Current Medical Imaging - Volume 20, Issue 1, 2024

Hip dysplasia is one of the most prevalent disorders in children and one of the three primary congenital orthopedic deformities. Although there are numerous existing methods (e.g., CT, MRI and arthrography) for early identification of hip dysplasia, their diagnostic criteria differ widely. It is critical to establish a safe, accurate, and reliable way for early diagnosis and treatment of hip dysplasia.

This study aimed to analyze the diagnostic efficacy of high-frequency ultrasound (HFU) for congenital developmental hip dysplasia and hip dislocation and to provide a reference for the early diagnosis of congenital hip dysplasia in the future.

A total of 104 infants and children suspected of having congenital hip dislocation or developmental hip dysplasia admitted to our hospital from April 2019 to August 2022 were enrolled as study subjects. All the infants and children were subjected to HFU and X-ray examination in our hospital. The diagnostic efficacy of HFU for congenital hip dysplasia was observed using X-ray as the gold standard.

HFU confirmed 79 cases of congenital hip dysplasia, while X-ray confirmed 71 cases. The sensitivity and specificity of HFU were 77.42% and 83.33%, respectively, in the diagnosis of congenital developmental hip dysplasia, 76.47% and 96.55% in the diagnosis of congenital hip dislocation, and 77.22% and 60% in the diagnosis of congenital hip abnormality, which is very close to the gold standard. According to statistics on infants and children, the majority of patients were girls, and the left joint was more likely to be affected.

HFU has excellent diagnostic efficiency for congenital developmental hip dysplasia and hip dislocation, which can be considered an early assessment method for congenital hip dysplasia in the future.

Non-invasive imaging methods are still lacking for the evaluation of muscle changes in diabetes.

To investigate the feasibility of muscle CT radiomics in evaluating muscle changes in diabetes.

60 diabetics and 60 health controls (HC) were assessed with the method of muscle CT radiomics. 93 CT images of radiomics features of the pectoralis major muscle (PMM) were obtained by using the software 3D Slicer and were then compared between diabetics and HC cases. The least absolute shrinkage and selection operator (LASSO) regression method was used to establish a prediction model. The receiver operating characteristic (ROC) curve was used to determine the performance of the model.

Diabetics and HC cases differed in 19 radiomics features (P<0.05). By using the LASSO method, 6 features were finally selected. The AUC of the model in the discrimination of diabetics and HC were 0.92 and 0.90, respectively, for the training cohort and validation cohort.

Muscle CT radiomics is feasible in evaluating muscle changes in diabetes.

The degree of cervical foraminal stenosis on MRI scans may be measured and categorised using the Kim or modified Kim methods. These grading scales have not previously been validated in a cohort of patients awaiting surgery.

To establish the normal foraminal and root diameters as well as the consistency of inter and intra-rater grading using the Kim and modified Kim grading systems in pre-operative surgical patients.

Asymptomatic cervical nerve roots and foramina demonstrated on the pre-operative MRI scans of adult surgical patients with cervical radiculopathy were measured and categorised by six raters using the Kim and modified Kim grading methods. Repeat “second pass” measurements were made by the same assessors on the same images a minimum of one month later.

Foraminal diameters (mm) in asymptomatic foramina were C2/C3 (mean ± SD): 4.18 ± 1.44, C3/C4 2.96 ± 1.23, C4/C5 3.02 ± 1.19, C5/C6 3.15 ± 1.33, C6/C7 3.53 ± 1.36, C7/T1 3.93 ± 1.34. Nerve root diameters were C3 3.11 ± 0.87, C4 2.95 ± 0.77, C5 2.56 ± 0.73, C6 2.26 ± 0.76, C7 2.56 ± 0.82, C8 3.83 ± 0.86.

Inter-rater consistency was kappa [95% CI]: Kim 0.01 [0.00, 0.03], modified Kim 0.08 [0.05, 0.10]. Intra-rater consistency was kappa [95% CI]: Kim 0.81 [0.77, 0.86], modified Kim 0.69 [0.62, 0.76].

There was poor inter-rater consistency but good intra-rater consistency when assessing the severity of foraminal stenosis on axial T2 MRI scans. Foraminal diameter was narrowest at C3/C4 and C4/C5, whereas the smallest root diameter was C5/C6. Volumetric or oblique MR may improve consistency.

