Search Results (790)

Background: Endocrine disturbances are increasingly recognized as components of long COVID, yet long-term data remain limited. This study evaluated the prevalence of dysglycemia and thyroid autoimmunity four years after SARS-CoV-2 infection in adults without previously known endocrine disease. Methods: We conducted a retrospective longitudinal 4-year evaluation of adults hospitalized for COVID-19 between 2020 and 2021. Of 1009 eligible patients without prior diabetes or thyroid disease, 96 completed a standardized 4-year post-infection evaluation. Acute-phase data included COVID-19 severity, admission glucose, inflammatory markers, imaging findings, and treatments. The 4-year evaluation comprised fasting plasma glucose, thyroid function tests, anti-thyroid antibodies (anti-TPO, anti-Tg), and thyroid ultrasonography. Baseline HbA1c, thyroid autoantibodies, and thyroid imaging were not available. Results: At four years post-infection, 27.1% of patients exhibited dysglycemia compatible with type 2 diabetes mellitus, 41.6% showed thyroid autoimmunity, and 15.6% presented with both conditions. Overall, 47.9% developed at least one endocrine alteration. Admission hyperglycemia strongly predicted long-term dysglycemia (OR 6.67; 95% CI: 1.45–30.58), and diabetes prevalence increased with acute disease severity. Thyroid autoimmunity was frequent but not associated with initial COVID-19 severity. Conclusions: Four years after SARS-CoV-2 infection, a substantial proportion of patients exhibited persistent metabolic and autoimmune alterations, supporting a long COVID immunometabolic phenotype. In the absence of baseline endocrine data, the reported findings reflect long-term endocrine alterations identified at the 4-year evaluation, with a potential role of SARS-CoV-2 infection. These findings highlight the importance of baseline metabolic and thyroid assessment—including HbA1c and thyroid autoantibodies—in hospitalized COVID-19 patients and underscore the need for structured long-term endocrine monitoring. Full article

Sjögren’s syndrome is a chronic autoimmune disease marked by lymphocytic infiltration of the exocrine glands and the development of sicca symptoms, yet some patients also develop extraglandular involvement. Imaging has become relevant for describing these systemic features and supporting clinical assessment. This review discusses the roles of ultrasonography, elastography, computed tomography, and magnetic resonance imaging in evaluating multisystem disease associated with Sjögren’s syndrome. Ultrasonography and elastography help assess muscular involvement by showing changes in echogenicity and stiffness that reflect inflammation and later tissue remodeling. In joints, ultrasound can detect synovitis, tenosynovitis, and early erosive changes, including abnormalities not yet evident on examination. Pulmonary disease, most often with interstitial lung involvement, is best evaluated with high-resolution computed tomography, which remains the most reliable imaging modality for distinguishing interstitial patterns. Magnetic resonance imaging is valuable in assessing neurological complications. It can reveal ischemic and demyelinating lesions, neuromyelitis optica spectrum features, or pseudotumoral appearances. Imaging is also essential for detecting lymphoproliferative complications, for which ultrasound and magnetic resonance imaging can reveal characteristic structural and diffusion-weighted imaging findings. When combined with clinical and laboratory information, these imaging methods improve early recognition of systemic involvement and support accurate monitoring of disease progression in Sjögren’s syndrome. Full article

