It is my pleasure to announce the launch of a new journal in Sonography titled "American Journal of Sonography" (AJS). As its Editor-in-Chief, I am proud to work alongside Sheila Sheth, our highly accomplished associate editor. Additionally, we have distinguished set of individuals serving on our international advisory board encompassing more than 20 countries including USA, China, France, and India.

Lymphangiomatosis is a rare disorder. Chylous effusion and osteolytic lesions are diagnostic clues. Radiographic findings can be suggestive of the disease, but the final confirmatory diagnosis is made histologically. We report a case of an infant who presented with life threatening refractory chylothorax and chylopericardium due to diffuse pulmonary lymphangiomatosis leading to critical condition with challenging management. With multi-disciplinary approach the child improved and was discharged home with satisfactory outcome.

Absence of blood flow in the testicle is classically thought to be secondary to testicular torsion, however other etiologies of absent testicular blood flow have been described (Lin et al.). We present an unusual case of testicular ischemia secondary to inguinal hernia. A 58-year-old male presented to the emergency department with right sided scrotal pain and swelling. Doppler ultrasound evaluation demonstrated lack of blood flow in the right testicle and a right sided inguinal hernia. The testicular blood flow was re-established with reduction of inguinal hernia. Absence of blood flow secondary to hernia has been described, however very few case reports exist in the literature.

Intratesticular masses are common and widely presumed to be malignant until proven otherwise. The most common testicular tumors include germ cell and non-germ cell tumors, typically presenting as solitary, unilateral lesions. Some testicular tumors present with bilateral involvement, the most common of which is Leydig cell hyperplasia, with case reports of other synchronous and metachronous bilateral testicular tumors in the literature. Testicular plasmacytomas in the setting of multiple myeloma have been reported as well but are uncommon. Bilateral testicular plasmacytomas are extremely rare. We present sonographic features, with histopathologic correlation in a 71-year-old man who presented with scrotal pain and was found to have bilateral testicular hypoechoic masses confirmed to be plasmacytomas.

We present a case of a 34-year-old male with a unilateral papillary cystadenoma of the right epididymis (PCE). His past medical history is remarkable for Von Hippel-Lindau disease (VHLD), bilateral renal clear cell carcinoma, and hemangioblastomas. The patient noticed an abnormality with mild tenderness in the right scrotum. Ultrasound (US) of the right scrotum demonstrated a solid and cystic epididymal lesion. In this case report, we present the sonographic features of the PCE in the setting of a patient with VHLD.

Objective: The objective of this study was to determine the sensitivity and accuracy of five sonographic features of Hashimoto thyroiditis (HT) in histologically confirmed cases. In addition, to determine if sonographic features can serve as a predictor of underlying malignancy. Methods: A cohort of 101 patients who underwent thyroidectomy for malignancy or other clinical conditions with histologically confirmed HT and a pre-operative thyroid ultrasound examination were included. A retrospective analysis of sonographic features and radiology reports was conducted and comparative statistical analysis completed. Results: Among the cohort of 101 patients, 84% demonstrated sonographic evidence of HT. The following features were used for the identification of HT: Diffuse hypoechoic echogenicity, parenchymal heterogeneity, hypoechoic micronodularity, echogenic septations, and hypervascularity. There was a female predominance (9:1) with an average age of 50 years. Among the studied sonographic features of HT, parenchymal heterogeneity was the most sensitive (88.2%) and hypervascularity was the least sensitive (17.7%). Approximately 44% of the study cohort had malignancy; papillary thyroid carcinoma was by far the most common, accounting for 89% of all malignancies. Hypoechoic micronodularity was the feature with the greatest positive predictive value (PPV) for malignancy. Nodal metastasis was less common in patients with sonographically evident HT. Conclusion: HT is the most common cause of hypothyroidism in iodine sufficient areas of the world. Parenchymal heterogeneity and diffuse hypoechogenicity were the most sensitive sonographic features of HT. Hypoechoic micronodularity demonstrated the greatest PPV for malignancy.

Hydrocolpos is commonly due to obstructive causes such as imperforate hymen and vaginal septum. Transient hydrocolpos or non-obstructive hydrocolpos is an under-recognized entity due to a phenomenon called "vesicovaginal reflux" (VVR). It is commonly seen during voiding cystourethrography although it is not a familiar entity for radiologists. Failure to recognize VVR often leads to unnecessary higher imaging modalities. We report a case of young married woman who presented with daytime urinary continence and found to have transient hydrocolpos due to VVR.

