Journal of Ultrasound最新文献

Purpose: Pudendal neuropathy is a debilitating condition often underdiagnosed due to its complex clinical presentation and overlapping symptoms with other pelvic disorders. This review aims to provide an updated synthesis of anatomical, clinical, and technical aspects of ultrasound-guided pudendal nerve infiltration, highlighting its diagnostic and therapeutic relevance in neuropathic pelvic pain.

Methods: A narrative analysis was conducted of the pudendal nerve's anatomy, etiologies of neuropathy, clinical manifestations, diagnostic tools, and image-guided intervention strategies. Particular attention was dedicated to high-resolution ultrasound (HRUS) for anatomical visualization and to the technical considerations underlying perineural injection procedures.

Results: Perineural infiltration of the pudendal nerve provides immediate, partial pain relief after anesthetic administration, with the addition of corticosteroids contributing to sustained relief. Ultrasound guidance minimizes complications and has proven superior to traditional landmark-based approaches. The technique demonstrates feasibility, safety, and reproducibility in clinical practice, for both diagnostic and therapeutic purposes. However, clinical results have varied, and repeated sessions or integration with multimodal strategies, including physical therapy, drug therapy, and lifestyle modifications, have often been required.

Conclusion: Ultrasound-guided pudendal nerve infiltration is a minimally invasive, safe, and effective technique for both diagnosis and treatment of pudendal neuropathy. While offering rapid pain relief and confirming nerve involvement, infiltrations should be considered as part of a broader multimodal management strategy. Future directions include standardization of protocols, refinement of imaging guidance, and exploration of novel injectates or regenerative therapies to optimize long-term outcomes.

Study design: Descriptive observational cohort study.

Setting: Hospital Municipal de Derqui in Argentina, Buenos Aires, Pilar.

Aim: To assess the prevalence of malnutrition in patients admitted to the Intensive Care Unit (ICU) in the Hospital Municipal de Derqui January 2023 to January 2024.

Methods: An observational cohort prospective study of consecutive patients admitted to the ICU. We carried out measurement of muscle thickness (MT) of the rectus femoris and vastus intermedius on day 3 and 10 of ICU stay as well as strain elastography ratio (SER).

Results: A total of 21 patients completed the study. The average loss in centimeters of the rectus femoris section was 2.9 cm (16.6 cm SD 4 on day 3 vs 14.8 cm SD 5 on day 10, p 0.05). For the vastus medialis, it was 2.6 cm (13.4 cm SD 3.5 on day 3 vs 10.8 cm SD 4.7 on day 10, p 0.02). The average SER was 1.13 (CI 0.69-1.56), with a non-significant p-value of 0.53.

Conclusions: There is a significant loss of MT in critical patients during the first days of hospitalization as measured by ultrasound, while SER showed a trend towards increased muscle stiffness. Further research is needed to determine its usefulness in the early detection of changes in muscle quality. Ultrasonography emerges as a practical and accessible tool for monitoring muscle mass in critical patients.

Background: Placenta accreta spectrum (PAS) is a major cause of obstetric hemorrhage and maternal morbidity. Accurate antenatal prediction is vital for surgical planning. Conventional ultrasound markers such as placental lacunae and myometrial thinning have limited specificity. Novel markers, including intracervical lakes (ICL) and absence of the cleavage line, may improve diagnostic accuracy.

Methods: A prospective observational study was conducted at Minia University Maternity Hospital (March 2024-February 2025). A total of 150 women with placenta previa were enrolled and classified by intraoperative blood loss: < 2500 mL (n = 86) and ≥ 2500 mL (n = 64). All underwent standardized preoperative ultrasound evaluation, including traditional and novel markers. Intraoperative findings were the reference standard.

Results: Massive bleeding occurred in 64 women (42.7%) who required longer operative times, more transfusions, and had higher rates of hysterectomy (18.8% vs. 0%) and bladder injury (60.9% vs. 12.8%) than controls (all p < 0.001). Traditional ultrasound signs showed only moderate accuracy; lacunae grade > 2 had 88% sensitivity, 53% specificity, and an AUC of 0.78. In contrast, ICL achieved 97% sensitivity, 98% specificity, and an AUC of 0.99 (95% CI 0.94-1.00). Absence of the line of cleavage also performed well (96% sensitivity, 85% specificity, AUC = 0.90). Neonatal outcomes did not differ significantly (p > 0.05).

