Ultrasound最新文献

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.

Purpose: This study aimed to determine the suitability and optimal concentration of an ultrasonic contrast agent (SonoVue) for intralesional application during contrast-enhanced ultrasonography (CEUS).

Methods: An in vitro model simulating an existing lesion in the anatomical environment of the mandibular ascending ramus was developed. After intralesional application, different SonoVue dilutions were compared with dilutions of an iodine-containing radiographic contrast agent (Imeron300) during cone-beam computed tomography.

Conclusions: SonoVue provided a significant contrast effect for distinguishing the lesion from the surrounding soft tissue at dilutions of 1/10 and 1/20. Imeron300 showed a slightly superior contrast effect, even at dilutions of 1/50 and 1/100. However, CEUS using SonoVue in low dilutions seemed suitable for intralesional application in vitro. Further in vivo studies are required to validate the current results and determine the optimal contrast-agent concentration.

Aims: Patellofemoral pain syndrome is a prevalent cause of anterior knee pain, often challenging to diagnose due to its multifactorial aetiology. This study investigates the diagnostic utility of musculoskeletal ultrasonography in patellofemoral pain syndrome and its correlation with pain and functional impairment.

Methods: This case-control study enrolled 32 participants (16 patellofemoral pain syndrome, 16 controls). Sonographic measurements of patellar and quadriceps tendons, lateral retinaculum, joint effusion, and trochlear angle were taken. Pain intensity and knee function were assessed using the Visual Analogue Scale and Kujala Anterior Knee Pain Scale . Diagnostic accuracy was evaluated using receiver operating characteristic curve analysis.

Results: Significant differences in patellar tendon, quadriceps tendon, and lateral retinaculum thicknesses were observed between patellofemoral pain syndrome and control groups. Modified cut-offs adjusted for height improved diagnostic accuracy, with the combination of two out of three criteria yielding 96% sensitivity and 73% specificity. No significant correlation was found between Visual Analogue Scale and sonographic findings, but Kujala scores correlated significantly with tendon and retinaculum thicknesses.

Conclusion: Musculoskeletal ultrasonography offers a non-invasive, reliable diagnostic modality for patellofemoral pain syndrome. A two-out-of-three criteria approach enhances diagnostic precision, suggesting potential utility in clinical and screening settings.

Background & objectives: The ultrasound features of ovarian mature teratomas are well defined. However, literature regarding the ultrasound features of immature teratomas is lacking and features can often be confused with those of mature teratomas. The objective of this study was to evaluate the subjective assessment of ultrasound examiners of anonymised static B mode ultrasound images of immature and mature teratomas.

Method: An electronic questionnaire was distributed to levels 1 to 3 ultrasound examiners containing 23 anonymised ultrasound images including nine different immature teratomas and nine different mature teratomas. The images were collected retrospectively, and the reference test was the final histology of the surgically removed masses. The sensitivity and specificity test of the subjective assessment for each histological group was calculated. The live (at the time the scan was performed) subjective impression of each tumour was also recorded and the level of the examiner that performed the scan was noted.

Results: There were a total of 43 responses (30 from level 1, 9 from level 2 and 4 from level 3 examiners. The sensitivity and specificity of subjective assessment ranged from 16.3% to 97.7% and 81.6% to 96.1%, respectively, for all histological groups. The sensitivity and specificity to correctly diagnose mature teratomas and immature teratomas were 41.3% (95% CI: 36.3%-46.4%), 82.2% (95% CI: 78.9%-85.1%) and 41.2 % (95% CI: 36.2%-46.3%), 81.6 % (95% CI: 78.3%-84.7%), respectively. There was no statistical difference in the diagnostic performance of the subjective assessment of examiners between mature and immature teratomas (p = 0.975).

Conclusions: Diagnostic performance of static 2D ultrasound images for mature and immature teratomas is low. Immature teratoma still pose a diagnostic challenge.

Introduction: Midgut volvulus, a complication of intestinal malrotation, is a surgical emergency. Due to its embryologic aetiology, it is predominantly seen in neonates; with about 90% of cases involving children under the age of 1. The majority of these are diagnosed within the first month of life. However, midgut volvulus has been reported in adults of varying ages across the literature.

The case: We present a case of a 16-year-old girl with generalised but severe abdominal pain in the central and lower abdomen. Ultrasound revealed a clockwise malrotation of the bowel with involvement of the superior mesenteric vessels, in keeping with the 'whirlpool sign'. The proximal duodenum appeared distended. Within the whirlpool, there was evidence of peristalsis in the bowel loops and blood flow in the mesenteric vessels, suggesting a lack of ischaemia in the involved bowel loops. Three months later, the patient was presented to the emergency department with symptoms of vomiting and severe abdominal pain. Computed tomography scan revealed a mesenteric swirl in the mid-abdomen involving the mesenteric vessels, consistent with the previous ultrasound findings of midgut volvulus, and the proximal duodenum remained distended.

Discussion: Midgut volvulus is often overlooked in older children and teenagers presenting with abdominal pain, largely due to its rarity in these age groups.

Conclusion: Our case emphasises the importance of clinicians maintaining an open mind and considering imaging, particularly ultrasound, as part of the initial evaluation.

