Abstract The corpus callosum is the major interhemispheric tract that plays an important role in neurological function. Understanding the etiology and embryology development helps the ultrasound diagnosis for disorders of the corpus callosum and further counseling. The nonvisualization of cavum septum pellucidum or dysmorphic cavum septum pellucidum in axial view are indirect signs for beginners to diagnose complete agenesis of corpus callosum (cACC) and partial agenesis of the corpus callosum (pACC). Further coronal view, sagittal view, and fetal magnetic resonance imaging are also important for evaluation. Genetic testing plays an essential tool in anomalies of corpus callosum by revealing the underlying genetic pathophysiology, such as chromosomal anomalies and numerous monogenetic disorders in 30%–45% of ACC. Diagnosis and prediction of prognosis for hypoplasia or hyperplasia of the corpus callosum are more difficult compared to cACC and pACC because of the limited reports in the literature. However, the complex types often had poorer prognostic outcomes compared to the isolated types. Hence, it is important to evaluate and follow fetal conditions thoroughly to rule out intracranial or extracranial anomalies in other systems.
{"title":"Anomalies of the Corpus Callosum in Prenatal Ultrasound: A Narrative Review for Diagnosis and Further Counseling","authors":"Fang-Tzu Wu, Chih-Ping Chen","doi":"10.4103/jmu.jmu_49_23","DOIUrl":"https://doi.org/10.4103/jmu.jmu_49_23","url":null,"abstract":"Abstract The corpus callosum is the major interhemispheric tract that plays an important role in neurological function. Understanding the etiology and embryology development helps the ultrasound diagnosis for disorders of the corpus callosum and further counseling. The nonvisualization of cavum septum pellucidum or dysmorphic cavum septum pellucidum in axial view are indirect signs for beginners to diagnose complete agenesis of corpus callosum (cACC) and partial agenesis of the corpus callosum (pACC). Further coronal view, sagittal view, and fetal magnetic resonance imaging are also important for evaluation. Genetic testing plays an essential tool in anomalies of corpus callosum by revealing the underlying genetic pathophysiology, such as chromosomal anomalies and numerous monogenetic disorders in 30%–45% of ACC. Diagnosis and prediction of prognosis for hypoplasia or hyperplasia of the corpus callosum are more difficult compared to cACC and pACC because of the limited reports in the literature. However, the complex types often had poorer prognostic outcomes compared to the isolated types. Hence, it is important to evaluate and follow fetal conditions thoroughly to rule out intracranial or extracranial anomalies in other systems.","PeriodicalId":45466,"journal":{"name":"Journal of Medical Ultrasound","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135191926","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abstract Background: Rheumatoid arthritis (RA) is characterized by persistent synovitis and joint/bone destruction. There is an unmet need to predict the therapeutic response to disease-modifying anti-rheumatic drugs (DMARDs) and achieve a treat-to-target goal. Musculoskeletal ultrasound (MSUS) is widely used to identify structural change and assess therapeutic response in RA. This review aims to summarize the available evidence regarding the clinical application of MSUS in evaluating disease activity and predicting therapeutic responses to DMARDs. Methods: We searched the MEDLINE database using the PubMed interface and reviewed English-language literature from 2000 to 2022. This review focuses on the updated role of MSUS in assessing disease activity and predicting therapeutic responses to DMARDs in RA patients. Results: MSUS is now widely applied to identify articular structural change and assess the disease activity of RA. Combined use of gray scale and power Doppler MSUS is also superior to clinical assessment and laboratory examination in evaluating disease activity of RA. With portable use, good viability, and high sensitivity to articular inflammation, MSUS would be useful in assessing therapeutic response to biologic/targeted synthetic DMARDs (b/tsDMARDs) in RA patients. Given MSUS could also detect subclinical inflammation in a substantial proportion of RA patients with clinical remission, it is recommended to assess b/tsDMARDs-treated RA patients who have achieved low disease activity or remission. Conclusion: Although substantial literature data have revealed clinical utility of MSUS for monitoring disease activity and evaluating therapeutic response in RA patients, the evidence regarding its predictive value for the effectiveness of b/tsDMARDs is limited.