Scar pregnancy is a rare form of ectopic pregnancy. If not diagnosed early and managed appropriately, it may lead to serious complications such as uterine rupture and hemorrhage. We present a case of a 29-year-old female with a history of prior three cesarean sections who presented to our clinic with abdominal pain. She had taken misoprostol to terminate her 6 weeks pregnancy while being unaware that she had a scar pregnancy. Transvaginal ultrasound revealed a ruptured scar pregnancy with hematoma. Emergency laparotomy was performed and uterus was repaired

Objective: The objective of the study was to assess the accuracy of ultrasound examination for the diagnosis of rotator cuff tear and tendinosis performed by a short experienced operator, compared to magnetic resonance imaging (MRI) results. Method: A total of 70 subjects suspected to have rotator cuff tear or tendinosis and planned for shoulder MRI were included in the study. Shoulder ultrasound was performed either before or after the MRI scan on the same day. Ultrasound operator had a short experience in performing an ultrasound of the shoulder. Ultrasound findings were correlated to MRI findings. Results: Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy for the diagnosis of tendinosis were 58%, 84%, 63%, 80%, and 75%, respectively, and it was 68%, 91%, 73%, 88%, and 85%, respectively, for the diagnosis of rotator cuff tear. Conclusions: Sensitivity for diagnosing rotator cuff tear or tendinosis was moderate but had a higher negative predictive value. Thus, the ultrasound operator with a short experience in performing shoulder ultrasound had moderate sensitivity in diagnosing tendinosis or tears; however, could exclude them with confidence.

Objective: The objective of the study was to assess the accuracy of ultrasound examination for the diagnosis of rotator cuff tear and tendinosis performed by a short experienced operator, compared to magnetic resonance imaging (MRI) results. Method: A total of 70 subjects suspected to have rotator cuff tear or tendinosis and planned for shoulder MRI were included in the study. Shoulder ultrasound was performed either before or after the MRI scan on the same day. Ultrasound operator had a short experience in performing an ultrasound of the shoulder. Ultrasound findings were correlated to MRI findings. Results: Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy for the diagnosis of tendinosis were 58%, 84%, 63%, 80%, and 75%, respectively, and it was 68%, 91%, 73%, 88%, and 85%, respectively, for the diagnosis of rotator cuff tear. Conclusions: Sensitivity for diagnosing rotator cuff tear or tendinosis was moderate but had a higher negative predictive value. Thus, the ultrasound operator with a short experience in performing shoulder ultrasound had moderate sensitivity in diagnosing tendinosis or tears; however, could exclude them with confidence.

Objective: The objective of the study was to assess the accuracy of ultrasound examination for the diagnosis of rotator cuff tear and tendinosis performed by a short experienced operator, compared to magnetic resonance imaging (MRI) results. Method: A total of 70 subjects suspected to have rotator cuff tear or tendinosis and planned for shoulder MRI were included in the study. Shoulder ultrasound was performed either before or after the MRI scan on the same day. Ultrasound operator had a short experience in performing an ultrasound of the shoulder. Ultrasound findings were correlated to MRI findings. Results: Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy for the diagnosis of tendinosis were 58%, 84%, 63%, 80%, and 75%, respectively, and it was 68%, 91%, 73%, 88%, and 85%, respectively, for the diagnosis of rotator cuff tear. Conclusions: Sensitivity for diagnosing rotator cuff tear or tendinosis was moderate but had a higher negative predictive value. Thus, the ultrasound operator with a short experience in performing shoulder ultrasound had moderate sensitivity in diagnosing tendinosis or tears; however, could exclude them with confidence.

Umbilical cord hemangiomas are rare tumors of the umbilical cord. Doppler ultrasound has been shown to be useful in the diagnosis of cord hemangioma and evaluation of arterial blood flow through the mass. In this study, we present a 28-year-old pregnant woman with an umbilical cord mass with solid and cystic components. She was followed with weekly umbilical artery (UA) Doppler ultrasound, but the fact that the umbilical vein (UV) ran in the wall of the mass was not noted prospectively. At the time of placental delivery, the cystic component of the mass ruptured tearing the UV causing significant bleeding. The case illustrates the importance of using Doppler ultrasound to both look for UA compromise and to map the UV location through the entirety of the cord.

Intraluminal filling defect and non-compressibility of the vein are diagnostic of a deep vein thrombosis (DVT). However, other etiologies can present with features similar to DVTs; these include tumors extending into the vein and primary tumors arising from the vein such as leiomyosarcoma and hemangioendothelioma. Here, we present a case of an 80-year-old female with a right glomus jugulare tumor (GJT) with extension into the right internal jugular vein mimicking a DVT. This case report presents the sonographic features of GJT presenting as DVT and review of the literature of other tumors that can present in a similar fashion.

