Journal of Ultrasonography Feed

Aponeurotic expansion of the supraspinatus tendon: sonographic spectrum and proposed classifications

Tue, 17 Mar 2026 00:00:00 GMT

Aim The aponeurotic expansion of the supraspinatus tendon is a recognized but underappreciated anatomical structure of the shoulder. Its sonographic appearance may mimic or coexist with pathology of adjacent tendons, particularly the long head of the biceps tendon, creating diagnostic challenges. Although described in prior literature, many atypical variants remain insufficiently documented. This study aimed to characterize atypical sonographic manifestations of the aponeurotic expansion of the supraspinatus tendon and to propose new classifications based on its relationship with the supraspinatus tendon, its position within the rotator interval, and its association with the long head of the biceps tendon. Material and methods Between October 2018 and September 2025, a total of 3,600 shoulder ultrasound examinations were performed. Nineteen patients (15 women, four men; mean age 60.7 years, range 24–82 years) with pathologically altered aponeurotic expansions were retrospectively identified. Each case was evaluated for structural and positional changes in relation to the supraspinatus, long head of the biceps, and subscapularis tendons. Results The most frequent supraspinatus–aponeurotic expansion relationship was minor intrasubstance tearing (31.6%), followed by complete supraspinatus tears with retraction (21.1%). At the rotator interval, subluxation was observed in 36.8% of cases. Regarding interactions with the long head of the biceps tendon, aponeurotic expansion dislocation with preserved intragroove biceps alignment was most common (31.6%). Several theoretical subtypes were not observed. Conclusions Ultrasound enables detailed assessment of the aponeurotic expansion of the supraspinatus tendon. The proposed classifications provide a structured framework for clinical practice and may guide future research into the diagnostic and functional significance of this complex region.

Ultrasound evaluation of the ulnar nerve in cubital tunnel syndrome: anatomy, normal and abnormal findings, and postoperative aspects

Fri, 13 Mar 2026 00:00:00 GMT

Cubital tunnel syndrome is the second most common compressive neuropathy of the upper limb after carpal tunnel syndrome and results from entrapment of the ulnar nerve around the elbow. High-resolution ultrasound has become a central diagnostic modality because of its excellent spatial resolution, capacity for dynamic assessment, and broad availability in clinical practice. This review offers an integrated and updated overview of the ultrasonographic evaluation of the ulnar nerve in cubital tunnel syndrome, detailing relevant anatomy, characteristic normal and pathological appearances, and key considerations in postoperative follow-up. The ulnar nerve may be compressed at several anatomical sites, including the arcade of Struthers, the retrocondylar groove, Osborne’s ligament within the cubital tunnel, and the aponeurosis between the two heads of the flexor carpi ulnaris. Typical sonographic abnormalities include focal or segmental nerve enlargement, disruption or loss of the normal fascicular architecture, and changes in echogenicity. Dynamic maneuvers during ultrasound examination can further identify nerve subluxation, dislocation, or snapping over the medial epicondyle, all of which may contribute to clinical symptoms. Postoperative ultrasound evaluation is increasingly important for detecting complications or persistent compression following in-situ decompression, medial epicondylectomy, or anterior transposition. A standardized and reproducible ultrasound protocol is therefore essential for accurate diagnosis, appropriate management, and follow-up. Radiologists play a pivotal role in this multidisciplinary approach by providing detailed imaging assessments that guide surgical decision-making and help optimize patient outcomes.

Ultrasound in inflammatory conditions of subcutaneous and articular adipose tissue in the extremities

Tue, 10 Mar 2026 00:00:00 GMT

Adipose tissue of the extremities has been largely neglected in musculoskeletal ultrasound (US), beyond the assessment of superficial nodules or the exclusion of deep complications in superficial infections. Three developments have brought it to the fore: a more refined understanding of its anatomy and function − recognizing adipose tissue not merely as a passive fat store but as a metabolic and endocrine organ and a regulator of inflammation; advances in US technique; and the wider adoption of US across medical specialties, particularly dermatology and plastic surgery. Panniculitis refers to inflammation of the subcutaneous tissue and encompasses numerous disorders with considerable clinical overlap. Patients typically present with painful nodules in the extremities and often require histopathological confirmation. Histologically, panniculitides are classified according to the predominant site of involvement − septal, lobular, or mixed. US correlates strongly with these patterns. This review describes the principal sonographic appearances of the most frequent panniculitides and highlights key clinical and pathological features that help narrow the differential diagnosis. Entities that may mimic panniculitis on US are also discussed. Beyond diagnosis, ultrasonography supports disease assessment and monitoring, and it reliably guides targeted biopsy. Finally, the US features of inflammation in articular and periarticular adipose tissue are summarized, with emphasis on findings that should be considered during routine joint US examinations, as such involvement often accompanies internal derangement and may also represent the primary source of patient-reported symptoms.

