Progression of Uterine Artery Pseudoaneurysm Documented by Ultrasonography: A Case Report.

Introduction: Uterine artery pseudoaneurysm (UAP) is a rare cause of late postpartum hemorrhage. Insufficient understanding of this condition among clinicians may result in delayed diagnosis and treatment, potentially leading to incorrect interventions and poor prognosis, including fatal hemorrhage and even necessitating hysterectomy in severe cases. Case Report: The patient, a 41-year-old woman with a history of three pregnancies and two deliveries, underwent cesarean section and subsequently experienced persistent small amounts of vaginal bleeding for a duration of two months. Transvaginal ultrasonography revealed a hypoechoic mass in the cervix that was initially misdiagnosed as a cervical fibroid. Approximately 12 h prior to admission, she experienced an episode of acute vaginal bleeding of significant intensity. Emergency transvaginal ultrasound demonstrated an intrauterine mass located in the posterior wall of the cervix with swirling blood flow, exhibiting a to-and-fro pattern. The mass was connected to the left uterine artery adjacent to the cervix through a tear measuring approximately 0.5 cm in diameter. Emergency bilateral uterine artery embolization was performed. After a follow-up period of ten months, there was no recurrence of abnormal vaginal bleeding, and subsequent ultrasound examination confirmed the complete resolution of the cervical lesions. Conclusion: The findings of this case suggest that the UAP undergoes a dynamic process. In the early stages, the lesion may manifest as a small hypoechoic or anechoic area within the myometrium. Color Doppler imaging might not reveal blood flow signals within the lesion, potentially leading to misdiagnosis as other common uterine lesions such as fibroids or cysts. However, considering the close association between UAP and the uterine artery, meticulous observation of the relationship between the uterine artery and its branches is crucial for identifying myometrial lesions to facilitate early detection of UAP and minimize misdiagnosis.

Superb Micro-Vascular Imaging in Prenatal Ultrasound Diagnosis of Placental Infarction: A Case Report.

Background: Placental infarction refers to a localized area of ischemic villous necrosis resulting from the interruption of maternal blood flow to the intervillous space, which can be attributed to spasm, stenosis, or occlusion of the decidual spiral artery caused by systemic or localized maternal vascular disease. The presence of large placental infarcts may pose significant risks to fetal well-being, including intrauterine growth retardation, fetal distress, and even fetal demise. Although placental infarction is commonly identified during postnatal pathological examinations, its prenatal diagnosis through ultrasound remains challenging and has been rarely reported. Case Presentation: This report presents a case of acute placental infarction diagnosed by prenatal ultrasound using Superb Micro-vascular Imaging (SMI) technology. At 23 weeks' gestation, the ultrasound revealed that the placenta was attached to the left lateral and posterior walls of the uterus, showing localized thickening. Within this area of thickening, there were observed inhomogeneous hypoechoic regions. Superb Micro-vascular Imaging (SMI) revealed an abnormal echogenic region within the thickened placental tissue that lacked microvascular blood flow signals, but showed surrounding vascularity. Visually, this elliptical-shaped echogenic region enveloped by microvascular blood flow. From the 29th weeks of gestation onward, ultrasound suggested that the fetus was small for gestational age. A live baby weighing 2360g was delivered by cesarean section at 37 weeks' gestation. The placenta was approximately 20×18 × 3 cm with large grayish-yellow infarcts. Conclusion: SMI allows rapid screening of large placental infarcts and easy detection of regions without normal vessel trees, thereby reducing missed diagnoses. Infarct area is easily measured by measuring the area surrounded by small blood vessels, especially in acute placental infarction, which is very helpful in accurately determining infarct size.

Foetal death due to extensive extra-abdominal umbilical vein Varix with umbilical vein thrombosis: a case report.