{"title":"The Clinical Utility of Musculoskeletal Ultrasound for Disease Activity Evaluation and Therapeutic Response Prediction in Rheumatoid Arthritis Patients: A Narrative Review","authors":"Chia-Ching Chen, Der-Yuan Chen","doi":"10.4103/jmu.jmu_126_22","DOIUrl":"https://doi.org/10.4103/jmu.jmu_126_22","url":null,"abstract":"Abstract Background: Rheumatoid arthritis (RA) is characterized by persistent synovitis and joint/bone destruction. There is an unmet need to predict the therapeutic response to disease-modifying anti-rheumatic drugs (DMARDs) and achieve a treat-to-target goal. Musculoskeletal ultrasound (MSUS) is widely used to identify structural change and assess therapeutic response in RA. This review aims to summarize the available evidence regarding the clinical application of MSUS in evaluating disease activity and predicting therapeutic responses to DMARDs. Methods: We searched the MEDLINE database using the PubMed interface and reviewed English-language literature from 2000 to 2022. This review focuses on the updated role of MSUS in assessing disease activity and predicting therapeutic responses to DMARDs in RA patients. Results: MSUS is now widely applied to identify articular structural change and assess the disease activity of RA. Combined use of gray scale and power Doppler MSUS is also superior to clinical assessment and laboratory examination in evaluating disease activity of RA. With portable use, good viability, and high sensitivity to articular inflammation, MSUS would be useful in assessing therapeutic response to biologic/targeted synthetic DMARDs (b/tsDMARDs) in RA patients. Given MSUS could also detect subclinical inflammation in a substantial proportion of RA patients with clinical remission, it is recommended to assess b/tsDMARDs-treated RA patients who have achieved low disease activity or remission. Conclusion: Although substantial literature data have revealed clinical utility of MSUS for monitoring disease activity and evaluating therapeutic response in RA patients, the evidence regarding its predictive value for the effectiveness of b/tsDMARDs is limited.","PeriodicalId":45466,"journal":{"name":"Journal of Medical Ultrasound","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135191924","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Kutlu Barış Teke, Nurettin Özgür Doğan, İbrahim Ulaş Özturan, Serkan Yılmaz, Elif Yaka, Murat Pekdemir
Abstract Background: Chronic obstructive pulmonary disease (COPD) exacerbations constitute a significant proportion of patients presenting to the emergency department (ED). It has been suggested that measurement of jugular venous diameter and compliance may have prognostic value in patients with heart failure. We hypothesized that these measurements may also be valuable in patients with advanced COPD. Methods: This study was a single-center, prospective, and cross-sectional study conducted in a university hospital between November 2020 and November 2021. In the study, internal jugular vein (IJV) diameters (inspiration, forced expiration, and rest) and jugular venous compliance were measured with ultrasound in patients who presented to the ED with COPD exacerbation. One month later, data about mortality, intensive care unit (ICU) admission, and any hospitalization were obtained and evaluated together with a range of laboratory parameters. Results: Data from a total of 93 patients were analyzed. Of these, 17 (18.2%) died, 19 (20.4%) were admitted to the ICU, and 36 (38.7%) were hospitalized at the end of the 1-month period. Consequently, a total of 44 patients (47.3%) were in the good outcome group and 49 patients (52.7%) were in the poor outcome group. In terms of mortality, inspiratory IJV diameter was 5.6 ± 2.9 mm in the survived group ( n = 76) and 7.6 ± 3.9 mm in the deceased group ( n = 17) ( P = 0.031). There was no difference between the venous compliance values and other diameter measurements of the patients. In the analysis performed with the subgroup with high N-terminal prohormone brain natriuretic peptide values, it was shown that both resting and inspiration diameter measurements were higher in the group with poor outcomes. Conclusion: There was no difference between the jugular vein compliance values in terms of mortality in patients admitted to the ED with COPD exacerbation. However, these measurements may have prognostic value in patients with COPD exacerbations complicated by heart failure.
背景:慢性阻塞性肺疾病(COPD)急性加重在急诊科(ED)就诊的患者中占很大比例。有人认为，测量颈静脉直径和依从性可能对心力衰竭患者的预后有价值。我们假设这些测量对晚期COPD患者也有价值。方法:本研究是一项单中心、前瞻性、横断面研究，于2020年11月至2021年11月在某大学医院进行。在这项研究中，用超声测量了伴有COPD加重的ED患者颈内静脉(IJV)直径(吸气、用力呼气和休息)和颈内静脉顺应性。一个月后，获得死亡率、重症监护病房(ICU)入院和任何住院情况的数据，并与一系列实验室参数一起进行评估。结果:共分析了93例患者的资料。其中死亡17例(18.2%)，入住ICU 19例(20.4%)，1个月结束时住院36例(38.7%)。结果，良结局组44例(47.3%)，差结局组49例(52.7%)。在病死率方面，存活组为5.6±2.9 mm (n = 76)，死亡组为7.6±3.9 mm (n = 17) (P = 0.031)。静脉顺应性值与患者的其他直径测量值之间没有差异。在对n端激素原脑利钠肽值高的亚组进行的分析中，结果表明，在预后较差的组中，静息和吸入直径测量值都较高。结论:在急诊科合并COPD加重患者中，颈静脉顺应性值与死亡率无显著差异。然而，这些测量可能对合并心力衰竭的COPD加重患者有预后价值。
{"title":"Prognostic Value of Jugular Venous Diameters and Compliance in Patients with Exacerbation of Chronic Obstructive Pulmonary Disease","authors":"Kutlu Barış Teke, Nurettin Özgür Doğan, İbrahim Ulaş Özturan, Serkan Yılmaz, Elif Yaka, Murat Pekdemir","doi":"10.4103/jmu.jmu_83_23","DOIUrl":"https://doi.org/10.4103/jmu.jmu_83_23","url":null,"abstract":"Abstract Background: Chronic obstructive pulmonary disease (COPD) exacerbations constitute a significant proportion of patients presenting to the emergency department (ED). It has been suggested that measurement of jugular venous diameter and compliance may have prognostic value in patients with heart failure. We hypothesized that these measurements may also be valuable in patients with advanced COPD. Methods: This study was a single-center, prospective, and cross-sectional study conducted in a university hospital between November 2020 and November 2021. In the study, internal jugular vein (IJV) diameters (inspiration, forced expiration, and rest) and jugular venous compliance were measured with ultrasound in patients who presented to the ED with COPD exacerbation. One month later, data about mortality, intensive care unit (ICU) admission, and any hospitalization were obtained and evaluated together with a range of laboratory parameters. Results: Data from a total of 93 patients were analyzed. Of these, 17 (18.2%) died, 19 (20.4%) were admitted to the ICU, and 36 (38.7%) were hospitalized at the end of the 1-month period. Consequently, a total of 44 patients (47.3%) were in the good