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.

CurveletTransform-Based Texture Analysis of Carotid B-mode Ultrasound Images in Asymptomatic Men With Moderate and Severe Stenoses: A Preliminary Clinical Study.

The curvelet transform, which represents images in terms of their geometric and textural characteristics, was investigated toward revealing differences between moderate (50%-69%, n = 11) and severe (70%-100%, n = 14) stenosis asymptomatic plaque from B-mode ultrasound. Texture features were estimated in original and curvelet transformed images of atheromatous plaque (PL), the adjacent arterial wall (intima-media [IM]) and the plaque shoulder (SH) (i.e., the boundary between plaque and wall), separately at end systole and end diastole. Seventeen features derived from the original images were significantly different between the two groups (4 for IM, 3 for PL and 10 for SH; 9 for end diastole and 8 for end systole); 19 of 234 features (2 for IM and 17 for SH; 8 for end systole and 11 for end diastole) derived from curvelet transformed images were significantly higher in the patients with severe stenosis, indicating higher magnitude, variation and randomness of image gray levels. In these patients, lower body height and higher serum creatinine concentration were observed. Our findings suggest that (a) moderate and severe plaque have similar curvelet-based texture properties, and (b) IM and SH provide useful information about arterial wall pathophysiology, complementary to PL itself. The curvelet transform is promising for identifying novel indices of cardiovascular risk and warrants further investigation in larger cohorts.

Recent advances in vascular ultrasound imaging technology and their clinical implications.

In this paper recent advances in vascular ultrasound imaging technology are discussed, including three-dimensional ultrasound (3DUS), contrast-enhanced ultrasound (CEUS) and strain- (SE) and shear-wave-elastography (SWE). 3DUS imaging allows visualisation of the actual 3D anatomy and more recently of flow, and assessment of geometrical, morphological and mechanical features in the carotid artery and the aorta. CEUS involves the use of microbubble contrast agents to estimate sensitive blood flow and neovascularisation (formation of new microvessels). Recent developments include the implementation of computerised tools for automated analysis and quantification of CEUS images, and the possibility to measure blood flow velocity in the aorta. SE, which yields anatomical maps of tissue strain, is increasingly being used to investigate the vulnerability of the carotid plaque, but is also promising for the coronary artery and the aorta. SWE relies on the generation of a shear wave by remote acoustic palpation and its acquisition by ultrafast imaging, and is useful for measuring arterial stiffness. Such advances in vascular ultrasound technology, with appropriate validation in clinical trials, could positively change current management of patients with vascular disease, and improve stratification of cardiovascular risk.

Fascioliasis: A challenging differential diagnosis for radiologists.

We report a case of a 39 year old male who presented with nausea and right upper quadrant pain. Marked eosinophilia and a hypoechoic liver lesion on ultrasound were identified. The differential diagnosis included neoplasms, infectious diseases and hepatic abscess. Indirect hemagglutination test using purified adult Fasciola hepatica f1Ag confirmed serologic diagnosis of fascioliasis. Radiologists should keep in mind the importance of correlating imaging, clinical and laboratory findings in order to reach the correct diagnosis.

Contrast-enhanced ultrasound examination of the gallbladder and bile ducts: A pictorial essay.

The gallbladder and bile ducts are usually assessed initially with conventional gray-scale ultrasound (US). Contrast enhanced US (CEUS) is used when a diagnosis cannot be reached with conventional US. CEUS is easy to learn and perform. US contrast agents can be safely administered in patients with renal function impairment. In this pictorial essay the physics, examination technique and indications of CEUS for examining the gallbladder and bile ducts are reviewed. Gallbladder indications include elucidating normal variants, differentiating sludge from neoplastic lesions, benign and malignant pathology, infection, wall rupture and hemobilia. In the biliary tree CEUS is used for studying benign and malignant tumors, including metastases and cholangiocarcinoma, as well as intrabiliary injection.

Contrast enhanced ultrasound of the kidneys: what is it capable of?

One of the many imaging uses of contrast enhanced ultrasound (CEUS) is studying a wide variety of kidney pathology, due to its ability to detect microvascular blood flow in real time without affecting renal function. CEUS enables dynamic assessment and quantification of microvascularisation up to capillary perfusion. The objective of this paper is to briefly refresh basic knowledge of ultrasound (US) contrast agents' physical properties, to study technical details of CEUS scanning in the kidneys, and to review the commonest renal indications for CEUS, with imaging examples in comparison to baseline unenhanced US and computed tomography when performed. Safety matters and limitations of CEUS of the kidneys are also discussed.

Ultrasonographic features of kidney transplants and their complications: an imaging review.

Renal transplantation is the treatment of choice for managing patients with end-stage kidney disease. Being submitted to a very serious surgical procedure, renal transplant recipients can only benefit from follow-up imaging and monitoring strategies. Ultrasound is considered as the principal imaging test in the evaluation of renal transplants. It is an easily applied bedside examination that can detect possible complications and guide further imaging or intervention. In this imaging review, we present essential information regarding the sonographic features of healthy renal transplants, detailing the surgical technique and how it affects the sonoanatomy. We focus on various complications that occur following renal transplantation and their sonographic features by reviewing pertinent literature sources and our own extensive imaging archives.

Contrast-enhanced ultrasound performed under urgent conditions. Indications, review of the technique, clinical examples and limitations.

