Confounding factors in ultrasound elastography are of great importance in the results interpretation in the liver fibrosis assessment. The consideration of these factors is necessary also in performing of ultrasound elastometry for other purposes (for example, in prediction of cardiac events in patients with right heart failure, monitoring patients with hepatic sinusoidal obstruction syndrome, monitoring short-term and long-term results of angioplasty in Budd-Chiari syndrome patients). Confounding factors are related to the methodology of examination, ultrasound equipment, artifacts, individual clinical condition and external influences. Many of them are equal for any of methods of shear wave elastography. The presence of confounding factors influencing the results of elastometry should be described in the ultrasound report and considered in the conclusion, up to an indication that interpretation of the results is impossible.

The article presents a rare case of fibular hemimelia. Fibular hemimelia is a congenital abnormality of the lower extremity, characterized by the complete absence or hypoplasia of the fibula. Ultrasound was performed in 23-year-old pregnant women at 20 weeks 6 days of gestation as a part of second trimester screening with the use of ultrasound scanner H60 (Samsung, Korea) with a 4-8 MHz convex probe. During the evaluation of the left lower extremity, the following pathological signs were revealed: absence of the fibula, shortening of the tibia, shortening and abnormal foot position. Left tibia and left foot lengths were below the 3rd percentile for 20 weeks of gestation. There were no contralateral pathological findings. The length difference of tibias was 5 mm. The length of ulna was below the 3rd percentile for 20 weeks of gestation on both forearms. The patient decided to terminate the pregnancy. Fetal autopsy report confirmed the ultrasound findings: agenesia of the left fibula, hypoplasia of the left tibia, valgus deformity of the left foot.

Objective: to analyze the vortex flows in different types of left ventricular (LV) twist in systole in children aged from one to five years old, born prematurely with low, very low, and extremely low birth weight. Material and methods: echocardiography was performed in 25 children aged from one to five years, born with low, very low, and extremely low body weight, with the use of Vivid E95 (GE Healthcare, USA) on the standard protocol. Additionally, the types of LV twist were assessed with 2D speckle tracking imaging, and the flow related component (type of vortex flow at the end of diastole and in period of isometric contraction) with blood speckle imaging. Results: the first type (adult type) of LV twist were found in 11 of 25 children (44%), the second type (children’s type) - in 4 (16%), the third type (variant of children’s type) - in 4 (16%), and the fourth type (reverse type or negative apical rotation) - in 6 (24%). The first type (n = 11) characterized by a dominant apex directional flow along the posterior wall of the LV at the end of diastole, following by movement along the interventricular septum (IVS) towards the aorta. During the period of isometric contraction, the blood flow consists of two vortex flows, one at the apex and the other at the level of the papillary muscles. In the second and third types (n = 8) the vortex flow at the end of diastole is directed towards the apical segment of the IVS, where it turns towards the posterior wall of the LV up to the level of the posteromedial papillary muscle, and then moves towards the aorta. During the period of isometric contraction, in the second type of LV twist (n = 4), the vortex flow is directed from the posterior wall towards the IVS, the second flow at the level of papillary muscles is absent. During the same period in the third type (n = 4), the dominant vortex flow arises at the level of the papillary muscles in the direction of the IVS, then moves toward the apex, forming a curl at the level of the apical segment of LV posterior wall. In the fourth type of LV twist (n = 6) there was a multidirectional vortex flow (firework-like) at the end of diastole, with no dominant vortex. In the period of isometric contraction, only one vortex flow was observed, propagating at the level of the apex, papillary muscles, and partially basal segments. Conclusion: the arising of various types of vortex flows in children aged from one to five years, born with low, very low, and extremely low birth weight, is an integral part of the process of the child’s heart postnatal ontogenesis in case preterm birth anamnesis.

Baker cysts are the most common pathological finding in posterior knee ultrasound. The aspects of etiology, epidemiology, pathogenesis, clinical presentation, and treatment of Baker cysts are discussed in the literature review, with particular attention paid to the diagnosis. Baker cyst has a very variable ultrasound appearance. It is necessary to assess at longitudinal and transverse planes the contours of cyst’s walls (regularity, continuity, dissection, rupture), walls structure (the presence of synovial hypertrophy with villi thickening or parietal growths, septations), presence of intraarticular bodies (chondral, osteochondral, calcifications). Color Doppler imaging may be used to assess vascularity. Possible complications of long-existing Baker cysts include dissection of inferior part of the cyst capsule, without complete rupture; rupture of the cyst capsule in the inferior part with fluid outflow to the interfacial (intermuscular) space of the posterior calf and subcutaneous fat of the calf.

Objective: to evaluate the results of spontaneous soft-tissue hematomas ultrasound detection in COVID-19 patients. Material and methods: a retrospective analysis of 7,117 case reports of COVID-19 patients (3,130 (44.0%) male and 3,987 (56.0%) female) treated in the Central Clinical Hospital Russian Railways Medicine (Moscow) during the period from 01.10.2020 to 11.02.2021 and from 12.06.2021 to 16.08.2021 was carried out. The mean age of patients was 67.5 ± 14.9 years (20.0-100.0) (hereinafter: M ± SD (Min-Max)). The diagnosis COVID-19, virus identified (U07.1) established in 4,931 (69.3%) patients, COVID-19, virus not identified (U07.2) in 2,186 (30.7%) patients. Average hospital stay was 9.5 ± 4.5 days (1.0-40.0). The mortality was 699 (9.8%). Results: hemorrhagic complications were found in 119 of 7,117 (1.7%) patients, including hemorrhagic stroke in 2 (1.7%), nosebleeds in 3 (2.5%), genitourinary bleeding in 10 (8.4%), gastrointestinal tract bleeding in 12 (10.1%), gynecological bleeding in 4 (3.4%), soft-tissue hematomas in 88 (73.9%). The localization of spontaneous soft-tissue hematomas was: upper limbs (17.0%), chest (28.4%), anterior abdominal wall (26.1%), retroperitoneal region (14.8%), lower limbs (13.6 %). The volume of most soft-tissue hematomas (51.1%) was 500-1500 ml. Endovascular treatment was performed in 18 out of 88 (20.5%) cases of hematomas. There were no significant differences in mortality when comparing soft-tissue hematomas of various volume. In conservative treatment of hematomas mortality was 34.3% (24 out of 70), in endovascular treatment - 16.7% (3 out of 18) (P < 0.05). The ultrasound appearance of spontaneous soft-tissue hematomas has been changing during the follow-up period. Conclusion: spontaneous hematomas should be considered as a potential complication of COVID-19, especially in patients with unexplained anemia and abdominal or limb pain, treated with therapeutic doses of anticoagulants. Ultrasound is necessary for detection and follow-up of spontaneous soft-tissue hematomas.