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Natalia Buda, Wojciech Kosiak
Journal of Ultrasonography, Volume 17, pp 136-141; https://doi.org/10.15557/jou.2017.0021

Abstract:
Is a linear probe helpful in diagnosing diseases of pulmonary interstitial spaces?
, Daniel Soliński, Mateusz Łasecki, , Szymon Urban, Urszula Zaleska-Dorobisz
Journal of Ultrasonography, Volume 17, pp 123-128; https://doi.org/10.15557/JoU.2017.0018

Abstract:
Ultrasound imaging of the musculoskeletal system is an important element of the diagnostic and therapeutic protocol. Clinical decisions, including those regarding surgical procedures, are often based solely on ultrasound imaging. However, detailed knowledge on the anatomy and a correct scanning technique are crucial for an accurate diagnosis. Modern ultrasonographic equipment allows obtaining detailed anatomical images of muscle tendons, ligaments, nerves and vessels of the carpal area. Ventral wrist ultrasound is one of the most common diagnostic procedures in patients with suspected carpal tunnel syndrome. Ventral wrist evaluation is also often performed in patients with wrist pain of unclear etiology, rheumatic diseases, wrist injuries or symptoms of ulnar neuropathy. The aim of this paper is to present ultrasound images with corresponding anatomical schemes. The technique of ultrasound examination of the ventral wrist along with practical guidance to help obtain highly diagnostic images is also discussed. The present paper is the second part of an article devoted to ultrasound anatomy and wrist ultrasound technique – the part discussing the dorsal side of the wrist was published in the Journal of Ultrasonography, Vol. 15, No 61. The following anatomical structures should be visualized during an ultrasound examination of the ventral wrist, both in the carpal tunnel as well as proximally and distally to it: four flexor digitorum superficialis tendons, four flexor digitorum profundus tendons, flexor pollicis longus, flexor carpi radialis tendon, median nerve and flexor retinaculum; in the carpal tunnel as well as proximally and distally to it: the ulnar nerve, ulnar artery and veins; the tendon of the flexor carpi ulnaris muscle; carpal joints.
Amandeep Singh, Jasmeet Singh, Kamlesh Gupta
Journal of Ultrasonography, Volume 17, pp 133-135; https://doi.org/10.15557/JoU.2017.0020

Abstract:
Body stalk anomaly is a rare and severe malformation syndrome in which the exact pathophysiology and trigger factors are still unknown. Possible causes of body stalk anomaly include early amnion rupture with direct mechanical pressure and amniotic bands, vascular disruption of the early embryo, or an abnormality in the germinal disk. We present a case of body stalk anomaly diagnosed during antenatal sonographic evaluation at the first visit with the review of literature regarding this phenomenon. Sonographic features of the fetus included a severe midline defect of the fetal abdominal wall with a large extra-abdominal mass containing bowel and liver inside. Body stalk anomaly is accepted as a fatal anomaly, so it is important to differentiate it from other anterior wall defects for evaluating the management options.
, Simran Sekhon, Thomas W. Loehfelm, Sandra L. Wootton-Gorges, Adam Greenspan
Journal of Ultrasonography, Volume 17, pp 129-132; https://doi.org/10.15557/jou.2017.0019

Abstract:
A reminder of peristalsis as a useful tool in the prenatal differential diagnosis of abdominal cystic masses
, Robert Piórkowski, , Monika Pazura, Krzysztof Cendrowski, Włodzimierz Sawicki
Journal of Ultrasonography, Volume 17, pp 116-122; https://doi.org/10.15557/jou.2017.0017

Abstract:
Can ultrasound be helpful in selecting optimal management methods for pregnancies complicated by placental non-trophpblastic tumors?
Maria Magdalena Dresler, Jacek Kociszewski, , Piotr Pędraszewski, Agnieszka Trzeciak, Grzegorz Surkont
Journal of Ultrasonography, Volume 17, pp 101-105; https://doi.org/10.15557/JoU.2017.0014

Abstract:
Implants used to treat patients with urogynecological conditions are well visible in US examination. The position of the suburethral tape (sling) is determined in relation to the urethra or the pubic symphysis. The study was aimed at assessing the accuracy of measurements determining suburethral tape location obtained in pelvic US examination performed with a transvaginal probe. The analysis covered the results of sonographic measurements obtained according to a standardized technique in women referred for urogynecological diagnostics. Data from a total of 68 patients were used to analyse the repeatability and reproducibility of results obtained on the same day. The intraclass correlation coefficient for the repeatability and reproducibility of the sonographic measurements of suburethral tape location obtained with a transvaginal probe ranged from 0.6665 to 0.9911. The analysis of the measurements confirmed their consistency to be excellent or good. Excellent and good repeatability and reproducibility of the measurements of the suburethral tape location obtained in a pelvic ultrasound performed with a transvaginal probe confirm the test’s validity and usefulness for clinical and academic purposes.
Bianca A. Almeida, Livia T. Rios, Edward Araujo Júnior, Luciano M. Nardozza, Antonio F. Moron, Marília G. Martins
Journal of Ultrasonography, Volume 17, pp 91-95; https://doi.org/10.15557/JoU.2017.0012

Abstract:
The objective of this study was to assess the correlation between antenatal corticosteroids and peri-intraventricular haemorrhage (PIVH) using transfontanelle ultrasonography, as well as to evaluate the risk factors for its incidence. We performed a retrospective cohort study using medical records of preterm newborns. The protocol for maternal corticoid administration for foetal lung maturation included dexamethasone 4 mg (intramuscular) 8/8 hours per 48 hours, with one cycle per week. The diagnosis of periintraventricular haemorrhage was based on transfontanelle ultrasonography, using the Papile’s classification. The following risk factors for peri-intraventricular haemorrhage were assessed: birth weight, gestational age at delivery, type of delivery, newborn’s sex, surfactant administration, premature rupture of membranes and previous history of infection during the current pregnancy. The student’s t-test and chi-square test were used for statistical analysis. Our sample population included 184 preterm newborns. Transfontanelle ultrasonography revealed peri-intraventricular haemorrhage in 32 (74.4%) and periventricular leukomalacia in 11 (25.6%) newborns. Grade I haemorrhage was found in 20 (62.5%), grade II in five (15.6%), and grade III in seven (21.8%) newborns, as in accordance with Papile’s classification. Vaginal delivery (p = 0.010), birth weight <1500 g (p = 0.024), gestational age at delivery ≤32 weeks (p = 0.018), and previous history of infection during pregnancy (p = 0.013) were considered risk factors for peri-intraventricular haemorrhage in preterm newborns. Maternal corticoid administration for foetal lung maturation showed a protective effect against peri-intraventricular haemorrhage in preterm newborns. The risk factors for peri-intraventricular haemorrhage were determined.
, Oluwagbemiga O. Ayoola, Victor A. Adetiloye, Morenikeji A. Komolafe, Babalola I. Afolabi
Journal of Ultrasonography, Volume 17, pp 106-112; https://doi.org/10.15557/JoU.2017.0015