Immediate postoperative complications in renal transplants include renal artery thrombosis and dissection both of which carry significant risk for loss of the graft. We present an unusual case in which apparent devascularization of the upper pole of the transplant kidney was due to reversible vasospasm as a result of a drug interaction. Tacrolimus, a calcineurin inhibitor, is used for post-transplant immunosuppression. The antihypertensive medication nicardipine impairs liver metabolism of tacrolimus and, in this case, the combination of drugs resulted in supratherapeutic levels of tacrolimus causing acute nephrotoxicity as well as profound vasoconstriction which was most pronounced in the upper pole branch renal artery and simulated devascularization of almost half of the transplant kidney. This case highlights the fact that not all abnormal post-transplant Doppler findings are due to surgical technique or embolic events and illustrates the importance of drug interactions in this group of patients with complex medical conditions.

The absence of blood flow in the testis on ultrasound examination is the gold standard for diagnosis of testicular torsion. This imaging finding is seen in the vast majority of patients with testicular torsion, except in patients with partial torsion. Patients with partial testicular torsion may have reversal of arterial diastolic flow on spectral Doppler, decreased amplitude of the spectral Doppler waveform (parvus tardus wave), or monophasic waveforms. However, it is important to consider that not all absence of blood flow or reversal of diastolic flow in testis represents testicular torsion, as other conditions may have a similar appearance, including rare detection of such a pattern in normal asymptomatic patients. Conditions that commonly mimic testicular torsion include incarcerated inguinal hernias and complications following hernia repair, thrombotic phenomena, vasculitis, complicated epididymo-orchitis, asymptomatic variants, and technical limitations of ultrasonography. It is important for a practicing radiologist to be familiar with such cases to avoid unnecessary surgical interventions. We present a pictorial essay of cases in which the absence of testicular blood flow on color flow Doppler or abnormal waveforms on spectral Doppler are identified, without the presence of testicular torsion.

As the field of medicine moves toward practicing patient-centered care, radiologists in breast imaging must continue to look for ways to increase the value of their practice in the eyes of patients. Providing adjunct screening of women with dense breasts provides such an opportunity. The presence of dense breast tissue is not only an independent risk factor for breast cancer but also a risk factor for the delayed diagnosis of breast cancer as dense tissue reduces the efficacy of screening mammograms due to the tissue masking effect. As legislation for notifying women of their breast density becomes commonplace, both women and referring physicians need to understand the risks of dense breast tissue as well as the benefits of additional screening affords. Breast radiologists can become integral to their patients’ care team by offering education to both referring providers and patients on the topic of dense breasts and supplemental screening solutions, such as screening breast ultrasound, which has been shown to have benefit in overcoming mammography’s shortcomings in this demographic of women.

Testicular adrenal rest tumors (TARTs) are benign testicular masses but can lead to infertility without medical attention. It is important to identify TARTs in childhood, as early diagnosis has been shown to have good success in preserving fertility. It is also important to differentiate TARTs from other testicular masses to avoid unnecessary orchiectomy. Ultrasound is the preferred imaging modality for the evaluation of TARTs; however, sonographic differentiation from testicular neoplasms can sometimes be very difficult. In this article, we review the spectrum of sonographic features of TARTs and propose a decision tree that relies on these features, with the goal of increasing clinician’s confidence in diagnosing TARTs.

Objective: The objective of this study was to investigate the interobserver reliability when measuring the carotid intima media thickness (IMT) using superb microvascular imaging (SMI) and B-mode ultrasonography. Methods: Two sonologists were selected to scan the left common carotid artery and measure IMT first with B-mode and then with SMI on 20 patients. They were blinded to each other results. Intraclass correlation coefficients (ICCs) were calculated to estimate the inter-rater reliability using both the modes of scanning. Results: Interobserver agreement when using SMI, for both near wall and far wall, was almost perfect (ICC, 0.870; 95% confidence interval [CI], 0.700–0.946). Interobserver agreement when using B-mode was poor for near wall (ICC, 0.396; 95% CI, ?0.048–0.708) and moderate for far wall (ICC, 0.474, 95% CI, 0.070–0.749). Conclusions: SMI proved to be a greatly reliable tool in the measurement of carotid IMT.

Objective: The objectives of this study were to identify the causes of internal jugular vein (IJV) blood flow reversal revealed on ultrasound imaging. Methods: In this retrospective review, 4796 upper extremity venous ultrasounds completed at a single institution between January 2012 and December 2017 were reviewed to identify cases of flow reversal in the IJV. Fourteen patients were identified with IJV flow reversal. Medical charts of these 14 patients were reviewed to identify the etiology of blood flow reversal. Results: Intraluminal causes were the most common and were most frequently seen in patients with vascular damage secondary to placement of endovascular devices. Flow reversal most commonly occurred in the left IJV and was equally represented in men and women. Ages ranged from 41.38 to 82.76 years, with an average age of 61.92 years. Conclusion: Reversal of flow in the IJV is a rare finding which is most often diagnosed on ultrasound evaluation of the upper extremity. Further investigation should be performed when flow reversal is identified, as the underlying cause may have serious clinical implications.