Journal of Ultrasound最新文献

Background: To present a reproducible ultrasound-guided approach for the identification and injection of the long thoracic nerve (LTN) in patients with burning axillary pain.

Methods: High-resolution ultrasound was used to visualize the LTN along its superficial course, from its emergence through the middle scalene muscle to its trajectory over the serratus anterior muscle. It is used a high-frequency linear transducer (10-18 MHz) with patients positioned supine or lateral decubitus with arm abduction. Under sterile conditions, it is performed perineural injections both proximal to the cervical spine and distally to the axilla, using the in-plane technique.

Results: The LTN was identified at both the supraclavicular and lateral thoracic levels. Ultrasound guidance allowed for accurate needle placement and perineural distribution of the injectate. The procedure has proven feasible, safe, and reproducible in the clinical setting.

Conclusion: Ultrasound-guided injection of the long thoracic nerve is a precise and minimally invasive technique that combines precise diagnostic confirmation with lasting therapeutic benefit. It represents a valuable option in the management of long thoracic nerve neuropathy and may reduce the need for systemic medications. Further studies are needed to verify its long-term efficacy and define standardized protocols.

Preoperative localisation of non-palpable lymph nodes remains challenging, particularly in previously treated oncological patients. Current localisation techniques may require ionising radiation, dedicated detection systems or complex logistical support. We report the first application of an UltraCor^™ ultrasound-visible marker for ultrasound-only localisation of a cervical lymph node in suspected relapsed Hodgkin lymphoma. A 22-year-old man with previous stage IIIB nodular sclerosis Hodgkin lymphoma presented with constitutional symptoms and a suspicious non-palpable supraclavicular lymph node detected on computed tomography. Initial ultrasound-guided fine-needle aspiration was non-diagnostic. Due to persistent clinical suspicion and the need for accurate surgical localisation, an UltraCor^™ marker was deployed within the lymph node under real-time ultrasound guidance. Intraoperative ultrasound enabled accurate localisation and targeted surgical excision. Histopathological examination confirmed recurrent nodular sclerosis Hodgkin lymphoma. UltraCor^™ localisation may represent a feasible radiation-free alternative for ultrasound-guided selective surgical targeting of non-palpable cervical lymph nodes.

Objective: To assess the clinical value of VExUS-guided volume management in patients following CPB surgery.

Methods: A single-center, prospective, randomized controlled trial was performed. All adult patients undergoing CPB surgery between January 2024 and October 2025 were consecutively enrolled and randomly allocated in a 1:1 ratio to either a VExUS-guided intervention group or a conventional control group. Baseline demographics, intraoperative surgical parameters, serial postoperative fluid and transfusion metrics, and clinical outcomes were compared between the two cohorts. Intergroup comparisons were conducted using two-tailed statistical tests, with a significance level of P < 0.05.

Results: A total of 89 eligible participants completed the study, including 46 in the VExUS group and 43 in the control group. Baseline clinical profiles and all intraoperative variables showed no statistically significant intergroup differences (all P > 0.05). At 12 h and 24 h postoperatively, the median albumin transfusion volume was 0 g in both groups; however, the VExUS-guided cohort exhibited broader data distribution and a larger proportion of patients receiving high-dose albumin administration, with significant between-group differences (P = 0.007 and P = 0.015, respectively). The median postoperative hospital stay was markedly shorter in the VExUS group (15 days vs. 19 days, P = 0.027). No significant differences were observed in intensive care unit (ICU) or total mechanical ventilation time. Although the cumulative net fluid balance did not reach statistical significance between groups, the VExUS-guided group demonstrated a more prominent negative fluid balance trend at 48 h postoperatively, reflecting greater systemic decongestion.

Conclusion: VExUS-directed volume management optimizes personalized fluid therapy and shortens postoperative hospital stay in patients undergoing CPB surgery.

Purpose: To characterize longitudinal changes in axillary-pouch capsular thickness and clinical outcomes after ultrasound-guided hydrodilation with corticosteroid injection in patients with post-stroke adhesive capsulitis, and to examine associations between structural and clinical changes.

Methods: In this longitudinal observational study, 20 patients underwent clinical and ultrasonographic assessment before the first procedure (T0) and at follow-up (T1), separated by a median of 5.7 months. All participants also received conventional neurorehabilitation. Paired changes in pain measured using the Numeric Rating Scale (NRS), range of motion (ROM), strength, muscle tone, disability, quality of life, and capsular thickness were assessed using Wilcoxon signed-rank or exact McNemar tests. Associations between within-participant changes were explored using Spearman correlations.

