Ultrasound最新文献

{"title":"Congenital hepatic cyst: Prenatal and postnatal imaging findings.","authors":"Waldo Sepulveda,&nbsp;Francisco Sepulveda,&nbsp;Gloria Gonzalez,&nbsp;Claudio Arce,&nbsp;Elisa Alcalde","doi":"10.1177/1742271X20970601","DOIUrl":"https://doi.org/10.1177/1742271X20970601","url":null,"abstract":"<p><strong>Introduction: </strong>Congenital hepatic cyst is a rare hepatobiliary malformation that can present as an asymptomatic, unilocular, upper abdominal cystic mass in the fetus.</p><p><strong>Cases: </strong>We report two cases of congenital hepatic cyst in which the diagnosis was made by prenatal ultrasound at 25 and 33 weeks' gestation. The diagnosis was confirmed postnatally by abdominal ultrasound and radiologic imaging studies. Although the infants remained asymptomatic, laparoscopic excision was performed due to the increasing size of the cyst in both cases. Pathological examination of the resected specimens confirmed a simple cyst in one case and an epidermoid cyst in the other.</p><p><strong>Conclusions: </strong>Our cases and those described in the literature demonstrate the usefulness of incidental prenatal detection of congenital hepatic cyst, especially during late pregnancy. Such a diagnosis can allow for proper perinatal surveillance, selection of the route of delivery, and timely postnatal surgical intervention if required.</p>","PeriodicalId":23440,"journal":{"name":"Ultrasound","volume":"29 3","pages":"193-198"},"PeriodicalIF":0.8,"publicationDate":"2021-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1742271X20970601","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39451212","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}

{"title":"Editorial.","authors":"Hazel Edwards","doi":"10.1177/1742271X211033736","DOIUrl":"https://doi.org/10.1177/1742271X211033736","url":null,"abstract":"Welcome to the third issue of 2021 as we continue to face uncertain futures as a consequence of the persistence of COVID-19 and its evolving variants. Tentative plans in our professional and personal lives run the risk of being dashed, although I hope that, by the time this Editorial is printed, the United Kingdom at least may be free of most restrictions. I continue to receive many Covid-related articles describing and analysing datasets in a variety of environments. One area, however, where burgeoning research has undoubtedly benefitted and exploded over the last 18months is in the field of lung ultrasound. We always knew ultrasound could have a significant role in the management of this disease if training and equipment issues are addressed. Lung ultrasound is here to stay and will continue to be applied to situations other than the Covid lung long after the pandemic. It gives me pleasure therefore to offer an insightful guest editorial this month from three clinicians, with a passion for ultrasound, based in the south of the UK. In addition to their work and our usual Echoes page, I offer the usual broad spectrum of article types and topics including a review, a pictorial essay, three original research papers and three informative case reports. You will see that despite differing conditions, many of the articles have the same goal; the desire to detect diseases more quickly, thus allowing for earlier treatment plans. This goal aligns very much with current UK government health initiatives and likely reflects similar aims internationally. First up is a review by Venables et al. who found that raised renal resistive indices could be as reliable a predictor of early diabetic kidney disease as albuminuria levels and more reliable than estimated glomerular filtration rate. Next, a team from Delhi looked at nerves in diabetic patients with and without diabetic polyneuropathy and identified changes on ultrasound which, when compared with a control group of healthy volunteers, may precede clinical symptoms. They suggest that high resolution ultrasound could be used as a screening tool for early detection and thus earlier management of this painful condition. Results from a small study from Iran suggest that hypertension has a detrimental effect on aortic wall elasticity and left ventricular function regardless of patient age, potentially making the patient more at risk of a cardiovascular event. Earlier detection may allow for prompt treatment, thus slowing disease progression. A timely article from Reeve et al. discusses the value of online journal clubs as a source of continuing professional development during a global pandemic. Online journal clubs allow international participation that traditional journal clubs could not. The article focuses specifically on the first BMUS journal club article from August 2020, which investigated professional practice in obstetrics. Taylor and MacLean offer an informative educational piece on neonatal hip imaging ","PeriodicalId":23440,"journal":{"name":"Ultrasound","volume":"29 3","pages":"139"},"PeriodicalIF":0.8,"publicationDate":"2021-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1742271X211033736","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39452349","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}