outcome group and 49 patients (52.7%) were in the poor outcome group. In terms of mortality, inspiratory IJV diameter was 5.6 ± 2.9 mm in the survived group ( n = 76) and 7.6 ± 3.9 mm in the deceased group ( n = 17) ( P = 0.031). There was no difference between the venous compliance values and other diameter measurements of the patients. In the analysis performed with the subgroup with high N-terminal prohormone brain natriuretic peptide values, it was shown that both resting and inspiration diameter measurements were higher in the group with poor outcomes. Conclusion: There was no difference between the jugular vein compliance values in terms of mortality in patients admitted to the ED with COPD exacerbation. However, these measurements may have prognostic value in patients with COPD exacerbations complicated by heart failure.","PeriodicalId":45466,"journal":{"name":"Journal of Medical Ultrasound","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135191925","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abstract Background: There is continued research to find new faster, highly accurate, easily accessible, and portable methods of confirming endotracheal tube position during intubation. A newer modality for visualizing endotracheal tube location is transtracheal or transcricothyroid ultrasonography. The aim of this study was to see if ultrasound machine can also be routinely used for the confirmation of endotracheal tube position in operating theaters along with capnograph. Methods: The study was observational and prospective, conducted from January 2017 to July 2017. Study locations were at the Tribhuvan University Teaching Hospital and Manmohan Cardiothoracic Vascular and Transplant Center operating rooms. Sample size taken was 95. Results: In the study, 11 patients had esophageal intubation out of the 95. The accuracy of both ultrasonography and capnography was found to be 96.84%. For ultrasonography, the sensitivity, specificity, along with positive predictive value and negative predictive value were 97.62%, 90.91%, 98.80%, and 83.33%, respectively, while that for capnography were found to be 96.43%, 100%, 100%, and 78.57%, respectively. The kappa value was calculated to be 0.749, which suggested the degree of agreement of result between the methods to be good. Compared to capnography, ultrasonography was found to be significantly faster for the confirmation of endotracheal tube location by 16.36 s (15.70–17.02) ( P = 0.011). Conclusion: Both waveform capnography and ultrasonography were found to be accurate and reliable in confirming endotracheal tube location. The use of ultrasound during intubation can help confirm endotracheal tube location faster and also aid in precision when used along with capnography. Manual bag ventilations are not necessary when confirming endotracheal tube position by ultrasonography and thus may help in preventing aspiration of gastric contents into the lungs of the patient.
{"title":"Ultrasonography Imaging versus Waveform Capnography in Detecting Endotracheal Tube Placement during Intubation at a Tertiary Hospital","authors":"Shirish Shakti Maskay, Ninadini Shrestha, Priska Bastola, Bishwas Pradhan, Anil Shrestha","doi":"10.4103/jmu.jmu_98_22","DOIUrl":"https://doi.org/10.4103/jmu.jmu_98_22","url":null,"abstract":"Abstract Background: There is continued research to find new faster, highly accurate, easily accessible, and portable methods of confirming endotracheal tube position during intubation. A newer modality for visualizing endotracheal tube location is transtracheal or transcricothyroid ultrasonography. The aim of this study was to see if ultrasound machine can also be routinely used for the confirmation of endotracheal tube position in operating theaters along with capnograph. Methods: The study was observational and prospective, conducted from January 2017 to July 2017. Study locations were at the Tribhuvan University Teaching Hospital and Manmohan Cardiothoracic Vascular and Transplant Center operating rooms. Sample size taken was 95. Results: In the study, 11 patients had esophageal intubation out of the 95. The accuracy of both ultrasonography and capnography was found to be 96.84%. For ultrasonography, the sensitivity, specificity, along with positive predictive value and negative predictive value were 97.62%, 90.91%, 98.80%, and 83.33%, respectively, while that for capnography were found to be 96.43%, 100%, 100%, and 78.57%, respectively. The kappa value was calculated to be 0.749, which suggested the degree of agreement of result between the methods to be good. Compared to capnography, ultrasonography was found to be significantly faster for the confirmation of endotracheal tube location by 16.36 s (15.70–17.02) ( P = 0.011). Conclusion: Both waveform capnography and ultrasonography were found to be accurate and reliable in confirming endotracheal tube location. The use of ultrasound during intubation can help confirm endotracheal tube location faster and also aid in precision when used along with capnography. Manual bag ventilations are not necessary when confirming endotracheal tube position by ultrasonography and thus may help in preventing aspiration of gastric contents into the lungs of the patient.","PeriodicalId":45466,"journal":{"name":"Journal of Medical Ultrasound","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135191927","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Eduardo Reyna-Villasmil, Liliana Briceño-Sanabria, Juan Carlos Briceño-Sanabria, Carlos Briceño-Pérez
Abstract Pulmonary agenesis (PA) is a rare developmental malformation, with a frequency of approximately 1 in 10–15,000 pregnancies. Unilateral PA is often associated with other congenital anomalies, whereas bilateral PA is fatal. Prenatal diagnosis is rare and is diagnosed more frequently in the postnatal period than in the prenatal period. Is a challenge that may be difficult as it shares similar features with other more common pathologies. Ultrasound plays a crucial role in early diagnosis and management. Ultrasonographic findings for a correct prenatal diagnosis include mediastinum displacement with the absence of parenchymal or cystic tissue, decreased thoracic volume, an elevated diaphragm, cardiac axis deviation, and a hemithoracic cavity largely occupied by the heart. Cases of right PA have a worse prognosis compared to left PA, probably due to higher frequency of cardiac and great vessel abnormalities. A rare case of early prenatal ultrasound diagnosis of unilateral fetal PA, at 18 weeks of gestation, is reported.