Agreement between sonographic and pathoanatomic classifications of pediatric urachal remnants

Wed, 31 Dec 2025 00:00:00 GMT

AimUltrasound is the favorite method for follow-up of urachal remnants when conservative management is chosen instead of surgical resection. However, the success of conservative management depends on the type of urachal anomaly, and the agreement between sonographic and pathoanatomic diagnoses has not yet been assessed. Material and methodsWe retrospectively included all minors treated for a urachal anomaly at two German pediatric surgical centers between January 2008 and December 2020. Ultrasound examinations were conducted by specialized pediatric radiologists and compared with pathoanatomic reports following resection of the urachal anomaly, with respect to its type. ResultsWe included 15 patients with a median age of 0.2 years. The crude agreement between ultrasound and pathoanatomic diagnosis was 70%, and Cohen's κ was 0.66 (95% confidence interval: 0.3 – 1, z = 3.83, p <0.001). ConclusionsUltrasound identified the type of urachal anomaly with sufficient accuracy in this cohort; however, these findings should be corroborated by a substantially larger study.

Ultrasound assessment of larynx and trachea in the neonatal period – analysis of correlations and percentile charts

Wed, 31 Dec 2025 00:00:00 GMT

Introduction Assessment of the larynx and trachea presents a considerable challenge, particularly in the neonatal period, as conventional evaluation of these structures relies predominantly on invasive and uncomfortable methodologies. Ultrasonographic examination emerges as a non-invasive, readily accessible diagnostic modality that minimally compromises patient comfort. Methods The investigation was designed as a prospective study. Between 2022 and 2023, ultrasonographic examinations of the larynx and trachea were performed during the first days of life in a cohort of 300 Caucasian neonates, born between 32 and 42 weeks of gestation. Measurements of the anatomical structures of the larynx, trachea, and their lumens were obtained. Results Statistical analysis of the collected data examined correlations between the dimensions of the studied laryngeal and tracheal structures and the neonates’ anthropometric parameters, as well as their birth age. Using a percentile regression model, centile charts were generated to illustrate the relationships between the measurements of the larynx, trachea, and their lumens and the body weight of the newborns. Conclusion The findings contribute novel, previously unpublished insights into the ultrasonographic evaluation of the larynx and trachea in neonates. This publication offers an analytical account of data derived from the study, which has been registered with ClinicalTrials.gov (Identifier NCT05636410).

Assessment of the usefulness of ultrasound in the diagnosis of skull fractures in children – a five-year institutional experience

Wed, 31 Dec 2025 00:00:00 GMT

Aim To evaluate the diagnostic accuracy and clinical utility of cranial ultrasound in detecting skull fractures in children with head trauma, with computed tomography as the reference standard, and to assess the impact of imaging findings on hospital admission and management decisions. Material and methods This retrospective single-center observational study included 619 pediatric patients (0–14 years) presenting with head trauma to a pediatric hospital between 2020 and 2025. All patients underwent cranial ultrasound, and a subset subsequently underwent computed tomography. Suspected fractures were analyzed as positive findings for diagnostic purposes. Diagnostic accuracy metrics were calculated using computed tomography as the reference. Associations between clinical variables and outcomes were analyzed using appropriate nonparametric and categorical tests. Results Among 619 children, 62 ultrasound examinations were classified as positive or suspected for fracture. Computed tomography was performed in 13 cases, most frequently in preschool-aged children. When compared with computed tomography, ultrasound demonstrated 100.0% sensitivity, 63.6% specificity, 33.3% positive predictive value, and 100.0% negative predictive value. Overall, 101 patients were hospitalized, including all patients with ultrasound-confirmed fractures and most with suspected fractures. Admission was significantly associated with younger age and trauma mechanism. All patients were managed conservatively and discharged without complications. Conclusions Cranial ultrasound may serve as a safe, rapid, and accessible first-line imaging modality in the emergency setting for detecting skull fractures in children. Although specificity in this cohort was moderate, ultrasound showed a high negative predictive value, supporting its role in reducing unnecessary computed tomography scans and radiation exposure. Computed tomography should remain reserved for clinically ambiguous cases or those with persistent symptoms.