{"title":"Point-of-care lung ultrasound during and after the COVID-19 pandemic.","authors":"F D Lesser,&nbsp;N Smallwood,&nbsp;M Dachsel","doi":"10.1177/1742271X211033737","DOIUrl":"https://doi.org/10.1177/1742271X211033737","url":null,"abstract":"Wars, pandemics and disasters advance medical science and care. Oxygen saturationmonitors were initially only used in anaesthesia and intensive care but are now available from supermarkets and are used for home monitoring of COVID-19. Ultrasound is following a similar path from a specialist investigation to common use in acute care. In the next 10 years, a handheld ultrasound device could be in every medical practitioner’s pocket. Previously, point-of-care lung ultrasound (LUS) was used in acute care for diagnosing causes of hypoxia and so when COVID-19 developed into a global pandemic there was great interest in LUS for this disease. Initial case series from China detailed the LUS findings in COVID-19 with bilateral patchy B-lines, peripheral consolidations and a lack of large effusions. Further studies into diagnostic accuracy and prognostic ability of LUS for COVID-19 were ongoing or awaiting publication. Despite the lack of firm data, it still was useful during the first wave in the UK due to limitations in other diagnostic tests. There was very limited availability of rapid molecular tests and delays of several days for reverse transcriptase polymerase chain reaction (RTPCR). Other imaging methods were limited by poor specificity for disease (chest radiograph) or practical limitations in moving highly infectious patients within the hospital (computed tomography). LUS had a unique advantage, as it could be performed at the bedside giving results within minutes allowing rapid triage and treatment. During the second wave, rapid molecular testing was available in many centres and the turn-around time for RTPCR was significantly reduced. LUS also played a role in the diagnosis of patients with negative molecular tests and high clinical suspicion, particularly as nasopharyngeal RTPCR is only about 70% sensitive. In addition, LUS was used to rule out other causes of hypoxia such as pleural effusion and cardiac failure which can present in tandem with COVID-19. LUS findings consistent with COVID-19 should be treated with caution in times with low prevalence, as false positive rates will be higher. As the pandemic subsides, LUS will still play a key role in diagnosing other causes of hypoxia. The experience learnt in COVID-19 will lead to more practitioners being familiar with LUS and in particular with sonographic findings of a viral pneumonitis. It is unknown whether LUS will be useful in management of long COVID and its advantages over CT imaging of instant results at the bedside are far less important in chronic disease. A lack of equipment and suitably skilled practitioners restrict the availability of point-of-care LUS in the UK. The Society for Acute Medicine and Intensive Care Society are working hard to address this through their established LUS training pathways, while handheld devices provide a cost-effective alternative to cart-based machines. LUS can provide rapid diagnosis of COVID-19 at the bedside and there is now clear evidence to su","PeriodicalId":23440,"journal":{"name":"Ultrasound","volume":"29 3","pages":"140"},"PeriodicalIF":0.8,"publicationDate":"2021-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1742271X211033737","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39451205","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}

{"title":"Quantitative colour Doppler and greyscale ultrasound for evaluating prostate cancer.","authors":"Khalid Ashi,&nbsp;Brooke Kirkham,&nbsp;Anil Chauhan,&nbsp;Susan M Schultz,&nbsp;Bonnie J Brake,&nbsp;Chandra M Sehgal","doi":"10.1177/1742271X20952825","DOIUrl":"https://doi.org/10.1177/1742271X20952825","url":null,"abstract":"<p><strong>Introduction: </strong>Although transrectal ultrasound is routinely performed for imaging prostate lesions, colour Doppler imaging visualizing vascularity is not commonly used for diagnosis. The goal of this study was to measure vascular and echogenic differences between malignant and benign lesions of the prostate by quantitative colour Doppler and greyscale transrectal ultrasound.</p><p><strong>Methods: </strong>Greyscale and colour Doppler ultrasound images of the prostate were acquired in 16 subjects with biopsy-proven malignant or benign lesions. Echogenicity and microvascular flow velocity of each lesion were measured by quantitative image analysis. Flow velocity was measured over several cardiac cycles and the velocity-time waveform was used to determine microvascular pulsatility index and microvascular resistivity index. The Wilcoxon rank sum test was used to compare the malignant and benign groups.</p><p><strong>Results: </strong>Median microvascular flow velocity of the malignant lesions was 1.25 cm/s compared to 0.36 cm/s for the benign lesions. Median pulsatility and resistive indices of the malignant lesions were 1.55 and 0.68, respectively versus 6.38 and 1.0 for the benign lesions. Malignant lesions were more hypoechoic relative to the surrounding tissue, with median echogenicity of 0.24 compared to 0.76 for the benign lesions. The differences between the malignant and benign groups for each measurement were significant (p < 0.01).</p><p><strong>Conclusion: </strong>Marked differences were observed in flow velocity, microvascular pulsatility, microvascular resistance, and echogenicity of prostate cancer measured with quantitative colour Doppler and greyscale ultrasound imaging. Vascular differences measured together with echogenicity have the combined potential to characterize malignant and benign prostate lesions.</p>","PeriodicalId":23440,"journal":{"name":"Ultrasound","volume":"29 2","pages":"106-111"},"PeriodicalIF":0.8,"publicationDate":"2021-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1742271X20952825","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38999061","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}

