Unique endoscopic features of primary biliary diffuse large B-cell lymphoma: A case report with literature review (with video).

A 67-year-old man visited our hospital complaining of dark-colored urine and upper abdominal pain. Magnetic resonance cholangiopancreatography showed stricture of the distal bile duct, and contrast-enhanced computed tomography showed irregular thickening of the distal bile duct wall. However, no enlarged lymph nodes, pancreatic tumors, or other neoplastic lesions were apparent around the bile duct. Endoscopic ultrasonography and intraductal ultrasonography showed irregular thickening of the inner hypoechoic layer without the disappearance of the innermost thin hyperechoic layer. On the basis of these findings, we considered that the bile duct lesion was of non-epithelial origin. Thus, we repeatedly performed bile duct biopsies from the same site under fluoroscopy to obtain a sample of the submucosal tissue. The pathological diagnosis was diffuse large B-cell lymphoma, and the patient received systemic chemotherapy (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone). After six courses of rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone, positron emission tomography-computed tomography showed the disappearance of 18-fluorodeoxyglucose uptake in the bile duct and endoscopic retrograde cholangiography showed improvement of the bile duct stricture. Endoscopic findings and repeated biopsies were useful in making the diagnosis of primary biliary diffuse large B-cell lymphoma.

A practical new approach to ultrasonographic detection of the fetal situs: Modified Cordes technique.

This study presents the modified Cordes method, a novel ultrasonographic technique that provides a precise and practical evaluation of fetal situs during pregnancy, particularly in the first and early second trimesters. This method entails precisely aligning the probe and hand to obtain a clear image of the fetal thorax in the axial plane. The fundamental procedures involve ascertaining the initial location of the fetal head, rotating the probe, aligning the thorax at the center, and positioning the left hand to clearly identify the fetal situs. Tests conducted in many pregnancies have verified that the modified Cordes approach offers prompt and precise identification of fetal situs and is more accessible to acquire, particularly for new practitioners. The modified Cordes approach is a straightforward and reliable technique for establishing the position of the fetus. Its application during the first and early second trimesters improves diagnostic accuracy by minimizing the chances of misinterpretation. This method offers benefits by making the process of determining fetal situs more objective and straightforward for practitioners with varying degrees of experience.

A Case of Suspected Carpal Tunnel Syndrome: Ultrasonography Prior to the Scalpel.

Carpal tunnel syndrome (CTS) is the most prevalent focal mononeuropathy worldwide and is traditionally diagnosed based on clinical history, examination, and nerve conduction studies. Surgical release is the gold standard in cases where conservative management fails; however, it is prudent to obtain imaging before planning such intervention. We present the case of a 47-year-old woman who presented with typical symptoms of CTS, which was confirmed with nerve conduction studies and was being considered for carpal tunnel release surgery. Her history and laboratory studies revealed rheumatoid arthritis and subsequent ultrasonography showed swelling of the median nerve just proximal to the transverse carpal ligament at the level of pronator quadratus muscle. The possibility of a nerve sheath tumour or tenosynovitis with edematous fascicles of the median nerve was considered, and a decision was taken to give a short course of prednisolone 1 mg/kg, to which she clinically responded and the repeat ultrasonography showed near complete resolution of the focal nerve enlargement. This case emphasizes the role of point-of-care neuromuscular ultrasound (NMUS) in identifying the underlying cause of CTS and validates NMUS as a powerful tool in reaching a comprehensive diagnosis in entrapment neuropathies and it should be incorporated into the routine protocol of diagnosis of these disorders.

Identification of nonpregnant beef cows based on CL size vs. luteal blood perfusion at 21 days after timed artificial insemination.