Generalized cystic lymphangiomatosis (GCL) is a rare disease characterized by the widespread proliferation of lymphatic vessels, often seen in the pediatric patient group. Imaging techniques are instrumental in revealing the extent and morphological features of the disease.

The objective of this study is to interpret the radiological findings of GCL and address the differential diagnosis between GCL and other lymphatic malformations in light of the relevant literature data.

The sample of this retrospective study consisted of six pediatric patients, four males and two females, diagnosed with GCL based on clinical, radiological, and histopathological findings between 2015 and 2022. The age of the patients at the time of diagnosis and their symptoms at admission were obtained from the hospital database. Radiological imaging findings were evaluated in detail based on the involved systems (thorax, abdomen, and musculoskeletal).

The median age of the sample, 4/6 were male, was 9 years at admission (min. 3, max. 12). The most common symptom at admission was dyspnea, often accompanied by pleural effusion. Bone involvement was the most common extrathoracic finding. Abdominal involvement was primarily asymptomatic, and the spleen was the most frequently involved organ in the abdomen.

The diagnosis of GCL is challenging because of its rarity and overlapping diseases. Whole-body magnetic resonance imaging is a valuable tool as it reveals the typical radiological features of GCL and how far it has spread throughout the body.

Real-time shear wave elastography (SWE) has emerged as a useful imaging modality for detecting the lesion location of various diseases, including cervical diseases.

In this paper, the SWE was used to quantitatively determine the tissue hardness of the internal and external orifice of the cervix (IOC & EOC) and to relatively objectively analyze the impact of different production methods on the hardness of the cervical tissue.

A total of 48 patients were selected, and they were divided into three groups according to different production methods: control group (16 cases), cesarean section group (16 cases), and spontaneous delivery group (16 cases). Artificial intelligence has also been incorporated into this work. A deep flexible neural tree model and a new set of FNT models were proposed to assist in classifying cervical physical data in different states. The physical data was extracted as the features, and the different states were considered as category labels.

There was no statistically significant difference in the elasticity of the IOC and the EOC between the groups. However, the difference in the elasticity of the IOC and the EOC within each group was statistically significant. The classification results corresponded with the results of the statistical analysis. The hardness of the EOC is generally lower than that of the IOC, and there was no significant difference in hardness between the IOC and the EOC in the three groups.

There is no significant difference in the cervical elasticity hardness between different delivery modes.

Cesarean scar pregnancy (CSP) refers to the phenomenon in which a fertilized egg implants and develops in the scar of the uterus in a woman with a history of cesarean section.

The study aimed to explore the differential diagnostic value of two-dimensional ultrasound (2D US) combined with three-dimensional ultrasound (3D US) for CSP.

Clinical data of 89 patients with CSP admitted to our hospital from January 2022 to January 2023 were retrospectively analyzed. Of them, 65 patients met the inclusion criteria. Patients underwent 2D US, 3D US, and combined 2D and 3D US imaging. Using the clinical pathological diagnosis as the “gold standard”, the differential diagnostic value of 2D US, 3D US, and 2D US combined with 3D US for CSP was compared.

The detection rate of CSP using a combined 2D US and 3D US was 98.46%, which was higher than 84.62% and 89.23% achieved with 2D US and 3D US alone, respectively (P<0.05). The pathological results showed that among 65 patients, CSP type I accounted for 24.62%, type II accounted for 55.38%, and type III accounted for 20.00%. The coincidence rate of 2D US combined with 3D US was 98.46%, which was higher than that of 2D US (83.08%) and 3D US 89.23%) alone (P<0.05). The accuracy, specificity, and sensitivity of 2D US combined with 3D US in diagnosing CSP were higher compared to the two methods alone (P<0.05).

The combination of 2D US and 3D US can accurately detect and classify CSP, further improving diagnostic efficiency.

Fetal small bowel obstruction (SBO) is a serious condition with high morbidity and mortality rates. Prenatal ultrasound is an important tool for detecting SBO, but the optimal cutoff value for intestinal diameter remains undefined.

This study aimed to investigate the ultrasonic characteristics of fetal SBO and determine the optimal cutoff value for intestinal diameter to enhance prenatal ultrasound diagnosis.

We retrospectively analyzed the ultrasonic characteristics and postpartum data of 76 cases diagnosed with SBO. Receiver operating characteristic (ROC) curve analysis was performed to identify the optimal cutoff value for dilated intestinal diameter.

