Ultrasound Journal最新文献

{"title":"Inter-observer and intra-observer variability in ultrasound assessment of gastric content and volume in critically ill patients receiving enteral nutrition.","authors":"Héctor Andrés Ruiz Ávila,&nbsp;Carmelo José Espinosa Almanza,&nbsp;Cindy Yohana Fuentes Barreiro","doi":"10.1186/s13089-023-00312-x","DOIUrl":"https://doi.org/10.1186/s13089-023-00312-x","url":null,"abstract":"<p><strong>Background: </strong>The assessment of gastric content and volume using bedside ultrasound (US) has become a useful tool in emergency departments, anesthesiology departments and inpatient wards, as it provides a rapid and dynamic assessment of the gastric content of patients, which, allows making decisions regarding the risk of regurgitation or the need to adjust the strategy used to induce general anesthesia in patients with a full stomach. This assessment consists of two evaluations: a qualitative one, in which the status of the antrum, in terms of gastric content, is classified into three categories (empty, liquid content and full), and a quantitative one, where gastric volume is estimated. The objective of this study was to estimate the intra-observer and inter-observer agreement in ultrasound assessment of gastric content and volume in critically ill patients receiving enteral nutrition.</p><p><strong>Results: </strong>A total of 41 patients were included and each examiner performed 64 gastric US (n = 128). Participants' average age was 56.5 years (SD ± 12.6) and 63.4% were men. Regarding the qualitative evaluation of the antrum, in supine position both examiners classified the gastric content as grade 0 in 1 gastric US (1.5%), grade 1 in 4 gastric US (6.2%) and grade 2 in 59 (92.1%). Regarding intra-observer variability in the measurement of the area of the antrum, Lin's concordance correlation coefficient (CCC), the difference of means between measurements and the 95% limits of agreement of Bland and Altman values were 0.95 (95% CI 0.940-0.977), - 0.47 cm² (SD ± 1.64) and - 3.70 cm² to 2.75 cm², respectively, in EC1, and 0.94 (95% CI 0.922-0.973), - 0.18 cm² (SD ± 2.18) and - 4.47 cm² to 4.09 cm² in EC2. Concerning to inter-observer variability (EC1 vs EC2) in the measurement of the area of the antrum and of gastric volume, the following CCC, mean difference between measurements and 95% limits of agreement of Bland and Altman values were obtained: measurement of the area of the antrum: 0.84 (95% CI 0.778-0.911), - 0.86 cm² (SD ± 3.38) and - 7.50 cm² to 5.78 cm²; gastric volume measurement: 0.84 (95% CI 0.782-0.913), - 12.3 mL (SD ± 49.2) and - 108.8 mL to 84.0 mL.</p><p><strong>Conclusions: </strong>The assessment of gastric content and volume using bedside US in critically ill patients on mechanical ventilation and receiving enteral nutrition showed a good intra and inter-rater reliability. Most of the patients included in the study had a high risk of pulmonary aspiration, since, according to the results of the gastric US evaluation, they had gastric volumes > 1.5 mL/kg.</p>","PeriodicalId":36911,"journal":{"name":"Ultrasound Journal","volume":null,"pages":null},"PeriodicalIF":3.4,"publicationDate":"2023-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10024819/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9153800","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":"Start spreading the news: a deliberate approach to POCUS program development and implementation.","authors":"Mathilde Gaudreau-Simard,&nbsp;Elaine Kilabuk,&nbsp;Samantha Halman,&nbsp;Krista Wooller,&nbsp;Michael Y Woo,&nbsp;Robert Arntfield,&nbsp;Irene Ma,&nbsp;Alan J Forster","doi":"10.1186/s13089-023-00309-6","DOIUrl":"https://doi.org/10.1186/s13089-023-00309-6","url":null,"abstract":"<p><p>While there is an expanding body of literature on Point-of-Care Ultrasound (POCUS) pedagogy, administrative elements that are necessary for the widespread adoption of POCUS in the clinical environment have received little attention. In this short communication, we seek to address this gap by sharing our institutional experience with POCUS program development and implementation. The five pillars of our program, selected to tackle local barriers to POCUS uptake, are education, workflow, patient safety, research, and sustainability. Our program logic model outlines the inputs, activities, and outputs of our program. Finally, key indicators for the monitoring of program implementation efforts are presented. Though designed for our local context, this approach may readily be adapted toward other clinical environments. We encourage others leading the integration of POCUS at their centers to adopt this approach not only to achieve sustainable change but also to ensure that quality safeguards are in place.