The aim was to evaluate the efficiency of two different ultrasonographic systems, Doppler mode vs. Two-dimensional mode (B mode), to identify the pregnancy status of beef cows and heifers on day 21 (D21) after Timed Artificial Insemination (TAI). The experiment was performed on a commercial beef farm in central-west region of Brazil using 1895 Nelore heifers and cows. All females had ovulation synchronized for a TAI that was performed on D0. Twenty-one days after the TAI, all animals had their ovaries evaluated by ultrasound for pregnancy diagnosis based on the size of the corpus luteum (CL). Using B mode ultrasonography, females without a CL or with a CL ≤ 10 mm in diameter were considered nonpregnant, whereas females with a CL > 10 mm in diameter were considered potentially pregnant. After the B mode examination, the Doppler mode was turned on, and the CL was evaluated by the subjective percentage of blood perfusion in the total area of the CL. Using Doppler mode, females were considered nonpregnant if they had no CL or the CL had ≤25 % of the total area with detectable blood perfusion, whereas animals with >25 % blood perfusion in the CL were considered potentially pregnant. The results for each method (potentially pregnant or nonpregnant) were later compared with the gold standard technique, which was a pregnancy diagnosis on D33 after TAI using ultrasound with visualization of an embryonic heartbeat. The accuracy was determined using the 2 × 2 contingency table approach. The area under the curve using the receiver operating characteristic curve for Doppler mode and B mode were 0.929 and 0.902 (P < 0.01), respectively. There were almost no false negatives (designated non-pregnant but later pregnant at D33) with either technique (0.2 % vs. 0.3 %; P = 0.65 for Doppler mode vs. B mode, respectively). False positives (designated pregnant but non-pregnant on D33) were greater for B mode compared to Doppler (19.1 % vs. 14.0 %; P < 0.01). This resulted in Doppler mode having similar high values as B mode for Negative Predictive Value (99.9 vs. 99.6 %; P = 0.85) and Sensitivity (99.8 vs. 99.7 %; P = 0.86) but there were differences in Specificity (86 vs. 80.9 %; P < 0.01), Positive Predictive Value (88 vs. 84.3 %; P < 0.01), and Accuracy (93.0 vs. 90.4 %; P < 0.01). In conclusion, evaluation of CL blood perfusion by Doppler produced greater accuracy in the early identification of nonpregnant heifers and cows on D21 after TAI than measurement of CL diameter with B mode ultrasound; although both had over 90 % accuracy in identifying pregnant and nonpregnant females.

Peritoneal dialysis catheterization with an upward tunnel and exit site: An observational study.

BACKGROUND: The preferred techniques for peritoneal dialysis catheterization are uncertain. Catheter implantation with formation of an inferiorly-directed tunnel and exit site is widely recommended to reduce the risk of infective complications. We aimed to compare percutaneous peritoneal dialysis catheter insertion using an upwardly-directed tract to catheter insertion using a downwardly-directed tract. METHODS: A retrospective cohort study was performed on consecutive peritoneal dialysis catheterizations over a 10-year period at a single centre. Participants were classified into two groups: catheter insertion with an upward tunnel and exit site versus insertion with a downward tunnel and exit site. The primary outcome was peritoneal dialysis catheter survival. RESULTS: There were 247 peritoneal dialysis catheters inserted during the study period. The median catheter survival was 18 months, with no difference between the two groups (p = 0.23). The 12-month catheter patency rates were 76% for catheters with an upward tract and 79% for catheters with a downward tract (p = 0.15). Multivariate analysis identified no clinical factors predictive of catheter survival. A downward catheter tunnel and exit site was associated with an increased incidence of peritonitis (0.23 vs 0.11 episodes per year; p ⩽ 0.01). CONCLUSION: In this study, percutaneous peritoneal dialysis catheter insertion with an upward tunnel and exit site demonstrated similar catheter survival to insertion with a downward tunnel and exit site and was not associated with increased infections.

Visualizing thyroid health: a pictorial journey through 2017 ACR TI-RADS and common thyroid pathologies.

With the advent of high-resolution ultrasonography (HRUS), more thyroid nodules are being detected than ever before, and they are being identified at an earlier stage. It poses a challenge for radiologists and clinicians in deciding what to do next. Most nodules are benign and require no follow-up and intervention. Even highly suspicious nodules can be followed up, if the size is small. Variations in HRUS interpretation among radiologists are common, with frequent misidentifications between spongiform and solid-cystic lesions, hypoechoic and very hypoechoic nodules, and microcalcification and hyperechoic foci with comet-tail artifacts. Cystic lesions with echogenic contents are often confused with solid nodules, cystic papillary carcinoma thyroid is often confused with colloid cysts. The 2017 ACR TI-RADS (American College of Radiology Thyroid Imaging Reporting and Data System) aims to standardize the interpretation of thyroid nodules and guide further management. Rather than giving specific diagnosis like colloid cyst, adenomatous nodule and papillary carcinoma; ACR TI-RADS classifies nodules from TI-RADS 1 to TI-RADS 5 based on HRUS characteristics and recommends further management. What the authors often read are textual contents that are theoretical, and in practice, the authors get confused while interpreting the characteristics of thyroid nodules. This review offers a detailed visual overview of the 2017 ACR TI-RADS and common thyroid conditions, explaining key features through imaging data and examples for consistent interpretation. Combining textual explanations with visual aids, this article provides practical guidance for interpreting thyroid nodules for radiologists, and clinicians seeking a clear understanding of thyroid imaging and pathology.

