Ultrasound最新文献

Introduction: Undifferentiated paediatric patients can be difficult to correctly classify with the correct condition. This may be, in part, due to the unique differences in how symptoms present as well as the challenges clinicians face in undertaking a complete examination where cooperation may be hindered due to pain, anxiety or limited understanding. Point-of-care ultrasound is now recognised as a valuable tool to assist acute paediatricians in their decision-making and diagnosis when incorporated into their clinical assessment.

Conclusion: We describe six cases which presented to the Paediatric Emergency Department, where point-of-care ultrasound played a crucial role in uncovering malignant or invasive lesions and subsequently expedited further investigations, leading to much quicker diagnosis.

Background: Fibromatosis colli, or sternocleidomastoid pseudotumor of infancy, is a rare condition characterised by a unilateral neck mass in infants, often associated with birth trauma. Ultrasound is the primary diagnostic tool, but the role of Doppler ultrasound to assess lesion vascularity is underexplored. This study investigates the vascularity of fibromatosis colli lesions and explores its possible clinical implications.

Methods: A systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Four databases were searched twice for case reports involving patients aged 0-16 years diagnosed with fibromatosis colli and assessed with Doppler ultrasound. Data was analysed using SPSS^® to identify the proportion of vascularised fibromatosis colli lesions, with a secondary aim of establishing if there is a link between vascularisation status and age.

Results: Twenty case reports (34 cases total) were included. Sixty-two per cent of lesions were vascularised on Doppler ultrasound. No significant age-related difference (p = 0.24) was found between patients with vascularised versus non-vascularised lesions.

Conclusions: Doppler ultrasound is underused for assessing vascularity in fibromatosis colli, and standardised imaging protocols are lacking across published reports. The prognostic value of the presence of vascularisation in fibromatosis colli remains uncertain due to the limited and heterogeneous nature of the data. Larger, prospective studies using clearly defined Doppler protocols are necessary to determine the clinical relevance of vascularisation in fibromatosis colli management.

Introduction: Ectopic pregnancies complicate 11/1000 pregnancies in the United Kingdom and contribute significantly to maternal morbidities and mortality. Twin ectopic pregnancies are rare and preoperative diagnosis extremely so. The risk factors and clinical presentation for twin ectopic pregnancies are the same as for ectopic pregnancies in general. The nature of twin ectopic pregnancies, however, implies a potential for higher complication rates. Majority of cases are diagnosed and thus managed surgically; however, successful medical management has been documented with preoperative ultrasound diagnosis.

Case presentation: A nulliparous patient presented at six weeks gestation with abdominal pain and vaginal bleeding. An ultrasound diagnosis of right tubal twin ectopic pregnancy was made. She was initially commenced on medical management, but this was abandoned due to worsening symptoms. She subsequently had a laparoscopic right salpingectomy, which was uncomplicated.

Discussion: The case presented was one of unilateral twin tubal ectopic pregnancy, which is a rare occurrence. In this case, the diagnosis was preoperative unlike most reported cases. Although some reported cases have been successfully managed medically, medical management was unsuccessful in this case, necessitating surgical management.

Conclusion: Current guidelines for management of ectopic pregnancies do not consider twin ectopic pregnancy, and hence, there is presently no guidance as to the preferred management options for this unique subset of patients. Medical and surgical management options have been utilized successfully in reported cases. While most reported cases were diagnosed and managed surgically, medical management remains an option in carefully selected cases.

Introduction: Female pelvic congestion syndrome is associated with chronic pelvic pain and affects approximately 30% of women. There are no formal diagnostic criteria to assist with the diagnosis of pelvic congestion syndrome despite affecting such a large proportion of the population. Furthermore, the aetiology and anatomy of pelvic congestion syndrome has significant overlap with the causal factors of varicoceles in men, many of whom also experience chronic pain/aching. However, women are at greater risk of developing venous damage associated with pelvic congestion syndrome due to hormonal changes and pregnancy, both of which exacerbate pelvic congestion syndrome and its causes.

Methodology: A narrative review methodology was utilised to search for literature discussing ultrasound and its role in the diagnosis of pelvic congestion syndrome. The search used two databases and explored 'grey' literature published between 2014 and 2024. Sensitivities and specificities of diagnostic criteria proposed have been reported as well as other metrics which may be utilised in the ultrasound diagnosis of pelvic congestion syndrome.

