Hyperechoic Areas Research Articles

Ultrasound Characteristics of Keratoacanthoma: Differentiation From Well-Differentiated Cutaneous Squamous Cell Carcinoma.

This study aims to describe the ultrasound characteristics of keratoacanthoma (KA), providing valuable insights for non-invasive diagnosis and differentiation from well-differentiated cutaneous squamous cell carcinoma (wcSCC). Ultrasound characteristics of 16 KA and 13 wcSCC conformed by surgical pathology were retrospective analyzed. KA patients were younger (mean age 63.13 years) compared with wcSCC patients (mean age 76.23 years). Ultrasound characteristics revealed that KA lesions were generally smaller, more frequently domed-shaped (87.50 vs 38.46%), exophytic (93.75 vs 30.77%), and well-defined (93.75 vs 53.85%) compared with wcSCC. Both lesion types predominantly showed hypoechoic internal echoes and inhomogeneous echotexture. The prevalence of hyperechoic superficial area was notably high in both groups (93.75 vs 84.62%), precluding the reliable use of this feature as a discriminatory marker between these two distinct neoplastic entities. KA lesions were mostly confined to the epidermis and superficial dermis (87.50%), while wcSCC cases frequently infiltrated into the subcutaneous fat layer (84.62%). Color Doppler imaging demonstrated higher vascularity in wcSCC lesions, with 61.5% showing Grade 3 flow, compared with KA lesions, where 62.5% exhibited Grade 2 flow. High-frequency ultrasound reveals distinct ultrasound characteristics differentiating KA from wcSCC, offering a promising non-invasive tool for preliminary diagnosis and treatment planning.

Prolonged Fever After the Treatment of Ulcerative Colitis in an Adolescent.

A 17-year-old female was diagnosed with inflammatory bowel disease and started on infliximab. A few weeks after starting infliximab, she developed a recurrence of daily fevers associated with an intermittent dry cough, which worsened over the course of a month. A chest radiograph, abdominal ultrasound, and computed tomography scan of the chest and abdomen revealed a heterogeneous spleen with multiple hyperechoic areas, tiny splenic micronodules, and diffuse micronodularity throughout the lungs. She was transferred to a tertiary care hospital because of hypotension, new oxygen requirements, and ongoing fever. Her bloodwork on presentation to tertiary care revealed pancytopenia and elevated inflammatory markers; she had splenomegaly on MRI. As her clinical picture evolved, she continued to have persistent fevers and anorexia despite ongoing management. Infectious diseases, rheumatology, and gastroenterology were consulted to guide the evaluation and management of this patient's complex clinical course.

Myoid Hamartoma of the Breast With HMGA2 Rearrangement and Associated In-Situ and Invasive Carcinoma: Case Report and Review of Literature.

Myoid hamartoma of the breast is an uncommon benign breast neoplasm. We describe an unusual example of an in-situ and invasive carcinoma arising in a myoid hamartoma. We also describe the unique molecular findings in the myoid hamartoma and review the pertinent literature. In radiology studies, the mammogram showed increased density/attenuation, and the ultrasound revealed a change in the overall echogenicity with hyperechoic and anechoic areas. The stromal compartment contained smooth muscle bundles and adipose tissue on microscopic examination. The stromal cells showed HMGA2 gene rearrangement by fluorescence in-situ hybridization analysis and overexpression of HMGA2 by immunohistochemistry. The breast myoid hamartoma is likely underpinned by HMGA2 gene rearrangement and HMGA2 protein overexpression, which can be used as an ancillary test to diagnose this rare breast lesion. Although most myoid hamartomas have a benign clinical course, the likelihood of malignant transformation should always be considered.

Combining ultrasound and elastography for the detection of a non-palpable, non-sonographically visualized Peyronie's plaques. Our experience.

