Ultrasound Appearance Research Articles

Ultrasound Description of Follicular Development in the Louisiana Pinesnake (Pituophis ruthveni, Stull 1929).

Accurate monitoring of reproductive activity is necessary for success of captive breeding and recovery of endangered species. Using ultrasonography, we aimed to describe the stages of follicle development of the endangered Louisiana pinesnake (Pituophis ruthveni). Ultrasound procedures were performed weekly for 11 females during the 2020 reproductive season by submerging the last half of an unanesthetized female in water and using a 3.0-10.0 MHz linear array transducer placed and moved along the gastrosteges to explore the whole reproductive tract. The presence of follicles, their size, echogenicity, and stage of development was assessed. We observed small, round, anechoic, linearly aligned previtellogenic follicles in the coelom at the beginning of the reproductive season and found that structures dramatically increased in size and shifted in echogenicity as follicles matured and developed before and after ovulation. We classified follicles according to ultrasonographic appearance into 7 different follicle categories: previtellogenic, early vitellogenic, vitellogenic, preovulatory, peri-ovulatory, post ovulatory, and shelled. Using ultrasound, we developed markers of progressive follicular maturation for the Louisiana pinesnake and identified signs of abnormal development and post ovulatory follicle reabsorption. Detailed description of follicular maturation will be useful to improve captive breeding successes, identify mechanisms of reproductive failure, and develop artificial insemination.

The ultrasonographic appearance of renal medullary striations and their association with renal disease and renal histopathology in domestic cats.

Medullary striations (MS) have been anecdotally observed on ultrasound of feline kidneys; however, their significance is unknown. Aims of this retrospective, case control, pilot study were to describe the appearance, prevalence, and clinicopathological correlates of MS in a referral feline population. Still images from 1247 feline abdominal ultrasound studies performed between 2011 and 2021 were reviewed. Cats with MS were identified and compared with age-matched controls. Serum urea, creatinine, calcium, phosphate, and calcium-phosphate-product, plus urine specific gravity, urine protein: creatinine ratio (UPC), prevalence of active sediment (defined as>5red (RBC) or white blood cells (WBC) per high-power field) and prevalence of positive urine culture were compared between MS and control groups using the Mann-Whitney U test or Fisher's Exact test. Data are presented as median [range]. 27 cats were identified as having MS, giving a prevalence of 2.2% with a significantly higher proportion being seen in males (P =0.018). Medullary striation cats had significantly higher UPC values than controls (0.46 [0.16-7.57] vs. 0.16 [0.07-2.27]; P=0.006). Cats with MS were more likely to have active urinary sediments (39%vs 8%, P=0.023), but no difference in prevalence of positive urinary cultures was observed between groups. There was no significant difference in other parameters between MS and control cats. Renal histopathology performed in three MS cats revealed focal regions of linear medullary fibrosis. Medullary striations are associated with proteinuria and urinary tract inflammation in cats, which may reflect renal tubular dysfunction and/or inflammation. Hence identification might allow for earlier detection of renal pathology.

Ultrasound appearance of the kidney among radiology department attendees of a tertiary centre in Malawi

Ultrasound appearance of the kidney among radiology department attendees of a tertiary centre in Malawi

Ultrasound appearance of the kidney among radiology department attendees of a tertiary centre in Malawi

Ultrasound appearance of the kidney among radiology department attendees of a tertiary centre in Malawi

Ultrasonography of the Metacarpal/Tarsal-Phalangeal Joints in Healthy Racehorses: Normal Appearance, Breed-Related and Age-Related Features.

