Appendix-preserving elective herniorrhaphy for de Garengeot hernia: two case reports

Background Emergency appendectomy is often performed for de Garengeot hernia. However, in some cases, there may be a chance to perform an appendix-preserving elective surgery. Case description A 76-year-old woman presented to our hospital with complaints of a right inguinal swelling, which we diagnosed as a de Garengeot hernia using computed tomography (CT). B-mode ultrasonography (US) of the mass showed an appendix 4–6 mm in diameter with a clear wall structure; color Doppler US showed pulsatile blood flow signal in the appendiceal wall. Twenty-eight days later, herniorrhaphy with transabdominal preperitoneal repair (TAPP) was performed without appendectomy. Another 70-year-old woman presented to our hospital with complaints of a painful bulge in the right inguinal region. The diagnosis of de Garengeot hernia was made using CT. B-mode US showed an appendix 5 mm in diameter with a clear wall structure. Color Doppler US showed a pulsatile blood signal in the appendiceal wall. Seven days later, herniorrhaphy with TAPP was performed without appendectomy. Conclusion De Garengeot hernia is often associated with appendicitis; however, an appendix-preserving elective herniorrhaphy can be performed if US and intraoperative findings do not suggest appendicitis or circulatory compromise in the appendix.

A semiquantitative color Doppler ultrasound scoring system for evaluation of synovitis in joints of patients with blood-induced arthropathy

Background Intra-articular bleeds in patients with inherited bleeding disorders lead to active synovitis which may progress to a chronic state over time. We explored the diagnostic value of color Doppler ultrasound in detecting synovitis in boys with bleeding disorders. Results Sixty boys with hemophilia and 3 boys with type 3 von Willebrand disease aged 5 to 18 years (median 12.3 years) were imaged by gray-scale and color Doppler ultrasound (US) in three centers (Beijing, China [n = 22], Guangzhou, China [n = 12] and Toronto, Canada [n = 29])) in this observational study. Images were independently reviewed by two radiologists blinded to clinical data using a subjective semi-quantitative scoring system and objective measurements of synovial thickness and vascularity. Inter-reader reliability for using subjective versus objective color Doppler US methods for assessing synovial vascularity was excellent for the subjective method and moderate/lower range of substantial for the objective method. Agreement between degree of vascularity on color Doppler and extent of synovial hypertrophy on gray-scale US was overall poor for Canada data and moderate for China data. Correlations between degree of vascularity on color Doppler and synovial hypertrophy on gray-scale US, and clinical constructs (total and itemized HJHS scores and total Pettersson X-ray scores) for assessment of blood-induced arthropathy were all poor. Conclusion Color Doppler US is a valuable scoring method for evaluating reactive synovitis in joints of subjects with inherited bleeding disorders and holds potential for assessing post-bleed reactive synovitis once further information on its association with timing of the joint bleed becomes available in the literature.

Multiparametric ultrasound in torsion of the testicular appendages: a reliable diagnostic tool?

Aim: Torsion of the testicular appendages represents the most common cause of an acute scrotum in prepubertal boys. Its sonographic appearances on gray-scale US and color Doppler US have already been presented in several studies. The aim of this analysis was to expand those already established techniques with strain elastography and thus present typical features of this entity on multiparametric US.Material and methods: Retrospective analysis of all patients presented to the urological department with an acute scrotum between January 2018 and July 2020 identified eleven patients 6-17 years old (mean, 11.1 years), discharged with the diagnosis torsion of the testicular appendages that were examined with a high-end ultrasound device. Results: On gray-scale US all patients showed a round lesion with heterogenous echotexture adjacent to the upper pole of the testis/epididymis with a diameter of 4 to 11.1 mm (mean, 7.7 mm). Scrotal skin thickening and a concomitant hydrocele were found in 9 (81.8%) and 7 (63.6%) cases, respectively. On color Doppler images, all torsed appendages were avascular and in 9 (81.8%) patients we observed hyperemia of the adjacent epididymis. Strain elastography showed increased tissue stiffness in all documented images.Conclusion: Torsion of the testicular appendages has a set of features on multiparametric US. Awareness of this features can facilitate diagnosis of torsion of the testicular appendages and reduce unnecessary surgicalscrotal exploration or unwarranted antibiotic treatment.