B-mode ultrasound (US) medical imaging is very effective in localizing and describing Peyronie's disease (PD). Moreover, elastography is a new technique used to evaluate tissue elasticity to detect penile Peyronie's plaques that are not visible using standard B-mode US. The main objective of this study was to evaluate the diagnostic efficacy of real-time elastography (RTE) in PD patients and to determine whether its combined use with standard US improved diagnostic accuracy. RTE is also known as strain elastography (SE). Additionally, this study aimed to assess whether RTE was useful for monitoring PD patients undergoing conservative treatment. A group of 37 PD patients in the active phase was selected based on US examination showing isoechoic or hypo-isoechoic plaques, with or without associated hyperechoic or calcified plaque areas. All patients underwent traditional US combined with RTE before starting conservative treatment with antioxidants, during treatmentand after treatment. After each examination with RTE, a specific "Strain Ratio"(SR) was used to identify the specific elasticity of the tissue. Using B-mode US with RTE, we detected all 13 non-palpable penile plaques present in the 37 PD patients (100% of cases). Using only B-mode US, we detected only 8 of the 13 non-palpable plaques (61.5% of cases). The DI of the plaque decreased during and after treatment in all cases, indicating that RTE is effective for monitoring conservative PD treatment. A statistically significant correlation was found between the DI and plaque volume in all patients (p=0.002). Our study has shown that the combination of US and RTE methods allowed for a more accurate diagnosis in PD patients.

Study on microwave ablation temperature prediction model based on grayscale ultrasound texture and machine learning.

Temperature prediction is crucial in the clinical ablation treatment of liver cancer, as it can be used to estimate the coagulation zone of microwave ablation. Experiments were conducted on 83 fresh ex vivo porcine liver tissues at two ablation powers of 15 W and 20 W. Ultrasound grayscale images and temperature data from multiple sampling points were collected. The machine learning method of random forests was used to train the selected texture features, obtaining temperature prediction models for sampling points and the entire ultrasound imaging area. The accuracy of the algorithm was assessed by measuring the area of the hyperechoic area in the porcine liver tissue cross-section and ultrasound grayscale images. The model exhibited a high degree of accuracy in temperature prediction and the identification of coagulation zone. Within the test sets for the 15 W and 20 W power groups, the average absolute error for temperature prediction was 1.14°C and 4.73°C, respectively. Notably, the model's accuracy in measuring the area of coagulation was higher than that of traditional ultrasonic grey-scale imaging, with error ratios of 0.402 and 0.182 for the respective power groups. Additionally, the model can filter out texture features with a high correlation to temperature, providing a certain degree of interpretability. The temperature prediction model proposed in this study can be applied to temperature monitoring and coagulation zone range assessment in microwave ablation.

Diagnostic Accuracy of Hip Joint Ultrasound for Detection of Calcium Pyrophosphate Deposition.

Calcium Pyrophosphate Crystal Deposition (CPPD) disease is a chronic and disabling arthropathy. Ultrasound (US) has been shown to be a tool with high sensitivity and specificity for the diagnosis of CPPD disease, but its value at the hip joint has not yet been determined. Therefore, our objective was to evaluate the diagnostic accuracy of US for the identification of calcium pyrophosphate (CPP) crystals in the hip joint as compared with histopathology. Diagnostic test study involving patients over 50 years of age with osteoarthritis, scheduled for hip replacement surgery. US was performed on the affected hip. Acetabular fibrocartilage (FC) and hyaline cartilage (HC) of the femoral head were assessed, and a dichotomous score was used for the presence/absence of CPP crystals. Synovial fluid (SF) was obtained from the affected hip and examined using polarized light microscopy. Histopathological examination was performed by an experienced pathologist in search for CPP crystals in FC and HC samples. One hundred patients were enrolled, of whom 62% were found to have hyperechoic areas suggestive of CPP deposition on US examination. Pathological evaluation revealed a prevalence of 61% of CPP crystals. The sensitivity, specificity and the positive predictive and the negative predictive values were 90%, 82%, 89%, and 84%, respectively. The area under the curve for US compared with histopathology for the diagnosis of hip CPPD was 0.86 (CI 95% 0.78-0.94). US is a valid imaging modality with good diagnostic accuracy for the detection of hip CPPD.