</p>","PeriodicalId":36911,"journal":{"name":"Ultrasound Journal","volume":null,"pages":null},"PeriodicalIF":3.4,"publicationDate":"2023-03-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9998745/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9173064","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":"Utility of hand-held ultrasound for image acquisition and interpretation by trained Kenyan providers.","authors":"Grace Wanjiku,&nbsp;Lindsay Dreizler,&nbsp;Shirley Wu,&nbsp;Janette Baird,&nbsp;Benjamin Wachira","doi":"10.1186/s13089-023-00308-7","DOIUrl":"https://doi.org/10.1186/s13089-023-00308-7","url":null,"abstract":"<p><strong>Background: </strong>Point-of-care ultrasound (POCUS) plays a prominent role in the timely recognition and management of multiple medical, surgical, and obstetric conditions. A POCUS training program for primary healthcare providers in rural Kenya was developed in 2013. A significant challenge to this program is the acquisition of reasonably priced ultrasound machines with adequate image quality and the ability to transmit images for remote review. The goal of this study is to compare the utility of a smartphone-connected, hand-held ultrasound with a traditional ultrasound device for image acquisition and interpretation by trained healthcare providers in Kenya.</p><p><strong>Methods: </strong>This study took place during a routine re-training and testing session for healthcare providers who had already received POCUS training. The testing session involved a locally validated Observed Structured Clinical Exam (OSCE) that assessed trainees' skills in performing the Extended Focused Assessment with Sonography for Trauma (E-FAST) and focused obstetric exams. Each trainee performed the OSCE twice, once using a smartphone-connected hand-held ultrasound and once using their notebook ultrasound model.</p><p><strong>Results: </strong>Five trainees obtained a total of 120 images and were scored on image quality and interpretation. Overall E-FAST imaging quality scores were significantly higher for the notebook ultrasound compared to the hand-held ultrasound but there was no significant difference in image interpretation. Overall focused obstetric image quality and image interpretation scores were the same for both ultrasound systems. When separated into individual E-FAST and focused obstetric views, there were no statistically significant differences in the image quality or image interpretation scores between the two ultrasound systems. Images obtained using the hand-held ultrasound were uploaded to the associated cloud storage using a local 3G-cell phone network. Upload times were 2-3 min.</p><p><strong>Conclusion: </strong>Among POCUS trainees in rural Kenya, the hand-held ultrasound was found to be non-inferior to the traditional notebook ultrasound for focused obstetric image quality, focused obstetric image interpretation, and E-FAST image interpretation. However, hand-held ultrasound use was found to be inferior for E-FAST image quality. These differences were not observed when evaluating each E-FAST and focused obstetric views separately. The hand-held ultrasound allowed for rapid image transmission for remote review.</p>","PeriodicalId":36911,"journal":{"name":"Ultrasound Journal","volume":null,"pages":null},"PeriodicalIF":3.4,"publicationDate":"2023-03-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9995612/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9139764","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":"Monitoring of pulmonary involvement in critically ill COVID-19 patients - should lung ultrasound be preferred over CT?","authors":"Arthur W E Lieveld,&nbsp;Micah L A Heldeweg,&nbsp;Jasper Schouwenburg,&nbsp;Lars Veldhuis,&nbsp;Mark E Haaksma,&nbsp;Rutger M van Haaften,&nbsp;Berend P Teunissen,&nbsp;Jasper M Smit,&nbsp;Jos Twisk,&nbsp;Leo Heunks,&nbsp;Prabath W B Nanayakkara,&nbsp;Pieter Roel Tuinman","doi":"10.1186/s13089-022-00299-x","DOIUrl":"https://doi.org/10.1186/s13089-022-00299-x","url":null,"abstract":"<p><strong>Background: </strong>It is unclear if relevant changes in pulmonary involvement in critically ill COVID-19 patients can be reliably detected by the CT severity score (CTSS) and lung ultrasound score (LUSS), or if these changes have prognostic implications. In addition, it has been argued that adding pleural abnormalities to the LUSS could improve its prognostic value. The objective of this study was to compare LUSS and CTSS for the monitoring of COVID-19 pulmonary involvement through: first, establishing the correlation of LUSS (± pleural abnormalities) and CTSS throughout admission; second, assessing agreement and measurement error between raters for LUSS, pleural abnormalities, and CTSS; third, evaluating the association of the LUSS (± pleural abnormalities) and CTSS with mortality at different timepoints.