Arterial dissection is caused by intima damage and blood flow into the vascular wall, resulting in the separation of the intima and middle layer, intramural hematoma formation, and subsequently stenosis, occlusion, or aneurysm. A 68-year-old woman with bilateral common carotid artery dissection (CAD) caused by a dog bite two months prior was admitted to the hospital. Cerebral angiography, magnetic resonance angiography (MRA), and carotid color Doppler ultrasonography showed right CAD (aneurysm formation) with luminal stenosis (50%-69%), left common CAD (intramural hematoma formation). Bilateral common CAD caused by a dog bite is rare. The mechanism of CAD may be similar to iatrogenic dissection. After eliminating the contraindication of operation, right common carotid artery stenting was performed two months after conservative treatment.
Agenesis of the right lobe of the liver is an extremely rare congenital anomaly and usually detected by incidental cross-sectional imaging examination. Budd-Chiari syndrome is a rare cause of portal vein hypertension and hepatic failure, with the characteristic of the hepatic venous outflow tract obstruction. This article presented a clinical case of a 43 years old female diagnosed with agenesis of the right hepatic lobe combined with Budd-Chiari syndrome by ultrasonography (US) and computed tomography (CT) and conducted a literature review for imaging diagnosis of right hepatic lobe agenesis.
Leiomyoma, commonly known as fibroids, is a common female disease. Leiomyoma of the round ligament of the uterus is rare. Extraperitoneal leiomyoma of the round ligament can present as inguinal and vulvar mass mimicking an incarcerated hernia, lymph node, or lipomas. We are presenting a rare case of a 53-year-old female patient who was admitted to the hospital with a right inguinal mass. Our patient underwent surgery, and a leiomyoma of the round ligament was found. Before surgery, sonography and computed tomography (CT) will be helpful in the diagnosis of extraperitoneal leiomyoma of the round ligament.
We report a case of a 21-year-old woman with Klippel-Trenaunay-Weber syndrome (KTWS), a rare congenital syndrome involving capillary malformations, arteriovenous malformations, and soft tissue or bone hypertrophy. For this patient, ultrasound and digital subtraction angiography (DSA) were used to evaluate arteriovenous malformations. Arteriovenous shunts could be identified with both ultrasound and DSA. DSA was able to provide an overall view of the malformed blood vessels, whereas ultrasound was effective in showing the condition of the blood vessel walls and in assessing blood flow velocity. This case suggests that multiple imaging studies may be needed for the diagnosis and treatment of KTWS disease in these patients.
Cholesterol granuloma (CG) is a histological lesion caused by an inflammatory reaction of the cholesterol crystal rather than an independent disease. We report the case of an 87-year-old woman who came to our hospital for slight abdominal pain lasting a week and who had a history of a pelvic mass found forty years ago. Ultrasound examination revealed abnormal omentum, which was suspected to be a source of metastasis from the pelvic mass. However, ultrasound-guided biopsy confirmed the abnormal omentum was CG. By describing this case, we aim to share the value of ultrasound-guided omentum biopsy in clinical diagnosis and treatment.
Lymphatic vessels are the only pathway for lymphatic fluid to flow into venous bloodstream, and they are also one of the main channels for migration and metastasis of malignant tumor cells. High-frequency ultrasound imaging has been used popularly as first choice for examination and preliminary assessment of cervical lymph nodes. However, its capacity of displaying lymphatic vessels is still insufficient up to date. Recently, liquid isolation has been increasingly used in ultrasound-guided thermal ablation treatment of thyroid nodules, parathyroid nodules, or cervical lymph nodes with malignant metastasis, playing a key role of protecting adjacent surrounding structures. In this paper, the role of liquid isolation in optimizing the ultrasonic display of cervical lymphatic vessels was presented and further likely novel technique based on this case was outlook as well.
Cardiac lymphomas have an extremely low incidence, with primary cardiac lymphomas accounting for only 0.5% of all extranodal lymphomas and 2% of primary cardiac tumors. Early diagnosis is critical for these tumors, which can proliferate rapidly. Here, we report a rare case of a 66-year-old man with primary cardiac lymphomas in the right atrium and right ventricle. This case establishes that two- and three-dimensional echocardiography is instructive in establishing the relationship of the mass and surrounding tissues and providing relevant hemodynamic information.