Abstract:
To evaluate the usefulness of ultrasonographic acromion-greater tuberosity distance measurement and Shoulder ratio in detecting post-stroke inferior shoulder subluxation. Forty-five hemiplegic stroke patients and 45 controls underwent shoulder sonography to measure their acromion-greater tuberosity distance. Side-to-side acromion-greater tuberosity distance differences and Shoulder ratios were derived from the acromion-greater tuberosity distance values. The long head of biceps tendon, subscapularis tendon, supraspinatus tendon, and the infraspinatus tendon were also evaluated to exclude full thickness tendon tears. Data were analyzed using the Statistical Package for Social Sciences version 20.0 for windows. Normality of data distribution was checked using the Kolmogorov–Smirnov test. Mann–Whitney U test and Chi-square tests were utilized. Hemiplegic and control shoulders’ acromion-greater tuberosity distance values were 2.8 ± 0.6 cm and 2.4 ± 0.4 cm, respectively (p = 0.001). Hemiplegic and control shoulder ratios were 1.3 ± 0.3 and 1.1 ± 0.1, respectively; p < 0.001. Point biserial correlation showed that the presence of subluxation correlated moderately with higher shoulder ratios in all the hemiplegics (rpb = 0.520; p < 0.001). Our results suggest that acromion-greater tuberosity distance measurement is useful for detecting inferior shoulder subluxation. Shoulder ratio may be of complementary or supplemental value to acromion-greater tuberosity distance difference.
Journal of Ultrasonography, Volume 17, pp 113-115; https://doi.org/10.15557/jou.2017.0016

Abstract:
Detailed EFSUM recommendations on the scope of ultrasound assessment in patients with portal hypertension considering the diagnostic reference level
Andrzej Smereczyński, , Elżbieta Bernatowicz
Journal of Ultrasonography, Volume 17, pp 96-100; https://doi.org/10.15557/jou.2017.0013

Abstract:
Difficulties in differentiating the nature of ascites based on ultrasound imaging
Marcin Strzelczyk, Michał Podgórski, Susan Afshari, , Monika Pawlak-Bratkowska, Piotr Grzelak
Journal of Ultrasonography, Volume 17, pp 85-90; https://doi.org/10.15557/JoU.2017.0011

Abstract:
The most common hereditary kidney condition is autosomal dominant polycystic kidney disease. It is the cause of 5–10% of end-stage renal disease. Its symptoms are generally late-onset, typically leading to development of hypertension and chronic kidney disease. Ultrasonography is the imaging modality of choice in its diagnosis and management. The aim of this study is to determine the diagnostic value of grayscale ultrasound imaging in evaluating disease severity. The study group consisted of 81 patients diagnosed with autosomal dominant polycystic kidney disease, 35 adults and 46 children. Inclusion criterion for adults was the presence of at least 10 large cysts in each kidney; children included into the study had developed at least 1 large renal cyst in each kidney. The number of large cysts, echogenicity of kidney parenchyma, cortical thickness and presentation of cortex/medulla boundary were assessed with the use of Logiq E9 apparatus (GE Healthcare, Netherlands). Patients were divided into groups, based on these morphological parameters. Kidney function was assessed according to serum creatinine concentration and creatinine clearance. Statistical analysis was performed, with p-value lower than 0.05 considered as significant. The number of cysts and the degree of parenchymal dysfunction were the determinants of creatinine level and creatinine clearance, with the second predictor proving stronger. We recommend that an ultrasound kidney examination in patients with polycystic kidney disease should include evaluating renal parenchyma and the number of cysts for better assessment of disease severity.
Journal of Ultrasonography, Volume 17, pp 73-75; https://doi.org/10.15557/JoU.2017.0010

Abstract:
Posterior interosseous nerve palsy caused by a ganglion is not common and most previous patients were treated with excisional surgery. We treated a case conservatively with needle aspiration using ultrasonography, after a nerve conduction study. A 77-year-old man presented with impaired active finger extension of the left metacarpophalangeal joints. The nerve conduction study revealed conduction block of the left radial nerve near the elbow. Ultrasonography demonstrated a hypoechoic mass anterior to the radial neck compressing the posterior interosseous nerve. Then, needle aspiration of the mass was conducted under ultrasonography. Two months later, active finger extension recovered to normal. A ganglion can be diagnosed with ultrasonography and needle aspiration can be carried out safely under ultrasonography. A nerve conduction study can assess the degree of nerve damage. The combination of ultrasonography and a nerve conduction study can facilitate conservative treatment of needle aspiration for posterior interosseous nerve palsy caused by a ganglion.
Journal of Ultrasonography, Volume 17, pp 30-35; https://doi.org/10.15557/JoU.2017.0004

Abstract:
The goal of the work was comparing gas ultrasound images below the right diaphragm in two groups: in people with intestinal interposition below the diaphragm and ones with pneumoperitoneum and extracting the traits differentiating these two conditions. Retrospectively, the documentation of 22 patients with intestinal interposition below the diaphragm (group 1) was utilized. Clinical material was used for comparison, previously published, composed of 15 cases of pneumoperitoneum following laparotomy and of 14 cases following that symptom as a result of ulcer perforation – group 2 (in total n = 29). Moreover, the distance in millimeters of the gas surface reflecting ultrasounds from the parietal peritoneum was measured, the smoothness of the surface, parietal peritoneum enhancement at the place of gas adherence, gas continuity below the diaphragm with gas in the intestine located below the liver. Direct adherence of the gas surface to the diaphragm was observed in 100% of the cases of emphysema, but in no cases of intestinal interposition. Yet, in the group of patients with colonic interposition (n = 21) there was always a small gap (2–3 mm) and the gas surface among those patients in 100% of the cases was uneven. In differentiation between pneumoperitoneum and liver-diaphragm interposition of the intestine one should take into account – apart from gas movement below the diaphragm at body position changing – the presence of protrusion and section enhancement of the diaphragmatic peritoneum as well as the distance of the gas from the diaphragm, the smoothness of its surface and the continuity with the intestine below the liver. Interpositions of small diaphragm-liver penetration may subside in erect position.
Agnieszka Brodzisz
Journal of Ultrasonography, Volume 17, pp 66-72; https://doi.org/10.15557/JoU.2017.0009

