<abstract>
<title style='display:none'>Abstract</title>
Abdominal hernias are usually located in the inguinal canals. Differential diagnosis of hernias should consider other pathologies, which typically occur at this site. The aim of this review paper is to present fat-containing lesions located in the inguinal canal based on both our own experience and literature. The first part of the paper describes the embryogenesis and differences in the structure and content of male and female inguinal canal. The canal is clearly wider in men, which results from the presence of the spermatic cord and its components. The female canal contains only the narrow round ligament of the uterus. The second part of the paper discusses the incorrect use of the term “lipoma” for retroperitoneal fat, which penetrated into the lumen of the patent processus vaginalis – the authors using this term acknowledge its incorrectness. These lesions often coexist with oblique inguinal hernia and should be excised during a surgery as they may cause inguinal pain. As for other fat-containing inguinal pathologies, we discussed lipomatosis of the spermatic cord, liposarcoma and the greater omentum. Differential diagnosis of these lesions considers their echogenicity, echostructure and vascularity. Furthermore, attention was paid to the adipose tissue surrounding the lower epigastric vessels, which may be incorrectly localized in the inguinal canal. Finally, the importance of proper diagnostic methodology and knowledge of the inguinal anatomy for the correct ultrasonographic diagnosis was emphasized.
</abstract>

Differential diagnosis of fat-containing lesions in the inguinal canal using ultrasound

<abstract>
<title style='display:none'>Abstract</title>
Imaging has a very important role in evaluating abdominal pathology. A good knowledge of indications is of crucial importance in the management of the patient with abdominal pathology. Ultrasound, which on its own can lead to an accurate diagnosis, plays a pivotal role in the management of abdominal pathology. The use of ultrasound contrast agents has significantly improved ultrasound diagnostic capacities in both hepatic and non-hepatic pathology. The use of computed tomography should be limited due to the potential harmful side effects of ionizing radiation, but it has established roles in evaluating severe abdominal traumatic and non-traumatic emergencies as well as in staging oncologic patients. Magnetic resonance imaging has very limited utility in abdominal emergencies due to difficulty of accessing the scanner and the long duration of the examination compared to computed tomography or ultrasound. However, magnetic resonance imaging has well-established clinical roles particularly for evaluating diffuse or focal hepatic pathology, benign and malignant bile duct pathology, pancreatic tumors, inflammatory bowel disease and rectal tumors. The aims of the following paper are to familiarize the clinician with the indications for imaging in abdominal pathology, to guide the clinician and radiologist in choosing the correct technique for a particular clinical situation, to prevent the overuse of imaging techniques and to prevent misdiagnosis of disease and incorrect therapy resulting from inappropriate imaging.
</abstract>

Indications for abdominal imaging: When and what to choose?

<abstract>
<title style='display:none'>Abstract</title>
Ultrasonography is an established and effective imaging technique that can be used to evaluate articular and periarticular structures around the shoulder. It has been shown to be useful in a wide range of rotator cuff diseases (e.g. tendon tears, rotator cuff calcific tendinopathy and bursitis) as well as non-rotator cuff abnormalities (instability, synovial joint diseases and nerve entrapment syndrome). A scanning protocol is highly recommended to reduce the rate of operators’ errors by following a standardized scheme including a list of main structures. Shoulder ultrasound has several advantages: it is a relatively cheap and widely available technique, free from ionizing radiation, that can reach excellent diagnostic accuracy even compared to magnetic resonance imaging. Moreover, it is the only imaging technique that allows dynamic evaluation of musculoskeletal structures, which is important for the evaluation of impingement. Also, due to the shoulder’s superficial anatomical position, ultrasound can also be helpful in guiding interventional percutaneous procedures, both for diagnostic (e.g. magnetic resonance arthrography) and therapeutic purposes (e.g. percutaneous treatment of calcific tendonitis). Contrast-enhanced ultrasound and speckle tracking offer complimentary evaluations of shoulder anatomy and biomechanics. Moreover, the advent of ultra-high-frequency US, with probes up to 70 MHz allowing for a resolution as low as 30 μm, is a promising tool for further evaluation of the shoulder anatomy, and diagnostic and therapeutic strategies.
</abstract>

