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Akuri MC, Bencardino JT, Peixoto JB, Sato VN, Miyahara LK, Kase DT, Dell'Aquila AM, do Amaral E Castro A, Fernandes ARC, Aihara AY. Fungal Musculoskeletal Infections: Comprehensive Approach to Proper Diagnosis. Radiographics 2024; 44:e230176. [PMID: 38900682 DOI: 10.1148/rg.230176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/22/2024]
Abstract
Fungal musculoskeletal infections often have subacute or indolent manifestations, making it difficult to distinguish them from other diseases and infections, given that they are relatively uncommon. Fungal infections occur by hematogenous spread, direct inoculation, or contiguous extension and may be related to different risk factors, including immunosuppression and occupational activity. The infection can manifest in isolation in the musculoskeletal system or as part of a systemic process. The fungi may be endemic to certain regions or may be found throughout the world, and this can help to narrow the diagnosis of the etiologic agent. Infections such as candidiasis, cryptococcosis, aspergillosis, and mucormycosis are often related to immunosuppression. On the other hand, histoplasmosis, paracoccidioidomycosis, coccidioidomycosis, and blastomycosis can occur in healthy patients in geographic areas where these infections are endemic. Furthermore, infections can be classified on the basis of the site of infection in the body. Some subcutaneous infections that can have osteoarticular involvement include mycetoma, sporotrichosis, and phaeohyphomycosis. Different fungi affect specific bones and joints with greater prevalence. Imaging has a critical role in the evaluation of these diseases. Imaging findings include nonspecific features such as osteomyelitis and arthritis, with bone destruction, osseous erosion, mixed lytic and sclerotic lesions, and joint space narrowing. Multifocal osteomyelitis and chronic arthritis with joint effusion and synovial thickening may also occur. Although imaging findings are often nonspecific, some fungal infections may show findings that aid in narrowing the differential diagnosis, especially when they are associated with the patient's clinical condition and history, the site of osteoarticular involvement, and the geographic location. ©RSNA, 2024.
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Affiliation(s)
- Marina C Akuri
- From the Department of Diagnostic Imaging, Escola Paulista de Medicina, Universidade Federal de São Paulo, Napoleão de Barros Street, 800 Vila Clementino, São Paulo, SP, Brazil 04024-002 (M.C.A., J.B.P., V.N.S., L.K.M., D.T.K., A.d.A.e.C., A.R.C.F., A.Y.A.); Department of Radiology, Hospital das Clínicas da Faculdade de Medicina de Marília, Marília, São Paulo, Brazil (M.C.A.); Department of Radiology, Montefiore Medical Center, The University Hospital for Albert Einstein College of Medicine, Bronx, NY (J.T.B.); Department of Diagnostic Imaging, Laboratório Delboni, DASA, São Paulo, Brazil (J.B.P., V.N.S., L.K.M., D.T.K., A.Y.A.); Department of Radiology, Hospital do Coração, HCor and Teleimagem, São Paulo, Brazil (V.N.S.); Department of Infectious Diseases, Universidade Federal de São Paulo, São Paulo, Brazil (A.M.D.); Hospital Israelita Albert Einstein, São Paulo, Brazil (A.d.A.e.C.); and Department of Radiology, Grupo de Radiologia e Diagnóstico por Imagem-Rede D'Or, São Paulo, Brazil (A.R.C.F.)
| | - Jenny T Bencardino
- From the Department of Diagnostic Imaging, Escola Paulista de Medicina, Universidade Federal de São Paulo, Napoleão de Barros Street, 800 Vila Clementino, São Paulo, SP, Brazil 04024-002 (M.C.A., J.B.P., V.N.S., L.K.M., D.T.K., A.d.A.e.C., A.R.C.F., A.Y.A.); Department of Radiology, Hospital das Clínicas da Faculdade de Medicina de Marília, Marília, São Paulo, Brazil (M.C.A.); Department of Radiology, Montefiore Medical Center, The University Hospital for Albert Einstein College of Medicine, Bronx, NY (J.T.B.); Department of Diagnostic Imaging, Laboratório Delboni, DASA, São Paulo, Brazil (J.B.P., V.N.S., L.K.M., D.T.K., A.Y.A.); Department of Radiology, Hospital do Coração, HCor and Teleimagem, São Paulo, Brazil (V.N.S.); Department of Infectious Diseases, Universidade Federal de São Paulo, São Paulo, Brazil (A.M.D.); Hospital Israelita Albert Einstein, São Paulo, Brazil (A.d.A.e.C.); and Department of Radiology, Grupo de Radiologia e Diagnóstico por Imagem-Rede D'Or, São Paulo, Brazil (A.R.C.F.)
| | - Júlia B Peixoto
- From the Department of Diagnostic Imaging, Escola Paulista de Medicina, Universidade Federal de São Paulo, Napoleão de Barros Street, 800 Vila Clementino, São Paulo, SP, Brazil 04024-002 (M.C.A., J.B.P., V.N.S., L.K.M., D.T.K., A.d.A.e.C., A.R.C.F., A.Y.A.); Department of Radiology, Hospital das Clínicas da Faculdade de Medicina de Marília, Marília, São Paulo, Brazil (M.C.A.); Department of Radiology, Montefiore Medical Center, The University Hospital for Albert Einstein College of Medicine, Bronx, NY (J.T.B.); Department of Diagnostic Imaging, Laboratório Delboni, DASA, São Paulo, Brazil (J.B.P., V.N.S., L.K.M., D.T.K., A.Y.A.); Department of Radiology, Hospital do Coração, HCor and Teleimagem, São Paulo, Brazil (V.N.S.); Department of Infectious Diseases, Universidade Federal de São Paulo, São Paulo, Brazil (A.M.D.); Hospital Israelita Albert Einstein, São Paulo, Brazil (A.d.A.e.C.); and Department of Radiology, Grupo de Radiologia e Diagnóstico por Imagem-Rede D'Or, São Paulo, Brazil (A.R.C.F.)
| | - Vitor N Sato
- From the Department of Diagnostic Imaging, Escola Paulista de Medicina, Universidade Federal de São Paulo, Napoleão de Barros Street, 800 Vila Clementino, São Paulo, SP, Brazil 04024-002 (M.C.A., J.B.P., V.N.S., L.K.M., D.T.K., A.d.A.e.C., A.R.C.F., A.Y.A.); Department of Radiology, Hospital das Clínicas da Faculdade de Medicina de Marília, Marília, São Paulo, Brazil (M.C.A.); Department of Radiology, Montefiore Medical Center, The University Hospital for Albert Einstein College of Medicine, Bronx, NY (J.T.B.); Department of Diagnostic Imaging, Laboratório Delboni, DASA, São Paulo, Brazil (J.B.P., V.N.S., L.K.M., D.T.K., A.Y.A.); Department of Radiology, Hospital do Coração, HCor and Teleimagem, São Paulo, Brazil (V.N.S.); Department of Infectious Diseases, Universidade Federal de São Paulo, São Paulo, Brazil (A.M.D.); Hospital Israelita Albert Einstein, São Paulo, Brazil (A.d.A.e.C.); and Department of Radiology, Grupo de Radiologia e Diagnóstico por Imagem-Rede D'Or, São Paulo, Brazil (A.R.C.F.)
| | - Lucas K Miyahara
- From the Department of Diagnostic Imaging, Escola Paulista de Medicina, Universidade Federal de São Paulo, Napoleão de Barros Street, 800 Vila Clementino, São Paulo, SP, Brazil 04024-002 (M.C.A., J.B.P., V.N.S., L.K.M., D.T.K., A.d.A.e.C., A.R.C.F., A.Y.A.); Department of Radiology, Hospital das Clínicas da Faculdade de Medicina de Marília, Marília, São Paulo, Brazil (M.C.A.); Department of Radiology, Montefiore Medical Center, The University Hospital for Albert Einstein College of Medicine, Bronx, NY (J.T.B.); Department of Diagnostic Imaging, Laboratório Delboni, DASA, São Paulo, Brazil (J.B.P., V.N.S., L.K.M., D.T.K., A.Y.A.); Department of Radiology, Hospital do Coração, HCor and Teleimagem, São Paulo, Brazil (V.N.S.); Department of Infectious Diseases, Universidade Federal de São Paulo, São Paulo, Brazil (A.M.D.); Hospital Israelita Albert Einstein, São Paulo, Brazil (A.d.A.e.C.); and Department of Radiology, Grupo de Radiologia e Diagnóstico por Imagem-Rede D'Or, São Paulo, Brazil (A.R.C.F.)
| | - Daisy T Kase
- From the Department of Diagnostic Imaging, Escola Paulista de Medicina, Universidade Federal de São Paulo, Napoleão de Barros Street, 800 Vila Clementino, São Paulo, SP, Brazil 04024-002 (M.C.A., J.B.P., V.N.S., L.K.M., D.T.K., A.d.A.e.C., A.R.C.F., A.Y.A.); Department of Radiology, Hospital das Clínicas da Faculdade de Medicina de Marília, Marília, São Paulo, Brazil (M.C.A.); Department of Radiology, Montefiore Medical Center, The University Hospital for Albert Einstein College of Medicine, Bronx, NY (J.T.B.); Department of Diagnostic Imaging, Laboratório Delboni, DASA, São Paulo, Brazil (J.B.P., V.N.S., L.K.M., D.T.K., A.Y.A.); Department of Radiology, Hospital do Coração, HCor and Teleimagem, São Paulo, Brazil (V.N.S.); Department of Infectious Diseases, Universidade Federal de São Paulo, São Paulo, Brazil (A.M.D.); Hospital Israelita Albert Einstein, São Paulo, Brazil (A.d.A.e.C.); and Department of Radiology, Grupo de Radiologia e Diagnóstico por Imagem-Rede D'Or, São Paulo, Brazil (A.R.C.F.)