{"title":"Prenatal Ultrasound Diagnosis of Unilateral Pulmonary Agenesis","authors":"Eduardo Reyna-Villasmil, Liliana Briceño-Sanabria, Juan Carlos Briceño-Sanabria, Carlos Briceño-Pérez","doi":"10.4103/jmu.jmu_24_23","DOIUrl":"https://doi.org/10.4103/jmu.jmu_24_23","url":null,"abstract":"Abstract Pulmonary agenesis (PA) is a rare developmental malformation, with a frequency of approximately 1 in 10–15,000 pregnancies. Unilateral PA is often associated with other congenital anomalies, whereas bilateral PA is fatal. Prenatal diagnosis is rare and is diagnosed more frequently in the postnatal period than in the prenatal period. Is a challenge that may be difficult as it shares similar features with other more common pathologies. Ultrasound plays a crucial role in early diagnosis and management. Ultrasonographic findings for a correct prenatal diagnosis include mediastinum displacement with the absence of parenchymal or cystic tissue, decreased thoracic volume, an elevated diaphragm, cardiac axis deviation, and a hemithoracic cavity largely occupied by the heart. Cases of right PA have a worse prognosis compared to left PA, probably due to higher frequency of cardiac and great vessel abnormalities. A rare case of early prenatal ultrasound diagnosis of unilateral fetal PA, at 18 weeks of gestation, is reported.","PeriodicalId":45466,"journal":{"name":"Journal of Medical Ultrasound","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135874380","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
SECTION 1 – QUIZ CASE A 36-year-old man experienced pain in the dorsal area of his right foot after being struck by a stone 2 weeks ago. Initially, there had been visible bruising, which was absent by the time he visited the ultrasound examination room. However, the swelling was still present on the dorsal side of his right foot. There was not any instability of the ankle. The ultrasound (US) transducer was placed on the dorsal side of his right foot [Figure 1a] and gradually moved to the plantar surface [Figure 1b]. US image of the unaffected/asymptomatic side is given in Figure 2. Based on these findings, what is your suggestive diagnosis?Figure 1: Ultrasound imaging of the right anterolateral (a) and inferolateral (b) ankle. Black arrowheads, the lateral root of the inferior extensor retinaculum; black arrow, the intermediate root of the inferior extensor retinaculum; white arrowheads, the medial root of the inferior extensor retinaculum. T: Talus, C: Calcaneus, EDL: Extensor digitorum longus tendonFigure 2: Ultrasound imaging of the left inferolateral ankle. Black arrowheads, the lateral root of the inferior extensor retinaculum; white arrowheads, the medial root of the inferior extensor retinaculum. T: Talus, EDL: Extensor digitorum longus tendonDeclaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given his consent for his images and other clinical information to be reported in the journal. The patient understands that his name and initials will not be published, and due efforts will be made to conceal his identity, but anonymity cannot be guaranteed. Financial support and sponsorship This work was funded by the National Taiwan University Hospital, Bei-Hu Branch; Ministry of Science and Technology (MOST 106-2314-B-002-180-MY3 and 109-2314-B-002-114-MY3); and the Taiwan Society of Ultrasound in Medicine. Conflicts of interest Dr. Ke-Vin Chang, an editorial board member at the Journal of Medical Ultrasound, had no role in the peer-review process or decision to publish this article. The other authors declared no conflicts of interest in writing this article.
一名36岁的男子在两周前被石头击中后，右脚背部疼痛。起初，他身上有明显的瘀伤，但在他去超声波检查室检查时已经没有了。然而，他的右脚背部仍然肿胀。踝关节没有任何不稳定。将超声(US)换能器置于右脚背侧[图1a]，并逐渐移至足底表面[图1b]。未受影响/无症状一侧的美片如图2所示。基于这些发现，你的诊断是什么?图1:右踝关节前外侧(a)和外外侧(b)的超声成像。黑色箭头，下伸肌支持带侧根;黑箭头表示下伸肌支持带中间根;白色箭头，下伸肌支持带的内侧根。T:距骨，C:跟骨，EDL:指长伸肌腱。图2:左踝关节外外侧超声成像。黑色箭头，下伸肌支持带侧根;白色箭头，下伸肌支持带的内侧根。T:距骨，EDL:指长伸肌腱患者同意声明作者证明他们已经获得了所有适当的患者同意表格。在这张表格中，患者已经同意他的图像和其他临床信息将在杂志上报道。患者明白他的姓名和首字母不会被公布，并且会尽力隐藏他的身份，但不能保证匿名。本工作由台湾大学附属医院北湖分院资助;科技部(MOST 106-2314-B-002-180-MY3和109-2314-B-002-114-MY3);以及台湾超声医学学会。《医学超声杂志》(Journal of Medical Ultrasound)的编辑委员会成员张克文(Ke-Vin Chang)博士没有参与同行评议过程，也没有参与发表这篇文章的决定。其他作者声明在撰写这篇文章时没有利益冲突。
{"title":"A 36-year-old Man with Right Dorsal Ankle Pain","authors":"Ke-Vin Chang, Wei-Ting Wu, Levent Özçakar","doi":"10.4103/jmu.jmu_61_23","DOIUrl":"https://doi.org/10.4103/jmu.jmu_61_23","url":null,"abstract":"SECTION 1 – QUIZ CASE A 36-year-old man experienced pain in the dorsal area of his right foot after being struck by a stone 2 weeks ago. Initially, there had been visible bruising, which was absent by the time he visited the ultrasound examination room. However, the swelling was still present on the dorsal side of his right foot. There was not any instability of the ankle. The ultrasound (US) transducer was placed on the dorsal side of his right foot [Figure 1a] and gradually moved to the plantar surface [Figure 1b]. US image of the unaffected/asymptomatic side is given in Figure 2. Based on these findings, what is your suggestive diagnosis?Figure 1: Ultrasound imaging of the right anterolateral (a) and inferolateral (b) ankle. Black arrowheads, the lateral root of the inferior extensor retinaculum; black arrow, the intermediate root of the inferior extensor retinaculum; white arrowheads, the medial root of the inferior extensor retinaculum. T: Talus, C: Calcaneus, EDL: Extensor digitorum longus tendonFigure 2: Ultrasound imaging of the left inferolateral ankle. Black arrowheads, the lateral root of the inferior extensor retinaculum; white arrowheads, the medial root of the inferior extensor retinaculum. T: Talus, EDL: Extensor digitorum longus tendonDeclaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given his consent for his images and other clinical information to be reported in the journal. The patient understands that his name and initials will not be published, and due efforts will be made to conceal his identity, but anonymity cannot be guaranteed. Financial support and sponsorship This work was funded by the National Taiwan University Hospital, Bei-Hu Branch; Ministry of Science and Technology (MOST 106-2314-B-002-180-MY3 and 109-2314-B-002-114-MY3); and the Taiwan Society of Ultrasound in Medicine. Conflicts of interest Dr. Ke-Vin Chang, an editorial board member at the Journal of Medical Ultrasound, had no role in the peer-review process or decision to publish this article. The other authors declared no conflicts of interest in writing this article.","PeriodicalId":45466,"journal":{"name":"Journal of Medical Ultrasound","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135874382","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
SECTION 2 – ANSWER CASE A 36-year-old man experienced pain in the dorsal area of his right foot after being struck by a stone 2 weeks ago. Initially, there had been visible bruising which was absent by the time he visited the ultrasound (US) examination room. However, the swelling was still present on the dorsal side of his right foot. There was not any instability of the ankle. The US transducer was placed on the dorsal side of his right foot [Figure 1a] and gradually moved to the plantar surface [Figure 1b]. US image of the unaffected/asymptomatic side is given in Figure 2. Based on these findings, what is your suggestive diagnosis?Figure 1: Ultrasound imaging of the right anterolateral (a) and inferolateral (b) ankle. Black arrowheads: Lateral root of the inferior extensor retinaculum, black arrow: Intermediate root of the inferior extensor retinaculum, white arrowheads: Medial root of the inferior extensor retinaculum, T: Talus, C: Calcaneus, EDL: Extensor digitorum longus tendonFigure 2: Ultrasound imaging of the left inferolateral ankle. Black arrowheads: Lateral root of the inferior extensor retinaculum, black arrowheads: Intermediate root of the inferior extensor retinaculum, white arrowheads: Medial root of the inferior extensor retinaculum, T: talus, EDL: Extensor digitorum longus tendonINTERPRETATION In this case, US examination of the right ankle revealed normal anterior talofibular and calcaneofibular ligaments. However, the inferior extensor retinaculum appeared thickened and showed a loss of fibrillary patterns, particularly in its lateral root [Figure 1]. The extensor digitorum longus tendon seemed to be normal. Herewith, the left inferior extensor retinaculum maintained its fibrillary pattern and was thinner compared to the right side [Figure 2]. The diagnosis of an inferior extensor retinaculum injury was confirmed. Subsequently, the patient underwent physical therapy, including US diathermy and transcutaneous electrical stimulation. After 1 month of treatment, the patient’s pain subsided. As the patient experienced substantial symptom improvement after treatment, a follow-up US examination for the affected ankle was not scheduled. DISCUSSION The ankle region harbors three main retinacula. The anterior retinaculum covers the anterior aspect of the ankle and consists of the superior and inferior extensor retinacula.[1] The lateral aspect of the ankle is protected by the superior and inferior peroneal retinacula, while the medial ankle is reinforced by the flexor retinaculum. These retinacula are thickened extensions of the crural fascia, a connective tissue that surrounds the muscles of the lower leg. Their primary function is to stabilize the tendons of the ankle and foot. Since the anterior aspect of the ankle is more susceptible to traumatic injuries, pathologies involving the superior and inferior extensor retinacula are theoretically more common as compared to the flexor and peroneal retinacula. In this particular case, the
一名36岁男子在2周前被石头击中后，右脚背部疼痛。最初，他有明显的瘀伤，但当他去超声波(美国)检查室时已经没有了。然而，他的右脚背部仍然肿胀。踝关节没有任何不稳定。将US换能器置于右脚背侧[图1a]，并逐渐移至足底表面[图1b]。未受影响/无症状一侧的美片如图2所示。基于这些发现，你的诊断是什么?图1:右踝关节前外侧(a)和外外侧(b)的超声成像。黑色箭头:下伸肌支持带侧根，黑色箭头:下伸肌支持带中间根，白色箭头:下伸肌支持带内侧根，T:距骨，C:跟骨，EDL:指长伸肌肌腱图2:左踝关节外外侧超声成像。黑色箭头:下伸肌支持带侧根，黑色箭头:下伸肌支持带中间根，白色箭头:下伸肌支持带内侧根，T:距骨，EDL:指长伸肌腱解释本例右踝关节超声检查显示距腓骨前韧带和跟腓骨韧带正常。然而，下伸肌视网膜带增厚，并表现出纤维模式的缺失，特别是在其侧根[图1]。指长伸肌腱似乎正常。因此，左侧下伸肌视网膜带保持其原纤维形态，且较右侧更薄[图2]。确诊为下伸肌网膜损伤。随后，患者接受物理治疗，包括美国透热和经皮电刺激。治疗1个月后，患者疼痛减轻。由于患者在治疗后症状明显改善，因此未安排对受影响的踝关节进行后续美国检查。踝关节区域有三个主要的视网膜。前视网膜带覆盖脚踝的前部，由上伸肌和下伸肌视网膜组成。[1]踝关节外侧由上下腓网膜保护，踝关节内侧由屈肌网膜加强。这些视网膜是脚筋膜的增厚延伸，脚筋膜是包围小腿肌肉的结缔组织。它们的主要功能是稳定脚踝和足部的肌腱。由于踝关节前部更容易受到外伤性损伤，理论上，与屈肌和腓肌视网膜相比，涉及上伸肌和下伸肌视网膜的病变更常见。在这个特殊的病例中，主要的病理发现是在下伸肌视网膜带中观察到的，它由四个组成部分组成:额状韧带、斜内侧间带、斜上内侧带和斜上外侧带。[1]值得注意的是，并非所有病例都存在斜上外侧腱束，下伸肌支持带可能呈y形结构。[2]额状韧带主要包括外侧根、中间根和内侧根，包裹着指长伸肌。所有三个根都可以通过US成像在足的轴向面可视化。当下伸肌视网膜带受伤时，它经常变厚。[3]外伤性病例可表现为跟骨、胫骨、楔状骨和舟骨上附着的撕脱。部分或完全撕裂可导致下伸肌支持带不连续性。此外，还可能出现指长伸肌腱鞘炎。此外，在支持带松弛的情况下，指长伸肌可能会半脱位，因此动态超声检查肯定会有所帮助。最后但并非最不重要的是，对于下伸肌视网膜带损伤的患者，检查腓浅神经分支是否有潜在的附带损伤是至关重要的。[4]患者同意声明作者证明他们已经获得了所有适当的患者同意表格。在这张表格中，患者已经同意他的图像和其他临床信息将在杂志上报道。患者明白姓名和首字母不会被公布，并将尽力隐藏身份，但不能保证匿名。本工作由台湾大学附属医院北湖分院资助;科技部(MOST 106-2314B-002-180-MY3和109-2314B-002-114-MY3);以及台湾超声医学学会。 《医学超声杂志》(Journal of Medical Ultrasound)编委会成员张克文(Ke-Vin Chang)博士没有参与本文的同行评议过程或发表决定。其他作者声明在撰写这篇文章时没有利益冲突。