Importance of the enhanced cooling system for more spherical ablation zones: Numerical simulation, ex vivo and in vivo validation

IntroductionThis study aimed to investigate the efficacy of a small-gauge microwave ablation antenna (MWA) with an enhanced cooling system (ECS) for generating more spherical ablation zones. MethodsA comparison was made between two types of microwave ablation antennas, one with ECS and the other with a conventional cooling system (CCS). The finite element method was used to simulate in vivo ablation. Two types of antennas were used to create MWA zones for 5, 8, 10 min at 50, 60, and 80 W in ex vivo bovine livers (n = 6) and 5 min at 60 W in vivo porcine livers (n = 16). The overtreatment ratio, ablation aspect ratio, carbonization area, and other characteristcs of antennas were measured and compared using numerical simulation and gross pathologic examination. ResultsIn numerical simulation, the ECS antenna demonstrated a lower overtreatment ratio than the CCS antenna (1.38 vs 1.43 at 50 W 5 min, 1.19 vs 1.35 at 50 W 8 min, 1.13 vs 1.32 at 50 W 10 min, 1.28 vs 1.38 at 60 W 5 min, 1.14 vs 1.32 at 60 W 8 min, 1.10 vs 1.30 at 60 W 10 min). The experiments revealed that the ECS antenna generated ablation zones with a more significant aspect ratio (0.92 ± 0.03 vs 0.72 ± 0.01 at 50 W 5 min, 0.95 ± 0.02 vs 0.70 ± 0.01 at 50 W 8 min, 0.96 ± 0.01 vs 0.71 ± 0.04 at 50 W 10 min, 0.96 ± 0.01 vs 0.73 ± 0.02 at 60 W 5 min, 0.94 ± 0.03 vs 0.71 ± 0.03 at 60 W 8 min, 0.96 ± 0.02 vs 0.69 ± 0.04 at 60 W 10 min) and a smaller carbonization area (0.00 ± 0.00 cm2 vs 0.54 ± 0.06 cm2 at 50 W 5 min, 0.13 ± 0.03 cm2 vs 0.61 ± 0.09 cm2 at 50 W 8 min, 0.23 ± 0.05 cm2 vs 0.73 ± 0.05 m2 at 50 W 10 min, 0.00 ± 0.00 cm2 vs 1.59 ± 0.41 cm2 at 60 W 5 min, 0.23 ± 0.22 cm2 vs 2.11 ± 0.63 cm2 at 60 W 8 min, 0.57 ± 0.09 cm2 vs 2.55 ± 0.51 cm2 at 60 W 10 min). Intraoperative ultrasound images revealed a hypoechoic area instead of a hyperechoic area near the antenna. Hematoxylin-eosin staining of the dissected tissue revealed a correlation between the edge of the ablation zone and that of the hypoechoic area. ConclusionsThe ECS antenna can produce more spherical ablation zones with less charring and a clearer intraoperative ultrasound image of the ablation area than the CCS antenna.

Preliminarily exploring the intraoperative ultrasonography characteristics of patients with degenerative cervical myelopathy

