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A special issue of Diagnostics (ISSN 2075-4418). This special issue belongs to the section "Medical Imaging and Theranostics".

Deadline for manuscript submissions: closed (31 July 2022) | Viewed by 36351

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Prof. Dr. Michael Bachmann Nielsen

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Department of Diagnostic Radiology, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark
Interests: diagnostic radiology; cancer imaging; medical ultrasound; Doppler techniques; CT-scanning; medical presentations; musculoskeletal imaging
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Special Issue Information

Dear Colleagues,

Ultrasound examinations are performed within almost all medical specialties and are of paramount value in clinical medicine and as research tools. Diagnostic ultrasounds as well as ultrasound guidance for biopsy, drainage and tumor ablation have become an integral part of the clinical setting. The last ten years have seen an increase in new ultrasound techniques such as contrast-enhanced ultrasound (CEUS), elastography techniques, 3D ultrasound, image fusion with ultrasound and methods for flow visualization such as the vector Doppler method. In terms of the technical aspects, transducer technology has also evolved tremendously. This Special Issue invites submissions of both original and review papers, and technical as well as clinical papers within all aspects of ultrasound imaging.

Prof. Dr. Michael Bachmann Nielsen
Guest Editor

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Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Diagnostics is an international peer-reviewed open access semimonthly journal published by MDPI.

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Keywords

3D ultrasound
blood flow velocity
ultrasonography
contrast-enhanced ultrasound
elasticity imaging
endoscopic ultrasound
ultrasonography
ultrasonography
intervention

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Published Papers (12 papers)

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10 pages, 1473 KiB

Open AccessArticle

Muscle and Tendon Stiffness of the Lower Limb of Professional Adolescent Soccer Athletes Measured Using Shear Wave Elastography

by Claudia Römer, Julia Czupajllo, Enrico Zessin, Thomas Fischer, Bernd Wolfarth and Markus Herbert Lerchbaumer

Diagnostics 2022, 12(10), 2453; https://0-doi-org.brum.beds.ac.uk/10.3390/diagnostics12102453 - 11 Oct 2022

Cited by 6 | Viewed by 1903

Abstract

Background: While adolescents have specific risk factors for acute and chronic injury, there is a lack of preventive medicine algorithms for this vulnerable group. Shear wave elastography (SWE) is currently mainly used for assessing muscle and tendon stiffness in adult athletes and can diagnose tissue pathologies such as tendinopathy. The aim was to investigate differences in quadriceps tendon and muscle stiffness between adolescent and adult professional soccer players using SWE and identify lateral imbalances in order to improve the knowledge of preventive medicine algorithms for professional adolescent athletes. Methods: Standardized SWE examinations of both lower limb tendons and muscles (the quadriceps tendon (QT) and the vastus medialis (VM) muscle) in the longitudinal plane and relaxed tendon position were performed in 13 healthy adolescent soccer athletes (13–17 years), and a control group of 19 healthy adult professional soccer athletes (18–29 years). Results: Adolescent soccer players had lower stiffness values for both the quadriceps tendon (3.11 m/s vs. 3.25 m/s) and the vastus medialis muscle (1.67 m/s vs. 1.71 m/s) than adult athletes. Moreover, QT stiffness in adolescent soccer players was significantly lower on the right side (QT: adult 3.50 m/s (2.73–4.56) vs. adolescent 2.90 m/s (2.61–3.12); p = 0.031). Analysis of the lateral differences revealed softer QT and VM tissue on the right side in over two-thirds of adolescent soccer athletes. Over two-thirds of adults had stiffer QT and VM tissue on the right side. Conclusion: In adolescent soccer players, the stiffness of the QT and VM muscle measured by SWE is lower in the right leg. SWE of the musculoskeletal system may thus become a relevant diagnostic tool to detect early lateral imbalances as a main risk factor for injury and may thus contribute to the prevention of acute and chronic injury prevention in adolescent athletes. Full article

(This article belongs to the Special Issue Ultrasound Imaging in Medicine 2022)

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13 pages, 2855 KiB

Open AccessArticle

Endorectal Ultrasound Shear-Wave Elastography of Complex Rectal Adenoma and Early Rectal Cancer

by Martina Kastrup Loft, Malene Roland Vils Pedersen, Jan Lindebjerg, Hans Bjarke Rahr and Søren Rafael Rafaelsen

