Journal of Medical Ultrasound最新文献

Testicular torsion is an emergency clinical situation. It is rarely seen associated with ureterocele. We presented a case report where a 15-year-old adolescent boy presented with severe testicular and vague abdominal pain was found on imaging to have testicular torsion and ureterocele. Ultrasonography Doppler and computed tomography imaging are being described.

Levator avulsion (LA) is common during vaginal birth and is the principal etiological factor for the development of pelvic floor dysfunction. Most described nonsurgical treatments for LA in the literature are pelvic floor muscle exercises and pessary. Long-term benefits of conservative treatments in women with major LA are not clear. Research investigating surgeries for LA are scarce and engaging in heterogeneous procedures, such as reattachment of the levator ani muscle to the inferior pubic bone, reattachment of the levator ani muscle to the arcus tendineus of levator ani, and standard pelvic floor repairs for pelvic organ prolapse, with or without mesh. Currently, there is no consensus on the most appropriate treatment for women with LA. This article intends to discover the effective treatment for LA from the literature.

Background: Soft-tissue masses usually present as painless palpable lumps. Although histopathologic examination (HPE) is diagnostic, ultrasonography (USG), being cost-effective, is the preferred screening modality. However, as it is operator dependent, the diagnostic accuracy might be affected. Thus, this study was planned to determine the diagnostic accuracy of USG with Doppler in identifying the malignant nature of soft-tissue swellings and also to develop a scoring system with a valid cutoff to help differentiate malignant lesions from the benign ones.

Methods: This analytical study with longitudinal design was conducted from July 2022 to June 2024 on patients with soft-tissue swelling selected by systematic random sampling. Data were collected by face-to-face interview, USG with Doppler, and histopathological examination. Data were presented with the help of descriptive and inferential statistics.

Results: USG had 83.3% sensitivity, 89.5% specificity, 71.4% positive predictive value, 94.4% negative predictive value, and 88.0% accuracy in differentiating between benign and malignant soft-tissue swelling. The interrater reliability between USG and HPE indicated "substantial agreement" (Cohen's Kappa 0.689, P = 0.000). Using the scoring system, the swelling could be categorized into benign (score <3.50), indeterminate (score 3.50-6.50), and malignant (score ≥6.50).

Conclusion: USG with Doppler can accurately differentiate between benign and malignant soft-tissue swelling. USG with Doppler-based scoring system could increase the sensitivity and specificity of this imaging modality.

Background: Using conventional anatomical landmark or nerve stimulator guidance, injection of local anesthetic following paresthesia of the middle two fingers resulted in >97% block efficacy. "Corner pocket" and "intracluster" injections during ultrasound-guided supraclavicular brachial plexus have been suggested for better dermatomal coverage but have limitations. We hypothesized that a single injection of dye at the level of the middle trunk (MT) would result in diffusion in the superior and inferior trunks.

Methods: After ethics approval, ultrasound-guided injections were performed with a needle tip positioned within fatty connective tissue at the level of the MT bilaterally in 6 soft-embalmed cadavers. We injected 3.5, 7.5, and 15 ml diluted methylene blue dye in 2 cadavers each. Bilateral neck dissections were performed in the posterior triangle of the neck 30 min after injection in all cadavers to visualize the dye spread.

Results: Injection of the lower volume of dye (3.5 ml) spared the superior trunk, suprascapular and phrenic nerve (except 1 specimen), while an injection of the higher volume of dye (15 ml) consistently stained all trunks after a single injection at MT level. Similarly, the suprascapular and phrenic nerves were congruously stained with 15 ml injections, while with 7.5 ml 50% times, the PN was soaked. Dye dispersion in cadaveric brachial plexuses was deep with 15 ml and mild-to-moderate stain pattern with others.

Conclusion: We postulate that the use of a single injection MT block technique with an injectate volume of 7.5 ml or more can be an effective technique for a supraclavicular brachial plexus block. However, the findings of this cadaveric study need substantiation from clinical studies.

Background: The utility of lung ultrasound (LUS) in diagnosing respiratory disorders is being studied only in recent times. We aimed to describe the ultrasound (USG) features of pulmonary tuberculosis (TB) and compare them with those of lobar pneumonia. In addition, the LUS findings of both diseases were corroborated with chest X-ray findings.

