IMPORTANCE Immune checkpoint inhibitors (ICIs) have transformed the treatment paradigm for an ever-increasing number of cancers. However, their use has also led to the emergence of immunerelated adverse events, such as ICI-induced inflammatory arthritis. A reproducible, reliable, and accessible modality is needed to assess and distinguish early ICI-induced inflammatory arthritis and help in management. Magnetic resonance imaging (MRI) of joints may be helpful for early diagnosis, guiding therapeutic decision-making, and identifying patients at high risk for erosive disease.OBJECTIVE To assess the role of MRI of joints in patients with ICI-induced inflammatory arthritis. DESIGN, SETTING, AND PARTICIPANTSThis retrospective case series included patients enrolled at the National Institutes of Health Clinical Center in Bethesda, Maryland. Patients were evaluated by the rheumatology consultation service between December 27, 2016, and May 28, 2019. A retrospective health record review was performed to determine demographic characteristics, clinical characteristics of inflammatory arthritis and malignant tumors, and imaging findings. Inclusion criteria were patients who were enrolled on various institutional review board-approved protocols of ICIs, developed joint-related symptoms, and had MRI data for at least 1 joint. Data were analyzed from EXPOSURES Undergoing MRI of at least 1 joint. MAIN OUTCOMES AND MEASURESAll MRIs were reviewed for synovitis, tenosynovitis, bone marrow edema, and soft tissue conditions. RESULTS A total of 8 patients (mean [SD] age, 58.8 [5.2] years; 6 women and 2 men) between the ages of 50 and 65 years who were undergoing ICI therapy for a variety of malignant tumors were included in this study. Only 1 patient was receiving combined ICI therapy. The results of 13 separate MRI examinations were reviewed. The most commonly performed MRIs were of the hands and wrists (9 MRIs), followed by knee examinations (3 MRIs). Tenosynovitis and synovitis were frequently seen in the hands and wrists. Bone marrow edema and erosions were also found in 3 patients, suggesting early damage. In larger joints (ie, knees and ankles), joint effusions and synovial thickening were characteristic. Most patients (5 patients) were treated with corticosteroids and had good responses.In patients with high-risk features on MRI imaging (eg, bone marrow edema, erosions), diseasemodifying antirheumatic drug therapy was also discussed as a treatment option.CONCLUSIONS AND RELEVANCE These findings suggest that advanced imaging may help to distinguish ICI-induced inflammatory arthritis from other causes of joint pain, aid in identifying (continued)
Background Renal artery pseudoaneurysm (RAP) is a rare renal vascular abnormality but a life-threatening condition that requires multiple imaging modalities for diagnosis and successful management. It can occur as a complication associated with a percutaneous renal biopsy procedure, renal surgery, and trauma. Asymptomatic spontaneous RAP is also a rare entity and not reported in literature. Case Presentation A 28-year-old patient presented to the outpatient department for ultrasound of the breast for mastalgia and routine ultrasound of the abdomen. Ultrasound breast was normal; however, a cystic lesion with color uptake with a yin–yang pattern and to-and-fro spectral waveform was seen in the lower pole of left kidney suggesting a pseudoaneurysm. A computed tomography renal angiogram confirmed the diagnosis. The patient was completely asymptomatic with no history of any renal surgery or intervention or any trauma to the abdomen. Her general and systemic examinations were unremarkable. Digital subtraction angiography and coil embolization of the pseudoaneurysm were performed. Absent of flow in the lesion was demonstrated in postembolization angiography images and ultrasound images. Conclusion RAP has always been described in patients after renal biopsy, surgery, interventions, or trauma. However, we present a case of asymptomatic spontaneous RAP, which was incidentally discovered and effectively treated with coil embolization.
Introduction: Pregnancy is one of the predisposing factors for carpal tunnel syndrome, which may manifest as swelling of the median nerve. The purpose of this study was to obtain the mean cross-sectional area of median nerve using ultrasound in pregnant females at carpal tunnel inlet and its variations with different trimesters. Methods: A total of 102 pregnant females at first, second and third trimesters were evaluated for median nerve with ultrasonography. Mean cross sectional area of median nerve was calculated in both hands by using two methods- direct and indirect. The study was conducted after obtaining ethical clearance from Institutional Review Board of Institute of Medicine, and after obtaining the written informed consent from the subjects. Convenience sampling technique was used. Data obtained were compiled and analyzed using SPSS. Results: The overall mean cross-sectional area was 6.84±1.09 mm2 using direct method and 7.09±1.19 mm2 using indirect method. The values obtained with indirect method were greater than that obtained with direct method. Mean cross-sectional area of the median nerve were higher at third trimester in both hands and by both direct and indirect methods. Conclusions: From the study conducted, the normal value of mean cross-sectional area of median nerve in pregnant females was established.
Key Clinical MessageTuberculous liver abscess is an extremely rare condition, even in tuberculosis endemic countries. A 68-year-old male presented with 2 months of fever, significant weight loss, and hepatomegaly. Ultrasonography revealed a right hepatic lobe abscess. Guided aspiration of the fluid showed tubercular bacilli. He had no evidence of active Tuberculosis elsewhere.
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