most of the sites were higher in male than in female, and the density of epidermis and dermis in most of the sites were less in men than in women. The thicknesses/densities of dermis were lower in older age group in almost all sites, whereas only several sites reached statistical. The difference between the north and south regions showed the environment also influenced the thickness and density of the skin. HFUS provides a simple noninvasive method for evaluating the skin thickness and echo-density, which, reflecting intradermal structure, exhibit systematic regional variation. With the establishment of Chinese phenotypic database of skin thickness and density, it will be helpful for the skin disease assessment, skin surgery, and cosmetology technology.

IS THE PATENT FORAMEN OVALE AN INNOCENT BYSTANDER OR THE REAL CULPRIT? THE MILLION-DOLLAR QUESTION

IS THE PATENT FORAMEN OVALE AN INNOCENT BYSTANDER OR THE REAL CULPRIT? THE MILLION-DOLLAR QUESTION

SQUAMOUS CELL CARCINOMA OF THE LUNG LEADING TO MALIGNANT CARDIAC TAMPONADE DUE TO LARGE CARDIAC METASTASES

SQUAMOUS CELL CARCINOMA OF THE LUNG LEADING TO MALIGNANT CARDIAC TAMPONADE DUE TO LARGE CARDIAC METASTASES

SUPERIOR VENA CAVA SYNDROME DUE TO A MEDIASTINAL MASS WITH RIGHT ATRIAL INVOLVEMENT

SUPERIOR VENA CAVA SYNDROME DUE TO A MEDIASTINAL MASS WITH RIGHT ATRIAL INVOLVEMENT

PRESENTATION OF ACUTE CEREBROVASCULAR ACCIDENT IN A YOUNG ADULT WITH THROMBOTIC THROMBOCYTOPENIA PURPURA (TTP)

PRESENTATION OF ACUTE CEREBROVASCULAR ACCIDENT IN A YOUNG ADULT WITH THROMBOTIC THROMBOCYTOPENIA PURPURA (TTP)

Resistive index (RI) as a prognostic indicator of early morbidities in term neonates with hypoxic ischemic encephalopathy

Background: Hypoxemia and hypoxia sustained by neonates during birth process leads to Hypoxic-ischemic encephalopathy (HIE) which can give rise to immediate and/or long term sequelae of neonatal brain injury, increased neonatal morbidity and mortality worldwide. Material and methods: A prospective observational study done in tertiary neonatal intensive care unit of north Karnataka region. The study was conducted between September 2021 to May 2022. Results: A total of 44 neonates with HIE were studied. There were 26 (61%) male and 18 (39%) female babies and the male to female ratio was 1.4:1. There were 28 cases with grade I, 6 cases with grade II and 10 cases with grade III HIE. The Resistive index was normal in 30 (68.1%) cases and was abnormal in 14 (31.8%) cases. Common Doppler ultrasound findings were of increased echo density of cerebral parenchyma and increased periventricular density. There were 95% survivors and 5% deaths due to HIE. The most common complications were of acute kidney injury (34%) and seizures (11.4%).

The influence of cosmetics dedicated to oily and acne-prone skin on skin parameters.

Patient compliance with care recommendations is closely related to the role of cosmetics in delaying or preventing the side effects of medications used to treat acne. A total of 33 volunteers with symptoms of acne vulgaris were qualified for the study. The skin parameters were measured before the experiment, after the 4 and at the 8 weeks of use. The measurements were subject to moisturizing the skin and secretion of sebum and skin color. A skin acoustic parameters using high-frequency ultrasound (33 MHz) was also performed. The recorded images were used to determine the epidermal entrance echo thickness and echo density of dermis. The results show a change in the value of skin parameters during the 8-week application of a specific skin care procedure. The secretion of sebum did not change significantly, there was a decrease in hydration, and the level of melanin and hemoglobin remained at the same level. The thickness of the epidermis entrance echo in the ultrasound image was thinned. For many mild/moderate acne patients, cosmetics proven to be effective and well tested in clinical trials can offer a real benefit in reducing both inflammation, sebum production, melanin, and irritation, but should also be moisturizing.

Medial Tibial Osteophyte Width Strongly Reflects Medial Meniscus Extrusion Distance and Medial Joint Space Width Moderately Reflects Cartilage Thickness in Knee Radiographs.

BackgroundThe presence of medial tibial osteophytes on knee radiographs suggests cartilage wear, but may be associated with medial meniscus extrusion (MME). The joint space width of the medial compartment consists anatomically of cartilage and the medial meniscus, but which is most responsible for joint space narrowing remains unclear. Magnetic resonance imaging (MRI) reveals MME and cartilage thickness.PurposesTo determine which radiographic medial tibial osteophyte width correlates better with cartilage thickness or MME distance and which radiographic medial joint space width correlates better with cartilage thickness or MME distance.Study TypeCross‐sectional.PopulationTotal of 527 subjects, 253 females and 274 males, aged 30–79 years, included in the Kanagawa Knee Study.Field Strength/Sequence3 T/fat‐suppressed spoiled gradient echo and proton density weighted.AssessmentThe medial tibial osteophyte width and “the minimum joint space width at the medial compartment” (mJSW) were measured from plain radiographs. The cartilage region was automatically extracted from MRI data using software. The medial femoral and tibial cartilage regions were each divided into nine subregions, and the average thickness of the cartilage was determined in each region and subregion. MME was manually measured by two orthopedic surgeons using MRI coronal section images.Statistical TestsPearson's correlation coefficient and their comparison, with P < 0.05 considered statistically significant.ResultsThe absolute values of the correlation coefficients were 0.33 at maximum between osteophyte width and cartilage thickness and 0.76 between osteophyte width and MME; the value was significantly higher with MME than with cartilage thickness (P < 0.001). The absolute values of the correlation coefficients were 0.50 at maximum between mJSW and cartilage thickness and 0.16 between mJSW and MME; the value was significantly higher with cartilage thickness than with MME (P < 0.001).Data ConclusionThe medial tibial osteophyte width strongly reflected MME and the medial joint space width moderately reflected cartilage thickness.Level of Evidence3Technical Efficacy Stage3