Objectives: This study aimed to define the learning curve required for cardiac surgery residents to acquire basic technical and interpretive skills in transit-time flow measurement (TTFM) and high-resolution epicardial ultrasonography (HRUS) during coronary artery bypass grafting (CABG). Methods: Prospective, observational, single-center study evaluating performance using a novel scoring system combining functional (TTFM) and anatomical (HRUS) assessment criteria. This study was registered on ClinicalTrials.gov (Identifier: NCT06589323). Nine cardiac surgery residents without prior hands-on experience in TTFM or HRUS were enrolled. Twenty-seven elective CABG patients (67 grafts) were analyzed. Each measurement was compared with those obtained by an expert benchmark surgeon (N.T.) under standardized hemodynamic conditions. Results: Residents achieved the predefined primary endpoint (combined TTFM + HRUS score/number of grafts ≥ 11) after a median of 3 cases (IQR 2–4) and 7 anastomoses (IQR 7–10). Kaplan–Meier analysis showed a progressive increase in the probability of success, with a sharp rise after the seventh anastomosis. A shorter interval between attempts (<30 days) was significantly associated with earlier achievement of the endpoint (p < 0.05). Median acquisition time for TTFM was 25 s, with <10% inter-observer variability across all flow parameters. HRUS images of adequate quality were obtained within 60 s in >90% of cases, though slightly lower success rates were observed for lateral and inferior wall targets. No resident- or procedure-related variable was independently associated with performance improvement. Conclusions: Mastery of basic TTFM and HRUS skills requires only a few cases and anastomoses, demonstrating a short and attainable learning curve. These findings challenge the perception of a steep learning process and support the routine use of intraoperative graft verification techniques in all CABG procedures. Full article

Background and Clinical Significance: Hepatic sarcoidosis is a benign lesion of unknown etiology. The gold standard for diagnosing hepatic sarcoidosis is histopathological examination. The symptoms and imaging findings of patients with hepatic sarcoidosis are often atypical, leading to misdiagnosis as hepatocellular carcinoma (HCC). Ultrasound resolution microscopy (URM) can overcome the diffraction limit, enabling fine visualization and quantitative analysis of the microvascular networks. This study aimed to provide new evidence for the differential diagnosis of these two diseases by comparing the URM parameters of hepatic sarcoidosis initially misdiagnosed as HCC with those of HCC. Case Presentation: A 67-year-old woman was admitted to the hospital due to upper abdominal pain for two weeks. Ultrasonography revealed a liver mass. The lesion was located in segment IV of the left hepatic lobe, was approximately 18 × 10 mm in size, and appeared hypoechoic. Contrast-enhanced ultrasound and enhanced magnetic resonance imaging both showed a “fast-in, fast-out” pattern, strongly suggesting HCC. The tumor markers were within the normal range. The patient underwent a laparoscopic left hepatic lobectomy. The histopathological diagnosis of the resected specimen was “hepatic sarcoidosis”. URM examination was performed during the preoperative diagnostic process. Subsequently, the URM parameters of the patient’s lesion were analyzed and compared with those of HCC. The results showed differences in multiple URM parameters, including microvascular flow velocity, diameter, microvascular density ratio, and vascular distribution, between this case of hepatic sarcoidosis and HCC. Conclusions: URM can quantitatively and multidimensionally evaluate the microvasculature of liver lesions, providing new reference data for the diagnosis and differential diagnosis of hepatic sarcoidosis. Full article

Background and Clinical Significance: Breast hemangioma is an extremely rare benign vascular tumor of the breast. Its imaging findings are nonspecific, and differentiation from malignant tumors such as encapsulated papillary carcinoma, mucinous carcinoma or angiosarcoma is often difficult. We report a case of breast hemangioma that showed slow growth over an 11-year period. Case Presentation: A woman in her 50s presented with a well-defined 11 mm mass in the upper outer quadrant of the left breast detected by ultrasonography. A core needle biopsy revealed a benign lesion, and follow-up was recommended. Eleven years later, the mass had increased to 27 mm. Magnetic resonance imaging showed high signal intensity on T2-weighted images and a fast-plateau enhancement pattern extending from the periphery to the center. Although malignancy was suspected, vacuum-assisted biopsy revealed a hemangioma. Conclusions: Breast hemangioma can show slow enlargement over a long period. Recognition of a characteristic peripheral-to-central enhancement pattern may aid in distinguishing this benign vascular lesion from malignant tumors. Full article