Comparative evaluation of knee osteoarthritis: radiography vs. ultrasonography in Nepalese population: a cross-sectional study.

Background and objectives: Osteoarthritis (OA) is a degenerative and long-term debilitating disease with rising prevalence, predominantly involving larger joints including the knee joint. While radiography has traditionally been the primary modality for joint evaluation, there is a growing trend towards using ultrasonography (USG) for musculoskeletal disorders, including joint assessment. This study aimed to find the role of USG in the evaluation of OA of knee joints with comparison to the radiographs. Methods: This was a cross-sectional study done on patients with signs and symptoms of OA of the knee who visited the radiology department for knee radiographs. Kellgren and Lawrence system was used for grading OA in radiographs. USG of knee joints was done with high-frequency probes and searched for joint space width, articular cartilage thickness, marginal osteophytes, meniscal extrusion, and other articular/ extra-articular abnormalities. The USG findings were correlated with findings in anteroposterior and lateral radiographs. Results: The mean number of osteophytes was higher in USG compared to the radiographs (P<0.001). Mean joint spaces were comparable in both modalities. Meniscal extrusion was seen with USG, which significantly correlated with joint space width and cartilage thickness (P<0.005). USG also detected synovial changes, effusion, and Baker's cyst. Conclusion: Although radiography is the standard first-line radiological investigation for the diagnosis of OA of the knee joint, USG can be an adjunct as it well correlates with the radiograph findings and can provide more useful information.

Diagnostic value of ultrasonography in knee osteoarthritis: A systematic review.

Background: Knee osteoarthritis (KOA) is the most expected diagnosis for an arthropathy that causes discomfort and disability in older adults. Radiography is frequently used to assess patients with KOA and there have been few prior research evaluating the diagnostic efficacy of ultrasonography (US). The current study sought to assess the diagnostic efficacy of the US in identifying various characteristics of KOA in the scientific literature. Materials and Methods: This study was conducted following the Preferred Reporting Items for Systematic Reviews and Meta Analyses statement. A systematic search in PubMed, Web of Science, Scopus, and Embase databases was completed in March 2023. This study focused on the diagnostic value of US in KOA, including sensitivity, specificity, positive predictive value, and negative predictive value. The quality assessment was conducted using the Joanna Briggs Institute critical appraisal tools. Results: Out of 552 records of database searches, finally, two studies met this systematic review's eligibility criteria and were included in the study. Both of the included studies were cross sectional studies. US demonstrated remarkable sensitivity with adequate specificity for the detection of radiographic knee OA; however, it was found not to be an appropriate method for the detection of early KOA. Conclusion: This study as the first systematic review aims to evaluate the diagnostic performance of US in detecting KOA. These findings shed light on the importance of investigating the different US features in the evaluation of KOA to reach appropriate sensitivity and specificity in the diagnosis.

Kinematics of the anterior interval in individuals with knee osteoarthritis.

[Purpose] Abnormal anterior interval kinematics may be associated with knee pain and loss of knee motion. We investigated the anterior interval kinematics during passive knee extension in individuals with knee osteoarthritis (OA). [Participants and Methods] The anterior interval space was evaluated in 13 healthy knees (healthy group) and 11 knees with OA (knee OA group) at 30° and 15° knee flexion using ultrasonography. We measured the angle between the anterior tibia and patellar tendon, known as the patellar tendon-tibial angle (PTTA). [Results] The PTTA significantly increased as the angle of knee flexion decreased in the healthy group. In the knee OA group, the PTTA did not change significantly at 30° and 15° knee flexion. The knee OA group had a considerably higher PTTA at 30° knee flexion and a smaller amount of change in PTTA during knee angle changes than the healthy group. However, after adjusting for age and body mass index (BMI), no significant differences were observed between groups. [Conclusions] Differences in the anterior interval kinematics during knee motion between groups may be due to aging and high BMI. Further research is required to address most of the factors influencing these abnormalities.

