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Martin Necas 1 & Holly Smith 1

1    Waikato Hospital, Hamilton, New Zealand; martin@antegrade.net

*   Correspondence: martin@antegrade.net

Clinical History:

An 8-day-old female born at 23-weeks gestation was referred for abdominal ultrasound due to worsening metabolic acidosis, abdominal distension and discolouration. An X-ray performed prior to ultrasound showed paucity of bowel gas, a prominent fixed loop of small bowel centrally, with no definite signs of free gas. High-resolution abdominal ultrasound was performed using an ultra-broadband linear array transducer (eL18-4, Philips Epiq Elite ultrasound system).

 

View the October Case below, answer the question and then click check >

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Sofie Bech Andersen1,*

1    Department of Radiology, Rigshospitalet, DK-2100 Copenhagen, Denmark

*   Correspondence: anne.sofie.bech.andersen@regionh.dk

Clinical History:

A 54-year old female with a past medical history of rheumatoid arthritis, a hiatus hernia, and appendectomy as a child, presented with intermittent upper abdominal pain and vomiting. The abdominal pain had occurred every 2nd to 3rd month during the past years, each time lasting roughly 3 days. The pain radiated to the back. No fever, weight loss or alterations in feces and urine was reported.

A physical exam revealed the patient’s abdomen soft and non-tender with no palpable masses.

With a clinical suspicion of gall stones, an abdominal ultrasound examination was requested and performed.

View the September Case below, answer the question and then click check >

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Codruta Constantinescu1, Dana Nedelcu2, Nona Bejinariu3, Georgia Baltog2, Alina Constantin2, Cătălin Copăescu2, Adrian Săftoiu1,2

1. Research Center of Gastroenterology and Hepatology Craiova
2. Ponderas Academic Hospital Bucharest
3. Santomar Cluj

*  Correspondence: adriansaftoiu@gmail.com / constantinescu.codruta@yahoo.com

Clinical History:
A 32-year-old female with a history of Crohn’s disease for 8 years, receiving intermittent treatment with steroids, immunosuppressants and biologic treatment, had a pericolic abscess drained recently percutaneously. She presented to the Gastroenterology Clinic of Ponderas Academic Hospital, Bucharest, Romania for a second opinion. She had no complaints, no diarrhea and even reported weight gain.

Image 1a & 1b: B-mode ultrasound reveals a thickened colonic wall with ab-sent stratification.
Image 1a & 1b: B-mode ultrasound reveals a thickened colonic wall with ab-sent stratification.
Image 2: 3D reconstruction of virtual CT colonography showing retroperito-neal passage of the CO2 (arrows) through a patent colonic fistula.
Image 3: Virtual colonography “fly-through” shows progressive reduction of the colonic lumen up to an ample stenosis of the descending colon as well as the fistula entry site (red arrow).
Image 4: Colonoscopy reveals impassable stenosis of the descending colon.

Video: Power Doppler ultrasound shows a hypervascularized bowel wall.

View the May Case below, answer the question and then click check >

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Jonathan Cohen 1*

1   Department of Radiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark; mailjonathancohen@gmail.com

 *   Correspondence: mailjonathancohen@gmail.com

Clinical History:

A 44-year-old male presented to our clinic with swollen inguinal lymph nodes on the left side for about 2 weeks. The lymph nodes were tender on palpation, but there was no discoloring on the skin. The patient had no fever, was in good physical shape and did not suffer from any illnesses. Two weeks previously the patient had stayed at a vacation home in a forest, and remembered one day having removed a few small ticks walking on his leg. He had had no signs of erythema migrans, wounds or swelling on the leg.

An initial ultrasound examination was performed revealing the images below.

View the May Case below, answer the question and then click check >

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Douglas Almeida de Oliveira Filho, MD
Thiago Adler Ralho Rodrigues dos Santos, MD, PhD

  • Department of Radiology, University Hospital, Federal University of Mato Grosso do Sul (UFMS) Campo Grande –Brazil

Clinical History:

A 51-year-oldman complains about an increasing enlargement of the right testicle after a trauma 6 months ago. The physical examination showed a hardened painless right testicle, with volumetric increase, but no other signs or symptoms.

Fig. 1
Fig. 2
Fig. 3
Fig. 4

View the June Case below, answer the question and then click check >

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Caio Batalha Pereira, Simone Uezato Ota, Marcelo Schelini, Julia Diva Zavaris, Wagner Iared, Maria Cristina Chammas

  • Centro de Aperfeiçoamento e Pesquisa em Ultrassonografia Prof. Dr. Giovanni Guido Cerri, DASA, São Paulo, Brazil.

Clinical History:

A 23-year-old womanfrom the countryside of São Paulo came to our clinicfora routine gynecologic examination. She had no known comorbidity.

The figures represent:
Presence of ill-defined nodular formation, hyperechogenic, without Doppler flow, in the right ovary, measuring approximately 0.8 x 0.7 x 0.6 cm. Volume: 0.3 cm³.