BackgroundHow to quickly read and interpret intraoperative ultrasound (IOUS) images of patients with degenerative cervical myelopathy (DCM) to obtain meaningful information? Few studies have systematically explored this topic.PurposeTo systematically and comprehensively explore the IOUS characteristics of patients with DCM.Materials and methodsThis single-center study retrospectively included patients with DCM who underwent French-door laminoplasty (FDL) with IOUS guidance from October 2019 to March 2022. One-way ANOVA and Pearson’s /Spearman’s correlation analysis were used to analyze the correlations between the cross-sectional area of the spinal cord (SC) and individual characteristics; the relationships between the morphology, echogenicity, pulsation, decompression statuses, compression types of SC, location of the spinal cord central echo complex (SCCEC) and the disease severity (the preoperative Japanese Orthopedic Association score, preJOA score); the difference of the spinal cord pulsation amplitude(SCPA) and the SCCEC forward movement rate (FMR) between the compressed areas(CAs) and the non-compressed areas (NCAs).ResultsA total of 38 patients were successfully enrolled (30 males and 8 females), and the mean age was 57.05 ± 10.29 (27–75) years. The cross-sectional area of the SC was negatively correlated with age (r = − 0.441, p = 0.006). The preJOA score was significantly lower in the heterogeneous group than in the homogeneous group (P < 0.05, p = 0.005). The hyperechoic area (HEA) was negatively while the SCCEC FMR was positively correlated with the preJOA score (r = − 0.334, p = 0.020; r = 0.286, p = 0.041). The SCCEC FMR and SCPA in CAs were significantly greater than those in NCAs (p < 0.05, p = 0.007; P < 0.001, P = 0.000).ConclusionThe cross-sectional area of the SC decreases with age in adults. More changes in intramedullary echogenicity and less moving forward of the SCCEC often indicate poor SC status, and the SCCEC FMR and SCPA are more pronounced in CAs.

Evaluating Accuracy of Rectal Fecal Stool Assessment Using Transgluteal Cleft Approach Ultrasonography.

Transabdominal ultrasound is used to detect fecal impaction, but the rectum is difficult to visualize without bladder urine or with gastrointestinal gas. We developed a transgluteal cleft approach that is unaffected by these factors and sought to determine if our ultrasound method could detect and classify fecal matter in the lower rectum using this approach. We classified ultrasound images from hospitalized patients into four groups: Group 1 (bowed and rock-like echogenic areas), Group 2 (irregular and cotton candy-like hyperechoic areas), Group 3 (flat and mousse-like hyperechoic areas), and Group 4 (linear echogenic areas in the lumen). Stool characteristics were classified as hard, normal, and muddy/watery. Sensitivity and specificity were determined based on fecal impaction and stool classification accuracy. We obtained 129 ultrasound images of 23 patients. The sensitivity and specificity for fecal retention in the rectum were both 100.0%. The recall rates were 71.8% for Group 1, 93.1% for Group 2, 100.0% for Group 3, and 100.0% for Group 4. The precision rates were 96.6% for Group 1, 71.1% for Group 2, 88.9% for Group 3, and 100.0% for Group 4. Our method was 89.9% accurate overall. Transgluteal cleft approach ultrasound scanning can detect and classify fecal properties with high accuracy.

Clinical and ultrasound characteristics of deep endometriosis affecting sacral plexus.

