The macaroni sign of Takayasu’s arteritis and the hypoechoic halo sign of giant cell arteritis are characteristic signs of vasculitis on ultrasonographic images of the head and neck region. The macaroni sign is found in the common carotid artery, and the hypoechoic halo sign is found in the superficial temporal arteries. With both types of arteritis, inflammation of the large blood vessels causes various symptoms. On the other hand, some cases are diagnosed based on abnormal findings on carotid ultrasonography. The ultrasonographic findings in Takayasu’s arteritis include low-intensity lesions around the blood vessels, intima-media complex (IMC) thickening, adventitial ambiguity, constriction, and occlusion. The hypoechoic halo sign seen in giant cell arteritis is due to the presence of low luminance surrounding the circumference of the blood vessel. In addition, various other features, such as thickening of the IMC, expansion/meandering, aneurysm formation, and narrowing/occlusion of the lumen, are recognized.

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Aortic echo plays an important role in the primary diagnosis and management of aortic dissection. The aorta can be assessed using the 4S approach (Superior-sternal view, Small-scale view, Sub-xiphoid view, Supra-sternal view). I have presented EASY and/or EASY plus screening for killer chest pain. The flap in overt dissection may resemble the symbol of Mazda (the car company). The flap in triple barrel dissection may resemble the symbol of Mercedes Benz, although the original report suggested the component of flap and aortic valve. Intramural hematoma is similar to mural thrombi and atheroma. Echographic lesions in intramural hematoma can present a smooth surface, crescent form, lucent echo density, and extensive area, which might be recalled as sclerosis. Thromboembolic acute arterial obstruction as a complication of aortic dissection might present as echographic lesions characterized as 4Ms: 1) Manifestation of the intima-media complex next to the adventitia. 2) Mild to moderate echolucency of the intravascular structure. 3) Mobility of the intravascular structure. 4) Pulsatile movement of the arterial wall.

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Mantle sign and anechoic crescent (AC) sign are two representative ultrasound findings of aortic aneurysm. Mantle sign is a hypoechoic wall thickening of the anterior or anterolateral side of an aortic aneurysm, and suggests that the aortic aneurysm is inflammatory. AC sign is a crescent-shaped anechoic area between abdominal aortic aneurysmal wall and mural thrombus, and is sometimes misdiagnosed as aortic dissection. These signs are clinically useful; however, differential diagnosis from similar findings is often challenging. Close observation of ultrasound images is necessary for the correct diagnosis along with medical history, blood analysis, and other imaging modalities. We described important points for differential diagnosis using these signs, and the origin and clinical significance of these signs.

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Thromboangitis obliterans (Buerger’s disease) is a non-atherosclerotic, segmental inflammatory disease that commonly affects small and medium-sized distal arteries, veins, and nerves of the upper and lower extremities in heavy tobacco smokers before the age of 50 years. As with atherosclerotic obliterans, manifestations of Buerger’s disease are intermittent claudication, leg pain at rest, and ulceration of extremities. Therefore, accurate diagnosis of Buerger’s disease is important to provide appropriate therapy to the patient. The presence of the corkscrew sign, collateralization around areas of occlusion, is a characteristic finding of Buerger’s disease. This paper presents the corkscrew sign involving both the upper and lower limbs.

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Purpose: The aim of this study was to investigate the combination effects of pulsed HIFU (pHIFU) and phasechange nanodroplets (PCND) as a sensitizer on efficient induction of mechanical effects of pHIFU and chemically enhanced tumor growth inhibition for local anti-tumor therapy. Method: Changes in growth of colon 26 tumor tissue inoculated onto CDF1 mice were evaluated by the following treatments. (1) pHIFU exposure (1.1 MHz, 3.2 kW/cm², 300 cycles, and 50 ms interval) for 60 s, (2) PCND (1%) injection, (3) adriamycin (4 mg/kg) injection, (4) pHIFU exposure after PCND injection, and (5) pHIFU exposure after PCND+adriamycin injection simultaneously. Results: Significant changes in tumor growth were observed in the group with combination of pHIFU and PCND, although single therapy did not show any significant difference. PCND enhanced mechanical tissue fractionation by pHIFU, which was detectable by Realtime tissue elastography. Moreover, the combination of pHIFU and PCND+Adriamycin suppressed the tumor growth for 2 weeks, and 3 of 4 mice did not show any sign of regrowth during the 30-day observation. Conclusion: The combination of pHIFU and PCND exerted a significant anti-tumor effect and may be a new candidate for treatment of locally advanced cancer.

