Diagnostic imaging plays an important role in diagnoses of intracardiac masses and determining therapeutic strategies. Preoperative biopsy tissue diagnosis using forceps for intracardiac masses is contraindicated due to the risk of embolism. As such, the therapeutic strategy (surgery, thrombolytic therapy, or follow-up) is basically determined based on image diagnosis. On the other hand, the heart is a perpetually moving organ. There is a limit in evaluating the morphology and mobility of a moving intracardiac mass using CT or MRI with the limited frame rates. Therefore, noninvasive echocardiography with excellent temporal resolution plays a central role in diagnosing intracardiac masses and deciding therapeutic strategies. Furthermore, there are various types of tumors or masses found in the heart, such as thrombus, infectious vegetations, and benign or malignant tumors. In order to select the appropriate therapeutic strategy, physicians and sonographers who perform echocardiography need to be familiar with the basic differentiation points of these structures. This review briefly provides the basics of how to make a differential diagnosis of intracardiac mass by echocardiography.

Different examiners’ perceptions of manual sensitivity time control (STC) / time gain compensation (TGC) and differences in adjustment methods may prevent reproducible diagnosis and severity assessment. I describe several adjustment methods that are performed on a daily basis, although with little evidence, and discuss problems associated with them. I would like to emphasize again the significance of STC / TGC after reconfirming the origins of conventional B-mode images and the role of parameters. This is an unavoidable issue for the standardization of B-mode images, and we hope that this will be a good opportunity to deepen discussions in the future.

Purpose: To examine the usefulness of transperineal ultrasound in the diagnosis of anal sphincter injuries in cases of forceps delivery. Subjects and Methods: A prospective study was conducted between April 2013 and March 2015. Thirty primiparous women who underwent forceps delivery were evaluated for anal sphincter injuries via visual inspection by medical delivery assistants soon after delivery and via perineal ultrasound by a single physician (FJSUM) 4 days later. Results: Eight (27%) and 16 (52%) of the 30 patients were diagnosed with anal sphincter injuries by visual inspection and perineal ultrasound, respectively. Of the 22 patients not diagnosed with anal sphincter injuries via visual inspection, 11 (50%) had anal sphincter injuries according to perineal ultrasound. Conclusions: Perineal ultrasound made it possible to detect anal sphincter injuries that were not found via visual inspection by medical delivery assistants. Moreover, it was useful when we wanted to check whether the injuries were repaired or not.

A woman in her 60s presented with a left breast tumor in December. No abnormality was identified during breast cancer screening performed the previous year. A poorly movable mass (2 cm in diameter), which was elastic firm and had an irregular and indistinct border, located at the 12 o’clock position (A/C area) in the left breast was identified by palpation. Mammography findings were category I. Breast B-mode ultrasonography revealed a tumor (19×10×16 mm) with an irregular shape, well-defined and rough border, hypoechoic heterogenous internal echo with cystic change, no change in posterior echoes, no interruption of the interface between adipose tissue and the gland, and D/W 0.53. Doppler ultrasonography revealed a tumor without blood flow signals. Contrast-enhanced computed tomography scan showed a heterogeneous nodule of about 10 mm in diameter gradually becoming enhanced in the CD area, a finding which is consistent with breast cancer. We first suspected breast cancer, but the pathological diagnosis based on a needle biopsy was xanthogranulomatous inflammatory lesions consisting of chronic inflammatory cells and macrophages, and tumor cells were not identified by additional immunostaining. Ultrasonography was performed in May the next year for follow-up purposes, and the tumor diameter and depth width ratio were confirmed to have decreased to 16×7×14 mm and 0.44, respectively. Compared with the previous shape, the central part of the tumor dimpled and the protrusion towards the front disappeared. Although an internal echo showed uneven low echoes and linear high echoes, the cystic region disappeared and changed to images suggestive of benign disease. Xanthogranulomatous inflammation is a very rare disease, and is difficult to distinguish from malignancy based on image examination. We thus report this case with a review of the literature, focusing on changes in ultrasonographic findings.

Primary popliteal vein aneurysm is a rare pathology that often causes pulmonary thromboembolism. It often leads to recurrent pulmonary thromboembolism with anticoagulant treatment. Venous ultrasonography can very easily and quickly detect this aneurysm. Including venous ultrasonography in the work-up is therefore recommended in patients with pulmonary thromboembolism. We report two cases where venous ultrasonography was useful in detecting this rare disease. In the two patients, the first sign of popliteal vein aneurysm with thrombus was acute pulmonary thromboembolism; in one case, pulmonary thromboembolism was recurrent with anticoagulant treatment. Surgery is recommended in all cases. In our two cases, surgery was performed with complete recovery.