Background: Assessing fluid responsiveness in critically ill patients is challenging. Objective, noninvasive tests that are easy to perform are needed. Doppler measurements of dynamic carotid artery parameters such as carotid blood flow (CBF) and carotid flow time (CFT) are being studied as the potential indicators of volume responsiveness, but the data supporting its use are sparse. Methods: This prospective, observational study was conducted in the adult emergency department from June to September 2018. Patients who were prescribed a bolus of 500 ml of crystalloid for any indication were enrolled. Carotid Doppler was performed before and after a fluid bolus to measure the change in CBF and CFT. The aim of our study was to determine if CFT can be used as a marker of fluid responsiveness. Results: During the 4-month study period, 209 patients were recruited through convenient sampling after obtaining informed written consent. 29.6% of patients presented with a mean arterial pressure (MAP) <65, among whom 58.1% had septic shock. The baseline CBF was 643.0 ± 212.7 ml/min, and it was 583.9 ± 207.1 ml/min and 668 ± 210.8 ml/min in hypotensive and normotensive patients, respectively. Considering a >10% increase in CBF as fluid response, there were 59% responders and 41% nonresponders. The MAP increased by 9.5% in the responders, while there was no significant change in CFT after the fluid bolus. There was no difference in CFT among the responders as compared to the nonresponders. There was no correlation between the change of CBF and CFT (r^[207] = 0.013, P = 0.061) after the fluid bolus. Conclusion: Though easy to perform, CFT is probably not a good indicator of fluid responsiveness.

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Background: The purpose of this study was to determine the utility and diagnostic performance of strain elastography (SE) in differentiating benign from malignant lesions of the breast. Methods: In this prospective study, 50 palpable breast masses in 50 patients were examined by mammography, B-mode ultrasound (US) and SE. Lesions were categorized using Breast Imaging Reporting and Data System (BIRADS) scoring based on mammographic and sonographic features. Elasticity scores were assessed on a five-point scale based on the distribution of strain, and the lesion size on SE imaging and B-mode (elasticity imaging/B mode [EI/B] ratio) was compared. Findings were correlated with the BIRADS assessment and diagnostic performance of sonoelastography was evaluated taking histopathology as reference standard. Results: Histopathology revealed 29 (58%) malignant and 21 (42%) benign lesions. Infiltrative ductal carcinoma and fibroadenoma were the most common malignant and benign lesions, respectively. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of SE was 100%, 76.1%, 85.2%, 100%, and 90%, respectively. Higher elasticity score was significantly associated with malignant histopathology (P < 0.00001). The mean EI/B ratio for malignant lesions was 1.36 ± 0.24 while that of benign lesions was 1.03 ± 0.30 (P = 0.000). Conclusion: Real-time SE of the breast, with its superior sensitivity and specificity, could provide improved characterization of benign and malignant breast masses compared with mammography and conventional US. Due to greater diagnostic accuracy, SE can be an effective adjunctive tool to B-mode US in predicting malignancy of breast, as well as in reducing the need for biopsies in benign breast lesions.

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Background: The irregular sickle cells can block blood vessels, causing tissue and organ damage and in most cases presented with pain as a result of organ ischemia. Ultrasonography is an easily available instrument for investigating abdominal organs which are most commonly affected by sickle cell disease (SCD). This study was aimed to assessing liver, gall bladder, spleen, and kidney in children with SCD in Ilorin, Kwara State. Methods: A prospective cross-sectional study was conducted among children with SCD in Ilorin from September 2017 to April 2018. An ethical approval was obtained from the Human Research and Ethics Committee of the Kwara State Ministry of Health. In this study, 106 children with SCD and 106 normal children for control were included. Abdominal ultrasound scan was performed on all the selected subjects and the findings were recorded on the data capture sheet. Descriptive and inferential statistic was used in the data analysis, SPSS version 20 was used and the P = 0.05. Results: In the children with SCD, hepatomegaly was found in 45 (42.5%), 29 (27.4%) had coarse echo pattern of liver and 16 (15.1%) had hyperechoic liver, 5 (4.7%) had gallbladder stone, 2 (1.9%) had gallbladder sludge, and 6 (5.6%) had thickened gallbladder wall. Twenty-five (23.6%) had splenomegaly, and 7 (6.6%) had autosplenectomy. Four (3.8%) showed reduced corticomedullary differentiation in each kidney, five (4.7%) in each kidney had mild calyceal dilatation. One (0.9%) had mild calyceal dilatation with reduced corticomedullary differentiation with accompanying loss of renal sinus fat. Conclusion: Abdominal ultrasound imaging for patients with SCD showed a high incidence of abdominal abnormalities, especially in solid organs such as liver, kidney, and spleen.