Soft tissue hematomas on ultrasound: a case-based review and practical guide to diagnosis

Wed, 31 Dec 2025 00:00:00 GMT

Soft tissue hematomas are frequently encountered in both emergency and outpatient settings and often present a diagnostic challenge due to their variable ultrasound appearance and overlapping features with other soft tissue pathologies. Ultrasound is the first-line imaging modality for their evaluation, offering real-time, radiation-free assessment. The sonographic appearance of hematomas is influenced by the stage of evolution, etiology, and anatomical location, which can complicate their differentiation from other entities, particularly when clinical history is unclear or imaging findings are atypical. This article provides a comprehensive review of the sonographic features of hematomas, categorized by etiology (spontaneous, iatrogenic, traumatic), and supported by a series of illustrative clinical cases. These cases highlight key imaging patterns and clinical scenarios that commonly arise in routine practice and underscore the importance of correlating ultrasound findings with clinical evolution and patient a history, especially in diagnostically ambiguous presentations. Diagnostic workflows, practical scanning tips, and key features for differential diagnosis are reviewed, including abscesses, seromas, soft tissue sarcomas, and ruptured Baker’s cysts. Emphasis is also placed on integrating clinical context with imaging findings, particularly in anticoagulated or immunocompromised patients. Recognizing subtle sonographic signs and applying a structured approach can greatly improve confidence in diagnosis. This review aims to equip radiologists, sonographers, and clinicians with a structured, practical framework for the ultrasound evaluation of soft tissue hematomas, promoting diagnostic accuracy and optimal patient care.

Qualitative and quantitative ultrasonographic assessment of muscle and its association with comprehensive geriatric assessment results among older patients scheduled for abdominal surgery

Wed, 31 Dec 2025 00:00:00 GMT

Aim Sarcopenia, a key component of frailty, is a known risk factor for postoperative morbidity and mortality. This study aimed to assess ultrasonographic features of aging muscles and their association with frailty, as determined by the comprehensive geriatric assessment, in patients undergoing elective surgery. As a secondary objective, we evaluated the utility of muscle ultrasound in predicting postoperative complications. Material and methods Patients were assessed upon admission to the Department of General Surgery at the University Hospital in Krakow. The study enrolled 84 surgical patients aged 65 years and older. They underwent ultrasound examination of the right rectus femoris muscle and the comprehensive geriatric assessment. Preoperative findings were correlated with data on the postoperative course, including length of hospitalization and occurrence of adverse events. Results Frail patients had smaller rectus femoris muscles with higher echogenicity than fit patients. Muscle size parameters significantly correlated with muscle strength, and rectus femoris cross-sectional area emerged as an independent predictor of handgrip strength in the regression model. Increased rectus femoris echogenicity was associated with higher odds of frailty, while reduced rectus femoris muscle thickness was linked to probable sarcopenia. Notably, associations between muscle measurements and physical performance were stronger in men than in women. No strong correlations were observed between ultrasonographic muscle measurements and the occurrence or severity of postoperative complications. Conclusions Ultrasound-based muscle measurements showed weak to moderate associations with strength and physical fitness, but had limited predictive value for postoperative outcomes. While potentially complementary to the comprehensive geriatric assessment, the clinical utility of ultrasound remains uncertain and warrants validation in larger studies.