Among the 76 cases, 31 displayed the “double bubble sign” on ultrasound, with 20 cases identified as annular pancreas, 6 as duodenal atresia, and 5 as duodenal membranous stenosis. In 45 cases, the lesions were located in the jejunal or ileal segment and exhibited intestinal dilatation above the lesion site, including 27 cases of small bowel atresia, 7 cases of membranous jejunal stenosis, and 11 cases of small bowel volvulus. Out of the 76 cases, 9 showed no abnormalities after birth. ROC curve analysis determined optimal cutoff values of 17.5mm and 10.5mm for predicting “double bubble sign” lesions in the gastric and duodenal widths. For predicting small intestinal dilatation, the optimal cutoff values for dilated width and length of the intestinal tube were 11.5mm and 21.5mm, respectively, with high sensitivity and specificity.

Ultrasonic imaging and changes in intestinal diameter provide valuable information for prenatal diagnosis and management of SBO. Establishing these cutoff values can improve the accuracy of prenatal ultrasound diagnosis for SBO.

Preoperative T-staging is essential for planning optimal treatment and care for colorectal cancer (CRC).

To evaluate the accuracy of Dual-energy CT (DECT) in preoperative T-staging of CRC.

The clinical data and DECT images of 37 patients with 39 CRC lesions were retrospectively analyzed. The performance of the DECT quantitative parameters in CRC T-staging was evaluated. Postoperative pathologic results were used as a gold standard. Receiver operating characteristic curves were used to assess the diagnostic efficacy of DECT parameters. P < 0.05 was deemed significant.

The overall accuracy of T-staging by DECT was 76.9%. The DECT parameters were significantly different between the T3 pericolic fat stranding, T4a pericolic fat stranding, and normal pericolic fat stranding. Arterial phase λHU had the best diagnostic performance with a cut-off value of ≥0.967, resulting in a 70.6% sensitivity and a 100% specificity in differentiating between T3 and T4a stages of CRC.

DECT has high accuracy in the T-staging of CRC. Arterial phase λHU has the best diagnostic performance in differentiating between T3 and T4a stages of CRC.

Molybdenum cofactor deficiency (MoCD-A) is an extremely rare autosomal recessive disease that presents with intractable seizures. The diagnosis poses challenges due to the limited number of cases reported worldwide. Magnetic resonance imaging (MRI) is a useful diagnostic tool that can detect brain injury associated with the disorder. The prognosis of MoCD-A is poor partly because most cases are initially misdiagnosed as HIE (hypoxic ischemic encephalopathy), emphasizing the need for an early and accurate diagnosis to improve quality of life and provide adequate genetic counseling to avoid new cases in the future.

This report presents a case of molybdenum cofactor deficiency type A (MoCD-A) caused by MOCS1 gene mutations. A male newborn was admitted on the 10th day of birth due to uncontrolled seizures and feeding difficulties. Brain MRI showed severe cerebral damage with multiple foci that did not enhance upon contrast administration. The diagnosis was confirmed by genetic analysis and the patient received rehabilitation. His parents also received genetic counseling. To the best of our knowledge, this is the first reported MoCD-A case that had enhanced MR imaging with Gd-DTPA (0.1 mmol/kg). In addition, we reviewed the clinical and neuroimaging features of 25 newborns diagnosed with MoCD-A, as documented in the existing literature.

MRI is crucial in the diagnosis of MoCD-A. A correct diagnosis can provide the family with timely genetic counseling to prevent future cases.

Dissection of the lymph nodes posterior to the right recurrent laryngeal nerve (LN-prRLNs) in papillary thyroid cancer (PTC) remains controversial.

This study aimed to determine the capability of ultrasonography (US)-based radiomics for presurgical prediction of metastasis in LN-prRLNs in PTC.

Patients were retrospectively enrolled and pathologically confirmed as LN-prRLN metastasis with PTC after surgery. Radiomic analysis based on preoperative US images with manual segmentation of targets was used to develop a radiomics model. US features described in ACR TI-RADS were collected to construct a clinical model. The Radiomics model, a combined model integrating radiomics and clinical model, were also developed for the presurgical prediction of metastasis in LN-prRLNs.