Abstract:
The diagnostics of the abdominal cavity in children, especially in the neonatal-infantile period, requires knowledge in the field of anatomical and physiopathological differences as well as clinical symptomatology and pathology at every stage of the child’s development. Errors and mistakes in ultrasound diagnostics of the abdominal cavity in children result from many factors, including lack of experience in examining children and the knowledge concerning most frequent ailments and pathologies as well as the incidence or no changes in the ultrasound image of the abdominal cavity organs. The assessment of the ultrasound image should be always based on clinical data of the patient, information on the past diseases, surgeries and the results of additional examinations and laboratory tests. Particular attention should be paid to the occurrence of congenital diseases and inflammations, which may have varied clinical manifestation – especially in the case of pediatric diagnostics. The variety and non-specific nature of clinical symptoms may also mask the developing neoplastic process. Mistakes in ultrasound diagnostics, especially among the youngest children, may also be caused by technical difficulties related to carrying out the examination. The above situation results from lack of cooperation with the child, who is uneasy, wailing, fails to perform orders, which may lead to overlooking the existing lesion or overinterpreting, e.g. a full stomach or residual stool in the intestines to be a pathology. It is also of high importance to have a good class of the ultrasound equipment and technical knowledge concerning its operation. When performing an ultrasound examination in children, it is necessary to apply a wide range of phased-array, convex and linear heads and appropriate applications, the so-called pediatric software (stomach, kidneys, true pelvis, organs at the surface).
, Przemysław Bombiński, Michał Brzewski
Journal of Ultrasonography, Volume 17, pp 36-40; https://doi.org/10.15557/JoU.2017.0005

Abstract:
The double aorta artifact was described and studied thoroughly twenty-five years ago. Despite this, it is still not commonly known today and can cause diagnostic difficulty. Total aortic duplication can be considered an anatomic defect whilst partial duplication mimics aortic dissection. In the literature, this artifact has been compared with a very rare anomaly, i.e. the occurrence of two aortas in one patient. Currently, however, the differentiation of this artifact from abdominal aortic dissection seems to be of greater significance. The double aorta image occurs when ultrasound waves encounter prismatic fat tissue of the anterior abdominal wall. This artifact is more frequently observed in children and athletic young adults since the structure of this anatomic region in these individuals is conductive to the occurrence of this phenomenon. Moreover, it can be observed more often when curved transducers are used. Due to all these factors, an ultrasound beam undergoes greater refraction and make the artifact clearer. This phenomenon is usually easily recognizable and avoidable, but it sometimes might cause diagnostic difficulty. Obtaining an image of double abdominal vessels on ultrasound examination in transverse sections requires further inspection of the aorta in a different (sagittal) plane. This is not always possible due to poor patient preparation for scanning. Symmetrical flow on Doppler sonography is a typical feature of this artifact. Finally, magnetic resonance imaging or computed tomography can be considered to rule out a pathology.
, Wiesław Jakubowski
Journal of Ultrasonography, Volume 17, pp 59-65; https://doi.org/10.15557/JoU.2017.0008

Abstract:
The article discusses basic mistakes that can occur during ultrasound imaging of superficial lymph nodes. Ultrasound is the first imaging method used in the diseases of superficial organs and tissues, including lymph nodes. The causes of mistakes can be either dependent or independent of the performing physician. The first group of mistakes includes inappropriate interpretation of images of anatomical structures, while the latter group includes, among other things, similar ultrasound images of different pathologies. For instance, a lymph node, whether normal or abnormal, may be mimicked by anatomical structures, such as a partially visible, compressed vein. Lymph nodes in lymphomas may be indistinguishable from reactive lymph nodes, even when using Doppler option, as well as morphologically difficult to distinguish from metastases. Metastatic lymph nodes can mimic e.g. nodular, separated postoperative thyroid fragments, a lateral neck cyst, chemodectoma (carotid body tumor) or neuroma. The appearance of lymph nodes in granulomatous diseases, such as tuberculosis or sarcoidosis, can be very similar to that of typical metastatic lymph nodes or lymphomas. Anechoic or hypoechoic areas in a lymph node can represent necrosis or metastatic hemorrhages, but also suppuration in inflamed lymph nodes. Lymph nodes in lymphomas, metastatic and reactive lymph nodes can adopt the classical characteristics of a simple cyst. The overall ultrasound picture along with all criteria for the assessment of a lymph node should be taken into account during ultrasound imaging. It seems that the safest management is to refer patients diagnosed with lymph node abnormalities for ultrasound-guided targeted fine needle aspiration biopsy followed by a total lymph node resection for histopathological examination in the case of suspected lymphoma.
, , Department of Paediatric Radiology of the Medical University of Lublin
Journal of Ultrasonography, Volume 17, pp 43-58; https://doi.org/10.15557/jou.2017.0007

Abstract:
The standards of an ultrasound examination of the prostate gland. Part 2
Journal of Ultrasonography, Volume 17, pp 41-42; https://doi.org/10.15557/JoU.2017.0006

Abstract:
Technological progress forces us to present after several years the updated standards in ultrasound examination of newborns, infants and older children. It should be emphasized that the examination of the youngest patients requires one to use high-class equipment. Lack of cooperation on the part of the child and imaging small structures constitute a huge challenge for the examiner. The work presents equipment requirements, the technology of examining the abdominal cavity in children and the manner of preparing the examination result. Moreover, modern expectations as regards ultrasound surgery equipment, where children are subject to examination have been presented. The minimum set of transducers the ultrasound apparatus should be equipped with has also been pointed out as well as the minimum requirements concerning image recording. Extending the scope of transducers over “minimum” significantly raises the imaging possibilities in pediatrics. Standard preparation of children for ultrasound has been discussed, taking into consideration the age of the patient and indications. It is essential to understand that it differs from standard preparation for examination in the case of adults. The technique of examining the abdominal cavity has been described, which enables the repeatability of examinations and ensuring making all the available structures visible. It proves imperative especially in the case of a large number of examinations. Attention should be paid particularly to the urinary system imaging – owing to the greatest incidence of congenital diseases in that system.
Alberto Borges Peixoto, Taciana Mara Rodrigues Da Cunha Caldas, Fernando Felix Dulgheroff, Wellington P. Martins,
Journal of Ultrasonography, Volume 17, pp 23-29; https://doi.org/10.15557/jou.2017.0003

Abstract:
Fetal biometric parameters: Reference charts for a non-selected risk population from Uberaba, Brazil
Małgorzata Kobylecka, , , Katarzyna Fronczewska-Wieniawska, Joanna Mączewska, Adam Bajera, Maria Karlińska,
Journal of Ultrasonography, Volume 17, pp 17-22; https://doi.org/10.15557/JoU.2017.0002