Results: Median movement-evoked pain decreased by 4 NRS points during flexion and abduction and by 5 points during external rotation (all p < 0.001). Active and passive ROM improved across all assessed movements (all p ≤ 0.001). Median affected-side capsular thickness decreased from 3.7 to 2.45 mm, with a median within-participant reduction of 1.4 mm (p < 0.001). The proportion meeting the ultrasonographic criteria for adhesive capsulitis decreased from 20/20 at T0 to 4/20 at T1. Capsular-thickness changes were not significantly associated with changes in any clinical outcome (all |ρ|≤ 0.35; all p ≥ 0.13).

Conclusion: In this uncontrolled cohort, hydrodilation with corticosteroid injection, delivered alongside neurorehabilitation, was followed by reduced movement-evoked pain, improved shoulder mobility, and axillary-pouch capsular thinning. Capsular thickness should be interpreted as a complementary structural marker rather than a surrogate for clinical recovery.

Purpose: The biceps femoris long head (BFlh) has a complex architecture, posing challenges for accurately assessing its fascicle length. This study compared four 3D ultrasound (3DUS)-based methods for estimating mid-belly BFlh fascicle length in human cadavers (n = 6 legs).

Methods: Method 1 and Method 2 assumed straight fascicles within a single longitudinal plane, aligned with the muscle axis and oriented perpendicular to either proximal or distal aponeurosis. Method 3 represented multiplanar trajectory using two connected straight segments, whereas Method 4 further incorporated local in-plane curvature within each segment.

Results: Agreement relative to the direct measurement of fascicle length by dissection using Bland-Altman bias and 95% limits of agreement (LoA), together with mean difference. All 3DUS-based estimates showed good agreement with dissection (bias < 7.5%, LoA < 18.8 mm, mean differences < 7 mm). Method 3 and Method 4 yielded the lowest bias, narrowest limits of agreement, and smallest mean differences. While repeated-measures ANOVA revealed a significant main effect, post hoc analysis did not identify significant differences between methods (all p ≥ 0.096). All methods demonstrated good intra-rater repeatability (ICC (3,1) = 0.77-0.87) and moderate measurement precision (SEM = 5.51-8.74%).

Conclusion: Overall, these findings suggest that a two-plane approach yields higher accuracy for BFlh fascicle length measurements than approaches assuming straight fascicles within a single plane.

Testicular metastasis from gastric adenocarcinoma is rare, and serial ultrasonographic evolution of this process has seldom been documented. We report a 79-year-old man with gastric adenocarcinoma who presented with progressive left-dominant scrotal enlargement. Initial scrotal ultrasonography showed bilateral hydroceles, greater on the left, with septation but no definite intratesticular lesion. One month later, repeat ultrasonography demonstrated heterogeneous left testicular echotexture with multiple small solid nodules and mildly increased vascularity, indicating interval parenchymal involvement. Pelvic magnetic resonance imaging showed bilateral suspicious testicular and epididymal abnormalities with septal enhancement and diffusion restriction. Histopathology confirmed metastatic adenocarcinoma involving the left testis and left tunica vaginalis, with CDX-2 and SATB2 positivity supporting gastrointestinal differentiation. Biopsy of the right tunica vaginalis showed hydrocele without evidence of malignancy; therefore, the contralateral abnormalities remained radiologically suspicious but were not pathologically confirmed. Follow-up ultrasonography demonstrated destructive progression of the left testis and epididymis with chaotic vascularity. This case highlights the value of serial scrotal ultrasonography for recognizing interval progression from apparently benign hydrocele-dominant findings to metastatic testicular-epididymal involvement. In older patients with known extratesticular malignancy, evolving scrotal swelling should prompt careful reassessment of testicular parenchyma and vascularity on follow-up ultrasound.

This study describes a standardized ultrasound-guided double-needle lavage technique for acute calcific periarthritis of the hand and reports its technical feasibility and preliminary clinical outcomes. Five consecutive patients underwent ultrasound-guided percutaneous lavage. Clinical characteristics, affected joint, calcification size, sonographic features, complications, and visual analog scale (VAS) scores at baseline, 1 week, and 1 month were recorded. Four cases involved the metacarpophalangeal joints, whereas one involved the interphalangeal joint. Mean calcification size was 14.4 ± 6.0 mm. All deposits were mature and showed no posterior acoustic shadowing. Mean VAS decreased from 8.8 ± 1.8 at baseline to 0.4 ± 0.5 at 1 week and 0.2 ± 0.4 at 1 month, corresponding to mean pain reductions of 94.2% and 96.7%, respectively. No complications occurred. Ultrasound-guided lavage appears feasible, safe, and minimally invasive, providing rapid and substantial pain relief. Larger prospective studies are needed to confirm these preliminary findings.

