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Suliman YA, Bruni C, Hughes M, Matucci-Cerinic M, Furst DE. Ultrasonographic imaging of systemic sclerosis digital ulcers: A systematic literature review and validation steps. Semin Arthritis Rheum 2021; 51:425-429. [PMID: 33677309 DOI: 10.1016/j.semarthrit.2021.02.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Revised: 02/07/2021] [Accepted: 02/15/2021] [Indexed: 01/10/2023]
Abstract
INTRODUCTION/BACKGROUND Skin ulcers are a complex array of clinical manifestations of systemic sclerosis (SSc) and are often difficult to treat. However, the definition of SSc-skin ulcers has to date not been promising, demonstrating poor reliability and accuracy. There are emerging data that ultrasound has significant potential to evaluate SSc-skin ulcers. OBJECTIVE To perform a systematic literature review (SLR) to understand the degree to which ultrasound of SSc skin ulcers has been validated according to OMERACT criteria. METHODS In a SLR, we investigated the Cochrane Library, Web of Science and Pubmed databases for manuscripts from inception to 1st April 2020. Inclusion and exclusion criteria included manuscripts on SSc patients aged over 16 years, performing SSc-related skin ulcer evaluation with ultrasound machines. Papers on animal model, diseases other than SSc, venous ulcers were excluded. Data extraction used a uniform case report form which collected data on patient demographics, disease activity, description of the ultrasound machine and procedures and the degree to which domains of validity were fulfilled. Manuscript evaluation and extraction was performed by two independent assessors, with a third author being consulted in case of disagreement. RESULTS amongst 308 manuscripts that were identified, 6 published manuscripts/ posters fulfilled the inclusion/exclusion criteria and were extracted. Face validity was found. Three studies developed an US definition of SSc-ulcers across patients (content validity); one study evaluated the concordance between US image and clinical assessment. Criterion validity was shown by one study and ultrasound detected improvement (sensitivity to change) of SSc-skin ulcer in response to therapy. Feasibility was demonstrated by US use for skin ulcers in multiple settings (the 6 manuuscripts/posters). CONCLUSION This systematic literature review shows that ultrasound for skin ulcers in SSc has been partially validated. It has face, content, criterion validity, responsiveness and reasonable feasibility. Further validation for construct validity, reliability and discrimination is required.
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Affiliation(s)
- Yossra A Suliman
- Rheumatology and Rehabilitation Department, Assiut University Hospital, Assiut, Egypt; Department of Medicine, Rheumatology Division, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States.
| | - Cosimo Bruni
- Department of Experimental and Clinical Medicine, University of Florence, and Division of Rheumatology AOUC, Florence, Italy
| | - Michael Hughes
- Department of Rheumatology, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - Marco Matucci-Cerinic
- Department of Experimental and Clinical Medicine, University of Florence, and Division of Rheumatology AOUC, Florence, Italy
| | - Daniel E Furst
- Department of Medicine, Rheumatology Division, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States; Department of Experimental and Clinical Medicine, University of Florence, and Division of Rheumatology AOUC, Florence, Italy; Department of Rheumatology, University of Washington, Seattle, WA, United States.
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Henshaw FR, Reid IB, Spencer AM, Turner DE. Point of care ultrasound imaging as a wound assessment tool in diabetic foot ulcers: a case series. J Wound Care 2020; 29:S28-S34. [DOI: 10.12968/jowc.2020.29.sup8.s28] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Foot ulceration is a common and devastating complication of diabetes. Traditionally, diabetic foot ulcers (DFU) are managed by multidisciplinary teams in tertiary hospital settings. Wound management decisions are based largely on visual observations at the point of care, using rudimentary evaluation of superficial tissues, such as wound tracings and photography combined with expert knowledge of the treating practitioners. Imaging based methods of assessment, such as X-ray, magnetic resonance imaging, scintigraphy or computed tomography are able to more comprehensively categorise wounds and to determine whether re-epithelialised wounds are in fact healed. Ultrasound has been advocated by the World Health Organization for the monitoring of chronic diseases and for screening because it is considered low risk, comfortable for patients and low cost. It can be performed in real time at the point of care and using B-mode, Doppler and elastography has the potential to provide clinically meaningful information for monitoring the status of hard-to-heal wounds, but to date this imaging technique has not been exploited in this field. This case series highlights the utility of diagnostic musculoskeletal ultrasound as an adjunct to traditional wound assessment that can provide diagnostically meaningful information to assist in clinical decision making. Future research will be needed to determine if routine incorporation of ultrasound in wound assessment improves patient outcomes.
