Ultrasound最新文献

Introduction: Radiofrequency ablation is a procedure used to alleviate pain by destroying nerves with by radiofrequency-generated heat. Traditionally, radiofrequency ablation is preceded by diagnostic medial branch block injections, both guided by fluoroscopy. Fluoroscopic visualization of the superolateral aspect of the thoracic transverse process, where thoracic medial branch nerves occur, can be challenging due to anatomical complexities, especially in obese patients. We present a novel technique in which ultrasound was utilized in conjunction with fluoroscopy to perform medial branch block and radiofrequency ablation of the thoracic medial branch nerves.

Case report: First, two diagnostic thoracic medial branch nerve blocks were performed under ultrasound guidance. For the subsequent radiofrequency ablation, spinal needles were first advanced under ultrasound guidance to the target thoracic medial branch nerves. The position of those spinal needles was then used to guide the placement of cooled radiofrequency ablation probes using fluoroscopy. The patient reported 100% pain relief following the procedures.

Discussion: We found that the addition of ultrasound allowed us to overcome the challenge of visualizing the superolateral aspect of thoracic transverse process under fluoroscopy alone. Direct ultrasound visualization allowed us to accurately and safely perform a thoracic medial branch block and radiofrequency ablation in a patient with poor fluoroscopic anatomy, as demonstrated by the patient's complete pain relief after both medial branch block and radiofrequency ablation. We also theorize that our novel technique allows the provider to directly visualize the pleura, which could reduce the risk of severe pneumothorax associated with thoracic medial branch block and cooled radiofrequency ablation.

Introduction: Digital health is an opportune way of facilitating the implementation of point-of-care ultrasound (POCUS) in intensive care units (ICUs) of the Brazilian Unified Health System (SUS) through remote tele-mentored ultrasound (RTMUS). Therefore, this pilot diagnostic accuracy study aims to evaluate the sensitivity and specificity of RTMUS, using POCUS as the gold standard for the diagnosis of pulmonary oedema. As a secondary objective, these metrics will be assessed for pneumonia, chronic obstructive pulmonary disease (COPD), pneumothorax, pulmonary embolism, and cardiac tamponade.

Methods: The study was conducted in three adult ICUs, monitored by the TeleUTI project, and included 23 patients who underwent POCUS carried out by an ICU medical professional and RTMUS carried out by a tele-intensivist from the institution that proposed the project.

Results: The accuracy in diagnosing pulmonary oedema was 71.43%, COPD 89.96%, and for pneumonia, the results showed an accuracy of 65.22%. Analyses demonstrated that RTMUS has the same capability as POCUS for detecting true positive cases of pulmonary oedema, the same results of true negative cases for COPD, and a limitation in performance for pneumonia.

Conclusions: For COPD and pulmonary oedema, remote examination can support healthcare teams, suggesting that RTMUS has the potential to be a substitute for POCUS. We emphasise that the results should be interpreted within the context of the study, which is considered small and should be validated on a larger scale to consolidate the conclusions.

Introduction: Enthesitis-related arthritis is a specific subtype of juvenile idiopathic arthritis characterised by the co-presence of arthritis and enthesitis or the evidence of one of them coupled with at least two among sacroiliac joint tenderness, inflammatory back pain, presence of human leukocyte antigen-B27, acute symptomatic anterior uveitis, onset in a male child aged 6 years or older or history of spondyloarthropathy in a first-degree relative. Small joints like the sternoclavicular joint are rarely affected, and the prevalence of their involvement in enthesitis-related arthritis has been poorly assessed in the pertinent literature.

Case report: The authors report an atypical case of left sternoclavicular joint arthritis/enthesitis in a 12-year-old male child with juvenile idiopathic arthritis. The B-mode sonographic findings of articular effusion, synovial hypertrophy and capsular bulging, coupled with the microvascular mapping with colour Doppler of the sternoclavicular joint, have been crucial to optimising the pharmacological approach in clinical practice. In this sense, the sonographic examination presented as a natural extension of the physical examination to accurately define the poor control of disease activity using first-line pharmacological agents.

Discussion: The present case report can be considered the first to accurately report the B-mode and the colour Doppler findings of a pathological sternoclavicular joint in a patient enthesitis-related arthritis. Ultrasound imaging demonstrated intra-articular effusion, capsular bulging and synovial hypertrophy clearly defining sternoclavicular joint arthritis. Interestingly, the hypervascularisation involved both the synovial tissue and the capsule-bone interface - that is, the enthesis of the joint capsule - suggesting a potential co-existence of arthritis and enthesitis of the sternoclavicular joint in enthesitis-related arthritis patients.

Conclusion: The high-resolution point-of-care ultrasound seems to be a potential 'game changer' in paediatrics to promptly optimise the pharmacological management in enthesitis-related arthritis patients. Indeed, unlike other imaging modalities such as magnetic resonance imaging, modern high-frequency ultrasound transducers guarantee a superior spatial resolution of superficial joints and allow an accurate mapping of small-size and low-flow vascular elements of synovial and capsular tissues optimising the grading of disease activity and avoiding the use of contrast agent.

