Ultrasound最新文献

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: Imaging appearances and clinical presentation of soft tissue sarcoma and soft tissue haematomas are similar. It is imperative that sarcoma is differentiated from benign soft tissue lesions due to the poor outcomes and high morbidity associated with sarcoma.

Topic description: Part 1 of this pictorial review will summarise the paucity of guidance in management of suspected haematomas, the clinical features and ultrasound techniques used in the assessment of soft tissue masses.

Discussion: Ultrasound is the first-line test in the investigation of soft tissue masses. With the overlapping ultrasound appearances of soft tissue sarcoma and soft tissue haematoma, thorough and methodical clinical examination and scanning technique is fundamental so that practitioners understand when to escalate cases for further investigation.

Conclusion: The clinical assessment and clinical history taking into consideration the intensity of trauma and ecchymosis must correlate with the ultrasound appearances. This will facilitate an accurate diagnosis, timely management and improved patient outcomes.

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.

Introduction: Metastatic disease to the submandibular gland is a rare phenomenon with limited information available on related imaging findings.

Case presentation: We report a 59-year-old female who presented with a palpable nodule in the right submandibular gland 6 years after treatment for breast carcinoma. Ultrasound findings were concerning for distant metastatic disease from breast cancer recurrence. The histopathological analysis of the biopsied tissue confirmed infiltration of the right submandibular gland with an adenocarcinoma from a breast primary.

Discussion: Metastatic spread to the major salivary glands is relatively uncommon with a predilection to the parotid gland owing to its extensive intraglandular lymphatic system. Conversely, metastasis to the submandibular gland, which lacks intraglandular lymph nodes, is rare. Ultrasound is the optimal first-line imaging modality to aid in the assessment of submandibular gland disease. Malignant lesions often appear hypoechoic with heterogenous internal architecture and ill-defined borders. However, some low-grade malignancies, can have apparently benign features particularly when smaller in size. Where a focal submandibular gland lesion is identified and neoplasm is suspected, the early use of ultrasound-guided core biopsy is recommended to improve diagnostic yield for histological assessment.

Conclusion: While submandibular metastasis is rare, clinical assessment, sonographic findings and use of core needle biopsy aid in prompt diagnosis and management.

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: Preterm delivery is a grave and demanding problem that accounts for the major cause of neonatal deaths and long-term morbidities. It remains an unresolved health issue of global dimensions. Cervical elastography is evolving as a useful diagnostic tool for its timely prediction so that individualised management can be done.

Aim: To assess the diagnostic accuracy of transvaginal strain cervical elastography in prediction of preterm delivery.

Methods: This prospective observational study was conducted from June 2021 to August 2022 in a tertiary care institute of North India. A total of 75 low-risk asymptomatic women were included. Transvaginal ultrasound was performed for the cervical length in the second and third trimesters. In addition, we collected strain elastography data such as colour codes from six regions of the cervix, that is, at the anterior and posterior lips of internal os, middle one-third of the cervix and the external os, and the strain ratios from these three cervical levels were also calculated. Then these parameters were compared with cervical length, second and third trimester groups and also with preterm and term delivery groups.

Result: The red colour (soft colour) at the anterior lip of internal os was the best predictor of preterm delivery in our study with a sensitivity and specificity of 63.64% and 96.87%, respectively. The elastography strain ratio of >2 at the internal os and cervical length ⩽2.8 cm were the additional predictors for the same.

Conclusion: Cervical elastography can serve as a potential and reliable predictor for preterm delivery.

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.

Background: Ultrasound is a non-invasive tool that helps assess volume status.

Objectives: To assess the dehydration and passive leg raising impact on ultrasound-derived cardiac and inferior vena cava parameters to improve early detection of hypovolemia in children.

Design: Prospective observational study in a tertiary paediatric intensive care unit.

Methods: We recruited 66 healthy children 8-14 years old who fasted in Ramadan. Inferior vena cava diameter, inferior vena cava collapsibility, velocity time integral and maximum velocity (Vmax) were measured at left ventricle outflow tract pre- and post-fasting, with and without passive leg raising. Aorta diameter in systole was also measured pre- and post-fasting.

Outcome measures: Inferior vena cava diameter and collapsibility, velocity time integral and Vmax with and without passive leg raising, pre and post fasting, and inferior vena cava/Ao ratio pre and post fasting were measured.

Results: Median percentage of weight loss after fasting was 1.1% (range, 0%-3.9%). Inferior vena cava maximum diameter and inferior vena cava/aorta did not change significantly after fasting (p < 0.05). Inferior vena cava diameters increased and inferior vena cava collapsibility decreased after passive leg raising (p < 0.001) pre and post fasting. Velocity time integral increased with passive leg raising (p < 0.001) but was not affected by fasting (p = 0.17). Vmax increased with passive leg raising and decreased in fasting (p = 0.001).

Conclusion: Passive leg raising affected ultrasound measurements. Left ventricle outflow tract Vmax was affected by fasting/mild dehydration, and further trials are needed to confirm its value in predicting hypovolemia in children.

Limitations: There was no significant effect of dehydration on the measurements probably because of the small sample and mild dehydration. This cannot be generalised because it is a single-centre study and younger children were not included.

Introduction: A pancreatic neuroendocrine tumour (NET) originates from the neuroendocrine cells responsible for producing and releasing hormones. They are uncommon findings, mainly seen arising from the head of the pancreas and their appearances may vary among different imaging modalities.

Case report: Interesting case of an asymptomatic patient with an incidental finding of a pancreatic lesion and its variable appearances across different modalities and final histology findings.

Discussion: Ultrasound (US) is the most requested examination as an imaging modality due to its easy accessibility, affordability, and real time assessment feature. This case shows that ultrasound examination although deemed poor in assessing pancreas due to its location and overlying bowel gas, however, can play a vital role especially among asymptomatic patients. It discusses the range of differentials diagnoses including pancreatic NET, Gastrointestinal stromal tumour (GIST), adenocarcinoma, mucinous cystic neoplasm, and a pseudo papillary neoplasm due to variable imaging appearances of the pancreatic lesion on US and Magnetic Resonance Imaging (MRI). Results were reviewed in the Upper Gastrointestinal Multidisciplinary teams meeting and Endoscopic ultrasound scan (EUS) with tissue sampling was undertaken to confirm the diagnosis. The patient underwent prophylactic surgery, and the histology report concluded that the lesion to be a pancreatic NET.

Conclusion: To conclude, we felt that sharing this interesting complex case was important as it highlights the difficulty in diagnostic certainty when dealing with a pancreatic lesion due to its variability in presentation on different modalities and the requirement of multidisciplinary team approach.