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Palpable thigh nodularity is a relatively frequent indication for imaging of vaccination-age children, with patients often referred by their community physician or general practitioner. Ultrasound (US) is the imaging modality of choice to delineate the abnormality, and we present a number of characteristic findings that permit the radiologist and pediatrician to accurately identify the cause. A retrospective review was performed at the largest children's hospital in a European country between 2015 and 2017 over a 30-month period. A search was performed of the hospital's Picture Archiving and Communication System (PACS) for all children referred for a soft-tissue, upper limb, or lower limb US between January 2015 and July 2017. The findings were collated and stored in a spreadsheet. Nine patients were identified who developed subcutaneous nodules in the thigh at some point during their childhood vaccination schedule. Three of these patients had clinical histories strongly suggestive of a diagnosis of abscess or foreign body. The remaining six patients were selected for more in-depth analysis. Four of these patients had US features consistent with vaccination granuloma. Two patients were ultimately diagnosed with venolymphatic malformations. Palpable thigh nodularity in a child of vaccination age is encountered with a reasonable frequency. When encountered, granulomas tend to be located within the subcutaneous tissues, and we postulate that this is due to erroneous administration of a vaccine into the subcutis rather than into the muscle.

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Background: Congenital hypothyroidism is the most common cause of treatable mental impairment and growth retardation in newborns. Early diagnosis requires measurement of serum thyroid-stimulating hormone (TSH) and free T4 coupled with an ultrasound of the thyroid gland. However, detailed sonographic evaluation of the thyroid gland requires comparison to the local thyroid normative volumetric values, which is currently lacking. Methods: A cross-sectional study was conducted from November 10, 2015, to April 18, 2018, recruiting 165 healthy neonates with normal TSH in their 1^st week of life, from a single center in Northwest Malaysia. Ultrasound thyroid was done by a single ultrasonographer (κ = 0.86, percent agreement = 92.4), and the thyroid volume (TV) was calculated using the Brunn formula. Results: All measurements showed skewed distribution with no significant difference between the right and left lobes. The local normative values for neonatal total TV was 0.61 (interquartile range [IQR] = 0.230) cm³, 0.31 (IQR = 0.150) cm³ for right TV, and 0.28 (IQR = 0.110) cm³ for left TV. There was a strong correlation between the right and left TVs, r = 0.767, P < 0.001. There were also no differences in the total TV across different genders and races. Conclusion: The normative values for TV determined in our study may be used accordingly in clinical practice to evaluate thyroid hypoplasia or goiter by other Asian countries due to the similarly shared biodemography.

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Background: To clarify the changes in the echo intensity (EI) in the prefemoral fat pad (PFP) and identify the relationship between the PFP and clinical features of knee osteoarthritis (OA). Methods: Twenty-six women with knee OA (mean age: 76 years) and 17 healthy women (mean age: 73 years) were enrolled. The Kellgren and Lawrence grading scale was used for the radiographic evaluation of knee OA. The EI of the PFP was measured as grayscale values. The change ratio of the anteroposterior PFP length during quadriceps contraction was measured. Knee range of motion and pain (100-mm visual analog scale) were evaluated. Results: The EI was significantly higher in the OA group than in the healthy group (P < 0.001). The change ratio of the PFP in the OA group was significantly lower than that in the healthy group (P < 0.001). The ranges of knee flexion and extension were correlated with the EI of the PFP (both P < 0.01) and the change ratio of the PFP (both P < 0.01). There was no significant correlation observed with knee pain. Conclusion: Hyperechoic changes and a decreased change ratio of the PFP were observed in the patients with knee OA. High EI and decreased morphological PFP changes were associated with decreased ranges of motion.

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We report a case of a 12-year-old boy with an accessory spleen torsion. He presented with left-sided abdominal pain after trauma. A 4 cm oval mass without contrast enhancement was detected on contrast-enhanced computed tomography (CT), and ultrasound (US) showed a 4 cm oval mass below the spleen. The mass mainly consisted of high echoes similar to the spleen; the central part showed irregularly low echoes. Subsequent follow-up daily US examinations showed gradual expansion of the central low echoes with conspicuous hyperechoic dots. Discontinuation of the branch from the splenic artery to the mass was observed, both, on US and CT. These findings led to the diagnosis of a hemorrhagic infarct caused by torsion of the accessory spleen. Laparoscopy showed adherence of the accessory spleen to the omentum and colon by twisting four times around its axis. It was resected and confirmed the diagnosis of a torsioned accessory spleen.