Discussion: Ultrasound appearances associated with pelvic congestion syndrome include dilated pelvic veins, specifically; the left ovarian vein, adnexal veins, and intrauterine/myometrial veins. There are, however, few high-quality comparative studies assessing the accuracy of different venous diameter cut-off values which may be used in the diagnosis of pelvic congestion syndrome. Other ultrasound findings cited commonly include slow venous flow of less than 3 cm per second and demonstrable venous reflux on Valsalva manoeuvre.

Conclusion: Currently there are insufficient data to conclude formal diagnostic ultrasound criteria for pelvic congestion syndrome. Existing evidence supports a multifaceted diagnostic approach and ultrasound practitioners must be mindful of patients' clinical history and potential associated ultrasound features to avoid underdiagnosis of this common condition. In the meantime, further primary research is needed before the full value of ultrasound can be understood.

Introduction: Diastolic dysfunction precedes ventricular contractility changes in the ischaemic cascade. Both diastolic and systolic left ventricle dysfunctions are known to alter left atrial myocardial deformation by impairing its phasic function, which can be evaluated using speckle-tracking echocardiography.

Objective: The aim of this study was to assess the accuracy of left atrial strain in detecting myocardial ischaemia in patients undergoing dobutamine stress echocardiography.

Methods: Patients referred for dobutamine stress echocardiography due to suspected ischaemia were prospectively enrolled. Left atrial strain, including its three components - reservoir, conduit, and contractile - was analysed at each stage of dobutamine stress echocardiography. The diagnosis of myocardial ischaemia was defined as a new or worsening wall motion abnormality in at least two contiguous left ventricle segments during dobutamine stress echocardiography. Patients with a positive dobutamine stress echocardiography for ischaemia were compared with those with a negative dobutamine stress echocardiography for ischaemia.

Results: A total of 56 patients were included. Patients with inducible ischaemia had significantly lower left atrial reservoir strain (LASr) values at rest and throughout all dobutamine stress echocardiography phases, with the lowest values at peak stress (27.6% (24.0 to 28.4) vs 34% (29.6 to 42.7), p < 0.001). LASr at rest and during low-dose dobutamine predicted ischaemia during dobutamine stress echocardiography (rest: area under the curve = 0.68, p = 0.038; low dose: area under the curve = 0.78, p < 0.001). An LASr cutoff of ⩽29.7% at peak stress yielded high diagnostic accuracy in detecting inducible ischaemia (area under the curve = 0.88, p < 0.001).

Conclusion: Assessment of left atrial strain in patients undergoing dobutamine stress echocardiography for suspected myocardial ischaemia has diagnostic value and can be integrated into conventional dobutamine stress echocardiography to corroborate the findings of a positive test.

Introduction: Anterior talofibular ligament injury is the most common type in chronic ankle instability patients. While initial injuries are often treated conservatively, some patients still require surgery. Shear wave elastography provides quantitative, accurate assessment of ligament damage, offering an objective basis for surgical planning and rehabilitation monitoring.

Method: Shear wave elastography quantified shear wave velocity of bilateral anterior talofibular ligaments in neutral and stressed positions in 30 chronic ankle instability patients' group and 60 healthy controls' group. Functional assessments included the Cumberland Ankle Instability Tool, American Orthopaedic Foot & Ankle Society scale, Foot and Ankle Ability Measure for Activities of Daily Living and Foot and Ankle Ability Measure for Sports (FAAM-S) and Visual Analogue Scale for pain.

Results: Inter-observer and test-retest reliability for anterior talofibular ligament shear wave velocity were excellent (neutral position: intraclass correlation coefficient = 0.87, 0.93; stressed position: intraclass correlation coefficient = 0.89, 0.96). Shear wave velocity showed no significant differences by gender, age or body mass index. Chronic ankle instability patients had significantly higher shear wave velocity in affected anterior talofibular ligaments (neutral/stressed, p < 0.001) versus healthy controls; unaffected sides showed no difference. Affected ankles scored significantly worse on Cumberland Ankle Instability Tool, Foot and Ankle Ability Measure for Activities of Daily Living, Ankle Ability Measure for Sports, American Orthopaedic Foot & Ankle Society and Visual Analogue Scale (p < 0.001). Shear wave velocity in affected anterior talofibular ligaments (both positions) positively correlated with pain intensity (neutral: r = 0.488, p = 0.004; stressed: r = 0.514, p = 0.004). Neutral-position shear wave velocity negatively correlated with Foot and Ankle Ability Measure for Activities of Daily Living (r = -0.457, p = 0.011), but not with Ankle Ability Measure for Sports, American Orthopaedic Foot & Ankle Society or Cumberland Ankle Instability Tool scores.