Abstract:
The imaging techniques most commonly used in the diagnosis of hyperparathyroidisms are ultrasound and scintigraphy. The diagnostic algorithms vary, depending mainly on the population, and experience of physicians. Aim of the present research was to determine the usefulness of parathyroid scintigraphy and ultrasonography in patients diagnosed for hyperparathyroidism in own material. In the present research, 96 operated patients with documented primary, secondary and tertiary hyperparathyroidism were retrospectively analyzed. All patients underwent a 99mTc hexakis-2-methoxyisobutylisonitrile scintigraphy of the neck with the use of subtraction and two-phase examinations. Ultrasonography of the neck was performed in all the patients in B mode 2D presentation. A total number of 172 parathyroid glands were analyzed. The sensitivity and specificity of scintigraphy was 68% and 60%, respectively. The sensitivity of ultrasound was 49% and specificity 85%. Both techniques allowed visualization of 76 parathyroid glands. Ultrasound revealed 19 glands that were not visible in scintigraphy. Scintigraphy showed 76 parathyroid glands that were not visualized on ultrasound. Having combined the results of scintigraphy and ultrasound, the sensitivity of 76% and specificity of 50% were obtained. Considering the ability to locate the parathyroid glands in both techniques as a positive result, the sensitivity decreased to 37% and specificity rose to 95%. Scintigraphy showed greater sensitivity than ultrasound in the localization of enlarged parathyroid glands. Ultrasound, in turn, was characterized by a higher specificity. The combined use of scintigraphy and ultrasonography allowed to obtain the specificity of 95%. In the light of obtained results, scintigraphy and ultrasonography are complementary and should be used together.
, Lennart Jans, James Teh
Journal of Ultrasonography, Volume 17, pp 5-16; https://doi.org/10.15557/jou.2017.0001

Abstract:
Rheumatoid arthritis: what do MRI and ultrasound show
Iwona Sudoł-Szopińska, Genowefa Matuszewska, Piotr Gietka, Mateusz Płaza, Marta Walentowska-Janowicz
Published: 7 September 2016
Journal of Ultrasonography, Volume 16, pp 225-236; https://doi.org/10.15557/jou.2016.0023

Abstract:
Imaging of juvenile idiopathic arthritis. Part I: Clinical classifications and radiographs
Iwona Sudoł-Szopińska, Elżbieta Grochowska, Piotr Gietka, Mateusz Płaza, Grzegorz Pracoń, Fadhil Saied, Marta Walentowska-Janowicz
Published: 7 September 2016
Journal of Ultrasonography, Volume 16, pp 237-251; https://doi.org/10.15557/JoU.2016.0024

Abstract:
Juvenile idiopathic arthritis is the most common autoimmune systemic disease of the connective tissue affecting individuals in the developmental age. Radiography, which was described in the first part of this publication, is the standard modality in the assessment of this condition. Ultrasound and magnetic resonance imaging enable early detection of the disease which affects soft tissues, as well as bones. Ultrasound assessment involves: joint cavities, tendon sheaths and bursae for the presence of synovitis, intraand extraarticular fat tissue to visualize signs of inflammation, hyaline cartilage, cartilaginous epiphysis and subchondral bone to detect cysts and erosions, and ligaments, tendons and their entheses for signs of enthesopathies and tendinopathies. Magnetic resonance imaging is indicated in children with juvenile idiopathic arthritis for assessment of inflammation in peripheral joints, tendon sheaths and bursae, bone marrow involvement and identification of inflammatory lesions in whole-body MRI, particularly when the clinical picture is unclear. Also, MRI of the spine and spinal cord is used in order to diagnose synovial joint inflammation, bone marrow edema and spondylodiscitis as well as to assess their activity, location, and complications (spinal canal stenosis, subluxation, e.g. in the atlantoaxial region). This article discusses typical pathological changes seen on ultrasound and magnetic resonance imaging. The role of these two methods for disease monitoring, its identification in the pre-clinical stage and establishing its remission are also highlighted.
Giorgio Tamborrini, Christian Marx,
Published: 7 September 2016
Journal of Ultrasonography, Volume 16, pp 252-259; https://doi.org/10.15557/jou.2016.0025

Abstract:
Inter-rater reliability in the classification of supraspinatus tendon tears using 3D ultrasound – a question of experience?
Published: 7 September 2016
Journal of Ultrasonography, Volume 16, pp 281-287; https://doi.org/10.15557/jou.2016.0028

Abstract:
Non-invasive methods for liver stiffness assessment have been introduced over recent years. Of these, two main methods for estimating liver fibrosis using ultrasound elastography have become established in clinical practice: shear wave elastography and quasi-static or strain elastography. Shear waves are waves with a motion perpendicular (lateral) to the direction of the generating force. Shear waves travel relatively slowly (between 1 and 10 m/s). The stiffness of the liver tissue can be assessed based on shear wave velocity (the stiffness increases with the speed). The European Federation of Societies for Ultrasound in Medicine and Biology has published Guidelines and Recommendations that describe these technologies and provide recommendations for their clinical use. Most of the data available to date has been published using the Fibroscan (Echosens, France), point shear wave speed measurement using an acoustic radiation force impulse (Siemens, Germany) and 2D shear wave elastography using the Aixplorer (SuperSonic Imagine, France). More recently, also other manufacturers have introduced shear wave elastography technology into the market. A comparison of data obtained using different techniques for shear wave propagation and velocity measurement is of key interest for future studies, recommendations and guidelines. Here, we present a recently introduced shear wave elastography technology from Hitachi and discuss its reproducibility and comparability to the already established technologies.
Grzegorz Ćwik, Justyna Wyroślak-Najs, Michał Solecki, Grzegorz Wallner
Published: 7 September 2016
Journal of Ultrasonography, Volume 16, pp 260-272; https://doi.org/10.15557/jou.2016.0026

Abstract:
Aim: The goal of the paper was to evaluate the procedure of percutaneous drainage of symptomatic hepatic cysts under the transabdominal ultrasound control combined with obliteration. Material and method: Within the period from 2005 to 2015, 70 patients diagnosed with a simple hepatic cyst of symptomatic nature were subject to hospitalization and treated at the 2nd General, Gastroenterological and Cancer Surgery of the Alimentary System Center and Clinics of the Medical University of Lublin. All the patients subject to evaluation were qualified to percutaneous drainage under an ultrasound control. The drainage utilized typical sets of drains with the diameter of at least 9 F, most often of pigtail type. The fluid aspirated form the cyst was dispatched for complex laboratory testing. Further, a 10% sodium chloride solution was administered to the cyst through the drain, in the volume depending on the previous size of the cyst and the patient’s reaction. Results: Patients reported for a re-visit within the period from 3 to 9 months following the procedure. Complete obliteration of the cyst was confirmed only in 8 patients (11%). Cyst recurrence was reported in cases when during the ultrasound evaluation, the diameter of the cyst following aspiration and obliteration enlarged to over 75% of the initial dimension. In this group, in 10 out of 12 examined (83%) there was a relapse of the previously observed ailments. Among patients, who has a cyst imaged within the period of observation, which had the diameter from 50% to 75% of the previous size, only in 6 cases (37.5%) the initial symptoms relapsed. Conclusions: The utilization of a drainage and obliteration enables one to achieve the acceptable result of the therapy as well as significant decrease in the number of previously reported ailments and symptoms described.
Published: 7 September 2016
Journal of Ultrasonography, Volume 16, pp 273-280; https://doi.org/10.15557/JoU.2016.0027