A total of 570 patients, including 488 patients with non-LN-prRLN metastasis and 82 with LN-prRLN metastasis, were assessed. The 15 top-performing features finally remained significant for constructing the radiomics model. The combined model showed that US measured tumor size (OR: 1.036, P = 0.044), US suspected lateral lymph node metastasis (OR: 2.247, P = 0.009), multifocality (OR: 1.920, P = 0.021), Delphian lymph node metastasis (DLNM) (OR: 2.300, P = 0.039), VIa compartment metastasis (OR: 5.357, P = 0.000), the radiomics score (OR: 1.003, P = 0.001) were significant risk factors for predicting LN-prRLN metastasis. The combined model achieved a higher AUC of 0.849 than that of the clinical model (AUC: 0.826) and radiomics model (AUC: 0.759).

The US-based radiomics combined model can more effectively predict LN-prRLN metastasis in PTCs patients preoperatively. This approach had the potential to assist surgeons in decision-making regarding LN-prRLN dissection.

Only a small number of the investigations that were carried out in the Middle East attempted to characterize patients with NCFB. In order to characterize patients with NCFB, as well as their etiologies, microbiological profiles, and outcomes, we therefore carried out this investigation.

This retrospective cohort study was carried out at the Jordan University Hospital (JUH), a tertiary facility located in Amman, Jordan. Non-cystic Fibrosis Bronchiectasis (NCFB) was defined as an HRCT scan typical for bronchiectasis along with a negative sweat chloride test to rule out cystic fibrosis. Patients’ data were collected by the use of Electronic Medical Records (EMR) at our institution. Frequent exacerbation was defined as more than 2 exacerbations in 1 year of the onset of the diagnosis.

A total of 79 patients were included, and 54.4% of them were female. The mean and standard deviation of the patient's age was 48.61 ± 19.62. The etiologies of bronchiectasis were evident in 79.7% of the sample. Asthma, Chronic Obstructive Pulmonary Diseases (COPD), and Kartagener syndrome were the most prevalent etiologies, accounting for related illnesses in 21.8%, 21.5%, and 13.9% of the patients, respectively. The most frequent bacteria cultured in our cohort were Pseudomonas and Candida Species. Moreover, 43 patients of the study cohort were frequent exacerbators, and 5 patients died.

Our study supports the need to identify several bronchiectasis phenotypes linked to various causes. These findings provide information to clinicians for the early detection and treatment of bronchiectasis in Jordan.

Acquired immune deficiency syndrome (AIDS) associated with eosinophilic gastroenteritis is rare. We report a case of duodenal “stone” inducing acute pancreatitis with eosinophilic gastroduodenitis in an AIDS patient.

A 73-year-old female AIDS patient came to the hospital with recurrent abdominal pain for 20 days. Computed tomography (CT) showed pancreatitis with exudation and a high-density shadow under the gastric antrum. Gastroscopy showed that the descending part of the duodenum was blocked by a “stone”. The mucosa of the duodenum was rough, and a red polyp was found on the gastric body. The pathology result was chronic inflammation with eosinophilic granulocytes in the duodenal mucosa and gastric body polyp.

When AIDS patients suffer acute pancreatitis, the possibility of eosinophilic gastroenteritis needs to be considered to enable the patient to accept timely treatment.

Artificial intelligence-based aided diagnostic systems for pulmonary nodules can be divided into subtasks such as nodule detection, segmentation, and benign and malignant differentiation. Most current studies are limited to single-target tasks. However, aided diagnosis aims to distinguish benign from malignant pulmonary nodules, which requires the fusion of multiple-scale features and comprehensive discrimination based on the results of multiple learning tasks.

This study focuses on the aspects of model design, network structure, and constraints and proposes a novel model that integrates the learning tasks of pulmonary nodule detection, segmentation, and classification under weakly supervised conditions.

The main innovations include the following three aspects: (1) a two-dimensional sequence detection model based on a ConvLSTM (Convolutional Long Short-Term Memory) network and U-shaped structure network is proposed to obtain the context space features of image slices fully; (2) a differential diagnosis of benign and malignant pulmonary nodules based on multitask learning is proposed, which uses the annotated data of different types of tasks to mine the potential common features among tasks; and (3) an optimization strategy incorporating prior knowledge of computed tomography images and dynamic weight adjustment of multiple tasks is proposed to ensure that each task can efficiently complete training and learning.

Experiments on the LIDC-IDRI and LUNA16 datasets showed that our proposed method achieved a final competition performance metric score of 87.80% for nodule detection and a Dice similarity coefficient score of 83.95% for pulmonary nodule segmentation.