Multiparametric ultrasound evaluation of a case of bilateral carotid body tumor

Paragangliomas are a rare form of highly vascularized tumors that originate from paraganglia Baysal (J Med Genet 39: 617–622, 2002). In the head and neck PGL arise primarily in four distinct areas: vagal, middle ear, and larynx and more frequently carotid bifurcation. Imaging evaluations include sonography, color Doppler, US-elastosonography and contrast-enhanced ultrasound (CEUS). Additionally, Computed Tomography, Magnetic Resonance Imaging (MRI) as well as digital subtraction angiography can be performed Stoeckli et al. (Laryngoscope 112: 143–146, 2002). We present herein a case of a rare bilateral carotid body tumor assessed with multiparametric ultrasound evaluation, including CEUS and US-elastography.

Identification of Ulnar Artery Perforators Using Color Doppler Ultrasonography

Background The ulnar artery perforator (UAP) flap, which is hairless, thin, and pliable, has been used for the reconstruction of soft tissues from the finger to the elbow. Preoperative planning is essential for a perforator flap surgery, and there are some tests to identify perforators. Color Doppler ultrasonography (US) with a high-frequency transducer helps in detecting decreased flow in smaller vessels, such as perforators. The purpose of this study was to determine the anatomical locations and origins of perforators arising from the ulnar artery using color Doppler US in healthy volunteers. Methods Forty forearms of 20 healthy volunteers were included in the study. Perforators arising from the ulnar artery, within 100 mm proximal to the pisiform, were investigated using color Doppler US with a high-frequency transducer. Results A total of 205 perforators were identified. On comparing the locations in each 20 mm section from the pisiform, the largest number of perforators was 58 (28%), within 20 mm proximal to the pisiform. The axial view demonstrated 44 (21%), 64 (31%), 32 (16%), and 65 (32%) perforators in the radial, ulnar, superficial, and deep aspects of the ulnar artery, respectively. Fifty-two and 28 essential perforators were supplied by the UAPs arising from the superficial and ulnar aspect within 20 mm proximal to the pisiform and between 21 and 40 mm proximal to the pisiform, respectively, while elevating the UAP flap. Conclusion This is the first study to assess the UAP using color Doppler US. Identification of UAP using color Doppler US can be used as a preoperative assessment for reliable elevation of a UAP flap.

Brightness Mode and Color Doppler Ultrasound in Differential Diagnosis of Breast Lesions in Saudi Females

Objective: The aim of the study was to identify the pathological characteristics of benign and malignant breast lesions among Saudi females using brightness mode (B-mode) and color Doppler ultrasound (US). Materials and Methods: This study was retrospectively carried out in a single center in the Radiology and Medical Imaging Department, King Fahad Medical City, Riyadh, Saudi Arabia. A convenient method of sampling was used to include all patients referred for different diagnosis during the period of January 2016 and December 2018. A sample size of 100 cases was selected with 50% of the cases being benign breast lesions, while the rest were malignant. The data collection instruments comprised data collection sheets, while a Philips US system with a 9 MHz linear probe was used to give the differential results. The results were considered significant when P < 0.05. The statistical diagnostic test was used to detect sensitivity, specificity, and accuracy of US in the differential diagnosis of breast lesions in Saudi females. Results: B-mode and color Doppler US findings of breast mass measurements, shape, echotexture, and the presence and absence of vascularity present a sensitivity, specificity, and accuracy of 97.09%, 80.65%, and 93.28% in the diagnosis of benign and malignant breast masses. Conclusion: In Saudi females with dense breasts, the risk of breast cancer development is increased. Moreover, B-mode in combination with color Doppler US was highly determined the results of differential diagnosis for any breast lesions.