Introduction Adhesive capsulitis (AC), which is characterised by shoulder pain and a limited range of motion (ROM), is usually diagnosed on the basis of clinical suspicion, with imaging only being used to exclude other causes of similar symptoms. The aim of this study was to identify and describe the typical ultrasound (US) features of AC in a group of patients with shoulder pain and stiffness. Methods This was a cross-sectional study of 1486 patients with AC in which two experienced US specialists examined the axillary pouch (AP), the coracohumeral ligament (CHL), the superior glenohumeral ligament (SGHL), and the long head of the biceps tendon (LHBT), and dynamically visualised the infraspinatus tendon during passive external rotation (PER) during a US evaluation of shoulder ROM . Results AC was confirmed in 106 patients (7.1%). Thickening of the AP of more than 4 mm was observed in 93.4% of the patients, whereas 6.6% showed AP thickening of less than 4 mm but more than 60% of the thickening in the contralateral shoulder. Effusion within the LHBT sheath was detected in 71% of the patients, and thickening of the CHL or SGHL in 88%. The dynamic study of the infraspinatus tendon showed reduced sliding with folding towards the joint capsule in 73% of cases, thus changing the tendon’s profile from flat to concave during PER. The reduced tendon sliding was associated with a bouncing movement that returned the tendon to its baseline resting position in 41.5% of cases. Conclusions We believe a sufficiently experienced US specialist can confirm a clinical diagnosis of AC by carrying out a comparative study of APs, evaluating the thickness of the CHL and SGHL, and detecting reduced sliding of the infraspinatus tendon. Supplementary Information The online version contains supplementary material available at 10.1007/s40744-021-00413-w.
Objectives To assess the value of ultrasonography in studies of the ligaments within the sinus tarsi (ST) in healthy subjects. Materials and methods We examined 20 healthy volunteers using a 12-MHz transducer with THI and compound imaging. With the foot in inversion, the following structures were examined with coronal and transverse scans: (1) the root of the inferior extensor retinaculum (RIER); (2) the interosseous talocalcaneal ligament (ITCL); (3) the cervical ligament (CL); (4) the bifurcate ligament (BL); (5) the synovial recesses, which were examined for possible distention (distended synovial recesses, DSR). The sonographic features, orientation, and thickness of each ligament were assessed. Results The easiest structure to identify (visualized in 20/20 subjects) was the RIER, which formed a semiarch. The two deeper layers were hypoechoic, the superficial layer hyperechoic. The ITCL was situated posteriorly and deep with an oblique course. It appeared hypoechoic with a mean thickness of 4.06 mm ± 0.7. It was visualized in 18/20 (90 %) subjects. The CL (isoechoic/hyperechoic) was located more anteriorly at an intermediate depth. The orientation was almost vertical. It was visualized in 17/20 (85 %) subjects, with a mean thickness of 2.28 mm ± 0.34. The BL appeared hypoechoic. It was visualized in 19/20 (95 %) subjects with transverse (anterior end of the ST) and longitudinal scans. The calcaneonavicular and calcaneocuboid components displayed mean (SD) thicknesses of 2.09 mm ± 0.37 and 2.7 mm ± 0.32, respectively. The ITCL and RIER were visualized in the same scan as a semiarch. DSR was observed in 4/20 (20 %) subjects. Conclusions The present study shows that, in patients with suspected ST pathology, the anatomic structures that make up this recess can be adequately examined with ultrasonography performed with ordinary 12-MHz transducers.Keywords Musculoskeletal ultrasound Á Sinus tarsi Á Harmonic imaging Á Compound imaging Sommario Obiettivi indagare la capacità degli ultrasuoni (US) di identificare le strutture legamentose del seno del tarso (ST) in un gruppo di soggetti sani. Materiali e Metodi abbiamo studiato 20 volontari sani, utilizzando sonde da 12 MHz, Compound e THI attivati. Sono stati indagati con piede in inversione: (1) 123J Ultrasound (2016) 19:107-113 DOI 10.1007/s40477-014-0145-y retinacolo inferiore degli estensori (RIER) (2) legamento interosseo (ITCL) (3) legamento cervicale (CL) (4) legamento biforcato (BL) (5) eventuali distensioni di recessi sinoviali (DSR), con scansioni coronali e trasversali, valutando ecostruttura, orientamento e spessore dei legamenti. Risultati (1) la RIER, repere ecografico, è stata la struttura di più agevole identificazione: con decorso a semiarco, ipoecogena nei 2 strati profondi, iperecogena in quello superficiale, visualizzata in 20/20 soggetti (2) il ITCL in situazione posteriore e profonda, con andamento obliquo ha presentato spessore medio di 4.06 mm ± 0.7, ipoecogeno, visualizzato in 18/20 (90 %); (3) il CL, più anteriore e orientamento qua...
