Ultrasound Findings Research Articles

Changes in cerebral hemodynamics after week 32 of gestation in fetuses with late-onset fetal growth restriction

BACKGROUND: Late-onset fetal growth restriction is characterized by changes in fetal cerebral hemodynamic patterns. Blood flow parameters in the anterior, middle, and posterior cerebral arteries have been studied previously, and there was shown a relationship between changes in certain cerebral artery vascular resistance parameters and increased risk of adverse perinatal outcomes such as fetal hypoxia in labor, cesarean section, and stillbirth. AIM: The aim of this study was to search for cerebral hemodynamic patterns in fetuses with late-onset fetal growth restriction after week 32 of gestation. MATERIALS AND METHODS: This prospective study included 110 pregnant women at week 32 or more of gestation who underwent fetal ultrasound (fetometry and Doppler with additional measurement of vascular resistance parameters in the anterior and posterior cerebral arteries). Ultrasound findings were assessed for the presence of late-onset fetal growth restriction. The systole-diastolic ratio, resistance index, and pulsatility index were evaluated in appropriate-for-gestational-age fetuses and in fetuses with late-onset fetal growth restriction. RESULTS: A total of 128 middle, 86 anterior, and 87 posterior cerebral arteries measurements were included in the calculations. From weeks 32–33 to preterm gestation in appropriate-for-gestational-age fetuses, a decrease in the middle cerebral artery parameters was observed, while in the anterior and posterior cerebral arteries, the vascular resistance parameters remained at the same level or slightly increased. A nonlinear trend of blood flow changes in the anterior and posterior cerebral arteries was observed in fetuses with fetal growth restriction — the values increased by weeks 34–36 of gestation and decreased in preterm gestation. At the same time, differences (р 0.05) were found between the median values of the systolic-diastolic ratio, resistance index and pulsatility index in the anterior and posterior cerebral arteries at weeks 34–36 and those at preterm gestation. CONCLUSIONS: Changes in fetal cerebral hemodynamics in fetal growth restriction, in particular, a shift in the peak values of vascular resistance parameters to later gestational periods may be associated with changes in the development of integrative functions of the central nervous system and neurovascular development of the fetal brain (cortex), which occurs predominantly in the third trimester of pregnancy.

Ultrasonography Findings in Ovarian Hemangiomas: Report of Three Cases and Review of the Literature.

Ovarian hemangioma is a rare ovarian tumor. The imaging manifestations were rarely mentioned in previous literatures.One of the patients came to hospital with the complaints of an elevation of CA125. Another two patients found a mass in adnexa area accidentally. The oophorectomy procedures were performed and the pathological results of ovarian hemangioma were concluded. We summarized the ultrasound features of three cases retrospectively, of which could provide more information before operation to guide a management direction.A well-defined, regular-shape solid mass in ovary could be considered the possibility of hemangioma, especially when a richly vascularized tumor with prominent blood flow is detected on color Doppler sonography.

Ultrasound imaging of bowel obstruction in infants and children.

We review the etiologies of bowel obstruction in infants and children that can be identified on ultrasound (US) including perforated appendicitis, intussusception, foreign body ingestion, colonic volvulus, intra-abdominal mass lesions, internal hernia, and stricturing inflammatory bowel disease. US can potentially identify the cause of bowel obstruction in these age groups, without the need for additional cross-sectional imaging, and can aid in patient management including interventional and surgical planning. Hence, it is important to be familiar with the sonographic imaging findings of bowel obstruction in infants and children.