Imaging of spontaneous biliary perforation in neonates: focus on ultrasound findings with a review of the literature

Wed, 31 Dec 2025 00:00:00 GMT

Spontaneous biliary perforation in neonates is a rare but potentially life-threatening condition with nonspecific clinical presentation. Early diagnosis is challenging due to nonspecific clinical signs, yet it is critical for appropriate management. Our objective is to present two etiologically distinct cases of neonatal spontaneous biliary perforation and to review the literature, with a focus on imaging findings, particularly the role of ultrasound (US) in diagnosis. Abdominal US was the initial imaging modality. Indirect ultrasound signs, such as fluid collections near the gallbladder extending towards the duodenum, the porta hepatis, and further into the abdomen, gallbladder wall thickening, and bile duct abnormalities, helped raise suspicion of spontaneous biliary perforation. US findings can be nonspecific, and the direct sign – the so-called ‘hole sign’ – is rarely observed. The final diagnosis was confirmed using magnetic resonance cholangiopancreatography, hepatobiliary iminodiacetic acid scanning, and intraoperative cholangiography. A literature review was conducted focusing on the role of imaging in 23 neonatal cases of spontaneous biliary perforation reported since 1995. Ultrasound was the initial diagnostic tool in 19 cases. In eight cases (42%), US findings raised suspicion of spontaneous biliary perforation, including two cases with direct and six with indirect signs. Hepatobiliary iminodiacetic acid scanning and magnetic resonance cholangiopancreatography served as confirmatory methods. In 65.2% of cases, the diagnosis was ultimately confirmed surgically. Ultrasound plays an important role in the early diagnosis of spontaneous biliary perforation in neonates, mostly through recognition of indirect signs, highlighting the importance of familiarity with this entity.

Application of data science methods, including machine learning, in the classification of focal lesions in the thyroid gland

Wed, 31 Dec 2025 00:00:00 GMT

Aim The aim of the study was to train, evaluate, and optimize machine learning models for classifying focal lesions in the thyroid gland as benign or malignant based on their features. Material and methods A dataset of 841 focal thyroid lesions described by 17 features (ultrasonographic and patient characteristics) was considered. Using the Python programming language, statistical and then exploratory data analyses were conducted using the libraries, including the generation of graphs and heat maps of correlations between the considered features. Binary classification models were selected to categorize the focal lesion on the basis of their characteristics into one of two classes (benign lesion, malignant lesion). The following models were used: logistic regression-based, support vector machine-based, k-nearest neighbor model, Random Forest model, and decision tree classifier. We applied formulas to select those focal lesion features that most contributed to the models’ classification decisions. The final dataset consisted of 841 focal thyroid lesions described by seven ultrasonographic features and histopathological assessment of malignancy (benign or malignant). Classifiers were validated using 10-fold cross-validation. Model performance was evaluated using sensitivity, accuracy, measure-F, precision, area under the ROC curve, PPV, NPV, specificity. Results The best-performing model (in term of sensitivity) was the classifier based on a support vector machine: sensitivity = 71.17%, accuracy = 83.24%, area under the ROC curve = 84.86%, measure f1 = 69.13%, precision = 68.85%, PPV = 68.49%, NPV = 89.06%. Conclusions The study demonstrates the usefulness of data science methods in predicting the malignant nature of focal lesions in the thyroid gland. It proves that classification decisions made by the studied models are based on specific ultrasonographic features associated with increased or reduced risk of malignancy.

Dynamic ultrasound and three-dimensional reconstruction in the prenatal diagnosis of amniotic band syndrome

Wed, 31 Dec 2025 00:00:00 GMT

Evaluation of left ventricular function using various echocardiographic techniques in hypoxic neonates during therapeutic hypothermia and after rewarming

Tue, 30 Dec 2025 00:00:00 GMT

Aim The aim of this study was to evaluate left ventricular function in hypoxic neonates undergoing therapeutic hypothermia using echocardiography. Materials and methods This multicenter, prospective, case-control, observational study involved 113 neonates, including 55 in the hypothermic group and 58 nonhypothermic controls. Echocardiographic measurements were taken by two neonatologist (NB and RB) during therapeutic hypothermia and after rewarming using various techniques. Results There was a significant difference between the study group and controls in mean blood pressure (p <0.001) and heart rate (p = 0.004) during therapeutic hypothermia. Significantly higher post-rewarming heart rate was observed in the study group compared to controls (p <0.001). Significantly lower mean A-wave (A mv) (p = 0.04) and E-wave (E mv) (p = 0.003) mitral valve velocities, as well as reduced mitral annular plane systolic excursion (p <0.001), cardiac output (p <0.001), and left ventricular internal diameter in diastole (p <0.001) were observed in the study group compared to controls during therapeutic hypothermia. The mean left ventricular myocardial performance index was significantly higher in the study group (p = 0.006). Tissue Doppler imaging showed significantly lower left ventricular E’ velocity (p <0.001) and E’/A’ ratio during therapeutic hypothermia in the study group compared to controls. Left ventricular A’ (p = 0.006), E’ (p <0.001), and S’ (p = 0.003) velocities were significantly lower, while myocardial performance index (p <0.001) was significantly higher in the study group during therapeutic hypothermia than after rewarming. Conclusions Hypothermic neonates exhibit more severe global impairment compared to healthy controls. This is reflected in higher myocardial performance index values and lower E’/A’ ratio, which indicates diastolic dysfunction.

