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.
{"title":"Ultrasound-guided infiltration of the pudendal nerve: a technical approach for neuropathic pain management.","authors":"Fabio Vita, Danilo Donati, Federico Vender, Roberto Tedeschi, Salvatore Massimo Stella, Adriano Drago, Stefano Galletti, Laura Langone, Marco Miceli, Cesare Faldini","doi":"10.1007/s40477-025-01106-8","DOIUrl":"https://doi.org/10.1007/s40477-025-01106-8","url":null,"abstract":"<p><strong>Purpose: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":51528,"journal":{"name":"Journal of Ultrasound","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145953875","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}
Pub Date : 2025-12-24DOI: 10.1007/s40477-025-01100-0
Carolina Zúñiga, María Lourdes Posadas, Leandro Seoane
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.
研究设计:描述性观察队列研究。地点:阿根廷德基市立医院,布宜诺斯艾利斯,皮拉尔。目的:评估2023年1月至2024年1月在德基市立医院重症监护病房(ICU)住院的患者营养不良的发生率。方法:对连续入住ICU的患者进行观察性队列前瞻性研究。我们在ICU住院的第3天和第10天测量股直肌和股中间肌的肌肉厚度(MT)和应变弹性比(SER)。结果:共有21例患者完成了研究。股直肌平均损失2.9 cm(第3天16.6 cm SD 4 vs第10天14.8 cm SD 5, p < 0.05)。股内侧肌为2.6 cm(第3天13.4 cm SD 3.5 vs第10天10.8 cm SD 4.7, p < 0.02)。平均SER为1.13 (CI 0.69-1.56), p值为0.53,无统计学意义。结论:通过超声测量,危重患者在入院头几天有明显的MT丢失,而SER有肌肉僵硬增加的趋势。需要进一步的研究来确定它在早期检测肌肉质量变化中的作用。超声显像是一种实用的、易于获得的工具,用于监测危重病人的肌肉质量。
{"title":"Ultrasound and strain elastography in the intensive care setting for assessment of adult sarcopenia bedside.","authors":"Carolina Zúñiga, María Lourdes Posadas, Leandro Seoane","doi":"10.1007/s40477-025-01100-0","DOIUrl":"https://doi.org/10.1007/s40477-025-01100-0","url":null,"abstract":"<p><strong>Study design: </strong>Descriptive observational cohort study.</p><p><strong>Setting: </strong>Hospital Municipal de Derqui in Argentina, Buenos Aires, Pilar.</p><p><strong>Aim: </strong>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.</p><p><strong>Methods: </strong>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).</p><p><strong>Results: </strong>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.</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":51528,"journal":{"name":"Journal of Ultrasound","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145822115","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}
Pub Date : 2025-12-18DOI: 10.1007/s40477-025-01104-w
Mohamed Hassan M Abd Elghfar, Saad Abdelnaby Ahmed E L Gelany, Mohammed Khairy Abdel Hakeem Ahmed, Mohamed Adel Abdel Rashed, Islam Yousry Tammam Abdel Maged Mohammed, Heba Hassan Ahmed
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.
背景:胎盘增生谱(PAS)是产科出血和孕产妇发病的主要原因。准确的产前预测对手术计划至关重要。传统的超声标记如胎盘腔隙和子宫肌层变薄的特异性有限。新的标记,包括宫颈内湖(ICL)和卵裂线的缺失,可能提高诊断的准确性。方法:在Minia大学妇产医院(2024年3月- 2025年2月)进行前瞻性观察研究。结果:64名(42.7%)女性发生大出血,需要更长的手术时间,更多的输血,子宫切除术(18.8%对0%)和膀胱损伤(60.9%对12.8%)的发生率高于对照组(所有p 2敏感性为88%,特异性为53%,AUC为0.78)。相比之下,ICL的灵敏度为97%,特异性为98%,AUC为0.99 (95% CI 0.94-1.00)。无切割线也表现良好(96%的灵敏度,85%的特异性,AUC = 0.90)。新生儿结局无显著差异(p < 0.05)。结论:新的超声标记,尤其是ICL和乳沟线缺失,在预测前置胎盘PAS和大出血方面具有较高的准确性。将这些迹象纳入常规评估可以改善风险分层,手术准备,并降低产妇发病率。
{"title":"Intracervical lakes as a novel sonographic potential marker for placenta accreta spectrum: a prospective observational study.","authors":"Mohamed Hassan M Abd Elghfar, Saad Abdelnaby Ahmed E L Gelany, Mohammed Khairy Abdel Hakeem Ahmed, Mohamed Adel Abdel Rashed, Islam Yousry Tammam Abdel Maged Mohammed, Heba Hassan Ahmed","doi":"10.1007/s40477-025-01104-w","DOIUrl":"https://doi.org/10.1007/s40477-025-01104-w","url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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).</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":51528,"journal":{"name":"Journal of Ultrasound","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145783565","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}
Pub Date : 2025-12-15DOI: 10.1007/s40477-025-01103-x
David J McCreary, Navvya Girdhar
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.
{"title":"Shunt trouble or something else? Diagnosing an abdominal CSF pseudocyst in a child using point-of-care ultrasound.","authors":"David J McCreary, Navvya Girdhar","doi":"10.1007/s40477-025-01103-x","DOIUrl":"https://doi.org/10.1007/s40477-025-01103-x","url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Case presentation: </strong>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.</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":51528,"journal":{"name":"Journal of Ultrasound","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145764328","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}
Pub Date : 2025-12-09DOI: 10.1007/s40477-025-01101-z
Somayeh Hajiahmadi, Mohammadreza Elhaie, Ali Nikkhah, Seyyed-Ali Alaei
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.