{"title":"Hiding in plain sight: Diagnosing pleural tuberculosis using lung ultrasound.","authors":"Wan Aireene Wan Ahmed,&nbsp;Mohd Jazman Che Rahim,&nbsp;Nurashikin Mohammad,&nbsp;Mohd Hashairi Fauzi,&nbsp;Shaik Farid Abdull Wahab","doi":"10.1177/1742271X20959761","DOIUrl":"https://doi.org/10.1177/1742271X20959761","url":null,"abstract":"<p><strong>Introduction: </strong>Diagnosing pleural tuberculosis can be difficult in patients with ambiguous presentation, especially in resource-limited health centres. Thus, lung ultrasound had been studied as a novel method in helping clinicians to diagnose this condition.</p><p><strong>Case presentation: </strong>A 48-year-old woman presented with worsening dyspnoea and orthopnoea for one week. She had also experienced weight loss, minimal dry cough and right-sided pleuritic chest pain for several weeks. A chest radiograph showed a right lower zone pleural effusion with no apparent lung consolidation. Lung ultrasound showed a right apical consolidation and right lower zone septated pleural effusion. Pleural fluid investigations showed exudative features of mixed lymphocytic, mesothelial and neutrophilic cellular components. Tuberculin skin test was strongly positive. She was subsequently treated for pleural tuberculosis. One month after treatment, her symptoms had improved considerably.</p><p><strong>Discussion: </strong>Lung ultrasound has been found to be more effective than chest radiograph in detecting consolidation and diagnosing pneumonia. The portability and efficacy of today's ultrasound machines, including the handheld types, show that lung ultrasound is a practical, reliable and valuable diagnostic tool in managing pulmonary conditions including tuberculosis, provided that the operators are adequately trained.</p><p><strong>Conclusion: </strong>Lung ultrasound in tuberculosis is the next frontier for clinicians and researchers.</p>","PeriodicalId":23440,"journal":{"name":"Ultrasound","volume":"29 2","pages":"123-127"},"PeriodicalIF":0.8,"publicationDate":"2021-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1742271X20959761","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38988467","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}

{"title":"Peer review of third trimester abdominal circumference measurements.","authors":"Ellen Dyer,&nbsp;Trish Chudleigh","doi":"10.1177/1742271X20954226","DOIUrl":"https://doi.org/10.1177/1742271X20954226","url":null,"abstract":"<p><strong>Background: </strong>Third trimester growth scans represent a significant proportion of the workload in obstetric ultrasound departments. The objective of these serial growth scans is to improve the antenatal detection of babies with fetal growth restriction. The aim of this paper is to describe a method of peer review for third trimester abdominal circumference measurements which is realistic within busy obstetric ultrasound departments in the UK.</p><p><strong>Method: </strong>Twenty-two, third trimester, measured abdominal circumference images were randomly selected. Images were assessed subjectively by 12 sonographers using the image Criteria Achieved Score. For quantitative assessment, termed the Inter-operator Variability Score, three of the abdominal circumference (AC) images were blindly remeasured. Following this, a questionnaire was used to ascertain which image criteria sonographers considered most important and to reach an agreement on correct caliper placement.</p><p><strong>Results: </strong>The least frequently met image criteria with the lowest Criteria Achieved Score related to an oblique abdominal circumference section. These included fetal kidney present (Criteria Achieved Score 24.6%), multiple oblique ribs (Criteria Achieved Score 39.4%) and oblique spine (Criteria Achieved Score 37.5%). Caliper placement was also identified as inconsistent.</p><p><strong>Discussion: </strong>This study demonstrates that the perfect AC section is not always possible and sonographers use their professional judgement to determine whether an image is acceptable. Seventy-three percent of the images reviewed were of an acceptable standard. There can be inconsistencies in sonographer opinion regarding what is an acceptable third trimester abdominal circumference image. These differences need to be addressed to maximise the effectiveness of the third trimester ultrasound examination.</p><p><strong>Conclusion: </strong>Peer review can be used to monitor scan quality and identify areas of inconsistency.</p>","PeriodicalId":23440,"journal":{"name":"Ultrasound","volume":"29 2","pages":"83-91"},"PeriodicalIF":0.8,"publicationDate":"2021-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1742271X20954226","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38999058","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}