Less Invasive Surfactant Administration in Preterm Infants in Tertiary Neonatal Intensive Care Units in Germany: A Survey

Introduction: The European guideline for treatment of respiratory distress syndrome recommends less invasive surfactant administration (LISA) as the preferred method of surfactant administration in spontaneously breathing preterm infants. However, there is limited evidence on practical aspects such as sedation and catheter types, leading to considerable variability between centers. Methods: An anonymous online survey (www.soscisurvey.de) was sent to 164 tertiary neonatal intensive care units (NICUs) in Germany including 43 questions on practical aspects of LISA. Results: Of 122 (74%) participating NICUs, 117 (96%) reported experience with LISA with 82% of those reporting LISA as their preferred method of surfactant administration. Indications for surfactant administration differed widely between NICUs. Most (89%) used FiO2-thresholds only or in combination with other criteria, such as Silverman score/signs of dyspnea (41%) or lung ultrasound findings (3%). Prophylactic surfactant was administered by 42%. Differences in use of LISA in extremely immature infants were reported (e.g., 36% did not perform LISA in infants below 24–26 weeks). Preferred drugs for sedation were (Es-)Ketamine, followed by Propofol and Midazolam. Minimum time interval between subsequent LISA procedures was 4 (2–6) h. Catheters specifically designed for LISA were used by most NICUs (69%). Conclusion: This survey shows that LISA is common practice in German NICUs, but with considerable variability in practical aspects. These data may serve as a guidance for NICUs that have not yet implemented LISA and might be helpful design clinical trials with the aim to standardize and/or optimize LISA.

A Cross-Sectional Study on Bedside Abdominal Ultrasound Findings as a Diagnostic and Prognostic Tool in Dengue Fever in Manipal Hospital, Bengaluru, India.

Background Dengue fever poses a significant health burden globally, particularly in tropical and subtropical regions. Early diagnosis and effective management are crucial in reducing morbidity and mortality associated with the disease. Bedside abdominal ultrasound has emerged as a promising tool for assessing dengue patients, providing real-time imaging of abdominal organs, and aiding clinical decision-making. Materials and methods This cross-sectional study was conducted in55 adult emergency departments of Manipal Hospital, Bengaluru, from March 2017 to March 2018. Adult patients presenting with signs and symptoms suggestive of dengue fever were included. Clinical data, laboratory investigations, and bedside abdominal ultrasound findings were systematically recorded and analyzed using appropriate statistical methods. Results Descriptive statistics revealed characteristic clinical measurements and symptom ratings observed in dengue fever patients. Frequency distributions highlighted common symptoms encountered, while statistical analyses demonstrated significant associations between ultrasonic parameters, disease severity, and outcomes. The study found notable correlations between ultrasonic findings and dengue severity levels, emphasizing the potential of bedside ultrasound as a diagnostic and prognostic tool. Conclusion Bedside abdominal ultrasound shows promise as a valuable adjunctive tool in assessing dengue fever patients. The significant associations between ultrasonic parameters and disease severity suggest its utility in risk stratification and guiding clinical management decisions. Incorporating bedside ultrasound into routine practice may improve patient care and outcomes in dengue fever management. Further research is warranted to validate these findings and explore additional bedside ultrasound applications in dengue fever diagnosis and prognosis.

Applicability of combined high-frequency and contrast-enhanced ultrasound in finger extensor tendon injuries: three case reports

BackgroundBy combining high-frequency and contrast-enhanced ultrasound (CEUS), the position of the severed end of a finger extensor tendon injury and the injury classification can be determined as part of a comprehensive preoperative evaluation in clinical practice. However, there have been no reports of high-frequency ultrasound combined with CEUS for the preoperative diagnosis of human finger extensor tendon injury.Cases presentationOne case of complete rupture of the extensor tendon was diagnosed by ultrasound, which was completely consistent with the surgery; one case of incomplete rupture was ultimately confirmed clinically; and one case of distal phalangeal bone base avulsion fracture with tendon contusion and missed diagnosis on the first radiographic examination was confirmed by follow-up radiographic examination.ConclusionsDifferent types of finger extensor tendon injuries exhibit distinctive contrast-enhanced ultrasonography findings. Combined high-frequency and contrast-enhanced ultrasound can accurately locate the position of the severed end of the finger extensor tendon injury before surgery while observing the contrast agent filling area to clarify injury classification, providing a reliable imaging basis for clinical practice and ultimately developing personalized diagnosis and treatment plans for patients to ensure minimal trauma and pain, as well as optimal treatment effects.

