Minimal Fat Renal Angiomyolipoma: The Initial Study with Contrast-Enhanced Ultrasonography

We visualized minimal fat renal angiomyolipomas (AMLs) by contrast-enhanced ultrasonography (CEUS). Conventional ultrasound and CEUS images were retrospectively analyzed for solid minimal fat renal AML cases (n = 18) and solid renal cell carcinoma (RCC) cases (n = 105). We compared size, echogenicity and color flow signals with conventional ultrasound, and enhancement patterns with CEUS, in AMLs vs. RCCs. No significant differences in echogenicity and color flow signal existed between AMLs and RCCs using conventional ultrasound. With CEUS, slow centripetal enhancement in the cortical phase (83.3% of AMLs vs. 1.9% of RCCs) and homogeneous peak enhancement (100.0% of AMLs vs. 34.3% of RCCs) were valuable traits for differentiating these tumor types. These two CEUS-determined traits, combined, were differentiating criteria for minimal fat renal AMLs and RCCs; positive and negative predictive values were 100.0% and 97.2%, respectively. Slow centripetal enhancement in the cortical phase and homogeneous enhancement at peak are main features of CEUS-confirmed solid minimal fat renal AML.     

Comparison of Ultrasound Corticomedullary Strain with Doppler Parameters in Assessment of Renal Allograft Interstitial Fibrosis/Tubular Atrophy

To compare the capability of ultrasound strain and Doppler parameters in the assessment of renal allograft interstitial fibrosis/tubular atrophy (IF/TA), we prospectively measured ultrasound corticomedullary strain (strain) and intra-renal artery Doppler end-diastolic velocity (EDV), peak systolic velocity (PSV) and resistive index (RI) in 45 renal transplant recipients before their kidney biopsies. We used 2-D speckle tracking to estimate strain, the deformation ratio of renal cortex to medulla produced by external compression using the ultrasound transducer. We also measured Doppler EDV, PSV and RI at the renal allograft inter-lobar artery. Using the Banff scoring system for renal allograft IF/TA, 45 patients were divided into the following groups: group 1 with ≤5% (n = 12) cortical IF/TA; group 2 with 6%–25% (n = 12); group 3 with 26%–50% (n = 11); and group 4 with >50% (n = 10). We performed receiver operating characteristic curve analysis to test the accuracy of these ultrasound parameters and duration of transplantation in determining >26% cortical IF/TA. In our results, strain was statistically significant in all paired groups (all p < 0.005) and inversely correlated with the grade of cortical IF/TA (p < 0.001). However, the difference in PSV and EDV was significant only between high-grade (>26%, including 26%–50% and >50%) and low-grade (≤25%, including <5% and 6%–25%) cortical IF/TA (p < 0.001). RI did not significantly differ in any paired group (all p > 0.05). The areas under the receiver operating characteristic curve for strain, EDV, PSV, RI and duration of transplantation in determining >26% cortical IF/TA were 0.99, 0.94, 0.88, 0.52 and 0.92, respectively. Our results suggest that corticomedullary strain seems to be superior to Doppler parameters and duration of transplantation in assessment of renal allograft cortical IF/TA.     

Value of Contrast-Enhanced Ultrasound Using Perflubutane Microbubbles for Diagnosing Liver Fibrosis and Cirrhosis in Rats

We determined the ability of contrast-enhanced ultrasound (CEUS) using perflubutane microbubbles to diagnose liver fibrosis and cirrhosis in rats using histology as the reference standard. Fibrosis was induced by oral administration of carbon tetrachloride to 32 Wistar rats. Features with baseline ultrasound (US) and enhancement level of liver and spleen with CEUS were obtained. In the post-vascular phase of CEUS, images of normal livers (n = 5) were significantly brighter than images of fibrotic (n = 6) and cirrhotic livers (n = 13) by quantitative analysis (all p < 0.05). The contrast between livers and spleens in rats with cirrhosis was quantitatively greater than that in normal rats and rats with fibrosis (all p < 0.05). Compared with US, CEUS improved sensitivity from 63% to 84% and accuracy from 71% to 88%. Specificity was 100% for both. The increased value of CEUS in diagnosing liver fibrosis and cirrhosis in rats supports its evaluation in clinical trials.     