{"title":"A 36-year-old Man with Right Dorsal Ankle Pain – Ultrasound Examination for Inferior Extensor Retinaculum Injury","authors":"Ke-Vin Chang, Wei-Ting Wu, Levent Özçakar","doi":"10.4103/jmu.jmu_62_23","DOIUrl":"https://doi.org/10.4103/jmu.jmu_62_23","url":null,"abstract":"SECTION 2 – ANSWER CASE A 36-year-old man experienced pain in the dorsal area of his right foot after being struck by a stone 2 weeks ago. Initially, there had been visible bruising which was absent by the time he visited the ultrasound (US) examination room. However, the swelling was still present on the dorsal side of his right foot. There was not any instability of the ankle. The US transducer was placed on the dorsal side of his right foot [Figure 1a] and gradually moved to the plantar surface [Figure 1b]. US image of the unaffected/asymptomatic side is given in Figure 2. Based on these findings, what is your suggestive diagnosis?Figure 1: Ultrasound imaging of the right anterolateral (a) and inferolateral (b) ankle. Black arrowheads: Lateral root of the inferior extensor retinaculum, black arrow: Intermediate root of the inferior extensor retinaculum, white arrowheads: Medial root of the inferior extensor retinaculum, T: Talus, C: Calcaneus, EDL: Extensor digitorum longus tendonFigure 2: Ultrasound imaging of the left inferolateral ankle. Black arrowheads: Lateral root of the inferior extensor retinaculum, black arrowheads: Intermediate root of the inferior extensor retinaculum, white arrowheads: Medial root of the inferior extensor retinaculum, T: talus, EDL: Extensor digitorum longus tendonINTERPRETATION In this case, US examination of the right ankle revealed normal anterior talofibular and calcaneofibular ligaments. However, the inferior extensor retinaculum appeared thickened and showed a loss of fibrillary patterns, particularly in its lateral root [Figure 1]. The extensor digitorum longus tendon seemed to be normal. Herewith, the left inferior extensor retinaculum maintained its fibrillary pattern and was thinner compared to the right side [Figure 2]. The diagnosis of an inferior extensor retinaculum injury was confirmed. Subsequently, the patient underwent physical therapy, including US diathermy and transcutaneous electrical stimulation. After 1 month of treatment, the patient’s pain subsided. As the patient experienced substantial symptom improvement after treatment, a follow-up US examination for the affected ankle was not scheduled. DISCUSSION The ankle region harbors three main retinacula. The anterior retinaculum covers the anterior aspect of the ankle and consists of the superior and inferior extensor retinacula.[1] The lateral aspect of the ankle is protected by the superior and inferior peroneal retinacula, while the medial ankle is reinforced by the flexor retinaculum. These retinacula are thickened extensions of the crural fascia, a connective tissue that surrounds the muscles of the lower leg. Their primary function is to stabilize the tendons of the ankle and foot. Since the anterior aspect of the ankle is more susceptible to traumatic injuries, pathologies involving the superior and inferior extensor retinacula are theoretically more common as compared to the flexor and peroneal retinacula. In this particular case, the ","PeriodicalId":45466,"journal":{"name":"Journal of Medical Ultrasound","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135874383","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Rohit Ravindra Joat, Suresh Vasant Phatak, Azhar Shoaib Shaikh, Gajanan K. Wattamwar, Ganesh S. Narwane
SECTION 2 – ANSWER Case A 45-year-old nondiabetic male presented with complaints of pain in the right hypochondrium for 6 months, which was aggravated in the last 10 days. There was no history of trauma. Ultrasound and computed tomography (CT) evaluation of the abdomen was performed [Figures 1-3].Figure 1: Grayscale ultrasonography image of the liver and gallbladder showing multiple calculi in the lumen of the gallbladder which shows posterior acoustic shadowingFigure 2: Grayscale ultrasound image showing the defect in the wall of gallbladder (sonographic hole sign)Figure 3: Computed tomography image showing defect in the gallbladder wall (sonographic hole sign) and pericholecystic collectionInterpretation Ultrasound and CT images of the abdomen showed a defect in the wall of the gallbladder with pericholecystic fluid collection [Figures 2 and 3]. Hence, the diagnosis, here, is gallbladder perforation. Furthermore, we can see a hyperechoic focus in the lumen of the gallbladder showing posterior acoustic shadowing [Figure 1], which is consistent with the diagnosis of cholelithiasis. Perforation of the gallbladder is a rare entity with devastating consequences and risk to life. Various causes of perforation include idiopathic, traumatic, iatrogenic, cholelithiasis, infections, steroid use, and uncontrolled diabetes. These patients are predisposed to this condition.[1] Patients with gallbladder perforation present with acute pain without any known cause. The pain is usually starts in the right hypochondrium and then spreads to whole of the abdomen. The pain aggravates on movement and relieved by rest. The patient also has tenderness, rigidity, and guarding which are also the signs of peritonitis. Other symptoms with which patient can present include nausea and vomiting. Spectrum of ultrasound finding includes gallbladder distension, pericholecystic fluid, and sonographic hole sign which has a very high specificity for diagnosis.[2] CT is considered a superior modality than ultrasound due to its ability to show focal wall defect. It also shows extraluminal gallstones as well as Mercedes-Benz sign (gas within gallstones) along with location and extent of abscess due to perforation.[3] Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given his consent for his images and other clinical information to be reported in the journal. The patient understands that his name and the initials will not be published and due efforts will be made to conceal the identity, but anonymity cannot be guaranteed. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.