| | - Adriana M Dell'Aquila
- From the Department of Diagnostic Imaging, Escola Paulista de Medicina, Universidade Federal de São Paulo, Napoleão de Barros Street, 800 Vila Clementino, São Paulo, SP, Brazil 04024-002 (M.C.A., J.B.P., V.N.S., L.K.M., D.T.K., A.d.A.e.C., A.R.C.F., A.Y.A.); Department of Radiology, Hospital das Clínicas da Faculdade de Medicina de Marília, Marília, São Paulo, Brazil (M.C.A.); Department of Radiology, Montefiore Medical Center, The University Hospital for Albert Einstein College of Medicine, Bronx, NY (J.T.B.); Department of Diagnostic Imaging, Laboratório Delboni, DASA, São Paulo, Brazil (J.B.P., V.N.S., L.K.M., D.T.K., A.Y.A.); Department of Radiology, Hospital do Coração, HCor and Teleimagem, São Paulo, Brazil (V.N.S.); Department of Infectious Diseases, Universidade Federal de São Paulo, São Paulo, Brazil (A.M.D.); Hospital Israelita Albert Einstein, São Paulo, Brazil (A.d.A.e.C.); and Department of Radiology, Grupo de Radiologia e Diagnóstico por Imagem-Rede D'Or, São Paulo, Brazil (A.R.C.F.)
| | - Adham do Amaral E Castro
- From the Department of Diagnostic Imaging, Escola Paulista de Medicina, Universidade Federal de São Paulo, Napoleão de Barros Street, 800 Vila Clementino, São Paulo, SP, Brazil 04024-002 (M.C.A., J.B.P., V.N.S., L.K.M., D.T.K., A.d.A.e.C., A.R.C.F., A.Y.A.); Department of Radiology, Hospital das Clínicas da Faculdade de Medicina de Marília, Marília, São Paulo, Brazil (M.C.A.); Department of Radiology, Montefiore Medical Center, The University Hospital for Albert Einstein College of Medicine, Bronx, NY (J.T.B.); Department of Diagnostic Imaging, Laboratório Delboni, DASA, São Paulo, Brazil (J.B.P., V.N.S., L.K.M., D.T.K., A.Y.A.); Department of Radiology, Hospital do Coração, HCor and Teleimagem, São Paulo, Brazil (V.N.S.); Department of Infectious Diseases, Universidade Federal de São Paulo, São Paulo, Brazil (A.M.D.); Hospital Israelita Albert Einstein, São Paulo, Brazil (A.d.A.e.C.); and Department of Radiology, Grupo de Radiologia e Diagnóstico por Imagem-Rede D'Or, São Paulo, Brazil (A.R.C.F.)
| | - Artur R C Fernandes
- From the Department of Diagnostic Imaging, Escola Paulista de Medicina, Universidade Federal de São Paulo, Napoleão de Barros Street, 800 Vila Clementino, São Paulo, SP, Brazil 04024-002 (M.C.A., J.B.P., V.N.S., L.K.M., D.T.K., A.d.A.e.C., A.R.C.F., A.Y.A.); Department of Radiology, Hospital das Clínicas da Faculdade de Medicina de Marília, Marília, São Paulo, Brazil (M.C.A.); Department of Radiology, Montefiore Medical Center, The University Hospital for Albert Einstein College of Medicine, Bronx, NY (J.T.B.); Department of Diagnostic Imaging, Laboratório Delboni, DASA, São Paulo, Brazil (J.B.P., V.N.S., L.K.M., D.T.K., A.Y.A.); Department of Radiology, Hospital do Coração, HCor and Teleimagem, São Paulo, Brazil (V.N.S.); Department of Infectious Diseases, Universidade Federal de São Paulo, São Paulo, Brazil (A.M.D.); Hospital Israelita Albert Einstein, São Paulo, Brazil (A.d.A.e.C.); and Department of Radiology, Grupo de Radiologia e Diagnóstico por Imagem-Rede D'Or, São Paulo, Brazil (A.R.C.F.)
| | - André Y Aihara
- From the Department of Diagnostic Imaging, Escola Paulista de Medicina, Universidade Federal de São Paulo, Napoleão de Barros Street, 800 Vila Clementino, São Paulo, SP, Brazil 04024-002 (M.C.A., J.B.P., V.N.S., L.K.M., D.T.K., A.d.A.e.C., A.R.C.F., A.Y.A.); Department of Radiology, Hospital das Clínicas da Faculdade de Medicina de Marília, Marília, São Paulo, Brazil (M.C.A.); Department of Radiology, Montefiore Medical Center, The University Hospital for Albert Einstein College of Medicine, Bronx, NY (J.T.B.); Department of Diagnostic Imaging, Laboratório Delboni, DASA, São Paulo, Brazil (J.B.P., V.N.S., L.K.M., D.T.K., A.Y.A.); Department of Radiology, Hospital do Coração, HCor and Teleimagem, São Paulo, Brazil (V.N.S.); Department of Infectious Diseases, Universidade Federal de São Paulo, São Paulo, Brazil (A.M.D.); Hospital Israelita Albert Einstein, São Paulo, Brazil (A.d.A.e.C.); and Department of Radiology, Grupo de Radiologia e Diagnóstico por Imagem-Rede D'Or, São Paulo, Brazil (A.R.C.F.)
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Hosokawa T, Deguchi K, Takei H, Sato Y, Tanami Y, Oguma E. Ultrasonography for the Detection of Osteomyelitis in Pediatric Patients With Soft Tissue Infection: A Pilot Study. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2024; 43:1223-1234. [PMID: 38456324 DOI: 10.1002/jum.16446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 02/22/2024] [Accepted: 02/25/2024] [Indexed: 03/09/2024]
Abstract
OBJECTIVES To demonstrate the usefulness of ultrasonography for differentiating soft tissue infections with or without osteomyelitis in pediatric patients who underwent ultrasonography and subsequent magnetic resonance imaging (MRI). METHODS Twenty-three patients were classified into 2 groups: 12 patients with and 11 patients without osteomyelitis based on MRI. Osteomyelitis using ultrasound is characterized by the presence of bone cortex irregularity and/or subperiosteal abscess formation. The diagnostic performance of ultrasonography for detecting osteomyelitis and subperiosteal abscess formation was compared with that of MRI. Diagnostic accuracy, sensitivity, specificity, positive predictive value, and negative predictive value were calculated with 95% confidence intervals (CIs). RESULTS Of 12 osteomyelitis cases, 11 had abnormal bone marrow enhancement (one residual case did not undergo contrast enhancement study) and 5 had subperiosteal abscesses. The diagnostic accuracy of ultrasonography for osteomyelitis was 82.6% (number of correct diagnosis of osteomyelitis/total number = 19/23; 95% CI, 61.2-95.0) and for detecting periosteal abscess was 95.7% (number of correct diagnosis of periosteal abscess/total number = 22/23; 95% CI, 78.1-99.9), respectively. The sensitivity and specificity of ultrasonography for detecting osteomyelitis were 66.7% (95% CI, 34.9-90.1) and 100% (95% CI, 71.5-100), respectively. The sensitivity and specificity of ultrasonography for detecting periosteal abscess were 80% (95% CI, 28.4-99.5), and 100% (95% CI, 81.5-100), respectively. One-third of osteomyelitis cases could not be detected using ultrasonography. CONCLUSIONS Ultrasonography may be useful for diagnosing osteomyelitis in pediatric patients; however, the technique appears limited by low sensitivity. However, it is more accurate for diagnosis of periosteal abscess in these patients.
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Affiliation(s)
- Takahiro Hosokawa
- Department of Radiology, Saitama Children's Medical Center, Saitama, Japan
| | - Kuntaro Deguchi
- Department of Infectious Diseases and Immunology, Saitama Children's Medical Center, Saitama, Japan
| | - Haruka Takei
- Department of Infectious Diseases and Immunology, Saitama Children's Medical Center, Saitama, Japan
| | - Yumiko Sato
- Department of Radiology, Saitama Children's Medical Center, Saitama, Japan
| | - Yutaka Tanami
- Department of Radiology, Saitama Children's Medical Center, Saitama, Japan
| | - Eiji Oguma
- Department of Radiology, Saitama Children's Medical Center, Saitama, Japan
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Pal D, Roy SG, Singh R, Hayeri MR. Imaging features of soft-tissue infections. Skeletal Radiol 2024:10.1007/s00256-024-04694-4. [PMID: 38702530 DOI: 10.1007/s00256-024-04694-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Revised: 04/07/2024] [Accepted: 04/22/2024] [Indexed: 05/06/2024]
Abstract
Skin and soft tissues are among the most common sites of infections. Infections can involve the superficial epidermis to deep muscles and bones. Most infections spread through contiguous structures, although hematogenous spread can occur in the setting of an immunocompromised state and with atypical infections. While clinical diagnosis of infections is possible, it often lacks specificity, necessitating the use of imaging for confirmation. Cross-sectional imaging with US, CT, and MRI is frequently performed not just for diagnosis, but to delineate the extent of infection and to aid in management. Nonetheless, the imaging features have considerable overlap, and as such, it is essential to integrate imaging features with clinical features for managing soft tissue infections. Radiologists must be aware of the imaging features of different infections and their mimics, as well as the pros and cons of each imaging technique to properly use them for appropriate clinical situations. In this review, we summarize the most recent evidence-based features of key soft tissue infections.