A two-year-old, intact female, domestic fawn-colored dwarf lop rabbit was presented with apathy and anorexia. Clinical examination revealed hypothermia, tachycardia, and abdominal pain. Routine hematology, biochemistry, radiographic and ultrasonographic examinations were performed. Radiographic evaluation demonstrated pneumoperitoneum, generalized small intestinal distention and marked focal dilation of the descending colon by amorphous and partially mineralized material. Ultrasonography confirmed the presence of free gas along with abdominal effusion. Exploratory laparotomy revealed focal perforation of the descending colon associated with mural abscess formation containing fecal material and pus. The severity of the lesions and multiple adhesions to adjacent organs (urinary bladder and uterus) led to the decision for intraoperative euthanasia. This case report describes clinical, imaging and surgical findings of pneumoperitoneum related to septic peritonitis secondary to colonic perforation in a domestic rabbit. Full article

The hospital-at-home (HaH) model delivers hospital-level care to patients in their homes, with point-of-care ultrasonography (PoCUS) serving as a cornerstone diagnostic tool for respiratory illnesses such as pneumonia. This review—the third in a series—addresses the prognostic, synchronous, and potential overdiagnostic concerns of lung ultrasound (LUS) in managing pneumonia within HaH settings. LUS offers advantages of safety and repeatability, allowing clinicians to identify “red flag” sonographic findings that signal complicated or severe disease, including pleural line abnormalities, fluid bronchograms, absent Doppler perfusion, or poor diaphragmatic motion. Serial LUS examinations correlate closely with clinical recovery, showing progressive resolution of consolidations, B-lines, and pleural effusions, and thus provide a non-invasive method for monitoring therapeutic response. Compared with chest radiography, LUS demonstrates superior sensitivity in detecting pneumonia, pleural effusion, and interstitial syndromes across pediatric and adult populations. However, specificity may decline in tuberculosis-endemic or obese populations due to technical limitations and overlapping imaging patterns. Overdiagnosis remains a concern, as highly sensitive ultrasonography may identify minor or clinically irrelevant lesions, potentially leading to overtreatment. To mitigate this, PoCUS should be applied in parallel with conventional diagnostics and integrated into comprehensive clinical assessment. Standardized training, multi-zone scanning protocols, and structured image acquisition are recommended to improve reproducibility and inter-operator consistency. Full article

Introduction: Ultrasound elastography is increasingly used across medical imaging, yet its role in thoracic disease remains poorly defined. While both transthoracic ultrasonography (TUS) and endobronchial ultrasound (EBUS) offer real-time assessment of pleural and pulmonary structures, the diagnostic and clinical value of elastography in this context remains uncertain. Materials and Method: A systematic search of MEDLINE, EMBASE, and the Cochrane Library was conducted according to PRISMA guidelines (April 2023; updated January 2025). Original studies evaluating transthoracic or endobronchial elastography for pleural or pulmonary conditions were included. Data extraction and quality assessment were performed independently by three reviewers, with QUADAS-2 used to evaluate risk of bias. Results: Thirty studies met inclusion criteria. Twenty-eight evaluated TUS elastography and two examined EBUS. Shear wave elastography was most frequently applied, particularly for differentiating malignant from benign pleural effusion or subpleural lesions. Surface wave elastography demonstrated consistently higher stiffness values in patients with interstitial lung disease compared with healthy controls, correlating with radiological and functional disease severity. Elastography-guided pleural biopsy improved diagnostic yield compared with conventional ultrasound-guided biopsy. Overall, substantial methodological variation existed among scanning techniques, elastography modalities, reporting methods, and diagnostic thresholds, limiting cross-study comparison. Conclusions: Ultrasound elastography shows promise for evaluating pleural effusion and pulmonary lesions, procedural guidance, and interstitial lung disease possibly improving diagnostic possibilities with bedside evaluation and reducing patient exposure to radiation. However, methodological variation and limited high-quality evidence preclude clinical implementation. Standardized acquisition protocols and multicentre validation studies are necessary to define its diagnostic utility in thoracic imaging. Full article