Comparison of two- and three-dimensional ultrasound for volume estimation of the meal-stimulated gallbladder

Mon, 17 Nov 2025 00:00:00 GMT

Aim To compare two- and three-dimensional (2D and 3D) ultrasound of the gallbladder in an adult cohort. Material and methods In this observational, cross-sectional study, gallbladder volumes were measured using 2D and 3D ultrasound. Examinations were performed in the fasting state and at predefined time intervals after ingestion of a standardized nutritional drink. At each time point, measurements were performed twice using 2D and twice using 3D ultrasound. Volumes were calculated using the ellipsoid method for 2D ultrasound. For 3D, manual tracing was performed. Results Sixty-two subjects were included, yielding 2,328 volume measurements. The mean age was 69 years (SD 6.6) and the median BMI was 24.3 kg/m2 (IQR 22.9–28.6). The mean difference between 2D measurements was significantly larger than the difference between 3D measurements (3.3 cm3 vs. 1.9 cm3, p <0.001). The intraclass correlation coefficient (ICC) between two sequential 2D measurements was 0.94 (p <0.001, 95% CI 0.94–0.95), and between two sequential 3D measurements 0.96 (p <0.001, 95% CI 0.96–0.97). The ICC between 2D and 3D measurements was 0.85 (95% CI 0.74–0.91, p <0.001). Conclusions Our findings indicate that 3D ultrasound exhibits lower intra-observer variation when determining gallbladder volumes compared to 2D ultrasound. The discrepancy between the two methods increases with gallbladder volume.

Differentiation of triple-negative breast cancer and benign breast lesions using multiparametric ultrasonography

Tue, 30 Sep 2025 00:00:00 GMT

Aim Assessment of features of triple-negative breast cancer (TNBC) and benign breast lesions in multipara-metric ultrasonography, with an emphasis on the added value of sonoelastography. Material and methods Forty-one women with TNBC and 51 with benign breast lesions, underwent sonographic evaluation at the Maria Skłodowska-Curie National Research Institute of Oncology, Warsaw, between 05.2020 and 11.2023. A retrospective analysis was conducted. The following features of the tumors were evaluated: B-mode characteristics, presence of vascularity, and tissue stiffness in shear wave elastography. Two sets of data were extracted from the database: the first encompassing the total group of tumors (TG), the second comprising small lesions (<20 mm, SG). Statistical analysis for both groups was run independently to investigate if and how the size of the tumor would influence the diagnostic accuracy of the sonographic evaluation. TNBCs and benign entities were compared with t-Student’s test, Mann-Whitney U test, Pearson’s chi-square test or Fisher’s exact test. ROC analysis and logistic regression were conducted. Results For TG, ultrasound showed high predictive accuracy (AUC >0.8) for the following single parameters: elastography other than soft (>80 kPa) and irregular shape. Adding 2 features improved performance, with the highest AUC (0.858) for non-circumscribed margins and irregular shape. For SG, single parameters with the best predictive effectiveness (AUC >0,8) were: irregular shape, elastography other than soft (>80 kPa), and noncircumscribed margins. Elastography other than soft revealed high specificity. Combinations of features with AUC >0.9 were: irregular shape and hypoechogenicity; non-circumscribed margins and hypoechogenicity; and non-circumscribed margins, irregular shape, and hypoechogenicity. Conclusions Accurate assessment of shape and margins, enhanced by information about tissue stiffness, substantially improves differentiation between TNBC and benign breast lesions.