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Affiliation(s)
- Frances R Henshaw
- School of Health Sciences, Western Sydney University, Campbelltown, NSW, Australia
- Royal North Shore Hospital, North Sydney-Ryde Health Service, St. Leonards, NSW, Australia
| | - Ian B Reid
- Royal North Shore Hospital, North Sydney-Ryde Health Service, St. Leonards, NSW, Australia
| | - Anna M Spencer
- School of Health Sciences, Western Sydney University, Campbelltown, NSW, Australia
| | - Deborah E Turner
- School of Health Sciences, Western Sydney University, Campbelltown, NSW, Australia
- Queensland University of Technology, Brisbane, Queensland, Australia
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Collado P, Windschall D, Vojinovic J, Magni-Manzoni S, Balint P, Bruyn GAW, Hernandez-Diaz C, Nieto JC, Ravagnani V, Tzaribachev N, Iagnocco A, D’Agostino MA, Naredo E. Amendment of the OMERACT ultrasound definitions of joints' features in healthy children when using the DOPPLER technique. Pediatr Rheumatol Online J 2018; 16:23. [PMID: 29631610 PMCID: PMC5892017 DOI: 10.1186/s12969-018-0240-2] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 03/27/2018] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Recently preliminary ultrasonography (US) definitions, in B mode, for normal components of pediatric joints have been developed by the OMERACT US group. The aim of the current study was to include Doppler findings in the evaluation and definition of normal joint features that can be visualized in healthy children at different age groups. METHODS A multistep approach was used. Firstly, new additional definitions of joint components were proposed during an expert meeting. In the second step, these definitions, along with the preliminary B-mode-US definitions, were tested for feasibility in an exercise in healthy children at different age groups. In the last step, a larger panel of US experts were invited to join a web-based consensus process in order to approve the developed definitions using the Delphi methodology. A Likert scale of 1-5 was used to assess agreement. RESULTS Physiological vascularity and fat pad tissue were identified and tested as two additional joint components in healthy children. Since physiological vascularity changes over the time in the growing skeleton, the final definition of Doppler findings comprised separate statements instead of a single full definition. A total of seven statements was developed and included in a written Delphi questionnaire to define and validate the new components. The final definitions for fat pad and physiological vascularity agreed by the group of experts reached 92.9% and 100% agreement respectively in a web survey. CONCLUSION The inclusion of these two additional joints components which are linked to detection of Doppler signal in pediatric healthy joints will improve the identification of abnormalities in children with joint pathologies.