Objective: To investigate the application of remote ultrasound in COVID-19 isolation ward.Methods: Two patients with suspected COVID-19 were admitted to the isolation ward in critical condition. In the isolation ward, the intensive care unit (ICU) physician used ultrasound to evaluate patients’ heart, lung, abdomen, blood volume, and lower limb veins, guided by an ultrasound expert in remote.Results: (1) Under the guidance of the ultrasound expert, the ICU physician successfully performed ultrasound examination and gathered clear images. (2) The main manifestations of the patients’ lung lesions were multiple B3-lines in both lungs fused to “white lung” and pulmonary consolidation in the subpleural area. A small amount of effusion was observed in the bilateral costal diaphragmatic angle and left lower extremity vein thrombosis was found in patient No.1. Ultrasound was also used to assess the inner diameter and respiratory variability of the inferior vena cava for adjusting fluid supplementation. Patient No.1’s condition was severe with rapidly progressing pulmonary lesions. After treatment, ultrasound showed improvement in pneumonia and disappearance of pleural effusion and the left lower extremity vein thrombosis. (3) There was a high degree of consistency between ultrasound and chest computerized tomography (CT) findings in two patients.Conclusion: The application of remote ultrasound can reduce the risk of cross-infection and save the personal protective equipment in the COVID-19 outbreak. Ultrasound experts can also provide real-time guidance for ICU physician to maintain a good quality of patient care and receive high-quality images for accurate diagnosis.
Real-time ultrasound imaging has been used for the evaluation of pulmonary abnormalities and other complications during the outbreak of COVID-19. However, conventional ultrasound examination requires operators to conduct scanning either in the examination room or patient ward, which may increase the potential infective risk. Tele-operated ultrasound robotics can provide a unique technique for doctors to remotely scan patients. During the COVID-19 pandemic, we attempted to apply a 5G network-based scanning robot to conduct remote ultrasound examination on COVID-19 patients and to explore the feasibility of this technique for teleultrasound diagnosis and consultation during critical infectious situations.
Protective measures that are needed when treating patients with highly contagious severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) add difficulty when performing interventional procedures in isolation wards. We describe two cases of ultrasonography-guided nasogastric tube placement in severe COVID-19 patients, both disabled elderly patients who were unconscious and had complicated underlying diseases. The first is an 83-year-old patient with Alzheimer's, hemiplegia, and epilepsy; the second is a 67-year-old patient with hemiplegia and thoracic deformity. Nasogastric tube indwelling for severe patients like this was essential but challenging. With the help of ultrasonography, intubation proceeded successfully and rapidly. Operator’s confidence of appropriate placement was established because of definite tube visualization. These cases demonstrated that bedside ultrasonography in isolation wards can not only facilitate diagnosis but also assist interventional operations.
Objective: To evaluate the role of ultrasound in the use and maintenance of ECMO for COVID-19 cases.Methods: During the outbreak of COVID-19 in China, three critically ill patients were treated with ECMO in our hospital. Bedside ultrasound was used throughout all procedures, including in the delivery and daily monitoring of ECMO.Results: Structural and functional changes of heart, pleural effusion, as well as thrombus formation in one patient’s right atrium were noted with ultrasonography. Using bedside ultrasound as a troubleshooting tool throughout ECMO therapy provided a lot of useful and reliable real-time information to assist clinical decision making.Conclusion: Ultrasound shall play an important role in the use and maintenance of ECMO for COVID-19 cases.
Neuromyelitis optica spectrum disorder (NMOSD) is an idiopathic autoimmune inflammatory disorder which is characterized by central nervous system (CNS) demyelinating. Common symptoms of area postrema clinical syndrome (APS) include intractable hiccup, nausea and vomit which may lead to aspiration pneumonia. In this article, we report a patient with suspicious COVID-19 infection and complicated with NMOSD and aspiration pneumonia. The question still remains that whether 2019-nCoV could infect CNS and cause NMO.
