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Background Ultrasonography (US) is highly dependent on operators’ skills. It is not only a matter of correct scan techniques; there are anatomical structures and variants, as well as artifacts, which can produce images difficult to interpret and which, if not properly understood, can be causes of errors. Objectives This paper will review relatively common US pitfalls and artifacts that can be encountered in trauma patients and will offer tips to recognize and avoid them. Discussion Normal anatomical structures and anatomical variants can mimic fluid collections or perisplenic lesions. Examination along multiple scan planes, real-time observation of movements or repetition of the study after the patient has drunk some fluid or after placing a finger on her/his body wall can help proper identification. The term artifact in US imaging refers to display phenomena not properly representing the imaged structures. This can result in images suggesting fracture lines within organs or at their borders, lung consolidations, or pleural effusions, and abdominal fluid collections. Their knowledge is the first step to recognize them; then, use of multiple scan planes or repetition of the study after voiding or changes of equipment setting can make them disappear or clarify their nature. Conclusion We present possible anatomic pitfalls and artifacts that may affect correct interpretation of US images in patients with abdominal trauma and suggest how to avoid or to clarify them during the examination. Knowing their existence, their appearances, and the reasons why they are produced is important for proper use of this diagnostic technique.

Acute scrotum is characterized by intense acute scrotal pain, which may be associated with other symptoms and signs such as abdominal pain, inflammation, and fever. Many pathologic conditions can present in this way, most which involve the scrotal contents. Nonscrotal conditions, however, can rarely present clinically only as acute scrotum: among them, renal colic, aneurysm rupture or other causes of retroperitoneal hemorrhage, primary abdominal or pelvic tumors and metastases, pancreatitis, pelvic inflammation, and muscle injuries. The pathophysiologic characteristics of the clinical presentation, clues for diagnosis, and imaging features of a series of nonscrotal lesions presenting clinically with acute scrotal pain are herein reported and illustrated. In patients presenting with acute scrotal symptoms and normal scrotal ultrasound findings, nonscrotal causes of acute scrotal pain should be considered in the differential diagnosis. Therefore, an ultrasound investigation of the abdomen, groin, and thighs is indicated.

Contrast-enhanced ultrasound (CEUS) represents one of the most interesting and promising examples of imaging application in clinical practice. Ultrasound contrast media are defined as “blood pool” agents because they remain confined into blood vessels without reaching the excretory tract. They are classified into first and second generation depending on the gas in microbubbles. When the ultrasound beam hits microbubbles in the blood flow, their compressible gas cores oscillate in response to the high-frequency sonic energy field. The microbubbles reflect a unique echo that stands in stark contrast to the surrounding tissue due to the orders of magnitude mismatch between microbubble and tissue echogenicity. Both contrast generations are characterised by an excellent safety profile, with rare hepatic and central nervous system side effects and absent nephrotoxicity thanks to their predominant pulmonary clearance. The clinical utility of CEUS, which is widely recognised in the study of liver diseases, is also becoming relevant to the pathology of other organs, such as genitourinary system, gastrointestinal tract, peripheral vascular system, spleen and lymph nodes, and breast, lung, and endocrine and exocrine glands. Possible applications of CEUS in nephrology include renal ischemia, differential diagnosis of cystic and solid lesions, follow-up of ablative therapies, kidney trauma, kidney transplant, inflammatory diseases, renal artery stenosis, and vesicoureteral reflux.

According to international guidelines, native arteriovenous fistula (AVF) is the preferred vascular access for hemodialysis. Evaluation and choice of blood vessels suitable for AVF creation have been carried out for decades exclusively through the physical examination of the upper limbs. However, it provides useful information exclusively on the superficial venous system, whereas arterial system can be examined only through the palpation of the arterial pulses and the patency of the palmar arch with the Allen test. The use of Doppler ultrasound (DUS) has increased the number of patients that are eligible for AVF. It allows an accurate measurement of arterial and venous diameters and the capacity of the feeding artery to dilate, therefore optimizing the search for vessels suitable for surgical intervention (preoperative vascular mapping). Furthermore, color Doppler imaging (CDI) has improved the survival of native AVF by increasing the early diagnosis of complications (postoperative surveillance). Access flow assessment in the feeding artery (usually the brachial) by DUS is a well-known predictor of vascular access outcomes. Vessel diameter measurement could also be useful to detect and follow venous stenosis, which represents one of the main causes of AVF failure. CDI is the only imaging technique able to provide both morphological and functional information about native vascular access and it is the only tool directly available to the nephrologist.

