Esophageal stenosis is a common complication in patients with RDEB, even when they do not have dysphagia. We recommend regular esophagographic examinations of all patients with RDEB.

Objectives To evaluate the usefulness of a negative D-dimer in peripheral or central venous blood to screen for asymptomatic catheter-related thrombosis in cancer patients. Methods D-dimer was measured in blood from central venous catheter and peripheral venous samples in 48 patients with cancer. Asymptomatic catheter-related thrombosis was identified via Doppler ultrasound. Bland and Altman's limits of agreement analysis was used to compare sample sites. Sensitivity and specificity of D-dimer was calculated. Results Overall, 33 of the central samples and 32 of the peripheral samples had D-dimer levels below the cutoff (≥0.3 mg/l). Mean central D-dimer was 0.31 ± 0.35 mg/l; peripheral 0.24 ± 0.22 mg/l (p = 0.5). Bland-Altman plot showed that the two sample sites were not equivalent. Catheter-related thrombosis was demonstrated in five patients, and there were three false negatives. Peripheral D-dimer had a negative predictive value of 90.9%. Conclusions A negative D-dimer may be useful for screening asymptomatic catheter-related thrombosis in patients with cancer, but the central and peripheral sample sites are not equivalent.

Amyand’s hernia is an uncommon form of inguinal hernia. It represents <1% of all hernias and its complication with appendicitis is still rarer with 0.1–0.13% being reported. A 78-year-old woman was taken to the emergency room with pain in the right groin. The patient was assessed by ultrasound with the clinical suspicion of an inguinal hernia. We present the ultrasonographic features of appendicitis within an inguinal hernia sac. A tubular image that terminated in a blind-ended tip in the longitudinal plane and a target image on the cross-sectional plane were consistent with the sonographically demonstrated appendix. The diagnosis of Amyand’s hernia is difficult in the clinical setting. The patient is frequently referred to surgery with the diagnosis of an incarcerated hernia. Ultrasound is a good imaging modality that detects and characterizes this uncommon condition.

Introduction:The spectral patterns for detecting traumatic arterial limb injuries by spectral color Doppler ultrasound (CDUS) have not been clearly defined. The aims of this pictorial essay were to (1) identify spectral patterns on spectral CDUS in patients with suspected arterial limb injuries, and ( 2) propose an algorithm for diagnosing arterial limb injury in patients in the emergency department. Material and Methods: We included patients with blunt, penetrating, or gunshot wounds with suspected limb arterial injuries assessed with spectral CDUS and grayscale ultrasound. Spectral patterns were evaluated at the level of the injury and proximal and distal to this site. Results: Traumatic limb injuries of 582 patients were included. Seven cases with absent arterial flow were referred for computed tomography angiography (CTA) and/or surgical exploration. Arterial spectral flow in the extremities was present in 575 cases; 360 (62.6%) showed a triphasic spectral pattern (normal), and a limb artery lesion was ruled out. In 67 (11.7%) cases, a high-resistance biphasic spectral pattern was identified due to soft tissue edema adjacent to the lesion, so no further imaging studies were indicated. Abnormal spectral patterns for a probable arterial limb lesion were observed in 148 patients (25.7%), such as low-resistance monophasic or biphasic, monophasic "tardus parvus, " bidirectional or obstructive, so that CTA and/or surgical exploration were indicated. Conclusion: For the first time, an Arterial Limb Trauma Ultrasonographic Assessment (ALTUA) algorithm by spectral CDUS is proposed to classify spectral patterns as triphasic or high-resistance biphasic patterns reflecting vessel wall integrity in the absence of arterial injury, and abnormal spectral patterns for probable traumatic arterial limb lesion in the emergency department.

Introduction:The association of extrathyroidal extension (ETE) with local lymph node metastases in patients with papillary thyroid cancer assessed by ACR TI-RADS has not been sufficiently studied. This study aimed to evaluate ACR TI-RADS ultrasonographic features of thyroid nodules in patients with papillary thyroid cancer and define their association with histopathology-confirmed local lymph node metastases. Material and methods: This study was a retrospective cohort of patients with surgically treated papillary thyroid carcinoma evaluated preoperatively with thyroid ultrasound. The odds ratio (OR) for all ultrasonographic ACR TI-RADS criteria was calculated with binary logistic regression. The sensitivity, specificity, and accuracy of ultrasound and a ROC analysis to define the optimal cutoff point of tumor size for detecting ETE were calculated. A p-value < 0.05 was statistically significant. Results: Seventy thyroid nodules from 57 patients with papillary thyroid cancer were included. An association with histopathology-confirmed local lymph node metastases was found in 29 (41.4%) thyroid nodules and ETE demonstrated by ultrasound had an increased risk of local lymph node metastasis (OR 6.50,. ETE detection by ultrasound showed a diagnostic accuracy of 85.7%, a sensitivity of 57.1%, and a specificity of 95.2%. ROC analysis showed that a tumor size of 15.5 mm was the optimal cutoff point for ETE-detection by ultrasound and histopathology. Conclusions: This study is the first in Mexico to demonstrate that ultrasonographic findings of ETE in thyroid nodules were associated with local lymph node metastases in patients with papillary thyroid cancer.

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Canal of Nuck hernia is a rare condition of the inguinal region of the woman, more frecuently in infants, and rarely in adult women. The clinical presentation is a mass in the inguinal region that extends to the labia majora of the vagina. It is important to know the anatomy of the inguinal region of the women to make this diagnosis. The assessment of these patients should be done immediately due to the risk of strangulation of the hernia sac. Ultrasound is the best imaging method to assess these patients.

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