Successful Treatment of Peripheral Nerve Sheath Tumor-related Pain with Perineural Steroid Injection: a case report.

Pain associated with Neurofibromatosis Type 1 (NF1) is poorly understood. To date, no treatment options have been approved for NF1-related pain. We present the case of a young female NF1 patient with intermittent buttock pain radiating down the leg who presented with positive dural tension signs. The patient was diagnosed with neurofibroma sciatic nerve compression, which was successfully managed with ultrasound-guided perineural steroid injection. There is sparse literature regarding the efficacy of ultrasound-guided perineural steroid injection in NF1 patients for treatment of benign peripheral nerve sheath tumor compressions. This case describes the utility of perineural steroid injections for symptomatic relief of NF1 neurofibroma-related pain. Perineural steroid injections should be considered when neurofibroma-related pain fails to respond to other conservative treatment. Steroid injections provide an alternative to oral medicinal management and avoid the often morbid risks of surgical intervention.

Integrating Ultrasound-Guided Multifidus Injections with Repeated Peripheral Magnetic Stimulation for Low Back Pain: A Feasibility Study.

Background: Low back pain is a globally prevalent musculoskeletal issue. Repetitive peripheral magnetic stimulation (rPMS) is emerging as a promising modality for managing musculoskeletal pain, while ultrasound-guided lumbar facet/multifidus injections are a potential therapeutic option for low back pain. This study explores the feasibility of combining these two treatments for managing low back pain. Materials and Methods: Ultrasound-guided injections were administered using 5 mL of 50% dextrose and 5 mL of 1% lidocaine. Bilateral injections targeted the L4/L5 and L5/S1 facet joints with 1 mL at each site, and the remaining 8 mL was distributed over the multifidus muscles using peppering techniques. Following injections, rPMS therapy was conducted with the TESLA Stym® device, targeting the bilateral lumbosacral region over 12 sessions. Pain intensity was measured using the visual analog scale (VAS), and disability was assessed with the Oswestry disability index (ODI) at baseline, after six sessions, and after 12 sessions of rPMS. Results: Three participants were enrolled. Baseline VAS and ODI scores were 8.33 ± 0.29 cm and 49.63 ± 1.28%, respectively. After six rPMS sessions, VAS and ODI scores changed to 4.33 ± 3.75 cm and 21.48 ± 19.42%, respectively. After 12 sessions, VAS decreased to 0.83 ± 1.44 cm and ODI to 5.19 ± 8.98%. Significant differences were observed between baseline and final assessments. Conclusion: Combining ultrasound-guided lumbar facet/multifidus injections with rPMS shows promise for treating low back pain. However, long-term efficacy and comparison with conventional treatments require further investigation through prospective randomized controlled trials.

Morphological changes of endometriomas during pregnancy and after delivery detected using ultrasound.

OBJECTIVE: To assess changes in morphology and size of endometriomas during pregnancy and after delivery. DESIGN: This was a prospective observational cohort study performed during 2013 - 2024 at a tertiary care center (Ultrasound Unit, Department of Obstetrics and Gynecology, Skane University Hospital, Malmo, Sweden). Women were offered repeated ultrasound examinations every month during pregnancy and thereafter 3 and 12 months after delivery. Ultrasound examinations were performed either transvaginally or transabdominally depending on the gestational week and assessability of the ovaries. SUBJECTS: Pregnant women with an ovarian cyst suggestive of endometrioma based on subjective assessment were eligible and those with the pregnancy that continued beyond gestational age of 22 weeks were included. In total, 57 women were included. EXPOSURE: Pregnancy. MAIN OUTCOME MEASURES: Changes in morphology (cyst type, cyst content and signs of decidualization) and size of the endometrioma and the largest solid component were assessed during follow-up ultrasound examinations. RESULTS: During pregnancy, endometriomas changed in morphology in 42/57 women (74%, 95% CI 60 - 84) and decreased in size in 42/57 women (74%, 95% CI 60 - 84). Decidualization of endometrioma was observed in 33/57 women (58%, 95% CI 44 - 71) and was detected first time at gestational age of 17 weeks (median, IQR 15 - 22, range 6 - 29). Size of endometriomas decreased while size of solid components increased from gestational age of 22+0 weeks. Signs of decidualization disappeared after delivery. CONCLUSION: Three out of four endometriomas undergo morphological changes during pregnancy. Decidualized endometrioma may mimic borderline malignancy, however, changes regress after delivery. Knowing natural behavior of endometriomas during pregnancy is crucial to reduce the risk of misclassification of endometriomas as malignant masses. Follow-up ultrasound examination after delivery helps to reassure the benign nature of the cyst.