Shoulder ultrasound: current concepts and future perspectives

<abstract><title style='display:none'>Abstract</title>The paper discusses the rules of the proper performing of the ultrasound examination of the prostate gland. It has been divided into two parts: the general part and the detailed part. The first part presents the necessary requirements related to the ultrasound equipment needed for performing transabdominal and transrectal examinations of the prostate gland. The second part presents the application of the ultrasound examination in benign prostatic hyperplasia, in cases of prostate inflammation and in prostate cancer. Ultrasound examinations applied in the diagnostics of benign prostatic hyperplasia accelerated the diagnosis, facilitated the qualification to surgery and the selection of the treatment method. The assessment of the size of the prostate gland performed using the endorectal ultrasound examination is helpful in making the choice between transurethral electroresection and adenomectomy. In prostate inflammation this examination should be performed with particular gentleness due to pain ailments. The indication for performing the examination in acute inflammation is the suspicion of prostate abscess. In chronic, exacerbating prostatitis it is possible to perform an intraprostatic antibiotic injection. In the recent years increased morbidity and detectability of prostate gland cancer is observed among men. In Poland it ranks second (13%) among diseases occurring in men. The indication for an endorectal examination is the necessity to assess the size of the prostate gland, its configuration, the echostructure in classical ultrasonography, the vascularization in an ultrasound examination performed with power doppler and, if possible, the differences in the gland tissue firmness (consistency) in elastography. The ultrasound examination is used for performing the mapping biopsy of the prostate gland – from routine, strictly defined locations, the targeted biopsy – from locations suspected of neoplastic proliferation and the staging biopsy – from the neurovascular bundles, the seminal vesicles, from the apex of the prostate and from the periprostatic tissue – this type of biopsy is supposed to help in determining local staging of the neoplastic disease. The ultrasound examination is also helpful during the treatment of the neoplasm performed using brachytherapy or using the method of ultrasonic ablation which is still in the phase of clinical trials.</abstract>

The standards of an ultrasound examination of the prostate gland. Part 2

<abstract><title style='display:none'>Abstract</title>For centuries tissue palpation has been an important diagnostic tool. During palpation, tumors are felt as tissues harder than the surrounding tissues. The significance of palpation is related to the relationship between mechanical properties of different tissue lesions. The assessment of tissue stiffness through palpation is based on the fact that mechanical properties of tissues are changing as a result of various diseases. A higher tissue stiffness translates into a higher elasticity modulus. In the 90's, ultrasonography was extended by the option of examining the stiffness of tissue by estimating the difference in backscattering of ultrasound in compressed and non-compressed tissue. This modality is referred to as the static, compression elastography and is based on tracking the deformation of tissue subjected to the slowly varying compression through the recording of the backscattered echoes. The displacement is estimated using the methods of cross-correlation between consecutive ultrasonic lines of examined tissue, so calculating the degree of similarity of ultrasonic echoes acquired from tissue before and after the compression was applied. The next step in the development of ultrasound palpation was to apply the local remote tissue compression by using the acoustic radiation force generated through the special beam forming of the ultrasonic beam probing the tissue. The acoustic radiation force causes a slight deformation the tissue thereby forming a shear wave propagating in the tissue at different speeds dependent on the stiffness of the tissue. Shear wave elastography, carries great hopes in the field of quantitative imaging of tissue lesions. This article describes the physical basis of both elastographic methods: compression elastography and shear wave elastography.</abstract>

Introduction to ultrasound elastography

<abstract>
<title style='display:none'>Abstract</title>
Developmental dysplasia of the hip comprises a broad spectrum of abnormalities in hip development, of variable severity. Besides physical examination, ultrasound is the preferred imaging modality for screening for developmental dysplasia of the hip in children aged younger than six months. The Graf method is the most widely used ultrasound technique for infant hips; a stepwise approach will be shown in this article. Furthermore, the process of dynamic ultrasound imaging will be explained as well as the use of transinguinal ultrasound in infants wearing a spica cast. There is no consensus on the best way to screen for developmental dysplasia of the hip, which is probably the reason why different screening programs exist throughout Europe, as will be discussed in this article. The use of universal versus selective ultrasound remains a controversy, as does the timing. Is it better to perform sonography in all newborn infants like in Germany and Austria? Or should we examine only the infants with clinical hip instability or risk factors (breech position, positive family history), like in the UK and the Netherlands? This article reviews the epidemiology, static and dynamic ultrasound techniques in screening for developmental dysplasia of the hip, and differences in screening programs throughout Europe. Set aside the uncertainties about whom and when to screen, it needs to be emphasized that ultrasound screening for developmental dysplasia of the hip is important, since the disease is initially occult and easier to treat when identified early. In this way, the radiologist can aid in preventing serious disability of the hip.
</abstract>

