Ultrasonic Diagnosis of Congenital Enterocolitis Fistula: A Case Report

Background: Congenital enterocolic fistula, an abnormal connection between the small intestine and the colon, is a rare condition with the potential for significant complications affecting the patient's quality of life. Case Report: A 2 year and 7 months old girl presented with abdominal pain and diarrhea lasting more than 10 days. The formation of the intestinal fistula was first detected by ultrasound, and the blood flow in the intestinal wall was preliminally analyzed. Surgical exploration revealed a colonic fistula formed by the attachment of the jejunum to the descending colon. Postoperatively, symptoms improved; no secondary infection occurred and the fistula healed well. Conclusion: Congenital colon fistula is rarely reported, and ultrasound is becoming more and more important in its diagnosis. Here, we report a case of congenital colonic fistula diagnosed by ultrasound. Ultrasound can dynamically and in real-time observe the intestinal condition, which is conducive to the early diagnosis and staging of congenital intestinal diseases and the determination of diagnosis and treatment schemes.

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Predictive value of ultrasonography in polyneuropathy diagnosis: electrophysiological and ultrasonographic analysis

Peripheral neuropathy may cause serious complications such as foot ulcers and Charcot joint which can prevent by early diagnosis. We aimed to analyze the diagnostic value of ultrasonographic measurements of nerves and muscles in distal symmetric axonal polyneuropathy (DSAP). Study included 51 DSAP patients and 51 controls. Nerve conduction studies were performed. Median, ulnar, tibial, superficial peroneal, and sural nerves and the abductor pollicis brevis (APB), abductor digiti minimi (ADM), first dorsal interosseous (FDI), extensor digitorum brevis (EDB), abductor hallucis (AH) and tibialis anterior (TA) muscles were evaluated with ultrasound. The Toronto clinical scoring system (TCSS) was used to assess the severity of neuropathy. The median, ulnar, and tibial nerve cross-sectional areas (CSA) were higher in the DSAP group (p = 0.025, p = 0.011, p < 0.001 respectively) while superficial peroneal and sural nerve CSAs were not differed. Only AH and EDB ultrasonographic findings from the muscles differed between the two groups. Effect of diabetes and DSAP on sonographic findings were assessed with two-way ANOVA. Results indicated that only DSAP had a significant effect on sonographic nerve and muscle examination. The area under the ROC curve was 0.831 ± 0.042 for tibial nerve CSA (p < 0.001) with a cut-off value of 15.5 mm2 (sensitivity 74% and specificity 83%). Median, ulnar and tibial nerve CSAs were found to be larger in polyneuropathy patients and they were associated with the clinical and electrophysiological severity of polyneuropathy. ROC analysis showed that tibial nerve CSA may have a predictive value in the diagnosis of DSAP.

A complementary comment on primary hepatic angiosarcoma: A case report

BACKGROUND

This article examines primary hepatic angiosarcoma (PHA) and fat-poor angiomyolipoma (AML), two uncommon vascular cancers. Clinical decisions in these situations are frequently aided by pathology reports and imaging techniques. Uncommon malignant tumors of the vascular endothelium include PHA. Another diagnosis that should not be overlooked when employing contrast-enhanced MR and contrast-enhanced computed tomography (CT) imaging techniques is fat-poor AML, one of the uncommon vascular tumors of the liver. In both conditions, biopsy is the primary means of diagnosis.

CASE SUMMARY

In our article, besides the diagnosis of PHA, fat-poor AML, one of the other rare vascular tumors of the liver, is mentioned. In the case, a 50-year-old female patient with VHL Syndrome was admitted to our hospital with nonspecific lesions such as right upper quadrant pain, weight loss, and nausea. Abdominal ultrasonography (US) revealed a hypoechoic heterogeneous lesion with occasional faint contours. In computed tomography, it was observed as a hyperdense nodular lesion in segment 4. Magnetic resonance imaging (MRI) revealed that the lesion did not contain fat. In connection with the known history of VHL Syndrome, we first evaluated the possibility of AML. Thereupon, a histopathological sample was taken and the diagnosis was made as fat-poor AML with 5% fat content.

CONCLUSION

In conclusion, PHA in our case report and fat-poor AML in our clinic are two uncommon liver vascular malignancies with comparable incidences. Important imaging techniques like contrast-enhanced US (CEUS), CECT, and CEMRI give us substantial advantages in both cases. However, a biopsy is used to provide the final diagnosis.

Primary hepatic angiosarcoma: A case report

BACKGROUND

Primary hepatic angiosarcoma (PHA) is a rare malignant tumor of the vascular endothelium. Clinical manifestations and laboratory and imaging examinations often lack specificity for PHA. We report a case of PHA, and describe the ultrasound characteristics and characteristic changes in laboratory values associated with PHA.