Simple SummaryThe ultrasound appearance of cartilage thickness and subchondral bone changes according to the age of the horse and the health status of the joints. Specific ultrasound features have been described in different joint diseases in horses. Knowledge of the normal features is thus essential during clinical investigations. The present research evaluates the ultrasound features of metacarpal/tarsal-phalangeal joints in healthy racehorses, according to the age and breed. Twenty-eight racehorses (standardbreds and thoroughbreds) were enrolled and grouped according to age (<5 and ≥5 years old). Fetlock cartilage appearance, thickness and subchondral bone appearance were ultrasonographically assessed. In younger compared to older standardbreds, the cartilage appeared thinner and with a normal ultrasound appearance, which suggests the use of specific references for the ultrasound features of the fetlock.In adult horses, specific ultrasound (US) features and reference values have been reported for the appearance of the joint cartilage and thickness according to the type of joint, such as femoropatellar and tarsocrural. The US appearance of the fetlock has been described in several diseases. The present research evaluates the US features of the metacarpal/tarsal-phalangeal joints in healthy racehorses according to age and breed, since no information is available in the literature. Seventy-one fetlocks in 28 healthy horses (15/28 thoroughbreds and 13/28 standardbreds) were assessed. The horses were grouped as follows: group A < 5 years old vs. group B ≥ 5. A portable ultrasound machine and a linear transducer (5–7.5 MHz) were used. Dorsal metacarpal/tarsal-phalangeal joints were scanned. The US images were reviewed offline in terms of articular cartilage appearance, thickness, and subchondral bone appearance by an experienced observer. Data were reported as the median, minimum, and maximum for cartilage thickness values, and differences between groups were evaluated. Cartilage thickness values were statistically lower in group A than B in the standardbreds, except for the lateral thickness in longitudinal view. No differences were detected in the thoroughbreds within age groups. All of the young standardbreds showed a normal cartilage and subchondral appearance. No statistical differences were found between breeds. Our results highlight the characteristics of the US appearance of metacarpal/tarsal-phalangeal joints specifically in racehorses, with some variations according to age. Since the cartilage can change according to joint growth, age and training activity, the present findings suggest the use of specific references for US features, which are key to correctly evaluating the health of the fetlock.

EP25.02: Ultrasound appearance and outcomes of fetal ovarian cysts: what is essential

EP25.02: Ultrasound appearance and outcomes of fetal ovarian cysts: what is essential

EP29.09: Fetal ovarian cyst‐changing ultrasound appearance and unanswered questions

EP29.09: Fetal ovarian cyst‐changing ultrasound appearance and unanswered questions

EP34.35: Placenta accreta spectrum ultrasound appearance following synechia after a cervicoisthmic embolised and instrumentally evacuated pregnancy

EP34.35: Placenta accreta spectrum ultrasound appearance following synechia after a cervicoisthmic embolised and instrumentally evacuated pregnancy

Ultrasonographic appearance of the endometrium after saline infusion in women presenting with PRM-associated endometrial changes, due to the use of ulipristal acetate

Ulipristal acetate (UPA), used for the treatment in women with symptomatic fibroids, is associated with endometrial changes visualised on ultrasound as thickening up to more than 16 mm in approximately 10% of the patients. Is saline infusion sonography (SIS) a good alternative for more invasive techniques, to evaluate the presence of intrauterine pathology? Ten patients, presenting with UPA associated endometrial changes at their follow up ultra-sonographic evaluation, were included. Our study demonstrated that SIS is feasible and painless in patients presenting with UPA associated endometrial changes. The thickened endometrium appears to divide at the midline, making it possible to study both layers separately and exclude any suspected intrauterine pathology. Our findings suggest that SIS may be a first choice, non-invasive, painless technique to provide a proper visualisation to rule out intrauterine pathology when UPA associated endometrial changes are diagnosed after fibroid treatment. This is especially of clinical interest in front of assisted reproductive technology treatment. Invasive techniques can be withheld for patients in whom SIS examination is not contributive. Impact Statement What is already known on this subject? Reversible endometrial changes after ulipristal acetate (UPA) treatment in patients with symptomatic fibroids have been described. In patients who receive UPA, especially if planned to undergo ART, assessment of potential endometrial pathology is important as such interfere with proper implantation after ART. Consequently, clinicians may consider ruling out intrauterine pathology by invasive examinations such as biopsy or hysteroscopy after visualisation of the thickened endometrium. What do the results of this study add? Saline infusion sonography (SIS) was feasible and painless in patients presenting with UPA associated endometrial changes. What are the implications of these findings for clinical practice and/or further research? SIS may be a first choice, non-invasive, painless technique to provide a proper visualisation to rule out intrauterine pathology when UPA associated endometrial changes are diagnosed after fibroid treatment. This is especially of clinical interest in front of assisted reproductive technology treatment. Invasive techniques can be withheld for patients in whom SIS examination is not contributive in excluding intrauterine pathology.

High-Frequency Ultrasound Imaging Findings of Different Mental Injectable Soft Tissue Fillers.