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Affiliation(s)
- Devpriyo Pal
- North Bengal Medical College, Siliguri, West Bengal, India
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Barton MF, Al Jalbout N, Barton BL, Alnuaimi M, Shokoohi H. Novel techniques in performing extraoral ultrasound in diagnosing dental abscesses. Am J Emerg Med 2023; 70:57-60. [PMID: 37201451 DOI: 10.1016/j.ajem.2023.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 04/30/2023] [Accepted: 05/02/2023] [Indexed: 05/20/2023] Open
Abstract
INTRODUCTION Dental abscesses are a common reason patients present to the emergency department (ED). Facial and dental imaging are sometimes necessary to support the clinical diagnosis. While radiographs and computed tomography scans are frequently used, point-of-care ultrasound (US) offers several advantages, including decreased radiation exposure, reduced costs, and shorter patient length of stay. This report outlines the use of US in evaluating patients with suspected dental abscesses in the ED. DISCUSSION The typical orofacial US techniques include examining the affected area for cobblestoning or fluid collections. To improve the accuracy of diagnoses, novel techniques such as the Oral Hydroscan (OHS) and the Tongue Pointing Techniques (TPT) may be employed in specific cases. The OHS utilizes a water-filled oral cavity to enhance the spatial resolution of ultrasound images, providing improved visualization of near-field structures and preventing air accumulation between the gingiva and the buccal mucosa. The TPT involves asking the patient to extend their tongue towards the affected area, pointing to the painful location, and serving as a visual reference for an extraoral US. CONCLUSION US presents several advantages as an alternative imaging method for patients with suspected dental abscesses in the ED. Using innovative techniques such as the OHS and the TPT can further increase the visibility of tissue planes and help define the area of interest in these cases.
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Affiliation(s)
| | - Nour Al Jalbout
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
| | | | - Maryam Alnuaimi
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA; Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates.
| | - Hamid Shokoohi
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
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Lo CM, Lai KL. Deep learning-based assessment of knee septic arthritis using transformer features in sonographic modalities. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2023; 237:107575. [PMID: 37148635 DOI: 10.1016/j.cmpb.2023.107575] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 02/21/2023] [Accepted: 05/02/2023] [Indexed: 05/08/2023]
Abstract
PURPOSE Septic arthritis is an infectious disease. Conventionally, the diagnosis of septic arthritis can only be based on the identification of causal pathogens taken from synovial fluid, synovium or blood samples. However, the cultures require several days for the isolation of pathogens. A rapid assessment performed through computer-aided diagnosis (CAD) would bring timely treatment. METHODS A total of 214 non-septic arthritis and 64 septic arthritis images generated by gray-scale (GS) and Power Doppler (PD) ultrasound modalities were collected for the experiment. A deep learning-based vision transformer (ViT) with pre-trained parameters were used for image feature extraction. The extracted features were then combined in machine learning classifiers with ten-fold cross validation in order to evaluate the abilities of septic arthritis classification. RESULTS Using a support vector machine, GS and PD features can achieve an accuracy rate of 86% and 91%, with the area under the receiver operating characteristic curves (AUCs) being 0.90 and 0.92, respectively. The best accuracy (92%) and best AUC (0.92) was obtained by combining both feature sets. CONCLUSIONS This is the first CAD system based on a deep learning approach for the diagnosis of septic arthritis as seen on knee ultrasound images. Using pre-trained ViT, both the accuracy and computation costs improved more than they had through convolutional neural networks. Additionally, automatically combining GS and PD generates a higher accuracy to better assist the physician's observations, thus providing a timely evaluation of septic arthritis.
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Affiliation(s)
- Chung-Ming Lo
- Graduate Institute of Library, Information and Archival Studies, National Chengchi University, Taipei, Taiwan
| | - Kuo-Lung Lai
- Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan; Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan.
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Malik DG, Dahiya N, Young SW, Heng LXX, Patel MD. Non-Vascular Considerations When Interpreting Extremity Arterial and Venous Examinations. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2022; 41:3145-3158. [PMID: 35984099 DOI: 10.1002/jum.16087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 07/29/2022] [Accepted: 08/02/2022] [Indexed: 06/15/2023]
Abstract
Peripheral arterial and venous examinations are performed regularly in vascular labs and interpreted by physicians of different specialities. Many vascular examinations have nonvascular pathology that is either inadvertently imaged by the sonographer or imaged with intent as it relates to patient's symptoms. It is prudent for every reader of vascular studies to be acquainted with the sonographic appearance of these non-vascular lesions to enable appropriate and optimal interpretation that has a direct bearing on patient's clinical care. Our review includes a discussion of the nonvascular pathologies like lymph nodes, soft tissue edema, soft tissue fluid collections, musculotendinous injuries, soft tissue masses, and joint and bursal pathologies that may be encountered during interpretation of vascular exams. The pictorial essay includes a discussion of their sonographic appearances and pitfalls in interpretation. Multiple illustrative examples and sonographic images of the non-vascular pathologies found during interpretation of vascular studies have been utilized to highlight their appearances.
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Affiliation(s)
- Dania G Malik
- Department of Radiology, Mayo Clinic Arizona, Phoenix, Arizona, USA
| | - Nirvikar Dahiya
- Department of Radiology, Mayo Clinic Arizona, Phoenix, Arizona, USA
| | - Scott W Young
- Department of Radiology, Mayo Clinic Arizona, Phoenix, Arizona, USA
| | | | - Maitray D Patel
- Department of Radiology, Mayo Clinic Arizona, Phoenix, Arizona, USA
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Katsura C, Chuo CB. Unusual ultrasound diagnosis of hair implantation osteomyelitis of the thumb. BMJ Case Rep 2022; 15:e250596. [PMID: 36129353 PMCID: PMC9438018 DOI: 10.1136/bcr-2022-250596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Osteomyelitis is a challenging condition to diagnose and successfully treat. A clinician diagnosing osteomyelitis is reliant on relevant aspects of clinical history, inflammatory markers and radiological imaging such as X-rays, CT and contrast MRI. The confirmation of the presurgical diagnosis is made from microbiological analysis of the bone biopsy and/or histological analysis for features of inflammatory changes. An ultrasound scan is generally thought to have less value in osteomyelitis diagnosis due to its inability to interrogate bone. However, this investigation can be helpful in detecting the site and size of soft tissue collections secondary to osteomyelitis and the presence of any associated foreign bodies. We present a case where an ultrasound scan played a key role in supporting the diagnosis of osteomyelitis of the thumb in a dog groomer. This is the first reported case of hair implantation osteomyelitis presenting without a cutaneous sinus.
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Affiliation(s)
- Chie Katsura
- Department of Plastic Surgery, Hull University Teaching Hospitals NHS Trust, Hull, Kingston upon Hull, UK
| | - Cher Bing Chuo
- Department of Plastic Surgery, Hull University Teaching Hospitals NHS Trust, Hull, Kingston upon Hull, UK
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Kucharzik T, Tielbeek J, Carter D, Taylor SA, Tolan D, Wilkens R, Bryant RV, Hoeffel C, De Kock I, Maaser C, Maconi G, Novak K, Rafaelsen SR, Scharitzer M, Spinelli A, Rimola J. ECCO-ESGAR Topical Review on Optimizing Reporting for Cross-Sectional Imaging in Inflammatory Bowel Disease. J Crohns Colitis 2022; 16:523-543. [PMID: 34628504 DOI: 10.1093/ecco-jcc/jjab180] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND AIMS The diagnosis and follow up of patients with inflammatory bowel disease [IBD] requires cross-sectional imaging modalities, such as intestinal ultrasound [IUS], magnetic resonance imaging [MRI] and computed tomography [CT]. The quality and homogeneity of medical reporting are crucial to ensure effective communication between specialists and to improve patient care. The current topical review addresses optimized reporting requirements for cross-sectional imaging in IBD. METHODS An expert consensus panel consisting of gastroenterologists, radiologists and surgeons convened by the ECCO in collaboration with ESGAR performed a systematic literature review covering the reporting aspects of MRI, CT, IUS, endoanal ultrasonography and transperineal ultrasonography in IBD. Practice position statements were developed utilizing a Delphi methodology incorporating two consecutive rounds. Current practice positions were set when ≥80% of the participants agreed on a recommendation. RESULTS Twenty-five practice positions were developed, establishing standard terminology for optimal reporting in cross-sectional imaging. Assessment of inflammation, complications and imaging of perianal CD are outlined. The minimum requirements of a standardized report, including a list of essential reporting items, have been defined. CONCLUSIONS This topical review offers practice recommendations to optimize and homogenize reporting in cross-sectional imaging in IBD.