Diagnostics 2022, 12(9), 2166; https://0-doi-org.brum.beds.ac.uk/10.3390/diagnostics12092166 - 06 Sep 2022

Cited by 3 | Viewed by 1423

Abstract

Purpose: To investigate the diagnostic performance of endorectal ultrasound (ERUS), shear-wave elastography (SWE), and magnetic resonance imaging (MRI) in patients with a complex rectal adenoma or an early rectal cancer, i.e., T1 or T2 adenocarcinoma in a clinical setting, and to evaluate the association between SWE and stromal fraction (SF) and apparent diffusion coefficient (ADC) and SF. Method: This prospective study included patients undergoing ERUS and SWE for a rectal tumor subsequently confirmed by histopathology to be an adenoma or a T1 or T2 adenocarcinoma. The accuracy of the imaging methods was assessed by comparing the T category as determined by ERUS and MRI with histopathology, which served as the gold standard. SF was assessed on surgical specimens. Results: A total of 86 patients were included. Of these, 62 patients had adenomas and 24 patients had carcinomas, of which 11 were T1 tumors and 13 were T2 tumors. ERUS and MRI yielded sensitivity, specificity, and accuracy of 0.79 and 0.73, 0.95 and 0.90, and 0.86 and 0.78, respectively, for discrimination between benign and malignant lesions. The area under the receiver operating characteristics curve for SWE was 0.88, and with a cut-off value of 40 kPa the sensitivity, specificity, and accuracy were 0.79, 0.89, and 0.86, respectively. There was a positive correlation between SF and SWE with a p-value of <0.001 and a negative correlation between SF and ADC with a p-value of 0.011. Conclusion: Both ERUS and MRI classified T categories with a high accuracy; however, ERUS classified more adenomas correctly than MRI. In this small population, SWE could differentiate an adenoma from early carcinoma. SF was correlated with both SWE and ADC, as increasing SF tended to yield higher SWE and lower ADC values. Full article

(This article belongs to the Special Issue Ultrasound Imaging in Medicine 2022)

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11 pages, 2350 KiB

Open AccessArticle

Can Ultrasound and Contrast-Enhanced Ultrasound Help Differentiate between Subpleural Focal Organizing Pneumonia and Primary Lung Malignancy?

by Ying Fu, Yutao Lei, Ligang Cui, Tingting Du and Fang Mei

Diagnostics 2022, 12(9), 2074; https://0-doi-org.brum.beds.ac.uk/10.3390/diagnostics12092074 - 26 Aug 2022

Cited by 1 | Viewed by 1219

Abstract

Background: Subpleural focal organizing pneumonia (FOP) and primary lung malignancy (PLM) are usually confused. The aim of this study was to explore the value of ultrasound (US) and contrast-enhanced ultrasound (CEUS) in the differential diagnosis of FOP and PLM. Methods: A total of 23 patients (mean age: 64.57 ± 11.86 years) with FOP and 100 (mean age: 66.29 ± 11.05 years) with subpleural lesions diagnosed as PLM, confirmed by pathological diagnosis and clinical follow-up, were retrospectively enrolled. The largest lesion diameter, angle between the lesion border and thoracic wall, air bronchial sign, internal blood supply, blood supply form, and pleural effusion examined using conventional US were retrospectively analyzed. The indicators of CEUS included the arrival time of contrast agent in the lesion, lesion–lung arrival time difference, degree of enhancement, distribution uniformity of contrast medium, presence of non-enhancing region, and arterial filling mode in the lesion. A p < 0.05 was considered statistically significant. Results: Presence of air bronchial sign (odds ratio [OR] = 6.18, p = 0.025), acute angle between the lesion border and thoracic wall (OR = 7.124, p = 0.033), and homogeneous enhancement (OR = 35.26, p = 0.01) showed predictive value for the diagnosis of FOP. According to the results of the logistic regression analysis, the area under the receiver operating curve of the above features combined was 0.960, and the sensitivity and specificity were 95.0% and 82.6%, respectively. Conclusions: US combined with CEUS has the potential to differentiate between FOP and PLM. Full article

(This article belongs to the Special Issue Ultrasound Imaging in Medicine 2022)

