Carotid artery ultrasonography is capable of diagnosing or inferring the presence or absence of stenosis or occlusion of the internal carotid artery (ICA) and vertebral artery (VA), as well as the not directly observable distal ICA, middle cerebral artery (MCA), and basilar artery (BA). Stenosis at the origin of the ICA is mainly evaluated using the parameter peak systolic velocity (PSV), with values of ≥ 200-230 cm/s indicating severe stenosis. Recently, the acceleration time ratio has been reported for diagnosis of ICA origin stenosis. An indicator called the end-diastolic (ED) ratio can be used for diagnosing occlusion of the distal ICA or the M1 segment of the MCA. The PSV of stenosis can be used to diagnose stenosis at the beginning of the VA or V1, and mean flow velocity, mean ratio, and diameter ratio can be used to diagnose distal VA occlusion. Furthermore, the usefulness of the VA pulsatility index and resistance index has been suggested for diagnosing stenosis or occlusion of the BA. This review outlines diagnostic sonography criteria for stenosis and occlusion of extracranial and intracranial arteries.

Purpose: This study aimed to assess the prevalence of median arcuate ligament syndrome (MALS) in the Japanese population by observing the celiac artery (CA) during abdominal ultrasound screenings. Subjects and Methods: Between January 2022 and February 2023, 532 abdominal ultrasound examinations were performed by a single sonographer at our institution. Of the 532 individuals screened, 223 Japanese patients were selected, excluding those whose examination purpose was suspicion of MALS, health check-ups, or non-Japanese individuals. The screening for MALS included: (1) observing the direction and diameter of the CA during rest expiration in a longitudinal epigastric scan, with a significant displacement of the CA axis towards the head or narrowing of the vessel being considered indicative of MALS; (2) checking for CA narrowing and turbulence, and measuring the vessel diameter and peak systolic velocity (PSV) during inhalation and exhalation at the narrowed part; and (3) if respiratory-induced changes in the CA axis, stenosis, or turbulence were noted, and if the PSV in the turbulent area exceeded 200 cm/s, or if there was a difference of more than 50 cm/s in PSV between inhalation and exhalation, MALS was suspected. Results and Discussion: MALS was suspected in 11 out of 223 individuals (4.9%). Among these, seven underwent a detailed examination with abdominal contrast-enhanced CT, and all were diagnosed with MALS (3.1%). Four patients with severe abdominal symptoms (1.3%) underwent surgery, resulting in symptom improvement for all. The average time for detailed CA observation was 6.8 ± 1.2 minutes. Conclusion: The detection rate of MALS in this study was found to be 3.1%. MALS can cause abdominal pain and visceral artery aneurysm, but surgery can improve symptoms. The diagnostic accuracy of ultrasound for MALS is high. Therefore, it is advisable to perform a detailed observation of CA, taking into account the possibility of MALS.

A 64-year-old man was admitted to our hospital with fever and fatigue. Blood cultures yielded negative results. Repeated echocardiography during hospitalization revealed marked exacerbation of mitral valve regurgitation, and transesophageal echocardiography revealed a vegetation (2.65 × 1.51 cm) attached to the mitral valve and perforation of the anterior leaflet. Blood culture-negative infective endocarditis due to Bartonella henselae was considered because of his cat ownership. The mitral valve was replaced. Polymerase chain reaction of the valve revealed B. henselae DNA. Minocycline was administered for 6 weeks, and gentamicin was administered for 2 weeks. No fever was observed after treatment, and the patient was discharged to home. As in this case, blood culture-negative infective endocarditis caused by B. henselae is difficult to diagnose because B. henselae is a fastidious microorganism that does not cause typical symptoms, such as fever and elevated white blood cell counts. The findings in this case, i.e., those revealed by repeated echocardiography, are important in diagnosing blood culture-negative infective endocarditis due to B. henselae. Additionally, diagnosis is time-consuming, and the infection tends to progress. Therefore, surgical intervention should be considered when it is diagnosed.

Paratesticular fibrous pseudotumor is a rare benign intrascrotal lesion. Although it may be difficult to preoperatively distinguish from malignancy, testis-sparing surgery is preferable if the tumor and testis can be dissected, especially in younger patients. We report a case of a paratesticular fibrous pseudotumor in which orchiectomy could be avoided. A man in his thirties presented with left scrotal swelling. An ultrasound examination revealed hypoechoic multinodular solid lesions attached to the thickened tunica vaginalis. Color Doppler showed mild vascularity in the nodules. Magnetic resonance imaging (MRI) revealed low signal intensity on T1-, T2-, and diffusion-weighted images with moderate contrast enhancement. Since the adhesion between the mass and the testis was not noticeable on surgical exploration, testis-sparing surgery was performed. Histopathologically, there was densely hyalinized fibrous tissue with scattered aggregates of inflammatory cells. The final histopathological diagnosis was a fibrous pseudotumor of the tunica vaginalis. Fibrous pseudotumor should be considered when a multinodular mass attached to the tunica vaginalis is hypoechoic on ultrasonography and shows low signal intensity on MRI T1-, T2-, and diffusion-weighted images. If the testis and the mass can be dissected intraoperatively, testicular sparing may be possible.