The Chances of Infertility in a Patient Presenting with PCOS in Childbearing Age

Background: PCOS is a leading cause of infertility globally. Polycystic ovarian syndrome (PCOS) is a complicated disease pigeon-holed by high testosterone levels, irregular menstruation, and/or tiny cysts on one or both ovaries. The disease can be anatomical (polycystic ovaries) or biochemical (hyperandrogenemia). Follicular developmental inhibition, ovarian microcysts, anovulation, and menstrual irregularities are all symptoms of hyperandrogenism, a clinical characteristic of PCOS. Objective: The objective is to determine the chances of infertility in a patient presenting with PCOS in childbearing age. Methodology: Data was collected from Medline, PubMed, ScienceDirect, and the Obsgyne online library for papers published between 2005 and 2021 using specified MeSH keywords in this systematic review. We examined 10 cross-sectional type analytical studies for data collecting in this systematic work. Results: 10 studies conducted between the years 2005 to 2021 were included in this systematic review. There were 3900 women in the study, ranging in age from 10 to 40. The 2nd most prevalent etiology of feminine factor-related infertility was determined to be PCOS in this investigation. In 70% of cases of anovulatory infertility, PCOS is the reason. As a result, it's critical to screen for and treat it in primary care settings. Ultrasound is the best modality for the detection of PCOS. PCOS has been identified using ultrasonography methods in several investigations. The basal follicle counts by TVS might be included among sonographic findings in the diagnosis of PCOS, with basal follicle counts of more than 10 is a PCOS criterion. Slightly swollen stroma, hypertrophy, enhanced ovarian mass and thickness, and the percentage of ovarian stroma to total ovary area are among the other characteristics. Conclusion: From this systematic review we concluded that infertility is most commonly caused by PCOS. In 70% of cases of anovulatory infertility, PCOS is the reason. Despite the fact that TVS is the gold standard for detecting ovarian abnormalities in young girls we examine trans-abdominally by using a high-frequency probe. Ultrasonography results for PCOS of the periphery cyst patterns include a considerable variety of small subcapsular follicles (10 follicles with a maximal diameter of 8 millimeter), enhanced ovarian volume (12.3 millimeter), and increased echo density of the ovarian stroma.

Abstract 1122‐000052: Endovascular Management of Infectious PICA Aneurysm in the Setting of Recent Dental Work

Introduction : Infectious intracranial aneurysms (IIA) of the posterior inferior cerebellar artery (PICA) are exceedingly rare and have been infrequently reported. IIAs are typically distal and located in the anterior circulation, particularly the middle cerebral artery and its distal branches. Etiology is secondary to hematogenous spread of septic emboli from a proximal source such as infective endocarditis. Few cases have documented an association between IIA and dental disease or procedures. We describe a rare case of an infectious PICA aneurysm in the setting of recent dental work and successfully treated with endovascular intervention. Methods : An 88‐year‐old male with medical history of atrial fibrillation on anticoagulation presented with one month duration of recurrent falls and progressive generalized weakness. CT head demonstrated left cerebral hemorrhage with scattered subarachnoid hemorrhage. MRI brain noted a rounded enhancing intra‐axial lesion located at the left paramedian cerebellum measuring 7 mm in maximal dimension. Further investigation with cerebral angiography demonstrated an infectious intracranial aneurysm of the left PICA. He underwent workup with an echocardiogram that noted a mobile echo density on the aortic valve consistent with a vegetation. Blood cultures were positive for Streptococcus salivarius and viridans. Investigation revealed that he had recent dental work performed and missed taking his prophylactic amoxicillin. Infectious disease was consulted and etiology was determined to be seeding of aortic valve from recent dental procedure that ultimately led to IIA formation. Results : Patient was treated with 6‐week course of intravenous ceftriaxone and underwent glue embolization for his left PICA aneurysm. Post embolization angiogram did not reveal any evidence of contrast filling within the aneurysm. He tolerated the procedure well with no complications and was subsequently discharged to inpatient rehabilitation with a modified Rankin scale (mRS) score of 3. Conclusions : IIAs of PICA in the setting of recent dental procedures are exceptionally rare and challenging to diagnose. They may be clinically silent until rupture and are usually identified incidentally on imaging or during autopsy. Physicians should maintain vigilance for this unique entity as prompt recognition and timely intervention may prevent severe morbidity and mortality.