</p><p><strong>Methods: </strong>This is a prospective, observational study, conducted during the second COVID-19 wave at the AmsterdamUMC, location VUmc. Adult COVID-19 ICU patients were prospectively included when a CT or a 12-zone LUS was performed at admission or at weekly intervals according to local protocol. Patients were followed 90 days or until death. We calculated the: (1) Correlation of the LUSS (± pleural abnormalities) and CTSS throughout admission with mixed models; (2) Intra-class correlation coefficients (ICCs) and smallest detectable changes (SDCs) between raters; (3) Association between the LUSS (± pleural abnormalities) and CTSS with mixed models.</p><p><strong>Results: </strong>82 consecutive patients were included. Correlation between LUSS and CTSS was 0.45 (95% CI 0.31-0.59). ICCs for LUSS, pleural abnormalities, and CTSS were 0.88 (95% CI 0.73-0.95), 0.94 (95% CI 0.90-0.96), and 0.84 (95% CI 0.65-0.93), with SDCs of 4.8, 1.4, and 3.9. The LUSS was associated with mortality in week 2, with a score difference between patients who survived or died greater than its SDC. Addition of pleural abnormalities was not beneficial. The CTSS was associated with mortality only in week 1, but with a score difference less than its SDC.</p><p><strong>Conclusions: </strong>LUSS correlated with CTSS throughout ICU admission but performed similar or better at agreement between raters and mortality prognostication. Given the benefits of LUS over CT, it should be preferred as initial monitoring tool.</p>","PeriodicalId":36911,"journal":{"name":"Ultrasound Journal","volume":null,"pages":null},"PeriodicalIF":3.4,"publicationDate":"2023-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9968403/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10860999","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":"Alveolar capillary dysplasia with misalignment of pulmonary veins in a premature newborn: the role of lung ultrasound.","authors":"Macarena L Atun,&nbsp;Silvia A Fernandez Jonusas,&nbsp;Cecilia M Acosta","doi":"10.1186/s13089-023-00310-z","DOIUrl":"https://doi.org/10.1186/s13089-023-00310-z","url":null,"abstract":"<p><strong>Background: </strong>Alveolar capillary dysplasia with misalignment of pulmonary veins (ACD/MPV) is a lethal neonatal lung disorder characterized by the decrease of the alveolar units, abnormalities in the air-blood barrier of the lung, and impaired gas exchange. Typically, it affects a full-term newborn; the symptoms usually start within a few hours after birth, resulting in severe respiratory distress and pulmonary hypertension. In most of the cases, this disorder is refractory to conventional pulmonary support.</p><p><strong>Case presentation: </strong>We report a case of a newborn male of 29 weeks gestational age, with birth weight of 850 g and intrauterine growth restriction. Severe respiratory distress appeared a few minutes after birth; non-invasive ventilatory support was provided in the delivery room and, as a consequence of persistent respiratory failure, he was admitted to the neonatal intensive care unit (NICU) where mechanical ventilation was required. Due to the symptoms and pulmonary ultrasound pattern suggestive of respiratory distress syndrome, surfactant treatment was administered. Lung ultrasound (LU) was used for monitoring the responsiveness to surfactant; severe pulmonary hypertension ensued, followed by respiratory failure, refractory shock, and death within 48 h. Owing to the poor response to the established therapy, ACD/MPV was suspected. The diagnosis was confirmed through autopsy. The main goal of this case report is to show the role of LU for monitoring the evolution of this disorder.</p><p><strong>Conclusion: </strong>LU could provide essential information to help diagnose and follow-up the underlying cause of persistent pulmonary hypertension of the newborn in an earlier and more effective way than chest X-ray. LU is suitable for routine monitoring of lung disease in the NICU.