A major feature of medical ultrasonic diagnostic devices is the ability to observe in vivo organs in real time. By using the color Doppler method, it becomes possible to observe the blood flow on a real-time image. By using a contrast agent, smaller vessels inside the organ can be observed at a high frame rate. Ultrasound shear wave elastography is an imaging technique that quantifies tissue stiffness by measuring the speed of shear waves in tissue. This technique uses dynamic excitation to generate shear waves in the body and monitors the shear waves as they travel through tissue in real-time imaging. This article describes the basic ultrasound physics, measurement method, and applications of shear wave elastography.
A variety of vascular diseases are encountered in the clinical setting in Japan. Vascular diseases of the head and neck include both those that are infrequently encountered even if their names are familiar and those that are extremely rare. A typical example of the former is vasculitis, and an anatomical anomaly is a typical example of the latter. Forms of vasculitis one should be aware of are Takayasu’s arteritis and giant cell arteritis, which are types of large-vessel vasculitis. In the case of pathophysiologies that involve mainly the intracranial arteries, such as moyamoya disease, distinctive findings may be observed when the cervical arteries are affected. In addition, there are relatively rare pathophysiologies in the area of the vertebral arteries, such as vertebral artery dissection and bow hunter’s syndrome. Rarer diseases include internal carotid artery aplasia, carotidynia, and false aneurysm of the carotid artery. When these rare diseases are encountered, steps should be taken to ensure that video is utilized to obtain clear images.
The brachial artery is the major artery of the upper arm, and it divides into the radial artery and the ulnar artery at the distal site of the elbow. However, there are rare cases of high brachial artery bifurcation that divides near or below the axillary region. We encountered a case of high brachial artery bifurcation that we could diagnose accurately by ultrasonography. The patient was a 68-year-old female. She had a complaint of ulcers in some fingers of the right hand. Ultrasonography revealed high brachial artery bifurcation that divided near the axillary region. Though the blood flow of the radial and ulnar arteries was maintained in the upper arm, both of these arteries totally occluded in the forearm. A slight blood flow signal in the interosseous artery in the forearm could be confirmed. She underwent endovascular therapy. We marked the bifurcation of the radial and ulnar arteries under ultrasound guidance. The access site was the left femoral artery. We advanced the guidewire to the right subclavian artery and the right axillary artery. We identified the origin of the radial artery by the echo-guided marking and angiography, and the guidewire passed through the radial artery occlusion site. We expanded the balloon catheter into the occlusion site and successfully recanalized the blood flow. The right radial artery was subsequently palpable. Identifying the origin of the radial artery by ultrasonography was useful information for the success of the endovascular therapy. It is important to be aware of the high brachial artery bifurcation. Confirming the high bifurcation by ultrasonography in advance helps to decide the access site for the endovascular therapy, making it possible to proceed with the procedure efficiently with the minimum number of devices.
Background: Abdominal vessels are generally examined using conventional ultrasound. These vascular disorders can be incidentally found when echocardiography and lower extremity vascular echography are performed. The present review focused on relatively rare abdominal vascular diseases. Abdominal veins: Persistent left inferior vena cava (IVC) and/or absence of right IVC can be observed as a venous anomaly. Intravenous structures in the IVC may be complicated in malignancy, and need to be differentiated from thrombosis. Portal vein thrombosis may be complicated with inflammatory diseases. Left renal vein stenosis between the superior mesenteric artery and abdominal aorta is known as the nutcracker sign. Abdominal arteries: Inflammatory abdominal aortic aneurysm and retroperitoneal fibrosis have received attention as IgG4-related disorders. Localized arterial dissection may sometimes be observed in the superior mesenteric artery. Conclusions: Simultaneous examination of abdominal vessels with conventional echocardiography and lower vascular echography can reveal asymptomatic or symptomatic abdominal vascular disorders.
The frequency of arteriosclerosis obliterans (ASO) is increasing in Japan in association with an aging population and westernization of eating habits. The main purpose of lower limb artery echo is to diagnose ASO precisely. On the other hand, there are some rare cases that do not have typical ASO. In cases with very rare disease, lower limb artery echo should be done step by step as follows: differentiation from an arteriosclerosis-related lesion, exclusion of acute arterial disease, and anatomical and structural assessment of blood vessels. Furthermore, clinical information such as the status of lower limb skin or various patient complaints is very important to make a final diagnosis.