Conclusion: Novel ultrasound markers, especially ICL and the absence of the cleavage line, provide superior accuracy for predicting PAS and massive bleeding in placenta previa. Incorporating these signs into routine assessment can improve risk stratification, surgical preparedness, and reduce maternal morbidity.

Background: With increasing rates of survival amongst pre-term infants, patients with ventriculoperitoneal shunts are an increasingly common presentation to the emergency department, meaning that paediatricians must be familiar with the potential complications shunts can bring. Abdominal cerebrospinal fluid pseudocyst is a rare complication of ventriculoperitoneal shunts but remains an important cause of distal site failure in children. Irradiating imaging modalities have been traditionally relied upon in the past to help make such diagnoses, however, point of care ultrasound offers many advantages to this and presents itself as a reliable alternative.

Case presentation: A 7-year-old girl who was born prematurely at 27 + 6 weeks and had a ventriculoperitoneal shunt inserted as an infant was brought to the Paediatric Emergency Department by her grandparents after they noticed her abdomen was distended. Her grandfather stated that he had replaced her gastrostomy recently and had unable to obtain aspirates for the past 48 h. POCUS revealed a large anechoic fluid collection with the shunt tip visible within it consistent with a CSF pseudocyst. POCUS was also able to confirm position of the gastrostomy balloon in the expected location helping to exclude malposition as a potential differential diagnosis.

Conclusions: In patients with ventriculoperitoneal shunts, POCUS can correctly identify the presence of abdominal CSF pseudocyst differentiating it from other causes of abdominal distension including gastrostomy-related complications. This case supports the role of POCUS as a safe, reliable first-line imaging tool for diagnosing CSF pseudocysts in patients with ventriculoperitoneal shunts, particularly where previous similar complications have existed.

Background: Chronic venous disease is prevalent, particularly in the form of varicose veins, and often involves saphenous vein incompetence. While correlations between vein diameters and reflux presence are established, associations with reflux duration remain underexplored. This study aimed to evaluate the relationship between great and small saphenous vein diameters and reflux durations across lower limb segments in varicose vein patients, and to determine predictive diameter thresholds for reflux.

Methods: In a cross-sectional study with case-control component (2021-2023, Blinded), 753 incompetent veins were analyzed for diameter-reflux correlations using Pearson/Spearman coefficients. Reflux was defined as > 1000 ms at saphenofemoral junction (SFJ) or > 500 ms elsewhere. A subsample of 300 cases was compared to 303 healthy controls for diameter differences via t-tests and receiver operating characteristic (ROC) analyses to identify optimal cut-offs via Youden index.

Results: Significant negative correlations were found proximally (SFJ: r = - 0.163, P < 0.05; cranial great saphenous vein [GSV]: r = - 0.150, P < 0.01) and positive correlation distally (mid-calf GSV: r = 0.130, P < 0.01; caudal small saphenous vein [SSV]: r = 0.300, P < 0.01). Cases had larger diameters across segments (all P < 0.001). Highest ROC accuracy was for cranial GSV (5 mm cut-off; area under curve [AUC] = 0.775; accuracy = 72.65%) and cranial SSV (3.6 mm; AUC = 0.779; accuracy = 70.02%); lowest for ankle GSV (2.3 mm; accuracy = 53.31%) and caudal SSV (2.2 mm; accuracy = 59.83%).

Conclusions: Segment-specific diameter-reflux associations highlight the inadequacy of diameter alone for assessing reflux duration, necessitating comprehensive duplex ultrasound evaluation for venous insufficiency management.

Background: Cerebrospinal fluid (CSF) analysis remains the gold standard for diagnosing meningitis but it requires technique and time. In infants, open fontanels allow ultrasound visualization, making cranial ultrasound a low-cost, point-of-care diagnostic tool for suspected meningitis. This study aimed to develop a standardized cranial ultrasound checklist, and to assess the sensitivity and specificity of cranial ultrasound as a diagnostic tool for infants with meningitis compared with the gold standard cerebrospinal fluid (CSF) analysis.