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Affiliation(s)
- Torsten Kucharzik
- Department of Gastroenterology, Klinikum Lüneburg, University of Hamburg, Bögelstr. 1, 21339 Lüneburg, Germany
| | - Jeroen Tielbeek
- Department of Radiology, Spaarne Gasthuis, Boerhaavelaan 22, Haarlem, the Netherlands; Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands
| | - Dan Carter
- Department of Gastroenterology, Chaim Sheba Medical Center, Tel Hasomher, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Stuart A Taylor
- Centre for Medical Imaging, University College London, London, UK
| | - Damian Tolan
- Radiology Department, St James's University Hospital, Leeds Teaching Hospitals NHS Trust, Beckett Street, Leeds, UK
| | - Rune Wilkens
- Gastrounit, Division of Medicine, Hvidovre University Hospital, Copenhagen, Denmark; Copenhagen Centre for Inflammatory Bowel Disease in Children, Adolescents and Adults, University of Copenhagen, Hvidovre Hospital, Copenhagen, Denmark
| | - Robert V Bryant
- Department of Gastroenterology, The Queen Elizabeth Hospital, Adelaide, South Australia
| | - Christine Hoeffel
- Department of Abdominal Radiology, CHU Reims and CRESTIC, URCA, 51100 Reims, France
| | - Isabelle De Kock
- Department of Radiology, Ghent University Hospital, Ghent, Belgium
| | - Christian Maaser
- Outpatient Department of Gastroenterology, Department of Geriatrics, Klinikum Lüneburg, University of Hamburg, Bögelstr. 1, 21339 Lüneburg, Germany
| | - Giovanni Maconi
- Gastroenterology Unit, 'Luigi Sacco' University Hospital, Milan, Italy
| | - Kerri Novak
- Department of Radiology and Medicine, Division of Gastroenterology, University of Calgary, Alberta, Canada
| | - Søren R Rafaelsen
- Department of Radiology, University Hospital of Southern Denmark, Vejle, Denmark
| | - Martina Scharitzer
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Antonino Spinelli
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, Milan, Italy.,IRCCS Humanitas Research Hospital, Division of Colon and Rectal Surgery, via Manzoni 56, 20089 Rozzano, Milan, Italy
| | - Jordi Rimola
- IBD unit, Radiology Department, Hospital Clínic Barcelona, Barcelona, Catalonia, Spain
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9
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Jacobson JA, Middleton WD, Allison SJ, Dahiya N, Lee KS, Levine BD, Lucas DR, Murphey MD, Nazarian LN, Siegel GW, Wagner JM. Ultrasonography of Superficial Soft-Tissue Masses: Society of Radiologists in Ultrasound Consensus Conference Statement. Radiology 2022; 304:18-30. [PMID: 35412355 DOI: 10.1148/radiol.211101] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The Society of Radiologists in Ultrasound convened a panel of specialists from radiology, orthopedic surgery, and pathology to arrive at a consensus regarding the management of superficial soft-tissue masses imaged with US. The recommendations in this statement are based on analysis of current literature and common practice strategies. This statement reviews and illustrates the US features of common superficial soft-tissue lesions that may manifest as a soft-tissue mass and suggests guidelines for subsequent management.
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Affiliation(s)
- Jon A Jacobson
- From the Departments of Radiology (J.A.J.), Pathology (D.R.L.), and Orthopaedic Surgery (G.W.S.), University of Michigan Medical Center, Ann Arbor, MI; Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (W.D.M.); Department of Radiology, Georgetown University School of Medicine, Washington, DC (S.J.A.); Department of Radiology, Mayo Clinic, Scottsdale, Ariz (N.D.); Department of Radiology, University of Wisconsin, Madison, Wis (K.S.L.); Department of Radiology, University of California Los Angeles, Los Angeles, Calif (B.D.L.); Department of Radiology, American Institute of Radiologic Pathology, Silver Spring, Md (M.D.M.); Department of Radiology, Thomas Jefferson University, Philadelphia, Pa (L.N.N.); Department of Radiology, University of Oklahoma, Oklahoma City, Okla (J.M.W.)
| | - William D Middleton
- From the Departments of Radiology (J.A.J.), Pathology (D.R.L.), and Orthopaedic Surgery (G.W.S.), University of Michigan Medical Center, Ann Arbor, MI; Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (W.D.M.); Department of Radiology, Georgetown University School of Medicine, Washington, DC (S.J.A.); Department of Radiology, Mayo Clinic, Scottsdale, Ariz (N.D.); Department of Radiology, University of Wisconsin, Madison, Wis (K.S.L.); Department of Radiology, University of California Los Angeles, Los Angeles, Calif (B.D.L.); Department of Radiology, American Institute of Radiologic Pathology, Silver Spring, Md (M.D.M.); Department of Radiology, Thomas Jefferson University, Philadelphia, Pa (L.N.N.); Department of Radiology, University of Oklahoma, Oklahoma City, Okla (J.M.W.)
| | - Sandra J Allison
- From the Departments of Radiology (J.A.J.), Pathology (D.R.L.), and Orthopaedic Surgery (G.W.S.), University of Michigan Medical Center, Ann Arbor, MI; Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (W.D.M.); Department of Radiology, Georgetown University School of Medicine, Washington, DC (S.J.A.); Department of Radiology, Mayo Clinic, Scottsdale, Ariz (N.D.); Department of Radiology, University of Wisconsin, Madison, Wis (K.S.L.); Department of Radiology, University of California Los Angeles, Los Angeles, Calif (B.D.L.); Department of Radiology, American Institute of Radiologic Pathology, Silver Spring, Md (M.D.M.); Department of Radiology, Thomas Jefferson University, Philadelphia, Pa (L.N.N.); Department of Radiology, University of Oklahoma, Oklahoma City, Okla (J.M.W.)
| | - Nirvikar Dahiya
- From the Departments of Radiology (J.A.J.), Pathology (D.R.L.), and Orthopaedic Surgery (G.W.S.), University of Michigan Medical Center, Ann Arbor, MI; Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (W.D.M.); Department of Radiology, Georgetown University School of Medicine, Washington, DC (S.J.A.); Department of Radiology, Mayo Clinic, Scottsdale, Ariz (N.D.); Department of Radiology, University of Wisconsin, Madison, Wis (K.S.L.); Department of Radiology, University of California Los Angeles, Los Angeles, Calif (B.D.L.); Department of Radiology, American Institute of Radiologic Pathology, Silver Spring, Md (M.D.M.); Department of Radiology, Thomas Jefferson University, Philadelphia, Pa (L.N.N.); Department of Radiology, University of Oklahoma, Oklahoma City, Okla (J.M.W.)
| | - Kenneth S Lee
- From the Departments of Radiology (J.A.J.), Pathology (D.R.L.), and Orthopaedic Surgery (G.W.S.), University of Michigan Medical Center, Ann Arbor, MI; Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (W.D.M.); Department of Radiology, Georgetown University School of Medicine, Washington, DC (S.J.A.); Department of Radiology, Mayo Clinic, Scottsdale, Ariz (N.D.); Department of Radiology, University of Wisconsin, Madison, Wis (K.S.L.); Department of Radiology, University of California Los Angeles, Los Angeles, Calif (B.D.L.); Department of Radiology, American Institute of Radiologic Pathology, Silver Spring, Md (M.D.M.); Department of Radiology, Thomas Jefferson University, Philadelphia, Pa (L.N.N.); Department of Radiology, University of Oklahoma, Oklahoma City, Okla (J.M.W.)
| | - Benjamin D Levine
- From the Departments of Radiology (J.A.J.), Pathology (D.R.L.), and Orthopaedic Surgery (G.W.S.), University of Michigan Medical Center, Ann Arbor, MI; Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (W.D.M.); Department of Radiology, Georgetown University School of Medicine, Washington, DC (S.J.A.); Department of Radiology, Mayo Clinic, Scottsdale, Ariz (N.D.); Department of Radiology, University of Wisconsin, Madison, Wis (K.S.L.); Department of Radiology, University of California Los Angeles, Los Angeles, Calif (B.D.L.); Department of Radiology, American Institute of Radiologic Pathology, Silver Spring, Md (M.D.M.); Department of Radiology, Thomas Jefferson University, Philadelphia, Pa (L.N.N.); Department of Radiology, University of Oklahoma, Oklahoma City, Okla (J.M.W.)
| | - David R Lucas
- From the Departments of Radiology (J.A.J.), Pathology (D.R.L.), and Orthopaedic Surgery (G.W.S.), University of Michigan Medical Center, Ann Arbor, MI; Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (W.D.M.); Department of Radiology, Georgetown University School of Medicine, Washington, DC (S.J.A.); Department of Radiology, Mayo Clinic, Scottsdale, Ariz (N.D.); Department of Radiology, University of Wisconsin, Madison, Wis (K.S.L.); Department of Radiology, University of California Los Angeles, Los Angeles, Calif (B.D.L.); Department of Radiology, American Institute of Radiologic Pathology, Silver Spring, Md (M.D.M.); Department of Radiology, Thomas Jefferson University, Philadelphia, Pa (L.N.N.); Department of Radiology, University of Oklahoma, Oklahoma City, Okla (J.M.W.)
| | - Mark D Murphey
- From the Departments of Radiology (J.A.J.), Pathology (D.R.L.), and Orthopaedic Surgery (G.W.S.), University of Michigan Medical Center, Ann Arbor, MI; Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (W.D.M.); Department of Radiology, Georgetown University School of Medicine, Washington, DC (S.J.A.); Department of Radiology, Mayo Clinic, Scottsdale, Ariz (N.D.); Department of Radiology, University of Wisconsin, Madison, Wis (K.S.L.); Department of Radiology, University of California Los Angeles, Los Angeles, Calif (B.D.L.); Department of Radiology, American Institute of Radiologic Pathology, Silver Spring, Md (M.D.M.); Department of Radiology, Thomas Jefferson University, Philadelphia, Pa (L.N.N.); Department of Radiology, University of Oklahoma, Oklahoma City, Okla (J.M.W.)
| | - Levon N Nazarian
- From the Departments of Radiology (J.A.J.), Pathology (D.R.L.), and Orthopaedic Surgery (G.W.S.), University of Michigan Medical Center, Ann Arbor, MI; Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (W.D.M.); Department of Radiology, Georgetown University School of Medicine, Washington, DC (S.J.A.); Department of Radiology, Mayo Clinic, Scottsdale, Ariz (N.D.); Department of Radiology, University of Wisconsin, Madison, Wis (K.S.L.); Department of Radiology, University of California Los Angeles, Los Angeles, Calif (B.D.L.); Department of Radiology, American Institute of Radiologic Pathology, Silver Spring, Md (M.D.M.); Department of Radiology, Thomas Jefferson University, Philadelphia, Pa (L.N.N.); Department of Radiology, University of Oklahoma, Oklahoma City, Okla (J.M.W.)
