Ultrasound of ankles in the diagnosis of complications of chikungunya fever

Abstract

ObjectiveTo describe the main ultrasound findings of chikungunya fever in the ankle.Materials and MethodsThis was a cross-sectional observational study involving 52 patients referred to the Hospital Universitário Pedro Ernesto and presenting with clinical and biochemical evidence of chikungunya fever. The examinations were performed by a radiologist with more than 20 years of experience in ultrasound.ResultsThe predominant gender was female (in 88.5%), and the mean age was 58.4 years. The majority (61.5%) of the patients came from the northern part of the city of Rio de Janeiro, and 46.2% were using corticosteroids to treat inflammatory symptoms. The most common alterations observed by ultrasound were joint effusion (in 69.2%), tenosynovitis (in 59.6%), cellulitis (in 46.2%), Kager's fat pad thickening (in 29.9%), myositis (of the soleus or flexor hallucis longus muscle) (in 17.3%), retrocalcaneal bursitis (in 5.8%), tendon ruptures (in 3.8%), and increased vascular flow on power Doppler (in 3.8%).ConclusionSigns of synovitis and tenosynovitis were the main ultrasound findings in a predominantly female population with a mean age of 58.4 years. Further studies are needed in order to define the role of ultrasound in the follow-up of such patients.

Management of acute-stage chikungunya disease: Contribution of ultrasonographic joint examination

“…A highpower Doppler signal (grade 2 or 3, Szkudlarek classification) was emitted by 28.3% of the effusions. Only 2 patients, one with unilateral and the other bilateral involvement, had detectable tenosynovitis, this is quite opposite to what is observed in the chronic phase of chikungunya (Canella, 2017;Mogami et al, 2017).…”

“…Although the contribution of joint DUS to early rheumatoid arthritis diagnosis has been shown (Xiao et al, 2014), joint imaging studies on CHIKV-infected subjects are rare, except (Manimunda et al, 2010;Moga et al, 2018;Canella, 2017;Mogami et al, 2017). Joint DUS can confirm the presence of joint effusion, bone edema, synovial thickening, tenosynovitis and erosions in patients with persistent pain >1 month after the acute phase, but no ultrasound data are available for the early stage of the CHIKV disease.…”

“…Joint DUS can confirm the presence of joint effusion, bone edema, synovial thickening, tenosynovitis and erosions in patients with persistent pain >1 month after the acute phase, but no ultrasound data are available for the early stage of the CHIKV disease. During chikungunya there are only ultrasound analyses in secondary and tertiary forms (Manimunda et al, 2010;Moga et al, 2018;Canella, 2017;Mogami et al, 2017).…”

Ultrasonography and Power Doppler Studies in Chikungunya Disease: Comment on the Article by Chang et al

“…Our group recently performed studies in 50 patients with a confirmed diagnosis of chikungunya fever . The study was performed between 2016 and 2017 in Rio de Janeiro, Brazil.…”

“…Classically, there are 3 phases of disease: acute (first 10 days), subacute (between 10 and 90 days), and chronic (after 90 days). In our studies , ultrasonography was performed, on average, during the subacute stage of the disease. We believe that this period is the most appropriate for identifying, with ultrasonography and power Doppler studies, cases with the potential to evolve poorly.…”