Purpose: To investigate the utility of ultrasonography (US) for delineating the left adrenal gland using the left renal vein (LRV) as a landmark, based on anatomical analysis of computed tomography (CT) images. Methods: (i) The position of the left adrenal gland was analyzed in relation to the abdominal aorta (Ao), celiac artery (CA), superior mesenteric artery (SMA), and LRV in 50 cases where CT was performed for suspected left adrenal nodules. Based on this analysis, a novel method for delineating the left adrenal gland was developed. (ii) Three technicians compared the delineation of the left adrenal gland using the conventional method (left intercostal scan) and the novel method in 148 normal cases with a history of CT imaging and six nodule cases encountered during the same period. Results: (i) All left adrenal glands were located on the left side of the Ao and cephalad to the LRV, with the majority (82%) positioned between the CA and SMA. Based on these findings, a transverse midline scan to delineate the LRV followed by a search of the region left of the CA-SMA origin (hereafter referred to as the “novel method”) was considered the most effective approach. (ii) The delineation rate of the left adrenal gland using the novel method was 55% in normal cases and 100% in cases with nodules, significantly higher than the conventional method (9% in normal cases and 50% in nodular cases). The delineation rate of the LRV in the non-visualization group was low (21%), suggesting that elevated BMI notably impacts the LRV delineation status. Conclusion: The delineation method using the LRV as a landmark for the left adrenal gland is considered useful for detecting both normal and nodular cases.

Purpose: Steatotic liver disease (SLD) is associated with both liver-related and cardiovascular risks, necessitating early detection. This study assessed the effectiveness of a simplified screening method for SLD using point-of-care ultrasound (POCUS) as part of a community-based health awareness initiative. Subjects and Methods: Between October 2023 and March 2024, fatty liver screenings were conducted at three community events with dedicated examination booths. Handheld ultrasound devices were used, and SLD was diagnosed based on hepatorenal echo contrast, evaluated by certified sonographers and ultrasound specialists. An interview-based questionnaire collected data on medical history, body measurements, and exercise habits. Results and Discussion: A total 123 participants (75 men, 48 women) underwent screening, with 43 (35％) diagnosed with SLD. The SLD group had a significantly higher BMI (25.3 vs. 21.2 kg/m², p < 0.001) and a relatively higher prevalence of no exercise habits (66.7％ vs. 44.3％, p = 0.065). No significant difference in SLD prevalence was found based on medical history (38.1％ vs. 31.2％, p = 0.445). Additionally, 53 participants (43.1％) underwent ultrasound screening for the first time. The study demonstrated that POCUS-based screening for SLD was highly efficient, requiring only three minutes per case, and was comparable to routine health checkups in detection rate. Conclusion: POCUS-based screening for SLD proved an effective and efficient tool for community health initiatives. Its implementation in non-hospital settings may enhance early detection and preventive interventions, expanding the role of POCUS in public health and primary care.

Transthoracic echocardiography (TTE) in the emergency room during initial evaluation plays a crucial role in the diagnosis and therapeutic decision-making for patients with acute coronary syndrome (ACS). At our institution, certified cardiac sonographers are available 24 hours a day, including nights, allowing for full TTE studies to be performed promptly in the emergency setting. Here, we present a rare case in which an initial TTE performed in the emergency room was pivotal in diagnosing a left atrial myxoma complicated by takotsubo syndrome in a patient initially suspected of having ST-elevation myocardial infarction (STEMI). The patient was a woman in her 50s who developed persistent chest pain while riding a bicycle on a Saturday evening. She was referred to our hospital by a duty physician with a presumptive diagnosis of STEMI. Initial TTE in the emergency room revealed a well-defined, highly mobile, multilobulated mass with a stalk arising from the interatrial septum, strongly suggestive of a left atrial myxoma. Additionally, severe regional wall motion abnormalities were noted in the left ventricular apex and hypercontractility in the basal portion of the left ventricle, prompting consideration of takotsubo syndrome or myocardial infarction secondary to tumor embolism. Emergency coronary angiography revealed no significant coronary stenosis or occlusion. The following day, urgent surgical resection of the tumor was performed, and histopathology confirmed the diagnosis of a left atrial myxoma. Subsequent cardiac magnetic resonance imaging and nuclear imaging studies led to a final diagnosis of takotsubo syndrome. This case underscores the critical importance of high-quality TTE imaging, even under time constraints and limited patient positioning during initial emergency evaluation. The diagnostic clarity provided by early echocardiographic assessment was instrumental in guiding appropriate and timely therapeutic intervention.

The patient was a 20-year-old man in whom a nodule in the right lower lung field was detected during routine chest radiography, leading to a referral to our Department of Thoracic Surgery for further evaluation. Chest computed tomography revealed a well-defined, 20-mm tumor adjacent to the right chest wall. There was no evidence of costal cartilage invasion, fat components, calcification, or contrast enhancement. Ultrasonography (US) revealed a 20-mm tumor on the posterior side of the right sixth costal cartilage. The tumor had a well-defined border, a lobulated shape, and homogeneous hypoechoic signals with posterior echo enhancement. Doppler US showed no blood flow. Repetitive horizontal movement of the visceral pleura corresponding to respiratory motion (lung sliding) was observed; however, the tumor did not move with lung sliding, suggesting a chest wall origin. Thoracoscopic tumor resection, which also served as a biopsy, was performed. Intraoperatively, we observed that the tumor was covered by the parietal pleura and was continuous with the costal cartilage. It appeared to be fragile, white, translucent, and firm. Histopathological examination revealed hyaline cartilage tissue without atypia or malignant features, leading to a diagnosis of chondroma. Continuity within the costal cartilage was also confirmed ultrasonically, indicating that the tumor was a periosteal chondroma. While comprehensive reports on US for chest wall tumors are limited, the lack of lung sliding in this case effectively demonstrated the origin of the tumor in the chest wall. Although rare, periosteal chondroma of the rib has characteristic ultrasonographic features, including continuity with costal cartilage, a homogeneous hypoechoic internal texture reflecting the cartilaginous matrix, and the absence of blood flow.