View the April Case below, answer the question and then click check >

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Case of the Month March 2021- A heart liver

by Admin

Caio Batalha Pereira, Simone Uezato Ota, Marcelo Schelini, Wagner Iared, Maria Cristina Chammas

  • Centro de Aperfeiçoamento e Pesquisa em Ultrassonografia Prof. Dr. Giovanni Guido Cerri, DASA, São Paulo, Brazil.

Clinical History:

A 67-year-old woman from the countryside of São Paulo came to our clinic with complaints of mild right upper quadrant abdominal pain and slightly elevated serum liver enzymes. She had heart failure as comorbidity.

View the March Case below, answer the question and then click check >

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Matthew Gourlay

  • Fowler Simmons Radiology. Adelaide, South Australia

Clinical History:

57 year old female runner. Recent increase in running load with increasing medial knee pain.

Image 1- Medial tibial plateau and pes anserine longitudinal view- left to right comparison. Medial collateral ligament (solid white arrow), tibia (open white arrow), Inferomedial genicular neurovascular bundle (black arrow).
Image 2- Medial tibial plateau transverse view. Tibia (open white arrow), deep fascia (white arrow).

View the February Case below, answer the question and then click check >

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Giovanna G. B. Motta, Alessandra RodriguesSilva Chiovatto*, Eduardo Davino Chiovatto, Maria Cristina Chammas, Wagner Iared

  • Centro de Aperfeiçoamento e Pesquisa em Ultrassonografia
  • Prof. Dr. Giovanni Guido Cerri, DASA, São Paulo, Brazil.

*Corresponding author:  arrsilva@gmail.com

Clinical History:

A 15-days-old white female infant was referred to our clinic with a history of breech presentation. She was delivered by cesarean without evident clinical issues. Ultrasound of the hip was performed as a screening due to the breech presentation.

Image 01: Ultrasound image of the left infant hip -coronal plane

View the January Case below, answer the question and then click check >

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Sirine Dehmani 1, Christoph F Dietrich 2

  • Kliniken Hirslanden Beau Site, Salem und Permanence, Bern, Switzerland, Sirine.Dehmani@hirslanden.ch
  • *Kliniken Hirslanden Beau Site, Salem und Permanence, Bern, Switzerland, ChristophFrank.Dietrich@hirslanden.ch

*    Correspondence: ChristophFrank.Dietrich@hirslanden.ch

Clinical History:

A 56-year-old-male with a history of previous cough and dyspnea on exercise was admitted to our clinic for evaluation and CoViD testing. At the time of the US examination he had no dyspnea or other symptoms.

View the December Case below, answer the questions and then click check >

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By Osmar Saito, MD and Maria Cristina Chammas MD, Director of Ultrasound

Clinicas Hospital, Department of Radiology, School of Medicine, University of São Paulo, São Paulo, Brazil

Clinical History:

A 36-year-old male with a history of intermittent pain in his right testicle was admitted to the emergency radiology ward with a fast enlarging testicle, without previous trauma.  He had also lost weight. Physical examination revealed an enlarged firm testicle without pain on the right side and a normal left testicle. The patient had no fever, no trauma, no chronic disease and denied any sexually transmitted diseases.  After some time the patient remembered that 6 years previously he had had leukemia and had underwent a bone marrow transplant.

Ultrasound:

B Mode US in the supine position showed a heterogeneous, enlarged testicle (Figure 1, 2 and 3). Color Doppler showed that the right testicle had an increased vascular pattern (Figure 4, 5 and 6).

View the December Case below, answer the question and then click check >

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Case of the Month November 2020- Thyroid lesion

by Admin

Alessandra Rodrigues Silva Chiovatto, Eduardo Davino Chiovatto, Julia Diva Zavariz, Maria Cristina Chammas. 

Centro de Aperfeiçoamento e Pesquisa em Ultrassonografia Prof. Dr. Giovanni Guido Cerri, DASA, São Paulo, Brazil. 

Clinical History:

A 12-year-old female was referred to our service for a follow-up of suspected asymptomatic thyroid nodule found about 3 months ago. The patient was healthy, with no comorbidities. 

View the November Case below, answer the question and then click check >

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Case of the Month October 2020- Facial Cleft

by Admin

Anh Lam*, Nguyen Ha*

* Imaging Diagnostic Department, Tu Du Hospital, Vietnam

Corresponding author: drlamngocanh@gmail.com

Clinical History:

A 32 year-old pregnant woman, PARA 0000, was sent to our hospital at 20 weeks and 5 days. She had no history of medical diseases and abuse of drugs or alcohol. Her family history was normal.

Video 01: UPPER LIP

Video 02: NOSE

Video 03: ORBIT

Video 04: MAXILLARY

View the October Case below, answer the question and then click check >

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 Lucas Japiassu Mendonça Rocha1 ; Eduardo Davino Chiovatto1 ; Alessandra Rodrigues Silva Chiovatto1 ; Renato Davino Chiovatto1, 4; Maria Cristina Chammas1, 2; Wagner Iared1, 3

  1. Ultrasonography Improvement and Research Center Dr. Giovanni Guido Cerri, DASA, São Paulo, Brazil. 
  2. Institute of Radiology – Hospital das Clínicas School of Medicine – University of São Paulo, São Paulo, Brazil
  3. Departament of Medicine – Federal University of São Paulo, São Paulo, Brazil. 
  4. Institute of Heart – Hospital das Clínicas School of Medicine – University of São Paulo, São Paulo, Brazil

Clinical History:

A 61-year-old woman with a previous history of right side lumbar herniorrhaphy was referred to our clinic for a diagnostic ultrasound exam. She had noticed a bulging in the right flank, associated with local pain 4 months previously. The clinical examination revealed a palpable lump more pronounced in standing position on the right flank upper quadrant. A surgical scar could be seen just below the examined site.