Intestinal ultrasound for intestinal Behçet disease reflects endoscopic activity and histopathological findings.

Intestinal Behçet disease is typically associated with ileocecal punched-out ulcers and significant morbidity and mortality. Intestinal ultrasound is a noninvasive imaging technique for disease monitoring. However, no previous reports have compared intestinal ultrasound with endoscopic ulcer activity or histopathological findings for intestinal Behçet disease. We evaluated the usefulness of intestinal ultrasound for assessing the activity of ileocecal ulcers in intestinal Behçet disease. We retrospectively compared intestinal ultrasound findings with 73 corresponding endoscopic images and 6 resected specimens. The intestinal ultrasound findings were assessed for 7 parameters (bowel wall thickness, vascularity [evaluated using the modified Limberg score with color Doppler], bowel wall stratification, white-plaque sign [strong hyperechogenic lines or spots], mesenteric lymphadenopathy, extramural phlegmons, and fistulas), and endoscopic ulcer activity was classified into active, healing, and scar stages. Histopathological findings were evaluated by consensus among experienced pathologists. Bowel wall thickness (P< 0.001), vascularity (P< 0.001), loss of bowel wall stratification (P= 0.015), and white-plague sign (P= 0.013) were significantly exacerbated in the endoscopic active ulcer stage. Receiver operating characteristic curve analysis revealed that a bowel wall thickness of > 5.5 mm (sensitivity 89.7%, specificity 85.3%) was potentially useful for detecting active lesions. When compared with histopathological findings, an increase in bowel wall thickness reflected the ulcer marginal ridge, and the white-plaque sign reflected the ulcer bottom. Intestinal ultrasound is useful for monitoring intestinal ulcer activity in intestinal Behçet disease.

Prenatal diagnosis and postnatal outcome of fetal intracranial hemorrhage: a single-center experience.

To assess prenatal ultrasonographic findings and postnatal outcomes in fetuses with intracranial hemorrhage (ICH). This retrospective study included fetuses prenatally diagnosed with ICH between December 2012 and August 2023. Maternal characteristics, prenatal ultrasonographic findings, and postnatal outcomes were reviewed. Twenty-seven fetuses with ICH were reviewed. Intracranial hemorrhage was classified as grade 3 and 4 in 24 fetuses. Twenty-two fetuses had ICH, four had ICH with subdural hemorrhage, and one had ICH with subarachnoid hemorrhage. Ventriculomegaly was the most common ultrasonographic finding, and was observed in 22 of the 27 (81.5%) fetuses. Seven fetuses were lost to follow-up, and four intrauterine fetal deaths occurred. The remaining 16 fetuses were delivered at a median gestational age of 35+2 weeks. The infants were followed-up for 40.1 months (range, 4-88). Nine of the 16 infants underwent ventriculoperitoneal placement. One infant underwent brain surgery for severe epilepsy. Motor impairment, including cerebral palsy, was observed in 13 infants (81.2%). Neurologic impairment occurred in six infants (37.5%), developmental delay in nine (56.2%), and epilepsy in 11 (68.7%). Fetal ICH is a rare complication diagnosed during pregnancy, which results in subsequent fetal neurological sequelae or death. This study demonstrated that the common ultrasonographic findings in fetal ICH were progressive ventriculomegaly and increased periventricular echogenicity. Fetuses diagnosed with prenatal ICH, especially those affected by higher-grade ICH, may be at an increased risk of long-term neurodevelopmental problems.