{"title":"Predictive value of great and small saphenous vein diameters for venous reflux in lower extremity chronic venous insufficiency: A segmental analysis using duplex ultrasonography.","authors":"Somayeh Hajiahmadi, Mohammadreza Elhaie, Ali Nikkhah, Seyyed-Ali Alaei","doi":"10.1007/s40477-025-01101-z","DOIUrl":"https://doi.org/10.1007/s40477-025-01101-z","url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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%).</p><p><strong>Conclusions: </strong>Segment-specific diameter-reflux associations highlight the inadequacy of diameter alone for assessing reflux duration, necessitating comprehensive duplex ultrasound evaluation for venous insufficiency management.</p>","PeriodicalId":51528,"journal":{"name":"Journal of Ultrasound","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145710306","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}
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.
{"title":"Cranial ultrasound as a diagnostic tool for infant meningitis in a low-or middle income setting: \"sensitivity and specificity\".","authors":"Sadia Parkar, Kiran Hilal, Zaubina Kazi, Kumail Khandwala, Mahjabeen Zehra, Nadia Mazhar, Sanam Umair, Ali Faisal Saleem","doi":"10.1007/s40477-025-01089-6","DOIUrl":"https://doi.org/10.1007/s40477-025-01089-6","url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Materials and methods: </strong>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.</p><p><strong>Results: </strong>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%).</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":51528,"journal":{"name":"Journal of Ultrasound","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145710354","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}
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.
目的:肩部损伤,特别是在从事头顶运动的运动员中,是常见的和使人虚弱的,通常是由于过度使用和不正确的姿势造成的。圆肩畸形是一种与肩部功能障碍和肩袖不平衡有关的姿势异常。因此,本研究比较了有和没有圆肩的头顶运动员的肩袖肌厚度和肩肱骨距离(AHD)。方法:采用横断面研究方法,将32名头顶运动员分为有圆肩组和无圆肩组。通过超声波(Versana Premier, GE Healthcare,韩国)测量肌肉厚度和肩肱距离。Image J软件采用摄影测量法测量圆角。数据分析采用95%显著水平的独立t检验(α)结果:冈上肌差异无统计学意义(P)结论:两组肩胛肌厚度及肩肱距离差异无统计学意义(P)。对于年龄、运动史和圆肩持续时间对结果的可能影响,应该进行进一步的研究。然而,应该记住的是,肌肉厚度的评估可能不是评估运动员在运动过程中肌肉表现的合适指标。
{"title":"Comparison of rotator cuff muscle thickness and acromiohumeral distance in overhead adolescent athletes with and without rounded shoulders.","authors":"Mansoureh Mohammadi, Rahman Sheikhhoseini, Hashem Piri, Ebrahim Ebrahimi","doi":"10.1007/s40477-025-01102-y","DOIUrl":"https://doi.org/10.1007/s40477-025-01102-y","url":null,"abstract":"<p><strong>Purpose: </strong>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.</p><p><strong>Methods: </strong>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).</p><p><strong>Results: </strong>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.</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":51528,"journal":{"name":"Journal of Ultrasound","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145688586","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}
Pub Date : 2025-12-01Epub Date: 2025-03-06DOI: 10.1007/s40477-025-01003-0
Nuno Ferreira-Silva, Tomás Ribeiro-Da-Silva, Lia Lucas-Neto, Keith Aziz, Wesley Troyer, Raúl A Rosario-Concepción
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.
{"title":"Minimally invasive ultrasound-guided thread carpal tunnel release: a video demonstration protocol.","authors":"Nuno Ferreira-Silva, Tomás Ribeiro-Da-Silva, Lia Lucas-Neto, Keith Aziz, Wesley Troyer, Raúl A Rosario-Concepción","doi":"10.1007/s40477-025-01003-0","DOIUrl":"10.1007/s40477-025-01003-0","url":null,"abstract":"<p><p>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.</p>","PeriodicalId":51528,"journal":{"name":"Journal of Ultrasound","volume":" ","pages":"803-810"},"PeriodicalIF":1.4,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12675869/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143568789","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01Epub Date: 2024-02-28DOI: 10.1007/s40477-023-00857-6
Carolina Fonseca de Jesus Silva, R Haridian Sosa Barrios, Víctor Burguera Vion, Milagros Fernández Lucas, Maite E Rivera Gorrín
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.
{"title":"Reversed diastolic intrarenal flow in page kidney following renal biopsy.","authors":"Carolina Fonseca de Jesus Silva, R Haridian Sosa Barrios, Víctor Burguera Vion, Milagros Fernández Lucas, Maite E Rivera Gorrín","doi":"10.1007/s40477-023-00857-6","DOIUrl":"10.1007/s40477-023-00857-6","url":null,"abstract":"<p><p>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.</p>","PeriodicalId":51528,"journal":{"name":"Journal of Ultrasound","volume":" ","pages":"1049-1053"},"PeriodicalIF":1.4,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12675876/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139984518","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01Epub Date: 2025-07-02DOI: 10.1007/s40477-025-01044-5
Salvatore Chirumbolo
{"title":"Comments on: Morphological characterization of two dermal and hypodermal alterations in an adult man: surgical scar vs. stretch mark.","authors":"Salvatore Chirumbolo","doi":"10.1007/s40477-025-01044-5","DOIUrl":"10.1007/s40477-025-01044-5","url":null,"abstract":"","PeriodicalId":51528,"journal":{"name":"Journal of Ultrasound","volume":" ","pages":"1103-1104"},"PeriodicalIF":1.4,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12675887/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144546084","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}