In recent years, the use of mental injectable soft tissue fillers is popular. However, some fillers are difficult to distinguish from pathological tissue, and some non-absorbable fillers need to be removed in time. Therefore, identification of different fillers is important. In this study, we summarized the ultrasonic manifestations of different mental injectable soft tissue fillers to provide references for clinical practice. We screened the mental ultrasound images from November 2014 to November 2021 in the Plastic Surgery Hospital of Chinese Academy of Medical Sciences, identified different filling injection materials, and summarized and classified the ultrasonic characteristics of each filling material. A total of 244 cases were included, involving 62 cases of hyaluronic acid, 126 cases of polyacrylamide hydrogel, 19 cases of growth factor, 16 cases of calcium hydroxyapatite, 15 cases of silicone oil and 6 cases of fat. The ultrasonic manifestation of hyaluronic acid was anechoic area, which could be divided into six types according to the distribution characteristics. The ultrasonography of polyacrylamide hydrogel showed fine punctate echo, which could be divided into nine types. The ultrasonographic appearance of growth factor was similar to the echo of the surrounding tissue, and the boundary was not clear. Calcium hydroxyapatite was characterized by uneven hyperechoic area, which was spread in the tissue space, with unclear boundary with surrounding tissues. Sonographic patterns of silicone oil were hyperechoic and cloudy on high-frequency ultrasound. The deep tissue and periosteum layer were not clear. Transplanted fat showed isoechoic area or uneven low-echo area, with clear boundary and peripheral adipose tissue acoustic enhancement. High-frequency ultrasound is safe and reliable for identification and typing of chin filling injection materials, which can be applied in clinical practice. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

High-Resolution Ultrasonographic Anatomy of the Carpal Tendons of Sporting Border Collies.

Simple SummaryDog agility is a canine sport that has gained popularity among pet owners in recent decades. Because of the high-performance level, injuries to dogs competing in this sport are becoming frequent. The need for better knowledge of the anatomy of the structures involved in athletic movements is an essential starting point for correctly managing agility-related injuries. The aim of this paper was to investigate the ultrasonographic anatomy of the carpal joint, creating a baseline reference for the Border Collie, which is the breed most utilised in agility competitions. The data acquired could be of use in future studies regarding sport-induced injuries in the canine carpus.Recent literature has demonstrated that high-resolution ultrasonographic anatomy of the canine carpus is possible; however, only the structures of the dorsal face were described. The aims of this prospective study were: (1) to describe the normal ultrasonographic appearance of the carpal tendons in sporting Border Collies; (2) to measure the height, length, and thickness of the tendon at the radial ulnar notch level in order to create a baseline reference for the breed, and (3) to describe a standardised protocol to ultrasonographically evaluate the carpal faces and visible tendinous structures. A pilot study based on ten cadaveric front limbs was used to identify the structures. A subsequent clinical phase of the study using twenty-six Border Collies was recorded. The tendons of the Extensor Carpi Radialis, Extensor Digitorum Communis, and Extensor Digitorum Lateralis were identified and followed from the tenomuscular junction to the distal insertion on the dorsal face of the digits. On the lateral face, the tendon of the Extensor Carpi Ulnaris was recognised and followed. On the palmar face, the two heads of the Flexor Carpi Ulnaris tendon ending on the accessory carpal bone, the adjacent Flexor Digitorum Superficialis tendon, and the deep and medially located Flexor Digitorum Profundus tendon were seen and followed. The Flexor Carpi Radialis and the Abductor Pollicis Longus tendons were seen in the medial carpal face. The ulnar notch of the radius was used as the measurement and starting point of the ultrasonography. These data could be used as a standard reference in the case of chronic overuse and trauma-induced changes in the canine carpus.

Ultrasonographic Findings of Exocrine Pancreatic Insufficiency in Dogs.