Abstract:
So far, a fatty pancreas has been related to obesity and the ageing processes in the body. The current list of pathogenetic factors of the condition is clearly extended with genetically conditioned diseases (cystic fibrosis, Shwachman-Diamond syndrome and Johanson-Blizzard syndrome), pancreatitis, especially hereditary and obstructive, metabolic and hormonal disorders (hypertriglyceridemia, hypercholesterolemia, hyperinsulinemia and hypercortisolemia), alcohol overuse, taking some medicines (especially adrenal cortex hormones), disease of the liver and visceral adiposis. As regards lipomatosis of that organ resulting mainly from dyslipidemia and hyperglycemia, the term “nonalcoholic fatty pancreas disease” was introduced. Experimental studies on animals and histological preparations of the pancreatic fragments show that the lipotoxicity of the collected adipocytes collected ion the organ release a cascade of proinflammatory phenomena, and even induces the processes of carcinogenesis. Pancreas adiposis is best defined in Computed Tomography and Magnetic Resonance Imaging. However, a series of works proved the usefulness in the diagnostics of that pathology of transabdominal and endoscopic ultrasonography. In that method, the degree of adiposis was based on the comparison of echogenicity of the pancreas and the liver, renal parenchyma, spleen and/or retroperitoneal adipose. Recently, the evaluation was expanded by the evaluation of the degree of pancreatic adipose with the pancreas-to-liver index, utilizing to that end a special computer program. According to our experience, the simplest solution is the method utilized by us. On one crosssection of the body of the pancreas, its echogenicity is assessed in comparison to retroperitoneal adipose and the visibility of the splenic vein, pancreatic duct and the major retroperitoneal vessels. Depending on the visualization of these structures, it is possible to determine the degree of pancreas adiposis. Such a study applies to 250 people, in whom the adiposis was detected in 16.5%, which is close to other cohort US examinations results.
, Maciej Kielar
Published: 7 September 2016
Journal of Ultrasonography, Volume 16, pp 288-295; https://doi.org/10.15557/JoU.2016.0029

Abstract:
The purpose of the study was to improve the ultrasonographic assessment of the anterior cruciate ligament by an inclusion of a dynamic element. The proposed functional modification aims to restore normal posterior cruciate ligament tension, which is associated with a visible change in the ligament shape. This method reduces the risk of an error resulting from subjectively assessing the shape of the posterior cruciate ligament. It should be also emphasized that the method combined with other ultrasound anterior cruciate ligament assessment techniques helps increase diagnostic accuracy. Ultrasonography is used as an adjunctive technique in the diagnosis of anterior cruciate ligament injury. The paper presents a sonographic technique for the assessment of suspected anterior cruciate ligament insufficiency supplemented by the use of a dynamic examination. This technique can be recommended as an additional procedure in routine ultrasound diagnostics of anterior cruciate ligament injuries. Supplementing routine ultrasonography with the dynamic assessment of posterior cruciate ligament shape changes in patients with suspected anterior cruciate ligament injury reduces the risk of subjective errors and increases diagnostic accuracy. This is important especially in cases of minor anterior knee instability and bilateral anterior knee instability. An assessment of changes in posterior cruciate ligament using a dynamic ultrasound examination effectively complements routine sonographic diagnostic techniques for anterior cruciate ligament insufficiency.
, Jarosław Maczuch, Jarosław Skupiński, Karolina Kukawska-Sysio, Wojciech Wawrzynek
Published: 7 September 2016
Journal of Ultrasonography, Volume 16, pp 296-303; https://doi.org/10.15557/jou.2016.0030

Abstract:
Internal snapping hip syndrome in dynamic ultrasonography
Wojciech Mądry,
Published: 7 September 2016
Journal of Ultrasonography, Volume 16, pp 304-316; https://doi.org/10.15557/JoU.2016.0031

Abstract:
In this paper, the authors attempt to concisely present the anatomical and pathophysiological bases as well as the principles for echocardiographic evaluation of mechanical aspects of cardiac function based on speckle tracking method. This technique uses a phenomenon involving the formation of characteristic image units, referred to as speckles or acoustic markers, which are stable during cardiac cycle, on a two-dimensional echocardiographic picture. Changes in the position of these speckles throughout the cardiac cycle, which are monitored and analyzed semi-automatically by a computer system, reflect deformation of both, cardiac ventricle as a whole as well as its individual anatomical segments. The values of strain and the strain rate, as well as the range and velocity of the movement of these markers, which are in close relationship with multiple hemodynamic parameters, can be visualized as various types of charts – linear, two- and three-dimensional – as well as numerical values, enabling deeper insight into the mechanical and hemodynamic aspects of cardiac function in health and disease. The use of information obtained based on speckle tracking echocardiography allows to understand previously unclear mechanisms of physiological and pathophysiological processes. The first part of the study discusses the formation of a two-dimensional ultrasound image and the speckles, as well as the technical aspects of tracking their movement. The second part presents in more detail the methodology of speckle-tracking echocardiography, the characteristic abnormalities of cardiac mechanics presenting in different clinical entities, and the limitations related to given clinical and technical issues.
, Caroline Augris, Clémence Aubergy, Dominique Chassard
Published: 7 September 2016
Journal of Ultrasonography, Volume 16, pp 317-321; https://doi.org/10.15557/JoU.2016.0032

Abstract:
We report two cases of patients presenting for elective surgery, in whom significant gastric contents were identified by performing fortuitous ultrasound examination of their antral area. The first patient presented for a day-case surgery scheduled under regional anesthesia. With his consent, ultrasound examination of the antral area was by chance performed within the context of training for this technique, showing significant solid contents in the stomach. The patient admitted that he had not respected preoperative fasting. The second patient was scheduled for an elective ophthalmologic surgery. Ultrasound examination of the antrum showed that the antrum was dilated, with significant solid and liquid gastric contents. This case may be related to a strongly delayed gastric emptying. These two cases demonstrate that some elective patients may present with significant gastric contents exposing them to the risk of pulmonary aspiration in the case of general anesthesia.
Piotr Zajkowski, Aleksandra Ochal-Choińska
Journal of Ultrasonography, Volume 16, pp 175-190; https://doi.org/10.15557/JoU.2016.0019

