Utility of point-of-care ultrasound in patients with suspected diverticulitis in the emergency department

In emergency department (ED) cases with clinically suspected diverticulitis, diagnostic imaging is often needed for diagnostic confirmation, to exclude complications, and to direct patient management. Patients typically undergo a CT scan in the ED; however, in a subset of cases with suspected diverticulitis, point-of-care ultrasound (POCUS) may provide sufficient data to confirm the diagnosis and ascertain a safe plan for outpatient management.We review the main sonographic features of diverticulitis and discuss the diagnostic accuracy and potential benefits of a POCUS First model.     

Giant choledochal cyst and infantile polycystic kidneys as prenatal sonographic features of Caroli syndrome

Caroli syndrome is a developmental disorder caused by complete or partial arrest of ductal plate remodeling, leading to dilated bile ducts along with fibrosis surrounding the portal tracts. It is most commonly associated with autosomal recessive polycystic kidney (ARPKD). We report a unique case of Caroli syndrome, diagnosed prenatally at 24 weeks of gestation in a 29-year-old Thai woman. Ultrasound findings revealed the association of a fetal giant choledochal cyst with ARPKD. Autopsy findings showed ductal plate malformation, typical of Caroli syndrome, associated with giant choledocal cyst and ARPKD.     

First-trimester treatment of cesarean scar pregnancy using a cervical ripening—double-balloon catheter: A case report

Cesarean scar pregnancies are relatively rare. In the first trimester, if the decision is made to terminate the pregnancy, it should be done as soon as possible to avoid complications. We report a successful termination of a live, 6 weeks and 4 days cesarean scar pregnancy using a double-balloon cervical ripening catheter in a patient with two previous cesarean deliveries.     

Wall Shear Stress Measurements Based on Ultrasound Vector Flow Imaging

Wall shear stress (WSS) is considered as a key factor for atherosclerosis development. Previous WSS research based on pulsed wave Doppler (PWD) showed limitations in complex flows. To improve accuracy for nonlaminar flow, a commercial ultrasound vector flow imaging (UVFI)-based WSS calculation is proposed. Errors for PWD are presented theoretically when flow is not laminar. Based on this, simulations of WSS calculations between PWD and UVFI were set up for different turbulent flows. Our simulations show that UVFI has obviously better performance than PWD in WSS calculations. Wall shear stress results in different flow conditions at carotid bifurcations are described.     

Combining real-time elastography with fine-needle aspiration biopsy to identify malignant thyroid nodules

ObjectivesTo evaluate the diagnostic performance of real-time elastography (RTE) combined with fine-needle aspiration (FNA) biopsy in identifying malignant thyroid nodules.MethodsThis was a single-centre, retrospective study and involved patients who had underogone partial or total thyroidectomy from 01 January 2014 to 31 December 2018 at our centre. Eligible patients were at least18 years of age, had reliable grayscale ultrasound imaging results, a RTE evaluation and had undergone a FNA biopsy.ResultsData were available from 437 patients. A high RTE score was a significant independent risk factors for malignancy. RTE plus FNA biopsy increased diagnostic accuracy compared with either method alone and the sensitivity and specificity of the combined model were 86% and 78%, respectively.ConclusionsThe combination of RTE imaging with FNA biopsy improves the diagnostic performance in differentiating benign and malignant thyroid nodules.     

Evaluation of thyroid hemangioma by conventional ultrasound combined with contrast-enhanced ultrasound: a case report and review of the literature

Primary thyroid hemangioma is an extremely rare clinical disease. Only 31 cases have been reported to date according to a PubMed search, and most were postoperatively diagnosed by pathologic examination. Ultrasonography is the first-line imaging modality for thyroid disease screening. However, preoperative ultrasonic diagnosis of thyroid hemangioma has been rarely reported. We herein describe a 24-year-old woman with a painless mass in the left thyroid lobe. Routine ultrasound (US) and contrast-enhanced US (CEUS) were performed. Routine US revealed an anechoic tumor with linear echogenic septal lines and compressibility. CEUS showed a characteristic “slow in and slow out” pattern of contrast filling and perfusion. Based on the combined findings of routine US and CEUS, the initial diagnosis was thyroid venous hemangioma. Postoperative pathological examination demonstrated multiple irregular dilated vessel lumens filled with red blood cells and multiple hemorrhagic zones. Immunohistochemical staining showed positivity for CD31 and smooth muscle actin.. Overall, this case showed US characteristics of a rare case of thyroid hemangioma, which is of importance for preoperative planning to avoid a large amount of blood loss during surgery. This case together with our literature review will help radiologists to bridge the knowledge gap of thyroid hemangioma, especially at the initial US screening.