Contrast-enhanced ultrasound (CEUS) is an imaging technique with various indications, most of which refer to scheduled examinations. However, CEUS can also be performed under urgent conditions for the investigation of many different clinical questions. This article reviews basic physics of ultrasound contrast agents and examines the commonest urgent clinical applications of CEUS. These include, among others, abdominal solid organ trauma and infarcts, scrotal and penile pathology and blood vessel imaging. Patients can be examined with a very short time delay at their bedside, without exposure to ionising radiation or risk of anaphylactic reaction and renal failure, while contraindications are minimal. CEUS technique is described for various urgent indications and imaging examples from our department's experience are presented. Safety matters and limitations of CEUS are also mentioned. Teaching Points • Contrast-enhanced ultrasound (CEUS) can be performed urgently for various clinical applications. • Abdominal indications include solid organ trauma and infarcts. • CEUS in abdominal organ trauma correlates well with CT and can replace it for patient follow-up. • CEUS images testicular torsion, infection and infarction, as well as testicular and penile trauma. • Blood vessels can be assessed with CEUS for obstruction, aneurysm, thrombosis and dissection.

Sonographic lobe localization of alveolar-interstitial syndrome in the critically ill.

Introduction. Fast and accurate diagnosis of alveolar-interstitial syndrome is of major importance in the critically ill. We evaluated the utility of lung ultrasound (US) in detecting and localizing alveolar-interstitial syndrome in respective pulmonary lobes as compared to computed tomography scans (CT). Methods. One hundred and seven critically ill patients participated in the study. The presence of diffuse comet-tail artifacts was considered a sign of alveolar-interstitial syndrome. We designated lobar reflections along intercostal spaces and surface lines by means of sonoanatomy in an effort to accurately localize lung pathology. Each sonographic finding was thereafter grouped into the respective lobe. Results. From 107 patients, 77 were finally included in the analysis (42 males with mean age = 61 ± 17 years, APACHE II score = 17.6 ± 6.4, and lung injury score = 1.0 ± 0.7). US exhibited high sensitivity and specificity values (ranging from over 80% for the lower lung fields up to over 90% for the upper lung fields) and considerable consistency in the diagnosis and localization of alveolar-interstitial syndrome. Conclusions. US is a reliable, bedside method for accurate detection and localization of alveolar-interstitial syndrome in the critically ill.

Emergency ultrasound of the scrotum: a review of the commonest pathologic conditions.

Ultrasound is the first imaging modality to be performed in emergency conditions of the scrotum. The commonest pathologic entities are divided into the 4 following groups: torsion, trauma, infection, and tumors. Sonographic examination should be performed as soon as possible to ensure fast diagnosis and treatment. Less acute conditions can also be noted while scanning on an emergency basis, such as anatomic variants, hydrocele, oscheocele, clinically evident varicocele, calcifications, etc. Although not threatening for scrotal integrity, they should be assessed during an emergency examination or later on. In this article, complex scrotal anatomy is reviewed and the basic examination technique is described. The commonest emergency conditions are analyzed, along with their pathophysiological basis. Nonemergent entities are also briefly mentioned. Ultrasound images of the commonest emergency conditions are demonstrated.

Pulmonary nocardiosis in a patient with idiopathic thrombocytopenic purpura.

We present a case of pulmonary nocardiosis in a patient suffering from idiopathic thrombocytopenic purpura (ITP), an autoimmune disorder in which platelets are immunologically destroyed. ITP corticosteroid therapy, as well as the patient's diabetes mellitus history caused immunosuppression, leading to an incidental lung infection by nocardia asteroides. The combination of pulmonary nocardiosis and ITP is, as far as we know, very rare.

Thyroid hormone and cardioprotection: study of p38 MAPK and JNKs during ischaemia and at reperfusion in isolated rat heart.

It has been recently shown that long-term thyroxine administration increases the tolerance of the heart to ischaemia. The present study investigated whether thyroxine induced cardioprotection involves alterations in the pattern of p38 mitogen activated protein kinase (p38MAPK) and c-Jun NH2-terminal kinases (JNKs) activation during ischaemia-reperfusion. L-thyroxine (T4) was administered in Wistar rats (25 microg/100 g/day, subcutaneously) for 2 weeks (THYR), while normal animals served as controls (NORM). NORM and THYR isolated rat hearts were perfused in Langendorff mode and subjected to 10 or 20 min of zero-flow global ischaemia only and also to 20 min of ischaemia followed by 10, 20 or 45 min of reperfusion. Postischaemic recovery of left ventricular developed pressure at 45 min of reperfusion was expressed as % of the initial value. Activation of p38 MAPK and JNKs was assessed at the different times of the experimental setting by standard Western blotting techniques using a dual phospho p38MAPK and phospho JNKs (p46/p54) antibodies. Activation of p38 MAPK was significantly attenuated during ischaemia and reperfusion in thyroxine treated hearts compared to normal hearts. JNKs were found to be activated only during the reperfusion period. The levels of phospho JNKs were found to be lower in thyroxine treated hearts as compared to untreated hearts, though not at a statistically significant level. Postischaemic functional recovery was higher in THYR as compared to NORM, p < 0.05. In summary, in hearts pretreated with thyroxine, p38 MAPK was attenuated during ischaemia and at reperfusion and this was associated with improved postischaemic recovery of function.