Detection of Cerebral High-Intensity Transient Signals by NeoDoppler during Cardiac Catheterization and Cardiac Surgery in Infants

There is a risk of gaseous and solid micro-embolus formation during transcatheter cardiac interventions and surgery in children with congenital heart disease (CHD). Our aim was to study the burden of high-intensity transient signals (HITS) during these procedures in infants. We used a novel color M-mode Doppler (CMD) technique by NeoDoppler, a non-invasive ultrasound system based on plane wave transmissions for transfontanellar continuous monitoring of cerebral blood flow in infants. The system displays CMD with 24 sample volumes and a Doppler spectrogram. Infants with CHD undergoing transcatheter interventions (n = 15) and surgery (n = 13) were included. HITS were manually detected based on an “embolic signature” in the CMD with corresponding intensity increase in the Doppler spectrogram. Embolus-to-blood ratio (EBR) defined HITS size. A total of 1169 HITS with a median EBR of 9.74 dB (interquartile range [IQR]: 5.10–15.80 dB) were detected. The median number of HITS in the surgery group was 45 (IQR: 11–150), while in the transcatheter group the median number was 12 (IQR: 7–24). During cardiac surgery, the highest number of HITS per hour was seen from initiation of cardiopulmonary bypass to aortic X-clamp. In this study we detected frequent HITS and determined the feasibility of using NeoDoppler monitoring for HITS detection.     

Contrast-Enhanced Ultrasound Imaging of Carotid Plaque Neo-vascularization: Accuracy of Visual Analysis

The aim of our study was to evaluate whether neo-vascularization of the carotid plaque can be accurately assessed by visual analysis of contrast-enhanced ultrasound images and whether these findings correlate with intensity-over-time curve analysis (ITC) and histopathology. Patients with ≥50% symptomatic or ≥60% asymptomatic stenosis according to European Carotid Surgery Trial criteria were included. Four investigators evaluated contrast enhancement visually (three grades), with positive agreement when three or more investigators were unanimous. ITC analysis of contrast enhancement was performed in the plaque and in the lumen. Histopathology (microvessel density with CD34 + staining) was completed when endarterectomy was performed. Visual grading (33 patients, inter-observer agreement = 94%) correlated significantly with ITC analysis (p = 0.03). Histopathology (n = 19) revealed a larger CD34 + area in patients with grade 1/2 versus grade 0 (p = 0.03). Visual analysis of neo-vascularization by means of contrast-enhanced ultrasound imaging is accurate and reproducible, with significant correlations with ITC and histopathology.     

Primary Application of Micro-Flow Imaging Technology in the Diagnosis of Hepatic Tumors

The purpose of the study was to evaluate the vascular architecture of focal liver lesions with the newly released non-contrast micro-flow imaging (MFI) technique. Eighty patients with 80 hepatic tumors were enrolled in this study. The richness of displayed blood flow was first compared with color Doppler flow imaging using grades according to Adler's method. The results indicated that MFI outperformed color Doppler flow imaging with a statistically significant difference (p <0.0001). With the enhanced position in arterial phase of contrast-enhanced ultrasound imaging as the ground truth, the displayed blood flow distribution within tumors in MFI was further evaluated. The coincidence rate between MFI and contrast-enhanced ultrasound was 73.75% (59/80), which was higher than that of color Doppler flow imaging (52.5%, 42/80) (p < 0.0001). Moreover, for the five cases of focal nodular hyperplasia, MFI clearly revealed the spoke-wheel or radiating intra-tumoral vasculature, a finding specific to the diagnosis of focal nodular hyperplasia.     