View the September Case below, answer the question and then click check >

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Simone Uezato Ota, Caio Batalha Pereira, Marcelo Schelini, Fernando Linhares Pereira, Wagner Iared, Maria Cristina Chammas.

Centro de Aperfeiçoamento e Pesquisa em Ultrassonografia Prof. Dr. Giovanni Guido Cerri, DASA, São Paulo, Brazil.

Clinical History:

A 56-year-old man, diabetic, hypertensive, smoker and chronic alcoholic with dyslipidemia from the countryside of the State of São Paulo, with negative serology for viral hepatitis, was referred to our clinic for an ultrasound examination to follow-up on liver cirrhosis.
The following are his ultrasound images:

View the August Case below, answer the question and then click check >

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A female with an acute onset of severe pain in the lower abdomen

Dr. Serghei Puiu, Dr, PhD

Department of Radiology and Imaging, State University of Medicine and Pharmacy “Nicoale Testemitanu”, Chisinau, Republic of Moldova

Corresponding author: Serghei Puiu
Email: puiusv@yahoo.com

Clinical History:

A 47-year-old lady was referred to our department for a second opinion before surgery regarding an ovarian mass suspect of an ovarian tumour. She had an acute onset of severe pain in the lower right abdominal quadrant one week previously, which disappeared spontaneously. When she presented in our department, she had no pain or fever. Blood tests, including tumour markers, were normal.

Transabdominal and transvaginal ultrasound scans were performed. They showed an enlarged, but well-defined right ovary, appearing as a mass (Fig. 1-2). The stroma was heterogeneous due to edema displacing the follicles peripherally (Fig. 3). An echogenic thickened fallopian tube seemed to wrap the enlarged ovary (Fig. 4 a-c). The ovarian arterial and venous flow was preserved (Fig. 5 a-b). A small fluid collection in the Douglas pouch and around the ovary was seen. There was a slight pain on transducer touch.

Figure 1. Enlarged right ovary mimicking a solid adnexal mass.
Figure 2. Enlargement (up to 139 cm3) of the right ovary.
Figure 3. Peripherally located ovarian follicles, displaced by the ovarian stromal edema. Note the heterogeneous appearance of the ovarian stroma.
Figures 4 a-c. Thickened fallopian tube surrounding the enlarged ovarian mass. Small anechoic fluid collection around the ovary. Compare the swollen right tube (thick arrow) and normal appearance of the left tube (thin arrow).
Figures 5 a-b. Present ovarian arterial and venous flow, showing typical Doppler patterns.
Figure 6 a-c. Normal appearance and vascular flow of the right ovary two months later. The right fallopian tube is difficult to visualize.

View the July Case below, answer the question and then click check >

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Case of the Month June 2020- Liver Red Flags

by Admin

Liver Red Flags

Eduardo Davino Chiovatto1
Alessandra Rodrigues Silva Chiovatto1
Marcelo Violi Schelini1
Fernando Linhares Pereira1, 2
Julia Diva Zavaris1, 2
Maria Cristina Chammas1, 2
Wagner Iared1, 3

1.) Ultrasonography Improvement and Research Center Prof. Dr. Giovanni Guido Cerri, DASA, São Paulo, Brazil. 

2.) Institue of Radiology, Hospital das Clinicas School of Medicine, University of São Paulo, São Paulo, Brazil

3.) Department of Medicine – Federal University of São Paulo, São Paulo, Brazil. 

Clinical History:

A 68-year-old female from the countryside of São Paulo was referred to our clinic for a routine ultrasound examination. She had diabetes and arterial hypertension and no history of hepatitis, alcoholism or AIDS.

View the June Case below, answer the question and then click check >

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Jaundice in an infant

  Rogerio Augusto Pinto da Silva, MD
 Belo Horizonte, Minas Gerais State – Brazil

 Email: ecosala1@gmail.com

Clinical History:

A 94-days-old boy referred to ultrasound imaging due to the development of jaundice.

Figure 1. Upper left: portal vein diameter (4.8 mm) and right portal vein branch diameter (3.9 mm); Lower left: hepatic artery diameter (2.5 mm) ; Lower right: Gallbladder volume (0.025 cm3); Upper right: Portal bifurcation
Figure 2. Upper left: Splenic longitudinal axis (78.9 mm); Lower left: portal bifurcation; Right: Right liver lobe 2D-SWE (Canon i600): Median 33.8 kPa (IQR 1.8) / 3.32 m/s (IQR 0.07)

View the May Case below, answer the question and then click check >

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