Phased-array real-time transcranial ultrasound with a 2.5-MHz transducer was used to examine 23 normal adult volunteers and patients, and 8 selected patients with abnormalities proven by computed tomography. Normal cerebral landmarks were consistently seen and pulsed Doppler signals were often obtainable from central cerebral arteries. Dilated lateral ventricles, subdural hygromas, or cerebral masses were identified in 6 of the 8 patients. In the 2 others abnormal cases, known suprasellar aneurysms were missed. While current technology will not provide accurate screening for cerebral abnormalities, ultrasound imaging may often be adequate for follow-up examinations and for midline evaluation, and may provide simplified preoperative localization of some brain lesions. Doppler ultrasound examinations may be used for intracranial vessel hemodynamic evaluation.

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The computed tomographic (CT) appearance, angiographic appearance, and clinical features of a patient with cervical Castleman disease, an uncommon disease of benign lymph node hyperplasia, are reported. CT scans showed a densely enhancing cervical mass. On external carotid angiography, the mass was seen as hypervascular with a capillary blush. Differential diagnosis included carotid body chemodectoma, vagal neuroma, tumor of the salivary gland, tuberculous adenitis and other granulomatous diseases, inflammatory lymph nodes, metastatic disease, and lymphoma.

Aims Multiple guidelines exist for the management of aortic stenosis (AS). We systematically reviewed current guidelines and recommendations, developed by national or international medical organizations, on management of AS to aid clinical decision making. Methods and results Publications in MEDLINE and EMBASE between June 1st, 2010 and January 15th, 2021 were identified. Additionally, the International Guideline Library, National Guideline Clearinghouse, National Library for Health Guidelines Finder, Canadian Medical Association Clinical Practice Guidelines Infobase, and websites of relevant organizations were searched. Two reviewers independently screened titles and abstracts. Two reviewers assessed rigor of guideline development and extracted the recommendations. Of the 7 guidelines and recommendations retrieved, 5 showed considerable rigor of development. Those rigorously developed, agreed on the definition of severe AS and diverse hemodynamic phenotypes, indications and contraindications for intervention in symptomatic severe AS, surveillance intervals in asymptomatic severe AS, and the importance of multidisciplinary teams (MDT) and shared decision-making. Discrepancies exist in age and surgical risk cut-offs for recommending surgical (SAVR) vs. transcatheter aortic valve implantation (TAVI), the use of biomarkers and complementary multimodality imaging for decision-making in asymptomatic patients and surveillance intervals for non-severe AS. Conclusions Contemporary guidelines for aortic stenosis management agree on the importance of MDT involvement and shared decision-making for individualized treatment and unanimously indicate valve replacement in severe, symptomatic AS. Discrepancies exist in thresholds for age and procedural risk used in choosing between SAVR and TAVI, role of biomarkers and complementary imaging modalities to define AS severity and risk of progression in asymptomatic patients.

A number of guidelines exist with recommendations for diagnosis and management of mitral stenosis (MS). We systematically reviewed existing guidelines for diagnosis and management of MS, highlighting their similarities and differences, in order to guide clinical decision-making. We searched national and international guidelines in MEDLINE and EMBASE (5/4/2011 - 5/9/2021), the Guidelines International Network International, Guideline Library, National Guideline Clearinghouse, National Library for Health Guidelines Finder, Canadian Medical Association Clinical Practice Guidelines Infobase, and Web sites of relevant organizations. Two independent reviewers screened titles and abstracts, and full-text of potentially relevant articles where needed. Selected guidelines were assessed for rigor of development; only guidelines with Appraisal of Guidelines for Research and Evaluation II (AGREE II) instrument score >50% were included in the final analysis. Four guidelines were retained for analysis. There was consensus for percutaneous mitral balloon commissurotomy (PMBC) as first-line treatment of symptomatic severe rheumatic MS with suitable anatomy. In patients with unfavourable anatomy, surgical intervention should be considered. Exercise testing is indicated if discrepancy exists between symptoms and echocardiographic measurements. There was no clear divide between rheumatic MS and degenerative MS for their respective diagnoses and management. Pregnancy in severe MS is discouraged and the stenosis should be treated before conception. Long-term antibiotic prophylaxis is recommended for patients with rheumatic MS. Recommendations for the management of patients with mixed valvular diseases are lacking.