Ultrasound of the neonatal hip as a screening tool for DDH: how to screen and differences in screening programs between European countries

Point-of-care ultrasound (POCUS) to the rescue in VA-ECMO

<abstract>
<title style='display:none'>Abstract</title>
<sec><title style='display:none'>Aim</title>This study aimed to examine the feasibility and potential benefits of an optical see-through head-mounted display (OST-HMD) during real-time ultrasound-guided thoracentesis simulations.
</sec>
<sec><title style='display:none'>Material and methods</title>
Six physicians performed a thoracentesis simulation using an OST-HMD and a wireless image transmission system. The time required, puncture needle visibility, pleural fluid collection success rate, and head movement during the procedure using a smart glass equipped with an inertial measurement unit were all recorded and compared with and without the HMD.
</sec>
<sec><title style='display:none'>Results</title>
Study participants successfully extracted effusions in all procedures. The use of OST-HMD did not significantly affect the time of the procedure, but notably decreased the horizontal and vertical head movements during the procedure.
</sec>
<sec><title style='display:none'>Conclusions</title>
The study demonstrated the feasibility of using an OST-HMD in a simulated real-time ultrasound-guided thoracentesis procedure and showed the potential of HMD in thoracentesis to improve ergonomics and accuracy. Further research is necessary to confirm these findings.
</sec>
</abstract>

Real-time ultrasound-guided thoracentesis simulation using an optical see-through head-mounted display: a proof-of-concept study

<abstract>
<title style='display:none'>Abstract</title>
<sec><title style='display:none'>Aim</title>
The aim of the study was to estimate the relationship between bladder neck hypermobility as assessed by ultrasound and the occurrence of stress urinary incontinence as measured with the UDI-6 questionnaire in primiparous women 9–18 months postpartum.
</sec>
<sec><title style='display:none'>Materials and methods</title>
The study included 100 women 9–18 months after their first delivery, 19% of whom (study group) presented with urethral hypermobility. Ultrasound was used to determine the position and mobility of the bladder neck in order to assess the urethral hypermobility. A vector of ≥15 mm was defined as urethral hypermobility. Symptoms of stress urinary incontinence were assessed using question 3 of the UDI-6 questionnaire, in which the presence of symptoms was defined as a response rated from 1 to 4.
</sec>
<sec><title style='display:none'>Results</title>
We demonstrated a statistically significant relationship between urethral hypermobility and the symptoms of stress urinary incontinence with a statistical significance level of <italic>p</italic> &lt;0.002.
</sec>
<sec><title style='display:none'>Conclusions</title>
Stress urinary incontinence is a common disorder in women, the pathophysiology of which is not fully understood. It has adverse effects on the quality of life, perception of one’s own body and sexual function. Impairment of urethral fixation may play an important role in the pathophysiology of this common form of urinary incontinence. The study showed that urethral hypermobility, as assessed by ultrasound, contributes to stress urinary incontinence, as measured with the UDI-6 score. Although stress urinary incontinence is a multifactorial disorder influenced by anatomical changes and congenital anatomical features, it is easily diagnosed. Suburethral slings are an effective surgical technique; however, the incidence of postoperative voiding dysfunction or recurrent stress urinary incontinence is 10–20%. Therefore, an assessment of anatomical changes in stress urinary incontinence may help individualize the surgical strategy.
</sec>
</abstract>

An assessment of the relationship between urethral hypermobility as measured by ultrasound and the symptoms of stress urinary incontinence in primiparous women 9–18 months postpartum