Introduction: Neutropenic enterocolitis (NEC) can be a life-threatening complication of chemotherapy in leukemic patients. Early diagnosis and treatment is therefore crucial. Methods: A 38-year-old woman with acute lymphoblastic leukemia and chemotherapy-induced neutropenia suddenly developed symptoms suspicious of NEC. Transabdominal ultrasound showed features consistent with NEC, later confirmed by computed tomography (CT) scan. Results: The patient was scanned using portable ultrasound (US) equipment (Esaote My Lab 25). US findings showed involvement of the cecum, appendix, ascending colon and proximal middle transverse colon, with features resembling gas containing fissures within the colon wall itself. The risk of colon rupture was confirmed by CT scan. The patient underwent successful hemicolectomy after intravenous treatment with broad spectrum antibiotics, granulocytecolony stimulating factor (G-CSF), platelets and fresh frozen plasma transfusion. Discussion: A prompt bedside US examination upon development of symptoms allowed an early diagnosis of NEC and identified features consistent with imminent colon wall rupture, shifting the management of this life-threatening complication from medical to surgical. Multidisciplinary intervention was crucial for a successful hemicolectomy in a severely affected neutropenic patient.Sommario Introduzione: La tiflite (Neutropenic enterocolitis, NEC) può essere una complicanza fatale in pazienti affetti da leucemia e sottoposti a chemioterapia. Una precoce diagnosi e terapia sono essenziali. Metodi: Una donna di 38 anni affetta da leucemia linfoblastica acuta durante la neutropenia indotta dalla chemioterapia improvvisamente ha sviluppato segni e sintomi compatibili con NEC. Una ecografia addominale ha mostrato segni di NEC confermati successivamente con la TC. Risultati: È stato utilizzato un ecografo portatile (Esaote My Lab 25). Segni ecografici di coinvolgimento intestinale sono stati trovati a carico del cieco, appendice, colon ascendente e della parte prossimale del colon trasverso, con aspetti compatibili con presenza di gas nella parete stessa. Il rischio di perforazione del colon è stato confermato con l'esame TC. La paziente è stata sottoposta con successo a una emicolectomia dopo aver ricevuto antibiotici per endovena, G-CSF, e trasfusione di granulociti, piastrine e plasma fresco congelato. Discussione: Una ecografia eseguita precocemente al letto del paziente appena sono comparsi i sintomi ha permesso non solo di identificare segni compatibili con NEC, ma di identificare segni di possibile imminente rottura della parete, cambiando il trattamento da medico a chirurgico. Un intervento multidisciplinare è stato essenziale permettendo alla paziente di essere sottoposta con successo a una emicolectomia durante neutropenia. ª
Among the rheumatic diseases whose symptoms are more often associated with the possibility of cancer and other malignancies are systemic sclerosis, dermatomyositis and rheumatic polymyalgia. However, a differential diagnosis should be performed in each case of non-typical rheumatic disease and/or other neoplastic disease risk factors. The article’s aim was based on a literature review of this subject and presentation own a case description and discussion about arthritis as a paraneoplastic syndrome. The conclusions of our analysis were as follows: more often paraneoplastic arthritis occurs in men, in ages higher than 50 years old, in patients who poorly respond to treatment of arthritis with polyarticular symmetrical involvement of the limbs, seronegative type of inflammatory joint disease. In this group of patients, complete remission after treatment of the primary tumor and recurrence of the symptoms in the presence of metastasis was observed.
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