Journal of Ultrasound最新文献

Thoracic disc herniation (TDH) is one of the most complex and technically challenging pathologies in spine surgery. Multiple approaches have been described to manage this condition, including the lateral extracavitary approach (LECA). The use of intraoperative ultrasound (IOUS) has been scarcely described in TDH surgery and the available experiences have been limited to posterolateral approaches. To our knowledge, the implementation of IOUS in LECA-based surgery has not yet been described in the literature. In this article, we describe how we use IOUS in these cases, including our step-by-step technique and its potential benefits. We performed LECA-based surgery to treat a T10-T11 predominantly central calcified TDH in a 55-year-old patient with severe neurological deficit of lower limbs. On the one hand, LECA provided us an excellent view of the anterior midline aspect of the spinal canal. On the other hand, we used IOUS to ensure the location and degree of resection of the TDH. There were no major technical difficulties during its use. We achieved gross total resection of the TDH and the patient progressively regained mobility in the lower limbs.

IgG4-related submandibular gland inflammation (IgG4-RSGI) is an immunologically mediated condition characterized by chronic fibroinflammatory lesions and elevated serum IgG4 levels. It often lacks specific clinical and imaging features, leading to misdiagnosis.We present a case of IgG4-RSGI to enhance clinical recognition and diagnostic accuracy. A patient presented with a four-month history of progressive bilateral submandibular gland enlargement. Ultrasonography revealed bilateral submandibular gland enlargement with heterogeneous internal echoes, a "mesh-like" pattern, and nodular hypoechoic areas. Color Doppler flow imaging (CDFI) showed increased vascularity. Ultrasound-guided biopsy confirmed the diagnosis, establishing ultrasound as a valuable initial diagnostic tool in the clinical assessment of IgG4-RSGI.

Introduction: Vertebral artery dissection (VAD) is a serious complication of cervical trauma. Standard imaging such as computed tomography angiography (CTA), magnetic resonance angiography (MRA), and duplex ultrasonography (DUS) may be limited in critically ill patients. This case report aims to describe the innovative application of transoral ultrasound (TOUS) for bedside diagnosis of VAD in an intubated intensive care unit (ICU) patient.

Case presentation: A 75-year-old woman with C2 fractures and compromised cervical access was admitted after a motor vehicle accident. Standard cervical vascular ultrasound was technically limited due to the presence of an endotracheal tube and cervical immobilization. Bedside TOUS was performed by an intensivist with over 15 years of ultrasonography experience using a microconvex endocavitary probe (4-9 MHz, footprint 10 mm) with color and power Doppler, PRF range of 1-3 kHz, wall filter 50 Hz, and optimized gain settings. The patient was sedated and mechanically ventilated, allowing optimal tolerance. The left vertebral artery V2 segment demonstrated a high-resistance waveform proximally and a filiform Doppler signal distally, suggesting dissection. CTA performed subsequently confirmed VAD at C1-C2.

Conclusion: Our case demonstrates that TOUS enables bedside detection of vertebral artery dissection via direct insonation of the distal vertebral artery. This approach is particularly feasible in intubated ICU patients and allows access to segments not visible with standard cervical windows. Limitations include the need for operator expertise and reduced tolerability in non-intubated patients. Overall, TOUS represents a practical and innovative tool for diagnosing VAD in critically ill trauma patients when conventional imaging is limited.

Ectopic thymic tissue is a rare finding and a rare cause of lateral neck masses. Here, we present a case of a 3-month-old male infant with a painless left sided submandibular mass. The case highlights the diagnostic power of ultrasound in differentiating ectopic thymic tissue from other pediatric neck masses, often rendering more expensive or invasive imaging unnecessary or potentially counterproductive and allowing to avoid unnecessary procedures and possible complications.

Hydatid cysts infrequently affect the genital tract, with uterine involvement being exceptionally rare. Diagnosing such cases is challenging due to potentially misleading clinical and radiological findings, with confirmation often achieved only through surgical exploration and histopathological examination. In this article, we present case of a disseminated hydatid disease with rare uterine involvement.

Ibrutinib, a Bruton's tyrosine kinase (BTK) inhibitor, has transformed the management of mantle cell lymphoma (MCL) but is associated with an elevated risk of bleeding. We report a rare case of hepatic subcapsular hematoma due to ibrutinib in a patient with relapsed MCL. Ultrasound was crucial in the early detection, monitoring, and management of this rare but potentially severe complication.

Isolated hip fractures incur significant mortality within 1 year of operative repair. Adequate analgesia is important in maintaining functional status and facilitating recovery. A multi-modal pain management strategy incorporating regional anesthesia may decrease the need for high-dose narcotics and promote faster recovery. The Pericapsular Nerve Group (PENG) block was thus developed as a regional anesthesia option for patients with hip fractures. It involves an ultrasound-guided approach that targets the anterior hip zone to provide a motor-sparing hip block. This write-up provides a sequential, step-by-step guide on how to perform the PENG block in the emergency department.

Background: Traditionally quadratus lumborum block has been performed in lateral or supine positions. We propose that transmuscular or anterior quadratus lumborum block performed in a prone position may offer comparable or improved technical conditions, image quality and also aid in resident training. This study aimed to assess the technical ease of performing Tm-QLB in the prone position.

Methods: This retrospective study included female patients undergoing elective gynecologic oncology surgery via midline incision, who received bilateral preoperative prone-position transmuscular quadratus lumborum block. Block performance was evaluated using a composite score derived from normalized ultrasound image quality, time taken, number of attempts, and redirections. Blocks were categorized into five difficulty levels based on the composite score.

Results: Ninety blocks were analyzed. Mean age was 40.18 ± 12.05 years; BMI was 23.90 ± 1.86 kg/m². The median composite score was 0.81 (IQR: 0.17). Over 50% of blocks were rated "Very Easy" or "Easy," reflecting high image quality, low redirection rates, and brief procedure times.

Conclusion: Prone-position Tm-QLB is technically easy and operator-friendly, making it a viable alternative for training and clinical practice in suitable patients.