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12 pages, 9939 KiB

Open AccessArticle

Multicenter Observational Study to Evaluate the Diagnostic Value of Sonography in Patients with Chronic Rhinosinusitis

by Alessandro Bozzato, Christoph Arens, Maximilian Linxweiler, Victoria Bozzato, Peter Jecker, Gregor Hilger, Hans-Jürgen Welkoborsky, Johannes Zenk and Lukas Pillong

Diagnostics 2022, 12(9), 2065; https://0-doi-org.brum.beds.ac.uk/10.3390/diagnostics12092065 - 26 Aug 2022

Cited by 1 | Viewed by 1467

Abstract

(1) Background: Computed tomography (CT) is considered mandatory for assessing the extent of pathologies in the paranasal sinuses (PNS) in chronic rhinosinusitis (CRS). However, there are few evidence-based data on the value of ultrasound (US) in CRS. This multicenter approach aimed to compare diagnostic imaging modalities in relation to findings during surgery. (2) Methods: 127 patients with CRS were included in this prospective multicenter study. Patients received preoperative US and CT scans. The sensitivity and specificity of CT and US were extrapolated from intraoperative data. (3) Results: CT scans showed the highest sensitivity (97%) and specificity (67%) in assessing CRS. Sensitivities of B-scan US were significantly lower regarding the maxillary sinus (88%), the ethmoid sinus (53%), and the frontal sinus (45%). The highest overall sensitivity was observed for assessing the pathology of the maxillary sinus. (4) Conclusions: We observed high accuracy with CT, confirming its importance in preoperative imaging in CRS. Despite the high US expertise of all investigators and a standardized examination protocol, the validity of CT was significantly higher than US. Ultrasound of the PNS sinuses is applicable in everyday clinical practice but lacks diagnostic accuracy. Nevertheless, it might serve as a complementary hands-on screening tool to directly correlate the clinical findings in patients with PNS disease. Full article

(This article belongs to the Special Issue Ultrasound Imaging in Medicine 2022)

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15 pages, 2606 KiB

Open AccessArticle

Multiparametric Ultrasound of Cervical Lymph Node Metastases in Head and Neck Cancer for Planning Non-Surgical Therapy

by Julian Künzel, Moritz Brandenstein, Florian Zeman, Luisa Symeou, Natascha Platz Batista da Silva and Ernst Michael Jung

Diagnostics 2022, 12(8), 1842; https://0-doi-org.brum.beds.ac.uk/10.3390/diagnostics12081842 - 30 Jul 2022

Cited by 5 | Viewed by 5103

Abstract

Background: We aimed to evaluate multiparametric ultrasound, to achieve a better understanding of the baseline characteristics of suspected cervical lymph node metastases in head and neck cancer before induction chemotherapy or chemoradiation. Methods: From February 2020 to April 2021, our complete ultrasound examination protocol was carried out on clinically evident malignant lymph nodes of histologically proven HNSCC in the pre-therapeutic setting. Results: A total of 13 patients were eligible for analysis. Using elastography, irregular clear hardening in areas in the center of the lymph node could be detected in all cases. Elastographic Q-analysis showed a significantly softer cortex compared to the center and surrounding tissue. The time–intensity curve analysis showed high values for the area under the curve and a short time-to-peak (fast wash-in) in all cases compared to the surrounding tissue. A parametric evaluation of contrast enhanced the ultrasound in the early arterial phase and showed an irregular enhancement from the margin in almost all investigated lymph nodes. These results show that the implementation of comprehensive, multiparametric ultrasound is suitable for classifying suspected lymph node metastasis more precisely than conventional ultrasound alone in the pre-therapeutic setting of HNSCC. Thus, these parameters may be used for improvements in the re-staging after chemoradiation or neoadjuvant therapy monitoring, respectively. Full article

(This article belongs to the Special Issue Ultrasound Imaging in Medicine 2022)

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13 pages, 3116 KiB

Open AccessArticle

Biomechanical Properties of Strictures in Crohn’s Disease: Can Dynamic Contrast-Enhanced Ultrasonography and Magnetic Resonance Enterography Predict Stiffness?

by Rune Wilkens, Dong-Hua Liao, Hans Gregersen, Henning Glerup, David A. Peters, Charlotte Buchard, Anders Tøttrup and Klaus Krogh

Diagnostics 2022, 12(6), 1370; https://0-doi-org.brum.beds.ac.uk/10.3390/diagnostics12061370 - 02 Jun 2022