Introduction: In the United Kingdom, uterine artery Doppler ultrasound, specifically measurement of the pulsatility index, is recommended in the second trimester of pregnancies at risk of developing conditions like pre-eclampsia and fetal growth restriction, to facilitate timely monitoring and intervention. The aim of this study was to evaluate the effectiveness of uterine artery Doppler in detecting pregnancies at risk for adverse outcomes by analysing a cohort of high-risk pregnancies.

Methods: A total of 218 pregnancies were retrospectively selected post-delivery, having been identified prior to anomaly scanning as at high risk for adverse outcomes. They had bilateral uterine artery Doppler between 18 and 24 weeks of gestation as part of normal care. Mean uterine artery pulsatility index above the 95th percentile was considered abnormal. Subjects received close monitoring in the third trimester, including 2-3 weekly growth ultrasounds with umbilical artery Doppler, and regular blood pressure checks. Sensitivity, specificity, positive predictive value and negative predictive value of uterine artery Doppler were calculated to assess its predictive accuracy for pre-eclampsia and low birthweight.

Results: Sensitivity of uterine artery Doppler > 95th percentile was 20% for pre-eclampsia (positive predictive value: 14%) and 46% for birthweight < 3rd centile (positive predictive value: 30%). Specificity was 80% for pre-eclampsia (negative predictive value: 86%) and 84% for birthweight < 3rd centile (negative predictive value: 91%).

Conclusion: Uterine artery Doppler pulsatility index alone has limited sensitivity for predicting pre-eclampsia, and small for gestational age births in a high-risk population. These findings underscore the need for multimodal approaches, incorporating other biomarkers and clinical risk factors.

Background: Acute viral hepatitis A remains a significant public health concern.

Objective: This study investigated the relationship between gallbladder wall pathology, liver stiffness measurements, controlled attenuation parameter, and biochemical markers in adult patients with acute viral hepatitis A.

Methods: Overall, 42 patients with acute viral hepatitis A were studied over 3 months. Patients underwent ultrasound and transient elastography examinations. Gallbladder wall thickness was categorised into two groups: 3-10 mm (group A) and ⩾10 mm (group B).

Results: Gallbladder wall thickening was detected in 95% of patients. Stratification and fluid accumulation were present in 71% and 38% of patients, respectively. Gallbladder wall thickness ⩾10mm was significantly associated with stratification and fluid accumulation (p < 0.0001). Higher gallbladder wall thickness correlated with elevated alanine aminotransferase (p = 0.008), ammonia levels (p = 0.011), and international normalised ratio (p = 0.047). A positive correlation was observed between procalcitonin levels ⩾0.25 ng/mL and gallbladder wall thickness ⩾10 mm (p = 0.011). The controlled attenuation parameter values were significantly lower in patients with greater gallbladder wall thickness (p = 0.013), while liver stiffness measurement showed no correlation with gallbladder wall thickness.

Conclusion: In acute viral hepatitis A, gallbladder wall thickening is almost a pathognomonic finding. Increased gallbladder wall thickness correlates with increased alanine aminotransferase, ammonia, international normalised ratio, and procalcitonin levels, highlighting its potential as a non-invasive marker of disease severity. Controlled attenuation parameter and liver stiffness measurement require cautious interpretation in acute inflammation. These findings support gallbladder wall assessment as a valuable tool in evaluating acute viral hepatitis A.

Background: Post-traumatic calf injuries most commonly involve the medial head of the gastrocnemius muscle. In contrast, injuries to the tibialis posterior muscle, particularly at the myotendinous junction, are rare.

Case report: We present the case of a healthy young male who experienced a fall, followed by pain and swelling in the posterior calf. Radiographs excluded a fracture, and subsequent ultrasound evaluation identified an injury at the myotendinous junction of the tibialis posterior muscle.

Discussion: Traumatic injuries to the calf typically affect the medial gastrocnemius and soleus muscles, which form part of the triceps surae complex. Ultrasound imaging proved instrumental in localising the injury and allowed for dynamic assessment. This modality is reproducible and facilitates monitoring the healing process. To our knowledge, similar cases involving the tibialis posterior myotendinous junction have not been documented in the literature.

Conclusion: Ultrasound evaluation of a post-traumatic calf injury revealed a rare myotendinous lesion of the tibialis posterior, highlighting the importance of comprehensive imaging in atypical presentations.

Background: Neonatal osteomyelitis is rare, and rib involvement is even more uncommon. Early diagnosis is challenging due to nonspecific clinical signs and the limitations of conventional imaging methods.

Objective: To describe a case of neonatal rib osteomyelitis and highlight the diagnostic utility of point-of-care ultrasound in its early detection.

Methods: A case of a 25-week preterm neonate with a localized thoracic swelling was investigated. Diagnosis was made using point-of-care ultrasound, which identified a fluid collection and cortical disruption, while radiography showed no abnormalities. A review of the literature was conducted to compare findings with other reported cases.

Results: The neonate was diagnosed with rib osteomyelitis caused by Staphylococcus aureus and treated with a 6-week course of targeted antibiotics. The infant made a full recovery. A literature review revealed three other cases of neonatal rib osteomyelitis, all associated with S. aureus, with localized swelling as the primary clinical symptom. Imaging results varied, with ultrasound proving to be more sensitive than radiography in early detection. None of the cases underwent magnetic resonance imaging.

Conclusions: Neonatal rib osteomyelitis, though extremely rare, should be considered in neonates presenting with localized chest wall abnormalities. Point-of-care ultrasound is a valuable diagnostic tool, enabling early detection and potentially improving outcomes through timely intervention.