Echocardiography is a noninvasive diagnostic technique used to evaluate structural, functional, and hemodynamic abnormalities. It is among the most valuable techniques for solving many clinical problems encountered in the emergency room, especially in the acute-care setting.

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Ultrasound is an essential modality in the pediatric setting. We discuss simple techniques and an array of diagnostic considerations. The examination is most likely to provide useful information when such tools as footswitches and various useful probes are available and the order in which examinations to rule out possible problems has been carefully worked out. Use of sedatives during the examination can be minimized if children are accompanied by their parents and provided with picture books, toys, and amusing video; younger children can be given milk or confectionery items. Considerations in diagnosing abdominal tumors and alimentary tract, hepatobiliary, urogenital diseases, among other disorders, are also covered.

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We describe basic aspects of the ultrasonographic study of the head and neck region. Because such limited organs such as the thyroid and parotid gland, as well as the entire cervical region are included in the area of examination, and because diseases occurring in these regions are closely related in a substantial proportion of cases, examination of the head and neck region requires thorough understanding of the anatomy and pathology and thorough investigation of all aspects of the disease to avoid any oversights. We outline the basics of the examination, anatomical characteristics, normal findings, indicated diseases, and concrete procedures for the examination and diagnosis. The importance of ultrasonography for the head and neck region is also explained.

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We used ultrasound to study the low-echoic preoperative localization and ultrasonographic image of parathyroid tumors in 47 patients with primary hyperparathyroidism and a single parathyroid tumor (mean age, 61 years; range, 41 to 89 years). Thirty-three patients were pathologically diagnosed with parathyroid adenoma, 13 with single hyperplasia, 1 with parathyroid carcinoma. The excised parathyroid tumors weighed 935±940 mg (range, 98 to 4413 mg). Localization of parathyroid tumors was correctly diagnosed with ultrasonography in 37 (78.7%) patients, while that of 10 (21.3%) patients was not diagnosed. Parathyroid tumors showed an internal echo, had solid, homogeneous content, and produced no strong ultrasonographic echoes in peripheral or internal lesions. A characteristic hyperechoic line was observed along the border between the parathyroid tumor and thyroid gland in 27 of 29 tumors located in the back of the thyroid gland. Power Doppler ultrasonography detected intratumoral vessels in 20 (54.0%) of 37 patients. Detection of parathyroid tumors in patients with coexisting thyroid nodules or Hashimoto's thyroiditis was difficult. However, these results show ultrasonic diagnosis to be effective and useful in the preoperative localization of parathyroid tumors in patients with primary hyperparathyroidism.

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Purpose: To develop a new contour extraction method for identifying abnormal tissue. Methods: We combined two techniques: logarithmic K distribution of a scattering model (method 1) and regional discrimination using the characteristics of local ultrasound images (method 2) into an integrated method (method 3) that provides accurate contours, which are essential for quantitizing border information. Results: The diagnostic tissue information around the border of an image can be characterized by its shape and texture statistics. The degrees of circularity and irregularity and the depth-width ratio were calculated for the extracted contours of breast tumors. In addition, gradients, separability, and variance between the two regions along the contour and the area and variance of the internal echoes, were calculated as indices of diagnostic criteria of breast tumors. The quantitized indices were able to discriminate among cysts, fibroadenomas, and cancer. Conclusion: In many ultrasound images of breast tumors, the combined techniques, the variance ratio of the logarithmic K distribution to the logarithmic Rayleigh distribution and the multilevel technique with local image information can effectively extract abnormal tissue contours.

