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Polfer EM, Hoyt BW, Senchak LT, Murphey MD, Forsberg JA, Potter BK. Fluid collections in amputations are not indicative or predictive of infection. Clin Orthop Relat Res 2014; 472:2978-83. [PMID: 24691841 PMCID: PMC4160471 DOI: 10.1007/s11999-014-3586-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND In the acute postoperative period, fluid collections are common in lower extremity amputations. Whether these fluid collections increase the risk of infection is unknown. QUESTIONS/PURPOSES The purposes of this study were to determine (1) the percentage of patients who develop postoperative fluid collections in posttraumatic amputations and the natural course of the collection; (2) whether patients who develop these collections are at increased risk for infection; and to ask (3) are there objective clinical or radiologic signs that are associated with likelihood of infection when a fluid collection is present? METHODS We performed a review of all 300 patients injured in combat operations who sustained at least one major lower extremity amputation (at or proximal to the tibiotalar joint) and were treated definitively at our institution between March 2005 and April 2009. We segregated the groups based on whether cross-sectional imaging was performed less than 3 months (early group) after closure, greater than 3 months (late group) after closure, or not at all (control group, baseline frequency of infection). Our primary study cohort where those patients with a fluid collection in the first three months. The clinical course was reviewed and the primary outcome was a return to the operating room for irrigation and débridement with positive cultures. For those patients with cross-sectional imaging, we also collected objective clinical parameters within 24 hours of the scan (white blood cell count, maximum temperature, presence of bacteremia, tachycardia, oxygen desaturation), extremity examination (presence of erythema, warmth, and/or drainage), and characteristics of the fluid collections seen (size of the fluid collection, enhancement, complexity (simple versus loculated), surrounding edema, skin changes, tract formation, presence of air, and changes within the bone itself). The presence of a fluid collection on imaging was analyzed to determine whether it was associated with infection. We further analyzed clinical parameters, objective physical examination findings at the extremity, and characteristics of the fluid collection to determine if there were other parameters associated with infection. RESULTS Over half (55%) of the limbs demonstrated fluid collection in the early postoperative period and the prevalence decreased in the late group (11%; p = 0.001). There was no association between the presence of a fluid collection and infection. However, there was an association between objective clinical signs at the extremity (erythema and/or drainage) and infection (p < 0.001) in our primary study cohort. CONCLUSIONS Fluid collections are common in combat-related amputations in the immediate postoperative period and become smaller and less frequent over time. In the absence of extremity erythema and wound drainage, imaging of a residual limb to evaluate for the presence of a fluid collection appears to be of little clinical use.
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Riente L, Delle Sedie A, Filippucci E, Scirè CA, Iagnocco A, Gutierrez M, Possemato N, Meenagh G, Valesini G, Montecucco C, Grassi W, Bombardieri S. Ultrasound Imaging for the rheumatologist XXVII. Sonographic assessment of the knee in patients with rheumatoid arthritis. Clin Exp Rheumatol 2010; 28:300-303. [PMID: 20576224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2010] [Accepted: 06/21/2010] [Indexed: 05/29/2023]
Abstract
The aims of our study were to investigate the prevalence of ultrasound (US) pathologic abnormalities and to compare them with the clinical findings in the knee of rheumatoid arthritis (RA) patients. One hundred RA patients were enrolled in the study. Bilateral US examination of the knee was performed to visualise the presence of effusion, synovial proliferation, bone erosions, femoral cartilage abnormalities, quadricipital and/or patellar enthesopathy. The popliteal fossa and the calf region were also evacuate to detect popliteal cyst. We observed joint effusion in 140 out of 200 (70%) knees. Synovial hypertrophy was present in 115 out of 140 (82%) knees associated with effusion and in 22 out of 115 (19%) knees intra-articular power Doppler (PD) signal was found. Hyperechoic spots within the cartilage layer, suggestive of pyrophosphate crystals deposit, were detected in the knees of 3 patients. US signs of quadricipital and/or patellar enthesopathy were detected in 53 out 200 (26%) knees. Bone erosions were visualised in 16 out 200 (8%) knees. Popliteal cyst was found in 66 out of 200 (33%) joints. US examination of the knee is more sensitive than clinical examination in the detection of joint inflammation and allows for the identification of different patterns of pathologic changes at knee level, including morphostructural changes at both cartilage and tendon level.