| | - Geoffrey W Siegel
- From the Departments of Radiology (J.A.J.), Pathology (D.R.L.), and Orthopaedic Surgery (G.W.S.), University of Michigan Medical Center, Ann Arbor, MI; Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (W.D.M.); Department of Radiology, Georgetown University School of Medicine, Washington, DC (S.J.A.); Department of Radiology, Mayo Clinic, Scottsdale, Ariz (N.D.); Department of Radiology, University of Wisconsin, Madison, Wis (K.S.L.); Department of Radiology, University of California Los Angeles, Los Angeles, Calif (B.D.L.); Department of Radiology, American Institute of Radiologic Pathology, Silver Spring, Md (M.D.M.); Department of Radiology, Thomas Jefferson University, Philadelphia, Pa (L.N.N.); Department of Radiology, University of Oklahoma, Oklahoma City, Okla (J.M.W.)
| | - Jason M Wagner
- From the Departments of Radiology (J.A.J.), Pathology (D.R.L.), and Orthopaedic Surgery (G.W.S.), University of Michigan Medical Center, Ann Arbor, MI; Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (W.D.M.); Department of Radiology, Georgetown University School of Medicine, Washington, DC (S.J.A.); Department of Radiology, Mayo Clinic, Scottsdale, Ariz (N.D.); Department of Radiology, University of Wisconsin, Madison, Wis (K.S.L.); Department of Radiology, University of California Los Angeles, Los Angeles, Calif (B.D.L.); Department of Radiology, American Institute of Radiologic Pathology, Silver Spring, Md (M.D.M.); Department of Radiology, Thomas Jefferson University, Philadelphia, Pa (L.N.N.); Department of Radiology, University of Oklahoma, Oklahoma City, Okla (J.M.W.)
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10
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Leitao J, Martin L, Desclaux A, Dutronc H, Neau D, Dauchy FA. Experience of ultrasound performed by infectiologists, an innovating approach for the management of patients. Infect Dis Now 2020; 51:451-455. [PMID: 34366081 DOI: 10.1016/j.idnow.2020.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 09/25/2020] [Accepted: 10/30/2020] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Ultrasound imaging has many clinical applications, but there is a lack of data about its use by infectiologists. The aim of this study was to describe ultrasound performed routinely by infectiologists and to assess the diagnostic performance of ultrasound with aspirate and fluid analysis in prosthetic joint infections. METHODS Retrospective study between 1st June 2019 and 1st June 2020 in an infectious and tropical diseases unit in a tertiary University Hospital. RESULTS One hundred and thirty-one ultrasounds were performed on 127 patients by the infectious diseases team. These included 64 musculoskeletal ultrasounds (31 in native joints and 33 in prosthetic joints including 15 knees, 13 hips and 5 spacers) and 33 led to a fluid aspirate. Fourteen lung ultrasounds were done, 11 confirmed pneumopathy and 7 resulted in pleural puncture. Twenty-three vascular ultrasounds were done, 17 to insert a catheter, and four to perform a blood test. Five ultrasounds explored adenopathy, of which one node tuberculosis and one Bartonella infection were diagnosed. In prosthetic joint infections, sensitivity and specificity of ultrasound with fluid aspirate and analysis were respectively 100% and 100% for the knee and 40% and 100% for the hip. CONCLUSION Ultrasound performed by infectiologists is useful and contributes to a faster diagnosis. Furthermore, the specificity of ultrasound with aspirate and fluid analysis is very high in prosthetic joint infection. Ultrasound training courses should be considered for infectiologists including residents.
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Affiliation(s)
- J Leitao
- Service de maladies infectieuses et tropicales, Centre de référence Infections ostéo-articulaires complexes, Hôpital Pellegrin, CHU de Bordeaux, 33000 Bordeaux, France.
| | - L Martin
- Service de maladies infectieuses et tropicales, Centre de référence Infections ostéo-articulaires complexes, Hôpital Pellegrin, CHU de Bordeaux, 33000 Bordeaux, France
| | - A Desclaux
- Service de maladies infectieuses et tropicales, Centre de référence Infections ostéo-articulaires complexes, Hôpital Pellegrin, CHU de Bordeaux, 33000 Bordeaux, France
| | - H Dutronc
- Service de maladies infectieuses et tropicales, Centre de référence Infections ostéo-articulaires complexes, Hôpital Pellegrin, CHU de Bordeaux, 33000 Bordeaux, France
| | - D Neau
- Service de maladies infectieuses et tropicales, Centre de référence Infections ostéo-articulaires complexes, Hôpital Pellegrin, CHU de Bordeaux, 33000 Bordeaux, France
| | - F-A Dauchy
- Service de maladies infectieuses et tropicales, Centre de référence Infections ostéo-articulaires complexes, Hôpital Pellegrin, CHU de Bordeaux, 33000 Bordeaux, France
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11
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Perone MV, Yablon CM. Musculoskeletal Ultrasound in the Emergency Department: Is There a Role? Semin Roentgenol 2020; 56:115-123. [PMID: 33422179 DOI: 10.1053/j.ro.2020.09.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | - Corrie M Yablon
- Department of Radiology, University of Michigan, Ann Arbor, MI.
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12
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Gupta R, Saran S, Malik S, Khanna T. Tubercular osteomyelitis with abscess formation in manubrium sterni. Sudan J Paediatr 2020; 19:171-174. [PMID: 31969749 DOI: 10.24911/sjp.106-1550892037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Reema Gupta
- Department of Radiology, Subharti Medical College, Meerut, UP, India
| | - Sonal Saran
- Department of Radiology, Subharti Medical College, Meerut, UP, India
| | - Sunil Malik
- Department of Pediatrics, Subharti Medical College, Meerut, UP, India
| | - Tanvi Khanna
- Department of Radiology, Subharti Medical College, Meerut, UP, India
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13
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Sonographic assessment of musculoskeletal causes of calf pain and swelling. Emerg Radiol 2019; 26:349-359. [PMID: 30761444 DOI: 10.1007/s10140-019-01680-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 02/05/2019] [Indexed: 10/27/2022]
Abstract
Calf pain or swelling is a common presentation to the emergency department. The differential diagnoses are wide. Deep vein thrombosis (DVT) is often the first diagnosis to be excluded given its potentially fatal complications. Musculoskeletal causes of calf pain or swelling such as Baker's cyst, muscle or tendon tear, soft tissue infection, and inflammation are not uncommon and can often be confidently diagnosed with ultrasonography (US). Familiarity with these conditions and the sonographic findings would be useful in making timely and correct diagnosis.
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14
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Sonographic imaging of hand and wrist injuries: applications in the ER setting. Emerg Radiol 2018; 26:227-240. [DOI: 10.1007/s10140-018-1649-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 09/26/2018] [Indexed: 01/14/2023]
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15
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Nguyen JC, Lee KS, Thapa MM, Rosas HG. US Evaluation of Juvenile Idiopathic Arthritis and Osteoarticular Infection. Radiographics 2017; 37:1181-1201. [PMID: 28696851 DOI: 10.1148/rg.2017160137] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Juvenile idiopathic arthritis (JIA) and osteoarticular infection can cause nonspecific articular and periarticular complaints in children. Although contrast material-enhanced magnetic resonance imaging is the reference standard imaging modality, musculoskeletal ultrasonography (US) is emerging as an important adjunct imaging modality that can provide valuable information relatively quickly without use of radiation or the need for sedation. However, diagnostic accuracy requires a systemic approach, familiarity with various US techniques, and an understanding of maturation-related changes. Specifically, the use of dynamic, Doppler, and/or multifocal US assessments can help confirm sites of disease, monitor therapy response, and guide interventions. In patients with JIA, ongoing synovial inflammation can lead to articular and periarticular changes, including synovitis, tenosynovitis, cartilage damage, bone changes, and enthesopathy. Although these findings can manifest in adult patients with rheumatoid arthritis, important differences and pitfalls exist because of the unique changes associated with an immature and maturing skeleton. In patients who are clinically suspected of having osteoarticular infection, the inability of US to evaluate the bone marrow decreases its sensitivity. Therefore, the US findings should be interpreted with caution because juxtacortical inflammation is suggestive, but neither sensitive nor specific, for underlying osteomyelitis. Similarly, the absence of a joint effusion makes septic arthritis extremely unlikely but not impossible. US findings of JIA and osteoarticular infection often overlap. Although certain clinical scenarios, laboratory findings, and imaging appearances can favor one diagnosis over the other, fluid analysis may still be required for definitive diagnosis and optimal treatment. US is the preferred modality for fluid aspiration and administering intra-articular corticosteroid therapy. © RSNA, 2017.
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Affiliation(s)
- Jie C Nguyen
- From the Department of Radiology, University of Wisconsin School of Medicine and Public Health, American Family Children's Hospital, Madison, Wis (J.C.N., K.S.L., H.G.R.); and the Department of Radiology, Seattle Children's Hospital, Seattle, Wash (M.M.T.)
| | - Kenneth S Lee
- From the Department of Radiology, University of Wisconsin School of Medicine and Public Health, American Family Children's Hospital, Madison, Wis (J.C.N., K.S.L., H.G.R.); and the Department of Radiology, Seattle Children's Hospital, Seattle, Wash (M.M.T.)
| | - Mahesh M Thapa
- From the Department of Radiology, University of Wisconsin School of Medicine and Public Health, American Family Children's Hospital, Madison, Wis (J.C.N., K.S.L., H.G.R.); and the Department of Radiology, Seattle Children's Hospital, Seattle, Wash (M.M.T.)
| | - Humberto G Rosas
- From the Department of Radiology, University of Wisconsin School of Medicine and Public Health, American Family Children's Hospital, Madison, Wis (J.C.N., K.S.L., H.G.R.); and the Department of Radiology, Seattle Children's Hospital, Seattle, Wash (M.M.T.)