Cystic splenic lesions: a sonographic approach-retrospective study in 111 patients.

OBJECTIVES: To describe and categorize splenic cystic-appearing lesions (S-CAL) with B-mode and contrast-enhanced ultrasound (CEUS). MATERIALS AND METHODS: This retrospective study investigated S-CALs in 111 patients between 2003 and 2023 in an interdisciplinary ultrasound center with B-mode ultrasound, color Doppler sonography (CDS), and CEUS. S-CAL was characterized by echogenicity, diameter, and shape, as well as additional features like septation, calcification, or wall thickening, and CDS/CEUS were used to identify perfusion. Histological examination or imaging follow-up was necessary to determine the nature of S-CAL. Moreover, 'S-CAL with risk' was defined, necessitating further procedures. Four types (0-III) of S-CALs were defined based on ultrasound parameters. Fisher's exact test was used to compare non-parametric data. RESULTS: S-CAL of 111 patients (58 female, 53 men-average age: 58.6 years) was examined. Final diagnoses were: splenic cyst (n = 64, 57.7%); splenic abscess (n = 10, 9.0%); intrasplenic pseudoaneurysm (n = 10, 9.0%); splenic metastasis (n = 10, 9.0%); splenic infarction (n = 6, 5.4%); splenic hematoma (n = 4, 3.6%); other (n = 7, 6.3%). S-CAL groupings were type 0 (n = 11, 9.9%), type I (n = 33, 29.7%), type II (n = 24, 21.6%), and type III (n = 43, 38.7%). 'S-CAL with risk' was diagnosed in n = 41 (36.9%). Malignant S-CAL was only seen in type II (n = 2, 8.2%) and type III (n = 9, 20.9%) (p < 0.001). 'S-CALs with risk' were found more frequently in type 0 (n = 11, 100%), type II (n = 16, 66.7%) and type III (n = 13, 30.2%) than in type I (n = 1, 3%) (p < 0.001). CONCLUSION: B-mode ultrasound, CDS, and CEUS are useful to further characterize and follow-up S-CAL and identify 'S-CAL with risk', requiring further procedures. CLINICAL RELEVANCE STATEMENT: Ultrasound imaging is valuable for the detection, categorization, and monitoring of cystic-appearing lesions of the spleen, as well as for the identification of those with risk. KEY POINTS: An S-CAL may introduce uncertainty in clinical practice as imaging-based risk stratification is missing. B-mode and CEUS, along with the clinical context and follow-up, assist in characterizing and identifying 'S-CAL with risk'. S-CALs encompass various lesions, including simple cysts, metastases, abscesses, and intrasplenic pseudoaneurysms.

Accuracy of intraoral ultrasound to evaluate alveolar bone level: an ex vivo study in human cadavers.

OBJECTIVES: This study aimed to evaluate the reliability and accuracy of an intraoral ultrasound (US) device to evaluate alveolar bone by comparing it between different raters and to microCT (µCT) measurements. METHODS: 38 teeth distributed across three human cadavers were prepared by placing two notches on the facial enamel surface. The maxillary and mandibular teeth were imaged with a custom-designed intraoral 20 MHz ultrasound and µCT with 0.03 mm voxel size. µCT was considered the reference standard for this study. For each sample, the distance from the inferior border of the most apical notch to the tip of the alveolar bone crest on the facial aspect of the teeth was measured from the US and µCT images. Intraclass correlation coefficient (ICC) and standard deviation were calculated. RESULTS: The intra-examiner and inter-examiner reliability for both the µCT and US alveolar bone measurements were found to be excellent (intra-examiner ICC was 0.998 for µCT and 0.997 for US, inter-examiner ICC was 0.996 for µCT and between 0.947 and 0.950 for US). The accuracy of the US was found to be good compared to µCT (ICC between 0.885 and 0.894). CONCLUSION: The study demonstrated that intraoral ultrasound is highly reliable and accurate compared to the µCT reference standard for evaluating facial alveolar bone height.