CASE SUMMARY

A 75-year-old woman presented with right upper quadrant abdominal pain for half a month. Magnetic resonance imaging (MRI) at a local hospital revealed multiple liver space-occupying lesions, and she was admitted to our hospital for further diagnosis. Contrast-enhanced ultrasound (CEUS) revealed multiple slightly hyperechoic nodules in the liver, which were suspected to be of malignant vascular origin. Contrast-enhanced computed tomography revealed multiple low-density nodules in the liver, considered to be metastatic hematopoietic malignancies. Contrast-enhanced MRI showed that the multiple liver nodules shared features with infectious lesions. Laboratory examination revealed normal alpha-fetoprotein levels, slightly increased other liver enzymes, decreased platelets, and significantly increased D-dimer levels. Liver biopsy and histopathology confirmed the presence of PHA.

CONCLUSION

CEUS can provide valuable clues for the diagnosis of PHA and greatly improve the success rate of puncture biopsy.

Artificial intelligence for identification of focal lesions in intraoperative liver ultrasonography

PURPOSE

Intraoperative ultrasonography (IOUS) of the liver is a crucial adjunct in every liver resection and may significantly impact intraoperative surgical decisions. However, IOUS is highly operator dependent and has a steep learning curve. We describe the design and assessment of an artificial intelligence (AI) system to identify focal liver lesions in IOUS.

METHODS

IOUS images were collected during liver resections performed between November 2020 and November 2021. The images were labeled by radiologists and surgeons as normal liver tissue versus images that contain liver lesions. A convolutional neural network (CNN) was trained and tested to classify images based on the labeling. Algorithm performance was tested in terms of area under the curves (AUCs), accuracy, sensitivity, specificity, F1 score, positive predictive value, and negative predictive value.

RESULTS

Overall, the dataset included 5043 IOUS images from 16 patients. Of these, 2576 were labeled as normal liver tissue and 2467 as containing focal liver lesions. Training and testing image sets were taken from different patients. Network performance area under the curve (AUC) was 80.2 ± 2.9%, and the overall classification accuracy was 74.6% ± 3.1%. For maximal sensitivity of 99%, the classification specificity is 36.4 ± 9.4%.

CONCLUSIONS

This study provides for the first time a proof of concept for the use of AI in IOUS and show that high accuracy can be achieved. Further studies using high volume data are warranted to increase accuracy and differentiate between lesion types.

Clinical application of gastrointestinal contrast-enhanced ultrasonography in diagnosis of gastric duodenal diseases

Gastrointestinal contrast-enhanced ultrasound examination is performed by giving patients an oral gastrointestinal ultrasound developer to enhance the imaging of the gastrointestinal structure, which can significantly reduce or even eliminate the interference of gastrointestinal gas and effectively reflect the gastric and duodenal lesions as well as their size, shape, and echo, with high diagnostic accuracy. This article mainly expounds the application of gastrointestinal contrast-enhanced ultrasonography in gastric and duodenal diseases to provide reference for clinicians.

Clinical manifestation and surgical treatment analysis of five cases with biatrial myxoma

BACKGROUND

Cardiac myxomas (CMs) are a major primary heart tumor which often causes unexpected symptoms or sudden death. Among CMs, biatrial myxomas are even rare. This study was designed to investigate the clinical characteristics and surgical treatment of 5 cases with biatrial myxoma, to summarize the treatment experience and the effect of short-to-mid-term prognosis.

METHODS

Five patients with biatrial myxoma were included in this study. The patients' relative literature, chest X-ray, body-surface electrocardiogram, and ultrasonic cardiogram (UCG) were used to investigate the clinical characteristics. The experience of surgical treatment and perioperative treatment were analyzed.

RESULTS

Among the 5 cases, patients had presented discomfort of precordial area and cardiac insufficiency symptoms such as dyspnea and chest discomfort. There were characteristic changes on echocardiography (ECG). All patients accepted resection of both tumor and its basement tissue. Their symptoms were all improved after surgery, no deaths occurred.

CONCLUSION

In conjunction with clinical features, diagnostic clue and echocardiography, the detectable rate of biatrial myxoma could be significantly improved. Early diagnosis showed good effect on prognosis.

Clinical value of color doppler ultrasound in prenatal diagnosis of umbilical cord entry abnormity

OBJECTIVE

To study the clinical value of prenatal diagnosis of umbilical cord entry abnormity (UCEA) by means of color Doppler ultrasound (CDUS).

METHODS

Clinical data of sixty-four cases with confirmed umbilical cord entry abnormity were reviewed and the specific UCEA conditions and the outcomes of perinatal infants were analyzed.

