Abdominal ultrasound screening examinations are explained for six organs: liver, gallbladder, pancreas, spleen, kidney, and abdominal aorta. Ultrasound examinations need to be divided into several scans, because only a small range is displayed on the monitor. We recommend that you decide the scan location and order in advance in order to reduce missed areas, to improve objectivity when the images are read by another doctor, and to make it easier to train newcomers, etc. Each organ is scanned from a different angle. For stored images, it is desirable to store volume data (including a moving image of a sector scan in one direction) that best reflect the highlights of the ultrasound examination. However, the method of saving images differs from institution to institution. Therefore, 25 still images are used as recommended stored images. Essential points for observing each cross section and technical points related to scanning are explained.
In recent years, thyroid nodules are frequently detected incidentally by other imaging tests such as carotid duplex, chest CT, and PET-CT. Ultrasonography is essential for diagnosis of these nodular thyroid diseases, and based on the thyroid nodule (mass) ultrasound diagnostic criteria issued in 2011, it is important to distinguish between benign and malignant thyroid nodules. The typical ultrasonographic findings of papillary carcinomas are irregular shape, blurred border, internal hypoechoic, heterogeneity, internal fine calcification, increased internal blood flow on color Doppler, and hard nodule on elastography. On the other hand, it is also important to reduce unnecessary medical procedures by diagnosing that non-neoplastic lesions such as colloid cysts and adenomatous nodules do not need to be further examined with fine needle aspiration cytology, for example.
A 68-year-old woman was admitted to our hospital for progressive respiratory distress and orthopnea. Marked elevation of serum concentrations of BNP and H-troponin, and findings of lung congestion with bilateral pleural effusion on chest X-p, suggested severe congestive heart failure. Transthoracic echocardiography showed a marked decrease in left ventricular wall motion, and the ejection fraction was 23%. The aortic valve showed pure severe stenosis and the effective orifice area was 0.3 cm2. Using color Doppler echocardiography, the orifice of the aortic valve showed only one commissure, indicating unicuspid valve. Coronary angiography showed no significant stenosis. Owing to the poor response to medical treatment for heart failure, emergent aortic valve and ascending aortic replacement was performed. The anatomical surgical finding of the aortic valve showed that the valve orifice was a 2×12-mm slit-like shape with one commissure, suggesting unicuspid aortic valve. Adult aortic unicuspid valve is extremely rare, and it is difficult to diagnose by transthoracic echocardiography. Here, we report a rare case of unicuspid aortic valve diagnosed by means of precise observation with transthoracic echocardiography.
A 44-year-old man underwent hematopoietic stem cell transplantation as treatment for myelodysplastic syndrome. Liver dysfunction and weight gain were observed 30 days after transplantation. Ultrasonography (US) was performed 40 days after transplantation for further evaluation of an elevated serum total bilirubin level (3.8 mg/dL) and weight gain (5.4%). It revealed hepatomegaly, ascites, and hepatofugal flow in the portal vein (PV). Prednisolone, recombinant thrombomodulin, and danaparoid sodium were administered based on a diagnosis of veno-occlusive disease (VOD). Hepatopetal flow of the PV was restored during the course of treatment, and we observed reduction in the patient’s serum total bilirubin level and body weight. He was discharged 99 days after transplantation. VOD is usually diagnosed based on a patient’s clinical presentation; however, US is useful in such cases and is therefore included in the diagnosis and severity criteria for VOD (the European Society for Blood and Marrow Transplantation, 2016). In the present case, PV evaluation was useful for the accurate diagnosis of VOD and assessment of treatment response.
A woman in her 20s noticed pain and a mass in her left forearm. She was referred to our hospital for a cardiovascular surgery consultation. Ultrasound images: In this case, some changes in ultrasound images of the radial artery were observed over 4 years; the size got bigger, the thickness of the arterial wall increased, and a solid lesion with little blood in the wall was observed. Surgical findings: The tumor was a membrane-covered lesion and had no adhesions around it. Histopathological examination of the aneurysm removed during surgery was performed, and the diagnosis was epithelioid hemangioma. We report the changes in ultrasound images over 4 years in a case of radial artery epithelioid hemangioma.