{"title":"A Male Patient with Severe Pain in the Right Hypochondrium","authors":"Rohit Ravindra Joat, Suresh Vasant Phatak, Azhar Shoaib Shaikh, Gajanan K. Wattamwar, Ganesh S. Narwane","doi":"10.4103/jmu.jmu_92_23","DOIUrl":"https://doi.org/10.4103/jmu.jmu_92_23","url":null,"abstract":"SECTION 2 – ANSWER Case A 45-year-old nondiabetic male presented with complaints of pain in the right hypochondrium for 6 months, which was aggravated in the last 10 days. There was no history of trauma. Ultrasound and computed tomography (CT) evaluation of the abdomen was performed [Figures 1-3].Figure 1: Grayscale ultrasonography image of the liver and gallbladder showing multiple calculi in the lumen of the gallbladder which shows posterior acoustic shadowingFigure 2: Grayscale ultrasound image showing the defect in the wall of gallbladder (sonographic hole sign)Figure 3: Computed tomography image showing defect in the gallbladder wall (sonographic hole sign) and pericholecystic collectionInterpretation Ultrasound and CT images of the abdomen showed a defect in the wall of the gallbladder with pericholecystic fluid collection [Figures 2 and 3]. Hence, the diagnosis, here, is gallbladder perforation. Furthermore, we can see a hyperechoic focus in the lumen of the gallbladder showing posterior acoustic shadowing [Figure 1], which is consistent with the diagnosis of cholelithiasis. Perforation of the gallbladder is a rare entity with devastating consequences and risk to life. Various causes of perforation include idiopathic, traumatic, iatrogenic, cholelithiasis, infections, steroid use, and uncontrolled diabetes. These patients are predisposed to this condition.[1] Patients with gallbladder perforation present with acute pain without any known cause. The pain is usually starts in the right hypochondrium and then spreads to whole of the abdomen. The pain aggravates on movement and relieved by rest. The patient also has tenderness, rigidity, and guarding which are also the signs of peritonitis. Other symptoms with which patient can present include nausea and vomiting. Spectrum of ultrasound finding includes gallbladder distension, pericholecystic fluid, and sonographic hole sign which has a very high specificity for diagnosis.[2] CT is considered a superior modality than ultrasound due to its ability to show focal wall defect. It also shows extraluminal gallstones as well as Mercedes-Benz sign (gas within gallstones) along with location and extent of abscess due to perforation.[3] Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given his consent for his images and other clinical information to be reported in the journal. The patient understands that his name and the initials will not be published and due efforts will be made to conceal the identity, but anonymity cannot be guaranteed. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.","PeriodicalId":45466,"journal":{"name":"Journal of Medical Ultrasound","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136312289","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Rohit Ravindra Joat, Suresh Vasant Phatak, Azhar Shoaib Shaikh, Gajanan K. Wattamwar, Ganesh S. Narwane
SECTION 1 – QUIZ Case A 45-year-old male presented with complaints of pain in the right hypochondrium for 6 months, which was aggravated in the last 10 days. There was no history of trauma. Ultrasound and computed tomography evaluation of the abdomen were performed [Figures 1-3].Figure 1: Grayscale ultrasound image of the liver and gallbladderFigure 2: Grayscale ultrasound image of the gallbladderFigure 3: Computed tomography image of the abdomenDeclaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given his consent for his images and other clinical information to be reported in the journal. The patient understands that his name and initials will not be published, and due efforts will be made to conceal the identity, but anonymity cannot be guaranteed. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.