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Adhikari S, Blaivas M. Utility of bedside sonography to distinguish soft tissue abnormalities from joint effusions in the emergency department. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2010; 29:519-526. [PMID: 20375371 DOI: 10.7863/jum.2010.29.4.519] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
OBJECTIVE The purpose of this study was to determine the utility of bedside sonography to differentiate soft tissue abnormalities from joint effusions. METHODS We conducted a retrospective review of emergency department (ED) patients presenting with joint pain, erythema, and swelling who received bedside sonography. The ED sonographic examinations were performed by emergency physician sonologists who were not involved in clinical assessment and management of these patients. The treating physician's opinions regarding the probability of joint effusion and need for aspiration were documented in the sonography log before the sonographic examination was performed. The bedside sonograms of all patients included in this study were also reviewed for accuracy. Descriptive statistics were used to summarize the data. RESULTS A total of 54 patients (mean age +/- SD, 41 +/- 18.9 years) were identified over a 1-year period. The symptomatic joints in our study subjects were as follows: knee, 24 of 54 (44%); elbow, 21 of 54 (38%); ankle, 8 of 54 (15%); and metatarsophalangeal joint, 1 of 54 (2%). Twenty-two of 54 patients (40.7%; 95% confidence interval [CI], 27.6%-53.8%) were found to have joint effusions on sonography. Sonography altered management in 35 of 54 patients (65%; 95% CI, 52%-77.5%). Joint aspiration was planned in 39 of 54 cases (72.2%; 95% CI, 60.2%-84.1%) before sonography. After sonography, only 20 of these patients (37%; 95% CI, 24.1%-49.9%) underwent joint aspiration. There was a statistically significant difference in treatment plans after the addition of bedside sonographic results (P < .01). CONCLUSIONS Our study suggests that bedside sonography is useful in differentiating joint effusions from soft tissue abnormalities and directing appropriate therapy.
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Koskas M, Nizard J, Salomon LJ, Ville Y. Abdominal and pelvic ultrasound findings within 24 hours following uneventful Cesarean section. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2008; 32:520-526. [PMID: 18683208 DOI: 10.1002/uog.6120] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
OBJECTIVES To describe prospectively the normal abdominal and pelvic ultrasound features within 24 h following uneventful Cesarean section. METHODS Transabdominal ultrasound examination was performed between 1 and 3 h, and again at 24 h, following lower-segment Cesarean section (LSCS). The myometrium, endometrium, and amount and distribution of free peritoneal fluid were studied in 30 women with singleton pregnancies who underwent LSCS delivery. RESULTS Examinations were performed easily in all cases except one who was morbidly obese (body mass index > 40 kg/m(2)). At 1-3 h after delivery, mean +/- SD endometrial thickness was 13 +/- 2 mm. Mean uterine length, from the fundus to the cervical external os, was 160 +/- 15 mm. Measurement of uterine length in the mid-sagittal plane of the pelvis was impossible in eight cases (27%) owing to pain. No abnormal intrauterine findings were observed. Mean uterine width was 110 +/- 10 mm. Mean distance between the sacral promontory and uterine fundus was 104 +/- 11 mm. Mean thicknesses of the anterior and posterior walls of the uterus were 40 +/- 5 mm and 39 +/- 7 mm, respectively. No fluid was seen in Morrison's or Douglas' pouches. There was a consistent and significant reduction between the measurements performed at 1-3 h and those at 24 h after LSCS, except for the distance between the fundus and external os. CONCLUSIONS Ultrasound examination is feasible after Cesarean section. Images are obtained easily, even when scanning through the scar. In normal pregnancies, there is no fluid in the abdomen or pelvis. These results could help clinicians in the decision-making process in cases of early postpartum hemorrhage or hemodynamic instability following LSCS.
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Chen HJ, Tu CY, Ling SJ, Chen W, Chiu KL, Hsia TC, Shih CM, Hsu WH. Sonographic appearances in transudative pleural effusions: not always an anechoic pattern. ULTRASOUND IN MEDICINE & BIOLOGY 2008; 34:362-369. [PMID: 17996356 DOI: 10.1016/j.ultrasmedbio.2007.09.009] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2007] [Revised: 09/05/2007] [Accepted: 09/12/2007] [Indexed: 05/25/2023]
Abstract
Pleural effusion patterns in sonographic appearances can be subclassified as anechoic, complex nonseptated, complex septated and homogeneously echogenic. Previous studies have suggested that transudates are usually anechoic; however, in daily practice we find frequently that heterogeneous echogenic material is present in transudative pleural effusions. This clinical study was to re-evaluate the sonographic appearances of transudative pleural effusions. A total of 127 patients with transudative pleural effusion that met Light's criteria ([1] a pleural fluid-serum protein ratio of <0.5, [2] a pleural fluid-serum lactate dehydrogenase [(LDH] ratio of <0.6 and [3] a pleural fluid LDH of less than two thirds of the upper limit of normal for serum LDH) and clinical presentations were enrolled. Results showed that transudative pleural effusions had the following sonographic appearances: an anechoic pattern in 45% (57/127) and a complex nonseptated pattern in 55% (70/127). There was no complex septated or homogenously echogenic pattern. In conclusion, sonographic presentations in transudative pleural effusions are not always in an anechoic pattern. If an afebrile patient without infectious symptoms/signs has bilateral pleural effusion compatible with transudate of Light's criteria, treat the underlying problems and ignore the complex nonseptated sonographic appearance. (E-mail: hsuwh@www.cmuh.org.tw).