The cross-validation results of the LIDC-IDRI and LUNA16 datasets show that our model achieved 87.80% of the final competition performance metric score for nodule detection and 83.95% of the DSC score for pulmonary nodule segmentation, representing the optimal result for that dataset.

This study aimed to determine the utility of a radiomic nomogram combined with clinical imaging and radiomic features based on MRI for the diagnosis of triple-negative breast cancer.

Multi-parametric MRI images of 136 breast cancer patients were retrospectively analyzed, 95 cases were stratified into the training cohort, and 41 cases were selected for the test group. According to the pathological molecular typing, the patients were divided into 23 cases of triple-negative breast cancer and 113 cases of non-triple-negative breast cancer. ITK software was used to manually delineate the lesion volume region of interest (VOI), and the Pyradiomics package was used to extract radiomic features for screening and model building. The platform was then used to analyze the clinical and imaging risk factors of breast cancer to build a characteristic model separately. Finally, a radiomic nomogram was constructed by integrating the radiomic and independent clinical image features. The diagnostic performance of the model was assessed using ROC curves.

Univariate and multivariate analyses showed that the menstrual cycle, glandular density, and skin thickening were risk factors for clinical imaging characteristics of triple-negative breast cancer. The Area Under the Curve (AUC) was 0.839 and 0.826 for univariate and multivariate analysis, respectively. After screening, 11 radiomic features participated in the calculation of the radiomic score, and its AUC in the test set was 0.803. Combining it further with clinical models, the AUC improved to 0.899.

The radiomic nomogram developed in this study has great value in the diagnosis of triple-negative breast cancer.

Osteonecrosis of the femoral head (ONFH) is an incapacitating disease that frequently results in the collapse of the femoral head and secondary osteoarthritis. The diagnosis and staging of this pathology, which usually rely on imaging studies, are challenging. Currently, conventional radiography is the basis of the initial diagnostic assessment. In recent decades, however, radiographs have been considered insensitive to early changes in ONFH and thus, a suboptimal diagnostic tool. Paradoxically, the imaging features of radiographs are often profuse, substantial, and characteristic. This study aimed to elucidate the real limitations of this radiologic tool by assessing the diagnostic reliability of the key radiologic features and staging.

This was a retrospective study in which radiographs from 28 idiopathic ONFH confirmed cases who underwent hip arthroplasty were analyzed by eight observers who were asked to identify the presence or absence of ONFH universally reported imaging features in AP hip radiographs.

Concordance analysis revealed a poor agreement between observers for most of the assessed imaging features. Only the identification of femoral head flattening and osteoarthritis signs exhibited moderate agreement with statistical significance. In contrast, the detection of radiological osteoporosis and the loss of trabeculation showed the lowest reliability, with negative kappa coefficients.

There is a lack of agreement between qualified observers, even for the identification of the most characteristic ONFH radiographic features. The reliability of plain radiography for the detection of basic radiological elements is even weaker in the early stages of the disease.

Vitrectomy combined with internal limiting membrane (ILM) peeling or ILM inverted flap greatly improves hole closure and vision prognosis for idiopathic macular holes (IMH). The application of indocyanine green (ICG) in MH surgery increases the visibility of ILM and the safety of surgery. However, the area of ILM peeling and the state of the flap and a closed hole has not been well observed.

Fundus autofluorescence at 7935nm can show the range of ILM peeling and the state of the hole site and ILM flap by monitoring residual ICG postoperatively. However, the characteristics of fundus autofluorescence especially the site of the closed hole, and its relationship with vision prognosis have not been explored. The aim of this project was to find the autofluorescence features of the closed hole and their relation with vision.

To investigate the characteristics of fundus autofluorescence imaging after ICG-assisted vitrectomy for IMH and to evaluate the correlations of fluorescence patterns at the MH site with visual acuity and macular anatomic outcomes.

We retrospectively evaluated 33 IMH patients (33 eyes) who underwent a 25G pars plana vitrectomy (follow-up, 6-14.5 months). ICG staining (2.5 mg/mL) was either used to remove the internal limiting membrane (ILM) or the inverted ILM flap was overlaid on the hole. After surgery, fluorescence imaging of the fundus was obtained using a scanning laser ophthalmoscope at 795 nm.