Simple SummaryExocrine pancreatic insufficiency (EPI) is a syndrome characterized by insufficient synthesis of pancreatic enzymes leading to clinical symptoms of malabsorption; this pathology has also been described in dogs. No studies are present about ultrasonographic appearance of the pancreas in the course of EPI in dogs. The purpose of this retrospective study was to describe ultrasound features of the pancreas during EPI in this species. In our study, the pancreas had a significantly lower thickness compared to the reference values of healthy dogs previously proposed; however, most of the dogs did not have other ultrasonographic pancreatic alterations. Moreover, in 85% of dogs, ultrasonographic intestinal abnormal findings were also identified. Based on our study, ultrasound could be a useful tool in the diagnosis of EPI. A normal but thinned pancreas associated with sonographic intestinal signs of inflammatory bowel disease in dogs with supportive clinical signs should suggests a diagnosis of EPI.Exocrine pancreatic insufficiency (EPI) is a syndrome characterized by insufficient synthesis of pancreatic enzymes leading to clinical symptoms of malabsorption and maldigestion. There are no studies about ultrasonographic appearance of the pancreas with EPI in dogs. The purpose of this retrospective study was to describe ultrasound features of the pancreas during EPI in this species. Dogs with history and clinical signs of maldigestion, serum canine trypsin-like immunoreactivity (cTLI) values <5 µg/L, and abdominal ultrasound exam were included in the study. Size, shape, margin, echogenicity, echostructure, and pancreatic duct appearance of the right pancreatic lobe were valued. Additional sonographic intestinal findings were recorded. Thirty-four dogs were included. The mean pancreatic thickness in our population was significantly lower than the mean reference values of healthy dogs. In 68% of dogs, the pancreas had a normal ultrasound appearance. Ultrasonographic intestinal abnormal findings were identified in 85% of dogs and were suggestive of inflammatory bowel disease. Despite the fact that EPI is a functional diagnosis, ultrasound evaluation should be considered among the useful tests. The finding of a normal but thinned pancreas associated with sonographic intestinal signs of inflammatory bowel disease in dogs with typical history and supportive clinical signs could suggest a diagnosis of EPI.

Ultrasound features of highly vascularized uterine myomas (uterine smooth muscle tumors) and correlation with histopathology

To correlate the ultrasound appearance of highly vascularized uterine myomas with their histopathological diagnosis. This was a prospective observational study of patients with a preoperative ultrasound diagnosis of a highly vascularized uterine myoma (color score of 3 or 4, according to the Morphological Uterus Sonographic Assessment (MUSA) criteria), characterized by circumferential and intralesional vascular pattern, who underwent myomectomy or hysterectomy. For each patient, ultrasound characteristics were recorded at baseline, including the number of lesions, the size, echogenicity and border regularity of the lesion, presence of cystic areas and shadowing within the myoma, and visualization of the endometrium. Ultrasound features were correlated with the definitive histological diagnosis. Ultrasound features were then compared between malignant and benign lesions. We included 70 patients with highly vascularized uterine myomas on power/color Doppler. Their mean age was 46.5 ± 11.4 years and 13 (18.6%) were postmenopausal. At histological examination, 65 (92.9%) uterine myomas were benign lesions, comprising 32 typical leiomyomas, 29 leiomyoma variants and four adenomyomas. The remaining five (7.1%) uterine myomas were malignant masses, comprising two uterine sarcomas, one leiomyosarcoma, one neuroendocrine tumor and one uterine smooth muscle tumor of uncertain malignant potential (STUMP). The mean age of patients with a malignant lesion was significantly higher than the age of those with a benign lesion (64.8 ± 16.0 vs 42.4 ± 5.1; P < 0.001). Four out of five patients with a malignant lesion were over 45 years old. Ultrasound demonstrated cystic areas within the lesion in 10/32 (31.3%) typical leiomyomas, 16/29 (55.2%) leiomyoma variants, all four adenomyomas and in the cases of STUMP and leiomyosarcoma. Lesion borders were regular in 64/65 (98.5%) benign lesions and 2/5 (40%) malignant lesions (P < 0.05). No significant differences were observed between benign and malignant lesions with respect to echogenicity, presence of shadowing and size. The endometrium was visible in 55/65 women with benign lesions and in 2/5 with malignant lesions (P = 0.03). Our results showed that ultrasound features of uterine myomas, such as circumferential and intralesional vascularity, cystic areas and lesion borders, are important parameters for differential diagnosis, especially when combined with the patient's age. Such features could be useful to differentiate typical myomas from benign variants and malignant lesions in a preoperative setting and to select patients that may benefit from conservative management rather than surgery. © 2022 International Society of Ultrasound in Obstetrics and Gynecology.