Anatomical variations of the cervical vagus nerve on ultrasonography: a cross-sectional study

Tue, 30 Sep 2025 00:00:00 GMT

Aim To identify anatomical variations in the cervical vagus nerve using ultrasonography and assess their relationship with age, sex, side, site, and proximity to the thyroid gland. Materials and methods A cross-sectional observational study was conducted on 347 patients undergoing routine or clinically indicated neck ultrasonography. High-frequency linear ultrasound probes were used to scan the cervical region bilaterally. The cervical vagus nerve was identified relative to the common carotid artery and internal jugular vein, and its anatomical course was classified using a reference C-I axis. Anatomical variation types and proximity to the thyroid gland in potentially vulnerable configurations were recorded. Demographic factors, including age and sex, were analyzed in association with variation prevalence. Results Anatomical variations of the cervical vagus nerve were observed in 132 of 347 participants (38%). There was a statistically significant left-sided predominance (67.1%) compared to right-sided variations (6%) (p <0.001). Eight patients had bilateral variations. The most common type was the anteromiddle variation, followed by anterolateral, anteromedial, and medial types. Variation prevalence increased with age and was higher in males than in females (46.6% vs. 34.4%, p = 0.033). In 69 cases, the cervical vagus nerve was located less than 2 mm from the thyroid gland, with 13 abutting it directly. Conclusion Ultrasonography is a valuable, non-invasive imaging modality for identifying anatomical variations of the cervical vagus nerve. Awareness of these variations is essential for surgical planning and for preventing iatrogenic nerve injury, especially during procedures like thyroidectomy, vagus nerve stimulation, and radiofrequency ablation, particularly in older patients and on the left side of the neck. Preoperative mapping of the nerve using ultrasonography could, therefore, be considered as a routine measure.

Application of artificial intelligence in the ultrasonographic diagnosis of thyroid nodules

Tue, 30 Sep 2025 00:00:00 GMT

Introduction The aim of this study was to assess whether integrating selected ultrasound features into a convolutional neural network improves its ability to differentiate benign from malignant thyroid nodules. Material and methods A total of 242 patients (196 women, 46 men) with thyroid lesions were included in the study. All patients underwent surgical treatment and histopathological analysis. Thyroid ultrasonography was also performed for all participants. Images were recorded in DICOM and AVI formats, and archived in a local database. Thyroid lesions were assessed according to the EU-TIRADS classification. Convolutional neural network models were developed using established architectures, including DenseNet and VGG16, as well as custom-designed models tailored to the dataset. Hybrid models were created by incorporating selected ultrasound features into these architectures as additional inputs. Performance was compared between the baseline convolutional neural network models and their feature-supported hybrid counterparts. Results Model performance was evaluated using several metrics, including sensitivity and area under the ROC curve. Baseline convolutional neural network models served as the reference, while hybrid variants included structured ultrasound features. The VGG model showed a sensitivity of 0.78, and DenseNet achieved a sensitivity of 0.80 with an AUC of 0.84, demonstrating low variability. Inception models performed similarly, with balanced positive predictive value (PPV) (0.83) and negative predictive value (NPV) (0.74). Custom models also reached AUC values over 0.80. Selected ultrasonography features improved AUC by up to 7%, with additional gains in sensitivity and NPV. Conclusions Eight baseline convolutional neural network models used to differentiate benign from malignant thyroid nodules were enhanced by incorporating five expert-assessed ultrasound features. This hybrid approach improved classification performance across all models, yielding an average AUC increase of approximately 7%.

Standardized bilateral thoracic ultrasound image comparison as a tool for the diagnosis of pneumothorax: a pilot exploratory study

Tue, 30 Sep 2025 00:00:00 GMT

Aim Pneumothorax is a potentially life-threatening condition whose diagnosis can be challenging. Ultrasound chest examination is generally fast and user-friendly, but in non-expert hands or with uncooperative patients, it may still be difficult and time-consuming. Adding another tool to support the suspicion of pneumothorax might be useful, potentially enhancing the diagnostic accuracy of standard ultrasound chest examination. We evaluated the feasibility of standardized bilateral ultrasound image comparison as a potential new tool for pneumothorax diagnosis. Materials and methods We enrolled 60 subjects (30 with pneumothorax and 30 controls) and collected bilateral ultrasound images of their chests (each image contained one frame from the left lung and one from the right lung). Ten physicians (eight blinded to diagnosis) divided into five groups according to expertise evaluated the images for potential grayscale differences and/or horizontal artifacts between the two frames. All images were then analyzed with image analysis software for grayscale pixel assessment (one sub-analysis for the entire area under the pleural line, one for a 100-pixel-wide rectangle under the pleural line). Results All clinicians achieved good results in terms of diagnostic accuracy and inter-operator reliability, even those unexperienced in ultrasound. Mean, range, and median grayscale pixel ratio between the pneumothorax side and the healthy side in a single patient proved to be the most reliable parameters, reaching excellent sensitivity and specificity. Combining these parameters proved to be an excellent diagnostic tool (ROC area under curve = 1.00, p-value = 0.02). Conclusions Standardized bilateral thoracic ultrasound image comparison may be a potential new tool for the diagnosis of pneumothorax.