<abstract>
<title style='display:none'>Abstract</title>
<sec><title style='display:none'>Aim</title>
Determination of blood flow parameters in the ophthalmic artery and central retinal artery using Doppler ultrasound in patients with type 1 diabetes mellitus without fundus signs of diabetic retinopathy and with mild non-proliferative retinopathy.
</sec>
<sec><title style='display:none'>Material and methods</title>
To eliminate the impact of other systemic factors on vascular flow, the study enrolled a total of 80 patients with type 1 diabetes mellitus, aged between 18 and 45 years. The study participants did not have any diabetic complications or other systemic or ocular comorbidities. The control group comprised 81 healthy individuals within a similar age range. Color Doppler ultrasound examinations of the ophthalmic artery and central retinal artery were performed to evaluate selected blood flow parameters including peak systolic velocity, end-diastolic velocity, and resistance index.
</sec>
<sec><title style='display:none'>Results</title>
Patients with type 1 diabetes mellitus exhibited statistically significant decrease in both systolic and end-diastolic velocities in the central retinal artery, accompanied by an elevation in resistance index, compared to the control group. The study revealed differences in blood flow parameters between the patients without fundus changes and those exhibiting mild non-proliferative retinopathy. Specifically, patients with retinopathy showed a significant decrease in both systolic velocity and end-diastolic velocity in the central retinal artery. No differences were observed for the same parameters in the ophthalmic artery. When analyzing the patients’ blood flow parameters in relation to the degree of diabetes control, as determined by glycated hemoglobin levels, a statistically significant reduction in systolic velocity was identified in both the ophthalmic and central retinal arteries in the group with poorly controlled diabetes.
</sec>
<sec><title style='display:none'>Conclusions</title>
Examination of the orbital vessels using Doppler ultrasound in patients with type 1 diabetes mellitus holds promise as an effective method for early detection of vascular abnormalities.
</sec>
</abstract>

Doppler ultrasound-based evaluation of hemodynamic changes in the ophthalmic artery and central retinal artery in patients with type 1 diabetes mellitus without retinopathy and with mild non-proliferative retinopathy

<abstract>
<title style='display:none'>Abstract</title>
<sec><title style='display:none'>Aim</title>
Abnormal uterine vascular pattern can be observed during transvaginal ultrasound examination used for investigating post-abortion bleeding and secondary postpartum hemorrhage. The purpose of this series of cases was to evaluate almost all the rare causes of uterine vascular abnormalities linked to pregnancy complications, and determine how to arrive at the diagnosis to optimize patient management, which is crucial for preventing life-threatening massive vaginal bleeding.
</sec>
<sec><title style='display:none'>Material and methods</title>
Retrospective observational case series study including 20 women with postpartum or post-abortion vaginal bleeding who were found to have an abnormal uterine vascular pattern during a transvaginal color duplex assessment.
</sec>
<sec><title style='display:none'>Results</title>
The study yielded the following findings: 10 cases of enhanced myometrial vascularity, two cases of pseudoaneurysm in the uterine artery, one case of myometrial venous varix, one case of large uterine venous pseudoaneurysm, one case of uterine arteriovenous malformation, one case of retained placental polyp, one case of invasive vesicular mole, and three cases of subinvolution of the placental implantation site.
</sec>
<sec><title style='display:none'>Conclusions</title>
Transvaginal color duplex ultrasound plays a crucial role in detecting uterine vascular abnormalities as a cause of post-abortion or secondary postpartum hemorrhage and can help differentiate the pathologies responsible for the abnormal vascular pattern, which is highly recommended to optimize patient management.
</sec>
</abstract>

Uterine vascular abnormalities linked to pregnancy complications: color and power Doppler-assisted transvaginal ultrasound evaluation

<abstract>
<title style='display:none'>Abstract</title>
Intrahepatic cholangiocarcinoma (ICC) is a rare, heterogeneous, highly lethal tumor of the biliary tract. Due to the lack of effective treatments, an early identification of ICC is essential to achieve the best outcome in terms of therapy and prognosis aiming for a curative intent. ICC may arise on a normal liver or with an underlying liver disease, making the diagnosis more difficult and complex. Contrast-enhancement ultrasound (CEUS) is an accurate procedure able to detect ICC-specific contrast vascular pattern, and thus facilitating the correlation between radiological and histopathological findings with high specificity and sensitivity. CEUS has been shown to have a high diagnostic potential in the diagnosis of ICC thanks to the possibility of studying in real time the intralesional microcirculation and evaluating the precocity of the enhancement of the lesion during the arterial phase. All these features allow to differentiate the ICC from hepatocarcinoma (HCC) with high sensitivity and specificity. Furthermore, CEUS is a rapid, non-invasive, non-nephrotoxic or non-allergenic tool. The only limitations CEUS may have are related to the disease site and patient characteristics (obesity) and compliance, including the operator’s experience. A clinical evaluation of the patient, together with tumor markers and biochemical tests assessment, to differentiate ICC from HCC are highly suggested.
</abstract>