On fluorescence imaging, the area of ILM peeling in all eyes showed hypofluorescence with no changes over time. The inverted ILM flap (performed in 18 eyes) was positioned on the inferior retina and exhibited early mild hyperfluorescence with blurred edges. This was gradually enhanced up to 3-6 months postoperatively and was then attenuated. MHs showed two distinct patterns on optical coherence tomography: granular (21 eyes) and patchy hyperfluorescence (12 eyes). Best-corrected visual acuity improved postoperatively in all cases (p<0.001, Z=-4.744). VA was worse in the patchy (vs. granular) hyperfluorescence cases (p=0.011, Z=-2.548).

The status of the ILM peeling area, ILM flap, and closed MH can be clearly observed using autofluorescence imaging at 795 nm. Fluorescence may be due to ICG staining of the ILM and accumulation in retinal pigment epithelium cells during ICG-assisted surgery. Granular hyperfluorescence at the MH site may indicate good anatomic and visual prognoses.

A number of studies have evaluated the effect of colour Doppler ultrasound in patients with cervical cancer.

Objective: This study aims to evaluate the efficacy of colour Doppler ultrasound and two-dimensional ultrasound of monitoring patients with cervical cancer.

Colour Doppler ultrasound (Experimental group) and two-dimensional ultrasound (Control group) are used to monitor cervical cancer and assess the treatment effects. PFS, CI, HR, DCR, ORR, PR, SD, PD, ROD, sensitivity, and specificity, accuracy between the two groups were collected and analyzed.

A total of 50 patients are included in this study, and the results show that PFS (Experimental group (EG) 5.8±2.2 versus Control group (CG) 6.1±2.6), CI (EG 20% versus CG 16%), HR (EG0.31±0.18 versus CG 0.36±0.21), DCR (EG 80% versus CG 84%), ORR(EG 28% versus CG 36%), PR (EG 16% versus CG 20%), SD (EG 48% versus CG 56%), PD (EG 12% versus CG 16%) (EG 12% versus CG 16%), ROD(EG 44% versus CG 52%) between the two groups are >0.05, and the values of sensitivity (EG 75.6% versus CG 40.2%), specificity (EG 78.4% versus CG 43.3%), and accuracy(EG 80.5% versus CG 41.4%) between the two groups are<0.05.

Both Colour Doppler ultrasound and two-dimensional ultrasound are effective methods to evaluate the efficacy of concurrent chemo-radiotherapy in patients with cervical cancer.

Wire localisation techniques are used widely for precision surgery in many specialities. This convenient technique has not yet become mainstream in the field of head and neck surgery. With limited space and many vital structures coursing through the head and neck region, pathological nodes that are difficult to palpate can be a challenge for clinicians.

A patient with a history of papillary thyroid cancer treated with surgery and radioactive iodine had a single pathological node detected on ultrasound surveillance. An isolated recurrence of papillary thyroid carcinoma was confirmed. An excisional biopsy was performed using ultrasound wire guidance to successfully remove the diseased node with minimal morbidity.

Wire-guided lymph node excision biopsy is a safe and effective method that can be applied to multiple pathologies. As of yet, it is not routine practice to employ this technique. Larger studies would increase the generalisability and safety profile of this technique in the head and neck region.

The current article presents a clinical case of ultrasound controlled transthoracic tru-cut needle biopsy of a small metastatic lesion in the left lung, performed with contrast-enhanced ultrasonography (CEUS). The following case demonstrates a real-time interventional manipulation of a very small lesion, which was done under local anesthesia, with a minimal invasion to the patient.

A 72-year-old woman is presented, hospitalized for a left-sided pleural effusion with bilateral, multiple nodulеs of different sizes in the lungs. Thoracentesis revealed data for atypical cells in the pleural fluid. The CT scan suspected a probable neoplastic process, but the subsequently performed fiberbronchoscopy couldn’t prove the existence of the same. The final diagnosis was established after ultrasound controlled transthoracic tru-cut needle biopsy of a pulmonary lesion with the application of a contrast medium.

The CEUS allows precise detection of the metastatic area because of its unique perfusion characteristics and ability to remain hypocontrasted after the application of the contrast medium sulfur hexafluoride. The persistence of a concomitant left-sided pleural effusion is used as an ultrasound window during the performance of the manipulation, with the successful verification of the pathology as primary pulmonary adenocarcinoma. By the application of this minimally invasive manipulation, an accurate final histological result was obtained.