The main purpose of lower extremity venous ultrasonography is to evaluate deep vein thrombosis (DVT) and leg varicosity. These screening examinations account for the majority of routine work. If you learn the procedure by acquiring a certain degree of skill, you will be able to deal with many types of screening examinations, but without knowledge of the disease state of various diseases, it is not possible to obtain sufficient examination results. Congenital venous malformation, i.e., Klippel-Trenaunay syndrome (KTS), may accompany deep vein hypoplasia and DVT, and the course of superficial veins is not uniform. Therefore, a standardized examination procedure for ultrasonography does not exist, but it is important to know how to indicate the various clinical conditions. Pelvic congestion syndrome (PCS) is the cause of a particular type of leg varicosity. It is possible to diagnosis suspected PCS by ruling out reflux to the sapheno-femoral junction and side branch, which are the cause of the normal types of varicosity (saphenous type, side branch type), and the presence of an incompetent perforating vein in the thigh back. Nutcracker syndrome may be the cause of PCS, so if it is a lean type of patient, left kidney venous disease should be confirmed. Many of the venous diseases are often caused by pressure change due to exclusion or reflux. When we encounter abnormal findings, we will confirm and guess what the cause is, and for that understanding we think that we need to understand the anatomy, physiology, and disease condition.
Jeune syndrome is a ciliary disorder characterized by short ribs, polydactyly, and multisystem organ abnormalities. This is a case report of a fetus terminated at 19 weeks of gestation because of short limbs, short ribs, and ascites. The fetus was found to have different mutations in both alleles of the DYNC2H1 and was diagnosed as having Jeune syndrome (MIM #613091) caused by compound heterozygotes. We present and describe skeletal images at 18 weeks of gestation recorded using three-dimensional sonography and helical computed tomography.
A bipartite placenta develops in 3% of monochorionic diamniotic twin pregnancies. It initially resembles a dichorionic placenta on ultrasonography, but has one chorionic and two amniotic membranes. Almost all monochorionic diamniotic twin placentae have intertwin vascular anastomoses. Older case reports have recorded cases of bipartite placenta in monochorionic diamniotic twins, with vascular anastomoses between the two fetuses－a finding considered to be a reliable marker of a monochorionic placenta. We report two cases of monochorionic diamniotic twin pregnancies, presenting with separate placental masses, and without any intertwin vascular anastomoses. Histological examination revealed a monochorionic and diamniotic intertwin membrane, but a dye injection study in each case demonstrated a complete absence of vascular anastomoses between the two parts of the placenta.
This case of Takayasu arteritis (TA) was examined using ultrasonography (US) over a period of 79 weeks from the early phase. A 26-year-old woman presented with a fever and tenderness on the left side of her neck. The initial US revealed abnormal wall thickness and a poorly defined outer membrane from the left common carotid artery (CCA) to the left internal carotid artery (ICA). In the same vessels, the T2-weighted images of magnetic resonance imaging (MRI) indicated abnormal structure in the outer membrane and perivascular tissue, suggesting inflammation. The magnetic resonance angiography (MRA) images showed neither stenosis nor dilatation of these vessels. Based on these findings, carotidynia was suspected. The case was re-examined 23 weeks later using US, and decreased wall thickness of the left ICA was noted. In a second follow-up at 30 weeks, the US images showed surface irregularity of the intimal membrane in the left CCA, consistent with a diagnosis of TA. At 55 weeks after the initial consultation, we found increased wall thickness of the left proximal CCA, a finding which also strongly indicated TA. The patient was administrated prednisolone (30 mg/day). At 57 weeks, MRA demonstrated stenosis of the left subclavian artery with a smooth lumen. This finding led to the final diagnosis of TA. In TA, by the time a patient presents with symptoms, it is common to see advanced image findings of the vessels with circumferential wall thickening, sometimes called “macaroni sign”. Therefore, there are few reports of cases with images of TA in the early phase. We could not find any reports that tracked changes over time using US. We experienced a case of TA in the early phase with images similar to carotidynia that could be followed up by US. We think is a very important a case of TA.