Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Sep 2013
Review Case ReportsManagement of thyroid incidentalomas encountered by anesthesiologists and pain physicians.
Unexpected, asymptomatic thyroid lesions incidentally discovered during unrelated diagnostic or therapeutic interventions are called thyroid incidentalomas (TIs). These lesions are extremely common, creating a clinical problem that most anesthesiologists and pain specialists are unfamiliar with. Ultrasonography (US), which allows high-quality real-time visualization of tissues during brachial plexus block, stellate ganglion block, central vascular access, and other interventions, is the imaging modality of choice of many anesthesiologists and pain medicine specialists for therapeutic interventions on the neck. ⋯ Interventionalists are responsible for acquiring optimal images, accurate needle positioning during interventions, and storage and appropriate labeling of the obtained images. Ignoring the TI or disclosing the presence of a "tumor" can substantially affect the patient's well-being. In this literature review, we discuss 2 clinical cases of incidentalomas, summarize the current evidence-based strategies, and provide readers with practical guidelines-possibly applicable to other abnormal findings-for the management of incidentally found thyroid lesions.
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Reg Anesth Pain Med · Sep 2013
High-definition ultrasound imaging defines the paraneural sheath and the fascial compartments surrounding the sciatic nerve at the popliteal fossa.
The connective tissue layers that surround the sciatic nerve at the popliteal fossa are poorly defined. We present high-definition ultrasound images of the sciatic nerve, which were acquired during ultrasound-guided popliteal sciatic nerve block (SNB), that clearly demonstrate these fascial layers. ⋯ We have demonstrated the paraneural sheath and the fascial compartments, that is, the "subepimyseal perineural compartment" and the "subparaneural compartment" that surround the sciatic nerve and act as conduits for local anesthetic spread during a popliteal SNB.