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Affiliation(s)
- P. Collado
- 0000 0001 0635 4617grid.411361.0Hospital Universitario Severo Ochoa., Madrid, Spain
| | - D. Windschall
- Department of Pediatrics, Asklepios Hospital Weissenfels, Weissenfels, Germany
| | - J. Vojinovic
- 0000 0001 0942 1176grid.11374.30Department of Pediatrics, Clinical Center, Faculty of Medicine, University of Nis, Nis, Serbia
| | - S. Magni-Manzoni
- 0000 0001 0727 6809grid.414125.7Rheumatology Division, IRCCS Ospedale Pediatrico Bambino Gesù, Rome, Italy
| | - P. Balint
- 0000 0004 0637 0256grid.419642.c3rd Department of Rheumatology, National Institute of Rheumatology and Physiotherapy, Budapest, Hungary
| | - G. A. W. Bruyn
- Department of Rheumatology, MC Groep, Lelystad, the Netherlands
| | - C. Hernandez-Diaz
- 0000 0004 0633 2911grid.419223.fInstituto Nacional de Rehabilitación, Mexico City, Mexico
| | - J. C. Nieto
- 0000 0001 0277 7938grid.410526.4Department of Rheumatology, Hospital Universitario Gregorio Marañon, Madrid, Spain
| | - V. Ravagnani
- 0000 0004 0493 6690grid.413174.4Department of Internal Medicine, ASST Mantova, C. Poma Hospital, Mantova, Italy
| | - N. Tzaribachev
- Pediatric Rheumatology Research Institute, Bad Bramstedt, Germany
| | - A. Iagnocco
- grid.7841.aRheumatology Unit, Sapienza Università di Roma, Rome, Italy
| | - M. A. D’Agostino
- 0000 0001 2323 0229grid.12832.3aRheumatology Department, Hôspital Ambroise Paré, Boulogne Billancourt; INSERM U1173, Laboratoire d’Excellence INFLAMEX, UFR Simone Veil, Versailles-Saint-Quentin University, Yvelines, France
| | - E. Naredo
- grid.419651.eDepartment of Rheumatology, Hospital Universitario Fundación Jimenez Díaz and Autonoma University, Madrid, Spain
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Raffaeli G, Borzani I, Pinzani R, Giannitto C, Principi N, Esposito S. Abdominal mass hiding rib osteomyelitis. Ital J Pediatr 2016; 42:37. [PMID: 27068333 PMCID: PMC4828859 DOI: 10.1186/s13052-016-0251-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Accepted: 04/04/2016] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Rib osteomyelitis is a rare entity, occurring in approximately 1 % or less of all cases of haematogenous osteomyelitis. Given its rarity and clinical heterogeneity, the diagnosis of rib osteomyelitis can be challenging and requires a high index of suspicion. We present a case of acute osteomyelitis of the rib due to community-acquired methicillin-resistant Staphylococcus aureus (MRSA), which occurred in an otherwise healthy 3-month-old infant and mimicked an epigastric hernia at first. CASE PRESENTATION An otherwise healthy 3-month-old female infant was sent by her primary care paediatrician to the paediatric emergency department for possible incarcerated epigastric hernia because for 2 days, she had suffered from mild to moderate fever, irritability, poor feeding, and tender epigastric swelling. Ultrasonographic imaging excluded epigastric hernia, and transthoracic echocardiography ruled out endocarditis. However, clinical assessment combined with laboratory criteria classified the child into the high-risk group for having severe bacterial infection. Consequently, awaiting the definitive diagnosis, she was immediately treated with a broad-spectrum regimen of intravenous antibiotic therapy based on vancomycin (40 mg/kg/die in 3 doses) and meropenem (100 mg/kg/die in 3 doses). Three days after admission, the blood culture result was positive for methicillin-resistant Staphylococcus aureus, and vancomycin remained as antibiotic therapy. On day 3, a second swelling appeared at the level of the seventh left rib, 2 cm-wide, non-erythematous, mildly painful. Ultrasonography of the left chest wall on this occasion showed an image consistent with an acute osteomyelitis of the anterior osteo-chondral region of the 7th rib and associated adjacent periosteal and soft tissue collection and magnetic resonance imaging confirmed the osteomyelitis of the anterior middle-distal part of the 7th left rib, near the costochondral junction. Vancomycin was continued up to a total of 6 weeks of therapy, and at the end, the child was discharged in good condition with no relapse during the follow-up. CONCLUSION This is one of the few reported cases of paediatric rib osteomyelitis caused by community-acquired MRSA. Timely identification associated with prompt and targeted antibiotic therapy may allow full recovery.