BACKGROUND: Foetal anaemia and umbilical vein thrombosis are rare pregnancy complications that can increase the risk of perinatal adverse events, which, in severe cases, can lead to foetal death. During pregnancy, umbilical vein varix (UVV) commonly occurs in the intra-abdominal part of the umbilical vein and is associated with an increased risk of foetal anaemia and umbilical vein thrombosis. However, UVV occurring in the extra-abdominal part of the umbilical vein is rare, especially when accompanied by thrombosis. In this case report, we describe a rare case of an extensive extra-abdominal umbilical vein varix (EAUVV), which ultimately resulted in foetal death due to umbilical vein thrombosis. CASE PRESENTATION: In this report, we describe a rare case of an extensive EAUVV that was discovered at 25 weeks and 3 days of gestation. During the examination, there were no abnormalities in foetal haemodynamics. The estimated weight of the foetus was only 709 g. In addition to refusing to be hospitalized, the patient refused close monitoring of the foetus. As a result, we were limited to choosing an expectant therapy. The foetus died 2 weeks after diagnosis and was confirmed to have EAUVV with thrombosis after the induction of labour. CONCLUSION: In the case of EAUVV, lesions are extremely rare, and it is very easy for thrombosis to form, which may result in the death of the child. When determining the next step in the treatment of the condition, the degree of UVV, possible complications, gestational age, foetal haemodynamics, and other relevant factors are strongly connected to the clinical therapy decision, and these factors should be considered comprehensively when making a clinical decision. We recommend close monitoring with hospital admission (to facilities capable of handling extremely preterm foetuses) after variability in delivery for worsening haemodynamic status.

A Case of Intramural Pregnancy: Differential Diagnosis for Distinguishing from Retained Products of Conception and Gestational Trophoblastic Disease.

Intramural pregnancy refers to the implantation of fertilized eggs in uterine musculature, separated from the uterine cavity and tube. We report a case of intramural pregnancy previously misdiagnosed as retained products of conception and gestational trophoblastic disease. This case highlights the difficulty in the diagnosis of intramural pregnancy. Clinicians should be clear about the risk factors of the disease. Judicious selection of the appropriate imaging modalities is vital to making an accurate diagnosis and providing effective treatment.

[Ultrasound Measurement of Uterus and Ovary from Childhood to Adolescence and Ultrasound in Diagnosis of Precocious Puberty].

OBJECTIVE: To analyze the diagnostic value of ultrasound combined with Z-score in various types of precocious puberty of girls. METHODS: Ultrasound was used to measure the uterus and ovary of normal girls aged between 3 and 21, and Z-score model was established. Ultrasound was used to measure the uterus and ovary of girls with central precocious puberty (CPP), peripheral precocious puberty (PPP), premature pubarche (PP), and premature thelarche (PT). The highest age-related variable was selected to calculate the Z value of the above measurements. The best diagnostic cut-off point was obtained by ROC curve. RESULTS: Ovarian volume and uterine body length had the best correlation with age. The ovarian volume and uterine body length of the girls with CPP were longer and larger than those in normal girls. The area under curve (AUC) of ovarian volume was 0.94 and the best diagnostic cut-off value was Z=2.16 (sensitivity 100%, specificity 81.1%). The AUC of uterine body length was 0.845 and the best diagnostic cut-off value was Z=1.14 (sensitivity 91.6%, specificity 84.9%). In the girls with PPP, only the length of uterine body was longer than that of normal girls. The AUC was 0.910 and the best diagnostic cut-off value was Z=1.06 (sensitivity 98.0%, specificity 82.0%). There was no significant difference between the girls with PP, PT and normal girls. CONCLUSIONS: Ultrasound combined with Z value has certain significance in differentiating CPP from PPP. It is speculated that this method can be used in the treatment and monitoring of precocious puberty.

Fetus in fetu: From Prenatal Sonographic Diagnosis to Postnatal Confirmation.

A case of prenatal sonographic diagnosis of fetus in fetu is described. Postnatal laparotomy was performed and the diagnosis was confirmed by pathological examination.

Trends in the prescribing of psychotropic medications for inpatient children and adolescents, 2000-2010: a study from China.

The objective of this study was to investigate the patterns in prescribing of psychotropic drugs for children and adolescents within the psychiatric department of a general hospital in China. Medical records of 878 patients (0-18 years old) were reviewed in 2000, 2005 and 2010. Patient characteristics, total psychotropic drug use and the proportionate use of each drug class (antipsychotics, antidepressants, mood stabilizers and anxiolytic-hypnotic drugs) were analysed. The results indicated that there was a 19.2% increase in the overall use of psychotropic drugs during the study period. The use of selective serotonin reuptake inhibitors increased from 24.8 to 45%, whereas that of tricyclic antidepressants decreased from 17.7 to 0.5%. The use of second-generation antipsychotics increased from 56 to 80%. In contrast, the use of first-generation antipsychotic decreased from 26.2 to 6.5%. The use of valproate also increased significantly from 2.1 to 16.4%. In patients diagnosed with schizophrenia, the use of selective serotonin reuptake inhibitors increased from 1.2 to 18.9% and that of valproate increased from 0 to 12.6%. The increasing trends in psychotropic drug use necessitate addition research to confirm their safety and efficacy in this specific population.