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Atchia I, Birrell F, Kane D. A modular, flexible training strategy to achieve competence in diagnostic and interventional musculoskeletal ultrasound in patients with hip osteoarthritis. Rheumatology (Oxford) 2007; 46:1583-6. [PMID: 17890273 DOI: 10.1093/rheumatology/kem187] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE This study sought to establish a model of training and an assessment of competency in musculoskeletal ultrasound (MSUS) diagnosis of hip synovitis and/or effusion and in MSUS-guided injection of the hip. METHODS The 'trainee' (no previous experience in MSUS) was trained by an 'expert' [a rheumatologist who is a trainer on the European League Against Rheumatism (EULAR) MSUS course] using a modular approach focused on hip ultrasound only. This consisted of (i) a 1.5 h initial tutorial and practical demonstration and (ii) indirectly supervised non-continuous scanning of 40 hips over 5 h. Competency was assessed in three ways: (i) ability to obtain standard EULAR reference MSUS images of the hip of sufficient image quality, (ii) accuracy in diagnosis of synovitis or hip effusion by measurement of the anterior femur-capsule distance, and (iii) accuracy in ultrasound-guided hip aspiration and injection. RESULTS After a period of scanning of 75 min (10 hips), the images obtained by the trainee were consistently graded as acceptable for routine clinical use. Next, blinded triplicate measurements of the anterior femur-capsule distance performed by the trainee and expert showed agreement regarding diagnosis of hip effusion (>7 mm thickness) in 16/17 cases of hip arthritis (kappa 0.876). The trainee performed 40 MSUS-guided hip injections (seven directly supervised followed by 33 indirectly supervised). After 10 consecutive MSUS-guided hip injections, the novice achieved a subsequent accuracy rate of 25/26 (96%) confirmed by radiographic localization of radiopaque contrast. CONCLUSIONS Using a modular approach, a learner-centred curriculum and a self-directed learning strategy with a minimum of direct supervision, a trainee achieved competence in MSUS diagnosis of hip effusion/synovitis and in MSUS-guided hip aspiration/injection.
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Abstract
OBJECTIVES To assess the incidence of fluid collections in postoperative amputee stumps and the impact on limb-fitting outcomes in patients with such collections. DESIGN Cohort study. SETTING Inpatient rehabilitation ward. PARTICIPANTS Successive patients with amputation examined with ultrasound over 1 year. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES The presence of discrete fluid collections on admission and outcomes of successful limb fitting, length of inpatient stay, and presence of psychologic symptoms. RESULTS In 105 consecutive admissions, we detected discrete fluid collections in 28 (27%) of stumps with a median volume of 38.5 mL (range, 16-216 mL). All collections diminished and disappeared by discharge with 81% undetectable within 30 days since surgery. A transfemoral amputee was more likely to develop a collection than a transtibial amputee (P<.01). Patients with collections took 9.5 days longer to achieve limb fitting (P=.04) and had a 10-day longer inpatient stay (P=.02). However, the overall success of limb fitting was similar as was the incidence of psychologic distress. CONCLUSIONS Discrete fluid collections are common in postoperative amputation stumps but regress by discharge. Although limb fitting may be delayed, the ultimate success of limb fitting is not reduced and patients can be reassured.
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Figurska M, Warczyńska A, Warczyński A. [Diagnostic difficulties of advanced forms of exudative AMD]. KLINIKA OCZNA 2007; 109:312-316. [PMID: 18260287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
UNLABELLED Advanced forms of exudative AMD often form diagnostic difficulties and need to be differentiated with other proliferative diseases of the posterior pole. The necessary diagnostic examinations in theses cases are fluorescein and indocyanine green angiography, and nuclear magnetic resonance (MR) of the eye balls. Angiogenesis in the degenerative changes of the retina results in similar degree of enhancement in MR as in melanomas and metastases. The aim of this presentation is to discuss and compare the images of advanced forms of exudative AMD in images from fluorescein angiography, ultrasound, and especially MR based on clinical cases. CONCLUSIONS Despite being a very sensitive method due to its high tissues differentiation MR does not allow to define degenerative and proliferative changes in small foci.