Cited by 2 | Viewed by 1607

Abstract

Strictures and abdominal pain often complicate Crohn’s disease (CD). The primary aim was to explore whether parameters obtained by preoperative contrast-enhanced (CE) ultrasonography (US) and dynamic CE MR Enterography (DCE-MRE) of strictures associates with biomechanical properties. CD patients undergoing elective small intestinal surgery were preoperatively examined with DCE-MRE and CEUS. The excised intestine was distended utilizing a pressure bag. Luminal and outer bowel wall cross-sectional areas were measured with US. The circumferential stricture stiffness (Young’s modulus E) was computed. Stiffness was associated with the initial slope of enhancement on DCE-MRE (ρ = 0.63, p = 0.007), reflecting active disease, but lacked association with CEUS parameters. For structural imaging parameters, inflammation and stricture stiffness were associated with prestenotic dilatation on US (τ_b = 0.43, p = 0.02) but not with MRE (τ_b = 0.01, p = 1.0). Strictures identified by US were stiffer, 16.8 (14.0–20.1) kPa, than those graded as no or uncertain strictures, 12.6 (10.5–15.1) kPa, p = 0.02. MRE global score (activity) was associated with E (ρ = 0.55, p = 0.018). Elastography did not correlate with circumferential stiffness. We conclude that increasing activity defined by the initial slope of enhancement on DCE-MRE and MRE global score were associated with stricture stiffness. Prestenotic dilatation on US could be a potential biomarker of CD small intestinal stricture stiffness. Full article

(This article belongs to the Special Issue Ultrasound Imaging in Medicine 2022)

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10 pages, 1758 KiB

Open AccessArticle

Study of the Anatomical Association between Morton’s Neuroma and the Space Inferior to the Deep Transverse Metatarsal Ligament Using Ultrasound

by María del Mar Ruiz-Herrera, Juan José Criado-Álvarez, Mario Suarez-Ortiz, Marko Konschake, Simone Moroni and Félix Marcos-Tejedor

Diagnostics 2022, 12(6), 1367; https://0-doi-org.brum.beds.ac.uk/10.3390/diagnostics12061367 - 01 Jun 2022

Cited by 4 | Viewed by 5231

Abstract

Morton’s neuroma (MN) is a common condition in clinical practice. The compressive etiology is the most accepted, in which compression occurs in the tunnel formed by the adjacent metatarsals, the deep transverse metatarsal ligament (DTML) and the plantar skin. Ultrasound (US) is a reliable method of study. The presence of insufficient space under the DTML may be related to the appearance of MN. Objectives: To verify the relationship between MN and the space under the DTML between the metatarsal heads of the third (M3) and the fourth (M4) metatarsals using US. Methods: This is a cross-sectional epidemiological study. The research study using the ultrasound (US) technique was carried out on 200 feet belonging to 100 patients aged 18 to 65 of both sexes, with a control group formed by 62 patients and a study group formed by 38 patients diagnosed with MN. Results: The presence of MN and the factors associated with it were studied in 100 patients using ultrasound (US). The assessment and comparison with US of the space inferior to the DTML between M3 and M4 in control groups and patients with MN show that patients with MN have a smaller size in the variable “h” (height or distance DTML-plantar skin), in the variable “b” (base or intermetatarsal distance M3 and M4) and in the variable “s” (surface of the parallelogram “h” × “b”). The predictors of MN are a decrease in dimension “b” and an increase in weight. Sitting in an office chair and the use of a bicycle, due to equinus, have an influence on the space below the DTML, reducing it and promoting the appearance of MN. Conclusions: The two US measurements (“h” and “b”) in the space below the DTML are smaller in patients with MN than in the asymptomatic group. A shorter distance between M3 and M4, and an increase in BMI are predictors of MN. Full article

(This article belongs to the Special Issue Ultrasound Imaging in Medicine 2022)

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11 pages, 1312 KiB

Open AccessArticle

Doppler and Spectral Ultrasound of Sacroiliac Joints in Pediatric Patients with Suspected Juvenile Spondyloarthritis

by Paolo Falsetti, Edoardo Conticini, Carla Gaggiano, Caterina Baldi, Maria Tarsia, Marco Bardelli, Stefano Gentileschi, Roberto D’Alessandro, Suhel Gabriele Al Khayyat, Alessandra Cartocci, Claudia Fabiani, Luca Cantarini, Maria Antonietta Mazzei and Bruno Frediani

