Background: It has been demonstrated that agar-based gel phantoms can emulate the acoustic parameters of real tissues and are the most commonly used tissue-mimicking materials for high-intensity focused ultrasound applications. The following study presents ultrasonic attenuation measurements of agar-based phantoms with different concentrations of additives (percent of agar, silicon dioxide and evaporated milk) in an effort of matching the material's acoustic property as close as possible to human tissues. Methods: Nine different agar-based phantoms with various amounts of agar, silicon dioxide, and evaporated milk were prepared. Attenuation measurements of the samples were conducted using the through-transmission immersion techniques. Results: The ultrasonic attenuation coefficient of the agar-based phantoms varied in the range of 0.30–1.49 dB/cm-MHz. The attenuation was found to increase in proportion to the concentration of agar and evaporated milk. Silicon dioxide was found to significantly contribute to the attenuation coefficient up to 4% weight to volume (w/v) concentration. Conclusion: The acoustic attenuation coefficient of agar-based phantoms can be adjusted according to the tissue of interest in the range of animal and human tissues by the proper selection of agar, silicon dioxide, and evaporated milk.

Background: Endoscopic ultrasound (EUS)-guided cystogastrostomy with a single 7-French (Fr) double-pigtail stent (DPS) is less popular due to the concern of stent patency. We aimed to assess the effectiveness, complications, and long-term outcomes of a single 7-Fr DPS in the endoscopic drainage of uncomplicated pseudocysts, containing no or minimal (<10%) debris. Methods: A retrospective review of patients with pancreatic pseudocysts, who underwent EUS-guided cystogastrostomy during 2010–2018, and a systematic review of the literature were conducted. Results: Of 45 patients, 14 patients underwent endoscopic drainage of uncomplicated pseudocysts using a single 7-Fr × 5 cm DPS. The mean cyst size was 10.2 ± 3.5 cm. Stent placement had a 100% technical and clinical success, defined as complete resolution of symptoms and regression of the cyst size by more than 50% at 8 weeks after drainage. The median follow-up was 42.4 months (range, 10–103). The pseudocysts resolved without recurrence in 92.8%. Spontaneous stent dislodgment was noted in 70% at a mean follow-up of 18 months. Additional interventions were required in 14% of cases due to stent occlusion and migration. A systematic review of literature related to EUS-guided cystogastrostomy using single and multiple plastic stents included 9 of 333 studies (222 patients). The analysis showed the pooled clinical success of 89% (95% confidence interval [CI], 82.0–94.2) and complication rate of 13% (95% CI, 5.7–21.8). Conclusion: Selected uncomplicated pseudocysts can be treated effectively with a single 7-Fr DPS as it provides comparable clinical success and long-term outcomes as using larger or multiple stents.

Background: Diagnostic ultrasound or sonography is an image which can provide valuable information for diagnosing and treating a variety of diseases and conditions. This experiment was done to check the performance and evaluate the ultrasonic imaging system. There were three tests performed in this experiment: dead zone (transducer ring-down), vertical measurement calibration, and horizontal measurement calibration. Methods: The evaluation was made by performed all the tests with different depth on two different multipurpose phantom model #539. The tests were also performed by two different probes which were curved and flat (linear probe). The images were taken, and the measurements were made by electronic calipers on the ultrasound machine system. Observations and evaluations were done via all images and measurements taken. Results: The images formed by two various probes were different. The penetration settings were different since the depths were different. The depth influenced the penetrations to the formed image. From the comparison of all results and measurements recorded were all under the accepted value of the standard that was given by the manufacture of the phantom. Conclusion: Therefore, it can be concluded that the measurements were all not exceeding 2% of the standard value given based on the result that we get.

Background: High intra- and interobserver variability in the follicular assessment using two-dimensional (2D) ultrasound (US) is still a concern. To solve this issue, we have developed a novel software solution, which automatically provides follicles' count and their diameters using 2D US images obtained by a manual sweep of an ovary. The primary objective of this study was to compare the result of the automated solution with a manual 2D US-based assessment. Methods: In the first phase, multiple follicular US sweeps were collected from 54 subjects; these sweeps were used to develop the software. In the second phase, data from 10 subjects were collected for validation of the developed solution. During each phase, for follicles ≥5 mm, their count and diameters were recorded by the sonologist using 2D US. Results: For the total follicle count, a high correlation (0.787) was observed between the solution and manual assessment. The 95% limits of agreement between the two methods were in the range of 4.232 to −4.258. The two methods had an excellent correlation (0.817) for the measurement of mean follicular diameter. However, the solution had a tendency to underestimate the mean diameter by an average of 1.725 mm (±2.16 mm). The limits of agreement between the two methods for mean diameter measurement were from 2.508 to −5.960 mm. Conclusion: This study validates the feasibility of our solution for automatic assessment of follicle count and diameter with accuracy comparable to the 2D US-based manual assessment. We further observed that the solution's performance is better than known intra- and interobserver variability of the manual assessment. We recommend further validation of the solution to confirm these initial results and potential time gain with an automated assessment.