There is a broad spectrum of pathologies, both focal and systemic, chronically damaging the kidneys in many ways.

Acute renal failure (ARF) is characterized by a rapid reduction in glomerular filtration rate with secondary retention of slag (hyperazotemia, hypercreatininemia, alteration of the electrolyte balance, acidosis) due to organic or functional causes.

Erectile dysfunction (ED) is defined as the persistent inability to achieve and/or maintain an erection for a satisfactory sexual activity. It is secondary to several organic, psychogenic, and combined causes, and represents a serious health dilemma affecting both men and their partners. The diagnostic approach to erectile dysfunction has significantly changed in the last years with the advent of phosphodiesterase-5 (PDE5) inhibitors, and with the recognition that surgical treatment of both arterial insufficiency and penile venous leak have poor long-term clinical outcomes. Although imaging modalities have diminished in importance, differentiating among causes of erectile dysfunction remains mandatory in good medical practice, and ultrasound (US) still remains the cornerstone of the diagnostic workup. US provides an objective, minimally invasive evaluation of penile hemodynamics. Moreover, it provides an excellent depiction of the penile anatomy and of its changes in pathological conditions such as in patients with Peyronie’s disease, priapism, and posttraumatic erectile dysfunction.

Gray scale ultrasound has an important diagnostic role in native kidney disease. Low cost, absence of ionizing radiation and nephrotoxicity, short performance time, and repeatability even at the bedside, are the major advantages of this technique. The introduction of contrast enhancement ultrasound (CEUS) in daily clinical practice has significantly reduced the use of contrast enhancement computed tomography (CECT) and contrast enhancement magnetic resonance (CEMR), especially in patients with renal disease. Although there are many situations in which CECT and CEMRI are primarily indicated, their use may be limited by the administration of the contrast medium, which may involve a risk of renal function impairment, especially in the elderly, and in patients with acute kidney injury (AKI) and moderate to severe chronic kidney disease (CKD). In these cases, CEUS can be a valid diagnostic choice. To date, numerous publications have highlighted the role of CEUS in the study of parenchymal micro-vascularization and renal pathology by full integration with second level imaging methods (CECT and CEMRI) both in patients with normal renal function and with diseased kidneys. The aim of this review is to offer an updated overview of the limitations and potential applications of CEUS in native kidney disease.

INTRODUCTION AND OBJECTIVES:Testicular cancer represents the most common solid tumors in young men and malignant germ cell tumors constitute the majority of these masses. Orchiectomy is the treatme...

Acute scrotal pain can be due to different causes. Torsion of the spermatic cord must be identified in emergency, as delay in intervention may cause irreversible testicular damage. The commonest cause for acute scrotal pain in adults is bacterial epididymitis, normally managed successfully with antibiotics. Complications arising from severe inflammatory changes such as abscess formation and parenchymal ischemia may be seen. The main role of US in appendiceal torsion is to rule out testicular torsion or epididymo-orchitis. Other causes of acute scrotal pain are segmental testicular infarction and vasculitides. Conditions that arise outside the scrotum, such as renal colic, can present clinically with acute scrotal pain. Grayscale US and conventional Doppler modes are the methods of choice for patients with the clinical presentation of acute scrotal pain. CEUS and elastographic modes can have a role in selected cases.

Introduction. High-flow priapism is a rare condition in children, usually due to a perineal trauma. Materials and methods. We present a case of traumatic highflow priapism investigated by Doppler ultrasound and managed by angiography and selective embolization of a branch of the internal pudendal artery. Results. A 13-year-old gymnast underwent perineal trauma during training and developed a high-flow priapism. The first ultrasound (immediately after the trauma) showed the presence of an inhomogeneous area of 3 x 2 cm associated with an anechoic vascularized area (pseudoaneurysm) in the right corpus cavernosum. On the left side there was a similar finding, but of smaller size. After 3 weeks the pseudoaneurysm on the left was completely obliterated while the right one was still present. Angiography and superselective catheterization of a branch of the left pudendal artery and its embolization with microspheres and with metal microcoils were performed. After the procedure, ultrasound showed that the right pseudoaneurysm was completely obliterated and there were no more branches reaching it. The cavernous arteries were both pervious. Conclusions. Selective arterial embolization is a safe treatment that can also be used in pediatric patients.