To describe the sonomorphological changes and appearance of deep endometriosis (DE) affecting the nervous tissue of the sacral plexus (SP). This was a retrospective study of symptomatic patients who underwent radical resection of histologically confirmed DE affecting the SP and who had undergone preoperative transvaginal sonography (TVS) between 2019 and 2023. Lesions were described based on the terms and definitions of the International Deep Endometriosis Analysis (IDEA), International Ovarian Tumor Analysis (IOTA) and Morphological Uterus Sonographic Assessment (MUSA) groups. A diagnosis of DE affecting the SP on TVS was made when the sonographic criteria of DE were visualized in conjunction with fibers of the SP and the presence of related symptoms corresponding to sacral radiculopathy. Clinical symptoms, ultrasound features and histological confirmation were analyzed for each patient included. Twenty-seven patients with DE infiltrating the SP were identified in two contributing tertiary referral centers. Median age was 37 (range, 29-45) years and all patients were symptomatic and presented one or more of the following neurological symptoms: dysesthesia in the ipsilateral lower extremity (n = 17); paresthesia in the ipsilateral lower extremity (n = 10); chronic pelvic pain radiating in the ipsilateral lower extremity (n = 9); chronic pain radiating in the pudendal region (n = 8); and motor weakness in the ipsilateral lower extremities (n = 3). All DE lesions affecting the SP were purely solid tumors in the posterior parametrium in direct contact with, or infiltrating, the S1, S2, S3 and/or S4 roots of the SP. The median of the largest diameter recorded for each of the DE nodules was 35 (range, 18-50) mm. Echogenicity was non-uniform in 23 (85%) of the DE nodules, with all but one of these nodules containing hyperechogenic areas. The shape of the lesions was irregular in 24 (89%) cases. Only one lesion exhibited a lobulated form, with all other irregular lesions showing a spiculated appearance. An acoustic shadow was produced in 20 (74%) of the nodules, all of which were internal. On color- or power-Doppler examination, 21 (78%) of the nodules showed no signal (color score of 1). The remaining six (22%) of the lesions showed a minimal color content (color score of 2). According to pattern recognition, most DE nodules were purely solid, non-uniform, hypoechogenic nodules containing hyperechogenic areas, with internal shadows and irregular spiculated contours, and were poorly vascularized on color/power-Doppler examination. The ultrasound finding of a parametrial, unilateral, solid, non-uniform, hypoechogenic nodule with hyperechogenic areas and possible internal shadowing, as well as irregular spiculated contours, demonstrating poor vascularization on Doppler examination in proximity to or involving the structures of the SP, indicates DE affecting the SP. © 2024 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

Conventional and Doppler ultrasonographic diagnosis of subclinical pregnancy toxemia with altered serum cortisol and biochemical parameters in pregnant does

The pathogenesis and diagnosis of subclinical pregnancy toxemia (SCPT) remain elusive and need further investigation in pregnant does. Therefore, the aim of our study was to describe the typical properties of hepatic venous hemodynamics by Doppler ultrasonography. A total of 70 pregnant does were classified based on the blood serum concentrations of β-hydroxybutyric acid (βHBA), pregnant does were categorized into control group (βHBA concentrations <0.8 mmol/L; n = 40) and SCPT group (βHBA concentrations >0.8 mmol/L; n = 30). DRAMISKI 4vet slim diagnostic ultrasound scanner with B, M, and Doppler (color, power, pulsing wave) modes was used for diagnosis of SCPT. Total serum cortisol level was quantitative using chemiluminescent immunoassay. Serum glucose, triglycerides, cholesterol, HDL and LDL- cholesterol and LDH- cholesterol were measured by colorimetric and kinetic methods. Liver ultrasonography of does with SCPT had been shown mild fatty infiltration with rounded margin, which was characterized by hyperechoic area. There was a significant decrease in the values of portal vein diameter (PVD), portal vein area (PVA), portal mean velocity (PMV) and portal blood flow (PBF) in SCPT does compared to control pregnant does. PVD, PVA and PBF were negatively correlated with βHBA concentrations in does with SCPT (P < 0.05). PVD was inversely associated with serum cholesterol and triglycerides concentrations (P < 0.05). In conclusions, Doppler ultrasonography examinations of pregnant does with SCPT indicate abnormal hepatic variation. Reduced PVD, PVA, PMV and PBF together with increased βHBA concentrations could predict SCPT in does with fair sensitivity and specificity.