Acute cholecystitis in patients with multiple comorbidities and advanced malignancy presents unique diagnostic and therapeutic challenges. Contrast-enhanced ultrasound (CEUS) has emerged as a valuable tool for diagnosing complicated cholecystitis and guiding interventional procedures. A 69-year-old male with locally advanced pancreatic head carcinoma, chronic ischemic heart disease, and COPD who developed complicated acute cholecystitis with pericholecystic abscess. CEUS confirmed the diagnosis and guided percutaneous cholecystostomy placement via a transperitoneal approach. Intracavitary CEUS through the drainage catheters was subsequently used to verify correct positioning, assess gallbladder perforation, evaluate cystic duct patency, and monitor treatment response. The patient showed progressive clinical and laboratory improvement, with successful resolution of the acute episode without requiring emergency surgery.

Purpose: To determine the natural history of the cardiac manifestations, determined by advanced transthoracic echocardiography (TTE), due to COVID-19 in multiethnic hospitalised patients.

Methods: A prospective observational study, in a London NHS Trust, of patients admitted with COVID-19 undergoing TTE. Baseline TTE was taken during acute admission with follow-up TTE at a median of 17.6 months to assess the same left ventricular (LV), right ventricular (RV) and pulmonary pressure parameters with additional 3D and strain measures.

Results: There were a total of 117 patients with admission and follow-up TTE. LV parameters were largely unchanged at follow-up except E/A ratio decreasing from 0.98 to 0.85. LV global longitudinal strain measures detected subclinical LV impairment in 36% of patients. RV dimensions improved (mean mid RV diameter, 3.1 cm to 2.7 cm (p < 0.001)) but with persistence of RV impairment at follow-up (28%). 3D RV ejection fraction and global strain measures determined impairment in around 40% of patients. All pulmonary haemodynamic measures showed improvement with resolution of effects of RV afterload (p = 0.016), decrease in pulmonary artery systolic pressure (36 mmHg to 28 mmHg p = 0.032) and improvements in mean pulmonary valve acceleration time (113 ms to 120 ms), p = 0.025, and pulmonary vascular resistance (2.2 to 1.7 WU), p = 0.01.

Conclusion: Follow-up echocardiographic parameters compared to admission parameters of multiethnic hospitalised patients with COVID-19 demonstrate improved pulmonary haemodynamics but persistent LV and RV impairment which suggest possible myocarditic/microthrombotic lasting effects of COVID-19 infection.

Purpose: To determine whether ultrasound-based Carotid Plaque‑RADS adds incremental value beyond stenosis degree in distinguishing symptomatic from asymptomatic carotid atherosclerosis.

Methods: Patients with carotid artery stenosis diagnosed by ultrasound were retrospectively enrolled. Plaque-RADS scores and stenosis degree were independently assessed by two blinded radiologists. Binary logistic regression identified factors associated with symptoms. Model discrimination was evaluated by AUC with DeLong comparison. Incremental value was quantified by continuous NRI and IDI with bootstrap validation. Calibration was assessed using bootstrap-corrected slopes, and decision curve analysis evaluated clinical net benefit.

Results: A total of 161 patients were included (mean age 70.99 ± 9.86 years; 73.3% male). Plaque-RADS (OR = 3.51, P = 0.0058), stenosis (OR = 4.12, P = 0.0002), and age (OR = 1.07, P = 0.0053) were independent symptom predictors. Adding Plaque-RADS to stenosis improved AUC from 0.762 to 0.807 (P = 0.039). The combined model (Plaque-RADS, stenosis, age) achieved the highest AUC (0.838), though the gain over the model (stenosis plus age) was not significant (P = 0.080). All models showed good calibration (slopes 0.951-0.999). Adding Plaque-RADS to stenosis plus age significantly improved reclassification (continuous NRI = 0.432, P = 0.004; IDI = 0.058, P = 0.002). Decision curve analysis showed net benefit at higher thresholds (0.20-0.30), but no added benefit at lower screening thresholds.

Conclusion: Ultrasound-based Plaque-RADS provides independent incremental discriminative value beyond stenosis, primarily improving identification of symptomatic patients, supporting its utility as an adjunctive risk stratification tool for clinical decision-making.

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