Abstract:
The paper is an update of 2011 Standards for Ultrasound Assessment of Salivary Glands, which were developed by the Polish Ultrasound Society. We have described current ultrasound technical requirements, assessment and measurement techniques as well as guidelines for ultrasound description. We have also discussed an ultrasound image of normal salivary glands as well as the most important pathologies, such as inflammation, sialosis, collagenosis, injuries and proliferative processes, with particular emphasis on lesions indicating high risk of malignancy. In acute bacterial inflammation, the salivary glands appear as hypoechoic, enlarged or normal-sized, with increased parenchymal flow. The echogenicity is significantly increased in viral infections. Degenerative lesions may be seen in chronic inflammations. Hyperechoic deposits with acoustic shadowing can be visualized in lithiasis. Parenchymal fibrosis is a dominant feature of sialosis. Sjögren syndrome produces different pictures of salivary gland parenchymal lesions at different stages of the disease. Pleomorphic adenomas are usually hypoechoic, well-defined and polycyclic in most cases. Warthin tumor usually presents as a hypoechoic, oval-shaped lesion with anechoic cystic spaces. Malignancies are characterized by blurred outlines, irregular shape, usually heterogeneous echogenicity and pathological neovascularization. The accompanying metastatic lesions are another indicator of malignancy, however, final diagnosis should be based on biopsy findings.
, , Elżbieta Bernatowicz
Journal of Ultrasonography, Volume 16, pp 145-154; https://doi.org/10.15557/JoU.2016.0016

Abstract:
This article focuses on various cancerous lesions that are found beyond organs in the intra-abdominal fat and can be visualized with ultrasonography. These lesions are divided into five groups. The first group includes primary benign tumors containing adipocytes, such as lipoma, lipoblastoma, hibernoma and other lesions with an adipose tissue component, such as myolipoma, angiomyolipoma, myelolipoma and teratoma. The second group comprises primary malignant adipocytecontaining tumors, including liposarcoma and immature teratoma. The third group contains primary benign tumors without an adipocyte component that are located in intra-abdominal fat. This is a numerous group of lesions represented by cystic and solid tumors. The fourth group encompasses primary malignant tumors without an adipocyte component that are located in intra-abdominal fat. These are rare lesions associated mainly with sarcomas: fibrosarcoma, malignant fibrous histiocytoma, hemangiopericytoma and leiomyosarcoma. An epithelioid tumor at this site is mesothelioma. The last but not least group includes secondary malignant tumors without an adipocyte component located in intra-abdominal fat. This is the most numerous group with prevailing carcinoma foci. For each of these groups, the authors present ultrasound features of individual lesions and discuss their differential diagnosis. In the vast majority of cases, the material for cytological and histological analysis can be obtained during ultrasound-guided procedures. This is the advantage of this imaging modality.
Journal of Ultrasonography, Volume 16, pp 113-124; https://doi.org/10.15557/jou.2016.0013

Abstract:
For centuries tissue palpation has been an important diagnostic tool. During palpation, tumors are felt as tissues harder than the surrounding tissues. The significance of palpation is related to the relationship between mechanical properties of different tissue lesions. The assessment of tissue stiffness through palpation is based on the fact that mechanical properties of tissues are changing as a result of various diseases. A higher tissue stiffness translates into a higher elasticity modulus. In the 90’s, ultrasonography was extended by the option of examining the stiffness of tissue by estimating the difference in backscattering of ultrasound in compressed and non-compressed tissue. This modality is referred to as the static, compression elastography and is based on tracking the deformation of tissue subjected to the slowly varying compression through the recording of the backscattered echoes. The displacement is estimated using the methods of cross-correlation between consecutive ultrasonic lines of examined tissue, so calculating the degree of similarity of ultrasonic echoes acquired from tissue before and after the compression was applied. The next step in the development of ultrasound palpation was to apply the local remote tissue compression by using the acoustic radiation force generated through the special beam forming of the ultrasonic beam probing the tissue. The acoustic radiation force causes a slight deformation the tissue thereby forming a shear wave propagating in the tissue at different speeds dependent on the stiffness of the tissue. Shear wave elastography, carries great hopes in the field of quantitative imaging of tissue lesions. This article describes the physical basis of both elastographic methods: compression elastography and shear wave elastography.
, Anna Nowakowska-Płaza, Marta Walentowska-Janowicz, Marek Chojnowski, Iwona Sudoł-Szopińska
Journal of Ultrasonography, Volume 16, pp 210-215; https://doi.org/10.15557/JoU.2016.0022

Abstract:
This article presents a patient with a long history of type 1 diabetes mellitus complicated with neuropathy and Charcot disease. The most common cause of neuropathic osteoarthropathy, called Charcot osteoarthropathy, is poorly controlled diabetes. The clinical picture is characterized by considerable edema, redness and increased skin temperature with relatively slight pain due to injury to nerve fibers responsible for pain sensation. The differential diagnosis should include bacterial or autoimmune arthritis, arthritis associated with gout as well as venous thrombosis and injury. The contribution of a local inflammatory reaction and abnormal bone turnover with excessive osteoclast activity might play a role in the etiopathogenesis of this disease. As a result, osseous and articular destruction progresses rapidly leading to irreversible deformity of the foot. Avoiding weight-bearing and resting the foot in a specially selected plaster cast is the most important part of treatment. Patients with the aforementioned complaints are referred to radiologists for imaging examinations. An ultrasonographer should pay attention to changes typical of Charcot arthropathy, such as: inflammatory and destructive changes in joints of the foot, uneven contour of bones with thickening and periosteal hyperemia as well as soft tissue swelling.
, Tomasz Tomczyk, Piotr Luchowski, , Radosław Kaźmierski, Zbigniew Stelmasiak
Journal of Ultrasonography, Volume 16, pp 155-162; https://doi.org/10.15557/JoU.2016.0017

Abstract:
The paper presents standards related to ultrasound imaging of the cerebral vasculature and structures. The aim of this paper is to standardize both the performance and description of ultrasound imaging of the extracranial and intracranial cerebral arteries as well as a study of a specific brain structure, i.e. substantia nigra hyperechogenicity. The following aspects are included in the description of standards for each ultrasonographic method: equipment requirements, patient preparation, study technique and documentation as well as the required elements of ultrasound description. Practical criteria for the diagnosis of certain pathologies in accordance with the latest literature were also presented. Furthermore, additional comments were included in some of the sections. Part I discusses standards for the performance, documentation and description of different ultrasound methods (Duplex, Doppler). Part II and III are devoted to standards for specific clinical situations (vasospasm, monitoring after the acute stage of stroke, detection of a right-to-left shunts, confirmation of the arrest of the cerebral circulation, an assessment of the functional efficiency of circle of Willis, an assessment of the cerebrovascular vasomotor reserve as well as the measurement of substantia nigra hyperechogenicity).
Wojciech Mądry,
Journal of Ultrasonography, Volume 16, pp 135-144; https://doi.org/10.15557/JoU.2016.0015