Self-Reported Severity,Characteristics, and Functional Limitations of Chemotherapy-Induced Peripheral Neuropathy

BackgroundThe early identification of chemotherapy-induced peripheral neuropathy (CIPN) (e.g., numbness or tingling in the fingers or toes) is important due to its frequency and the few effective treatment options available. The identification of common patient-reported CIPN characteristics and associated functional limitations may help to facilitate patient-clinician discussions of CIPN in practice.AimsTo quantify the severity, duration, location, characteristics, and associated functional limitations of chemotherapy-induced peripheral neuropathy (CIPN) in patients receiving neurotoxic chemotherapy.DesignExploratory secondary analysis of a prospective, two-phase studySettingBreast, gastrointestinal, and multiple myeloma clinics at Dana-Farber Cancer Institute.Participants142 individuals who planned to receive at least three more cycles of neurotoxic chemotherapy after consent.MethodsParticipants self-reported CIPN using standardized measures (i.e., PRO-CTCAE? Numbness and Tingling Items or 0-10 numerical rating scale of worst CIPN pain intensity) and/or study team generated follow up questions about CIPN location, duration, characteristics, and functional limitations prior to three consecutive clinic visits (T1, T2, T3). Participants’ responses to the CIPN self-report questionnaires were described by chemotherapy type and age.ResultsOver approximately 36.5 days (T1-T3), the percentage of participants reporting at least mild CIPN increased from 59.3% to 71%. At T3, patients with non-painful (n = 98) or painful neuropathy (n = 34) frequently reported symptoms in the fingers (non-painful = 83.5%, painful = 76.5%) or toes (non-painful = 49.5%, painful = 41.2%) and characterized symptoms as numbness (non-painful = 54.1%, painful = 50%) or tingling (non-painful = 68.4%, painful = 82.4%). Self-reported CIPN functional limitations (n = 55) included difficulties with buttoning a shirt (38.2%) or walking (25.5%). Paclitaxel-related CIPN (n = 33) was frequently characterized as “continuous” (30.3%), whereas oxaliplatin-related CIPN (n = 51) was frequently characterized as “intermittent” (41.2%). Young adults (15-39 years old, n = 15) frequently reported moderate-severe non-painful CIPN (46.7%), painful CIPN (40%), and CIPN interference (33.3%).ConclusionsConsistent with qualitative research, participants frequently described CIPN as numbness and/or tingling in the fingers and/or toes.     

Comparison of Two Contrast Agents for Right-to-Left Shunt Diagnosis with Contrast-Enhanced Transcranial Doppler

We compared two contrast agents, agitated saline and agitated saline with blood, with respect to their efficacy in the diagnosis of right-to-left shunt with contrast-enhanced transcranial Doppler. Three hundred thirty Chinese patients underwent examinations with one of four different methods in random order: (i) 9 mL agitated saline solution with 1 mL air without the Valsalva maneuver (ASwoVM); (ii) 9 mL agitated saline solution with 1 mL air with the Valsalva maneuver (ASwVM); (iii) 9 mL agitated saline solution, 1 mL air and a drop of the patient's blood without the Valsalva maneuver (ASbwoVM); and (iv) 9 mL agitated saline solution, 1 mL air and a drop of the patient's blood, with the Valsalva maneuver (ASbwVM). Rates of detection were 11.5%, 17.9%, 16.7% and 23.6% for the ASwoVM, ASwVM, ASbwoVM, and ASbwVM examinations, respectively. The embolus track numbers for these examinations were 4.0 ± 1.83, 11.5 ± 6.2, 10.5 ± 4.9 and 33.7 ± 14.9, respectively. There were significant differences between the four groups (all comparisons, p < 0.001). For contrast-enhanced transcranial Doppler examinations, the agitated saline/blood agent yielded better rates of diagnosis of right to-left shunt than did the agitated saline alone.     

The Brighton musculoskeletal Patient‐Reported Outcome Measure (BmPROM): An assessment of validity,reliability, and responsiveness

Background

In response for the need of a freely available, stand‐alone, validated outcome measure for use within musculoskeletal (MSK) physiotherapy practice, sensitive enough to measure clinical effectiveness, we developed an MSK patient reported outcome measure.

