Primary tumors of the heart are rarely seen. Cardiac angiosarcomas are malignant tumors that almost always have a poor prognosis. Atrium rupture and coronary artery fistula are very rare complications of primary cardiac angiosarcoma. We describe a 57-year-old man suffering from primary cardiac angiosarcoma with spontaneous ruptures of the right atrium and right coronary artery (RCA). Theoretically, either of these ruptures invariably results in pericardial effusion and tamponade that is rare but potentially life threatening. In this instance, however, the patient might have developed fibrous adhesions resulted from previous bloody pericardial effusion. A massive pericardial effusion was localized, which consequently prevented cardiac tamponade and hemodynamic collapse. Echocardiography revealed the tumor progression leading to detectable infiltration of solid mass into the right atrial (RA) wall, which is close to RCA. And color Doppler displayed the flow into the pericardial cavity through a disrupted RA wall and perforated RCA. Echocardiography remains the primary method of choice for evaluation of cardiac masses.

Ovarian hyperstimulation syndrome (OHSS) is a common complication of assisted reproductive technology, caused by the excessive response of the ovaries to gonadotropins during the ovulation induction process. The clinical manifestations of OHSS include abdominal distension, abdominal pain, nausea, vomiting, etc. In severe cases, it can lead to life-threatening symptoms such as ovarian rupture, ascites, and pleural effusion. Ultrasound examination, as an important auxiliary diagnostic tool, can help doctors monitor the size of the ovaries, the number and morphology of follicles, and predict and diagnose the occurrence of OHSS. In terms of treatment, ultrasound-guided puncture and fluid drainage is an effective method to alleviate the symptoms of OHSS. This article reviews the application of ultrasound technology in the prediction, diagnosis, and treatment of OHSS, aiming to provide a more accurate and effective diagnostic and treatment strategy for clinical practice. Through in-depth research, it will help doctors better understand the pathophysiology of OHSS, formulate personalized treatment plans, improve treatment outcomes, and reduce the pain and economic burden on patients.

Background: Acute pancreatitis is a prevalent and severe digestive disease with significant mortality. Early identification of high-risk patients is essential for improving outcomes. The ratio of blood urea nitrogen to albumin (BAR) has emerged as a potential prognostic predictor in various critical illnesses. This study explores the associations between BAR and 28-day and 90-day mortality in acute pancreatitis patients. Methods: This retrospective cohort study enrolled patients diagnosed with acute pancreatitis from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database. BAR was calculated using initial blood urea nitrogen and serum albumin. Patients were categorized into three groups according to the tertiles (T1-T3) of BAR values. Kaplan-Meier survival analysis and restricted cubic spline (RCS) curve assessed the impact of BAR on overall survival. Multivariate Cox regression analysis was used to determine association of BAR with 28-day and 90-day mortality in acute pancreatitis. The receiver operating characteristic (ROC) curve was employed to assess the predictive value of BAR for 28-day and 90-day mortality in acute pancreatitis. Results: In this study, 452 patients with acute pancreatitis were analyzed, with 28-day mortality rate of 11.7% and 90-day mortality rate of 13.7%. Kaplan-Meier survival analysis indicated a notable increase in mortality rates at 28 days and 90 days among patients with elevated BAR levels (Log-rank P < 0.001). Moreover, RCS curve demonstrated a linear and positive relationship between BAR levels and mortality rates at 28 days and 90 days after adjusting all covariates. Multivariate Cox regression analysis identified BAR as an independent risk factor for 28-day and 90-day mortality. Subgroup analysis confirmed a consistent correlation between elevated BAR levels and poor outcomes in acute pancreatitis patients. The area under the curve (AUC) of BAR for predicting 28-day and 90-day mortality was 0.802 and 0.798 respectively, both performing comparably to the Simplified Acute Physiology Score II (SAPS II). Conclusion: Higher BAR values were significantly associated with increased 28-day and 90-day mortality in acute pancreatitis patients. Moreover, BAR may serve as a simple and effective tool for identifying higher death risk of patients with acute pancreatitis.

Axillary lymph node management in early-stage breast cancer has undergone a fundamental transformation over the past three decades, shifting from routine radical clearance to precision-guided de-escalation. Ultrasound (US) has emerged as the central imaging modality in this paradigm shift, serving as the first-line tool for preoperative nodal assessment, guidance for biopsy and clip placement, monitoring of response to neoadjuvant chemotherapy (NAC), and localization of marked nodes for targeted axillary dissection (TAD). This review systematically examines the evolution of axillary management in early-stage breast cancer through a US-centric lens. We summarize the historical transition from Halstedian axillary lymph node dissection (ALND) to sentinel lymph node biopsy (SLNB), critically appraise the landmark trials—Z0011, AMAROS, OTOASOR, and SOUND—that have progressively de-escalated axillary surgery, and detail the role of US in preoperative staging (including conventional B-mode, superb microvascular imaging, contrast-enhanced US, elastography, and AI-assisted diagnostics), US-guided biopsy and node marking, and post-NAC TAD. We further explore the integration of US with liquid biopsy, multigene profiling, and molecular subtype-guided systemic therapy to enable individualized decision-making. Finally, we propose a stepwise US-centric clinical algorithm and discuss future directions, including AI-powered real-time interpretation, imaging-omics, and US-guided targeted therapy. This review provides a comprehensive framework for incorporating ultrasound as a key component of multidisciplinary decision-making—alongside pathological, surgical, radiotherapeutic, and molecular inputs—in contemporary axillary management.