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Duplex ultrasonography Distal brachiocephalic trunk and proximal right subclavian artery, common, internal and external carotid arteries, vertebral arteries are defined on both sides. In a typical evaluation sections of the common carotid artery intima- media thickness is not thickened (0.6-0.7 mm), at all evaluated areas preserved layer differentiation. In the bifurcations of both common carotid arteries indicated the areas of improving the echogenicity of the intima with the loss of layer differentiation and a thickening of the intima-media thickness up to 1.3 mm. Areas of increasing echogenicity of the intima with the loss of layer differentiation and a thickening of the intima-media thickness up to 1.3 mm are marked at the bifurcations of both common carotid arteries. Intraluminal mass, causing reduction of the lumen more than 20%, are not detected. The geometry of the right subclavian, common arteries tract is normal. The right internal carotid artery has a corner bend before entering the cranium, the left internal carotid artery has an S-shaped deformity of the distal aspect. Deformation increasing the flow rate is not fixed. The diameter of the right vertebral artery is 2 mm, the left vertebral artery is 3.8 mm. Groove for vertebral artery is with vascular permeability (in the b- mode rendered at high quality). The track of both vertebral arteries in the transverse processes channels of the cervical vertebrae and over the grooves are irregular. The flow velocity in the vertebral artery is at a sufficient level (asymmetry measure time-averaged maximum flow velocity does not exceed 40%), peripheral vascular resistance is normal. In V4 intracranial segments the blood flow velocity is with the same asymmetry, as in extracranial departments. Intracranial: The quality of transtemporal imaging is satisfactory. Revealed fragments of both distal ICA, A1 segments of both anterior cerebral arteries, M1-M2 segments of both middle cerebral arteries, P1-P2 segments of both posterior cerebral arteries. The direction of blood flow in these arteries in the base of the brain normal, signs of collateralization are not revealed. Blood flow velocity and peripheral resistance in the arteries of the base of the brain are symmetrical on the sides (In the MCA of 120 cm/s, in PMA - 95 cm/s, in PCA - 55 cm/s). Blood flow velocity and peripheral resistance level of the basilar artery are normal. Conclusion: Echosonographic signs of atherosclerosis with localization in the extracranial part brachiocephalic arteries and signs of deformation of both the ICA (presumably as a manifestation of the emerging hypertensive polymacroangiopathy). Variant of the development with a small diameter right vertebral artery, hemodynamic predominance of the left vertebral artery. The deficit of cerebral blood flow in the vertebrobasilar system is not revealed. Ultrasonography of Kydney. Kidneys are usually located, symmetrical in size. Right kidney 104х48х45 mm, left kidney 100х48х43 mm). The thickness of parenchyma is 15-17 mm. Cortico-medullary differentiation is expressed. Accessory mass are not revealed. Pyelocaliceal system and ureters are not dilated. Accessory mass are not revealed in paranephral cellular tissue and in the projection of the typical anatomical location of the adrenal glands.
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