{"title":"Editorial.","authors":"Hazel Edwards","doi":"10.1177/1742271X211005281","DOIUrl":"https://doi.org/10.1177/1742271X211005281","url":null,"abstract":"The UK Covid-19 vaccination programme appears to have been a remarkable success and is allowing us as a nation to dare to dream again about leisure time and freedom as our summer approaches. That said, many ultrasound departments are still battling with appointment backlogs and managers are probably dreading staff taking time off for holidays even though breaks are, for healthcare workers, more important than ever now. I hope hospital services are able to return soon to normal levels of activity and that, perhaps in some imaging departments, staff have developed new and better ways of working, which will persist after the Covid-19 pandemic is passed. I’d welcome good quality articles exploring this topic. In the meantime, the Spring issue of Ultrasound offers some very interesting papers. It is reassuring to read that research findings from a team based in the south of England suggest that the British Thyroid Association guidelines for grading thyroid nodules are safe and robust enough to work equally well whether being used by a novice or experienced ultrasound practitioner. Sehgal et al. from the USA offer a small but very compelling study comparing Doppler flow and echogenicity in benign and malignant prostate lesions. They found that malignant lesions were hypoechoic, had faster blood flow and a lower resistive index compared with benign lesions. There are three obstetric-focused papers but investigating very different issues; Miloro et al. use a tissue mimicking phantom to produce and measure ultrasound-induced temperature rises in utero. They compare transducer types and frequencies and, although the values obtained remain within current safety recommendations, they are certainly significant. The team also reminds us that reducing the acoustic power is an easy way to minimise heating effects. Good simple advice, especially when machines’ default settings may be at 100% power output. Dyer and Chudleigh present an interesting audit of third trimester fetal abdominal circumference measurements. A good abdominal section is arguably one of the most difficult views to achieve in late pregnancy yet precision is essential if measurements are to be of value and reproducible. Factors influencing sonographers’ decision making on what constitutes a good image are explored, along with other variables like calliper placement. Agarwal et al. investigate the value of an ultrasound-based index for stratifying the risk of morbidly adherent placenta, in terms of its accuracy, ease of use and interobserver reliability. Nice supporting images are a timely reminder of this potentially devastating condition. Yumna Haroon et al. offer a comprehensive guide to ultrasound applications regarding paediatric anaesthetic procedures, while Panayiotou et al. offer an informative case report on focal nodular hyperplasia in a teenager. Excellent comparative imaging is what makes this report superior and the take-home message is of course to avoid where possible unnecessary ","PeriodicalId":23440,"journal":{"name":"Ultrasound","volume":"29 2","pages":"72"},"PeriodicalIF":0.8,"publicationDate":"2021-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1742271X211005281","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38999056","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}

{"title":"Role of placenta accreta index in prediction of morbidly adherent placenta: A reliability study.","authors":"Shubhra Agarwal,&nbsp;Arjit Agarwal,&nbsp;Shruti Chandak","doi":"10.1177/1742271X20959742","DOIUrl":"https://doi.org/10.1177/1742271X20959742","url":null,"abstract":"<p><strong>Objective: </strong>To estimate the level of interobserver agreement in the calculation of placenta accreta index (PAI) as well as to evaluate the accuracy of PAI in prediction of morbidly adherent placenta.</p><p><strong>Materials and methods: </strong>This was a prospective study where 45 pregnant women (from 28 to 37 weeks of gestational age) with at least one previous Caesarean section and ultrasound-proven placenta previa were included. A known and previously published scoring system, the PAI, was evaluated independently by two radiologists and the cases were followed for the delivery and histopathology outcome. The accuracy of the PAI and the level of interrater agreement was analysed using cross-table analysis, intraclass correlation efficient and Cohen's kappa as statistical variables.</p><p><strong>Results: </strong>Adherent placenta was found in 15 patients accounting for 33% of cases. The PAI showed nearly 90% sensitivity, specificity and the predictive values. Interrater agreement in calculation of PAI by the two radiologists was perfect with an intraclass correlation efficient of 0.959. An easy-to-use morbid adherent placenta score was also predicted to simplify the results of PAI, which showed moderate agreement (κ = 0.746).</p><p><strong>Conclusions: </strong>The PAI can be helpful in stratifying the individual risk of placental invasion above the baseline risk. The PAI-derived, simplified scoring system called morbid adherent placenta score can be used as a simple tool to interpret and convey the results of PAI.</p>","PeriodicalId":23440,"journal":{"name":"Ultrasound","volume":"29 2","pages":"92-99"},"PeriodicalIF":0.8,"publicationDate":"2021-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1742271X20959742","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38999059","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}

