Objective. To demonstrate, using clinical cases, the diagnostic value and the role of ultrasound in assessing metastatic involvement of superficial regional lymph nodes (LN) in patients with cutaneous melanoma.

Materials and Methods. Two clinical cases of patients with cutaneous melanoma and regional lymph nodes metastatic involvement are presented. Results of superficial lymph nodes ultrasound were compared with data of radiological methods (contrast-enhanced CT  and SPECT) and verified by histopathological examination of surgical specimens.

Results and Discussion. Case No.1 demonstrates the classic ultrasound features of lymph-node malignancy: a polycyclic outer contour, loss of corticomedullary differentiation, and a peripheral type of vascularization. In contrast, Case No. 2 shows poor ultrasound features: a rounded LN shape, focal cortical thickening, and hypoechoic areas with a few vascular loci, which are also indicative of secondary involvement.

Conclusion. Ultrasound allows to suspect the  secondary metastatic lymph nodes changes by the detection of a set of relevant signs in melanoma patients. It may be used as a first-line diagnostic modality to guide further diagnostic workup and treatment planning in patients with cutaneous melanoma.

Clinically significant fetal and neonatal arrhythmias occur in approximately 1 in 4,000 newborns and represent an important cause of morbidity and mortality. The most common arrhythmia is supraventricular tachycardia (SVT), which accounts for 70–75% of fetal cardiac rhythm disorders.

Objective. To compare cardiac contractile function and the hemodynamic state of fetuses with SVT that developed before 27.6 weeks of gestation versus SVT manifesting at 28–40 weeks of gestation.

Materials and Methods. The study was conducted from 2020 to 2024 and included 90 fetuses with the sustained form of SVT: 31 fetuses developed SVT before 27.6 weeks, and 59 fetuses presented with SVT after 28 weeks. The obtained findings were compared with corresponding parameters in control groups of 37 and 68 fetuses without cardiac rhythm disturbances at 20–27.6 weeks and 28–40 weeks of gestation, respectively.

Fetal cardiac contractile function was assessed using M-mode, the Fetal HQ program, Simpson’s method, and pulsed-wave Doppler evaluation of semilunar valve flow parameters. The overall fetal hemodynamic status was evaluated according to the cardiovascular profile score (J.C. Huhta, 2005; C.B. Falkensammer, J.C. Huhta, 2001).

Results. The study revealed distinct features of fetal cardiac function during the supraventricular tachyarrhythmia at different gestational ages. Across all gestational periods, SVT led to reduced transverse and longitudinal myocardial contractility; however, cardiac dysfunction was more pronounced when SVT developed before 27.6 weeks compared to onset after 28 weeks.

Before 27.6 weeks of gestation, left ventricular (LV) function was more significantly impaired, with marked reductions in both systolic and diastolic function, whereas after 28 weeks LV contractile alterations were minimal. In the right ventricle, before 27.6 weeks, diastolic function is impaired; after 28 weeks, systolic function is more significantly reduced.

Cardiac remodeling associated with SVT results in increase of  atrial and central venous pressures, impaired hepatic venous outflow, development of hepatic congestion, heart failure, and progression to non-immune hydrops fetalis. The degree and  severity of hydrops was significantly greater in fetuses with SVT onset before 27.6 weeks compared with those affected at 28–40 weeks of gestation (p < 0.001).

Conclusions. Fetal SVT at any gestational age leads to a reduction in myocardial contractile function; however, the earlier in gestation supraventricular tachycardia develops, the more severe the manifestations of cardiac failure. 

Preeclampsia is a severe obstetric complication that leads to adverse pregnancy and delivery outcomes. Existing multifactorial models make it possible to identify high-risk groups for the development of preeclampsia, but the task of improving prediction accuracy remains relevant. Therefore, the search for additional predictors of preeclampsia continues.

Objective. To identify specific features of Doppler indices of blood flow in the interlobar renal arteries and ophthalmic arteries in pregnant women over time (at 11–14 and 19–21 weeks of gestation) in groups with low and high risk of developing preeclampsia, as calculated using the Astraia software.

Materials and Methods. Ultrasound examinations of the maternal ophthalmic and renal arteries were performed during prenatal screening at 11–14 and 19–21 weeks of pregnancy. Next, we compared flow velocity parameters, resistance index, pulsatility index, and the ratio of peak systolic velocities in the ophthalmic arteries, as well as the resistance index in the renal arteries, over time in patients with low and high individual combined risk of preeclampsia.

Results. In the high-risk group, a decrease in blood flow resistance in the ophthalmic artery was observed. In the low-risk group, there was an increase in the resistance index in the renal arteries, an increase in peak systolic velocity in the ophthalmic artery, an increase in the DV/P2 ratio, and a decrease in PR.

Conclusions. In the low-risk group, blood flow parameters changed as pregnancy progressed, probably due to cardiovascular adaptive mechanisms. In the high-risk group, physiological changes in blood flow during pregnancy were nearly absent.  

