Ultrasound quarterly
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Ultrasound quarterly · Sep 2018
ReviewSonography of the Cecum: Gateway to the Right Lower Quadrant.
Sonography of the cecum has come of age largely as a consequence of the successful evolution of appendiceal sonography as a useful tool in the evaluation of patients with right lower-quadrant pain. At some medical centers, graded-compression sonography (GCS) has become the initial imaging study of choice in the assessment of these individuals. The cecum serves as a helpful anatomic landmark for localization of the appendix in these examinations-providing a sonographic starting point in the search for the appendix. ⋯ The accurate diagnosis of cecal abnormalities and their differentiation from acute appendicitis play valuable roles in the management of affected patients because the options for further workup and subsequent treatment vary greatly according to the diagnosis at hand. Additionally, the compressed cecum often becomes an acoustic window into the right lower quadrant, revealing pathology apart from the appendix within the right iliac fossa. The purpose of this pictorial essay is to highlight the importance and value of performing a careful evaluation of the cecum during GCS of patients with suspected appendicitis and to review the differential diagnosis and imaging findings of primary cecal abnormalities whose clinical presentations can mimic that of acute appendicitis.
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Ultrasound quarterly · Mar 2018
Meta AnalysisIs Lung Ultrasound Useful for Diagnosing Pneumonia in Children?: A Meta-Analysis and Systematic Review.
Childhood mortality due to pneumonia is high. Chest radiography is the primary imaging modality used for the evaluation of pneumonia in children. Lung ultrasonography (LUS) is a newer, alternative diagnostic method that has been gaining popularity in recent years. We conducted a meta-analysis to summarize the diagnostic usefulness of LUS for childhood pneumonia. ⋯ Current evidence supports LUS as a useful imaging alternative for the diagnosis of childhood pneumonia. That it is easily carried out, readily available, relatively inexpensive, and free from the hazards of radiation make it an attractive alternative to chest radiography and physical examination for the diagnosis and the follow-up of pneumonia in children.
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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.