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Duysinx BC, Larock MP, Nguyen D, Corhay JL, Bury T, Hustinx R, Louis R. 18F-FDG PET imaging in assessing exudative pleural effusions. Nucl Med Commun 2006; 27:971-6. [PMID: 17088683 DOI: 10.1097/01.mnm.0000243366.96012.c0] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND This study evaluates the accuracy of [F]fluorodeoxyglucose positron emission tomography (F-FDG PET) imaging with semi-quantitative analysis for differentiating benign from malignant pleural exudates and for guiding the search for the primary tumour of pleural metastases. METHODS Whole-body 18F-FDG PET was performed in 79 patients with exudative pleurisy. Standard uptake values were normalized for body weight, body surface area, lean body mass (SUVbw, SUVbsa, SUVlbm) with and without correction for blood glucose levels. Thoracoscopy was systematically performed to reveal pathological diagnosis. RESULTS All SUVs were significantly higher in all malignant pleural diseases (n = 51) than in benign (n = 28) (P < 0.001). Moreover SUVs were greater in the pleural metastases from pulmonary primaries (n = 25) and in mesotheliomas (n = 8) than in extrathoracic primaries (n = 18) (P < 0.01) with no significant difference between lung cancers and mesotheliomas. Receiver operating curve (ROC) analysis between benign and malignant lesions showed areas under the curves that ranged from 0.803 (SUVbsa g) to 0.863 (SUVbw). The cut-off value for SUVbw which gave the best accuracy (82.3%) was 2.2. When comparing thoracic with extrathoracic primaries the highest accuracy (80.4%) was found for a cut-off value of 2.6. CONCLUSION Semi-quantitative analysis of 18F-FDG PET imaging helps to differentiate malignant from benign pleural exudates and to distinguish between thoracic or extrathoracic primaries.
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Qvistgaard E, Torp-Pedersen S, Christensen R, Bliddal H. Reproducibility and inter-reader agreement of a scoring system for ultrasound evaluation of hip osteoarthritis. Ann Rheum Dis 2006; 65:1613-9. [PMID: 16728462 PMCID: PMC1798465 DOI: 10.1136/ard.2005.050690] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To evaluate the intra-reader and inter-reader agreements of ultrasonographic assessments of hip joints in patients with hip osteoarthritis. DESIGN Ultrasonography was performed on 100 patients with hip osteoarthritis at 14 MHz using a 8-15 MHz linear probe. Dynamic sweeps of the hip and representative still images were used for the analysis. A semiquantitative grading score was introduced in the evaluation of the ultrasound pictures and compared with an overall ultrasound evaluation. The evaluation was performed by a specialist in ultrasonography and a rheumatologist trained in musculoskeletal ultrasound examination. Clinical pain assessment and joint aspiration were obtained in parallel with the ultrasonography. RESULTS Intraobserver agreement represented by intraclass correlation coefficients (ICC) (exact agreement in percentage; unweighted kappa values) showed good to excellent correlation, 0.8 with regard to the osteophyte score, 0.78 with regard to the femoral head score, 0.71 with regard to the fluid score and 0.69 with regard to the synovial profile score. Interobserver agreement was fair to good with corresponding ICC 0.65, 0.63, 0.45 and 0.6, respectively. In comparison, the ICC for the global osteoarthritis and synovial assessments were 0.7 and 0.72, respectively, for the intraobserver rating and 0.56 and 0.58, respectively, for the interobserver rating. CONCLUSIONS This study suggests that ultrasound is a reproducible method for the assessment of changes in the osseous surface and synovium-related inflammation. The semiquantitative scoring system presented seemed to match the global assessment of a trained ultrasound investigator and might be used by less-trained investigators.
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Krogh RA, Rasmussen KL. [Vaginal vault fluid collection after hysterectomy. Frequency and clinical significance]. Ugeskr Laeger 2006; 168:1867-70. [PMID: 16756805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
INTRODUCTION Our aim was to investigate the prevalence of sonographically detectable vault fluid collection after hysterectomy and its relation to post-operative morbidity. MATERIALS AND METHODS We studied a group of 103 women below 60 years of age who had undergone abdominal or vaginal hysterectomy for benign causes apart from uterovaginal prolapse. A transvaginal ultrasound examination was carried out 24 to 72 hours after surgery. A telephone follow-up and a record review were done six to eight weeks later to determine the morbidity rate. RESULTS Of the 103 women scanned, 39 (38%) had sonographically detected vaginal vault fluid collection. A haemoglobin concentration drop was observed in a significant number of patients (33% vs. 13%) who had fluid collection in the immediate post-operative period. At follow-up, a significant increase in the complaints of post-operative pain (15% vs. 42%) and re-presentation (32% vs. 55%) was seen in the fluid collection group. The increased risk of re-presentation was not accompanied by an increased risk of needing additional treatment. CONCLUSION Sonographic detection of vaginal vault fluid collection is common after hysterectomy, but such a finding rarely indicates additional treatment. Vaginal ultrasound examination should not be performed routinely after hysterectomy.