Materials and methods: This diagnostic tool validation study compared cranial ultrasound with the gold standard cerebrospinal fluid (CSF) analysis for meningitis using consecutive sampling. Infants under 12 months of age with patent fontanelles presenting to the Aga Khan University Hospital with suspected meningitis were allowed to participate.

Results: Overall, 79 patients with suspected meningitis were enrolled. The mean age of the patients was 52.68 ± 82.27 days, and males were predominant (68.35%). The sensitivity, specificity, PPV, NPV, and accuracy of ultrasound were 46.81%, 56.25%, 61.11%, 41.86%, and 50.63%, respectively. The significant finding was thickened echogenic sulci 25 (31.64%), followed by meningeal thickening 23 (29.11%), white matter abnormalities 14 (17.71%), brain edema 12 (15.18%), ventricular system dilatation 6 (7.59%), and elevated CSF echogenicity 7 (8.86%).

Conclusion: Cranial ultrasound showed low diagnostic accuracy for infant meningitis in this study. However, it may be used as a front-line imaging modality in the initial diagnosis and monitoring of infants with acute meningitis. It holds potential as a point-of-care diagnostic tool, and its utility may be enhanced by additional scanning approaches and Doppler techniques.

Purpose: Shoulder injuries, particularly in athletes engaged in overhead sports, are common and debilitating, often resulting from overuse and improper posture. Rounded shoulder deformity is a postural abnormality linked to shoulder dysfunction and rotator cuff imbalances. Therefore, the current study compares rotator cuff muscle thickness and acromiohumeral distance (AHD) in overhead athletes with and without rounded shoulders.

Methods: In this cross-sectional research, 32 overhead athletes were divided into groups with and without rounded shoulders. The measurements were taken via ultrasound (Versana Premier, GE Healthcare, South Korea) to assess muscle thickness and acromiohumeral distance. The Image J software measured the rounded shoulder angle using the photogrammetric method. For data analysis, an independent T-test was used at the significant level of 95% (α < 0.05).

Results: There were no significant differences in supraspinatus (P < 0.250), infraspinatus (P < 0.449), teres minor (P < 0.353), and subscapularis (P < 0.823) thicknesses. Also, there was no significant difference in acromiohumeral distance (P < 0.139) among overhead adolescent athletes with and without rounded shoulders.

Conclusion: There is no significant difference between the two groups in the thickness of the shoulder muscles and the acromiohumeral distance. Further research should be conducted on the possible effect of age, sports history, and duration of rounded shoulder on the results. However, it should be kept in mind that the assessment of muscle thickness may not be a suitable indicator for evaluating the muscular performance of athletes during sports.

Carpal tunnel syndrome is the most common compressive peripheral neuropathy, often requiring surgical treatment. Recently, ultrasound-guided thread carpal tunnel release has become an attractive minimally invasive alternative to the traditional surgical approaches. This incision-less technique utilizes an abrasive thread and a Tuohy needle to achieve division of the transverse carpal ligament while sparing adjacent soft tissue to decrease post-procedural pain and enhance recovery. Although several step-by-step descriptions of the technique have been published in recent years, no video demonstration of the procedure and the pre-procedure scanning needed for surgical planning exists. This paper aims to provide a video-based guide to ultrasound-guided thread carpal tunnel release and propose a pre-procedure scanning protocol for physicians considering implementing this procedure into their practice.

Page's kidney is a condition that occurs due to external renal compression, usually caused by a subcapsular haematoma, generating a renal compartmental syndrome with parenchymal damage and renal perfusion alteration. Classically associated with renal trauma, Page's kidney can also arise after invasive renal procedures, such as renal biopsies or percutaneous nephrostomies. Clinically, it can trigger hypertension due to activation of the renin-angiotensin system induced by hypoperfusion secondary to renal parenchymal compression and can also present with varying degrees of renal function impairment. Furthermore, severe acute renal failure may be found particularly in patients with solitary kidneys or renal transplants. We present two cases of Page's kidney after renal biopsy and their PoCUS ultrasound findings. We would like to highlight the reversed diastolic flow on Doppler ultrasound in this entity, a pattern we have found in all two cases.