RESULTS

Detection rates of marginal umbilical cord entry abnormity and velamentous umbilical cord entry abnormity by means of CDUS at second trimester were 94.1% and 93.8% respecdtively much higher than 80.0% and 68.8% which were those of third trimester. Discrepancy had statistical significance (P<0.05). True positive rate of prenatal diagnosis of UCEA by means of CDUS was 85.9% (55/64), and false negative rate was 14.1% (9/64). Among sixty four patients with UCEA, seventeen patients (26.6%) underwent selective caesarean delivery; twenty-six patients (35.9%) underwent emergency caesarean delivery and twenty-four patients (37.5%) had normal delivery.

CONCLUSION

Prenatal diagnosis of UCEA by means of CDUS is intuitive and accurate. It provides an evidence for determination of the best time to diagnose UCEA, and also offers a proper advice for pregnant women about delivery mode to ensure the fetus survival rate, which is clinically valuable.

Application of percutaneous cardiopulmonary support for cardiac tamponade following blunt chest trauma: two case reports

Since the advent of percutaneous cardiopulmonary support (PCPS), its application has been extended to massively injured patient. Cardiac injury following blunt chest trauma brings out high mortality and morbidity. In our cases, patients had high injury severity score by blunt trauma and presented sudden hemodynamic collapse in emergency room. We quickly detected cardiac tamponade by focused assessment with sonography for trauma and implemented PCPS. As PCPS established, their vital sign restored and then, they were transferred to the operation room (OR) securely. After all injured lesion repaired, PCPS weaned successfully in OR. They were discharged without complication on day 26 and 55, retrospectively.

A novel global strain diastolic index correlates with plasma NT-proBNP levels in asymptomatic hypertensive patients with preserved left ventricular ejection fraction

BACKGROUND

The strain imaging diastolic index (SI-DI) was reported to be a sensitive marker of regional left ventricular (LV) delayed relaxation induced by ischemia. However, the clinical usefulness of the global SI-DI has not been evaluated. N-terminal pro-brain natriuretic peptide (NT-proBNP) is a sensitive biomarker for the detection of asymptomatic diastolic LV dysfunction. This study investigated the ability of a novel parameter, the global SI-DI, obtained using 2D speckle tracking imaging (2DSI) to correlate with the plasma NT-proBNP levels in asymptomatic hypertensive patients with preserved LV ejection fraction.

METHODS

We performed 2D echocardiography and 2DSI in 83 asymptomatic hypertensive patients with preserved ejection fraction (>45 %) and in 37 control subjects. In 2DSI, the LV longitudinal peak strain and the SI-DI of 18 LV segments were measured. NT-proBNP was measured in all subjects. The data were compared between hypertensive patients and normal controls.

RESULTS

The average peak strain and global SI-DI of 18 LV segments were significantly reduced in hypertensive patients compared with control subjects (P < 0.05); however, only the global SI-DI was significantly correlated with log10 NT-proBNP (r = -0.469, P = 0.001). In Pearson's correlation analyses, log10 NT-proBNP was significantly correlated with E/e', E/A ratio, early diastolic mitral annular velocity (e'), global peak strain, deceleration time of the E-wave, and LV ejection fraction. In the multiple stepwise regression analysis, the global SI-DI was the strongest independent determinant of log10 NT-proBNP (β = -0.386, P = 0.008).

CONCLUSIONS

The global SI-DI derived from 2DSI correlates well with plasma NT-proBNP levels and may have prognostic value in asymptomatic hypertensive patients with preserved ejection fraction.

Correlation between clinicopathological and ultrasonic diagnosis of small protuberant lesions of the gallbladder

AIM: To explore the correlation between clinicopathological and ultrasonic diagnosis of small protuberant lesions of the gallbladder (SPLG).

METHODS: Seven hundred and fifty-three patients who were diagnosed with SPLG by abdominal color Doppler ultrasonography and pathological examination were included in our study. The correlation between clinicopathological characteristics and ultrasonic imaging characteristics of SPLG was retrospectively analyzed.

RESULTS: For all the 753 patients with SPLG, ultrasonic diagnosis had a sensitivity of 98.26%, a specificity of 84.42%, an accuracy of 89.77%, a positive predictive value of 89.77%, and a negative predictive value of 89.61%. For the patients with cholesterol polyps, the positive predictive value of ultrasonic diagnosis was more than 92.72%. Between SPLG patients with cholecystitis and gallstones, a significant difference was found in clinicopathological characteristics (t = 3.417, P < 0.05). Of all the SPLG patients, 92.30% (695/753) had SPLG with a diameter ≤10 mm, of which 99.14% (689/695) had a benign disease and 0.86% (6/695) had a malignant disease, and 7.70% (58/753) had SPLG with a diameter >10 mm, of which 56.90% (33/58) had a benign disease and 43.10% (25/58) had a malignant disease. A significant difference was noted in the diameter of benign and malignant polyps (t = 15.381, P < 0.01).

