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A woman in her 20s fell down during cheerleading practice and she was referred to our neurosurgical outpatient clinic the next day due to persistent headache, neck pain, and dizziness. Neurological examination showed left upper limb paresis. MRI revealed a remarkably dilated flow void along the dural sac on the left side between C2 and C3 levels. Cerebral angiography confirmed a shunt from the left vertebral artery to the vein. Preoperative ultrasonography showed that the diameter of the left vertebral artery was markedly dilated to 10mm, and the blood flow volume between the cervical vertebrae was 1,873ml/min. Retrograde flow was detected in the distal part of the left vertebral artery using the foramen magnum approach. The patient underwent coil embolization of the left vertebral arteriovenous fistula and the shunt blood flow was significantly reduced. Ultrasonography performed the day after embolization revealed the blood flow volume of 748ml/min, and the retrograde flow in the left vertebral artery remained. On the seventh postoperative day, the blood flow volume was 135ml/min, and the peripheral left vertebral artery had changed to antegrade flow. On the 90th postoperative day, the blood flow volume was 95ml/min, and vertebral angiography at the same time showed that shunt blood flow had disappeared. Vascular ultrasound was useful in the preoperative evaluation and follow-up of vertebrobasilar arteriovenous fistula. [ABSTRACT FROM AUTHOR]

We report a suspected case of fungal mass in the right internal jugular vein. A 70-year-old man was admitted to our hospital with heart failure. He had a persistent fever and the inflammatory response increased. Serum β-Dglucan level was elevated, and Candida albicans was identified from blood culture. He was diagnosed with a fungal infection. A central venous catheter had been inserted into the right internal jugular vein for 3weeks. The ultrasonography showed a full mass image of 6 × 5mm which was attached to a string-like organizing thrombus of approximately 25mm long in the right internal jugular vein. The echogram presented a spherical and smooth outline, and slightly heterogeneous inside of the mass with scattered vesicular structures. We attempted to retrieve a foreign body using a catheter under ultrasound guidance. However, it cannot be detached from the vessel wall. Next, surgical resection was planned under intraoperative ultrasound examination, however, the surgical procedure was not performed because his general condition deteriorated. Fortunately, the level of β-Dglucan decreased after administration of amphotericin B and the foreign body, suspected fungal mass, became smaller on ultrasonography. We experienced a suspected patient with a fungal mass in the right internal jugular vein. Ultrasonography was useful in diagnosis, treatment or follow-up. [ABSTRACT FROM AUTHOR]