Unicamillus International Medical University

Diagnosis of intrahepatic cholangiocarcinoma with CEUS

<abstract><title style='display:none'>Abstract</title>Rheumatoid arthritis is the most common inflammatory arthritis, affecting approximately 1% of the world’s population. Its pathogenesis has not been completely understood. However, there is evidence that the disease may involve synovial joints, subchondral bone marrow as well as intra- and extraarticular fat tissue, and may lead to progressive joint destruction and disability. Over the last two decades, significant improvement in its prognosis has been achieved owing to new strategies for disease management, the emergence of new biologic therapies and better utilization of conventional disease-modifying antirheumatic drugs. Prompt diagnosis and appropriate therapy have been recognized as essential for improving clinical outcomes in patients with early rheumatoid arthritis. Despite the potential of ultrasonography and magnetic resonance imaging to visualize all tissues typically involved in the pathogenesis of rheumatoid arthritis, the diagnosis of early disease remains difficult due to limited specificity of findings. This paper summarizes the pathogenesis phenomena of rheumatoid arthritis and describes rheumatoid arthritis-related features of the disease within the synovium, subchondral bone marrow and articular fat tissue on MRI and ultrasound. Moreover, the paper aims to illustrate the significance of MRI and ultrasound findings in rheumatoid arthritis in the diagnosis of subclinical and early inflammation, and the importance of MRI and US in the follow-up and establishing remission. Finally, we also discuss MRI of the spine in rheumatoid arthritis, which may help assess the presence of active inflammation and complications.</abstract>

Rheumatoid arthritis: what do MRI and ultrasound show

<abstract>
<title style='display:none'>Abstract</title>
Point-of-care ultrasound has become firmly established in acute and critical care settings, and is now increasingly being used as an important tool in the assessment of the lungs. In this article, we briefly describe the technique of lung ultrasound and the various lines and signs commonly encountered during sonography of the lung, namely the normally visualised A- and T-lines and the bat sign, sliding sign (power slide sign on colour Doppler), sea-shore sign, curtain sign, and the lung pulse. We have also described signs seen in various pathological conditions like B-lines seen in cases of increased lung density; the quad sign, sinusoid sign, thoracic spine sign, plankton sign and the jelly fish sign seen in pleural effusion; the stratosphere sign and the lung point sign seen in pneumothorax; the shred/fractal sign and tissue-like sign in consolidation, and the double lung point sign seen in transient tachypnoea of the newborn. With adequate and appropriate training, lung ultrasound can be effectively utilised as a point-of-care investigation.
</abstract>

Signs and lines in lung ultrasound

<abstract><title style='display:none'>Abstract</title><sec id="j_jou.2017.0039_s_001"><title style='display:none'>Aim</title>The aim of the study was to review two techniques that can be used to verify focal lesions in the breasts: fine-needle aspiration biopsy and core-needle biopsy.</sec><sec id="j_jou.2017.0039_s_002"><title style='display:none'>Material and methods</title>Fifty-five articles (original papers and reviews), half of them published within the past 5 years, were included in the analysis. The authors also took their own experience into account.</sec><sec id="j_jou.2017.0039_s_003"><title style='display:none'>Results</title>Pre-operative assessment of focal lesions in the breasts is crucial in the planning of further therapeutic management. The role of fine-needle aspiration biopsy has been reduced lately due to its low sensitivity and specificity as well as a high rate of non-diagnostic, suspicious and false negative results. This method does not enable one to differentiate between in situ and invasive disease. Currently, fine-needle biopsy is recommended for cystic lesions, suspected of being recurrences in the chest wall, and lymph node metastases. Core-needle biopsy is the basic diagnostic method of breast lesions. According to the recommendations of the Polish Ultrasound Society and American College of Radiology, BIRADS 4 and 5 lesions should be evaluated histopathologically. Core-needle biopsy makes it possible to establish a final diagnosis more frequently than fine-needle biopsy, both in the case of benign and malignant lesions. It delivers more information about the nature of a tumor (mutation of HER-2, estrogen and progesterone receptors and Ki-67 index). Its limitations include: underestimation of invasion and failure to recognize the components of ductal carcinoma in situ in papillary and atypical lesions. Single fine-needle aspiration biopsy is inexpensive, but when considering the cost of further diagnosis due to non-diagnostic, suspicious and atypical results, this method generates high additional costs.</sec><sec id="j_jou.2017.0039_s_004"><title style='display:none'>Conclusions</title>Microscopic verification of focal breast lesions is crucial for further therapeutic decisions. It has been proven that histopathological verification is more accurate and has more advantages than cytological assessment.</sec></abstract>