Background/Objectives: This study aimed to evaluate the relationship between preoperative clinical, ultrasonographic, and cytologic findings and postoperative histopathology in patients with thyroid nodules, and to determine diagnostic factors associated with malignancy. Materials and Methods: A retrospective analysis was conducted on 100 patients who underwent thyroid surgery between September 2012 and April 2014. Preoperative data—including clinical examination, thyroid function tests, and high-resolution ultrasonography—were compared with fine-needle aspiration biopsy (FNAB) results and final histopathology. Ultrasonographic features (echogenicity, calcification, vascularity, and margin) were analyzed for their association with malignancy. Statistical tests included chi-square, t-test, and correlation analysis (p < 0.05 considered significant). Results: Among 100 patients (79 females, 21 males; mean age 47.5 ± 13.9 years), 29 (29%) had benign and 71 (71%) malignant histopathology. Malignancy was significantly associated with older age (p = 0.025), smaller nodule size (p = 0.019), hypoechogenicity (p = 0.001), microcalcifications (p = 0.014), and irregular margins (p = 0.017). FNAB showed a strong correlation with final histopathology (r = 0.65, p = 0.001). The overall sensitivity and specificity of FNAB were 25.4% and 82.8%, respectively. Conclusions: Hypoechogenicity, microcalcifications, and irregular margins were the most reliable ultrasonographic predictors of malignancy. FNAB remains a highly specific but variably sensitive diagnostic tool, and its accuracy increases when interpreted in conjunction with ultrasonographic findings. Integrating cytology with structured imaging systems such as ACR TI-RADS and Bethesda classification enhances diagnostic precision in thyroid nodule evaluation. Full article

In non-vasculitic immune-mediated neuropathies, imaging studies demonstrate an enlargement not only of clinically involved but also of clinically intact nerves. The present study aimed to present a pattern of nerve swelling and its relation to nerve function. In a group of patients with dysimmune motor and sensorimotor mononeuropathies, nerve cross-sectional areas (CSAs) were measured using ultrasonography (US) and compound muscle action potential (CMAP) amplitudes using electrodiagnostic (EDx) studies. Nerve CSAs were compared in (1) clinically involved, (2) swollen and clinically uninvolved, and (3) non-swollen (clinically uninvolved) nerves. Patients’ non-swollen nerves were also compared to those of controls. In swollen nerves, the correlation between nerve CSA and CMAP amplitude was calculated. Twenty-two patients (12 men) and 50 controls (28 men) were included in the study. Clinically involved nerves were thicker than swollen segments of clinically intact nerves (p < 0.001). The patients’ non-swollen (clinically uninvolved) nerves were thicker than the controls’. In swollen nerves, CSA was strongly negatively correlated with CMAP amplitude (r = −0.54, p < 0.001). In patients with immune-mediated mononeuropathies, nerve swelling correlates with clinical and EDx findings. Patients’ clinically uninvolved nerves were also swollen, but to a lesser degree. Full article

Background and Clinical Significance: We present an 85-year-old male case of primary hepatic SCC manifesting as multiple liver nodules with atypical imaging findings. Case Presentation: The patient was negative for hepatitis B surface antigen and hepatitis C virus antibody. Serum tumor markers were all within normal limits. Contrast-enhanced ultrasonography with perflubutane demonstrated hypervascular nodules in the early vascular phase, early washout in the portal phase, and a defect in the postvascular phase (10 mm in S5 and 25 mm in S6). Histopathological examination revealed irregularly shaped tumor cells with large hyperchromatic nuclei and basophilic cytoplasm, surrounded by dense fibrous stroma forming cords, solid nests, and sheet-like structures. Immunohistochemical analysis showed positivity for AE1/AE3, p40, CK5/6, c-kit, and NCAM. Conclusions: The lesions were diagnosed as primary hepatic squamous cell carcinoma and suggested the possible involvement of hepatic progenitor cells, supporting the hypothesis of de novo carcinogenesis. Full article

