Diagnostic value of contrast-enhanced ultrasound (CEUS) and comparison with color Doppler ultrasound and magnetic resonance in a case of scrotal trauma

Multimodal ultrasound diagnosis of epididymo-orchitis with secondary testicular infarction: A case report

We report a case of a 48-year-old man with testicular infarction caused by epididymo-orchitis (EO). Multimodal ultrasound showed extensive necrosis of the testis, and the patient underwent right orchiectomy. Postoperative pathology confirmed extensive necrosis of the testis. After 3 months of follow-up, the examination of scrotal ultrasound showed that the left testis and epididymis had no obvious abnormality.

Role and added value of contrast enhanced ultrasound of the painful scrotum in the emergency setting

Emergency imaging of the scrotum is part of routine medical practice. Indications include epididymitis/epididymo-orchitis, testicular torsion, trauma, tumors and infarction. Prompt diagnosis and management are needed to ensure optimal patient outcome. Ultrasound (US) is the initial, and often the only, imaging modality for testicular pathologies. Usually, B-mode and color Doppler US are adequate. In challenging cases, contrast-enhanced US (CEUS) facilitates final diagnosis or increases the examiner's confidence by confirming findings on non-enhanced US. This paper elaborates on the examination technique of CEUS for testicular pathologies, thereby showing its added value over baseline US techniques in the emergency setting.

Non-Operative Management of Polytraumatized Patients: Body Imaging beyond CT

In the transition from the operative to the conservative approach for the polytraumatized patients who undergo blunt trauma, diagnostic imaging has assumed a pivotal role, currently offering various opportunities, particularly in the follow-up of these patients. The choice of the most suitable imaging method in this setting mainly depends on the injury complications we are looking for, the patient conditions (mobilization, cooperation, medications, allergies and age), the biological invasiveness, and the availability of each imaging method. Computed Tomography (CT) represents the “standard” imaging technique in the polytraumatized patient due to the high diagnostic performance when a correct imaging protocol is adopted, despite suffering from invasiveness due to radiation dose and intravenous contrast agent administration. Ultrasound (US) is a readily available technology, cheap, bedside performable and integrable with intravenous contrast agent (Contrast enhanced US—CEUS) to enhance the diagnostic performance, but it may suffer particularly from limited panoramicity and operator dependance. Magnetic Resonance (MR), until now, has been adopted in specific contexts, such as biliopancreatic injuries, but in recent experiences, it showed a great potential in the follow-up of polytraumatized patients; however, its availability may be limited in some context, and there are specific contraindications, such as as claustrophobia and the presence non-MR compatible devices. In this article, the role of each imaging method in the body-imaging follow-up of adult polytraumatized patients will be reviewed, enhancing the value of integrated imaging, as shown in several cases from our experience.

A case report of staged testicular infarction

Segmental testicular infarction is a rare clinical condition most often seen as acute unilateral scrotal pain. Segmental testicular infarction should be suspected in patients with scrotal pain; when an ultrasound shows hypoechoic or mixed echogenic lesions within the testicular parenchyma; contrast-enhanced ultrasound shows a little or no contrast filling, along with negative multiple tumor markers. This report presents a 60-year-old male who presented with sudden onset of left testicular pain with no apparent cause. Emergency Doppler ultrasound, contrast-enhanced ultrasound, and laboratory tests showed findings characteristic of Segmental testicular infarction. The patient the final diagnosis was based on a combination of clinical findings (regression or cessation of symptoms, no tumor marker abnormalities, no palpable testicular mass) and ultrasound evidence of improvement (size reduction or shape change from oval to wedge) during a follow-up period of at least 3 months.

Diagnostic Value of Color Doppler Flow Imaging Combined with Serum CRP, PCT, and IL-6 Levels for Neonatal Pneumonia

Objective

To evaluate the diagnostic value of combined detection of color Doppler flow imaging (CDFI) and serum C-reactive protein (CRP), procalcitonin (PCT), and interleukin-6 (IL-6) levels for neonatal pneumonia.

Methods

In this prospective study, 30 newborns with pneumonia and 30 healthy newborns in our hospital from January 2019 to January 2020 were recruited. The healthy newborns were assigned to the control group, and the newborns with pneumonia were assigned to the experimental group. All subjects underwent CDFI and measurement of the levels of serum CRP, PCT, and IL-6. The serum indices and imaging results of the two groups were analyzed, and the specificity and sensitivity of different detection methods in the diagnosis of neonatal pneumonia were calculated and analyzed.

Results

The levels of serum CRP, PCT, and IL-6 in the experimental group were significantly higher than those in the control group (P < 0.001). Combined detection had a larger detection area, higher sensitivity, and a superior overall detection outcome than single detection (P < 0.05). The diagnostic results of combined detection and clinical diagnosis in 30 newborns with pneumonia were similar (P > 0.05).

Conclusion

The combined detection of CDFI and serum CRP, PCT, and IL-6 levels in the diagnosis of neonatal pneumonia shows a promising diagnostic outcome, so it is worthy of clinical application.

