Purpose: In B-mode ultrasonographic examination (B-mode image), medullary thyroid carcinomas appear as irregularly shaped or ovate nodules suggestive of follicular adenomas and papillary carcinomas, respectively. In histologic studies, stromal components of medullary carcinoma such as amyloid deposition, fibrosis, and calcification vary from case to case. Ultrasonographic expression of these stromal factors remains unclear, however. The following studies were carried out to determine how these stromal factors are presented in B-mode images. Subjects and Methods: We used images from 22 cases of medullary carcinoma examined ultrasonographically and histologically. Ultrasonographic findings of these 22 medullary thyroid carcinomas were divided into two groups according to the shape of the nodules and into two more groups based on presence or absence of coarse, strong echoes. Histologic specimens of these 22 cases of medullary carcinoma were stained with Congo-red and Elastica van Gieson, and amyloid and fibrous tissues were evaluated semi-quantitatively. Results and Discussion: Eight of 22 cases ,were placed in the ovate group (36.4%); 14 in the irregularly-shaped group (63.6%). The amounts of amyloid and collagen tissues were significantly abundant in the irregularly-shaped group (p=0.0195 and p=0.0014, respectively). Coarse, strong echoes were found in 15 cases, 13 of which were in the irregularly shaped group. All cases with coarse, strong echoes showed histologic evidence of calcification Frequency of coarse, strong echoes tended to increase with amount of amyloid deposition. Conclusion: Medullary thyroid carcinomas shown as irregularly-shaped nodules contained abundant amounts of such histologically demonstrated stromal tissues as amyloid and collagen tissues. Medullary thyroid carcinomas containing large amounts of amyloid tissue produced many coarse, strong echoes.

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Purpose: To investigate the effectiveness of treatment with ultrasound-guided injection versus blind injection in the treatment of subacromial bursitis. Although blind injection of the subacromial bursa is a frequently used treatment, a misplaced injection may produce a poor response. Ultrasound-guided injection is assumed to be more accurate than blind injection. Subjects and Methods: We tested 13 shoulders of 10 patients (mean age, 57.6 years) with subacromial bursitis. These patients received ultrasound-guided subacromial injection and blind subacromial injection of 1% lidocaine (2 ml) administered by the same orthopedic surgeon. The effectiveness of the treatment was indicated by points on a pain scale. Evaluation times were 1, 5, 10, 15, 20, 25, and 30 minutes before and after injection. Results: Average measured level of pain with ultrasound-guided subacromial injection was markedly lower than with blind subacromial injection at all time intervals, and the pain values were significantly lower at 1 min, 5 min, 10 min, 20 min, 25 min, 30 min after injection (P<0.05). Conclusion: The ultrasound-guided injection technique can result in significant reduction in shoulder pain as compared with the blind injection technique.

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Meckel′s diverticulum is the most frequent malformation of the digestive tract. It is known that strangulation can occur in association with a cord continuous with Meckel′s diverticulum. In this report, we present a case in which we could predict Meckel′s diverticulum and identify a cord continuous with it causing strangulation on preoperative ultrasound examination. On examination, we demonstrated a dilated loop of intestine, disappearance of to-and-fro movements of contents in the loop, thickened intestinal wall, obscured Kerckring folds, and localized ascites as findings indicating strangulation. In terms of findings of Meckel′s diverticulum, there was a dilated tubular structure with a blind end to the right of the umbilical region and a cord structure continuous with it. Although preoperative diagnosis is generally considered difficult, it might be possible to establish a preoperative diagnosis by carefully performing an ultrasound examination, keeping in mind the possibility of strangulation related to Meckel′s diverticulum.

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