Background/Objectives: Osteoarthritis (OA) remains a global health problem, as it can cause permanent joint damage, leading to irreversible disability. Therefore, there is a need for accessible and non-invasive alternative examinations, such as USG, serum COMP, and 25-hydroxyvitamin D [25(OH)D] assessment. This study aims to analyze the correlation between serum COMP and 25(OH)D levels and the degree of articular cartilage degradation in patients with knee OA, based on findings from USG and MRI examinations. Methods: A cross-sectional analytical study was conducted at Mohammad Hoesin Hospital, Palembang, from December 2024 to August 2025. 31 patients diagnosed with knee OA based on the 1990 American College of Rheumatology (ACR) classification criteria were enrolled. Serum COMP and 25(OH)D levels were measured. All patients underwent standardized USG and MRI examinations of the knee. Spearman’s rank correlation coefficient was used for statistical analysis. Results: The majority of the study subjects were female, comprising 23 (74.2%). The mean age was 63.90 ± 7.77 years with a body mass index of 25.46 ± 5.51 kg/m². Most subjects were engaged in heavy physical activity 17 (54.8%). Laboratory examination showed serum COMP levels with a median of 869 ng/mL and a range of 136–3302 ng/mL. Meanwhile, the 25(OH)D level demonstrated a mean value of 24.84 ± 7.33 ng/mL. The analysis revealed a strong and statistically significant positive correlation between serum COMP levels and the degree of articular cartilage degradation in knee OA. This correlation was observed in both USG (r = 0.61; p < 0.001) and MRI assessments (r = 0.72; p < 0.001). In contrast, serum 25(OH)D levels showed no significant correlation with cartilage degradation. The correlation coefficient between 25(OH)D levels and USG-assessed cartilage degradation was r = −0.12 (p = 0.51), and for MRI assessment, it was r = 0.17 (p = 0.92). Conclusions: A strong and significant positive correlation exists between serum COMP levels and the degree of articular cartilage degradation based on USG (r = 0.61; p < 0.001) and MRI (r = 0.72; p < 0.001). In contrast, serum 25(OH)D levels showed no significant correlation with cartilage degradation, implying that 25(OH)D may not directly reflect the extent of structural cartilage damage in knee osteoarthritis. This finding proves that an increase in serum COMP levels is associated with an increase in the degree of articular cartilage degradation in knee OA as measured by both USG and MRI. Full article

Purpose: Hyperparathyroidism (HPT) is a condition marked by excessive secretion of parathyroid hormone (PTH), leading to disturbances in calcium, phosphate, and vitamin D metabolism. HPT is classified into primary (pHPT), secondary (sHPT), and tertiary (tHPT) types, which can cause systemic complications. Parathyroidectomy (PTX) remains the cornerstone treatment for pHPT and refractory cases of sHPT and tHPT. Methods: A retrospective review was conducted on 10 pediatric patients who underwent PTX for HPT at our clinic between 2016 and 2024. Demographic data, preoperative imaging, laboratory findings, surgical details, pathology reports, and postoperative outcomes were analyzed. Patients were categorized as having either pHPT (n = 6) or renal HPT (r-HPT; n = 4), which included one case of sHPT and three cases of tHPT. Results: The mean age of pHPT and r-HPT patients was 15 and 13 years, respectively. While 50% of pHPT patients were female, all r-HPT patients were female. Preoperative imaging localized parathyroid lesions using ultrasonography in all cases, but Sestamibi scintigraphy had a lower detection rate (66.7%). Minimally invasive parathyroidectomy was performed in single-gland pHPT cases, while bilateral neck exploration was used for multiglandular pHPT and all r-HPT cases. No intraoperative complications were observed. Postoperatively, all patients demonstrated normalized calcium, phosphate, and PTH levels with significant symptomatic improvement. Hungry bone syndrome developed in one r-HPT patient and was managed successfully. No recurrences were noted during an average follow-up of 39 months. Conclusions: PTX is a safe and effective treatment for pediatric HPT, providing excellent biochemical and clinical outcomes. Multidisciplinary collaboration is crucial in managing pediatric cases, particularly those with complex renal HPT. Full article