SURGICAL TREATMENT OF SEVERE RUMINAL IMPACTION AND DYSTOKIA IN BEETAL GOAT

An orgasmic, restless, and persistently bloated female goat, approximately 22–24 months of age, was taken to the outdoor clinic of the Department of Clinical Sciences, Faculty of Veterinary Sciences, Bahauddin Zakariya University, Multan. The goat had a history of of pregnancy about four and a half months. Upon physiological examination, the rectal temperature was within normal limits; nevertheless, the heart rate and breathing rate showed modest deviations towards lower limits. The oral and conjunctival mucous membranes were congested, as shown by a physical examination. On abdominal palpation, a hard, mass was felt in the rumen (anterior abdomen). In addition, ultrasonography showed that two dead fetuses were present in the right uterine horn. Moreover, further scanning showed a hyperechoic area (D=5cm) in the rumen. A tentative diagnosis of impaction and dystocia was made based on the clinical evaluation and ultrasonography. An exploratory rumenotomy and hysterectomy were recommended after diagnosis. upon rumenotomy, the rumen was packed with 1.5 kg of calcified masse. It was composed of compressed foreign bodies ( plastic bags and rope). The surgery was performed according to standard protocol. The animal healed without incident after receiving parental antibiotics (Oxytetracycline @ 5 mg/kg), NSAIDs (Meloxicam 0.5-1 mg/kg), and fluids (NS &amp; RL) for seven days following surgery.

Multifocal tuberculosis with breast location: a rare location

The authors report the case of a 28-year-old patient, mother of two living and healthy children with a history of pregnancy toxemia, admitted for the management of pain in the left breast. Pain was twisting, permanent, radiating to the left armpit and associated with a sensation of a mass in the left breast that is painful when pressed. These symptoms have been evolving for a year, accompanied by evening-night fever without chills or sweating. Two months later she noticed a fistulized abscess in the upper outer quadrant of the left breast with yellowish pus coming out. The CA.15.3 marker was normal. HIV and Hbs antigen serologies were negative. The mammogram showed two nodules in the upper-inner quadrant of the left breast, graded ACR IV; two adenofibromas in the lower-inner and upper-outer quadrants of the left breast, ACR II, as well as a A retro-nipple abscess of the left breast. Abdominal ultrasound finds a normal-sized liver with a hyperechoic nodule with an angiomatous appearance in segment VIII of approximately 1 cm, the presence of 2 poorly defined heterogeneous hyperechoic areas in segment VII, punctuated by micro calcifications in favor of calcified granulomas. Chest x-ray showed a miliary tuberculous appearance. Biopsy of suspicious liver and breast lesions was carried out and the pathological examination revealed a tuberculous inflammatory granuloma with caseous necrosis.

New insight into the vasto-adductor membrane for safer adductor canal blockade.

: This study aimed to identify exact anatomical landmarks and ideal injection volumes for safe adductor canal blocks (ACB). : Fifty thighs from 25 embalmed adult Korean cadavers were used. The measurement baseline was the line connecting the anterior superior iliac spine (ASIS) to the midpoint of the patellar base. All target points were measured perpendicular to the baseline. The relevant cadaveric structures were observed using ultrasound (US) and confirmed in living individuals. US-guided dye injection was performed to determine the ideal volume. : The apex of the femoral triangle was 25.3 ± 2.2 cm distal to the ASIS on the baseline and 5.3 ± 1.0 cm perpendicular to that point. The midpoint of the superior border of the vasto-adductor membrane (VAM) was 27.4 ± 2.0 cm distal to the ASIS on the baseline and 5.0 ± 1.1 cm perpendicular to that point. The VAM had a trapezoidal shape and was connected as an aponeurosis between the medial edge of the vastus medialis muscle and lateral edge of the adductor magnus muscle. The nerve to the vastus medialis penetrated the muscle proximal to the superior border of the VAM in 70% of specimens. The VAM appeared on US as a hyperechoic area connecting the vastus medialis and adductor magnus muscles between the sartorius muscle and femoral artery. : Confirming the crucial landmark, the VAM, is beneficial when performing ACB. It is advisable to insert the needle obliquely below the superior VAM border, and a 5 mL injection is considered sufficient.

Anatomically realistic aortic dissection simulator as a potential training tool for point-of-care ultrasound.