Ultrasonographic Identification of the Parotid Cystadenolymphoma (Warthin’s Tumor) by Oral and Maxillofacial Surgeons: Supplement to the Matsuda and Colleagues’ Classification

Warthin’s tumor (WT), which is also known as papillary cystadenoma lymphomatosum, monomorphic parotid adenoma, adenolymphoma, cystadenolymphoma, and branchiogenic adenoma, is to be differentiated (in surgical practice) from other parotid masses. The purposes of our retrospective case series study are: (1) to describe ultrasound morphology (sonomorphology) of the WT in patients referred to our hospital, (2) based on the presented cases to propose a supplement to the Matsuda and colleagues’ classification (2017) of anechoic area patterns of the WT, and (3) to expand the knowledge of oral and maxillofacial surgeons for the preoperative ultrasonographic verification of the WT and for choosing the most appropriate surgical technique. Over three years, 5 patients (mean age, 65.4 years) with parotid WT had been examined with gray-scale, color, and power Doppler ultrasonography. Cystic components are visualized in all five WT cases but in different proportions. Case 1 and 4 showed the presence of septations. According to Matsuda and colleagues’ (2017) classification of anechoic area patterns, in our cases the US patterns of the WTs belong only to Group 3 (i.e., with large anechoic areas) (n = 4) and Group 4 (multiple and sponge-like anechoic areas) (n = 1). Moreover, based on the presented five cases, we offer an addition to the classification of Japanese authors. In conclusion, our supplement to Matsuda and colleagues’ classification of anechoic area patterns of the WT can help surgeons around the globe to be more accurate in preoperative verification of cystadenolymphoma. This case series illustrate the growing importance of ultrasonography in the professional life of oral and maxillofacial and head and neck surgeons. Based on the cystic structure of this benign tumor and the ultrasound appearance presented in our case series, we propose to continue using the term “cystadenolymphoma” with a purpose to emphasize the tumor`s structure.

Ultrasonographic and haematology findings as an indicator of uterine torsion prognosis in cattle

AbstractUterine torsion is considered an obstetric emergency. In severe cases, it compromises the survival of both the fetus and the dam. The purpose of the current report is to describe uterine torsion in an 8‐year‐old full‐term pregnant Nelore cow, at 275 days of gestation, presenting physiological and behavioural changes for 12 hours. Physical examination revealed tachycardia, tachypnoea and mucoid vaginal discharge. On rectal examination, absent signs of fetal viability, increased ultrasonographic appearance of the uterine wall, separation of its layers and hyperechogenic placentomes showing rough borders were observed. Blood sample evaluation revealed biochemical changes. The postmortem examination confirmed severe uterine torsion with detachment of uterine wall layers and severe subendometrial haemorrhage. Haematology and biochemistry profiles and ultrasonographic findings were helpful in determining the severity of uterine damage. Ultrasound examination is a rapid, non‐invasive and low‐cost procedure that can be used to establish a prognosis while avoiding expensive and unsuccessful therapeutic approaches.

Ultrasonographic Spectrum of Cutaneous Cysts With Stratified Squamous Epithelium in Pediatric Dermatology: Pictorial Essay.

High-resolution ultrasound (HRUS) is an important diagnostic method in dermatology, especially in pediatric population. The most common type of cutaneous cysts in children corresponds to cysts with stratified squamous epithelium (CSSE). The objective is to present the different ultrasonographic appearance of histologically proven CSSE in a retrospective review. Epidermoid, milium, trichilemmal, dermoid, and pilonidal cyst and steatocystomas are included. Utility of HRUS in diagnosis of cutaneous lesions is well established. It is important to know-and stay updated-about the wide spectrum of ultrasonographic appearance of CSSE in order to avoid misleading diagnoses.

Atypical gastric ultrasound appearance immediately after food intake.