{"title":"A Male Patient with Severe Pain in the Right Hypochondrium","authors":"Rohit Ravindra Joat, Suresh Vasant Phatak, Azhar Shoaib Shaikh, Gajanan K. Wattamwar, Ganesh S. Narwane","doi":"10.4103/jmu.jmu_89_23","DOIUrl":"https://doi.org/10.4103/jmu.jmu_89_23","url":null,"abstract":"SECTION 1 – QUIZ Case A 45-year-old male presented with complaints of pain in the right hypochondrium for 6 months, which was aggravated in the last 10 days. There was no history of trauma. Ultrasound and computed tomography evaluation of the abdomen were performed [Figures 1-3].Figure 1: Grayscale ultrasound image of the liver and gallbladderFigure 2: Grayscale ultrasound image of the gallbladderFigure 3: Computed tomography image of the abdomenDeclaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given his consent for his images and other clinical information to be reported in the journal. The patient understands that his name and initials will not be published, and due efforts will be made to conceal the identity, but anonymity cannot be guaranteed. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.","PeriodicalId":45466,"journal":{"name":"Journal of Medical Ultrasound","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136311390","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Mustafa Turgut Yildizgoren, Burak Ekici, Fatih Bagcier
Dear Editor, Piriformis syndrome (PS) is a condition that is characterized by pain associated with the piriformis muscle. This syndrome encompasses various pathological changes of the piriformis muscle, such as those caused by myofascial pain, anatomical variations, muscle hypertrophy, trauma, and any external condition that causes pain similar to PS. PS can arise from a range of lesions, including herniated or degenerative lumbar discs, lumbar facet syndrome, trochanteric bursitis, sacroiliac joint dysfunction, and endometriosis.[1] The management of PS typically begins with pharmacotherapy and physical therapy. When the conservative regimen fails, injection can be applied to the piriformis muscle to relieve pain.[2] Piriformis muscle injections were conventionally performed without image guidance in clinics by physicians. However, due to the muscle's small size, deep location, and proximity to critical neurovascular structures, using image guidance has been suggested to enhance accuracy and minimize risk.[3] Beaton and Anson explained six distinct anatomical configurations involving the relationship between the sciatic nerve and the piriformis muscle. In >80% of the population, the sciatic nerve passes deep and exits inferiorly to the inferior edge of the muscle belly/tendon.[4] The success rate of blind injections is generally low, as evidenced by the various techniques that utilize different landmarks. A study conducted on cadavers comparing ultrasound-guided versus fluoroscopically-guided piriformis injections revealed a success rate of 95% with ultrasound guidance, whereas only a 30% success rate was observed with fluoroscopic guidance.[3] Identifying the piriformis muscle through palpation of anatomical landmarks can be challenging. We recommend a four-step ultrasound-guided approach for the piriformis muscle. To find the piriformis muscle easily under ultrasound guidance, the patient is positioned prone, and the lumbosacral area is aseptically prepared for injection. Using a low-frequency curvilinear probe, the transverse plane is examined with the medial border of the probe positioned on the posterior superior iliac spine (PSIS). All steps are performed by using the transverse ultrasonographic view: Step 1: The transducer is positioned transversely on the PSIS [Figure 1a] Step 2: The transducer is moved laterally until the iliac cortex and gluteus Maximus muscle are appeared [Figure 1b]. The iliac bone appears as a hyperechoic structure (curved line) Step 3: At this level, the transducer is moved in the caudal direction toward to obtain the axial sonographic view of the sciatic notch [Figure 1c]. Using Doppler imaging, the inferior gluteal artery can be visualized close to the sciatic nerve, while the superior gluteal artery is situated between the gluteus Maximus muscle and the piriformis muscle [Figure 1d] Step 4: Next, one end of the transducer is directed toward the greater trochanter to obtain the piriformis muscle. At this level, t
{"title":"Find the Piriformis Muscle Easily: From Anatomical Landmark to Sonographic Target","authors":"Mustafa Turgut Yildizgoren, Burak Ekici, Fatih Bagcier","doi":"10.4103/jmu.jmu_48_23","DOIUrl":"https://doi.org/10.4103/jmu.jmu_48_23","url":null,"abstract":"Dear Editor, Piriformis syndrome (PS) is a condition that is characterized by pain associated with the piriformis muscle. This syndrome encompasses various pathological changes of the piriformis muscle, such as those caused by myofascial pain, anatomical variations, muscle hypertrophy, trauma, and any external condition that causes pain similar to PS. PS can arise from a range of lesions, including herniated or degenerative lumbar discs, lumbar facet syndrome, trochanteric bursitis, sacroiliac joint dysfunction, and endometriosis.[1] The management of PS typically begins with pharmacotherapy and physical therapy. When the conservative regimen fails, injection can be applied to the piriformis muscle to relieve pain.[2] Piriformis muscle injections were conventionally performed without image guidance in clinics by physicians. However, due to the muscle's small size, deep location, and proximity to critical neurovascular structures, using image guidance has been suggested to enhance accuracy and minimize risk.[3] Beaton and Anson explained six distinct anatomical configurations involving the relationship between the sciatic nerve and the piriformis muscle. In >80% of the population, the sciatic nerve passes deep and exits inferiorly to the inferior edge of the muscle belly/tendon.[4] The success rate of blind injections is generally low, as evidenced by the various techniques that utilize different landmarks. A study conducted on cadavers comparing ultrasound-guided versus fluoroscopically-guided piriformis injections revealed a success rate of 95% with ultrasound guidance, whereas only a 30% success rate was observed with fluoroscopic guidance.[3] Identifying the piriformis muscle through palpation of anatomical landmarks can be challenging. We recommend a four-step ultrasound-guided approach for the piriformis muscle. To find the piriformis muscle easily under ultrasound guidance, the patient is positioned prone, and the lumbosacral area is aseptically prepared for injection. Using a low-frequency curvilinear probe, the transverse plane is examined with the medial border of the probe positioned on the posterior superior iliac spine (PSIS). All steps are performed by using the transverse ultrasonographic view: Step 1: The transducer is positioned transversely on the PSIS [Figure 1a] Step 2: The transducer is moved laterally until the iliac cortex and gluteus Maximus muscle are appeared [Figure 1b]. The iliac bone appears as a hyperechoic structure (curved line) Step 3: At this level, the transducer is moved in the caudal direction toward to obtain the axial sonographic view of the sciatic notch [Figure 1c]. Using Doppler imaging, the inferior gluteal artery can be visualized close to the sciatic nerve, while the superior gluteal artery is situated between the gluteus Maximus muscle and the piriformis muscle [Figure 1d] Step 4: Next, one end of the transducer is directed toward the greater trochanter to obtain the piriformis muscle. At this level, t","PeriodicalId":45466,"journal":{"name":"Journal of Medical Ultrasound","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136312294","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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