This case report describes a patient with severe coronavirus disease 2019 (COVID-19) concomitated with spontaneous pneumothorax, along with retrospective analysis of effective diagnosis and treatment. The case shows how chest radiography and computed tomography can play an important role in diagnosing and providing useful information for clinical management. The patient’s outcome and prognosis was related to his clinical management. In particular, early comprehensive treatment was certainly key to reducing complications and mortality in severe novel coronavirus pneumonia.
Aorto-cardiac fistula (ACF) is a rare condition that is often complicated by perivalvular extension of infective endocarditis. Here we report the case of 43-year-old woman with aorto-left ventricle fistula in aortic valve endocarditis, whose echocardiographic manifestations mimicked a ruptured Valsalva sinus aneurysm. The patient was treated successfully with aortic valve replacement and repair of aorto-left ventricle fistula. Based on this rare case, we analyze the factors of misdiagnosis and offer suggestions to improve the diagnostic accuracy of ACF.
Many kinds of skin masses appeared as well-defined hypoechogenic lesion in ultrasound. Higher-frequency sound waves enable high resolution observation of the anatomical level and internal echogenic, In this study, 4 typical cases were observed by utilizing high resolution ultrasound (HRUS) at 10 to 20 MHz Ultrasound shows most Basal cell carcinoma (BCC ) was irregular-shaped while other kinds of cases appear as oval-shape, meanwhile, epidermoid cyst was located in the subcutaneous layer while the other three kinds of masses were located in the dermis. Color Doppler shows eccrine poromas and BCCs have flow signals, while dermatofibromas and eccrine poromas show a lack of vascularity. HRUS can provide noninvasive and effective diagnostic information for skin masses before surgery and can help the clinician evaluate whether the tumor was completely removed after surgery.
Aortic sinus aneurysm is a rare congenital malformation. During the embryonic period, dysplasia occurs in the middle elastic fiber of the aortic sinus wall and insufficient fusion occurs in the aortic valve annulus. Long-term high blood pressure can damage these weak compositions, leading to possible rupture and dissection of sinus aneurysms under a certain extreme hypertension. We report a rare case of giant coronary sinus aneurysm with intimal tear and aortic dissection that was detected by using transthoracic and transesophageal echocardiography.
Hepatocellular carcinoma (HCC) is the most common liver cancer, accounting for more than 90% of liver cancers. It results in between 250,000 and 1 million deaths globally per annum. Unlike other cancers, HCC can usually be diagnosed on imaging studies only, without tissue sampling confirmation. Nowadays, contrast-enhanced ultrasound (CEUS) is usually used to detect HCC in the clinic because it’s more applicable for the characterization of a known lesion. But the sensitivity of CEUS is less than 50% for small tumors.
Percutaneous endoscopic lumbar discectomy (PELD) has become a mature and mainstream minimal invasive surgical technique in the treatment of lumbar disc herniation (LDH). During the operation, transforaminal puncture is considered as a critical and complicated step which is usually carried out under the guidance of X-ray. However, radiation exposure brings a potential threat to the health of the patients and the surgeons. Besides, nerve roots and vessels may be injured since they are invisible on X-ray. So we still need a real-time accurate image guiding system, especially in difficult cases with anatomic variation. Here we report a case to describe a new method, volume navigation with fusion of real-time ultrasound and CT images, to guide PELD in a patient with right L4-L5 LDH who had anatomic variation of lumbar sacralization. Ultrasound volume navigation guided puncture and cannulation process lasted only 10 minutes and the operation decompression time lasted 60 minutes. The total emission radiation dose was 9mGy. The straight leg elevation increased from 50 to 80 degrees after PELD. The Visual Analog Scale (VAS) of low back pain reduced from 5 to 1 and leg pain reduced from 7 to 1 immediately after PELD. This is the first case of ultrasound volume navigation in guidance of the postural lateral transforaminal puncture and cannulation process of PELD.
Cervical pregnancy is a rare variety of ectopic pregnancy. The success of conservative treatment for cervical pregnancy depends on early and accurate diagnosis of ultrasound. We found Contrast-enhanced ultrasonography (CEUS) to be an accurate diagnosis approach for cervical pregnancy. In cervical pregnancy, CEUS showed rapid enhancement of the wall of the gestational sac during the early enhancement phase with the performance of hyper-enhanced. Enhancement sustained at a high level of intensity through the early enhancement phase, with the sign of doughnut-shaped in the wall of the gestational sac, and washed out slowly during the late enhancement phase. While the wall of the gestational sac showed no enhancement during the whole phase in aborting intrauterine pregnancy residing in the cervical canal.