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McLaughlin R, Collum N, McGovern S, Martyn C, Bowra J. Emergency department ultrasound (EDU): clinical adjunct or plaything? Emerg Med J 2005; 22:333-5. [PMID: 15843699 PMCID: PMC1726783 DOI: 10.1136/emj.2004.014241] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Emergency department ultrasound (EDU) is a physician performed ultrasound service aimed at improving patient flow and diagnosis in the emergency department. METHODS This paper describes the initial phase of the introduction of EDU with three illustrative case reports and a discussion on the pitfalls and benefits of EDU. RESULTS AND DISCUSSION In three cases discussed here, the use of EDU facilitated treatment and reduced the need for formal radiological scanning. While there are drawbacks to EDU, we believe these are far outweighed by the advantages, and in a recent survey of emergency medicine consultants throughout Ireland, the vast majority were in favour of its introduction. CONCLUSION EDU has become a routine part of our clinical practice, and although we are still on a learning curve with regard to its use, we have experienced significant benefits in patient care. With technological advances (such as improved image resolution and teleradiology) the potential for EDU will continue to expand, but training, practice, accreditation, and audit are essential.
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Kleffel T, Demharter J, Wohlgemuth W, Schalm J, Bohndorf K, Kirchhof K. [Comparison of contrast-enhanced low mechanical index (Low MI) sonography and unenhanced B-mode sonography for the differentiation between synovitis and joint effusion in patients with rheumatoid arthritis]. ROFO-FORTSCHR RONTG 2005; 177:835-41. [PMID: 15902633 DOI: 10.1055/s-2005-858194] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE To test whether contrast-enhanced low mechanical index (low MI) sonography is superior to non enhanced B-Mode sonography in differentiating synovitis and joint effusion. MATERIAL AND METHODS In a retrospective study, 22 patients with proven rheumatoid arthritis underwent B-Mode sonography and low-MI sonography of 25 symptomatic joints of the upper and lower limbs. For low-MI sonography, 5 ml Sonovue (Bracco Altana Pharma GmbH, Konstanz) were injected as an intravenous bolus followed by 10 ml of 0.9 % saline solution. Magnetic resonance imaging (MRI) was obtained additionally in 3 joints. With non-enhanced sonography, we diagnosed a synovitis in case of an echogenic and a joint effusion in case of an anechoic mass. With contrast-enhanced sonography, we diagnosed a synovitis in case of enhancement and a joint effusion in the absence of enhancement of the intraarticular mass. RESULTS In 13 joints, synovitis and joint effusion were differentiated by both non-enhanced and enhanced sonography. In 12 joints, this differentiation was only possible with contrast-enhanced sonography. In 3 patients diagnosed by sonography as having a synovitis, this diagnosis was proven by MRI. CONCLUSION Contrast-enhanced low-MI sonography is superior to non-enhanced B-Mode sonography in differentiating synovitis and joint effusion.
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Conaghan P, D'Agostino MA, Ravaud P, Baron G, Le Bars M, Grassi W, Martin-Mola E, Wakefield R, Brasseur JL, So A, Backhaus M, Malaise M, Burmester G, Schmidely N, Emery P, Dougados M. EULAR report on the use of ultrasonography in painful knee osteoarthritis. Part 2: exploring decision rules for clinical utility. Ann Rheum Dis 2005; 64:1710-4. [PMID: 15878902 PMCID: PMC1755323 DOI: 10.1136/ard.2005.038026] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Synovial inflammation (as defined by hypertrophy and effusion) is common in osteoarthritis (OA) and may be important in both pain and structural progression. OBJECTIVE To determine if decision rules can be devised from clinical findings and ultrasonography (US) to allow recognition of synovial inflammation in patients with painful knee OA. METHODS A EULAR-ESCISIT cross sectional, multicentre study enrolled subjects with painful OA knee who had clinical, radiographic, and US evaluations. A classification and regression tree (CART) analysis was performed to find combinations of predictor variables that would provide high sensitivity and specificity for clinically detecting synovitis and effusion in individual subjects. A range of definitions for the two key US variables, synovitis and effusion (using different combinations of synovial thickness, depth, and appearance), were also included in exploratory analyses. RESULTS 600 patients with knee OA were included in the analysis. For both knee synovitis and joint effusion, the sensitivity and specificity were poor, yielding unsatisfactory likelihood ratios (75% sensitivity, 45% specificity, and positive LR of 1.36 for knee synovitis; 71.6% sensitivity, 43.2% specificity, and positive LR of 1.26 for joint effusion). The exploratory analyses did not improve the sensitivity and specificity (demonstrating positive LRs of between 1.26 and 1.57). CONCLUSION Although it is possible to determine clinical and radiological predictors of OA inflammation in populations, CART analysis could not be used to devise useful clinical decision rules for an individual subject. Thus sensitive imaging techniques such as US remain the most useful tool for demonstrating synovial inflammation of the knee at the individual level.