{"title":"Ultrasound grading of thyroid nodules using the BTA U-scoring guidelines - Is there evidence of intra-and interobserver variability?","authors":"Michael Couzins,&nbsp;Stuart Forbes,&nbsp;Ganesh Vigneswaran,&nbsp;Indu Mitra,&nbsp;Elizabeth E Rutherford","doi":"10.1177/1742271X20971323","DOIUrl":"https://doi.org/10.1177/1742271X20971323","url":null,"abstract":"<p><strong>Introduction: </strong>U-score ultrasound classification (graded U1-U5) is widely used to grade thyroid nodules based on benign and malignant sonographic features. It is well established that ultrasound is an operator-dependent imaging modality and thus more susceptible to subjective variances between operators when using imaging-based scoring systems. We aimed to assess whether there is any intra- or interobserver variability when U-scoring thyroid nodules and whether previous thyroid ultrasound experience has an effect on this variability.</p><p><strong>Methods: </strong>A total of 14 ultrasound operators were identified (five experienced thyroid operators, five with intermediate experience and four with no experience) and were asked to U-score images from 20 thyroid cases shown as a single projection, with and without Doppler flow. The cases were subsequently rescored by the 14 operators after six weeks. The first and second round U-scores for the three operator groups were then analysed using Fleiss' kappa to assess interobserver variability and Cochran's Q test to determine any intraobserver variability.</p><p><strong>Results: </strong>We found no significant interobserver variability on combined assessment of all operators with fair agreement in round 1 (Fleiss' kappa = 0.30, <i>p</i> <0.0001) and slight agreement in round 2 (Fleiss' kappa = 0.19, <i>p</i> < 0.0001). Cochran's Q test revealed no significant intraobserver variability in all 14 operators between round 1 and round 2 (all <i>p</i>>0.05).</p><p><strong>Conclusions: </strong>We found no statistically significant inter- or intraobserver variability in the U-scoring of thyroid nodules between all participants reinforcing the validity of this scoring method in clinical practice, allaying concerns regarding potential subjective biases in reporting.</p>","PeriodicalId":23440,"journal":{"name":"Ultrasound","volume":"29 2","pages":"100-105"},"PeriodicalIF":0.8,"publicationDate":"2021-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1742271X20971323","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38999060","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}

{"title":"The use of ultrasound in the emergency department for the detection of thoracic outlet syndrome: A single case study.","authors":"Yale Tung-Chen,&nbsp;Raquel Marín-Baselga,&nbsp;Renzo Tejada-Sorados,&nbsp;Israel Enfedaque-Castilla","doi":"10.1177/1742271X20941174","DOIUrl":"https://doi.org/10.1177/1742271X20941174","url":null,"abstract":"<p><strong>Introduction: </strong>Thoracic outlet syndrome (TOS) refers to a spectrum of syndromes related to the compression of the brachial plexus (neurogenic TOS), subclavian vein or artery in the general region of the thoracic outlet, which is the area just above the first rib and behind the clavicle.</p><p><strong>Case report: </strong>We report a 27-year-old healthy man who presented to the emergency department with right upper limb pain, tingling and weakness. Point-of-care ultrasonography was performed following a dynamic protocol in the supraclavicular fossa in the right upper limb. A congenital cervical rib, as well as narrowing of the costoclavicular gap, causing vein, artery and spinal roots compression was evidenced. This maneuver reproduced the symptoms, confirming the suspicion of neurogenic TOS.</p><p><strong>Discussion: </strong>Early diagnosis is important, because the neurogenic compression associated with neurogenic TOS, if prolonged, can lead to muscle weakness and atrophy, being irreversible. Selected patients with neurogenic TOS who have progressive weakness, disabling pain, or who have failed to improve with conservative measures are considered for first rib resection.</p><p><strong>Conclusion: </strong>Using the dynamic approach during point-of-care ultrasonography examination, in combination with physical examination and cervical radiography, could help identify neurogenic TOS.</p>","PeriodicalId":23440,"journal":{"name":"Ultrasound","volume":"29 1","pages":"64-66"},"PeriodicalIF":0.8,"publicationDate":"2021-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1742271X20941174","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25341355","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}