Evaluation of subcutaneous mass is crucial in determining the course of treatment. While computed tomography (CT) is the standard, ultrasonography (US) can also provide extra information in assessing the characteristics of the mass. We report on a case of a 70-year-old woman who presented with a pulsatile occipital mass that was subsequently diagnosed as subcutaneous aneurysm. The trauma occurred in the home where she fell and hit the back of her head. The initial CT showed a subcutaneous hematoma without any intracranial traumatic lesions. However, a lump gradually grew, and she revisited the hospital 3 months later complaining of it being pulsatile. The follow-up CT revealed a subcutaneous mass of 3 cm at the left occipital region. The US showed an aneurysm of 30×14×23 mm arising from the occipital artery on the left side and the jet stream was observed through the orifice. The aneurysm was trapped and resected. The pathological diagnosis was concluded as pseudoaneurysm. The US had provided extra information to determine the disease as an aneurysm and was very useful for evaluation of subcutaneous mass of head.
Superb Micro-vascular Imaging (SMI) is a new Doppler imaging technique that uses a unique algorithm to minimize motion artifacts by eliminating clutter signals based on analysis of tissue movement. It was reported that ultrasound with SMI is useful for evaluation of vein. Ultrasonographic images of the lower extremities of a 33-year-old man with acute disseminated encephalomyelitis complicated with deep vein thrombosis (DVT) are shown. Because the SMI reduces motion artifacts significantly and allows visualization of low-velocity blood flow of vein, thrombus was clearly demonstrated compared to conventional methods. SMI is a new useful method to evaluate DVT.
We report two cases of stroke with calcified cerebral emboli (CCE). Case 1 was a 76 years old woman who experienced stroke with right hemiplegia. Non-contrast enhanced cranial computed tomography (CT) and magnetic resonance imaging on admission showed acute stroke and CCE in the branches of the left middle cerebral artery (MCA). A calcified plaque was seen as mitral annular calcification (MAC) on echocardiography. No other plaque was seen on echo and CT, so we identified MAC as the source of the emboli. Case 2 was 92 years old woman who experienced stroke with right hemiplegia and disturbance of consciousness. Non-contrast enhanced CT showed acute stroke and CCE in the branches of the MCA and a chest CT showed aortic arch calcification. We identified as aortic arch calcification as the source of the emboli. In these cases, ultrasound examination and CT were useful for the diagnosis of CCE. Since CCE is difficult to diagnose, further investigations are recommended.