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D'Agostino MA, Conaghan P, Le Bars M, Baron G, Grassi W, Martin-Mola E, Wakefield R, Brasseur JL, So A, Backhaus M, Malaise M, Burmester G, Schmidely N, Ravaud P, Dougados M, Emery P. EULAR report on the use of ultrasonography in painful knee osteoarthritis. Part 1: prevalence of inflammation in osteoarthritis. Ann Rheum Dis 2005; 64:1703-9. [PMID: 15878903 PMCID: PMC1755310 DOI: 10.1136/ard.2005.037994] [Citation(s) in RCA: 185] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To assess the prevalence of inflammation in subjects with chronic painful knee osteoarthritis (OA), as determined by the presence of synovitis or joint effusion at ultrasonography (US); and to evaluate the correlation between synovitis, effusion, and clinical parameters. METHODS A cross sectional, multicentre, European study was conducted under the umbrella of EULAR-ESCISIT. SUBJECTS had primary chronic knee OA (ACR criteria) with pain during physical activity >or=30 mm for at least 48 hours. Clinical parameters were collected by a rheumatologist and an US examination of the painful knee was performed by a radiologist or rheumatologist within 72 hours of the clinical examination. Ultrasonographic synovitis was defined as synovial thickness >or=4 mm and diffuse or nodular appearance, and a joint effusion was defined as effusion depth >or=4 mm. RESULTS 600 patients with painful knee OA were analysed. At US 16 (2.7%) had synovitis alone, 85 (14.2%) had both synovitis and effusion, 177 (29.5%) had joint effusion alone, and 322 (53.7%) had no inflammation according to the definitions employed. Multivariate analysis showed that inflammation seen by US correlated statistically with advanced radiographic disease (Kellgren-Lawrence grade >or=3; odds ratio (OR)=2.20 and 1.91 for synovitis and joint effusion, respectively), and with clinical signs and symptoms suggestive of an inflammatory "flare", such as joint effusion on clinical examination (OR=1.97 and 2.70 for synovitis and joint effusion, respectively) or sudden aggravation of knee pain (OR=1.77 for joint effusion). CONCLUSION US can detect synovial inflammation and effusion in painful knee OA, which correlate significantly with knee synovitis, effusion, and clinical parameters suggestive of an inflammatory "flare".
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Ryan MF, Hamilton PA, Sarrazin J, Chu P, Benjaminov O, Lam K. The halo sign and peripancreatic fluid: useful CT signs of hypovolaemic shock complex in adults. Clin Radiol 2005; 60:599-607. [PMID: 15851049 DOI: 10.1016/j.crad.2004.02.012] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2003] [Revised: 01/20/2004] [Accepted: 02/18/2004] [Indexed: 11/23/2022]
Abstract
AIM To report two new, useful computed tomography (CT) signs of the hypovolaemic shock complex (HSC) in adults admitted after blunt abdominal trauma: the halo sign (ring of fluid around a collapsed intra-hepatic inferior vena cava (IVC)), and peripancreatic retroperitoneal fluid. MATERIALS AND METHODS CT images of 498 consecutive patients admitted after blunt abdominal trauma were reviewed, of which 27 had CT signs of the HSC. The CT images of these 27 patients were analysed. A control group of 101 patients examined using CT for suspected blunt abdominal trauma who did not have the HSC were chosen for comparison. RESULTS The most common features involved the vascular compartment: diminished IVC diameter n = 27 a positive halo sign n = 21 diminished anteroposterior diameter of the aorta n = 13 and abnormal vascular enhancement n = 10. Peripancreatic retroperitoneal fluid in the absence of pancreatic injury, pancreatitis or pancreatic disease was observed in eight patients. Hollow visceral abnormalities included: diffuse increased mucosal enhancement of both the small and large bowel n = 19 diffuse thickening of the small bowel wall n =11 and small bowel dilatation n = 7. Solid visceral abnormalities included both decreased and or increased enhancement. Several concomitant intra- and extra-abdominal injuries were also identified. CONCLUSION In the setting of blunt abdominal trauma, early abdominal CT can show diffuse abnormalities due to the HSC, which occasionally may alert clinicians of unsuspected shock. Recognition of these signs as distinguished from injured viscera is important in order to avoid unnecessary laparotomy. Two new signs are described: the halo sign and peripancreatic retroperitoneal fluid.