Objectives

This study examined the validity and reliability of the newly developed Brighton musculoskeletal Patient‐Reported Outcome Measure (BmPROM) within physiotherapy outpatient settings.

Methods

Two hundred twenty‐four patients attending physiotherapy outpatient departments in South East England with an MSK condition participated in this study. The BmPROM was assessed for user friendliness (rated feedback, N = 224), reliability (internal consistency and test–retest reliability, n = 42), validity (internal and external construct validity, N = 224), and responsiveness (internal, n = 25).

Results

Exploratory factor analysis indicated that a two‐factor model provides a good fit to the data. Factors were representative of “Functionality” and “Wellbeing”. Correlations observed between the BmPROM and SF‐36 domains provided evidence of convergent validity. Reliability results indicated that both subscales were internally consistent with alphas above the acceptable limits for both “Functionality” (α = .85, 95% CI [.81, .88]) and ‘Wellbeing’ (α = .80, 95% CI [.75, .84]). Test–retest analyses (n = 42) demonstrated a high degree of reliability between “Functionality” (ICC = .84; 95% CI [.72, .91]) and “Wellbeing” scores (ICC = .84; 95% CI [.72, .91]). Further examination of test–retest reliability through the Bland–Altman analysis demonstrated that the difference between “Functionality” and “Wellbeing” test scores did not vary as a function of absolute test score. Large treatment effect sizes were found for both subscales (Functionality d = 1.10; Wellbeing 1.03).

Conclusion

The BmPROM is a reliable and valid outcome measure for use in evaluating physiotherapy treatment of MSK conditions.     

Nutrition-related outcomes and dietary intake in non–mechanically ventilated critically ill adult patients: A pilot observational descriptive study

BackgroundCritically ill patients who do not receive invasive mechanical ventilation (IMV) are a growing population, experiencing complex interventions that may impair dietary intake and nutrition-related outcomes.ObjectivesThe objectives of this study were to quantify intake and nutrition-related outcomes of non-IMV critically ill patients and to establish feasibility of methods to measure nutrition-related outcomes in this population.MethodsNon-IMV adult patients expected to remain in the intensive care unit (ICU) for ≥24 h were eligible. Nutrition-related outcomes were assessed at baseline by subjective global assessment (SGA); on alternate study days by mid-upper arm circumference (MUAC), calf circumference (CC), and ultrasound of quadriceps muscle layer thickness (QMLT); and daily by body weight and bioelectrical impedance analysis (BIA). Data were censored at day 5 or ICU discharge. Dietary intake from all sources, including oral intake via investigator-led weighed food records, was quantified on days 1–3. Feasibility was defined as data completion rate ≥70%. Data are expressed as mean (standard deviation) or median [interquartile range (IQR)].ResultsTwenty-three patients consented (50% male; 53 [42–64] y; ICU stay: 2.8 [1.9–4.0] d). Nutrition-related outcomes at baseline and ICU discharge were as follows: MUAC: 33.2 (8.6) cm (n = 18) and 29.3 (5.4) cm (n = 6); CC: 39.5 (7.4) cm (n = 16) and 37.5 (6.2) cm (n = 6); body weight: 95.3 (34.8) kg (n = 19) and 95.6 (41.0) kg (n = 10); and QMLT: 2.6 (0.8) cm (n = 15) and 2.5 (0.3) cm (n = 5), respectively. Oral intake provided 3155 [1942–5580] kJ and 32 [20–53] g protein, with poor appetite identified as a major barrier. MUAC, CC, QMLT, and SGA were feasible, while BIA and body weight were not.ConclusionsOral intake in critically ill patients not requiring IMV is below estimated requirements, largely because of poor appetite. The small sample and short study duration were not sufficient to quantify changes in nutrition-related outcomes. MUAC, CC, QMLT, and SGA are feasible methods to assess nutrition-related outcomes at a single time point in this population.     