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Affiliation(s)
- Genny Raffaeli
- Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Commenda 9, 20122, Milan, Italy
| | - Irene Borzani
- Pediatric Radiology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Raffaella Pinzani
- Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Commenda 9, 20122, Milan, Italy
| | - Caterina Giannitto
- Radiology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Nicola Principi
- Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Commenda 9, 20122, Milan, Italy
| | - Susanna Esposito
- Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Commenda 9, 20122, Milan, Italy.
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Mantsopoulos K, Wurm J, Iro H, Zenk J. Role of ultrasonography in the detection of a subperiosteal abscess secondary to mastoiditis in pediatric patients. ULTRASOUND IN MEDICINE & BIOLOGY 2015; 41:1612-1615. [PMID: 25796413 DOI: 10.1016/j.ultrasmedbio.2015.02.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Revised: 01/29/2015] [Accepted: 02/09/2015] [Indexed: 06/04/2023]
Abstract
The aim of the study described here was to evaluate experience in the diagnosis of a subperiosteal abscess secondary to mastoiditis by means of ultrasound. Ten consecutive cases in which an ultrasound examination of the retro-auricular region was performed for suspected mastoiditis were identified. In nine cases, we found a poorly demarcated, inhomogeneous, irregular, poorly perfused lesion abutting the outer table of the cranial vault, with elevation of the outer periosteum and a clearly delineated defect of the cortical layer. In one case, there was additional invasion of the insertion of the sternocleidomastoid muscle on the mastoid process of the temporal bone, raising the suspicion of Bezold mastoiditis. Ultrasound may help in selecting patients for further imaging and might spare computer tomography, especially in sensitive patient groups such as children and pregnant women, if a defect of the outer cortex of the temporal bone can be excluded with certainty.
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Affiliation(s)
- Konstantinos Mantsopoulos
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Erlangen-Nuremberg, Erlangen, Germany.
| | - Jochen Wurm
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Heinrich Iro
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Johannes Zenk
- Department of Otorhinolaryngology, Head and Neck Surgery, Hospital Augsburg, Augsburg, Germany
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Puccini PF, Ferrarini MAG, Iazzetti AV. Osteomielite hematogênica aguda em Pediatria: análise de casos atendidos em hospital universitário. REVISTA PAULISTA DE PEDIATRIA 2012. [DOI: 10.1590/s0103-05822012000300008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJETIVO: Descrever a ocorrência, a evolução e o desfecho de pacientes com osteomielite hematogênica aguda na faixa etária pediátrica. MÉTODOS: Estudo descritivo de 21 casos de pacientes de zero a 14 anos com diagnóstico de osteomielite hematogênica aguda, em acompanhamento no Ambulatório de Infectologia Pediátrica da Escola Paulista de Medicina entre 2005 e 2009. A coleta de dados ocorreu pelo levantamento de prontuários. Realizaram-se a análise descritiva e o teste de correlação de Spearman, com intervalo de confiança de 95%. RESULTADOS: Foi identificada maior incidência no sexo masculino e em crianças maiores de cinco anos. Febre e dor foram os sintomas mais frequentes. Os ossos longos foram os mais acometidos. O principal agente etiológico identificado foi o Staphylococcus aureus. Em média, o tempo de sintomatologia até o diagnóstico foi de 9,7 dias, o de internação, 24,7 dias, e o total de antibioticoterapia foi de 71,7 dias. A resolução completa do quadro ocorreu em 71,4% dos casos, com permanência de sequelas em 28,6% deles, sendo a evolução para osteomielite crônica a principal delas. CONCLUSÕES: As características dos pacientes e da doença referentes a sexo, idade, etiologia e evolução mostram-se concordantes com o descrito na literatura. O tempo de tratamento foi de aproximadamente dez semanas, valor acima do habitualmente encontrado nos diferentes estudos. Não foram encontradas correlações significantes entre o tempo de sintomatologia até o diagnóstico, o tempo de internação e o tempo total de antibioticoterapia, havendo a limitação do tamanho da amostra.
