Value of contrast-enhanced ultrasound in deep angiomyxoma using a biplane transrectal probe:A case report

BACKGROUND Deep angiomyxoma(DAM)is a very rare tumor type.Magnetic resonance imaging(MRI)is considered the best imaging modality for diagnosing DAM.Computed tomography(CT)is used mainly to assess the invasion range of DAM.The value of ultrasonography in the diagnosis of DAM is still controversial.Through a literature review,we summarized the current state of ultrasonic examination for DAM and reported for the first time the contrast-enhanced ultrasound(CEUS)features of DAM seen using a biplane transrectal probe.CASE SUMMARY A 37-year-old woman presented with a sacrococcygeal mass that had gradually increased in size over the previous 6 mo.MRI and CT examinations failed to allow a definite diagnosis to be made.Transperineal core needle biopsy(CNB)guided by transrectal ultrasound and CEUS was suggested after a multidisciplinary discussion.Grayscale ultrasound of the lesion showed a layered appearance with alternating hyperechoic and hypoechoic patterns.Transrectal CEUS showed a laminated distribution of the contrast agent that was consistent with the layered appearance of the tumor on grayscale ultrasound.We performed transperineal CNB of the enhanced area inside the tumor under transrectal CEUS guidance and finally made a definitive diagnosis of DAM through histopathology.The patient underwent laparoscopic-assisted transabdominal surgery combined with transperineal surgery for large pelvic tumor resection and pelvic floor peritoneal reconstruction.No recurrence or metastasis was found at the ninemonth follow-up.CONCLUSION Transrectal CEUS can show the layered perfusion characteristics of the contrast agent,guiding subsequent transperineal CNB of the enhanced area within the DAM.

Contrast-enhanced ultrasound of a traumatic neuroma of the extrahepatic bile duct:A case report and review of literature

BACKGROUND Traumatic neuromas result from nerve injury after trauma or surgery but rarely occur in the bile duct.However,it is challenging to diagnose traumatic neuromas correctly preoperatively.Although some previous reports have described the imaging features of traumatic neuroma in the bile duct,no features of traumatic neuromas in the bile duct have been identified by using contrast-enhanced ultrasound(CEUS)imaging before.CASE SUMMARY A 55-year-old male patient presented to our hospital with a 3-mo history of abdominal distension and anorexia and history of cholecystectomy 4 years ago.Grayscale ultrasound demonstrated mild to moderate intrahepatic bile duct dilatation.Meanwhile,a hyperechoic nodule was found in the upper extrahepatic bile duct.The lesion approximately 0.8 cm×0.6 cm with a regular shape and clear margins.The nodule of the bile duct showed slight hyperenhancement in the arterial phase and isoenhancement in the venous phase on CEUS.Laboratory tests showed that alanine aminotransferase and aspartate aminotransferase were increased significantly,while the tumor marker carbohydrate antigen 19-9 was increased slightly.Then,hilar bile duct resection and end-to-end bile ductal anastomosis were performed.The histological examination revealed traumatic neuroma of the extrahepatic bile duct.The patient had an uneventful recovery after surgery.CONCLUSION The current report will help enhance the current knowledge regarding identifying traumatic neuromas by CEUS imaging and review the related literature.