The use of point of care gastric ultrasound and anesthesia management in pediatric patients with preoperative fasting non-adherence scheduled for elective surgical procedures: a retrospective study

BackgroundFailure to adhere to perioperative fasting requirements increases aspiration risk and can lead to delay or cancellation of surgery. Point of care gastric ultrasound may guide decision-making to delay, cancel or proceed with surgery.MethodsThis study aimed to describe gastric contents using point of care gastric ultrasound in pediatric patients with known fasting guideline violations presenting for elective surgery. This was a single-center retrospectivechart review of gastric ultrasound scans in patients presenting for elective surgeries with “nothing by mouth” violation (per fasting guidelines) or unclear fasting status. The primary outcome is description of gastric contents using point of care ultrasound. The ultrasound findings were classified as low-risk for aspiration (empty, clear fluid < 1.5 ml/kg), high-risk (solids, clear fluid > 1.5 ml/kg), or inconclusive study. Gastric ultrasound findings were communicated to the attending anesthesiologist. For patients proceeding without delay the estimated time saved was defined as the difference between ultrasound scan time and presumed case start time based on American Society of Anesthesiologists fasting guidelines.ResultsWe identified 106 patients with a median age of 4.8 years. There were 31 patients (29.2%) that had ultrasound finding of high-risk gastric contents. These patients had cases that were delayed, cancelled or proceeded with rapid sequence intubation. Sixty-six patients (62.3%) were determined to be low-risk gastric contents and proceeded with surgery without delay. For these patients, a median of 2.6 h was saved. No aspiration events were recorded for any patients.ConclusionsIt is feasible to use preoperative point of care gastric ultrasound to determine stomach contents and risk-stratify pediatric patients presenting for elective surgical procedures with fasting non-adherence. Preoperative gastric ultrasound may have a role in determining changes in anesthetic management in this patient population.

Evaluation of the effect of SARS-CoV-2 infection on Doppler ultrasound and placental findings of pregnant women: a systematic review and meta-analysis.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can infect the human placenta and has been shown to have an adverse effect on Doppler ultrasound parameters and placental features. However, the specific effects of the SAS-CoV-2 infection on the fetal-placental unit in pregnant women remain unclear. The aim of this systematic review and meta-analysis was to evaluate the impact of SARS-CoV-2 infection on Doppler ultrasound and placental findings in pregnant women. A systematic search was conducted using four electronic databases (PubMed, Embase, Scopus, and Cochrane Library) to select publications published in peer-reviewed journals written in English. Odds ratios (ORs) were calculated, along with their 95% confidence intervals (CIs). Heterogeneity was assessed using Cochrane Q and I2 statistics and the appropriate P-value. The analysis used RevMan 5.3. This meta-analysis included 1,210 pregnant women from 10 case-control studies. SARS-CoV-2-infected pregnant women exhibited higher likelihoods of placental abnormalities (OR, 2.62; 95% CI, 1.66 to 4.13), aberrant Doppler values (OR, 1.95; 95% CI, 1.16 to 3.27), an abnormal cerebroplacental ratio (OR, 2.68; 95% CI, 1.52 to 4.75), altered fetoplacental circulation (OR, 1.56; 95% CI, 1.07 to 2.28), and increased placental thickness and placental venous lakes (OR, 1.85; 95% CI, 1.25 to 2.72). According to this meta-analysis, pregnant women infected with SARS-CoV-2 are more likely to experience altered Doppler ultrasonography parameters and placental abnormalities, including increased placental thickness, placental venous lakes, altered fetoplacental circulation, and cerebroplacental ratio. However, the limited number of case-control studies requires larger sample sizes to validate and enhance the evidence.

Ultrasonography of the suspensory ligament branches in yearling and 2-year-old Thoroughbred sales horses: Prevalence, progression of findings and associations with racing performance.