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16
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Abstract
Imaging is often used to establish a diagnosis of musculoskeletal infections and evaluate the full extent and severity of disease. Imaging should always start with radiographs, which provide an important anatomic overview. MRI is the test of choice in most musculoskeletal infections because of its superior soft tissue contrast resolution and high sensitivity for pathologic edema. However, MRI is not always possible. Alternative imaging modalities including ultrasound scan, computed tomography, and radionuclide imaging may be used. This article reviews the individual imaging modalities and discusses how specific musculoskeletal infections should be approached from an imaging perspective.
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Affiliation(s)
- Claus S Simpfendorfer
- Section of Musculoskeletal Radiology, Imaging Institute, Cleveland Clinic, CCLCM/CWRU, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
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17
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18
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Hayeri MR, Ziai P, Shehata ML, Teytelboym OM, Huang BK. Soft-Tissue Infections and Their Imaging Mimics: From Cellulitis to Necrotizing Fasciitis. Radiographics 2016; 36:1888-1910. [DOI: 10.1148/rg.2016160068] [Citation(s) in RCA: 81] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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19
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Abstract
Osteomyelitis is an important cause of morbidity and mortality in children and adults. Imaging plays a crucial role in establishing a timely diagnosis and guiding early management, with the aim of reducing long-term complications. Recognition of the imaging features of osteomyelitis requires a good understanding of its pathogenesis. In this review, the key imaging findings in osteomyelitis are correlated with the underlying pathological processes. There is a particular emphasis on magnetic resonance imaging (MRI), which is the best available imaging modality owing to its high sensitivity for detecting early osteomyelitis, excellent anatomical detail and superior soft tissue resolution. However, other modalities such as nuclear medicine and computed tomography (CT) are also useful in many clinical contexts, and will also be described in this review.
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Affiliation(s)
- Yu Jin Lee
- 1 Department of Radiology, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK ; 2 Department of Radiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Sufi Sadigh
- 1 Department of Radiology, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK ; 2 Department of Radiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Kshitij Mankad
- 1 Department of Radiology, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK ; 2 Department of Radiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Nikhil Kapse
- 1 Department of Radiology, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK ; 2 Department of Radiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Gajan Rajeswaran
- 1 Department of Radiology, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK ; 2 Department of Radiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
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Abstract
Percutaneous abscess drainage (PAD) has been proven to be a safe, effective, and widely used technique for treatment of patients with intra-abdominal fluid collections. Indications for PAD are ever expanding, and most abscesses are amenable to PAD. PAD is routinely used for treatment of simple unilocular abscesses however more complex collections require a collaborative strategy with surgical services for patient management. PAD is also used as a temporizing procedure for patients who will ultimately require operative intervention. A variety of imaging modalities are used for PAD including ultrasound and CT. Several catheter insertion techniques have proven effective. Complications from PAD are relatively uncommon.
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Chan HL, Wang HL, Fowlkes JB, Giannobile WV, Kripfgans OD. Non-ionizing real-time ultrasonography in implant and oral surgery: A feasibility study. Clin Oral Implants Res 2016; 28:341-347. [PMID: 26992276 DOI: 10.1111/clr.12805] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/24/2016] [Indexed: 01/17/2023]
Abstract
PURPOSE Ultrasound imaging has potential to complement radiographic imaging modalities in implant and oral surgery given that it is non-ionizing and provides instantaneous images of anatomical structures. For application in oral and dental imaging, its qualities are dependent on its ability to accurately capture these complex structures. Therefore, the aim of this feasibility study was to investigate ultrasound to image soft tissue, hard tissue surface topography and specific vital structures. MATERIAL AND METHODS A clinical ultrasound scanner, paired with two 14-MHz transducers of different sizes (one for extraoral and the other for intraoral scans), was used to scan the following structures on a fresh cadaver: (i) the facial bone surface and soft tissue of maxillary anterior teeth, (ii) the greater palatine foramen; (iii) the mental foramen and (iv) the lingual nerve. Multiple measurements relevant to these structures were made on the ultrasound images and compared to those on cone-beam computed tomography (CBCT) scans and/or direct measurements. RESULTS Ultrasound imaging could delineate hard tissue surfaces, including enamel, root dentin and bone as well as soft tissue with high resolution (110 μm wavelength). The greater palatine foramen, mental foramen and lingual nerve were clearly shown in ultrasound images. Merging ultrasound and CBCT images demonstrated overall spatial accuracy of ultrasound images, which was corroborated by data gathered from direct measurements. CONCLUSION For the first time, this study provides proof-of-concept evidence that ultrasound can be a real-time and non-invasive alternative for the evaluation of oral and dental anatomical structures relevant for implant and oral surgery.
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Affiliation(s)
- Hsun-Liang Chan
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA
| | - Hom-Lay Wang
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA
| | - Jeffery Brian Fowlkes
- Department of Radiology, University of Michigan Medical School, Ann Arbor, MI, USA.,Department of Biomedical Engineering, College of Engineering, University of Michigan, Ann Arbor, MI, USA
| | - William V Giannobile
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA.,Department of Biomedical Engineering, College of Engineering, University of Michigan, Ann Arbor, MI, USA
| | - Oliver D Kripfgans
- Department of Radiology, University of Michigan Medical School, Ann Arbor, MI, USA
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Computer Vision Based Automatic Extraction and Thickness Measurement of Deep Cervical Flexor from Ultrasonic Images. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2016; 2016:5892051. [PMID: 26949411 PMCID: PMC4753340 DOI: 10.1155/2016/5892051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/05/2015] [Revised: 12/21/2015] [Accepted: 12/28/2015] [Indexed: 11/27/2022]
Abstract
Deep Cervical Flexor (DCF) muscles are important in monitoring and controlling neck pain. While ultrasonographic analysis is useful in this area, it has intrinsic subjectivity problem. In this paper, we propose automatic DCF extractor/analyzer software based on computer vision. One of the major difficulties in developing such an automatic analyzer is to detect important organs and their boundaries under very low brightness contrast environment. Our fuzzy sigma binarization process is one of the answers for that problem. Another difficulty is to compensate information loss that happened during such image processing procedures. Many morphologically motivated image processing algorithms are applied for that purpose. The proposed method is verified as successful in extracting DCFs and measuring thicknesses in experiment using two hundred 800 × 600 DICOM ultrasonography images with 98.5% extraction rate. Also, the thickness of DCFs automatically measured by this software has small difference (less than 0.3 cm) for 89.8% of extracted DCFs.
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Lee SJ, Kim OH, Choo HJ, Park JH, Park YM, Jeong HW, Lee SM, Cho KH, Choi JA, Jacobson JA. Ultrasonographic findings of the various diseases presenting as calf pain. Clin Imaging 2015; 40:1-12. [PMID: 26490092 DOI: 10.1016/j.clinimag.2015.09.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Revised: 07/24/2015] [Accepted: 09/15/2015] [Indexed: 12/30/2022]
Abstract
There are various causes of calf pain. The differential diagnoses affecting the lower leg include cystic lesions, trauma-related lesions, infection or inflammation, vascular lesions, neoplasms, and miscellaneous entities. Ultrasound (US) provide detailed anatomical information of the calf structures, and it offers the ability to confirm, other calf abnormalities, particularly when deep vein thrombosis (DVT) is ruled out. The purpose of this article is to review the causes of a painful calf presenting as DVT and incidental findings found as part of the work-up of DVT, and to provide a broad overview of US findings and clinical features of these pathologies.
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Affiliation(s)
- Sun Joo Lee
- Department of Radiology, College of Medicine, Inje University, Pusan Paik Hospital, Busan, South Korea.
| | - Ok Hwa Kim
- Department of Radiology, College of Medicine, Inje University, Haeundae Paik Hospital, Busan, South Korea
| | - Hye Jung Choo
- Department of Radiology, College of Medicine, Inje University, Pusan Paik Hospital, Busan, South Korea
| | - Jun Ho Park
- Department of Radiology, College of Medicine, Inje University, Pusan Paik Hospital, Busan, South Korea
| | - Yeong-Mi Park
- Department of Radiology, College of Medicine, Inje University, Pusan Paik Hospital, Busan, South Korea
| | - Hae Woong Jeong
- Department of Radiology, College of Medicine, Inje University, Pusan Paik Hospital, Busan, South Korea
| | - Sung Moon Lee
- Department of Radiology, College of Medicine, Keimyung University Dongsan Medical Center, Daegu, South Korea
| | - Kil Ho Cho
- Department of Radiology, College of Medicine, Yeungnam University Medical Center, Daegu, South Korea
| | - Jung-Ah Choi
- Department of Radiology, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, South Korea
| | - Jon A Jacobson
- Department of Radiology, University of Michigan Medical Center, MI, US
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Yadavalli S. Radiologic Evaluation of Musculoskeletal Soft Tissue Infections: A Pictorial Review. CURRENT RADIOLOGY REPORTS 2015. [DOI: 10.1007/s40134-015-0119-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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25
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Naidoo P, Liu VJ, Mautone M, Bergin S. Lower limb complications of diabetes mellitus: a comprehensive review with clinicopathological insights from a dedicated high-risk diabetic foot multidisciplinary team. Br J Radiol 2015; 88:20150135. [PMID: 26111070 DOI: 10.1259/bjr.20150135] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Diabetic complications in the lower extremity are associated with significant morbidity and mortality, and impact heavily upon the public health system. Early and accurate recognition of these abnormalities is crucial, enabling the early initiation of treatments and thus avoiding or minimizing deformity, dysfunction and amputation. Following careful clinical assessment, radiological imaging is central to the diagnostic and follow-up process. We aim to provide a comprehensive review of diabetic lower limb complications designed to assist radiologists and to contribute to better outcomes for these patients.
