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Muthu V, Sehgal IS, Dhooria S, Agarwal R. Clinical significance and epidemiological evolution of epitrochlear lymphadenopathy in pre- and post-highly active antiretroviral therapy era: A systematic review of the literature. Lung India 2018; 35:150-153. [PMID: 29487251 PMCID: PMC5846265 DOI: 10.4103/lungindia.lungindia_13_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Epitrochlear lymphadenopathy is believed to be associated with distinct etiologies, however the evidence for the same is lacking. We systematically reviewed the reported causes of an enlarged epitrochlear lymph node and compared them over different time periods. Epitrochlear lymphadenopathy was encountered in a wide range of diseases, and we found no association with any particular disease.
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Affiliation(s)
- Valliappan Muthu
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Inderpaul Singh Sehgal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sahajal Dhooria
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ritesh Agarwal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Ong SCL, Tang PP. Epitrochlear lymphadenitis mimicking subcutaneous abscess. BMJ Case Rep 2018; 2018:bcr-2017-223669. [PMID: 29444798 DOI: 10.1136/bcr-2017-223669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Sidney Ching Liang Ong
- Radiology Department, Clinical Campus, International Medical University, Seremban, Negeri Sembilan, Malaysia
| | - Phing Phing Tang
- Department of Otorhinolaryngology, Hospital Tengku Ampuan Rahimah, Klang, Selangor, Malaysia
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Melville DM, Jacobson JA, Downie B, Biermann JS, Kim SM, Yablon CM. Sonography of cat scratch disease. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2015; 34:387-394. [PMID: 25715359 DOI: 10.7863/ultra.34.3.387] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVES To characterize the sonographic features of cat scratch disease and to identify features that allow differentiation from other causes of medial epitrochlear masses. METHODS After Institutional Review Board approval was obtained, patients who underwent sonography for a medial epitrochlear mass or lymph node were identified via the radiology information system. Patients were divided into 2 groups: cat scratch disease and non-cat scratch disease, based on pathologic results and clinical information. Sonograms were retrospectively reviewed and characterized with respect to dimension, shape (round, oval, or lobular), symmetry, location (subcutaneous or intramuscular), multiplicity, echogenicity (anechoic, hypoechoic, isoechoic, hyperechoic, or mixed), hyperechoic hilum (present or absent), adjacent anechoic or hypoechoic area, hyperemia (present or absent), pattern of hyperemia if present (central, peripheral, or mixed), increased posterior through-transmission (present or absent), and shadowing (present or absent). Sonographic findings were compared between the patients with and without cat scratch disease. RESULTS The final patient group consisted of 5 cases of cat scratch disease and 16 cases of other causes of medial epitrochlear masses. The 2 sonographic findings that were significantly different between the cat scratch disease and non-cat scratch disease cases included mass asymmetry (P = .0062) and the presence of a hyperechoic hilum (P = .0075). The other sonographic findings showed no significant differences between the groups. CONCLUSIONS The sonographic finding of an epitrochlear mass due to cat scratch disease most commonly is that of a hypoechoic lobular or oval mass with central hyperemia and a possible adjacent fluid collection; however, the presence of asymmetry and a hyperechoic hilum differentiate cat scratch disease from other etiologies.
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Affiliation(s)
- David M Melville
- Departments of Radiology (D.M.M., J.A.J., B.D., S.M.K., C.M.Y.) and Orthopedic Surgery (J.S.B.), University of Michigan, Ann Arbor, Michigan USA; and Department of Medical Imaging, University of Arizona Health Sciences Center, Tucson, Arizona USA (D.M.M.).
| | - Jon A Jacobson
- Departments of Radiology (D.M.M., J.A.J., B.D., S.M.K., C.M.Y.) and Orthopedic Surgery (J.S.B.), University of Michigan, Ann Arbor, Michigan USA; and Department of Medical Imaging, University of Arizona Health Sciences Center, Tucson, Arizona USA (D.M.M.)
| | - Brian Downie
- Departments of Radiology (D.M.M., J.A.J., B.D., S.M.K., C.M.Y.) and Orthopedic Surgery (J.S.B.), University of Michigan, Ann Arbor, Michigan USA; and Department of Medical Imaging, University of Arizona Health Sciences Center, Tucson, Arizona USA (D.M.M.)
| | - J Sybil Biermann
- Departments of Radiology (D.M.M., J.A.J., B.D., S.M.K., C.M.Y.) and Orthopedic Surgery (J.S.B.), University of Michigan, Ann Arbor, Michigan USA; and Department of Medical Imaging, University of Arizona Health Sciences Center, Tucson, Arizona USA (D.M.M.)
| | - Sung Moon Kim
- Departments of Radiology (D.M.M., J.A.J., B.D., S.M.K., C.M.Y.) and Orthopedic Surgery (J.S.B.), University of Michigan, Ann Arbor, Michigan USA; and Department of Medical Imaging, University of Arizona Health Sciences Center, Tucson, Arizona USA (D.M.M.)
| | - Corrie M Yablon
- Departments of Radiology (D.M.M., J.A.J., B.D., S.M.K., C.M.Y.) and Orthopedic Surgery (J.S.B.), University of Michigan, Ann Arbor, Michigan USA; and Department of Medical Imaging, University of Arizona Health Sciences Center, Tucson, Arizona USA (D.M.M.)