Reproductive system diseases are common in guinea pigs, but cases presenting with the coexistence of ovarian cysts and cystic endometrial hyperplasia (CEH) are poorly documented. This case describes a two-year-old female with abdominal tenderness and an ultrasonographic diagnosis of bilateral ovarian cysts and CEH, structured accordingly to the CARE guidelines. An ovariohysterectomy was performed via a ventral midline approach under multimodal anaesthesia and analgesia. Histopathological examination confirmed rete ovarii cysts and cystic endometrial hyperplasia. The postoperative course was uneventful, with complete recovery achieved within 21 days. To the authors’ knowledge, this is the first case report, structured accordingly to the CARE guidelines, to provide complete clinical aspects, diagnostic testing (including imaging), treatment, and final confirmation of the diagnosis of both lesions in the same patient. Abdominal ultrasonography proved to be an essential tool for the simultaneous diagnosis of ovarian and uterine abnormalities in guinea pigs. Surgical management combined with multimodal anaesthesia ensured safe outcomes and satisfactory recovery. This case report also highlights the importance and value of structuring veterinary case reports according to the CARE guidelines, thereby improving the quality, transparency, and reproducibility of clinical reporting in exotic animal medicine. Full article

Background: High-frequency ultrasonography (US) is increasingly used to guide closed reduction in nasal bone fractures, but near-field resolution over the curved nasal dorsum depends critically on the acoustic coupling medium. We aimed to determine whether a semi-solid standoff gel pad (PAD) provides superior image contrast and signal stability compared with a liquid gel barrier (LGB) during intraoperative nasal bone fracture sonography. Methods: In this prospective, single-center, within-subject crossover study, 30 adults with isolated nasal bone fractures underwent intraoperative high-frequency US of the nasal dorsum under two coupling conditions differing only by the medium used: a 7 mm hydrogel standoff pad (PAD) and a custom-made 7 mm liquid gel barrier (LGB). All scans were acquired on the same platform using fixed B-mode presets (10 MHz, 4.0 cm depth, single focal zone at the cortex). Rectangular regions of interest (ROIs) were placed on the cortical interface (bone ROI) and adjacent soft tissue (soft-tissue ROI) at matched depth. For each subject and condition, contrast-to-noise ratio (CNR) and two signal-to-noise ratios (SNR_bone, SNR_soft) were derived from ROI gray-level statistics and compared using paired t-tests. Results: The PAD yielded a significantly higher CNR at the cortical interface compared to the LGB (3.46 ± 0.17 vs. 2.50 ± 0.19; mean paired difference 0.96, 95% CI 0.88–1.04; p < 0.0001). SNR_bone was also higher with PAD (4.31 ± 0.35 vs. 3.63 ± 0.34; difference 0.68, 95% CI 0.52–0.83; p < 0.0001). Using the soft-tissue ROI as the noise reference (SNR_soft), PAD again outperformed LGB (7.64 ± 0.73 vs. 6.68 ± 0.78; difference 0.96, 95% CI 0.59–1.33; p = 0.000012). Conclusions: Compared with a liquid gel barrier of similar thickness, a semi-solid standoff gel pad provides higher near-field CNR and SNR at the nasal cortical interface under standardized intraoperative conditions. These quantitative differences support the use of a gel pad as a practical coupling medium for real-time ultrasound guidance during closed reduction in nasal bone fractures, although the impact on clinical outcomes remains to be determined. Full article