Methods: The study subjects consisted of adult subjects recently diagnosed with pulmonary TB and those diagnosed with lobar pneumonia. Both subsets of patients underwent LUS evaluation.

Results: Ninety-six subjects with 64 microbiologically confirmed TB and 32 lobar pneumonia patients were included. The study subjects' mean age was 46.78 ± 15.75 years and the majority were males (n = 62; 64.6%). LUS showed focal interstitial pattern, cavity, and irregular pleura in TB patients which were significantly different (P ≤ 0.001) from the findings of air bronchogram and/or shred sign seen in patients with lobar pneumonia. The overall sensitivity of LUS compared to X-ray, to identify abnormalities in TB and lobar pneumonia patients, was 88.6%. The LUS and CXR findings were concordant in 93.75% of TB patients and 90.6%) of lobar pneumonia patients. Additional USG abnormalities other than that seen on CXR were demonstrated in 13 (20.3%) TB patients.

Conclusion: LUS is a valuable tool to detect TB and lobar pneumonia and can discriminate between the two conditions. LUS performance was on par with CXR in the detection of abnormalities. The lack of radiation exposure and portability of LUS makes it an attractive tool for bedside use as well as in field conditions where radiography may not be readily available.

Tuberculosis (TB) remains a global health concern, and while primarily affecting the lungs, extrapulmonary manifestations such as genitourinary tubercular epididymitis are rare and diagnostically challenging. Accurate differentiation is crucial for appropriate treatment. This case study presents a 34-year-old man with left scrotal swelling, backache, and fever, highlighting the importance of considering TB in genitourinary conditions. High-resolution sonography revealed an edematous left testis with increased vascularity and hypoechoic nodules. Further imaging, including high-resolution computed tomography thorax and CEMRI dorso-lumbar spine, confirmed disseminated TB. Despite negative urine culture, aspiration cytology from the epididymal collection indicated tubercular etiology. Urogenital TB, especially isolated epididymal involvement without renal effects, presents diagnostic challenges, often occurring in immunocompromised patients. The case underscores the role of clinical, biochemical, and radiological evidence in establishing a correct diagnosis. High-resolution ultrasonography plays a crucial role in diagnosing scrotal pathologies, and when accompanied by an epididymal collection, further diagnostic steps involving biochemical parameters and aspiration followed by cytoanalysis and culture are essential. The diagnosis of TB epididymitis can be confirmed through acid-fast bacilli (AFB) identification, positive AFB culture, or granulomas seen in a biopsy specimen in the right clinical context. Radiological imaging aids in detecting local and disseminated disease forms, including complications such as hydrocele, testicular calcifications, scrotal abscesses, sinus tracks, and fistulous communications.

Background: Topographical ultrasound is gaining traction for brachial plexus visualization due to its value in regional anesthesia. However, existing artificial intelligence models for nerve localization are trained on high-resolution stationary ultrasound images, limiting their applicability to more convenient, low-resolution handheld devices. This study addresses this challenge by proposing a novel image segmentation model suitable for low-resolution images.

Methods: Thirty adult patients provided informed consent for participation in this study. A high-frequency, portable ultrasound probe was used to acquire B-mode images and video clips at 20 predefined positions. A training dataset of 60,000 images was constructed with expert annotations for landmark localization. A two-stage convolutional neural network architecture was implemented: Stage 1 for image classification and Stage 2 for segmentation with centroid refinement. Four novice physicians underwent testing for comparison. Model performance was evaluated using classification accuracy and segmentation precision metrics.

Results: Our model achieved high accuracy in classifying brachial plexus ultrasound image positions (99.2% sensitivity and 84.5% specificity) compared to novice physicians (81.1% sensitivity and 59.8% specificity). In addition, the model demonstrated significantly superior performance in landmark segmentation, with lower median distance error (0.19 mm vs. 4.9 mm) and superior shape similarity metrics (average symmetric surface distance, Hausdorff distance and intersection over union) compared to novice physicians.

Conclusion: We present a novel image segmentation model for brachial plexus ultrasound images. The model achieved high classification accuracy and significantly surpassed novice physicians in landmark segmentation. This performance suggests the potential for the model as an educational tool to aid novice physicians in learning brachial plexus anatomy.