Diagnostic Impact of Color Doppler Ultrasound-Guided Core Biopsy on Fine-Needle Aspiration of Anterior Mediastinal Masses

Although lymphoma and thymoma are common etiologies of anterior mediastinal masses (AMMs), smaller percentages and numbers of patients with these diseases have been enrolled in previous ultrasound-guided biopsy studies. To date, there has been no study of color Doppler sonographic features to support the differentiation of AMMs. For this retrospective cohort study, a search of the database of the China Medical University Hospital using the clinical coding “ultrasound-guided biopsy” was conducted for the period December 2003 to February 2013. We selected patients diagnosed with AMMs (not cysts) using radiographic records. This search yielded a list of 80 cases. Real-time ultrasound-guided core needle biopsy (CNB) was performed in all but 5 patients without a sufficient safety range. In 89% (67/75) of these ultrasound-guided CNB cases, the diagnostic accuracy achieved subclassification. Fine-needle aspiration cytology achieved subclassification in only 10% of cases. On color Doppler sonography, 71% of lymphomas were characterized as “rich vascular with central/crisscross collocations” and 29% as “avascular or localized/scattered peripheral vessels.” However, decreased proportions of “rich vascular with central/crisscross collocations” were found in lung cancer (4% [1/23], odds ratio = 0.018, 95% confidence interval: 0.002–0.154, p < 0.001) and thymoma/thymic carcinoma (25% [4/16]; odds ratio = 0.133, 95% confidence interval: 0.035–0.514, p = 0.003) compared with the lymphoma group. We conclude that the vessels in lymphoma AMMs have specific patterns on color Doppler sonography. Ultrasound-guided CNB of AMMs had an accuracy of ≤89% in diagnosis and subclassification. Fine-needle aspiration cytology itself cannot aid in the diagnosis. Color Doppler sonographic evaluation of AMMs followed by real-time CNB is a more efficient method.     

Tissue Elasticity Quantification by Acoustic Radiation Force Impulse for the Assessment of Renal Allograft Function

Acoustic radiation force impulse (ARFI) quantification, a novel ultrasound-based elastography method, has been used to measure liver fibrosis. However, few studies have been performed on the use of ARFI quantification in kidney examinations. We evaluated renal allograft stiffness using ARFI quantification in patients with stable renal function (n = 52) and those with biopsy-proven allograft dysfunction (n = 50). ARFI quantification, given as shear wave velocity (SWV), was performed. The resistance index (RI) was calculated by pulsed-wave Doppler ultrasound, and clinical and laboratory data were collected. Morphologic changes in transplanted kidneys were diagnosed by an independent pathologist. Mean SWV was more significantly negatively correlated with estimated glomerular filtration rate (eGFR) (r = –0.657, p < 0.0001) than was RI (r = –0.429, p = 0.0004) in transplanted kidneys. Receiver operating characteristic curve analysis revealed that the sensitivity and specificity of quantitative ultrasound in the diagnosis of renal allograft dysfunction were 72.0% and 86.5% (cutoff value = 2.625), respectively. The latter values were better than those of RI, which were 62.0% and 69.2% (cutoff value = 0.625), respectively. The coefficient of variation for repeat SWV measurements of the middle part of transplanted kidney was 8.64%, and inter-observer agreement on SWV was good (Bland-Altman method, ICC = 0.890). In conclusion, tissue elasticity quantification by ARFI is more accurate than the RI in diagnosing renal allograft function.     