Simulators for aortic dissection diagnosis are limited by complex anatomy influencing the accuracy of point-of-care ultrasound for diagnosing aortic dissection. Therefore, this study aimed to create a healthy ascending aorta and class DeBakey, type II aortic dissection simulator as a potential point-of-care ultrasound training model. 3D mould simulators were created based on computed tomography images of one healthy and one DeBakey type II aortic dissection patient. In the next step, two polyvinyl alcohol-based and two silicone-based simulators were synthesised. The results of the scanning electron microscope assessment showed an aortic dissection simulator's surface with disorganised surface texture and higher root mean square (RMS or Rq) value than the healthy model of polyvinyl alcohol (RqAD = 20.28 > RqAAo = 10.26) and silicone (RqAD = 33.8 > RqAAo = 23.07). The ultrasound assessment of diameter aortic dissection showed higher than the healthy ascending aorta in polyvinyl alcohol (dAD = 28.2 mm > dAAo = 20.2 mm) and Si (dAD = 31.0 mm > dAAo = 22.4 mm), while the wall thickness of aortic dissection showed thinner than the healthy aorta in polyvinyl alcohol, which is comparable with the actual aorta measurement. The intimal flap of aortic dissection was able to replicate and showed a false lumen in the ultrasound images. The flap was measured quantitatively, indicating that the intimal flap was hyperechoic. The simulators were able to replicate the surface morphology and echogenicity of the intimal flap, which is a linear hyperechoic area representing the separation of the aorta wall.

An effectively handled case of abnormal uterine bleeding due to retained intrauterine bony fragments: A rare case report

The presence of retained intrauterine fetal bones is a rare but well-known entity. Patients may present with abnormal uterine bleeding, subfertility, secondary infertility, chronic pelvic pain, vaginal discharge, and, pelvic inflammatory disease. Calcification appears as a hyperechoic area on ultrasound. Hysteroscopy-guided removal of bony fragments is the most widely practiced management and leads to complete resolution of symptoms.

Liposarcoma of the testis: A case report

Liposarcoma of the testis is a rare genitourinary tumor. Liposarcoma commonly arises in the spermatic cord and rarely arises in the testis. We describe the case of a 60-year-old man who presented with complaints of swelling, associated with pain, in the right testicular region for 3 weeks. The scrotal ultrasound showed a heterogenous, hyperechoic lesion measuring 10 × 7 cm on the right. The testicular lesion appeared irregularly marginated with heterogeneous echotexture, with a central hyperechoic area and peripheral hypoechogenicity. Contrast-enhanced computed tomography of the abdomen showed no intra-abdominal mass or lymphadenopathy. Tumor markers including alpha-fetoprotein, human chorionic gonadotropin, and lactate dehydrogenase were normal. A right high inguinal orchiectomy was performed, and the postoperative histopathologic examination showed features of liposarcoma of the testis with components of myxoid liposarcoma and well-differentiated liposarcoma. There was no evidence of recurrence up to 4 years post-surgery. Thus, misdiagnosis is common in liposarcoma testis due to the rarity and vague presentation. Ultrasound and tumor makers are often negative. A high index of suspicion is required in cases of tumor marker-negative testicular masses. The treatment of choice is high inguinal orchiectomy; evidence for the utility of chemotherapy and radiotherapy is limited.

Computed tomography and clinical outcomes in the diagnosis of acute appendicitis: Significance of periappendiceal fat tissue.