Equine suspensory ligament branch (branch) ultrasonography is becoming increasingly commonplace presale. No ultrasonographical branch reference data exists for Thoroughbred sales horses. To define the prevalence of ultrasonographical findings in the forelimb suspensory branches of yearling and 2-year-old sales Thoroughbreds and to analyse associations with racing performance. To track changes in branch findings between 1 and 2 years of age in horses that present for sale at both ages. Prospective cohort study using an enrolled sample. Horses were enrolled from a 2016 yearling sale and five 2017 2-year-old sales with consignor permission. Ultrasonography was performed immediately prior to the sales. Ultrasonographical findings relating to branch size, fibrillar pattern, the presence of hyperechoic foci, periligamentar tissue thickness and the adjacent proximal sesamoid bone surface were examined. Associations with racing performance from 2 to 4 years of age were investigated using multivariate regression analyses. Clinical follow-up was sought to ascertain why horses that did not race never started. A total of 593 sales yearlings and 367 2-year-olds had forelimb branch ultrasonography performed. Grade ≥2 fibrillar branch change was present in 8.9% of yearlings and 14.4% of 2-year-olds. A 0.25 cm increase in branch width was associated with a 49-day delayed start to racing careers (P < 0.001, 95% confidence interval (95% CI): 21-77 days). The presence of grade 2 hyperechoic foci was associated with significantly lower total earnings (P = 0.01, 95% CI: $2000-$16 022) and lower earnings per start (P = 0.003, 95% CI: $349-$1718) in United States Dollars. Grade 3 fibrillar branch change had clinically important reductions in the probability of racing, the calibre of racing performance and earnings. Grade 1 fibrillar pattern was associated with significantly higher earnings per start (P = 0.004, 95% CI: $2641-$5759). The findings are applicable to horses prepared for public auction and deemed fit to be entered for sale. The results may underestimate the proportion of severe lesions in horses not entered for sale. Reference values specific to young Thoroughbreds have been established. Grade 1 fibrillar branch change should be regarded as an acceptable appearance in sales yearlings and 2-year-olds. Approximately one-third of grade 2 yearling branches progressed to a grade 3 lesion. Evidence of enlarged branch width and grade 2 hyperechoic foci at 2-year-old sales constitute a risk to racing performance.

Ultrasonographic findings in diabetic cheiroarthropathy: a pilot study

Objective Diabetic cheiroarthropathy (DCA) is one of the musculoskeletal manifestations of diabetes mellitus. It is clinically diagnosed using the prayer and tabletop signs. The clinical appearance, however, mimics autoimmune-mediated polyarthritis of the hands and fingers. It is therefore crucial to positively identify DCA patients. Method We used high-frequency B-mode ultrasound to investigate 14 patients with DCA and seven non-DCA diabetics with anti-cyclic citrullinated peptide antibody-positive rheumatoid arthritis (RA). We recorded the frequency of synovitis in radiocarpal, metacarpophalangeal, and proximal interphalangeal joints, the presence of tenosynovitis of the finger flexor tendons, echogenicity of the synovia and the flexor tendon sheaths, and soft tissue alterations in the digits. We compared our findings between groups to determine sonographic characteristics of DCA. Results A low rate of small finger joint involvement in the presence of a high rate of finger flexor tendinopathy showed a high association with DCA in correlation (p = 0.002) and regression analysis (p < 0.001). Tendon sheaths were significantly more often hyperechoic and proliferative in DCA compared to RA (p = 0.008), and hypoechoic soft tissue alterations were almost exclusively seen in DCA patients (p = 0.003). Radiocarpal joint involvement and its echogenicity did not differ between groups. Conclusion Ultrasonography shows typical features in DCA, and is capable of discriminating DCA from non-DCA patients with RA and diabetes.

Expert Consensus Document: An Algorithm for the Care and Treatment of Patients with Constipation Based on Ultrasonographic Findings in the Rectum.

Chronic constipation is a common gastrointestinal disorder, and its management is critical. However, it is extremely difficult to assess its subjective symptoms when patients are unable to report them due to cognitive or physical disabilities, especially in cases of patients with incurable geriatric, pediatric, palliative, psychiatric, or neurological diseases. We had previously established a protocol for observing and assessing rectal fecal retention using ultrasonography and for classifying cases into three categories based on the rectal findings: no fecal retention, fecal retention without hard stools, and fecal retention with hard stools. However, although the detection of rectal fecal retention using ultrasonography would be expected to lead to better therapeutic management, there is no standard algorithm for selecting specific treatments and defecation care options based on ultrasonographic findings. Therefore, we organized an expert consensus meeting of multidisciplinary professionals to develop such an algorithm based on rectal ultrasonography findings for patients with constipation in both residential and hospital settings.