Be sweet to babies during painful procedures: Evaluation of a parent-targeted and mediated video in Farsi

Newborn screening is necessary for early detection of rare diseases, however, venipuncture and heel lance are painful for newborn infants. There are however effective evidence-based pain management strategies include breastfeeding or skin-to-skin care or giving a small volume of sweet solution. These strategies are demonstrated in a parent-targeted publicly accessible video titled Be Sweet to Babies, which has been produced and disseminated in multiple languages, including Farsi. We aimed to evaluate (1) the dissemination and reach of the Farsi video (using video analytics); and (2) viewers’ i) baseline knowledge and previous use of these pain management strategies; ii) intention to advocate for/recommend these strategies (using an online survey accessed from the video). Eight months after the release date, the video had 618,685 views and 202 viewers completed the survey. Almost half the participants knew about or used breastfeeding (n = 81, 40%), skin-to-skin care (n = 106, 53%) or sucrose (82, 41%) before viewing the video. After viewing the video, almost all participants (n = 195, 96%) intended to advocate for use or recommend these strategies to others. This study showed the acceptability, reach, and feasibility of the “Be Sweet to Babies” video, translated and voiced over in Farsi, as a parent-targeted and mediated knowledge translation tool.     

Chronic Pain and Frailty in Community-Dwelling Older Adults: A Systematic Review

ObjectiveOur aim was to examine the relationship between chronic pain and frailty in community-dwelling older adults.DesignA systematic review method following the Joanna Briggs Institute Reviewers’ Manual 2015.Data sourcesMEDLINE, Cochrane Library Plus, Science Direct, Scielo, LILACS, and the Joanna Briggs Institute database of systematic reviews and implementation reports were searched using different combinations of the terms “frail,” “frailty,” and “pain.”Review/analysis methodsOriginal publications of nononcologic chronic pain and frailty status in community-dwelling older adults published in English or Spanish were included. Because of the heterogeneity of the studies, a narrative approach was used to summarize the results.ResultsA total of 23 studies were finally selected for the systematic review. Most of them (n = 14) were cross-sectional studies, and there were also longitudinal studies (n = 4), cohort studies (n = 3), and randomized controlled trials (n = 2). Most of the studies found an association between chronic pain and frailty in terms of prevalence; approximately 45% of frail patients had chronic pain, and prevalence can reach 70%.ConclusionsThe studies analyzed suggest that chronic pain has a predictive effect for frailty in older adults compared with those reporting no pain. Higher pain intensity, chronic widespread pain, and higher pain interference were also related to frailty status. No specific interventions for managing chronic pain in frail or prefrail older adults were found.     

Dynamic Contrast-Enhanced Ultrasonography with Sonazoid for Diagnosis of Microvascular Invasion in Hepatocellular Carcinoma

The aim of the present study was to investigate the imaging features observed in pre-operative Sonazoid contrast-enhanced ultrasound (SZ-CEUS) and the correlations with the presence of microvascular invasion (MVI) in hepatocellular carcinoma (HCC) patients. In this single-center retrospective study, 31 patients with surgically and histopathologically confirmed HCC lesions were included. Patients were classified according to the presence of MVI into the MVI-positive group (n = 15) and MVI-negative group (n = 16). The CEUS examinations were performed within 2 or 3 d before surgery. Features, including tumor necrosis and ultrasound contrast agent (UCA) distribution characteristics in the arterial phase (AP), tumor types (single nodular [SN] or non-single nodular [non-SN]) in the post-vascular phase (PVP), wash-in time, wash-in slope, time to peak (TTP) and peak intensity (PI), were assessed. Univariate analysis revealed statistically significant differences between the two groups with respect to tumor necrosis (p = 0.002), inhomogeneous distribution of contrast agent in the AP (p = 0.001) and non-SN type in the PVP (p < 0.001). There was no significant difference in the quantitative parameters. Multivariate analysis revealed that non-SN type in the PVP was a significant independent risk factor for MVI of HCC (odds ratio = 30.51, 95% confidence interval [CI]: 2.335–398.731, p = 0.009). The area under the receiver operating characteristic (ROC) curve (AUC), sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were 0.873, 93.3%, 81.3%, 82.4% and 92.9%, respectively. Thus, SZ-CEUS can provide useful information for the diagnosis of MVI in HCC.     