Conclusion: Shear wave elastography noninvasively, conveniently and accurately assesses anterior talofibular ligament quality in chronic ankle instability patients, providing an objective approach for surgical decision-making and rehabilitation monitoring.

Introduction: Superior mesenteric artery syndrome is a rare pathological cause of gastric outlet obstruction. Traditionally, computer tomography and magnetic resonance imaging scans have been diagnostic investigations of choice. However, due to vague symptoms of gastric outlet obstruction, there is a delay to diagnosis of superior mesenteric artery syndrome in acute setting. This case describes the use of point-of-care ultrasound scan for diagnosis of superior mesenteric artery syndrome in the emergency department.

Case presentation: We present a case of a 25-year-old woman presenting to the emergency department with signs and symptoms of gastric outlet obstruction caused by superior mesenteric artery syndrome. Point-of-care ultrasound scan demonstrated a fluid-filled stomach with continuous bubbling of air (effervescence sign) and a loop of duodenum compressed between the aorta and the superior mesenteric artery, suggesting a diagnosis of superior mesenteric artery syndrome. Subsequent computed tomography scan confirmed the point-of-care ultrasound scan findings.

Discussion: Ultrasound has been described as a reliable diagnostic modality to diagnose the radiological signs of superior mesenteric artery syndrome. Our newly identified sign of continuous bubbling of air (effervescence sign) on point-of-care ultrasound scan, due to fermentation of stomach contents, and its ability to identify diagnostic features of superior mesenteric artery syndrome demonstrate its utility as a diagnostic tool in the emergency department reducing time delays and costs associated with traditional diagnostic modalities. Point-of-care ultrasound scan can aid in the diagnosis of superior mesenteric artery syndrome in the emergency department.

Conclusion: Increased awareness of the capabilities of using point-of-care ultrasound scan in the emergency department and our newly identified 'effervescence sign' will enable timely and low-cost diagnoses, while closing current literature gap and establishing point-of-care ultrasound scan as a feasible diagnostic tool for gastric outlet obstruction secondary to superior mesenteric artery syndrome.

Background: Bedside ultrasound of inferior vena cava is used by clinician sonographers in intensive care units. Its data can impact clinical decision-making. Subcostal view is a standard view for this issue. A significant proportion of the intensive care unit patients have very difficult approach to this view. In these patients, an alternative view is a transhepatic view, feasible in nearly every intensive care unit patient. Limited data on the ultrasound technique exist in literature.

Aim: In this review, we discuss in detail the technical aspects of the inferior vena cava ultrasound technique assessed from the transhepatic view, ultrasound tips, and pitfalls.

Methods: A search was performed using PubMed, Google Scholar, EMBASE, and Scopus databases with the terms "inferior vena cava ultrasound," "transhepatic view," "right mid-axillary view," "right lateral intercostal view," "ultrasound technique," "inferior vena cava pitfalls," and inferior vena cava ultrasound tips," "intensive care unit." The latest articles were reviewed and this review was written using the most current information.

Discussion: A standardised ultrasound approach from mid-axillary line provides optimal image acquisition. When there are difficulties finding inferior vena cava or in obesity alternative approaches should be used. Potential pitfalls during acquisition are: misidentifying the inferior vena cava; technical issues in inferior vena cava measurements; utility of the inferior vena cava data in isolation.

Conclusion: Mastering the ultrasound technique from the transhepatic view offers clinicians the opportunity to perform inferior vena cava ultrasound, even in the most challenging patients. Awareness of potential pitfalls and knowledge how to avoid them is important to intensive care unit clinicians to avoid wrong decisions at the bedside.

This reflection details how the purchase of a small portable ultrasound system enabled a pilot domiciliary paracentesis service. The service offers symptom relief through ascitic drainage to palliative, end-of-life, patients who wish to avoid a hospital admission. Identifying appropriate patients and considering risk, the service is offered and supported by appropriately trained advanced practitioners along with palliative, oncology and district nursing teams. A small number of patients have been involved, but anecdotally, this has offered great relief and comfort to both the patients and their families. The ongoing aim is continue offering this service and make more community teams within our area and beyond aware of its existence and to support the training of interested and skilled palliative health care professionals in performing these.