Abstract:
In this paper, the authors attempt to concisely present the anatomical and pathophysiological bases as well as the principles for echocardiographic evaluation of mechanical aspects of cardiac function based on speckle tracking method. This technique uses a phenomenon involving the formation of characteristic image units, referred to as speckles or acoustic markers, which are stable during cardiac cycle, on a two-dimensional echocardiographic picture. Changes in the position of these speckles throughout the cardiac cycle, which are monitored and analyzed semi-automatically by a computer system, reflect deformation of both, cardiac ventricle as a whole as well as its individual anatomical segments. The values of strain and the strain rate, as well as the range and velocity of the movement of these markers, which are in close relationship with multiple hemodynamic parameters, can be visualized as various types of charts – linear, two- and three-dimensional – as well as numerical values, enabling deeper insight into the mechanical and hemodynamic aspects of cardiac function in health and disease. The use of information obtained based on speckle tracking echocardiography allows to understand previously unclear mechanisms of physiological and pathophysiological processes. The first part of the study discusses the formation of a two-dimensional ultrasound image and the speckles, as well as the technical aspects of tracking their movement. The second part presents in more detail the methodology of speckle-tracking echocardiography, the characteristic abnormalities of cardiac mechanics presenting in different clinical entities, and the limitations related to given clinical and technical issues.
, Wojciech Baranowski, Wojciech Kosiak
Journal of Ultrasonography, Volume 16, pp 125-134; https://doi.org/10.15557/JoU.2016.0014

Abstract:
The study included 50 neonates from two hospitals in the Lower Silesia region of Poland; 25 of them were healthy patients (full-term newborns with no perinatal complications) and 25 were sick patients (newborns with heart defects such as ostium secundum atrial septal defect, ventricular septal defect, permanent foramen ovale and patent ductus arteriosus as well as newborns with neonatal jaundice or pneumonia that occurred during the first days of life). The ultrasound scans were conducted during the first days of the children's life. For every child inferior vena cava diameter was measured in the substernal area, longitudinal plane, M-mode in two respiratory phases: inhalation and exhalation. In addition, abdominal aorta diameter was determined (substernal area, transverse plane). The study demonstrated a statistically significant difference in the calculated inferior vena cava collapsibility index between both groups. Two other indices included the ratio of the inferior vena cava diameter during the expiratory phase to the diameter of the aorta and the ratio of the inferior vena cava diameter during the inspiratory phase to the diameter of the aorta; a statistically significant difference between both groups was found only for the measurements in the inspiratory phase. Based on the study results normal ranges for hydration indices in neonates were established. The need for the measurement of the abovementioned parameters in the inspiratory phase was determined. In addition, the usefulness of the ultrasound examination for the evaluation of body fluid status in this pediatric age group, particularly in preterm newborns, was noted due to its painless and non-invasive nature as well as easy access to equipment at neonatology wards.
, Wiesław Jakubowski
Journal of Ultrasonography, Volume 16, pp 191-203; https://doi.org/10.15557/JoU.2016.0020

Abstract:
Ultrasonography is the first imaging method applied in the case of diseases of the salivary glands. The article discusses basic mistakes that can be made during an ultrasound examination of these structures. The reasons for these mistakes may be examiner-dependent or may be beyond their control. The latter may include, inter alia, difficult conditions during examination (technical or patient-related), similarity of ultrasound images in different diseases, the lack of clinical and laboratory data as well as the lack of results of other examinations, their insufficient number or incorrectness. Doctor-related mistakes include: the lack of knowledge of normal anatomy, characteristics of ultrasound images in various salivary gland diseases and statistical incidence of diseases, but also attaching excessive importance to such statistical data. The complex anatomical structures of the floor of the oral cavity may be mistaken for benign or malignant tumors. Fragments of correct anatomical structures (bones, arterial wall fibrosis, air bubbles in the mouth) can be wrongly interpreted as deposits in the salivary gland or in its excretory duct. Correct lymph nodes in the parotid glands may be treated as pathologic structures. Lesions not being a simple cyst, e.g. lymphoma, benign or malignant tumors of the salivary glands or metastatic lymph nodes, can be mistaken for one. The image of disseminated focal changes, both anechoic and solid, is not pathognomonic for specific diseases in the salivary glands. However, in part, it occurs typically and requires an extended differential diagnosis. Small focal changes and infiltrative lesions pose a diagnostic problem because their etiology cannot be safely suggested on the basis of an ultrasound examination itself. The safest approach is to refer patients with abnormal focal changes for an ultrasoundguided fine-needle aspiration biopsy.
, Grzegorz Pracoń
Journal of Ultrasonography, Volume 16, pp 163-174; https://doi.org/10.15557/jou.2016.0018

Abstract:
Diagnostic imaging of psoriatic arthritis. Part II: magnetic resonance imaging and ultrasonography
Aleksandra Krasowska-Kwiecień, Jolanta Goździk, Magdalena Woźniak, Wojciech Czogała
Journal of Ultrasonography, Volume 16, pp 204-209; https://doi.org/10.15557/JoU.2016.0021

Abstract:
Infections in immunocompromised patients after hematopoietic stem cell transplantation can have a severe and atypical course. Some opportunistic pathogens are difficult to detect in microbiological tests, and that is why treatment success depends on an accurate clinical diagnosis. This article presents a case of a 7-year-old girl with severe aplastic anemia treated with bone marrow transplantation with post-transplantation period complicated by persistent, hectic fever, with peak episodes of 39–40°C, lasting several weeks. Repeated microbiological tests failed to reveal the etiological agent, and empirical anti-infective treatment was ineffective. In the fourth week of fever, imaging showed multiple foci resembling abscesses in the patient's internal organs and, subsequently, in soft tissues. The characteristics of these changes and data concerning environmental exposure led to the clinical diagnosis of cat scratch disease (bartonellosis) with multi-organ involvement and enabled the targeted treatment to be implemented. Fever subsided and organ lesions regressed. In this case, repeated ultrasound imaging was the basic diagnostic tool that helped arrive at a correct diagnosis and implement effective treatment of this life-threatening complication after hematopoietic stem cell transplantation.
Published: 25 February 2012
Journal of Ultrasonography, Volume 13, pp 31-49; https://doi.org/10.15557/JoU.2013.0003

