Journal of Ultrasound in Medicine最新文献

Author: Dawn Boynton, MBA, RDMS, RVT, RT(R)

Objectives: Demonstrate the ultrasound appearance of renal artery stenosis. Show dampened “parvus tardus” pulsed doppler waveforms. Illustrate “twinkle artifact,” or color comet tail artifact as the result of a renal stone.

Methods: Ultrasound imaging using B-mode imaging, pulsed wave and color Doppler flow of the renal arteries can detect renal artery stenosis when performed by a skilled sonographer. Renal artery stenosis or occlusive disease results in decreased blood flow to the kidneys. Prompt interventional treatment of proximal renal artery stenosis can be performed using stenting and ballooning to reduce hypertension and restore and preserve renal function.

Results: The goal of intervention with angioplasty and stenting is to preserve renal function and improve blood pressure control. With long standing RAS if intraparenchymal resistive index (RI) are > 0.80 irreversible renal damage has occurred therefore stenting may not improve renal function.

Conclusions: When performed by a skilled sonographer, ultrasound can demonstrate renal artery stenosis with color and Doppler flow. Flow to a stenotic renal artery can be improved with stenting and ballooning. Ultrasound can also demonstrate renal stones and a comet tail artifact.

Author: Karen Nussbaumer, BS, RDMS, RVT, Academy of Diagnostic and Osteopathic Medicine (ADOM)

Objectives: This case study presents a 24-year-old female with a history of arthritis, joint pain, and fatigue for over five years, initially misdiagnosed with Juvenile Idiopathic Arthritis and treated with Humira for 12 months. During a biopsy of a thyroid tumor, the vascular supply was accidentally ablated, resulting in the occlusion of the primary arterial supply. An ultrasound performed two days after the biopsy confirmed the ablation. The biopsy later identified the tumor as Hurthle cell carcinoma. The study aims to document the significant reduction in tumor size and the transformation of the tumor's characteristics from carcinoma to benign adenoma within 28 days, as confirmed by post-surgical biopsy.

Methods: A 9mm thyroid mass was identified as a Hurthle cell carcinoma via biopsy, showing typical carcinoma features on ultrasound: irregular borders, significant calcification, and hypervascular flow. During the biopsy, the vascular supply to the tumor was accidentally ablated, leading to occlusion of its primary arterial supply. Follow-up ultrasound was performed over a 28-day period to monitor the tumor's progression.

Results: Within 28 days of the vascular ablation, the tumor demonstrated remarkable regression, shrinking from 9mm to 2mm. Ultrasound findings indicated a dramatic change from an irregular, hypervascular tumor to a small cystic lesion with no signs of malignancy. Post-surgical biopsy of the remaining tissue revealed a benign Hurthle cell adenoma, contradicting the original carcinoma diagnosis.

Conclusions: This case illustrates the potential for spontaneous tumor regression following unintended vascular ablation, raising questions about the role of blood supply in the progression of certain thyroid carcinomas. The dramatic shift from Hurthle cell carcinoma to adenoma highlights the complexity of tumor biology and the need for further research into non-surgical interventions that could replicate these outcomes.

Ultrasound-guided nerve blocks (USGNBs) are increasingly used in the emergency department (ED) as a safe and effective part of multimodal pain management. Their use has been shown to reduce reliance on opioids and procedural sedation, improve pain scores, and enhance functional outcomes for patients. Additionally, USGNBs in the ED have a complication rate of 0.4%, markedly lower than procedural sedation (4-11%), and they significantly reduce opioid requirements, which is critical considering the current opioid epidemic and the risks of persistent opioid use and overdose. Despite these benefits, relevant concerns about medicolegal liability, informed consent, evolving standards of care, may still influence the adoption of USGNBs in clinical practice. To address these issues, this review examines the legal risks associated with USGNBs by drawing on current clinical literature, closed claims data, and case law. We highlight common adverse events such as peripheral nerve injury and local anesthetic systemic toxicity and assess their legal implications. Potential legal risk including liability related to alternatives like opioid use and procedural sedation, are discussed. While the risk of litigation remains low when best practices are followed, failing to offer a USGNB when clearly indicated may increasingly be viewed as a liability if preventable complications occur. This article aims to provide a practical, interdisciplinary framework, including legal risk assessment, training, credentialing, and risk mitigation, to help clinicians, educators, and hospital administrators safely and confidently integrate USGNBs into ED practice.