This study aimed to elucidate the diagnostic significance of changes in periappendiceal fat density observed on computed tomography (CT) in patients with acute appendicitis (AA). Patients who underwent surgery with a diagnosis of AA based on CT findings from January 1, 2020 to December 31, 2020 were included in the study. Patients were divided into three grades. In Grade 1, the periappendiceal tissue appears hypoechoic, indicative of normal tissue. In Grade 2, the periappendiceal tissue is slightly hyperechoic but confined to the periappendiceal area. In Grade 3, dense hyperechoic areas are present not only in the periappendiceal tissue but also extend into surrounding organs and deeper tissues. The groups were compared in terms of clinical, laboratory, and pathological outcomes. A total of 195 patients-131 males and 64 females-were included in the study. A correlation was identified between grade and several factors: appendix diameter, appendix wall thickness, incidence of lymphadenopathy, and duration of symptoms onset (p<0.001). Conditions such as appendicolitis, free air, and intra-abdominal abscesses were more frequently observed in Grade 3 patients compared to Grade 1 and Grade 2 patients (p=0.002, p<0.001). Both operative time and length of hospital stay were highest in Grade 3 patients (p<0.001). The rate of patients found to have a normal appendix upon pathological examination was significantly higher in Grade 1 than in Grade 2 (p=0.03). In cases where the diagnosis is uncertain, the hyperechogenicity in periappendiceal tissue observed on CT strengthens the diagnosis of AA. Additionally, cases of AA become increasingly complex as echogenicity in periappendiceal tissue increases.

Echotexture of recurrent laryngeal nerves: the depiction of recurrent laryngeal nerves at high-frequency ultrasound during radical thyroidectomy.

To investigate the ultrasound characteristics of recurrent laryngeal nerves (RLNs) during radical surgery for thyroid cancer and to enhance the understanding of RLN ultrasound features. From October 2021 to December 2022, a prospective study was conducted involving 24 patients scheduled for bilateral thyroid surgery. Near the conclusion of the surgery, intraoperative ultrasonography of the RLN within the tracheoesophageal groove was performed using a 15-7 MHz transducer. The thickness and width of the RLN were measured during the procedure. The internal architecture of the RLN was observed to consist of multiple hypoechoic, parallel, but discontinuous linear hyperechoic areas separated by bands. In the normal RLN group, the diameter of the RLN was relatively consistent, with thickness ranging from 2.20 to 2.71mm (mean: 2.48 ± 0.14mm) and width from 1.25 to 1.70mm (mean: 1.45 ± 0.11mm). Both weight and the body mass index (BMI) showed a statistically significant correlation with RLN thickness (Weight: r=0.544, P=0.001; BMI: r=0.605, P=0.001). The BMI also showed a statistically significant correlation with the RLN width (r=0.377, P=0.033). In the RLN invasion group, the width of invaded RLNs ranged from 1.9 to 2.3mm (mean: 2.10 ± 0.11mm), while the width of non-invaded RLNs ranged from 2.6 to 3.2mm (mean: 2.93 ± 0.20mm). Ultrasound effectively reveals the structural features of the RLN and enhances sonographers' understanding of RLN characteristics.

Hyperechoic Area Under Insular Gliomas: A Potentially Hazardous Intraoperative Ultrasound Artifact

Intraoperative ultrasound (IOUS) images can be distorted by various artifacts. During surgeries for insular low-grade gliomas (LGGs), we repeatedly observed a distinct hyperechoic artifact adjacent to medial tumor borders, localized in brain regions with normal appearance on magnetic resonance imaging (MRI) that has not been reported before. We retrospectively evaluated saved 3-dimensional (3D) IOUS images of 20 patients harboring insular LGGs. Twelve patients were operated on between 2010 and 2015 using an older navigated 3D IOUS system. Additionally, 3D-IOUS images of 8 patients operated on between 2021 and 2023 using a new high-end 3D-IOUS system were evaluated. The investigated region was the area under medial tumor borders, which were defined using preoperative MRI. In 17 out of 20 cases (85%), a distinct hyperechoic area adjacent to medial tumor borders localized in brain regions with normal appearance on preoperative MRI was found; in the remaining 3 cases the saved images were suboptimal and did not allow evaluation of the area under the medial tumor borders. Although the causes of this bright artifact are unclear, we can hypothesize that the reverberation in between different parallel layers of white and gray matter localized under the insula could play a role in its appearance. Importantly, as this hyperechoic area was depicted already before any tumor resection, it may lead to erroneous conclusion that the tumor spreads more medially. Potential resection in this region may cause significant neurologic sequelae.