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Affiliation(s)
- P Naidoo
- 1 Monash University, Diagnostic Imaging Department, Monash Health, Clayton, VIC, Australia
| | - V J Liu
- 2 Department of Radiology, St George Hospital, Kogarah, NSW, Australia
| | - M Mautone
- 3 Diagnostic Imaging Department, Monash Health, Clayton, VIC, Australia
| | - S Bergin
- 4 Department of Podiatry, Monash Health, Clayton, VIC, Australia
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26
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Forearm Swelling Due to Superficial Thrombophlebitis Following Intravenous Catheter Placement. J Med Ultrasound 2014. [DOI: 10.1016/j.jmu.2014.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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27
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Patel DB, Emmanuel NB, Stevanovic MV, Matcuk GR, Gottsegen CJ, Forrester DM, White EA. Hand Infections: Anatomy, Types and Spread of Infection, Imaging Findings, and Treatment Options. Radiographics 2014; 34:1968-86. [DOI: 10.1148/rg.347130101] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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28
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Chiu WY, Shiau EL. Extensive air dissection due to necrotizing fasciitis. QJM 2014; 107:389-90. [PMID: 23904520 DOI: 10.1093/qjmed/hct164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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29
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Gheno R, Cepparo JM, Rosca CE, Cotten A. Musculoskeletal disorders in the elderly. J Clin Imaging Sci 2012; 2:39. [PMID: 22919553 PMCID: PMC3424705 DOI: 10.4103/2156-7514.99151] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2012] [Accepted: 05/03/2012] [Indexed: 11/21/2022] Open
Abstract
Musculoskeletal disorders are among the most common problems affecting the elderly. The resulting loss of mobility and physical independence can be particularly devastating in this population. The aim of this article is to present some of the most frequent musculoskeletal disorders of the elderly, such as fractures, osteoporosis, osteoarthritis, microcrystal disorders, infections, and tumors.
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Affiliation(s)
- Ramon Gheno
- Department of Musculoskeletal Radiology, Centre Hospitalier Régional Universitaire de Lille, Hôpital Roger Salengro, Lille, France
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30
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Hill FCE, Yuen A, Ramakrishnan A. Vascular malformation of the flexor tendon presenting as tenosynovitis. Hand (N Y) 2012; 7:200-3. [PMID: 23730242 PMCID: PMC3351513 DOI: 10.1007/s11552-011-9384-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Affiliation(s)
- Fiona C. E. Hill
- Department of Plastic and Reconstructive Surgery, Royal Melbourne Hospital, P.O. Box 2192, Grattan Street, Parkville, Melbourne, VIC Australia
| | - Alex Yuen
- Department of Plastic and Reconstructive Surgery, Royal Melbourne Hospital, P.O. Box 2192, Grattan Street, Parkville, Melbourne, VIC Australia
| | - Anand Ramakrishnan
- Department of Plastic and Reconstructive Surgery, Royal Melbourne Hospital, P.O. Box 2192, Grattan Street, Parkville, Melbourne, VIC Australia
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31
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Imaging Pediatric Musculoskeletal Infection. Tech Orthop 2011. [DOI: 10.1097/bto.0b013e31823a07df] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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32
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Ultrasound of Musculoskeletal Infection. Tech Orthop 2011. [DOI: 10.1097/bto.0b013e31823a0960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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33
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Hashiuchi T, Sakurai G, Morimoto M, Komei T, Takakura Y, Tanaka Y. Accuracy of the biceps tendon sheath injection: ultrasound-guided or unguided injection? A randomized controlled trial. J Shoulder Elbow Surg 2011; 20:1069-73. [PMID: 21782470 DOI: 10.1016/j.jse.2011.04.004] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2010] [Revised: 03/28/2011] [Accepted: 04/06/2011] [Indexed: 02/01/2023]
Abstract
BACKGROUND Patients often localize pain in the anterior shoulder; however, this patient-localized pain does not necessarily correlate to the location of disease. Unguided shoulder injections are common in clinical practice. The accuracy of unguided biceps tendon sheath injections has not been studied. Patient management may be aided by the knowledge of injection accuracy. This study compared the accuracy of ultrasound-guided biceps tendon sheath injection with unguided injection. MATERIALS AND METHODS The study comprised 30 patients (30 shoulders) with reported anterior shoulder pain who had a primary diagnosis of tenosynovitis or tendinitis of the biceps tendon, or both. Shoulders were randomly allocated into ultrasound-guided and unguided injection groups. Computed tomography (CT) imaging was performed immediately after a contrast agent was injected into the biceps tendon sheath. The locations of contrast seen on CT scan were classified into 3 types: only within the tendon sheath (type 1); inside the tendon, tendon sheath, and surrounding area (type 2); and only the area outside the tendon sheath (type 3). RESULTS Ultrasound-guided injections resulted in 86.7% type 1 and 13.3% type 2 locations. Unguided injections resulted in 26.7% type 1, 40.0% type 2, and 33.3% type 3 locations. The difference for each location type was significant (P < .05). CONCLUSION Injection into the tendon sheath of the long head of the biceps brachii can be more accurately performed using ultrasound guidance than by the blind method.
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Affiliation(s)
- Tomohisa Hashiuchi
- Department of Orthopaedic Surgery, Nishinara Central Hospital, Nara City, Nara, Japan.
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34
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Phelan MP, Schils JP, Burval D, Isada CM. Methicillin-resistant Staphyloccocus aureus heel abscess: an uncommon emergency department diagnosis. J Emerg Med 2011; 41:e55-e58. [PMID: 18687561 DOI: 10.1016/j.jemermed.2008.02.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2006] [Revised: 05/16/2007] [Accepted: 08/08/2007] [Indexed: 05/26/2023]
Abstract
Heel abscesses present as heel pain that progressively worsens, with associated tenderness and fullness at the heel pad. Radiological studies like computed tomography, magnetic resonance imaging, or ultrasound can help correctly diagnose a heel pad abscess. Generally, these patients require i.v. antibiotics and operative management to adequately drain the abscess. It is recommended to avoid incising the plantar aspect of the heel to minimize chronic post-drainage heel pain.
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Affiliation(s)
- Michael P Phelan
- Department of Emergency Medicine, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA
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35
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Adhikari S, Blaivas M, Lander L. Comparison of bedside ultrasound and panorex radiography in the diagnosis of a dental abscess in the ED. Am J Emerg Med 2011; 29:790-5. [DOI: 10.1016/j.ajem.2010.03.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2009] [Revised: 02/07/2010] [Accepted: 03/07/2010] [Indexed: 01/04/2023] Open
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36
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Hankin D, Bowling FL, Metcalfe SA, Whitehouse RA, Boulton AJM. Critically evaluating the role of diagnostic imaging in osteomyelitis. Foot Ankle Spec 2011; 4:100-5. [PMID: 21193593 DOI: 10.1177/1938640010390934] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Early diagnosis, essential for timely appropriate treatment and reduction of complications, can be difficult. This article aims to give an overview of the role that different imaging modalities have to play in the diagnosis of osteomyelitis. Osteomyelitis is a heterogeneous disease in its pathophysiology, clinical presentation, and management. It infers inflammation of bone and marrow, whereas osteitis is inflammation of the bone only. Thus, a soft-tissue infection that reaches the bone surface but has not infected the marrow is osteitis and not osteomyelitis. Chronic osteomyelitis is divided into active and inactive forms. Newly appearing periosteal reaction or bone destruction within the chronic involucrum are indicators of activation. Imaging modalities represent different underlying pathophysiological processes that may be represented in differing types and differing phases of osteomyelitis. Sequential selection of appropriate imaging modalities requires a thorough understanding of the disease processes and the process by which each modality visualizes this dynamic disease process.
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Affiliation(s)
- David Hankin
- Central Manchester Foundation Trust, Manchester Diabetes Centre, Manchester Diabetes Centre, UK
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37
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Turecki MB, Taljanovic MS, Stubbs AY, Graham AR, Holden DA, Hunter TB, Rogers LF. Imaging of musculoskeletal soft tissue infections. Skeletal Radiol 2010; 39:957-71. [PMID: 19714328 DOI: 10.1007/s00256-009-0780-0] [Citation(s) in RCA: 106] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2009] [Revised: 08/03/2009] [Accepted: 08/06/2009] [Indexed: 02/02/2023]
Abstract
Prompt and appropriate imaging work-up of the various musculoskeletal soft tissue infections aids early diagnosis and treatment and decreases the risk of complications resulting from misdiagnosis or delayed diagnosis. The signs and symptoms of musculoskeletal soft tissue infections can be nonspecific, making it clinically difficult to distinguish between disease processes and the extent of disease. Magnetic resonance imaging (MRI) is the imaging modality of choice in the evaluation of soft tissue infections. Computed tomography (CT), ultrasound, radiography and nuclear medicine studies are considered ancillary. This manuscript illustrates representative images of superficial and deep soft tissue infections such as infectious cellulitis, superficial and deep fasciitis, including the necrotizing fasciitis, pyomyositis/soft tissue abscess, septic bursitis and tenosynovitis on different imaging modalities, with emphasis on MRI. Typical histopathologic findings of soft tissue infections are also presented. The imaging approach described in the manuscript is based on relevant literature and authors' personal experience and everyday practice.
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Affiliation(s)
- Marcin B Turecki
- Department of Radiology, University of Arizona, Tucson, AZ 85724, USA.