3D ultrasound of fetal congenital heart disease: findings from virtual and physical models

Tue, 30 Sep 2025 00:00:00 GMT

Mucinous adenocarcinoma of the prostate: a rare tumor − case report and literature review

Tue, 30 Sep 2025 00:00:00 GMT

Introduction Prostate cancer is the most prevalent non-cutaneous malignancy in men. Mucinous adenocarcinoma is a rare histological variant, accounting for less than 0.5% of cases. Its distinctive imaging and histopathological features present unique diagnostic challenges. Case presentation A 57-year-old male presented with sexual dysfunction, painful ejaculation, and hematuria. Clinical examination revealed a markedly enlarged prostate. Imaging studies, including scrotal and transrectal ultrasound, computed tomography, and multiparametric magnetic resonance imaging (MRI), demonstrated a complex, multilobulated prostatic mass with fluid-fluid levels and imaging features suggestive of mucin accumulation. Prostate biopsy confirmed adenocarcinoma with predominant mucinous features, including trabecular and cribriform patterns, and an ISUP grade group 4, indicating an aggressive tumor. On MRI, mucinous adenocarcinoma typically appears as a multicystic lesion with high T2 signal intensity and minimal diffusion restriction, which may delay diagnosis. These imaging characteristics differ from those of conventional prostate adenocarcinoma and can mimic benign cystic lesions. Discussion Histopathological diagnosis is often challenging due to the extracellular mucin content. While treatment generally follows standard protocols for high-grade prostate cancer, including surgery, radiotherapy, and hormonal therapy, the rarity of this variant leaves many questions regarding prognosis and optimal management unanswered. Conclusion Awareness of the distinct imaging and histopathological features of mucinous adenocarcinoma is crucial for accurate diagnosis and appropriate management. Further research is needed to better understand its clinical behavior and to establish evidence-based treatment guidelines.

Transesophageal echocardiography in the imaging of spinal cord structures – a systematic review of the literature

Tue, 30 Sep 2025 00:00:00 GMT

BackgroundTransesophageal echocardiography enables visualization of structures within the spinal canal, particularly in the upper thoracic and lower cervical regions, but its diagnostic performance and clinical roles remain unclear. AimTo systematically review studies evaluating the ability of transesophageal echocardiography to depict spinal canal anatomy and its potential diagnostic, monitoring, and interventional applications. Material and methodsA PRISMA-guided systematic review (PROSPERO CRD420251074380) was conducted to identify human studies evaluating transesophageal echocardiography for imaging spinal canal structures. PubMed/MEDLINE, Embase, and Web of Science were searched from inception to September 2025; screening and de-duplication were supported by Rayyan, and findings were synthesized narratively. ResultsThirteen studies met the inclusion criteria. Transesophageal echocardiography consistently identified key landmarks such as the epidural space, dura mater, subarachnoid compartment, and catheter position, with the best visualization reported in the upper thoracic and lower cervical segments. Reported applications included adjunctive diagnosis of selected pathologies, intraoperative assessment of spinal perfusion, and procedural guidance. Image quality and feasibility were influenced mainly by patient habitus and anatomy. Safety signals were favorable, although systematic assessment was lacking. No study provided robust comparative accuracy versus magnetic resonance imaging or computed tomography, and standardized outcome measures were uncommon. ConclusionsTransesophageal echocardiography shows promise for real-time visualization of spinal canal structures and select intraoperative and interventional uses. However, current evidence is limited to small, heterogeneous studies. Rigorous prospective research including standardized imaging endpoints and comparative evaluations is needed to define its diagnostic accuracy, safety, and clinical impact.