CONCLUSION: The positive predictive value of ultrasonic diagnosis of cholesterol polyps is more than 90%. Ultrasonic diagnosis has high clinical value and is the first choice for the diagnosis of SPLG.

Advances in ultrasonic diagnosis of hepatic fibrosis and early cirrhosis

With the development of medical ultrasonic technology, sonography has become an important means for diagnosis and evaluation of hepatic fibrosis and early cirrhosis. Two-dimensional sonography is the basic means of ultrasonic diagnosis and can be used to display the appearance and echo of the liver. Color Doppler sonography and Doppler frequency spectrum permit assessment of the portal venous system and detection of portal blood flow. They can be used not only for estimation of hepatic parenchymal changes but also for evaluation of portal hypertension and its complications. Contrast-enhanced ultrasound permits use of a blood-pool tracer and can assess the blood flow perfusion of hepatic parenchyma. Elasticity imaging indirectly reflects tissue pathological changes by measuring tissue elastic modulus. Fibroscan has shown great promise for staging and diagnosing hepatic fibrosis and monitoring the development of hepatic cirrhosis and portal hypertension, thus offering a new method for noninvasive diagnosis of hepatic diseases. The clinical application of these techniques has greatly improved the diagnosis of hepatic diseases. In this article, we will review the recent advances in ultrasonic diagnosis of hepatic fibrosis and early cirrhosis.

Idiopathic dissection from left subclavian artery to brachial artery: Spontaneous repair with conservative management

We report an unusual case of a 58-year-old female with idiopathic dissection of the left subclavian artery to the brachial artery which provoked vessel narrowing in the acute phase and was spontaneously repaired without surgical procedures in the chronic phase. We describe the serial imaging findings of the angiography and ultrasonography which demonstrate restoration of the dissection. In carefully selected patients, conservative management could be an alternative treatment to surgery or stenting with an excellent outcome.

Value of fatty renal capsule thickness in diagnosis of fatty liver disease

AIM: To explore the clinic value of fatty renal capsule thickness in diagnosis of fatty liver disease.

METHODS: Thirty cases with mild and or with moderate to severe degree of fatty liver were collected, and their fatty renal capsule thickness was measured.

RESULTS: The fatty renal capsule thickness had significant differences between the normal group and mild, moderate to severe degree groups (P < 0.05), and had no differences between the mild and moderate to severe degree groups (P > 0.05). If 1.25, 0.65, 1.05, 0.55 cm were used as the critical value of the fatty renal capsule thickness for ultrasonic diagnosis of fatty liver at the long axis inferior pole, short axis surround of right kidney and left kidney, the sensitivities were 72.7%, 75.0%, 72.7% and 77.3% respectively, the specificities were 93.7%, 87.5%, 93.7% and 87.5% respectively.

CONCLUSION: The fatty renal capsule thickness can be used as the reference index for the ultrasonic diagnosis of fatty liver disease.

Ultrasonic diagnosis of biliary atresia: A retrospective analysis of 20 patients

AIM: To investigate the clinical value of ultrasonographic diagnosis of biliary atresia (BA), a retrospective analysis of the sonogram of 20 children with BA was undertaken.

METHODS: Ultrasonography (US) was performed in 20 neonates and infants with BA, which was confirmed with cholangiography by operation or abdominoscopy. The presence of triangular cord, the size and echo of liver, the changes in empty stomach gallbladder and postprandial gallbladder were observed and recorded.

RESULTS: The triangular cord could be observed at the porta hepatis (thickness: 0.3-0.6 cm) in 10 cases. Smaller triangular cord (0.2-0.26 cm) can be observed in 3 cases. The gallbladder was not observed in 2 cases, and 1 case showed a streak gallbladder without capsular space. The gallbladders of 15 cases were flat and small. The gallbladders of 2 cases were of normal size and appearance, however, there was no postprandial contraction. The livers of all cases showed hepatomegaly and heterogeneous echogenicity. Statistical analysis was performed to compare the hepatomegaly and heterogeneous echogenicity and the stage of hepatic fibrosis.

CONCLUSION: The presence of the triangular cord at the porta hepatis is specific. However, it is not the only diagnostic criterion, since flat and small gallbladder and poor contraction are also of important diagnostic and differential diagnostic significance. The degree of hepatomegaly and heterogeneous echogenicity is proportional with liver fibrosis, and able to indicate the duration of course and prognosis.