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Schacherer D, Klebl F, Zorger N, Schölmerich J, Schlottmann K. [Sonographic controlled drainage of a fluid formation of the spleen in combination with pancreatitis]. ZEITSCHRIFT FUR GASTROENTEROLOGIE 2004; 42:1301-5. [PMID: 15558440 DOI: 10.1055/s-2004-813783] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
With regard to acute or chronic pancreatitis various complications involving the spleen can occur, hematoma of the spleen being a rare complication. We describe the case of a patient in reduced general condition with elevated pancreatic enzymes and signs of inflammation. During multiple examinations, hematoma of the spleen, as well as hematomas close to the left adrenal gland and a larger hematoma close to the gastric wall were detected. In computed tomography and due to the laboratory parameters a pancreatitis was diagnosed. After CT-controlled puncture a communication between both formations was considered possible which was in retrospect CT-assisted not successful. Subsequently an ultrasound controlled drainage was performed, finally resulting in a restitutio ad integrum, thereby avoiding splenectomy. The described percutaneous puncture of a fluid formation in the splenic area represents a non-surgical option in the therapy of intrasplenic pancreatic fluid formations.
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Zelikovich EI. [Computed tomography in the diagnosis of exudative otitis media]. VESTNIK RENTGENOLOGII I RADIOLOGII 2004:16-20. [PMID: 15587878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
Temporal bone computed tomography (CT) was used to examine 37 patients aged 2 to 55 years who had exudative otitis media; in 27 patients of them, a pathological process was bilateral. An analysis of 58 temporal bone CT scans identified the CT signs of chronic exudative otitis media. These included a partial or complete block of the osseous foramen of the auditory tube; impaired pneumatization of the tympanic cavity, mastoid process fenestrae, and antrum; pathological drawing-in of the tympanic membrane. The preservation of the auditory ossicles and the absence of destructive changes in the walls of the cavities of the middle ear were observed in most cases. Repeated temporal bone CT study was performed in 10 patients (14 temporal bones) in different periods (from 2 months to 3 years) after surgery. The results of tympanostomy were visually assessed. These included recovered pneumatization of middle ear cavities (7 temporal bones), a cicatricial process in the tympanic cavity (5 temporal bones), recurrence of the CT manifestations of exudative otitis media (2 temporal bones).
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Antonelli E, Morales MA, Dumps P, Boulvain M, Weil A. Sonographic detection of fluid collections and postoperative morbidity following Cesarean section and hysterectomy. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2004; 23:388-392. [PMID: 15065191 DOI: 10.1002/uog.1023] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
OBJECTIVES To evaluate the clinical significance of sonographically detected fluid collections following Cesarean section and hysterectomy, and to identify risk factors associated with their formation. METHODS This was a prospective study including 280 women, 145 of whom had undergone a Cesarean section and 135 of whom had undergone abdominal or vaginal hysterectomy. Ultrasound examinations were carried out on all women on day 4 after surgery to assess the presence of abdominal wall or pelvic fluid collections. The sonographers were unaware of the clinical course before the examination and were not involved in any clinical decision-making. Ultrasound findings were correlated with clinical data and postoperative morbidity. RESULTS A fluid collection was found in 69 (48%) women after Cesarean section, and in 59 (44%) women who had undergone hysterectomy. No risk factors for the development of fluid collections after Cesarean section or hysterectomy were identified. The risk of developing febrile morbidity was not related to the presence, location or size of fluid collections. CONCLUSIONS Postoperative fluid collections are common after Cesarean section and hysterectomy. As fluid collections detected by sonography were not associated with postoperative morbidity, this finding is unlikely to be useful in the workup for postoperative fever.
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Stocchero IN. Ultrasound in the diagnosis and management of fluid collection complications following abdominoplasty. Ann Plast Surg 2004; 52:331. [PMID: 15156994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
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Sakima N, Sakai H, Nakamura Y, Shinjo S, Tomoyose E, Hayakawa K, Sawaguchi S. [Ciliochoroidal effusion after remission of lens-induced glaucoma detected by ultrasound biomicroscopy]. NIPPON GANKA GAKKAI ZASSHI 2004; 108:38-43. [PMID: 14969092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
Abstract
PURPOSE To report the results of ultrasound biomicroscopy(UBM) cases of ciliochoroidal effusion after a lens-induced glaucoma attack. CASES Case 1 was an 83-year-old female. She had shallow anterior chamber with expanded cataract with exfoliation in her right eye. Intraocular pressure(IOP) of the right eye was 64 mmHg. On the next day, IOP was reduced to 16 mmHg by conservative therapy. UBM showed circumference ciliochoroidal effusion in the right eye. On the 5th day, IOP increased to 38 mmHg. UBM was repeated and showed the disappearance of ciliochoroidal effusion. On the 9th day, phacoemulsification was done to treat the lens induced glaucoma attack. Two weeks after operation, IOP of the right eye was 6 mmHg and UBM showed ciliochoroidal effusion. Case 2 was an 85-year-old female. She had been diagnosed by an ophthalmologist as having an attack of lens-induced glaucoma in her left eye. IOP was 46 mmHg. When she was referred to us, IOP was decreased to 24 mmHg and ciliochoroidal effusion was observed in her left eye by UBM. CONCLUSION We report two cases of ciliochoroidal effusion associated with lens-induced glaucoma attack. UBM is useful to observe changes in the ciliary body after lens-induced glaucoma attack.