Diagnostics 2022, 12(4), 992; https://0-doi-org.brum.beds.ac.uk/10.3390/diagnostics12040992 - 14 Apr 2022

Cited by 3 | Viewed by 2101

Abstract

Background: Power Doppler ultrasound (PDUS) with spectral wave analysis (SWA) has been compared with magnetic resonance imaging (MRI) in documenting active sacroiliitis in early spondyloarthritis (SpA) but, to date, PDUS/SWA has not been yet applied to the study of sacroiliac joints (SIJs) in children. Methods: A group of 20 children (13 F/7 M, mean age 14.2 y) with suspected juvenile SpA (jSpA) underwent PDUS/SWA and, subsequently, MRI of the SIJs. SIJs PDUS scoring and resistance index (RI) of the SIJs flows were recorded. The accuracy of PDUS/SWA for the diagnosis of active sacroiliitis was evaluated, with MRI as the gold standard. Results: PDUS signals were detected in 19 patients and 30 SIJs. Bone marrow edema (BME) lesions on MRI were detected in 12 patients (diagnosed as jSpA) and 22 SIJs. PDUS scoring on SIJs were higher in patients with a final diagnosis of jSpA (p = 0.003). On SWA, the mean RIs in patients with or without final diagnosis of active sacroiliitis were, respectively, 0.604 and 0.767 (p = 0.005) at joint level. A RI < 0.55 and PDUS > 1 showed the higher specificity for sacroiliitis (AUROC curve 0.854 for PDUS and 0.920 for RI). SIJs PDUS/SWA showed an overall concordance of 82.35%, with substantial agreement (k = 0.627) with MRI on the diagnosis of sacroiliitis. Conclusions: In children with sacroiliitis, PDUS demonstrates a rich vascularization into SIJs and low RIs (<0.55) have high specificity for this condition. SIJs PDUS/SWA could be useful as a screening method in children with suspected jSpA. Full article

(This article belongs to the Special Issue Ultrasound Imaging in Medicine 2022)

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10 pages, 1872 KiB

Open AccessArticle

Expert Consensus Document: Diagnosis for Chronic Constipation with Faecal Retention in the Rectum Using Ultrasonography

by Masaru Matsumoto, Noboru Misawa, Momoko Tsuda, Noriaki Manabe, Takaomi Kessoku, Nao Tamai, Atsuo Kawamoto, Junko Sugama, Hideko Tanaka, Mototsugu Kato, Ken Haruma, Hiromi Sanada and Atsushi Nakajima

Diagnostics 2022, 12(2), 300; https://0-doi-org.brum.beds.ac.uk/10.3390/diagnostics12020300 - 25 Jan 2022

Cited by 5 | Viewed by 10066

Abstract

Chronic constipation is a common gastrointestinal disorder in older adults, and it is very important to manage chronic constipation. However, evaluating these subjective symptoms is extremely difficult in cases where patients are unable to express their symptoms because of a cognitive or physical impairment. Hence, it is necessary to observe the patient’s colonic faecal retention using objective methods. Ultrasonography observation for colonic faecal retention is useful for diagnosing constipation and evaluating the effectiveness of treatment. Since there was no standard protocol for interpreting rectal ultrasonography findings, we developed an observation protocol through an expert consensus. We convened a group of experts in the diagnosis and evaluation of chronic constipation and ultrasonography to discuss and review the current literature on this matter. Together, they composed a succinct, evidence-based observation protocol for rectal faecal retention using ultrasonography. We created an observation protocol to enhance the quality and accuracy of diagnosis of chronic constipation, especially rectal constipation. This consensus statement is intended to serve as a guide for physicians, laboratory technicians and nurses who do not specialise in ultrasound or the diagnosis of chronic constipation. Full article

(This article belongs to the Special Issue Ultrasound Imaging in Medicine 2022)

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9 pages, 2547 KiB

Open AccessCase Report

Rare Case of Intravascular Myopericytoma—Imaging Characteristics and Review of the Literature

by Simona Manole, Roxana Pintican, Viorel Manole, Cosmin Rusneac, Calin Schiau, Ioana Bene, Carolina Solomon and Sorin Dudea

Diagnostics 2022, 12(10), 2473; https://0-doi-org.brum.beds.ac.uk/10.3390/diagnostics12102473 - 13 Oct 2022