We report the case of a 55-year-old man with a spontaneous fistula between the intrahepatic bile duct and stomach. Oral contrast-enhanced ultrasound (CEUS) was used in this patient and made the diagnosis of fistula as observed during open surgery. We found that oral CEUS should be considered as a safe, simple and effective method to diagnose and evaluate gastrobiliary fistulas.
Ultrasound (US) has been the most common imaging modality to guide ablation therapy. However, if the tumor is adjacent to intrahepatic bile ducts, only using US as guiding image may not be safe or effective. Gd-EOB-DTPA magnetic resonance imaging (MRI) enables improved liver lesion detection as well as a better illustration of the biliary system information [1-3]. We report two cases of microwave ablation (MWA) guided by a real-time image fusion of Gd-EOB-DTPA MRI and US for hepatocellular carcinoma (HCC) located adjacent to the intrahepatic bile ducts. The therapeutic effect was assessed by contrast enhanced ultrasound (CEUS) and MRI.
An autonomous functioning thyroid nodule (AFTN) is a benign disease. It can autonomously secrete excessive thyroid hormones without the need for TSH stimulation. It is not subject to the hypothalamic-pituitary-thyroid axis and is rare during pregnancy. Here we report a case of a 36-year-old pregnant woman with hyperthyroidism detected in early pregnancy, According to ultrasound and laboratory results, she was diagnosed with an AFTN. Ultrasound-guided (US-guided) microwave ablation (MWA) was used to treat AFTN during the second trimester of pregnancy. Hyperthyroidism crisis and other complications did not occur due to MWA. Thyroid function was normal at 2, 3 and 4 months after MWA. The volume reduction rate (VRR) was 83.67% at 4 months after MWA. The patient gave birth normally at 40 weeks gestation. All indices of thyroid function were normal during postpartum and lactation. US-guided MWA is a feasible and safe method for the treatment of AFTN during pregnancy, specifically in the second trimester.
Ultrasound-guided percutaneous trans-hepatic intestinal drainage is a rare intervention operation at home and broad.We report this case of percutaneous trans-hepatic intestinal drainage because of its mechanic intestinal obstruction. A 61-year-old woman was admitted to our hospital for abdominal distension, stomachache, vomit. The symptoms could not be alleviated by routine fast and nasogastric tube. She had received pancreaticoduodenectomy as a result of carcinoma of pancreatic head three months before this hospital visit. T-tube angiography showed obvious afferent loop obstruction and ultrasonography demonstrated dilated proximal intestines. Considering her poor laboratory results, we put a pigtail into the patient’s dilated proximal intestines instead of administering laparotomy to alleviate intestinal pressure in a short time. Our case mainly stresses the feasibility of ultrasound-guided percutaneous trans-hepatic catheter intestinal decompression in special circumstances.
Ultrasound guided fine-needle aspiration (FNA) is well-accepted in the evaluation of thyroid nodules. Though local pain and minor hematomas are the most common complications, other adverse events following FNA are rare. In this case report, we described a complication showing inflammation spreading in a healthy woman after FNA. We presented the case to make physicians aware of the potential complication.
Not every liver cancer is visible on ultrasound. We report a case that the liver cancer was invisible on gray-scale ultrasound but was very distinct on MRI. The microwave ablation was guided by imaging fusion and needle tracking, based on electromagnetic volume navigation. We took advantages both the visibility of MRI and the flexibility of ultrasound and made the needle tip always seen.
Clear cell sarcoma of kidney (CCSK) is an aggressive malignant renal tumor with poor prognosis. Although the clinical and imaging features of CCSK are similar to those of other malignant renal tumors, somehow ultrasonographic imaging characteristics presented particularity. Besides, the treatment strategy of CCSK is different as well. We reported a case of a 6-year-old boy with CCSK, who underwent surgery and multiple postoperative chemotherapy.