</p>","PeriodicalId":36911,"journal":{"name":"Ultrasound Journal","volume":null,"pages":null},"PeriodicalIF":3.4,"publicationDate":"2023-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9922097/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9274286","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":"Accuracy of linear-probe ultrasonography in diagnosis of infraorbital rim fractures.","authors":"Chatchai Pruksapong,&nbsp;Nuttadon Wongprakob,&nbsp;Minth Panphichet","doi":"10.1186/s13089-022-00298-y","DOIUrl":"https://doi.org/10.1186/s13089-022-00298-y","url":null,"abstract":"<p><strong>Background: </strong>Maxillofacial fractures are a common cause of visits to emergency department, accounting for more than 400,000 annual visits in the United States. Gold standard diagnostic tool is conventional computerized tomography (CT) or 3DCT reconstruction. However, the disadvantages of CT are radiation exposure, unavailable in some hospital and expensiveness. Whereas the bony structures overlap is a problem in diagnostic when using plain film X-ray. The objective of this study is to show the accuracy of a linear-probe ultrasound compared to computed tomography and plain film X-ray in diagnosis of infraorbital rim fracture.</p><p><strong>Methods: </strong>Patients clinically suspected of an inferior orbital rim fracture underwent linear-probe ultrasonographic investigation, plain film X-ray and CT. CT was used as gold standard in this diagnostic study. A radiologist and senior resident of plastic surgery were the examiner and interobserver for comparison.</p><p><strong>Result: </strong>A total of 34 patients with suspected infraorbital rim fractures were investigated. Sensitivity of the linear-probe ultrasonography versus CT in the detection of infraorbital rim fracture was 92.9% (95% CI 66.1-99.8), specificity was 90.0% (95% CI 68.3-98.8), positive predictive value was 86.7% (95% CI 59.5-98.3), negative predictive value was 94.7% ( 95% CI 74.0-99.9), accuracy 91%.</p><p><strong>Conclusion: </strong>Linear probe ultrasonography is a good diagnostic tool and has better reliability than the plain film X-ray and can be used as alternative to CT in inferior orbital rim fracture.</p>","PeriodicalId":36911,"journal":{"name":"Ultrasound Journal","volume":null,"pages":null},"PeriodicalIF":3.4,"publicationDate":"2023-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9918656/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9270626","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":"Feasibility of tele-guided patient-administered lung ultrasound in heart failure.","authors":"Ariella Pratzer,&nbsp;Eugene Yuriditsky,&nbsp;Tajinderpal Saraon,&nbsp;Michael Janjigian,&nbsp;Ali Hafiz,&nbsp;Jun-Chieh J Tsay,&nbsp;Pamela Boodram,&nbsp;Nikita Jejurikar,&nbsp;Harald Sauthoff","doi":"10.1186/s13089-023-00305-w","DOIUrl":"https://doi.org/10.1186/s13089-023-00305-w","url":null,"abstract":"<p><strong>Background: </strong>Readmission rates for heart failure remain high, and affordable technology for early detection of heart failure decompensation in the home environment is needed. Lung ultrasound has been shown to be a sensitive tool to detect pulmonary congestion due to heart failure, and monitoring patients in their home environment with lung ultrasound could help to prevent hospital admissions. The aim of this project was to investigate whether patient-performed tele-guided ultrasound in the home environment using an ultraportable device is feasible.Affiliations: Journal instruction requires a country for affiliations; however, these are missing in affiliations [1, 2]. Please verify if the provided country are correct and amend if necessary.Correct METHODS: Stable ambulatory patients with heart failure received a handheld ultrasound probe connected to a smart phone or tablet. Instructions for setup were given in person during a clinic visit or over the phone. During each ultrasound session, patients obtained six ultrasound clips from the anterior and lateral chest with verbal and visual tele-guidance from an ultrasound trained clinician. Patients also reported their weight and degree of dyspnea, graded on a 5-point scale. Two independent reviewers graded the ultrasound clips based on the visibility of the pleural line and A or B lines.</p><p><strong>Results: </strong>Eight stable heart failure patients each performed 10-12 lung ultrasound examinations at home under remote guidance within a 1-month period. There were no major technical difficulties. A total of 89 ultrasound sessions resulted in 534 clips of which 88% (reviewer 1) and 84% (reviewer 2) were interpretable. 