Fine-needle versus core-needle biopsy – which one to choose in preoperative assessment of focal lesions in the breasts? Literature review

<abstract>
<title style='display:none'>Abstract</title>
Diagnosis and treatment of ectopic cesarean scar pregnancy has become a challenge for contemporary obstetrics. With an increase in the number of pregnancies concluded with a cesarean section and with the development of transvaginal ultrasonography, the frequency of cesarean scar pregnancy diagnoses has increased as well. The aim of the study is to evaluate various diagnostic methods (ultrasonography in particular) and analyze effective treatment methods for cesarean scar pregnancy. An ultrasound scan, Doppler examination and magnetic resonance imaging are all useful in early detection of asymptomatic cesarean scar pregnancy, thus enabling effective treatment and preservation of fertility. Dilatation and curettage is not recommended as it carries significant risk of bleeding and very high risk of hysterectomy and fertility loss. Systemic methotrexate treatment should not be applied on the routine basis due to its low efficacy, high risk of fertility loss and adverse effects. Local methotrexate therapy (under ultrasound or hysteroscopy guidance) should be considered a perfect management method as it offers fertility preservation in asymptomatic pregnant patients without concomitant hemodynamic disorders. Synchronous usage of several treatment methods is an effective way to manage cesarean scar pregnancy. The combination of local methotrexate with simultaneous aspiration of gestational tissues under ultrasound or hysteroscopy guidance seems optimal. Subsequently, the remaining gestational tissues can be removed hysteroscopically in combination with vascular coagulation at the implantation site. In more advanced cases, local methotrexate treatment should be considered followed by laparoscopic or laparotomic wedge resection with subsequent surgical correction of the cesarean section scar.
</abstract>

Cesarean scar pregnancy – a new challenge for obstetricians

<abstract><title style='display:none'>Abstract</title><sec id="j_jou.2017.0038_s_001"><title style='display:none'>Introduction</title>Conjoined twins are identical twins with fused bodies, joined in utero. They are rare complications of monochorionic twinning. The purpose of this study is to describe the various types of conjoined twins, the role of imaging and recent advances aiding in their management.</sec><sec id="j_jou.2017.0038_s_002"><title style='display:none'>Material and methods</title>This was a twin institutional study involving 3 cases of conjoined twins diagnosed over a period of 6 years from 2010 to 2015. All the 3 cases were identified antenatally by ultrasound. Only one case was further evaluated by MRI.</sec><sec id="j_jou.2017.0038_s_003"><title style='display:none'>Results</title>Three cases of conjoined twins (cephalopagus, thoracopagus and omphalopagus) were accurately diagnosed on antenatal ultrasound. After detailed counseling of the parents and obtaining written consent, all the three cases of pregnancy were terminated. Delivery of the viable conjoined twins was achieved without any complications to the mothers, and all the three conjoined twins died after a few minutes.</sec><sec id="j_jou.2017.0038_s_004"><title style='display:none'>Conclusion</title>Ultrasound enables an early and accurate diagnosis of conjoined twins, which is vital for obstetric management. MRI is reserved for better tissue characterization. Termination of pregnancy when opted, should be done at an early stage as later stages are fraught with problems. Recent advances, such as 3D printing, may aid in surgical pre-planning, thereby enabling successful surgical separation of conjoined twins.</sec></abstract>

Conjoined twins – role of imaging and recent advances

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Journal of Ultrasonography is the official organ of the Polish Ultrasound Society. Mission of the...