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Catalano O, Nunziata A, Saturnino PP, Siani A. Epitrochlear lymph nodes: Anatomy, clinical aspects, and sonography features. Pictorial essay(). J Ultrasound 2010; 13:168-74. [PMID: 23397026 DOI: 10.1016/j.jus.2010.10.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The normal and abnormal aspects of the epitrochlear lymphatic station are not well known, mainly because the axillary basin is commonly regarded as the primary lymphatic target of all upper limb disorders. The purpose of this paper is to illustrate, through a review of specific cases, the normal and abnormal findings that can emerge during ultrasonographic (US) and color-Doppler US exploration of the epitrochlear region. We illustrate the normal anatomy and variations of the epitrochlear lymph nodes and highlight the functional role of this lymphatic station. Subsequently we describe the US and color-Doppler US findings. A number of different abnormalities are reviewed, including metastases (mainly from upper limb cutaneous melanomas), Hodgkin disease, and non-Hodgkin lymphoma, lymphadenitis (cat-scratch disease, foreign bodies, and IV drug abuse). Measures are suggested to avoid interpretative pitfalls and to carry out an effective differential diagnosis of elbow masses. This article represents a pictorial essay of the US and color-Doppler US features of various epitrochlear lymph node abnormalities that clinicians may not be familiar with.
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Affiliation(s)
- O Catalano
- Department of Radiology, National Cancer Institute IRCCS "Fondazione G. Pascale", Naples, Italy
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Finlay K, Ferri M, Friedman L. Ultrasound of the elbow. Skeletal Radiol 2004; 33:63-79. [PMID: 14714145 DOI: 10.1007/s00256-003-0680-7] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2002] [Revised: 06/15/2003] [Accepted: 06/16/2003] [Indexed: 02/02/2023]
Abstract
The elbow is an important synovial hinge joint of the upper extremity. This joint represents a common site of musculoskeletal symptomatology, affecting all age groups. The advantages of ultrasound imaging of the elbow include easy availability, multiplanar capability and the ability to assess structures dynamically. Patient symptomatology and site of maximal tenderness can be directly correlated with imaging findings. Comparison is easily made with the contralateral side. Particular strengths include the ability to assess para-articular structures, such as regional tendons and ligaments, in addition to assessment of joint effusions, loose bodies and regional bursae. With operator experience and excellent technique, ultrasound is a valuable imaging tool for assessment of disorders of the elbow joint.
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Affiliation(s)
- K Finlay
- McMaster University Department of Diagnostic Imaging, Hamilton Health Sciences, Henderson Hospital, 711 Concession Street E., L8V 1C3, Hamilton, Ontario, Canada
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Martinoli C, Bianchi S, Zamorani MP, Zunzunegui JL, Derchi LE. Ultrasound of the elbow. EUROPEAN JOURNAL OF ULTRASOUND : OFFICIAL JOURNAL OF THE EUROPEAN FEDERATION OF SOCIETIES FOR ULTRASOUND IN MEDICINE AND BIOLOGY 2001; 14:21-7. [PMID: 11567851 DOI: 10.1016/s0929-8266(01)00142-2] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This article describes the use of ultrasound (US) in the evaluation of the elbow. US is able to visualize several abnormalities affecting tendons, muscles, ligaments and bursae around the elbow joint as well as to delineate the nature of soft-tissue swelling, such as a space-occupying lesion or synovial enlargement. Occult fractures, osteophytes and intra-articular loose bodies can be depicted with this technique as well. At the cubital tunnel, US allows accurate imaging of the ulnar nerve and to document changes that occur in compressive syndromes. Over other imaging modalities, US offers several key advantages, including cost effectiveness, availability and ability to perform a dynamic examination of tendon movement and joint motion. With continued experience, it is likely that the use of US will increase further with regards to evaluation of soft-tissue abnormalities of the elbow.
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Affiliation(s)
- C Martinoli
- Cattedra di Radiologia "R"--DICMI-Università di Genova, Largo Rosanna Benzi 8. I-16132 Genoa, Italy.
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Lim-Dunham JE, Ben-Ami TE, Yousefzadeh DK. Septic arthritis of the elbow in children: the role of sonography. Pediatr Radiol 1995; 25:556-9. [PMID: 8545190 DOI: 10.1007/bf02015794] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Twelve children with suspected septic arthritis of the elbow were prospectively studied with plain-film radiography and ultrasound. Imaging data were correlated with clinical history and final diagnosis. Joint effusion was seen by sonography in six patients, four of whom underwent ultrasound-guided joint aspiration, confirming the diagnosis of septic arthritis in two patients and excluding it in two. Of nine patients whose plain films showed only soft tissue swelling, seven had one or more significant findings with sonography: joint effusion (without fat pad elevation on lateral plain films) in three patients, periosteal reaction in two, and epitrochlear mass in three. Sonography confirmed soft tissue swelling alone in two patients, thus excluding the diagnosis of septic arthritis and obviating unnecessary attempts at joint aspiration. Sonography of the elbow is an informative, easily performed examination, which is capable of showing both intra- and extra-articular abnormalities not apparent by plain radiography. Both the demonstration of pathologic changes and the failure to show joint fluid may affect clinical management.
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Affiliation(s)
- J E Lim-Dunham
- Department of Radiology, Wyler Children's Hospital, University of Chicago, Pritzker School of Medicine, IL 60637, USA
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