91% of ultrasound sessions produced interpretable clips bilaterally from the lateral chest area, which is most sensitive for the detection of pulmonary congestion. The average time to complete an ultrasound session was 5 min with even shorter recording times for the last session. All patients were clinically stable during the study period and no false positive B-lines were observed.</p><p><strong>Conclusions: </strong>In this feasibility study, patients were able to produce interpretable lung ultrasound exams in more than 90% of remotely supervised sessions in their home environment. Larger studies are needed to determine whether remotely guided lung ultrasound could be useful to detect heart failure decompensation early in the home environment.</p>","PeriodicalId":36911,"journal":{"name":"Ultrasound Journal","volume":null,"pages":null},"PeriodicalIF":3.4,"publicationDate":"2023-02-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9911571/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9260762","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":"Assessment of residual gastric volume using point-of-care ultrasonography in adult patients who underwent elective surgery.","authors":"T S Chaitra,&nbsp;Sanjeev Palta,&nbsp;Richa Saroa,&nbsp;Swati Jindal,&nbsp;Aditi Jain","doi":"10.1186/s13089-023-00307-8","DOIUrl":"https://doi.org/10.1186/s13089-023-00307-8","url":null,"abstract":"<p><strong>Background: </strong>Aspiration pneumonitis remains a dreaded complication that may lead to almost 9% of anaesthesia-related deaths. The presence of gastric contents has always been a contributing factor to an increased risk of aspiration. Preoperative gastric ultrasound has been suggested as a modality for determining residual volume in special populations and conditions. We conducted an observational study to determine the gastric residual volume in preoperative patients of elective surgery with gastric ultrasound and to study its correlation with patient factors.</p><p><strong>Methods: </strong>We enrolled 411 patients in the age group of 18-80 with ASA-PS I and II having BMI less than 35 kg/m². Patients with prior gastrointestinal surgery and parturients were excluded from the present study. Gastric antrum in both supine and right lateral decubitus positions was measured using USG in the immediate preoperative period, and gastric residual volume was calculated, which was subsequently correlated with various patient factors.</p><p><strong>Results: </strong>On qualitative assessment, 97 and 118 patients were observed to have distended stomachs in the supine and right lateral decubitus positions, respectively. On quantitative assessment, 336 had safe GRV, 60 patients were classified as having a low risk of aspiration (GRV < 1.5 ml/kg) while 13 had a high risk of aspiration (> 1.5 ml/kg). Eight patients with a fasting duration of more than ten hours and five who fasted between 6 and 10 h had a gastric residual volume of more than 1.5 ml/h. Patients who were premedicated with histamine blockers had a statistically significant higher antral cross-sectional area (p-value - 0.022*) and GRV (p-value - 0.018*) in the right lateral decubitus position compared to patients who had taken proton pump inhibitors (PPIs). As BMI increased, there was a statistically significant (p-value < 0.001) increase in mean antral CSA in both supine and right lateral decubitus positions. There was a statistically significant association found between type 2 diabetes (p-value 0.045*) with antral grade.</p><p><strong>Discussion: </strong>Patients can have significant residual volume (> 1.5 ml/kg) despite adequate fasting, and preoperative gastric ultrasound can help in assessing the same and guiding perioperative airway management. PPIs are more effective in reducing gastric residual volume as compared to histamine blockers. Patients with a BMI of more than 30 and type 2 diabetes mellitus have significant correlation with increased gastric residual volume mandating preoperative gastric ultrasound assessment for effective management.</p><p><strong>Conclusions: </strong>Patients with BMI over 30 and type 2 diabetes may benefit from POCGUS to guide perioperative airway management by stratifying GRV. Trial registration Name of registry-Clinical Trial Registry of India. Trial registration number-2020/03/024083. Date of registration-19.3.2020. URL- http://ctr","PeriodicalId":36911,"journal":{"name":"Ultrasound Journal","volume":null,"pages":null},"PeriodicalIF":3.4,"publicationDate":"2023-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9908785/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10745635","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":"\"Sponge pattern\" of the spleen: a rarely described high-frequency ultrasound pattern in HIV-positive patients.","authors":"Tom Heller,&nbsp;Francesco Taccari,&nbsp;Kelvin Rambiki,&nbsp;Tapiwa Kumwenda,&nbsp;Enrico Brunetti,&nbsp;Claudia Wallrauch","doi":"10.1186/s13089-022-00297-z","DOIUrl":"https://doi.org/10.1186/s13089-022-00297-z","url":null,"abstract":"<p><strong>Background: </strong>The spleen is frequently scanned in workup of infections. Hypoechoic splenic micro-abscesses are known signs of disseminated tuberculosis in HIV co-infected patients. The spleen of HIV patients is thus often scanned using high-frequency transducers.