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Early diagnosis of acute osteomyelitis in children by high-resolution and power Doppler sonography. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2011. [DOI: 10.1016/j.ejrnm.2011.05.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Abstract
The imaging approach to osteomyelitis has evolved in the past two decades. Advances in MRI allow for whole body imaging, decreasing the need for scintigraphy when symptoms are not localized or the disease may be multifocal. There is an increasing clinical need for depiction of abscesses in the soft tissues and subperiosteal space, particularly because methicillin-resistant Staphylococcus aureus infections constitute more than one-third of all the infections. The increasing emphasis on radiation dose reduction has also led away from scintigraphy and computed tomography. MR imaging has become the advanced imaging modality of choice in osteomyelitis. There is an increasing understanding of the appropriate role for gadolinium enhancement, which is not indicated when the pre-gadolinium images are normal. Other related infections, including pyomyositis, are best imaged with MRI.
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Musculoskeletal infection in children: literature review and update 2007–2009. CURRENT ORTHOPAEDIC PRACTICE 2009. [DOI: 10.1097/bco.0b013e3181bbd459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Balanika AP, Papakonstantinou O, Kontopoulou CJ, Baltas CS, Athanassia S, Kanelakopoulou K, Brountzos E, Gouliamos A, Kelekis NL. Gray-scale and color Doppler ultrasonographic evaluation of reactivated post-traumatic/postoperative chronic osteomyelitis. Skeletal Radiol 2009; 38:363-9. [PMID: 19082589 DOI: 10.1007/s00256-008-0616-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2008] [Revised: 10/09/2008] [Accepted: 10/30/2008] [Indexed: 02/02/2023]
Abstract
OBJECTIVE We aimed to carry out a systematic assessment of gray-scale and color Doppler ultrasonography (CDUS) findings of reactivated post-traumatic/postoperative chronic osteomyelitis (COM) in adults. MATERIALS AND METHODS Gray-scale and color Doppler ultrasonography were performed on 40 consecutive patients with a history of long-standing post-traumatic/post-operative chronic osteomyelitis and clinical suggestion of reactivation, in a 32-month-period. All patients had metallic implants: 16 internal fixations, nine external fixations, 11 hip arthroplasties and four knee arthroplasties. The final diagnosis of reactivated COM was based upon biopsy findings, with microbiological and histological examination (n = 27), or a combination of laboratory, clinical and magnetic resonance (MR) findings (n = 13). The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of sonographic signs, including fistulous tracts, periosteal thickening, cortical discontinuity, soft tissue abscess and cellulitis, juxtacortical fluid, distension of the pseudocapsule in arthroplasties, and periosteal vascularity, were estimated. RESULTS Statistically significant differences between patients with and without reactivated COM were found for fistulous tracts (P < 0.0001), juxtacortical fluid collections (P < 0.001) periosteal thickening (P < 0.01), distension of pseudocapsule (P < 0.05), and periosteal vascularity (P < 0.0001). Low-resistance arterial flow of periosteal vessels presented the highest sensitivity (92%), specificity, and PPV (100%), yielding only two false negative results in two obese patients. Among gray-scale findings, the presence of a fistulous tract yielded the highest specificity and PPV (100%), whereas periosteal thickening was the most sensitive (92%), though not specific, finding (specificity 50%). CONCLUSION A constellation of gray-scale and CDUS findings can be highly indicative of reactivated bone infection in patients with long-standing chronic post-traumatic/post-operative osteomyelitis.
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Affiliation(s)
- A P Balanika
- 2nd Department of Radiology, Attikon General University Hospital, National and Kapodistrian University of Athens, Rimini 1, Haidari, Athens, 12 464, Greece
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