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Background: Resistive index (RI), derived from color Doppler imaging (CDI), is a marker of vascular resistance used widely in varied clinical settings. The aim of this study was to analyze the association between RIs of the orbital vessels in a pure cohort of type 2 diabetic patients with or without retinopathy using CDI. Methods: Fifty patients having type 2 diabetes and 50 age-matched controls were evaluated in this prospective study. Diabetic retinopathy (DR) was diagnosed based on seven-field stereo fundus photography and diabetic patients were divided into two. Patients with no DR (n = 26) were taken as Group 1, while patients with DR (n = 24) were taken as Group 2. CDI was performed and the RIs of the ophthalmic artery (OA), posterior ciliary artery (PCA), central retinal artery (CRA), and central retinal vein (CRV) were measured. Results: Significant differences were observed in the mean RI values of all orbital arteries between controls and patients with DR (P < 0.05). Comparison of RI values between controls and Group 1 showed no significant differences. Mean RI values of the PCA and CRA were found to be significantly higher in the patients in Group 2 than in Group 1 (P = 0.03 and P < 0.001, respectively). The duration of diabetes correlated with the mean RI of all the orbital vessels. RI of the CRA was a reliable predictive indicator for DR (P = 0.001). Conclusion: RIs of the orbital arteries are significantly higher in patients with DR. RI of the orbital vessels can be a potentially useful biomarker in the early diagnosis and follow-up of patients with DR.

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We describe a case of fetal congenital mesoblastic nephroma (CMN) who was diagnosed with ultrasound at 32 weeks of gestation; after delivery, the neonate received left radical nephrectomy, and pathology report confirmed the diagnosis. All cross-sectional imaging studies, such as ultrasonography, computed tomography (CT) scanning, and magnetic resonance imaging, may help to define the organ of origin and the relationship to the ipsilateral kidney. To our knowledge, this is the first case of fetal CMN who was diagnosed in the third trimester and then with a live-born baby in Taiwan. The prenatal examination such as three-dimensional ultrasound and CT image was performed to help us for prenatal diagnosis.

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Paraganglioma is a tumor that originates from neuroendocrine cells of the sympathetic or parasympathetic systems. Patients may suffer from headaches, palpitations, diaphoresis, and hypertension due to catecholamine excess or symptoms from the mass effect of the tumor. In the absence of typical symptoms of catecholamine excess, the diagnosis of a nonfunctional paraganglioma is often delayed. Herein, we report a case of a 63-year-old female patient with a nonfunctional paraganglioma which is an accidental finding during investigation of a fever. Abdominal ultrasonography incidentally detected this lesion as a complex, solid, cystic mass in the left suprarenal retroperitoneum.

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Schwannomas, namely neurilemmomas, are benign nerve sheath tumors and comprise the myelin sheaths around the peripheral nerves. Schwannomas commonly occur in the head and neck, or extremities, less found in the mediastinum and retroperitoneum, and rarely in the pelvis. We report a 40-year-old male presenting with an 18-month history of nocturia and urinary frequency. Transrectal ultrasound revealed a well-defined, 2.81 cm Ö 3.77 cm in size, homogeneous, hypoechoic mass in the tail of the left seminal vesicle, compatible with the finding of a well-demarcated mass at the left seminal vesicle with homogeneous contrast enhancement on computed tomography. He underwent laparoscopic excision of the mass via da Vinci robotic surgical system. Intraoperative sonography showed that the mass exhibited the majority of hypoechoic density with some hyperechoic spots inside. Pathology reveals schwannoma. Both of erectile and ejaculatory functions were claimed postoperatively. Our case report highlights the potential of either intraoperative or preoperative sonography in the assessment of the seminal vesicle schwannoma.

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Radiofrequency ablation (RFA) is a thermal ablation technique widely used for the management of benign thyroid nodules. To date, five academic societies in various countries have reported clinical practice guidelines, opinion statements, or recommendations regarding the use of thyroid RFA. However, despite some similarities, there are also differences among the guidelines, and a consensus is required regarding safe and effective treatment in Asian countries. Therefore, a task force was organized by the guideline committee of the Asian Conference on Tumor Ablation with the goal of devising recommendations for the clinical use of thyroid RFA. The recommendations in this article are based on a comprehensive analysis of the current literature and the consensus opinion of the task force members.

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