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Komatsuda T, Ishida H, Konno K, Hamashima Y, Naganuma H, Sato M, Suzuki T, Shindoh K, Watanabe S. Differentiation of exudate from transudate ascites by Doppler sonography. ABDOMINAL IMAGING 2003; 28:609-13. [PMID: 14628860 DOI: 10.1007/s00261-002-0087-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND We investigated whether the addition of Doppler sonography (US) increases the diagnostic confidence of US for estimating the nature of ascites. METHODS Of the 127 cases reviewed in this study, there were 42 cases of transudate and 85 of exudate ascites. We reviewed the US, power Doppler, and pulsed Doppler images of these cases. RESULTS With US, the transudate ascites was imaged as free of echo in 38 of 42 cases (90.5%). The exudate ascites was imaged as free of echo in 22 of 85 cases (25.9%) and with internal echo spots in 63 of 85 cases (74.1%). With Doppler US, we obtained distinct pulsed signals from the transudate ascites in only two of 36 cases (5.6%). In contrast, we obtained distinct Doppler signals from the exudate ascites in 66 of 79 cases (83.5%). Those 66 cases included 16 of the 22 cases with echo-free ascites. CONCLUSION The presence or absence of echo spots within the ascites helped differentiate transudate from exudate ascites, as reported in the literature. However, the addition of Doppler US contributed to the differentiation of echo-free exudate (Doppler signals present) from echo-free transudate (Doppler signals absent) ascites.
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Abstract
Evaluation of the child presenting with an irritable hip often requires aspiration of the hip. There are various methods for doing this procedure. We present a new technique for hip aspiration using high-resolution ultrasound imaging with color Doppler and a needle guide. This technique maximizes chances for a successful aspiration, minimizes risks to the child, avoids radiation exposure, and is easy to do and teach.
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MESH Headings
- Age Factors
- Arthritis, Infectious/complications
- Arthritis, Infectious/diagnostic imaging
- Arthritis, Infectious/physiopathology
- Biopsy, Needle/methods
- Child
- Diagnosis, Differential
- Equipment Design
- Exudates and Transudates/diagnostic imaging
- Hip Joint
- Humans
- Pain/etiology
- Pain/prevention & control
- Range of Motion, Articular
- Risk Factors
- Ultrasonography, Doppler, Color/instrumentation
- Ultrasonography, Doppler, Color/methods
- Ultrasonography, Interventional/instrumentation
- Ultrasonography, Interventional/methods
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Tognini F, Manfredini D, Melchiorre D, Zampa V, Bosco M. Ultrasonographic vs magnetic resonance imaging findings of temporomandibular joint effusion. MINERVA STOMATOLOGICA 2003; 52:365-70, 370-2. [PMID: 14608257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
Abstract
AIM The aim of this study was to assess the accuracy of ultrasonography (US) in the evaluation of temporomandibular joint (TMJ) effusion compared with magnetic resonance imaging (MRI) findings, assumed as the gold standard. METHODS The study group consisted of 44 patients with signs and symptoms of temporomandibular disorders (TMD). Each joint (N=88) was evaluated using US and magnetic resonance (MR) to detect the presence of effusion. The 2 examinations were carried out by 2 blinded operators within no more than 2 weeks from each other. During that period the patients did not receive any kind of treatment. Sensitivity, specificity, positive predictive values (PPV) and negative predective values (NPV) of US were calculated. The agreement between the 2 diagnostic techniques was then evaluated by Cohen's K test. RESULTS MRI depicted intra-articular effusion in 41 of the 88 TMJs (46.5%) while no effusion was detected in the remaining 47 joints (53.5%). Ultrasonographic imaging revealed effusion in 42/88 joints (47.8%), while the remaining 46 joints (52.2%) showed no effusion. US showed a sensitivity of 75.6% and a specificity of 76.5%. The PPV and NPV were 73.8% and 78.2% respectively. US vs MRI agreement for the diagnosis of TMJ effusion was fairly good (pct. agreement 76.1%; K=0.521). CONCLUSION US is a low-cost, easy-performing, non-invasive, rapidly-executing imaging technique whose possible employ in the study of the TMJ is very promising.
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