Solitary necrotic nodule of liver (SNNL) is a rare, benign lesion with an uncertain etiology. There are no typical diagnostic clinical or radiological features. The two patients we described underwent liver resection because it was not possible to exclude a malignancy on preoperative imaging. The histopathological findings suggest the SNNL may be parasitic in origin and find parasitic worm in the nodules.
Horner’s syndrome (HS) has previously been reported in the literature as a complication of parathyroid surgery. It presents clinically with eyelid ptosis, miosis, enophthalmos, anhidrosis, and vascular dilatation, all of which result from a damaged sympathetic chain. Here, we report the case of a 45-year-old female patient who presented with miosis and eyelid ptosis following microwave ablation (MWA) of secondary hyperparathyroidism (SHPT). After 6 months of follow up, the patient’s miosis and ptosis was incompletely relieved. We aimed to try to avoid such devastating symptoms in future cases by exploring reasons for the destruction of the cervical sympathetic trunk.
The complications of thyroid fine needle aspiration biopsy (FNAB) have been long observed, but the knowledge of some rare complications is still improved. In this case report, a rare complication of acute transient thyroid swelling (ATS) shortly after FNAB was reported for the first time in the Chinese mainland. The patient showed an obvious swelling of the neck and suffered from acute pain less than 20 minutes after aspiration. Immediate thyroid ultrasound examination showed diffuse swelling of the entire thyroid gland with heterogeneous echo changes. 17 hours later, the repeated examination showed the thyroid was restored. Pathology of FNAB showed some atypical thyroid follicular epithelium and the final pathology showed it was papillary carcinoma. We also reviewed the literature and preliminary concluded that ATS was a sudden and rare complication of FNAB with a rapid self-repair result, while the reason for ATS was still unknown and further puncture for the diffuse altered area is necessary to explore the physiopathologic mechanism.
Epithelioid angiosarcoma is a very rare low-grade vascular neoplasm. We report a case of a 61-year-old woman who suffered it in the left atrium. This case is instructive in challenging our understanding of cardiac space-occupying lesions and highlighting the importance of careful clinical evaluation.
Primary hyperparathyroidism (PHPT) is a disorder of one or more of the parathyroid glands, which results in hypercalcemia. Hyperparathyroid crisis is a rare condition that sometimes occurs when people with PHPT experience another illness, like vomiting or diarrhea, which causes excessive fluid loss or severely limits the amount of fluid they can consume. Parathyroid adenoma and hyperplasia are the most common causes of PHPT. In clinical practice, functional parathyroid cysts are a very rare cause of PHPT. We report a rare case of a functional parathyroid cyst as a cause of hyperparathyroidism or even hyperparathyroid crisis. After surgery, the patient's blood calcium and PTH level returned to normal ranges. Histological examination showed in fibrous cystic wall, some of the inner wall of the capsule were covered with a single layer of flat epithelium, some were not covered with cells, and a small cluster of parathyroid tissue was extruded and deformed in the wall of the capsule.
Behçet's disease is an uncommon multisystem inflammatory disease characterized by oral and genital ulcers, skin lesions, and inflammation of the eyes. We reported the case of a young man with Behçet's syndrome who presented with severe aortic regurgitation that mimicked infectious endocarditis and required reoperation.
A 69-year-old woman with sick sinus syndrome underwent permanent pacemaker implantation in our hospital. A mild and persistent chest pain occurred 2 days after device implantation, and myocardial perforation without pericardial effusion was found at the tip of the right ventricular lead by two-dimensional transthoracic echocardiography. The diagnosis was then confirmed by fluoroscopy, and the lead was repositioned under fluoroscopic guidance.
Hepatic angiomyolipoma (AML) is a rare benign tumor with heterogeneous components composed of vascular, fat, and smooth muscle elements which is often misdiagnosed as other neoplasms such as hepatocellular carcinoma due to nonspecific clinical and image features. A typical case of hepatic AML located in liver with overall clinic and ultrasonography information was analyzed and relative references were reviewed in this article.
Open Access, Peer-reviewed
ISSN 2576-2516 (Online)
ISSN 2576-2508 (Print)
Copyright ©2018 Advanced Ultrasound in Diagnosis and Therapy
Advanced Ultrasound in Diagnosis and Therapy (AUDT) a>
is licensed under a Creative Commons Attribution 4.0 International License a>.