Abstract:
From January to July 2010 in the Ultrasound Department of the Cancer Centre, The Institute of Maria Skłodowska-Curie, 375 breast ultrasound examinations were conducted. The examined group included patients who in B-mode examinations presented indications for pathological verification. They were 80 women aged between 17 and 83 (mean age was 50) with 99 solid focal lesions in the breasts. All patients underwent: the interview, physical examination, B-mode ultrasound examination and elastography of the mammary glands and axillary fossae. The visualized lesions were evaluated according to BIRADS-US classification and Tsukuba score as well as FLR ratio was calculated. In all cases, the histopathological and/or cytological verification of the tested lesions was obtained. In the group of 80 patients, the examination revealed 39 malignant neoplastic lesions and 60 benign ones. The mean age of women with malignant neoplasms was 55.07 (SD = 10.54), and with benign lesions – 46.9 (SD = 15.47). In order to identify threshold values that distinguish benign lesions from malignant ones, a comparative analysis of statistical models based on BIRADS-US classification and Tsukuba score was conducted and the cut-off value for FLR was assumed. The sensitivity and specificity values for BIRADS-US 4/5 were 76.92% and 96.67% and for Tsukuba 3/4 – 64.1% and 98.33% respectively. The assumed FLR threshold value to differentiate between benign and malignant lesions in the breasts equaled 3.13. The combined application of both classifications (with the threshold value of BIRADS-US 4/Tsukuba 3) improved the total value of sensitivity and specificity of character differentiation of focal lesions (87.2% and 95% respectively). In the case of problematic focal lesions, i.e. BIRADS-US 3, the study revealed that obtaining Tsukuba score of 1 and 2 for lesions classified as BIRADS-US 3 confirms their benign character. This allows to avoid the cytological verification.
, Anna Nowakowska-Płaza, Grzegorz Pracoń, Iwona Sudoł-Szopińska
Published: 20 February 2016
Journal of Ultrasonography, Volume 16, pp 55-64; https://doi.org/10.15557/jou.2016.0006

Abstract:
Role of ultrasonography in the diagnosis of rheumatic diseases in light of ACR/EULAR guidelines
, , Elżbieta Bernatowicz
Published: 20 February 2016
Journal of Ultrasonography, Volume 16, pp 32-43; https://doi.org/10.15557/JoU.2016.0004

Abstract:
Adipose tissue does not belong to the most favorite structures to be visualized by ultrasound. It is not, however, free from various pathologies. The aim of this paper is to make abdominal cavity examiners more familiar with non-cancerous lesions found in intra-abdominal fat. The main focus is lesions that are rarely discussed in the literature. Visceral adiposity is one of important pathogenetic factors contributing to cardiovascular events, metabolic syndrome and even certain neoplasms. That is why this article exposes sonographic features that are the most characteristic of these lesions. The value of ultrasonography in the diagnosis of this pathology is underestimated, and a number of US scan reports do not reflect its presence in any way. Moreover, the article discusses more and more common mesenteritis, the lack of knowledge of which could pose difficulties in explaining the nature of symptoms reported by patients. Furthermore, this review presents lesions referred to in the literature as focal infarction of intra-abdominal fat. This section focuses on infarction of the greater and lesser omentum, epiploic appendagitis, mesenteric volvulus and focal fat necrosis resulting from pancreatitis. These lesions should be assessed with respect to the clinical context, and appropriate techniques of ultrasonography should be employed to allow careful determination of the size, shape, acoustic nature and location of lesions in relation to the integuments and large bowel, as well as their reaction to compression with an ultrasound transducer and behavior during deep inspiration. Moreover, each lesion must be obligatorily assessed in terms of blood flow. Doppler evaluation enables the differentiation between primary and secondary inflammation of intra-abdominal fat. The paper also draws attention to a frequent indirect sign of a pathological process, i.e. thickening and hyperechogenicity of fat, which sometimes indicates an ongoing pathology at a deeper site. This structure may completely conceal the primary lesion rendering it inaccessible for ultrasound. In such cases and in the event of other doubts, computed tomography should be the next diagnostic step.
Waldemar Białek, Sławomir Rudzki, Lech Wronecki
Published: 20 February 2016
Journal of Ultrasonography, Volume 16, pp 87-93; https://doi.org/10.15557/JoU.2016.0009

Abstract:
This paper presents the case of a very rare capillary hemangioma of the testis in a 23-year-old patient. Physical examination revealed a tumor located in the upper pole of the left testis, which was suspected of being malignant due to its significantly increased density and irregular contours. Blood levels of the following tumor markers were determined: alpha-fetoprotein, human chorionic gonadotropin and lactate dehydrogenase. No abnormalities were found in any of these tests. A gray-scale ultrasound scan of the scrotum revealed a lesion located in the upper pole of the left testis, 24 mm in diameter with slightly decreased echogenicity and irregular contours, which suggested infiltration of the tunica albuginea of the testis. Color and power Doppler scans demonstrated a dense network of blood vessels and increased blood flow in the lesion described. In addition, 3D ultrasound scan images were obtained, which allowed for a thorough determination of the topography of the lesion. No abnormalities were found in the patient's medical history, physical examination or ultrasound scan of the right testis. Taking into account the suspected malignancy with signs of infiltration of the tunica albuginea of the upper pole of the testis a decision was made to remove the left testis together with the spermatic cord using the inguinal approach. A histopathological examination of the whole specimen revealed a multifocal capillary hemangioma of the testis, signs of testicular fibrosis and significant atrophy of the spermatogenic epithelium of the seminiferous tubules. Immunohistochemistry: CD31 (+), CD34 (+), FVIII (−), vimentin (+), CK MNF116 (−), mesothelial cells (−), calretinin (−), MIB-1 = 8.4%. The tumor described is one of the few benign lesions originating from the tissues of the testis for which partial resection of the organ may be considered. Intraoperative histopathological examination and resection of the lesion with the preservation of a healthy tissue margin may be considered in patients with a single testis in whom the tumor is found to have a very rich vascular network and the levels of tumor markers are normal.
, Tomasz Tomczyk, Piotr Luchowski, , Radosław Kaźmierski, Zbigniew Stelmasiak
Published: 20 February 2016
Journal of Ultrasonography, Volume 16, pp 44-54; https://doi.org/10.15557/jou.2016.0005

Abstract:
Standards in neurosonology. Part II
Katarzyna Kapuścińska, Andrzej Urbanik
Published: 20 February 2016
Journal of Ultrasonography, Volume 16, pp 16-24; https://doi.org/10.15557/jou.2016.0002

Abstract:
Efficacy of high frequency ultrasound in postoperative evaluation of carpal tunnel syndrome treatment
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