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38
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de Tullio D, Rossi C, Bolzon S, Scagliarini L, Occhionorelli S. Necrotizing fasciitis: a surgical emergency. Updates Surg 2010; 62:83-7. [DOI: 10.1007/s13304-010-0019-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2010] [Accepted: 08/25/2010] [Indexed: 11/28/2022]
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39
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Huang MN, Chang YC, Wu CH, Hsieh SC, Yu CL. The prognostic values of soft tissue sonography for adult cellulitis without pus or abscess formation. Intern Med J 2010; 39:841-4. [PMID: 20233245 DOI: 10.1111/j.1445-5994.2009.02053.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Abstract The current practice for cellulitis in diagnosis and treatment is mainly based on subjective clinical judgement without validated objective guidance. For patients with non-purulent cellulitis needing intravenous antibiotic treatment in hospital, we found soft tissue sonography performed around 4 days after initiation of antibiotics might have prognostic values. The patients with soft tissue sonographic pattern of subcutaneous thickening alone had shorter duration of antibiotic treatment and higher rate of early treatment response to antibiotics than those with the pattern of cobblestone appearance. Larger-scale research may be warranted to validate the prognostic roles of sonography in cellulitis management.
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Affiliation(s)
- M-N Huang
- Division of Allergy, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
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40
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Comparative survey of pain-alleviating effects between ultrasound-guided injection and blind injection of lidocaine alone in patients with painful shoulder. Arch Orthop Trauma Surg 2010; 130:847-52. [PMID: 19756670 DOI: 10.1007/s00402-009-0965-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2009] [Indexed: 02/09/2023]
Abstract
BACKGROUND Complaints of shoulder pain are very frequent in clinical practice. To relieve this type of pain, intra-subacromial bursa (SAB) injection therapy is commonly employed. Injection procedures include blind and ultrasound-guided injection. In clinical practice, blind injection is routinely performed. However, the SAB is a very thin tissue. Poor response to blind injection may be due to a misplaced injection. It is assumed that ultrasound-guided injections are more effective than blind injections. The purpose of this study was to compare pain-alleviating effects between ultrasound-guided injection and blind injection with lidocaine alone. MATERIALS AND METHODS The subjects were 16 patients (20 shoulders) in whom pain was possibly derived from inflammation of the SAB. Initially, ultrasound-guided injection was performed with 2 ml of 1% lidocaine. After 1 week, blind injection was conducted in the same patient. They subjectively expressed the grade of pain at each time point (before and 1, 5, 10, 15, 20, 25, and 30 min after injection) as pain scores. We calculated the amelioration rate by dividing differences between the scores at each time point and before injection by the pre-injection score. RESULTS Pain scores of ultrasound-guided injection were lower than blind injection. Ultrasound-guided injection achieved higher mean amelioration rates compared to blind injection, showing significant differences at all time points (P < 0.01). CONCLUSIONS Ultrasound-guided technique achieved higher effectiveness compared to blind technique.
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41
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Shirley R, Mackey S, Meagher P. Necrotising fasciitis: a sequelae of varicella zoster infection. J Plast Reconstr Aesthet Surg 2010; 64:123-7. [PMID: 20570582 DOI: 10.1016/j.bjps.2010.03.031] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2009] [Revised: 01/26/2010] [Accepted: 03/11/2010] [Indexed: 11/25/2022]
Abstract
Necrotising fasciitis (NF) can complicate varicella zoster virus in children. This is rare and has not previously been reported in the plastic surgery literature. We report a case of a female toddler who developed necrotising fasciitis secondary to chicken pox. Her presentation and progress are reported, the diagnosis of necrotising fasciitis in children and the small number of case series and case control studies are discussed.
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Affiliation(s)
- Rebecca Shirley
- The Blizzard Institute, 4 Newark Street, London E1 2AT, United Kingdom.
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42
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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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Affiliation(s)
- Srikar Adhikari
- Department of Emergency Medicine, Northside Hospital Forsyth, 1200 Northside Forsyth Dr, Cumming, GA 30041-7659 USA
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Pineda C, Espinosa R, Pena A. Radiographic imaging in osteomyelitis: the role of plain radiography, computed tomography, ultrasonography, magnetic resonance imaging, and scintigraphy. Semin Plast Surg 2009; 23:80-9. [PMID: 20567730 PMCID: PMC2884903 DOI: 10.1055/s-0029-1214160] [Citation(s) in RCA: 227] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The diagnostic imaging of osteomyelitis can require the combination of diverse imaging techniques for an accurate diagnosis. Conventional radiography should always be the first imaging modality to start with, as it provides an overview of the anatomy and the pathologic conditions of the bone and soft tissues of the region of interest. Sonography is most useful in the diagnosis of fluid collections, periosteal involvement, and surrounding soft tissue abnormalities and may provide guidance for diagnostic or therapeutic aspiration, drainage, or tissue biopsy. Computed tomography scan can be a useful method to detect early osseous erosion and to document the presence of sequestrum, foreign body, or gas formation but generally is less sensitive than other modalities for the detection of bone infection. Magnetic resonance imaging is the most sensitive and most specific imaging modality for the detection of osteomyelitis and provides superb anatomic detail and more accurate information of the extent of the infectious process and soft tissues involved. Nuclear medicine imaging is particularly useful in identifying multifocal osseous involvement.
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Affiliation(s)
- Carlos Pineda
- Rheumatology Department, Instituto Nacional de Rehabilitacion, Mexico City, Mexico
| | - Rolando Espinosa
- Rheumatology Department, Instituto Nacional de Rehabilitacion, Mexico City, Mexico
| | - Angelica Pena
- Rheumatology Department, Instituto Nacional de Rehabilitacion, Mexico City, Mexico
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44
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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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Hashefi M. Ultrasound in the Diagnosis of Noninflammatory Musculoskeletal Conditions. Ann N Y Acad Sci 2009; 1154:171-203. [DOI: 10.1111/j.1749-6632.2009.04391.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Ramirez-Schrempp D, Dorfman DH, Baker WE, Liteplo AS. Ultrasound soft-tissue applications in the pediatric emergency department: to drain or not to drain? Pediatr Emerg Care 2009; 25:44-8. [PMID: 19148015 DOI: 10.1097/pec.0b013e318191d963] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Soft tissue infections frequently prompt visits to the pediatric emergency department. The incidence of these infections has increased markedly in recent years. The emergence of community-acquired methicillin-resistant Staphylococcus aureus is associated with an increasing morbidity, mortality, and frequency of abscess formation. Bedside ultrasound may have a significant impact in the management of patients that present to the pediatric emergency department with soft tissue infections, including cellulitis, cutaneous abscess, peritonsillar abscess, and necrotizing fasciitis. Ultrasound is an efficient, noninvasive diagnostic tool which can augment the physician's clinical examination. Ultrasound has been shown to be superior to clinical judgment alone in determining the presence or the absence of occult abscess formation, ensuring appropriate management and limiting unnecessary invasive procedures.
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Affiliation(s)
- Daniela Ramirez-Schrempp
- Department of Pediatrics, Division of Pediatric Emergency Medicine, Boston Medical Center, Boston University School of Medicine, Boston, MA 02118, USA.
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47
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Baker JR, McEneaney PA, Prezioso JL, Adajar MA, Goldflies ML, Zambrano CH. Aggressive management of necrotizing fasciitis through a multidisciplinary approach using minimal surgical procedures: a case report. Foot Ankle Spec 2008; 1:160-7. [PMID: 19825711 DOI: 10.1177/1938640008318966] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Necrotizing fasciitis is an aggressive, destructive infection of the soft tissue and fascia and is a life-threatening surgical emergency. A case study is presented of necrotizing fasciitis in the right lower extremity of a 53-year-old male resident of a long-term skilled nursing facility. Limb salvage was achieved through a multidisciplinary approach with early surgical management and aggressive postoperative management. Through 3 surgical procedures, the combined efforts of podiatric surgery, orthopaedic surgery, general/trauma surgery, and infectious disease provided early wound closure and limb salvage. An aggressive multidisciplinary approach to the management of necrotizing fasciitis in the lower extremity is necessary for limb salvage. Use of this multidisciplinary approach will minimize the number of surgical procedures and decrease the potential morbidity and mortality seen in patients with this infection.
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Affiliation(s)
- Jeffrey R Baker
- Weil Foot and Ankle Institute, Des Plaines, Illinois 60610, USA.
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Abstract
Osteomyelitis frequently requires more than one imaging technique for an accurate diagnosis. Conventional radiography still remains the first imaging modality. MRI and nuclear medicine are the most sensitive and specific methods for the detection of osteomyelitis. MRI provides more accurate information regarding the extent of the infectious process. Ultrasound represents a noninvasive method to evaluate the involved soft tissues and cortical bone and may provide guidance for diagnostic or therapeutic aspiration, drainage, or tissue biopsy. CT scan can be a useful method to detect early osseous erosion and to document the presence of sequestra. PET and SPECT are highly accurate techniques for the evaluation of chronic osteomyelitis, allowing differentiation from soft tissue infection.
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Affiliation(s)
- Carlos Pineda
- Instituto Nacional de Rehabilitación, Avenida México-Xochimilco No. 289, Arenal de Guadalupe, Tlalpan, Mexico City, 14389, Mexico.
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Piedra T, Martín-Cuesta L, Arnáiz J, de Lucas EM, Pellón R, García-Bolado A, González F. Necrotizing fasciitis secondary to diverticulitis. Emerg Radiol 2007; 13:345-8. [PMID: 17216174 DOI: 10.1007/s10140-006-0566-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2006] [Accepted: 12/05/2006] [Indexed: 11/25/2022]
Abstract
Necrotizing fasciitis is a rare, rapidly progressive infectious process primarily involving the fascia and the subcutaneous tissue, with thrombosis of the cutaneous microcirculation. We present a case of necrotizing fasciitis secondary to diverticulitis in an immunosuppressed patient with rheumatoid arthritis.
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Affiliation(s)
- Tatiana Piedra
- Radiology Department, Marqués de Valdecilla University Hospital, Avenida de Valdecilla, 39008 Santander, Spain.
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