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Purpose: This study aimed at prospectively evaluating bile duct anatomy on ultrasonography and evaluating the safety and utility of radiofrequency ablation (RFA) assisted by virtual ultrasonography from gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (Gd-EOB-DTPA)-enhanced magnetic resonance imaging (MRI). Methods: The institutional review board approved this study, and patients provided written informed consent prior to entry into the study. Bile duct anatomy was assessed in 201 patients who underwent Gd-EOB-DTPA-enhanced MRI for the evaluation of hepatic tumor. Eighty-one of these patients subsequently underwent RFA assisted by ultrasound imaging. In 23 patients, the tumor was located within 5 mm of the central bile duct, as demonstrated by MRI. Results: Virtual ultrasonography constructed by Gd-EOBenhanced MRI was able to visualize the common bile duct, left hepatic duct, and right hepatic duct in 96.5, 94.0, and 89.6% of cases, respectively. The target hepatic tumor nodule and biliary duct could be detected with virtual ultrasonography in all patients, and no severe complications occurred. Conclusion: The running pattern of the bile ducts could be recognized on conventional ultrasound by referencing virtual ultrasonography constructed by Gd-EOB-DTPAenhanced MRI. RFA assisted by this imaging strategy did not result in bile duct injury.

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Esophageal intramural hematoma is a rare disease with a fairly good outcome. We report a case of a 47-year-old woman with osteogenesis imperfecta who was hospitalized due to stomachache and hematemesis. Transthoracic echocardiogram revealed an abnormal mass posterior to the left atrium. Chest CT scan showed extensive swelling of the wall of the whole esophagus. Upper gastrointestinal endoscopy revealed a very large and dark red mass in the cardiac region of the stomach that extended from the upper esophagus. She was diagnosed with esophageal intramural hematoma and made a smooth recovery with conservative therapy. The patient’s symptoms had resolved by the 7^th hospital day, and follow-up transthoracic echocardiogram and CT scan revealed complete resolution of the hematoma. A 2^nd esophagoscopy performed 14 days later found complete disappearance of the hematoma and only an ulcer scar in the esophagus. In this case, we were able to follow the process of hematoma disappearance by transthoracic echocardiogram.

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A 63-year-old man took a Japanese herbal remedy containing sanshishi (gardenia fruit) for a long time. When the total amount of sanshishi reached 6300 grams, he was still asymptomatic, but wall thickness in the ascending colon was observed on ultrasonography. He was then diagnosed with mesenteric phlebosclerosis based on CT and colonoscopy findings. The ultrasonography findings were as follows: (1) The wall thickness quickly progressed after only 3 months; (2) The wall thickness began in a submucosal layer at an early stage; (3) High-echoic spots or lines were observed in the wall and along the ascending colon. There are few reports on ultrasound imaging in mesenteric phlebosclerosis in the literature. We discussed the significance of the findings in this case and the possibility of using ultrasonography in the screening of mesenteric phlebosclerosis.

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Twin anemia-polycythemia sequence (TAPS) is characterized by the presence of a small number of minuscule arterio-venous (AV) anastomoses on the placental surface, and arterio-arterial (AA) anastomoses are hardly observed. We encountered a case of TAPS with not only two AV anastomoses but also a single AA anastomosis on the placenta. In this case, the diagnosis of selective intrauterine growth restriction (IUGR) was made at 34 weeks of gestation, and the diagnosis of TAPS was made at 35 weeks of gestation by detecting an abnormal middle cerebral artery peak systolic velocity on Doppler ultrasound. A non-stress test showed recurrent late decelerations of the anemic twin; thus, an emergent cesarean delivery was performed. At the time of birth, the larger twin was plethoric and the hemoglobin level was 21.9 g/dl, whereas the smaller twin was pale and the hemoglobin level was 4.2 g/dl. AA anastomoses are believed to play a role in compensating the blood flow through the AV anastomoses between twins; however, our experience showed that TAPS can occur even if an AA anastomosis exists.

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