Introduction: The incidence of thyroid nodules in the general population is around 40%. The British Thyroid Association U-grading has high sensitivity for identifying the common thyroid cancer subtypes (papillary and follicular). However, ultrasound features of the rarer medullary thyroid cancer differ, with lower sensitivity for ultrasound detection.Hereditary medullary thyroid cancer accounts for 25% of cases, forming part of the multiple endocrine neoplasia syndromes (multiple endocrine neoplasia 2) and is associated with RET proto-oncogene mutation, for which gene testing is increasingly available. This study aims to evaluate British Thyroid Association U-grading for thyroid cancer risk stratification in this high-risk population.

Case report: This was a retrospective review of four multiple endocrine neoplasia 2 patients referred for thyroid ultrasound. A total of 10 thyroid nodules were graded as part of routine evaluation, taken from an endocrine and genetics tertiary referral centre. Patients with identifiable RET mutation from March 2017 to February 2023 were reviewed.

Discussion: Six patients had 10 thyroid nodules, of which 8 were graded as U2, 2 graded U3-5 and 8 confirmed as medullary thyroid cancer. However, two patients had no pathology data at the time of writing. For this cohort, U-grading and genetics were discordant, with RET gene testing more effective than ultrasound in cancer detection. All nodules should be considered high risk for medullary thyroid cancer, regardless of U-grade.

Conclusion: Our data demonstrate that British Thyroid Association U-score has limited value for medullary thyroid cancer detection in this high-risk group and cannot be used for risk stratification or surveillance. As a rarer thyroid cancer subtype, medullary thyroid cancer and the high-risk multiple endocrine neoplasia 2 population are under-represented in British Thyroid Association 2014 guidance and deserve consideration in future editions.

Objective: The study aims to evaluate the role of the posterior hard palate angle in the prenatal diagnosis of cleft palate.

Study design: Stored images of the axial transverse view of the fetal secondary palate, obtained at three-level obstetric ultrasounds, were used to evaluate the posterior border of the hard palate. The study population comprised 63 consecutive pregnancies of unaffected cases and 17 pregnancies suspected for a cleft palate without cleft lip, including 7 cases of cleft palate, 4 cases of high-arched palate, and 6 false-positive cases.

Results: The posterior angle of the hard palate was significantly larger in the cleft palate group than in the healthy controls and false-positive cases: 227° (±51°) vs 160° (±16°), p < 0.0001; and 173° ± 18°, p < 0.0001, respectively. Regression analysis revealed that reflex angle remained an independent risk factor for cleft palate (odds ratio, 58.67 (95% confidence interval 10-341)). The sensitivity and specificity of the posterior angle assessment were 73% and 96%, respectively.

Conclusions: The posterior hard palate angle could be an ultrasound marker of cleft palate without a cleft lip.

Introduction: This study aimed to explore the needs of newly qualified sonographers with respect to the requirements of preceptorship. This paper describes the first stage of research, with data obtained from a cohort of experienced preceptors. A second stage of research with data from newly qualified sonographers is pending synthesis with this work. The aim is to produce an evidenced-based tool to support departments in developing and implementing effective and robust preceptorship.

Methods: Twelve experienced participants from eight trusts, with a range of clinical backgrounds and experience were recruited. Two focus groups were held with questions structured around known themes highlighted in current evidence regarding newly qualified sonographers. The interviews were recorded and transcribed, and the qualitative data were analysed using thematic analysis.

Results: Four main themes with subthemes emerged. These were: (1) the gaps between qualification and proficiency, (2) the need for managerial investment and formalisation, (3) the preceptor and (4) tools to support the transition and prevent burnout. Frequency data and quotes are given as exemplars.

Conclusion: Participants report that newly qualified sonographers require support in report writing, clinical reasoning and confidence, and this should be addressed within preceptorship while acknowledging individual needs. Managerial investment is essential in ensuring adequate support and protected time is available for important preceptorship activities, such as meeting for feedback and feedforward with opportunity to clearly document progression. Inadequate support may be damaging for the wellbeing of preceptor and preceptee and ultimately impact the standard of our ultrasound services and patient care.

Introduction: The genicular nerves are sensory nerves around the knee. With the improvements in ultrasound imaging resolution, these nerves can be identified sonographically.

Topic description: Due to their small size, genicular nerves are often underappreciated and overlooked during routine sonographic imaging. Chronic pain associated with knee osteoarthritis, or postsurgical knee pain can be relieved by ultrasound-guided radiofrequency ablations or nerve blockades targeting the genicular nerves.

Discussion: To sonographically image these nerves, or guide nerve blocks or ablations, knowledge of the sonographic anatomy, technique and normal appearances of the genicular nerves and their surrounding structures is required and is unpacked in this pictorial essay.

Conclusion: Enhanced knowledge of the anatomy and a systematic approach to sonographically image and assess the genicular nerves of the knee can enhance the diagnosis of pathology, nerve injury or entrapment, and sonographic guidance of interventional procedures for pain relief.