Gastric point-of care-ultrasound (POCUS) is an emerging clinical tool. Its utility in guiding clinical decision-making relies on the ability to differentiate between the appearance of an empty stomach; fluid-filled stomach (clear versus particulate fluid); ‘early solid’ content; and ‘late solid’ content, with the most accurate imaging obtained when the patient is scanned in the right lateral decubitus (RLD) position [1]. The typical appearance of early solids is often referred to as a ‘frosted glass’ pattern, where the anterior wall of the antrum is visible with large acoustic shadowing posteriorly (Fig. 1a). This appearance is caused by air swallowed during eating, creating a mucosa-air interface indicated by multiple ‘ring-down’ artefacts on the anterior gastric wall which blur the posterior wall [1-4]. In contrast, the appearance of late solids occurs after the air is displaced, and a distended antrum with mixed echogenicity is seen (Fig. 1b). To our knowledge, all published descriptions of gastric ultrasound to date describe the frosted glass appearance immediately after food intake. In a study of six healthy volunteers, all volunteers demonstrated a late solid sonographic appearance when scanned 90 min after ingesting a solid meal [3]. However, the time period over which this occurs is described within the literature as “variable” [2]. Here, we present and discuss atypical gastric ultrasound images captured during a gastric POCUS workshop, immediately after food ingestion in a healthy woman in her early 20s with no relevant medical or surgical history. Initial ultrasound images of a fasted stomach were as expected (Fig. 1c). However, images captured immediately after a small meal showed a late solids appearance (Fig. 1d). This unexpected finding was again confirmed on repeat imaging of the same individual some weeks later. To our knowledge, this is the first report of the complete absence of the characteristic frosted glass appearance immediately after ingestion of food, giving the false appearance of a late solids state. We hypothesise that this is due to a lack of air being swallowed during ingestion. External observation of the subject's chewing and swallowing pattern did not reveal any obvious deviation from normal. It is difficult to comment on the true incidence of this finding, given that studies investigating the sonographic transition from early to late solids appearance have small sample sizes. Coupled with the lack of previous case reports, we believe this atypical appearance to be a rare finding. The clinical significance of this report is that a late solids appearance may be seen immediately after ingestion of food, giving the false impression that approximately 60–90 min has passed since ingestion. Adverse impact on patient care can be avoided if gastric POCUS is subsequently used to confirm an empty antrum, rather than relying on a specific timeframe after ingestion of food. This observation adds to the knowledge base of gastric sonography as it emerges as a routine clinical tool. This report was published with the written consent of the subject. The authors obtained additional written consent for the use of the ‘typical’ gastric ultrasound images. NS is the convener of the POCUS North Shore gastric ultrasound workshop. No external funding declared. Open access publishing was facilitated by The University of Auckland, as part of the Wiley - The University of Auckland agreement via the Council of Australian University Librarians.

Statistically Significant Difference in the First-trimester Fetal Heart Rate between Genders?

Background: The study aims to establish the pattern of fetal heart rates in the first and second trimesters and determine whether there is a statistically significant difference in the first-trimester fetal heart rate (FHR) of males and females.&#x0D; Methods: This retrospective observational research is a study of FHRs measured at 11+0–13+6 wk and 18+0–23+6 wk, and ultrasound scan-diagnosed fetal sex at 18+0–23+6 wk. Singleton fetuses with nonambiguous external genitalia were recruited. The FHR was measured in B or M mode with Pulsed Wave Doppler, while ultrasound appearance of external genitalia determined the fetal sex at 18+0–23+6 wk. Student’s t-test and Chi-square test were used for data analysis, and statistical significance was set at p &lt; 0.05.&#x0D; Results: A total of 2437 pregnancies meeting the study criteria were analyzed. The fetal sexes were 1398 (57.4%) males and 1039 (42.6%) females. There was no statistically significant difference in the first-trimester FHR between males and females (p = 0.74). However, females had higher mean FHR in both the first and second trimesters (First trimester: 165.4 ± 18.2 bpm vs 163.2 ± 17.1 bpm and Second trimester: 150.9 ±22.6 bpm vs 141.9 ±23.1 bpm). The FHR reduces with the increase in gestational age.&#x0D; Conclusion: There is no statistically significant difference in the first-trimester FHRs between sexes.

O-189 The effect of endometriosis on placental histopathology and perinatal outcome in singleton live births resulting from in vitro fertilization