Cited by 1 | Viewed by 1716

Abstract

Myopericytoma is a rare vessel wall tumor, a subtype of hemangiopericytoma that usually develops subcutaneously. Intravascular myopericytoma is a rarer subtype, with only few cases reported in the literature and even fewer with imaging modalities included. We report the case of a 36-year-old man who was referred to our institution with a painless, palpable mass in the right arm and was evaluated with MRI, grey-scale and Doppler-mode ultrasound. Tumor histopathology and imaging characteristics are presented together with the role that each imaging modality played in the management of the patient. Full article

(This article belongs to the Special Issue Ultrasound Imaging in Medicine 2022)

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10 pages, 13638 KiB

Open AccessCase Report

Fetal Atrial Flutter Associated with Atrial Septal Aneurysm

by Fuanglada Tongprasert, Suchaya Luewan, Kasemsri Srisupundit and Theera Tongsong

Diagnostics 2022, 12(7), 1722; https://0-doi-org.brum.beds.ac.uk/10.3390/diagnostics12071722 - 15 Jul 2022

Viewed by 1593

Abstract

Objective: To provide evidence that fetal atrial flutter (AF) caused by atrial septal aneurysm (ASA) can be completely cured by delivery. Methods: Cases series of three fetuses with ASA complicated by AF in late gestation, including hydrops fetalis in one case, were collected and completely followed up. Results: AF in all cases completely disappeared shortly after birth. New insights gained from this study are as follows: (1) PACs or bigeminy associated with ASA can progressively change to AF. (2) AF associated with ASA can cause hydrops fetalis and intrauterine treatment is needed; however, delivery is the definitive treatment. (3) AF associated with ASA completely resolves after birth. This is probably associated with changes in the circulation after birth, with no more blood flow crossing the foramen ovale and no turbulent flow in the ASA with reversal to hit the right atrial wall, activating ectopic pacemakers. Conclusions: This report may have clinical impact because it provides evidence that (1) in case of AF associated with ASA, the prognosis is much better than other causes and delivery should be strongly considered. (2) Fetuses diagnosed with AF should always be checked for the presence of ASA. (3) PAC/bigeminy related to ASA, different from isolated PAC, needs close follow-up for the development of SVT and AF. (4) Fetuses remote from term can benefit from intrauterine treatment to avoid hydrops fetalis, and to prolong gestation for maturity, early delivery is recommended once lung maturity is confirmed. Full article

(This article belongs to the Special Issue Ultrasound Imaging in Medicine 2022)

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10 pages, 3662 KiB

Open AccessCase Report

The Accelerated Right Ventricular Failure in Fetal Anemia in the Presence of Restrictive Foramen Ovale

by Suchaya Luewan, Fuanglada Tongprasert, Kasemsri Srisupundit and Theera Tongsong

Diagnostics 2022, 12(7), 1646; https://0-doi-org.brum.beds.ac.uk/10.3390/diagnostics12071646 - 06 Jul 2022

Viewed by 1514

Abstract

Objective: To describe serious hemodynamic changes secondary to anemia in the case of restrictive foramen ovale (FO). Case: A 43-year-old pregnant woman, G4P0030, underwent fetal echocardiography at 35 weeks of gestation and was found to have (1) restrictive FO; (2) poor right ventricular function; (3) unbalanced hemodynamics; (4) fetal anemia (high MCA-PSV and hepatosplenomegaly). Acid-elution test indicated feto-maternal hemorrhage. Cesarean section was performed for postnatal blood transfusion. Nevertheless, the newborn developed heart failure and died after partial blood exchanges. Conclusions: Insights gained from this study are as follows: (1) Restrictive FO in structurally normal hearts can modify fetal response to anemia differently, by unequally distributing blood volume, leading to much more deteriorating right ventricular function. (2) To make decisions for intrauterine or extrauterine treatment in cases of anemia-associated heart failure, several factors must be taken into account such as gestational age, fetal cardiac function, and placental function. Because of the hyperdynamic state of newborns immediately after birth, delivery can deteriorate the compromised heart to irreversible failure. Intrauterine transfusion for a well-prepared heart just before delivery may be the best option since the baby should be well oxygenated at the time of delivery. Full article

(This article belongs to the Special Issue Ultrasound Imaging in Medicine 2022)

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