Ultrasound quarterly
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Ultrasound quarterly · Sep 2016
Case ReportsThe Lung Point Sign, not Pathognomonic of a Pneumothorax.
Since the development of portable ultrasonography equipment, this technology has provided clinicians the ability to evaluate a variety of lung pathology at the bedside, but we are still learning how to accurately interpret the acquired images. Adequate interpretation and recognition of certain signs is crucial to diagnosing pathological processes. In addition, such signs must be adequately correlated with the patient's medical condition. ⋯ Further evaluation demonstrated absence of pneumothorax, with the patient having a large bulla. To our knowledge, this is the first case reported demonstrating that the "lung point sign" is not always indicative of a pneumothorax. We discuss the importance of both clinical correlation and understanding of the underlying pathophysiology when reviewing ultrasound images to accurately interpret ultrasound findings.
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Ultrasound quarterly · Sep 2016
When the Appendix Is Not Seen on Ultrasound for Right Lower Quadrant Pain: Does the Interpretation of Emergency Department Physicians Correlate With Diagnostic Performance?
A survey was administered to 166 academic emergency department (ED) physicians to determine their interpretation and practice after receiving an ultrasound (US) report with nonvisualization of the appendix (NVA). Annual incidence of reported NVA from 2 academic hospitals was calculated for 2002-2013. A retrospective review of the same hospitals revealed that 291 (17.4%) of 1672 USs performed for appendicitis in 2012 indicated NVA. ⋯ Inflammatory changes in right lower quadrant (P = 0.01) and focal tenderness (P = 0.02) noted on US were significant predictors of a positive computed tomography scan. Current perceptions and practice of some ED physicians equate NVA on US as an inadequate study to exclude appendicitis. However, reported NVA is itself a highly predictive sign (94.3%) of absence of appendicitis even when an alternate cause of pain is not seen.
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Ultrasound quarterly · Sep 2016
Case ReportsUltrasound and Electromyography Guidance for Injection of the Longus Colli With Botulinum Toxin for the Treatment of Cervical Dystonia.
Cervical dystonia, also called spasmodic torticollis, is a painful condition in which neck muscles contract involuntarily, and may cause abnormal head position or movements. The primary (or first line of) treatment of cervical dystonia is chemodenervation with injection of botulinum toxin into the affected muscles. We report a case of a young man with idiopathic cervical dystonia who developed anterocollis (forward flexion of the neck) not responsive to prior scalene and sternocleidomastoid muscle injections. ⋯ The patient responded well and had no complications. The longus colli has been reported to be injected using electromyography, fluoroscopy, computed tomography, and, less frequently, US. We propose that US guidance is an excellent technique for botulinum toxin injection, especially for deep cervical muscles such as the longus colli.