Journal of Medical Ultrasound最新文献

Isolated pelvic pain caused by aortic dissection is a very uncommon clinical presentation. This life-threatening cardiovascular lesion needs prompt diagnosis and intervention to prevent rupture. We report the case of a 45-year-old woman with Marfan syndrome who presented to our gynecologic clinic with low abdominal pain. Bedside point-of-care ultrasound revealed the bilocular echo lucent cystic lesion indicating the dissection of common iliac artery in her pelvis.

Amniotic fluid assessment is crucial in prenatal ultrasound to monitor fetal conditions, with polyhydramnios, characterized by excessive amniotic fluid, affecting 1%-2% of pregnancies. Polyhydramnios is linked to complications such as placental abruption, preterm labor, congenital anomalies, and postpartum hemorrhage, emphasizing the need for early detection and management. While idiopathic causes account for 60%-70% of cases, other causes include impaired fetal swallowing and increased urine production due to maternal, fetal, and placental conditions. Accurate amniotic fluid volume (AFV) assessment and surveying the underlying cause are important, with ultrasound methods such as deep vertical pocket (DVP) and amniotic fluid index (AFI) preferred. Polyhydramnios is defined by an AFV exceeding 2000 ml, an AFI over 24 cm, or DVP more than 8 cm. Management typically targets underlying causes, with treatments such as amnioreduction and indomethacin for severe cases. Antepartum monitoring includes detailed fetal ultrasound, genomic and genetic examinations, and tests for maternal diabetes and infections. Intrapartum management addresses complications such as malpresentation and shoulder dystocia, whereas postpartum care involves monitoring for uterine atony and hemorrhage. Perinatal outcomes in idiopathic polyhydramnios are generally poorer, with increased risks of fetal demise, preterm delivery, and neonatal complications, but these results may need further stratification and verification.

[This corrects the article on p. 275 in vol. 32, PMID: 39310878.].

Background: It is very well known that the supraclavicular nerve (SCN) which occupies the inferior part of the superficial cervical plexus basically originates from the ventral rami of C2-C4, then travels caudally into the investing layer of the deep cervical fascia (IL-DCF) alternatively termed the "prevertebral fascia."

Methods: This cadaveric study (a total of 6 soft-embalmed cadavers and bilateral dissections, i.e. 12 specimens) intended to ascertain the location of SCN within the layers of the IL-DCF. We hypothesized that ultrasonography identification of SCN within the IL-DCF and needle tip positioned between the layers of IL-DCF provide an alternative site for the blockade of the SCN.

Results: After dissection, we described a compact double-layered IL-DCF hosting the SCNs and a specific topographic arrangement at the C4 root with SCN lateral and C4 branches of the phrenic nerve medial to the C4.

Conclusion: We recommend another alternative site for the SCN block at a site in the compact double layer of IL-DCF. We conclude that a caudal site at the exit of SCN from the IL-DCF would be appropriate to perform the intervention.

Background: Pregnancy is associated with distinct risks of fascia thickness compared to nulliparous. Therefore, this study aimed to compare plantar fascia thickness between asymptomatic pregnant women and nulliparous, evaluating the relationship with age, body mass index (BMI), arch height index (AHI), gestational age, and number of pregnancies.

Methods: This cross-sectional study was conducted between January and March 2023, and subjects were through a simple random sampling method. The inclusion criteria were subjects aged 18-35 years old, while those with a history of foot pain, trauma, surgery, special orthosis during pregnancy, and other complications were excluded. Fascia thickness was measured at 10 mm distal from the insertion in the calcaneus. Age, BMI, AHI, gestational age, and pregnancy history were recorded. Student's t-tests were used to compare both groups.

Results: The average plantar fascia thickness in pregnant women was 2.67 ± 0.44 mm in both feet, while in nulliparous, it was 2.24 ± 0.41 mm and 2.26 ± 0.37 mm in the right and left foot, respectively. A significant difference was observed between the two groups based on BMI category (P < 0.05). Women who had experienced more than one pregnancy showed thicker fascia (P < 0.05). In multivariate analysis, BMI (B coefficient: 0.029-0.031, P < 0.05) and number of pregnancies (0.268-0.267, P < 0.05) had a significant effect on plantar fascia thickness in pregnant women, while age and BMI affected nulliparous.

Conclusion: Pregnant women had thicker plantar fascia compared to nulliparous. Consequently, screening and prevention in pregnant women and multiparous was necessary to prevent the occurrence of plantar fasciitis.

Rheumatoid arthritis (RA) presents a significant challenge among autoimmune diseases, affecting millions globally with diverse clinical manifestations, primarily targeting joints and inducing inflammation, pain, and deformities. In some cases, it leads to the formation of Bakers cysts, fluid-filled bursae in the popliteal region, resulting from chronic inflammation of the synovial membrane and subsequent pannus growth. Our case, a young female patient with RA, presenting with calf mass, highlights this complex interplay. She presented with large swelling and pain in her left calf region which on high-frequency ultrasound revealed a large, well-defined heteroechoic mass lesion distending bursa between the medial head of the gastrocnemius and semimembranosus muscle, measuring 25 cm craniocaudally, without any color Doppler abnormality. Ultrasound-guided biopsy was performed to rule out the possibility of sarcoma and it revealed inflammatory changes. Final diagnosis of excessive pannus formation within the Baker's cyst forming large mass was made, with RA identified as the underlying cause. The differential diagnosis of masses in the popliteal fossa includes synovial/meniscal/ganglion cysts, lipomas, vascular pathologies, and neoplastic conditions. High-resolution ultrasound is an important diagnostic modality for evaluating popliteal fossa masses. Magnetic resonance imaging is typically performed to assess for neoplastic causes and internal derangement of the knee. Our case of a massive pannus filling a Baker's cyst in the context of RA emphasizes the intricate nature of the disease and its diverse clinical expressions. It is important for the radiologist to be aware of this imaging appearance for timely diagnosis and management.

Background: Manual workers are at risk of developing lateral elbow tendinopathy (LET). We aimed to validate the hypothesis that asymptomatic elbows of manual workers with LET are more likely to have positive physical examination results and morpho-mechanical changes on elbow ultrasonography compared to healthy individuals.

Methods: This cross-sectional case-control study included 30 manual workers with unilateral LET (LET group) and 30 age- and sex-matched healthy volunteers (control group). Demographic data collection and functional evaluation were performed using the Disabilities of the Arm, Shoulder, and Hand; Patient-Rated Tennis Elbow Evaluation; and European Quality of Life Five-Dimensions questionnaires. Physical examination of the elbows and evaluation of the common extensor tendon (CET) with B-mode morphology ultrasonography and Young's modulus elastography were performed. The LET-unaffected and LET-affected elbows in the LET group were compared with the elbows in the control group.

Results: The LET-unaffected elbows in the LET group had a higher prevalence of positive chair test results and focal hypoechoic change and microcalcification on ultrasonography than those in the control group (P < 0.05, 0.005, and 0.05, respectively). In addition, LET-affected elbows showed higher focal hypoechoic change, microcalcification, erosive cortex, and neovascularity than elbows in the control group (P < 0.001, 0.001, 0.005, and 0.001, respectively). The unaffected and affected elbows showed greater CET thickness than those in the control group (P < 0.05 and 0.005).

Conclusion: The unaffected elbows of manual workers with unilateral LET should be considered at risk of LET. We proposed a risk assessment and surveillance protocol based on chair test results and abnormal ultrasonographic findings.