The role of upper airway ultrasonography in tracheal necrosis diagnosis: a case report

BackgroundTracheal necrosis post endotracheal intubation is a rare life-threatening disease that can compromise airway patency. We demonstrated a novel usage of upper airway ultrasonography (USG) to diagnose tracheal necrosis.Case presentationA middle-aged smoking male presented with productive cough, noisy breathing and exertional dyspnea for 2 weeks. He was intubated one month prior due to a traumatic brain injury. Upper airway USG findings showed irregular air-mucosal interface (AMI) and comet tail artefacts over the 1st and 2nd tracheal ring. A direct laryngoscopy in the operating room showed thick mucopus inferior to the vocal cords, with necrotic tracheal cartilages and debris obstructing the airway. He was successfully treated with parenteral antibiotics, wound debridement and tracheostomy.ConclusionOur case highlights the first documented USG findings of tracheal necrosis. Upper airway USG serves as a potential diagnostic modality in managing the condition.

Ultrasound detection of non-atherosclerotic intima-medial abnormalities of lower limbs arteries in amateur endurance runners

BackgroundStructural changes in the lower limb’s arterial wall in amateur endurance runners are a rare incidental finding, represented just by several case reports.AimStudy the incidence of non-atherosclerotic lower limb artery wall changes in defined group of amateur endurance runners and identify relationship with the training parameters and the relevant biochemical markers.MethodsAmateur male athletes engaged in endurance running for more than 5 years were enrolled. Tibial and anterior popliteal arteries on each side were examined by ultrasound with focus on non-atherosclerotic structural wall changes: intima-medial border blurring, presence and character of non-atherosclerotic noduli. Subsequently the descriptive and correlation analysis were performed.ResultsThe study enrolled 20 amateur male endurance runners from Black Swan Triathlon Club Slovakia. The low atherosclerotic risk was represented by normal lipid levels, BMI under 30 kg/m2 and non-smokers in all participants. At least one type of structural artery wall abnormality (noduli or intima-medial border blurring) was present in 19 of 20 participants (95%). The most present was the intima-medial blurring. (80% of participants). The noduli were present in 65% of study group, in almost 40% of these, they were considered as hyperechogenic. All these affections were predominantly in popliteal artery area (65%). The vast majority has bilateral affection. We find a mild correlation between these ultrasound findings and training load represented by annual kilometers and run hours. There was no association between these changes and lipid spectrum or CRP level.ConclusionThe subclinical lower limb artery changes, represented by intima-medial border blurring and non-atherosclerotic noduli were present in almost every amateur endurance runner. Despite the underlying mechanism is not understood, the increased training load seems to be one of the responsible factors.

Fallopian tube deciduosis with massive hemoperitoneum in a second-trimester pregnancy: a case report of ultrasound findings

Fallopian tube deciduosis with massive hemoperitoneum in a second-trimester pregnancy: a case report of ultrasound findings

Presumed renal arterial aneurysm in a cat.

A 3-year-old cat was presented for an abdominal ultrasound examination with apathy and anemia. The US revealed the enlargement of the left kidney with a hypoechoic subcapsular thickening. An abnormal, tortuous vessel was visible in the medulla with arterial flow on pulsed-wave Doppler examination. The CT examination confirmed the ultrasound findings and a presumptive diagnosis of the intraparenchymal renal aneurysm was made. Four days later, the cat presented again with a worsening of its condition. The US features were suggestive for that of an aneurysm rupture.

Quantitative Proteomics and Metabolomics of Culture Medium from Single Human Embryo Reveal Embryo Quality-Related Multiomics Biomarkers.