Abstract Study question Does endometriosis have an effect on the placental histopathology patterns in singleton live births resulting from in-vitro fertilization? Summary answer Endometriosis is associated with acute chorioamnionitis, placenta previa, subchorionic fibrin deposition, intervillous thrombosis, fetal vascular malperfusion, as well as with failed labour induction. What is known already Endometriosis is a common chronic benign disease that affects reproductive age women and causes chronic pelvic pain and infertility. The effect of endometriosis on the reproduction and perinatal outcomes may be explained by the impact on the implantation decreasing the pregnancy rate and by causing abnormal placentation. Suboptimal placentation in the presence of endometriosis was previously explained by the altered uterine contractility, increased progesterone resistance, increased secretion of interleukins, and chronic inflammation. However, the spectrum of certain anatomical, inflammation, vascular, and villous maturation features of placentas introduced by the presence of endometriosis has not been previously evaluated. Study design, size, duration We conducted a retrospective analysis of all live births following IVF treatment during 2009-2017 from one tertiary hospital. All women with either surgically confirmed endometriosis or persistent ovarian cysts (for at least 12-weeks duration) consistent with endometriomas in ultrasound appearance were included in the endometriosis group. Placental histopathology results, obstetrical, and perinatal outcomes from pregnancies complicated by endometriosis were compared with those without signs of adenomyosis or endometriosis. Participants/materials, setting, methods Full gross and histopathology assessment of all placentas irrelevant of complication status was performed. The pathologic findings were categorized according to the Amsterdam Placental Workshop Group Consensus. The primary outcomes included anatomical, inflammation, vascular malperfusion, and villous maturation placental disorders. The secondary outcomes included fetal, maternal, perinatal, and delivery complications. A multivariate logistic model was used to adjust the results for confounding factors potentially associated with significant placental and perinatal characteristics. Main results and the role of chance A total of 1057 live births were included in the final analysis and were allocated to the group of women with endometriosis (n = 75) and without endometriosis (n = 982). Demography, obstetric history, distribution of chronic co-morbidities, the results of infertility evaluation including ovarian reserve, infertility factor, and partner’s semen parameters were similar between the groups. Placental weight, cord length as well as the prevalence of small (&amp;lt;10 percentile) and large (&amp;gt;90 percentile) placentas were also similarly distributed. After the adjustment for confounding factors endometriosis was found to be significantly associated with acute chorioamnionitis with moderate to severe maternal (OR 2.2; 95% CI 1.1–4.6) and fetal (OR 4.9; 95% CI 1.8–13.1) inflammatory response, placenta previa (OR 3.1; 95% CI 1.2–7.8), subchorionic fibrin deposition (OR 3.4; 95% CI 1.2–9.1), intervillous thrombosis (OR 3.4; 95% CI 1.5–8.1), fetal vascular malperfusion (OR 5.1; 95% CI 1.4–18.1), as well as with failed labour induction (OR 4.2; 95% CI 1.2–16.7). Limitations, reasons for caution It is possible that control group may contain some women with endometriosis who went unrecognized. However, we would expect this possibility to decrease the likelihood of significant findings when comparing the control group to women with endometriosis. This would suggest that significant findings in the endometriosis group represent real differences. Wider implications of the findings This was the first clinical study evaluating the effect of endometriosis on the placental pattern according to the Amsterdam Placental Workshop criteria. Our study demonstrates new insights into the pathophysiology of endometriosis which has an impact on the reproductive potential and pregnancy outcomes by causing abnormal placentation. Trial registration number not applicable (observation study)

Multimodal Sonographic Appearance and Survival Outcomes of 69 Cases of Primary Thyroid Lymphoma Over 10 Years.

To investigate ultrasound appearance and the survival outcomes for patients with primary thyroid lymphoma (PTL). Ultrasonic images and clinical characteristics from pathologically confirmed 69 PTL patients (2008-2019) were retrospectively analyzed. The clinical characteristics, ultrasonic characters, and prognostic factors were analyzed. Survival curves were plotted using the Kaplan-Meier method. Univariate and multivariate analyses were performed. Of the 69 study patients, 23 were indolent PTL and 46 were aggressive PTL. Age (>70 years old) and elevated lactate dehydrogenase levels were statistically different clinical features between aggressive and indolent PTL. From ultrasonic images, 34 cases were nodular, 11 diffuse, and 24 mixed pattern. Mixed types displayed high invasiveness (45.7%) while diffuse types displayed higher inertness (39.1%), with statistically significant differences (P=.000). Invaded thyroid capsule and increased chaotic vascularity also showed significant differences between aggressive and indolent PTL. We also observed statistical difference in overall survival rates between aggressive and indolent PTL (P=.032). Single factor K-M analyses showed that age >70 years, aggressive pathology, and Ki67 >30% were positively correlated with the risk of poor PTL survival (P < .05). Multimodal ultrasound provides accurate ultrasonographic information and facilitates PTL invasiveness diagnostics for improved clinical treatment. In addition, PTL patients aged >70 years, with aggressive pathology, and Ki67 >30% were more likely to have a poor survival outcome.