Fibro-adhesive Bursitis: A Novel Sonographic Finding in Adhesive Capsulitis Patients and a Proposal of Management.

INTRODUCTION: Adhesive capsulitis, also known as "frozen shoulder," is a debilitating shoulder condition increasingly linked to fibroadhesive bursitis, particularly after COVID-19 and related vaccinations. There is no definitive gold standard for its treatment, the primary therapeutic objectives of which are the reduction of pain and the restoration of shoulder range of motion. The aim of our study was to analyze treatment outcomes based on quantitative measures of shoulder function and symptom relief. METHOD: Conducted between January 2022 and April 2023, the research involved 45 patients initially diagnosed with adhesive capsulitis and associated fibroadhesive bursitis. After excluding nine patients for other concomitant pathologies (five for calcific tendinopathy and four for rotator cuff injury), 36 patients were randomized into two groups: one group was treated with glenohumeral hydrodistension, the other with glenohumeral hydrodistension combined with bursal injection. Assessments were conducted at baseline and then 2, 4, and 6 months after treatment, focusing on changes in pain levels, functional scores, and range of motion in all planes. Each group followed a home-based rehabilitation protocol. RESULTS: Significant improvements were observed in both treatment groups, with the combined hydrodistension and bursal injection group showing notably superior outcomes. Specifically, the range of motion in flexion improved from an initial median of 80° to 155° in the combined treatment group, compared to an increase from 75.5° to 129° in the group treated with hydrodistension alone. This enhancement was statistically significant (p < 0.001). Regarding pain reduction, the combined treatment group demonstrated a dramatic decrease in visual analogue scale (VAS) scores, from a baseline median of 7 to 1 at the 6-month follow-up. In contrast, the hydrodistension-only group showed a reduction from 7 to 3, with these differences also proving statistically significant (p < 0.001). CONCLUSIONS: Ultrasound-guided hydrodistension of the glenohumeral joint, if combined with bursal injection and specific exercises, effectively reduces pain, decreases disability, and improves range of motion in patients with second-stage adhesive capsulitis. This study highlights the importance of a combined approach in the management of this complex condition, especially after the histological changes that occurred after COVID-19 and related vaccinations. TRIAL REGISTRATION: ClinicalTrials.gov identifier NCT06062654.

A case with rare complication of chronic puerperal uterine inversion and underwent operation reduction.

OBJECTIVE: Puerperal uterine inversion is a rare and severe complication and is associated with short cord, uncontrolled cord traction, placenta accreta, or uterine atony. CASE REPORT: A primigravida woman gave birth a 2770 gm newborn at term at our hospital, and clinically presented postpartum hemorrhage, hypovolemic shock, postpartum preeclampsia and urinary retention. She discharged 3 days postpartum, but she complained persist vaginal bleeding and lower abdominal pain for more than 1 month. Uterine inversion was diagnosed and laparoscope surgery for reduction was done. CONCLUSION: The non-specific clinical presentation made diagnosis of uterine inversion more difficult. Except pelvic examination, sonographic and hysteroscopic images were record in this article. Surgical intervention was performed. A fundus incision was effective for reduction and had low risk of bladder and bowel injury.

A rare subclavian artery aneurysm potentially misidentified as the internal jugular vein in ultrasound-guided central venous catheterization-a case report.

Background: Central venous catheterization by anesthesiologists carries risks such as accidental arterial puncture. This case report highlights a rare subclavian artery aneurysm (SAA) detected during ultrasound-guided internal jugular vein (IJV) access, emphasizing the importance of recognizing anatomical variations. Case: An 88-year-old female with hypertension and atrial fibrillation was scheduled for lumbar laminectomy and posterior fusion. Preoperative evaluation revealed right lower lobe atelectasis and mild aortic sclerosis. During ultrasonography for right IJV catheterization, two vessels of different diameters were observed on the common carotid artery's (CCA's) lateral side. The larger vessel disappeared at the upper neck level, showing arterial pulsation on Color Doppler. Postoperative neck computed tomography confirmed a right SAA and a 5-mm saccular aneurysm in the left intracranial artery. The patient had no vascular disease, trauma, or relevant family histories. Conclusions: Anesthesiologists should be aware of anatomical variations during IJV catheterization. Ultrasound with Doppler is crucial for accurate artery identification.