Journal of Ultrasound最新文献

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.

Purpose: All ultrasound scanner components, including transducer arrays, cables, and connectors, may undergo a number of damages, due to injuries, overuse, and aging. Damages impact on image quality, patient safety and healthcare budgets. Probes, particularly represent very important, sophisticated, and expensive components. This review aims to illustrate common forms of damage and educate ultrasound operators on how to recognize, manage, and prevent them.

Methods: Through the years we have collected a number of images related to damages to ultrasound equipment, including their appearance on the ultrasound screen, such artifact in B-mode image, color artifact, and noise in image. Based on our experience and a literature review, we provide information and recommendations for recognizing and managing such damage.

Results: Common causes of probe damage include improper handling, transport, cleaning, storage, and reprocessing. Main damages are defective cable conditions, acoustic lens issues, crystal damage, transducer house assembly cracks, multiplexer scanning image issue, strain relief condition, connector issues, gel issue/matching layer swelling, and leakage of probe oil.

Conclusion: Ultrasound operators must be aware of probe damage and respond promptly to signs of malfunction. This vigilance may prevent irreversible harm and enable repair rather than replacement. Proactive care and regular inspections are essential. Periodic inspection and quality control tests must be scheduled. Remote control of the scanners by the manufacturer may also be helpful.

Purpose: To determine the magnitude of fetal growth restriction (FGR) using fetal Doppler integrated with antenatal ultrasound in third-trimester screened pregnant women at Agra in northern India.

Methods: Screened participants underwent routine third-trimester ultrasound assessments integrating fetal Doppler studies. Any one or more of mean uterine artery (UtA) or umbilical artery (UA) pulsatility index > 95th centile, middle cerebral artery (MCA) or cerebroplacental ratio (CPR) PI < 5th centile, absent or reversed end-diastolic velocity, or ductus venosus PI > 95th centile was considered abnormal Doppler studies. Fetuses with estimated fetal weight (EFW) < 3rd percentile or EFW 3rd to 10th percentile with abnormal Doppler were categorised as FGR. Fetuses with EFW 3rd to 10th percentile and normal Doppler were classified as small for gestational age (SGA) and EFW 10th to 50th percentile and abnormal Doppler were classified as appropriate for gestational age (AGA) fetuses with adapted growth restriction.

Results: Among 1065 screened participants, 142 fetuses (13.33%) had an EFW < 10th centile and 139 (13.05%) fetuses had both EFW and fetal AC < 10th centile. Stage 1 FGR was identified in 58 (5.45%) fetuses, 75 fetuses (7.04%) were classified as SGA and 77 (7.23%) were adapted growth-restricted AGA fetuses. Reclassifying FGR after integrating Doppler assessments reduced magnitude by 52.13, 51.11, and 76.82% from the estimates of FGR derived based on EFW < 10th centile alone, both EFW and fetal AC < 10th centile and either EFW or fetal AC < 10th centile respectively.

Conclusion: Integrating fetal Doppler studies with routine third-trimester ultrasound assessment significantly reclassifies FGR with a huge reduction in the proportion of fetuses that need more intense surveillance in the third trimester.

Purpose: To describe a standardized intraoperative transvaginal ultrasound (IOTVUS) technique for assessing rectosigmoid deep infiltrating endometriosis (DIE), and to explore its potential advantages in guiding real-time surgical decision-making.

Methods: This technical report outlines a stepwise protocol for performing IOTVUS during laparoscopic surgery. Following pelvic dissection and bowel mobilization, the pelvis is filled with saline to improve acoustic transmission. A 2D convex end-fire transvaginal probe is inserted to assess the rectosigmoid colon. Lesions are evaluated in multiple planes, measuring their dimensions, depth, circumferential involvement, and proximity to the anal verge. Findings are used intraoperatively to guide the choice of surgical approach-shaving, disc excision, or segmental resection.

Results: IOTVUS provides real-time, high-resolution imaging of rectosigmoid DIE, enabling accurate characterization of lesion morphology after anatomical restoration. The technique facilitates the selection of the most appropriate surgical intervention based on objective, intraoperative assessment. It also allows post-excision verification of lesion removal.

Conclusion: IOTVUS is a promising, underutilized tool for intraoperative guidance in rectosigmoid DIE surgery. It supports precise lesion characterization and personalized surgical planning.

Lung ultrasound has become indispensable in managing critically ill patients, offering bedside evaluation capabilities for intensive care unit physicians without ionizing radiation. This noninvasive technique demonstrates high sensitivity and specificity in diagnosing various lung pathologies, including pleural effusion and consolidation syndrome. A novel trans-hepatic subcostal approach enhances visualization of the lower right lung lobe, revealing the diaphragm dome and inferior lobe through oblique coronal sections. Challenges include inadequate liver visibility hindering right lung views and difficulties in left lung assessment due to gastric interference. Despite limitations, this method proves invaluable when conventional imaging is impractical, showcasing its utility in critical care settings.

Pallister - Hall syndrome is a rare malformation that involves the presence of a suprasellar hamartoma and associated malformations. Prenatal diagnosis is also rare, and few cases have been reported using magnetic resonance imaging (MRI). A 35-year-old G5P2A2 woman at the 35th week of gestation was referred to our service. Fetal MRI showed an isointense image in the suprasellar region, pushing the brainstem up and backward, and compressing the vermis and cerebellum on T2-weighted images. On T1-weighted images, the hypointense signal of the tumor was similar to that of the brain parenchyma. Ultrasound images showed a suprasellar mass, which was more echogenic than the normal cerebral parenchyma, posteriorly pushing the brain stem, with involvement of the vermis of the tumor and compression of the posterior fossa. Three-dimensional reconstruction using MRI scan data showed a space view of the tumor and its relationships with the other brain tissues allowing better understanding by parents and multidisciplinary team.

The popularity of weight training, bodybuilding and general physical conditioning has led to an increased rate of musculoskeletal injuries, such as nerve compression caused by muscle hypertrophy and, stretching of nerves peripherally. We present a case of anterior interosseous nerve (AIN) entrapment syndrome/neuropathy otherwise known as Kiloh-Nevin syndrome in a 22-year-old weightlifter. Knowledge of this injury is paramount for practitioners to increase awareness among athletes and bodybuilders.