</p><p><strong>Methods and findings: </strong>We describe a reticulo-nodular \"sponge pattern\" in the spleen of an HIV-positive patient with Hodgkin's lymphoma. Disseminated throughout the spleen, very small (1.5-2.0 mm) hypoechoic lesions having a branching reticulo-nodular distribution were seen. The lesions partly, but not entirely, follow splenic vasculature. Review of stored images of other patients identified 15 more cases showing a similar pattern. All patients were HIV positive, almost all with CD4 counts below 200 cells/mm³. Seven (44%) were additionally diagnosed with HHV-8-associated diseases, but the pattern was seen with various underlying opportunistic infections.</p><p><strong>Discussion and conclusion: </strong>After comparison with spleen microscopic anatomy, we hypothesize that the white pulp of spleens in our patients is hyperplastic or otherwise changed in consistency to be better visible by high-frequency ultrasound. Concomitant human herpesvirus-8 infection may be another cause of this visible white pulp. While we can only speculate about the etiology of the splenic \"sponge pattern,\" it needs to be recognized as it may be misinterpreted as splenic micro-abscesses of disseminated infections, like tuberculosis in severely immune-compromised patients.</p>","PeriodicalId":36911,"journal":{"name":"Ultrasound Journal","volume":null,"pages":null},"PeriodicalIF":3.4,"publicationDate":"2023-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9898479/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10665577","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":"Ultrasonographic measurement of the optic nerve sheath diameter to detect intracranial hypertension: an observational study.","authors":"Christian Daniel Yic, Julio Pontet, Mauricio Mercado, Matias Muñoz, Alberto Biestro","doi":"10.1186/s13089-022-00304-3","DOIUrl":"10.1186/s13089-022-00304-3","url":null,"abstract":"<p><strong>Objectives: </strong>To evaluate the ultrasonographic measurement of optic nerve sheath diameter (ONSD) as a predictor of intracranial hypertension as compared to the invasive measurement of intracranial pressure (ICP).</p><p><strong>Design: </strong>Cross-sectional observational study.</p><p><strong>Setting: </strong>Intensive Care Unit (ICU) of two tertiary university hospitals in Montevideo, Uruguay.</p><p><strong>Patients: </strong>We included 56 adult patients, over 18 years of age, who required sedation, mechanical ventilation, and invasive ICP monitoring as a result of a severe acute neurologic injury (traumatic or non-traumatic) and had a Glascow Coma Score (GCS) equal to or less than 8 on admission to the ICU.</p><p><strong>Interventions: </strong>Ultrasonographic measurement of ONSD to detect intracranial hypertension.</p><p><strong>Measurements and main results: </strong>In our study, a logistic regression model was performed in which it was observed that the variable ONSD is statistically significant with a p value of 0.00803 (< 0.05). This model estimates and predicts the probability that a patient will have an ICP greater than 20 mmHg. From the analysis of the cut-off points, it is observed that a value of 5.7 mm of ONSD maximizes the sensitivity (92.9%) of the method (a greater number of individuals with ICP > 20 mmHg are correctly identified).</p><p><strong>Conclusions: </strong>In sedated neurocritical patients, with structural Acute Brain Injury, the ONSD measurement correlates with the invasive measurement of ICP. It was observed that with ONSD values less than 5.7 mm, the probability of being in the presence of ICP above 20 mmHg is very low, while for ONSD values greater than 5.7 mm, said probability clearly increases.</p>","PeriodicalId":36911,"journal":{"name":"Ultrasound Journal","volume":null,"pages":null},"PeriodicalIF":3.4,"publicationDate":"2023-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9895168/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10651072","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}