We explained the crucial points of ultrasound diagnosis for benign mass lesions of the liver. Accurate ultrasound diagnosis is important to reduce unnecessary secondary tests. First, the condition of the liver (evaluation of diffuse liver disease) is evaluated, followed by presence diagnosis (region, number of tumors, and size) and qualitative diagnosis, using ultrasonography. A qualitative diagnosis is made by evaluating the relationship between the tumor morphology, capsule, border (periphery / margin), internal structure and condition, non-tumor condition, and other intrahepatic lesions using ultrasonography. We also explained the crucial points of ultrasonic diagnosis for liver cysts, hepatic hemangiomas, hepatocellular adenomas, focal nodular hyperplasia, and inflammatory pseudo tumors.

As a basis for diagnosing lymph node metastasis, combinations of lymph node size, short diameter, morphology (presence or absence of fat in lymph node), presence or absence of cortical thickening, and so on are being investigated. Although not standardized, diagnostic imaging is useful, with ultrasound, MRI, CT, and PET/CT being utilized. Ultrasound has a sensitivity of 49-87% and a specificity of 56-97% for axillary lymph node metastasis of breast cancer. When ultrasound-guided needle biopsy is performed, the sensitivity increases to 79.6%, specificity 98.3%, and PPV 97.1%. Lymph nodes are classified as regional lymph nodes due to the primary cancer, but metastasis occurs at lymph nodes that are important for lymph flow such as inguinal, supraclavian, and axillary lymph nodes, regardless of the specific primary lesion, and is found as a cancer of unknown primary origin. Needle biopsy is useful for dealing with these superficial lymphadenopathies. Biopsy is possible with minimal invasiveness under local anesthesia. If malignant, cancer/sarcoma/lymphoma diagnosis, histological type of cancer, biomarker search by IHC method, and genetic testing are possible. Actual needle biopsy of superficial lymph nodes is explained in detail, and four cases are presented. Implantation of tissue markers in lymph nodes is also discussed. In a case of axillary lymph node metastasis of breast cancer, a study in which a marker was placed in advance in the metastatic lymph node to accurately evaluate the therapeutic effect is described.

Purpose: Shear wave elastography (SWE) has been validated in chronic hepatitis C and B; however, limited data are available in non-alcoholic fatty liver disease (NAFLD). This study aimed to evaluate the accuracy of SWE and FIB4 index for the diagnosis of fibrosis in a cohort of consecutive patients with biopsy-proven NAFLD, and to evaluate the effects of other histologic parameters on SWE measurement. Methods: Written informed consent was obtained from all patients, and this study was approved by our internal review board and ethics committee. Seventy-one patients with histologically proven NAFLD (mean age 50.8 years ± 15.7) were examined. All patients underwent SWE (Aixplorer; SuperSonic Imagine) and FIB4 index (based on age, aspartate aminotransferase and alanine aminotransferase levels, and platelet counts) measurements. SWE measurements were compared with the histologic features based on the NAFLD activity score and FIB4 index. Results: The area under the ROC curve for the diagnosis of hepatic fibrosis stage 3 or higher was 0.821 (optimal cut-off value 13.1 kPa, sensitivity 62.5%, specificity 57.4%) for SWE and 0.822 (optimal cut-off value 1.41, sensitivity 71.9%, specificity 53.9%) for FIB4 index. The median liver stiffness values measured using SWE showed a stepwise increase with increasing hepatic fibrosis stage (P < 0.001), inflammation score (P = 0.018), and ballooning score (P < 0.001), and showed a stepwise decrease with increasing hepatic steatosis stage (P = 0.046). Conclusions: SWE and FIB4 index are useful noninvasive tools for estimating the severity of fibrosis in NAFLD patients. However, the presence of severe steatosis may affect the liver stiffness measurement, resulting in underestimations of liver fibrosis.

The sensitivity of ultrasound to detect liquid components in the thoracic cavity is very high, and it is possible to visualize even very small pleural effusions that cannot be discerned by X-ray. There have been many reports that ultrasonography is useful for the diagnosis of pleural effusion, including empyema. However, there have been few reports of chest wall abscess. We report a case of empyema necessitatis that was diagnosed with ultrasonography from the body surface. A 69-year-old man had a mass on the right chest wall during the postoperative course of gastric and lung cancer. He was diagnosed with pleural recurrence of lung cancer and was suspected to have subcutaneous infiltration based on chest CT, and was admitted to the hospital for referral. Ultrasonography showed pleural effusion and oval hypoechoic lesions in the chest wall. A fistula between the pleural cavity and the hypoechoic lesion in the chest wall was detected on ultrasonography. Pleural effusion was seen to flow from the pleural cavity to the chest wall to and fro. We suspected pyothorax necessitatis and made a diagnosis of pyothorax based on thoracentesis. The chest wall mass disappeared for the most part with thoracic drainage. Real-time observation using ultrasonography could be useful for the diagnosis of empyema necessitatis.

Purpose: We planned a series of webinars on echocardiography using cloud-based video conferencing software (Zoom) and conducted a questionnaire survey of participants in the seminars in order to examine the future of echocardiography seminars. Subjects and Methods: We held six echocardiographic web seminars in April and May 2020, and an online questionnaire survey was conducted after the seminars. The subjects of this research are 361 people who answered the questionnaire. Results and Discussion: The subjects were mostly in their 20s and 30s, with 77% being clinical laboratory technicians and 14% being doctors. About 70% used Zoom for the first time. In addition to being able to watch at home or at work, an advantage of the web seminar was the ability to participate in the seminar for those who could not attend in the past due to the distance to the venue or time restrictions due to childcare, work, and so on. There were few negative opinions about web seminars, and in terms of the ideal approach for echocardiography seminars in the future, there were many people who would like to have them broadcast on the web and made available on demand even when a seminar is held at a venue. Conclusions: Web seminars not only avoid the spread of infection under the COVID-19 epidemic but also have many advantages compared with seminars held at a venue. Web seminars seem to have great potential as a new approach for medical education in the "with corona" era.