Journal of Clinical Ultrasound最新文献

A 40-year-old woman presented with chronic left anterior shoulder, upper arm, and axillary pain following a routine mammogram 3 years prior. Despite multiple interventions, her pain persisted significantly affecting her quality of life. Ultrasound examination revealed fascicular edema in the medial brachial cutaneous nerve (MBCN), intercostobrachial cutaneous nerve (ICBN), and a positive sono-Tinel. Ultrasound-guided hydrodissection of these nerves provided complete axillary pain relief and significant improvement in anterior arm pain, sustained for 6 months. This case highlights the diagnostic challenges of cutaneous nerve entrapment syndromes, often overlooked and misdiagnosed, especially without a clear inciting injury. Ultrasound proves superior to electrodiagnostic studies in visualizing nerve pathology, particularly in small cutaneous nerves. Incorporating ultrasound into the diagnostic process for nerve entrapments can reduce the need for more expensive tests like magnetic resonance imaging (MRI) with the added benefit of therapeutic intervention. Moreover, routine mammography should be considered a cause for ICBN and MBCN neuropathy, a rare but significant condition. Neuromuscular ultrasound offers distinct advantages in diagnosing and treating such neuropathies, exemplified by the successful management of our patient's condition.

Gossypiboma, or retained surgical sponge, is a rare post-surgical complication with very few reported cases due to medico-legal purposes. Diagnosis is very challenging due to the myriad of clinical presentations and imaging features. We present the case of a gossypiboma detected in a 72-year-old female with a recent history of vaginal hysterectomy. We describe the imaging findings in detail with the step-wise use of X-rays and ultrasound in raising suspicion and computed tomography (CT) and magnetic resonance imaging (MRI) to rule out other differentials and finally come to the diagnosis of gossypiboma, which was confirmed surgically.

Objective: This study aimed to evaluate the association between ophthalmic artery (OA) Doppler indices and adverse neonatal outcomes in women with pregnancies complicated by preeclampsia (PE).

Methods: A prospective cross-sectional study involving 110 pregnant women who were diagnosed with PE in the first 24 h of hospitalization was conducted at three hospitals in southeastern Brazil from April 2020 to December 2022. The ophthalmic parameters analyzed were the resistance index (RI), pulsatility index (PI), first peak systolic velocity (PSV1), second peak systolic velocity (PSV2), ratio of PSV2 to PSV1 (PSV ratio or the peak ratio [PR]), and end-diastolic velocity (EDV). The outcome measures were neonatal death (during hospitalization), neonatal intensive care unit (ICU) admission, gestational age at delivery < 32 weeks, birth weight < 1500 g, birth weight < 10th percentile, the presence of comorbidities associated with prematurity, the use of invasive mechanical ventilation, an Apgar score at the 5th minute < 7.0, and signs of neurological impairment.

Results: Pregnant women with severe features of PE showed higher values of systolic (152.8 ± 20.7 vs. 136.3 ± 11.9, p = 0.000) and diastolic (98.1 ± 12.8 vs. 88.1 ± 10.8, p = 0.000) blood pressure values and lower gestational age at admission (31.5 ± 3.8 vs. 33.7 ± 4.3, p = 0.009) than PE without severe features. No significant differences were found between the mean values of the OA Doppler indices when comparing the presence or absence of neonatal outcomes in the women with PE.

Conclusions: OA Doppler, while valuable for the prediction, diagnosis, and evaluation of adverse maternal outcomes, does not independently predict adverse neonatal outcomes in women with severe features of PE.

Objective: The aim of this study was to compare prenatal ultrasound markers and perinatal outcomes in newborns with simple and complex gastroschisis.

Methods: A retrospective cohort study was performed on pregnant women with gastroschisis fetuses and their respective newborns between 2009 and 2019. Binary logistic regression was used to determine the best prenatal ultrasound markers of complex gastroschisis and adverse perinatal outcomes.

Results: After delivery, 36 gastroschisis were classified as simple and 10 as complex. Newborns with complex gastroschisis had a higher prevalence of early neonatal death compared to newborns with simple gastroschisis (30.0% vs. 2.8%, p = 0.007). The abdominal wall defect diameter became a significant prenatal ultrasound marker of neonatal sepsis [X2: 6.31 (1), OR:0.92, CI 95% (0.85-0.98), p = 0.020]. The presence of complex gastroschisis [X2: 7.33 (1), OR: 23.25, CI 95% 1.92-280.77, p = 0.013] was the only significant predictor of early neonatal death, and the presence of complex gastroschisis increased the risk of early neonatal death by 23.25 times. There was no significant effect of the type of gastroschisis in relation to gestational age, amniotic fluid index, intra-abdominal intestinal dilation, extra-abdominal intestinal dilation, and thickness of the intestine diameter.

Conclusion: Abdominal wall defect diameter was a significant prenatal ultrasound marker of adverse perinatal outcomes in newborns with simple and complex gastroschisis. Complex gastroschisis was a significant predictor of early neonatal death.

Peripheral nerve sheath tumors of the hand are rare occurrences. Among them, schwannomas are benign tumors originating from peripheral nerves. In this case report, we presented a patient with schwannomas in the palm, examined using ultrasound for preoperative assessment and was confirmed by pathological specimen. By highlighting the utility of ultrasound in detecting this condition, we aimed to enrich existing literature and ultimately enhance patient outcomes.

Objectives: Analyze the clinical and ultrasound characteristics of 15 cases of abdominal pregnancy (AP) to improve the ultrasonography-based diagnosis.

Methods: A retrospective research of AP patients from 2010 to 2021 with pathology was performed, clinical and ultrasound characteristics were analyzed and summarized.

Results: Fifteen cases of AP occurred in early pregnancy. Most cases of AP were implanted in the pelvic cavity, with a few on the greater omentum and diaphragm, etc. Eight cases showed mixed hyperechoic, four cases had gestational sacs, and three cases exhibited mixed hypoechoic.

Conclusion: Combined with the characteristics of AP, ultrasound can provide a valuable diagnosis.

Objective: Necrosis, a rare histologic alteration caused by the fine-needle aspiration biopsy (FNA) of thyroid tumors, could be problematic in the clinical management of such cases due to the difficulty in making a definitive histopathologic diagnosis. The aim of this study was to define US features that may help to predict FNA-induced necrosis which is more common in oncocytic tumors.

Materials and methods: This cross-sectional study consists of all patients who underwent thyroid surgery in our center between January 2011 and December 2023. All nodules, which complete/near-complete necrosis reported on final histopathology, were included into study when full video record of preoperative US exam also available for re-evaluation. US findings of necrotic tumors compared with control group consisting of similar histopathology without necrosis.

Results: A total of 11 patients have met the inclusion criteria during study period. Of these cases, seven were papillary thyroid carcinomas and four were follicular adenomas. Among the evaluated distinctive US features, necrotic ring offers the best accuracy (88%) and area under the curve (0.91) values in detecting necrosis after FNA and most valuable when combined with lack of intranodular vascularity.

Conclusion: In the preoperative evaluation of surgical candidates, necrotic ring, refractive edge shadowing, posterior acoustic enhancement, and lack of vascular signal may predict complete/near-complete necrosis with great accuracy.