Behavioral traits of the nursing students with special educational needs in Japan

Nursing students with tendencies toward developmental disorders or special educational needs could face difficulties while studying nursing. The study examined the behavioral traits of nursing students with special educational needs who graduated in Japan in March 2011. Nurse educators from 341 programs provided information concerning students who had been identified as difficult to teach while enrolled in nursing programs. Behavioral traits were examined in students with special educational needs (n = 139) and those who did not have special needs but were identified as difficult to teach by the nurse educators (n = 84). The most prevalent behaviors in students with special needs were “making excessive excuses” in unstressful situations and “lapsing into silence” under stressful circumstances. The number of students with special needs who were prone to “blaming others” and “disappearing” was higher relative to that of students without special needs under unstressful circumstances. Under stressful circumstances, “blaming others,” “disappearing,” and “staying at home” were reported more frequently for students with special needs than they were for students without special needs. Nurse educators should pay attention to these behaviors in students facing difficulties while studying nursing.     

Presentation of Chloromas in B-Mode Ultrasound and Contrast-Enhanced Ultrasound

Chloromas, also referred to as myeloid sarcomas, describe rare extramedullary tumor aggregates of malignant myeloid progenitor cells. The aim of this study was investigate the diagnostic features and characteristics of chloromas using contrast-enhanced ultrasound (CEUS). Between July 2007 and April 2021, 15 patients with 20 myeloid neoplasms and suspected chloroma manifestations were examined using B-mode US (B-US) and CEUS. Clinical data and B-US (echogenicity, border, size) and CEUS (hyper-, iso-, hypo- or complex enhancement) characteristics were retrospectively analyzed. Absolute and relative frequencies were determined. In B-US, the chloromas were most frequently hypo-echoic (n = 15, 75%). In addition, a hyperechoic (n = 2, 10%) or echocomplex (n = 3, 15%) presentation was observed. On CEUS, 7 chloromas (35%) had an arterial hyperenhancement, 8 (40%) an iso-enhancement and 3 (15%) a complex enhancement. Two chloromas (10%) did not exhibit any enhancement. We describe for the first time CEUS and B-US patterns of chloromas. They are typically hypo-echoic on B-US and have a strong iso- or hyperenhancement on CEUS, which may help in the differential diagnosis of some unclear masses (e.g., hematoma, abscess) in patients with myeloid neoplasias. Nevertheless, histology is necessary for a reliable diagnosis.     

Prevalence of hemorrhagic ovarian cysts in patients with rare inherited bleeding disorders

BackgroundIn comparison with the general population, women with bleeding disorders are more prone to develop obstetrical and gynecological problems. However, no comprehensive evaluation has investigated the prevalence of hemorrhagic ovarian cysts (HOCs) in rare bleeding disorders (RBDs). In this study, we sought to determine the prevalence of HOCs in a large cohort of Iranian patients with RBDs.MethodsA total of 210 symptomatic patients suspected of HOCs with RBD were included. The median age of the study population was 24 years. Patients were diagnosed with fibrinogen disorders (n = 7, 3%), factor (F) II (n = 4, 2%), FV (n = 28, 13%), FVII (n = 4, 2%), FX (n = 6, 3%), FXIII (n = 122, 58%), combined FV and FVIII (n = 8, 4%), Glanzmann’s thrombasthenia (n = 10, 5%), and von Willebrand disease (VWD) type 3 (n = 21, 10%).ResultsFollowing further clinical and ultrasound examinations of these 210 patients, 68 (32.4%) were confirmed with a diagnosis of HOCs. Of which, FXIII deficiency with 46 cases (67.6%), followed by VWD type 3 (6 cases, 8.8%) showed the highest number. Other coagulation defects associated with HOCs were including fibrinogen deficiency (n = 2, 3%), FII (n = 2, 3%), FV (n = 4, 6%), FVII (n = 2, 3%), FX (n = 1, 1.5%), combined FV and FVIII (n = 2, 3%), and Glanzmann’s thrombasthenia (n = 3, 4.5%).ConclusionThis study found a high prevalence of HOCs in patients with RBDs, indicating the importance of early diagnosis and optimal management of obstetric and gynecological complications in these patients.