An effective tool to assess embryo quality in the assisted reproduction clinical practice will enhance successful implantation rates and mitigate high risks of multiple pregnancies. Potential biomarkers secreted into culture medium (CM) during embryo development enable rapid and noninvasive methods of assessing embryo quality. However, small volumes, low biomolecule concentrations, and impurity interference collectively preclude the identification of quality-related biomarkers in single blastocyst CM. Here, we developed a noninvasive trace multiomics approach to screen for potential markers in individual human blastocyst CM. We collected 84 CM samples and divided them into high-quality (HQ) and low-quality (LQ) groups. We evaluated the differentially expressed proteins (DEPs) and metabolites (DEMs) in HQ and LQ CM. A total of 504 proteins and 189 metabolites were detected in individual blastocyst CM. Moreover, 9 DEPs and 32 DEMs were identified in different quality embryo CM. We also categorized HQ embryos into positive implantation (PI) and negative implantation (NI) groups based on ultrasound findings on day 28. We identified 41 DEPs and 4 DEMs associated with clinical implantation outcomes in morphologically HQ embryos using a multiomics analysis approach. This study provides a noninvasive multiomics analysis technique and identifies potential biomarkers for clinical embryo developmental quality assessment.

Ultrasound findings and clinical characteristics in differentiating renal urothelial carcinoma from endophytic clear cell renal cell carcinoma.

This study aimed to evaluate the clinical characteristics and features of conventional ultrasound (CUS) and contrast-enhanced ultrasound (CEUS) in differentiating between renal urothelial carcinomas (RUC) and endophytic clear cell renal cell carcinomas (EccRCC). A total of 72 RUCs and 120 EccRCCs confirmed by pathology were assessed retrospectively. Both CUS and CEUS were performed within 4 weeks before the surgery. Logistic regression analyses were used to select statistically significant variables of clinical, CUS, and CEUS features for the differentiation of RUC and EccRCC. Sensitivity (SEN), specificity (SPE), and the area under the receiver-operating characteristic curve (AUC) were assessed for diagnostic performance. Inter- and intra-observer agreements of CUS and CEUS features were evaluated using the intra-class correlation coefficient(ICC). Multiple logistic regression analysis demonstrated that clinical (age >50 years old and hematuria), CUS (size <4.0 cm, hypo-echogenicity, irregular shape, hydronephrosis) and CEUS (absence of non-enhancement area, iso- /hypo-enhancement in cortical phase and absence of rim-like enhancement) features were independent factors for RUC diagnosis. When combining clinical characters with CUS and CEUS features into an integrated diagnostic criterion, the AUC reached 0.917 (95% CI 0.873-0.961), with a sensitivity of 95.8% and specificity of 87.5%. ICC ranged from 0.756 to 0.907 for inter-observer agreement and 0.791 to 0.934 for intra-observer agreement for CUS and CEUSfeatures. The combination of clinical features of age and hematuria with imaging features of CUS and CEUS can be useful for the differentiation between RUC and EccRCC.

Disseminated Tuberculosis with Testes Involvement: An Intriguing Case Report

Background: Disseminated tuberculosis (TB) is the presence of two or more noncontiguous sites resulting from hematogenous dissemination of Mycobacterium tuberculosis. We report a case of disseminated TB with testicular involvement. Case: A 21-year-old male patient presented to the outpatient department with bilateral testicular enlargement and tenderness for last six months. It was suspected to be a case of epididymo-orchitis and empirical antimicrobial therapy was initiated. However, ultrasonography findings were inconsistent with epididymo-orchitis. Two weeks later the patient again presented with increased nodularity in the right testes. Non-seminomatous germ cell tumor was suspected. However, tumor markers came back normal. Magnetic resonance imaging revealed enlarged lymph nodes in the right inguinal and retroperitoneal region raising a suspicion of testicular lymphoma. Positron emission tomography with computed tomography showed multiple lymphadenopathies. Histopathology of the left axillary lymph node finally confirmed the diagnosis to be tuberculosis. No drug resistance were found and the patient responded well to anti-tubercular drugs. Conclusion: Diagnosing disseminated TB is difficult as it mimics conditions, such as infarction, cancer, torsion, etc. Attention to small details is necessary. We faced a similar situation in our patient. The patient went through a myriad of tests before finally being diagnosed with TB. Histopathological study was able to get it whereas cytology could not. Similar and totally opposite cases were found in the literature. This highlights the difficulty and importance of these type of cases.