Background: Gestational diabetes mellitus (GDM) incidence can increase up to 14%. GDM creates a risk for developing type 2 diabetes mellitus after pregnancy. Umbilical artery (UA) and fetal middle cerebral artery (MCA) changes in GDM have been studied before. The previous studies have contradictory results. In the current study, we aim to detect and define the impairment of color Doppler ultrasound (CDUS) characteristics in UA and MCA for the pregnant with GDM. Methods: US examinations were all performed at 18–22 weeks of gestation with a 3.5 MHz convex transducer. We recorded peak systolic velocity (PSV), end diastolic velocity, pulsatility index, resistive index, and systole/diastole ratio values of both UA and MCA at 18–22 weeks of gestation. GDM diagnosis was created according to the American Diabetes Association guidelines. Results: Sixty GDM patients and 61 healthy controls were included into the study. Median MCA PSV value was lower in GDM group (28 cm/s vs. 32 cm/s, P = 0.37). Among UA CDUS parameters, we cannot find any significant difference. In GDM group, we could not detect any significant correlation between CDUS parameters and HbA1C values. Conclusion: GDM changes fetal brain hemodynamics and the change can be detected at 18–22 weeks of gestation. Decreased fetal MCA PSV values can serve as an early warning for GDM.

Background: Peripheral arterial disease is defined as a clinical disorder in which there is a stenosis or occlusion of the arteries of the limbs. The most common etiology is ischemia due to occlusive disease. The objective of this study is to assess the severity of lower-limb peripheral arterial diseases based on various Doppler parameters. Methods: This descriptive cross-sectional study comprised 55 patients with clinical signs and symptoms of lower-limb peripheral arterial disease. Both inpatients and outpatients attending the authors' institute were taken up for the study. In this study, Doppler sonography was performed using 3–12 MHz linear array and 1–7 MHz curvilinear array transducers (SAMSUNG RS80A Ultrasound System). Results: Out of 55 patients, Doppler sonography demonstrated echogenic plaques in 32 patients and corkscrew collaterals in 15 patients. Monophasic waveform with peak systolic velocity ratio of >2:1 was found in 42 patients, which is consistent with significant stenoses. Conclusion: Our study shows that Duplex Doppler sonography aided by color Doppler sonography can accurately locate the site and severity of stenosis/occlusion. It is safe, cost-effective, repeatable, and noninvasive.

Fetus acardius is a rare manifestation of twin reversed arterial perfusion and is a parasite due to vascular circulation from donor twin and lacks any resemblance to human embryos. Antenatal diagnosis is challenging as there are no well-defined features. We report here a case which presented as placental mass, the diagnosis of which was evident after delivery. Antenatal diagnosis, review of the literature, and differential diagnosis from the placental mass are discussed. A primigravida in the late third trimester had ultrasonography (USG) showing a 7 cm × 5 cm mass adjacent to the placenta. She had no complaints and fetal biometry was normal. She delivered a healthy baby; placenta showed an attached mass without identifiable fetal body or limbs, and was covered with skin having scanty hairs, which was identified as an amorphous fetus. Early diagnosis is possible by early USG; an acardiac amorphous fetus may present as placental mass. Characteristic feature on USG supplemented by magnetic resonance imaging may help in reaching a correct diagnosis and optimal management.

We report a case of a huge congenital pulmonary airway malformation (CPAM) that was referred as congenital diaphragmatic hernia (CDH). Initial ultrasound evaluation revealed a huge cystic lesion with septations, in the thorax, causing mediastinal shift and compression effects, suggesting the possibility of a thoracic lymphangioma, or bowel herniation with obstruction. A fetal magnetic resonance imaging reported possible bowel herniation through a posterior defect in the diaphragm, with volvulus, reinforcing the diagnosis of CDH. It was only on autopsy and subsequent histopathology examination that the diagnosis of a rare variant of CPAM–nonmucinous papillary type, could be made. To the best of our knowledge, a CPAM this huge has not been reported prenatally at this gestation. We recommend considering the potential diagnosis of CPAM in any thoracic cystic irrespective of its size or appearance.

Ceftriaxone has been increasingly used in pediatric population, due to its bacteriological and pharmacokinetic features. Association between ceftriaxone and biliary sludge/pseudolithiasis formation has been documented in the literature. More rarely, biliary symptoms and cholecystitis during ceftriaxone therapy have been reported. We present a case of acute cholecystitis related to ceftriaxone administration and its management.

Arthroscopic joint lavage was proposed as a treatment option for different joint conditions such as septic or inflammatory arthritis. Ultrasound (US) is today considered a fundamental tool in musculoskeletal diseases as for diagnostic and guide for interventional procedures such as synovial fluid sampling and drug injections. To enable faster recovery and to have an alternative to surgery, to reduce risks and costs, we performed an US-guided double-needle lavage of the shoulder joint. Here, we present two different clinical cases, the first with septic arthritis and the second with recalcitrant gouty arthritis, successfully treated with this technique.

Intussusception and appendicitis share similar clinical features. However, their concurrent occurrence is exceedingly rare. Appendix involvement in intussusception must be ruled out when appendix is not visualized on high-resolution ultrasonography in cases with ileocolic intussusception. This case report describes the sonological appearance of a combination of ileocolic intussusception with concurrent acute appendicitis in a 4-year-old child.