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Purpose: In recent years, advances in ultrasonographic techniques have allowed the detection of even small hepatocellular carcinomas. However, many cases do not show distinctive ultrasonographic features. A quantitative ultrasonographic procedure for making the diagnosis would therefore be desirable. It is recognized that radio-frequency (RF) signals from hepatic tumors conform to the K distribution. The K distribution is used for the characterization of the statistical properties of backscattering signals from heterogeneous regions. In this study, RF signals were acquired from hemangioma of the liver (hemangioma) and hepatocellular carcinoma (HCC), and parameters of the K distribution, i.e., φ (the mean square of the amplitude of RF signals) and α (the number of effective scatterers), were calculated for the quantitative ultrasonographic evaluation of hepatic tumors. Methods: This study included 10 nodules of 10 patients with hemangioma and 27 nodules of 24 patients with HCC. The A-mode RF signals passing through the hepatic tumors were acquired with an Aloka SSD-1000 ultrasound system, and measurement units comprising 279 points were set on the RF signals corresponding to the tumor lesion. The parameters of the K distribution that were most consistent with the histogram were calculated and assessed. Results: With regard to φ, the values were high in hemangioma, and there was a significant (P<0.05) difference in the φ value between hemangioma and HCC. On the other hand, there was no significant difference in the a value between hemangioma and HCC. Conclusion: The α values of hemangioma were equivalent to those of HCC, while the φ values for hemangioma were higher than those for HCC. It was deduced from these observations that a situation in which an electron beam is likely to scatter exists in the tumor. This is also consistent with the pathological findings reported from previous studies. The use of these parameters is expected to allow quantitative ultrasonographic evaluation of hepatic tumors.

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Purpose: The current state and effectiveness of abdominal ultrasonography (US) were investigated by reviewing statistical data for US of the kidney as part of complete medical screenings conducted at our institution between April 1994 and March 2004. Methods. Among 4339 individuals with US findings, computed tomography (CT) was performed on 129 individuals at our institution. Among these individuals, US findings and CT diagnoses were compared and analyzed. Results: US findings indicated renal tumors in 73 of the 129 subjects, and the breakdown of CT diagnoses for these 73 individuals was as follows: no lesion, n=45 (61.6%); simple renal cyst, n=13 (17.8%); complicated renal cyst, n=5 (6.8%); suspected malignant tumor, n=5 (6.8%); renal angiomyolipoma, n=2 (2.7%); pelvic dilatation, n=1 (1.4%); granuloma, n=1 (1.4%); teratoma, n=1 (1.4%). Magnetic resonance imaging (MRI) was performed on 4 of the 5 subjects with suspected malignant tumor, and surgery was performed in all 4 cases with suspected kidney cancer. Kidney cancer was histopathologically confirmed in 2 patients, resulting in a detection rate of 0.046% for kidney cancer by US as part of a complete medical screening. In the 2 patients with kidney cancer, differentiating cystic renal cell cancer from a renal cyst was not possible based on US findings alone in 1 patient, and no thorough examinations were performed in the 3 years leading up to surgery. Conclusions: These results suggest that additional US and thorough examinations are necessary if a lesion cannot be confirmed as a simple renal cyst on initial US. Furthermore, to improve the skill levels of healthcare professionals who perform and interpret US, a feedback system should be established where data related to complete medical screenings are available to the personnel involved.

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Double orifice mitral valve is a rare congenital cardiac malformation. We report a 20-year-old female patient with a bicuspid aortic valve and a double orifice mitral valve. She had an ejection systolic murmur and a diastolic murmur. Transthoracic echocardiograms showed a bicuspid aortic valve and two perfectly defined mitral valve orifices. Color Doppler echocardiogram showed two separate mitral inflows during diastole in four-chamber view and massive aortic regurgitation in apical long axis view. Operative findings revealed bicuspid and highly thickened and prolapsed aortic valves and a complete bridge type of double orifice mitral valve.

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Most femoral hernias contain small intestine or greater omentum. We used ultrasonography to diagnose a case of femoral hernia containing appendices disturbing the blood-flow in the femoral vein. An 83-year-old woman sought consultation at this institution because of swelling and pain in the right inguinal area lasting several days. Ultrasound examination showed a cystic mass compressing the femoral vein. The mass continued as far as the vermiform appendices in the abdominal cavity. Femoral blood flow was disturbed, and moyamoya echo was visible. The diagnosis was femoral hernia containing appendices, and surgery was performed. The top of the appendices was incarcerated to the canalis femoralis and the mucosa of the strangulated portion of the appendices was necrotic, confirming the diagnosis. This case demonstrates the usefulness of ultrasonographic examination in the preoperative diagnosis of femoral hernia containing appendices.

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