Application of Color Doppler Ultrasound in Microscopic Imaging Diagnosis of Adenomyosis

In order to explore the value of color Doppler ultrasonography (TVCDS) in the diagnosis and differential diagnosis of adenomyosis. A total of 150 patients with adenomyosis admitted to a hospital from January 2020 to December 2021 were selected, taking transvaginal three-dimensional color Doppler ultrasound and abdominal ultrasound for examination, all results were compared with patient pathology or surgical results, in order to compare the accuracy of the two inspection methods. The positive predictive value of three-dimensional color Doppler ultrasonography was higher than that of abdominal ultrasonography, and the difference was statistically significant (P < 0.05). The coincidence rate, sensitivity, and specificity of three-dimensional color Doppler ultrasonography were higher than those of abdominal ultrasonography, while the misdiagnosis rate was lower than that of abdominal ultrasonography, and the differences were statistically significant (all P < 0.05). The imaging features of vaginal three-dimensional color Doppler ultrasound in patients with adenomyosis are mainly enlarged uterus, slightly stronger echoes in the myometrium with enhanced echogenic spots, and short or short branch blood flow signals in the lesions. After statistical analysis, there was a significant difference in the blood flow changes between benign and malignant endometrial echoes and abnormal echoes in the uterine cavity, P < 0.05. Normal endometrium and benign intrauterine lesions mainly showed no blood flow signal, while malignant lesions in the uterine cavity mostly showed changes in blood flow signal. Compared with abdominal examination, transvaginal color Doppler ultrasonography has obvious advantages in the diagnosis of adenomyosis. According to the characteristics of ultrasound images, blood flow distribution, frequency spectrum, etc., it can provide a more accurate basis for clinical timely, provide the identification points of uterine fibroids, and provide help for clinicians to choose a treatment plan.

Imaging Review of Pelvic Ring Fractures and Its Complications in High-Energy Trauma

Pelvic ring fractures are common in high-energy blunt trauma, especially in traffic accidents. These types of injuries have a high rate of morbidity and mortality, due to the common instability of the fractures, and the associated intrapelvic vascular and visceral complications. Computed tomography (CT) is the gold standard technique in the evaluation of pelvic trauma because it can quickly and accurately identify pelvic ring fractures, intrapelvic active bleeding, and lesions of other body systems. To properly guide the multidisciplinary management of the polytrauma patient, a classification criterion is mandatory. In this review, we decided to focus on the Young and Burgess classification, because it combines the mechanism and the stability of the fractures, helping to accurately identify injuries and related complications.

Can contrast enhanced ultrasound (CEUS) be useful in the diagnosis of ovarian torsion in pediatric females? A preliminary monocentric experience

PURPOSE

To describe contrast enhanced ultrasound (CEUS) characteristics of ovarian torsion in pediatric females, assessing the potential diagnostic advantages of method as well as its limitations.

MATERIALS AND METHODS

A retrospective study design was used. Between January 2018 and December 2020 we analyzed all pediatric females who underwent explorative surgery with a suspected diagnosis of ovarian torsion, and who were previously evaluated by conventional ultrasound (US), color-Doppler ultrasound (CDUS) and CEUS.

RESULTS

We examined twenty pediatric females with a median age of 12 years. US identified 9/20 ovarian complex masses against 13/20 by CEUS. At US abdominal free fluid was shown in 13/20 patients and in 18/20 cases with CEUS. In our case series the evaluation of contrast enhancement at CEUS in the detection of ovarian torsions revealed a sensitivity of 94.1%, a specificity of 100% and an overall accuracy of 95%.

CONCLUSION

Although there is a known ultrasound semeiotics suggestive of ovarian torsion, it is not always possible to obtain a diagnosis of certainty with conventional US even with CDUS. The study reports that complementation with CEUS showed excellent agreement with surgery obtaining a diagnosis in almost all the pediatric females examined.

The Application Value of Contrast-Enhanced Ultrasound in Testicular Occupied Lesions

Objective

To discuss the clinical application value of contrast-enhanced ultrasound (CEUS) in testicular occupied lesions.

Methods

Nine conventional-ultrasound-found testicular occupied lesions which underwent CEUS meantime were analyzed retrospectively. The CEUS perfusion pattern was compared with the surgical pathological result or follow-up findings.

Results

Among all the 9 testicular occupied lesions, there were 5 testicular malignant tumors, 1 testicular benign tumor, 1 testicular tuberculosis, and 2 testicular hematomas. CEUS diagnosed 6 testicular malignant tumors, 1 testicular benign tumor, and 2 testicular hematomas, and its diagnostic accuracy was about 88.9%.

Conclusion

CEUS has high clinical application value in the differential diagnoses of benign and malignant testicular occupied lesions.

Role of color flow Doppler ultrasound in the evaluation of acute scrotal pain

Color flow Doppler ultrasound is a critical tool in the assessment of the scrotum. Ultrasound is the first-line imaging modality and can rapidly differentiate between surgical and nonsurgical conditions, allowing for appropriate and prompt patient management. We review the role of color flow Doppler in the evaluation of acute scrotal pain, highlighting some of the most commonly seen pathologies such as epididymo-orchitis and testicular torsion.

Ultrasound of scrotal and penile emergency: how, why and when

High-resolution ultrasound is the most common imaging technique used to supplement the physical examination of scrotum and penis with great accuracy in assisting the diagnosis of the various pathologies of male genital system, with the highest diagnostic potential in emergency conditions. Technical advancements in real-time high-resolution, color flow Doppler sonography and contrast enhanced ultrasonography (CEUS) have led to an increase in the clinical applications of scrotal and penile sonography. In this pictorial review we focus on common and uncommon male genitalia emergency with special emphasis on the role of ultrasound assessment and its specific findings to improve diagnostic accuracy.

High-flow post-traumatic priapism: diagnostic and therapeutic workup

Priapism is a prolonged penile tumescence or erection unrelated to sexual stimulation that lasts more than 6 h. High-flow priapism is a rare condition usually due to a perineal trauma with the formation of an arterio-cavernosal fistula between a cavernosal artery and the lacunar spaces of the penis. High-flow priapism is usually diagnosed by clinical examination and color Doppler ultrasound, and the gold standard therapeutic management is represented by digital subtraction angiography. We report a case of a young patient with high-flow priapism after a motorcycle blunt perineal trauma, examining in detail the specific color Doppler ultrasound findings, the diagnostic workup and the therapeutic management.