Twin-to-twin transfusion syndrome (TTTS) Stage V is a severe complication of monochorionic multiple pregnancy associated with a high risk of severe anemia in the surviving co-twing, cerebral hemorrhage or ischemic stroke and fast intrauterine fetal death of this co-twin.

A 27-year-old pregnant patient D., admitted with the diagnosis: second pregnancy, 21 weeks 1 day, TTTS Stage V (intrauterine death of the hydropic donor twin), underwent ultrasound evaluation of the surviving fetus, which demonstrated signs of severe anemia (peak systolic velocity in the middle cerebral artery [MCA-PSV] 1.77 MoM), hydrops, and absent end-diastolic flow in the umbilical artery). The first step was amnioreduction of 2500 ml, followed by fetal transfusion of 20 ml.. Fetal hemoglobin levels were  normalized (45–134 g/L, 0.39–1.17 MoM), and hemodynamics  was stabilized. Despite this, the fetus developed persistent anuria for 48 hours, and hemorrhagic central nervous system injury was diagnosed. The pregnancy was terminated for medical reasons. All abnormalities were confirmed morphologically, and karyotypic discordance between the twins was identified.

The clinical case demonstrates that Doppler assessment of fetal MCA-PSV allows reliable detection of anemia in TTTS, highlights the significant compensatory capacity of the fetal cardiovascular system that may permit successful treatment of severe anemia even under critical hemodynamic conditions, and emphasizes the importance of comprehensive morphological and genetic evaluation following an adverse pregnancy outcome to ensure correct interpretation of obstetric management decisions. 

Objective. To assess hemodynamic parameters in the extra- and intracranial segments of the brachiocephalic arteries (BCA) in patients with metabolic syndrome (MS) using duplex ultrasonography.

Materials and Methods. The study included 82 patients, of whom 62 had MS and 20 were practically healthy controls. All patients underwent duplex ultrasonography of the extra- and intracranial segments of the BCA with evaluation of qualitative and quantitative parameters: intima–media complex (CIM) in the bifurcation of the brachiocephalic trunk, in the common carotid arteries (CCA), and in the vertebral arteries (VA), as well as quantitative blood-flow parameters in the CCA, internal carotid arteries (ICA), VA, and middle cerebral arteries (MCA). All patients also underwent biochemical blood testing.

Results. Patients with MS demonstrated a statistically significant increase in peripheral resistance indices in the ICA (left ICA pulsatility index (PI), p = 0.05) and in the MCA/ICA resistance index ratio on the left side compared with controls (p = 0.026). No statistically significant differences in linear or volumetric blood-flow velocities were found in the studied  arteries. Significant correlations were found between quantitative blood-flow parameters and MS components based on Pearson’s linear correlation coefficients: the end-diastolic velocity in the left ICA correlated with low-density lipoproteins (LDL), total cholesterol (TC), atherogenic index, and both absolute and relative glucose dynamics in the oral glucose tolerance test; PI of the left ICA correlated with the CARO index; PI of the right VA correlated with LDL and TC; the MCA/ICA PI ratio on the left side correlated with LDL, high-density lipoproteins, TC, triglycerides, and the triglyceride–glucose index; as well as with fasting insulin, HOMA-IR index, and CARO index. Pearson correlation coefficients ranged from −0.41 to 0.24 at p < 0.05.

Conclusion. Comprehensive ultrasound evaluation of hemodynamics in the extra- and intracranial segments of the BCA in patients with MS allows detection of blood-flow alterations associated with structural remodeling of the vascular wall induced by the negative impact of multiple metabolic factors.

Groin pain in athletes remains one of the most challenging and controversial issues in modern sports medicine. Behind the apparent simplicity of clinical manifestations lies a wide spectrum of pathological conditions requiring thorough differential diagnostic analysis. Diagnostic errors often lead to the chronicity of the condition, reduced athletic performance, and prolonged rehabilitation periods. This review is dedicated to the systematization and critical assessment of current perspectives on the terminology, classification, anatomy, and clinical presentation of groin pain in athletes. Particular attention is paid to the issues of medical imaging and the capabilities of ultrasound as a primary and dynamic method for assessing the state of the groin region in athletes.

Calcium pyrophosphate deposition disease (CPPD) is one of the most common inflammatory arthropathies. It is characterized by the deposition of calcium pyrophosphate dihydrate (CPPD) crystals within joints and periarticular tissues. In routine clinical practice, imaging plays a central role in the diagnosis of CPPD. In recent years, ultrasound has emerged as a leading modality for early detection of crystal deposits across various anatomical regions, for monitoring disease progression, and for guiding aspiration procedures. The article presents a pictorial literature review highlighting the role of ultrasound in the diagnosis of calcium pyrophosphate deposition disease. Based on current clinical recommendations, the main ultrasound features of CPPD are described (detection of calcium pyrophosphate deposits in fibrous and hyaline cartilage, tendons, joint capsule, and intra-articular contents) allowing for correct interpretation of findings for timely diagnosis, differential diagnosis, and dynamical assessment during therapy.