Hypoechoic Swelling Research Articles

Ultrasound appearance of regenerative peripheral nerve interface with clinical correlation.

To describe the ultrasound (US) appearance of regenerative peripheral nerve interfaces (RPNIs) in humans, and correlate clinically and with histologic findings from rat RPNI. Patients (≥ 18years) who had undergone RPNI surgery within our institution between the dates of 3/2018 and 9/2019 were reviewed. A total of 21 patients (15 male, 6 female, age 21-82years) with technically adequate US studies of RPNIs were reviewed. Clinical notes were reviewed for the presence of persistent pain after RPNI surgery. Histologic specimens of RPNIs in a rat model from prior studies were compared with the US findings noted in this study. There was a variable appearance to the RPNIs including focal changes involving the distal nerve, nerve-muscle graft junction, and area of the distal sutures. The muscle grafts varied in thickness with accompanying variable echogenic changes. No interval change was noted on follow-up US studies. Diffuse hypoechoic swelling with loss of the fascicular structure of the nerve within the RPNI and focal hypoechoic changes at the nerve-muscle graft junction were associated with clinical outcomes. US findings corresponded to histologic findings in the rat RPNI. Ultrasound imaging can demonstrate various morphologic changes involving the nerve, muscle, and interface between these two biological components of RPNIs. These changes correspond to expected degenerative and regenerative processes following nerve resection and muscle reinnervation and should not be misconstrued as pathologic in all cases. N5 and N1 morphologic type changes of the RPNI were found to be associated with symptoms.

Airway obstruction requiring tracheal intubation after fine-needle aspiration of the thyroid gland: a case report

BackgroundThere have been no reports of tracheal intubation for airway obstruction after acute thyroid swelling following fine-needle aspiration (FNA) of the thyroid gland.Case presentationA 58-year-old woman with a 22 mm × 13 mm right hypervascular thyroid nodule underwent FNA once with a 22G needle under ultrasonographic guidance. Shortly after the aspiration, ultrasound revealed hypoechoic swelling with a crack-like pattern. The patient was observed under bed rest in the Fowler position and received intravenous steroids. A computed tomography (CT) scan showed swelling not only of the thyroid but also of the retropharyngeal space, and the patient complained of difficulty swallowing saliva. Laryngeal fiberscopy revealed protrusion of the posterior pharyngeal wall, edematous changes in the mucosa of the pharynx and epiglottis, and retention of saliva. The patient was intubated awake and hydrocortisone was administered every 8 h. She was extubated 3 days after FNA and discharged without any complications.ConclusionsWhen neck swelling is noticed after FNA, ultrasonographic findings are especially important to assess potential causes. If airway obstruction is suspected, CT findings and fiberscope observation of the pharynx provide particularly useful information.

Entrapment Neuropathies I: Upper Limb (Carpal Tunnel Excluded)

Several entrapment neuropathies of the upper extremity can cause hypoechoic swelling and nerve compression as seen at ultrasound. The ulnar nerve can be compressed at the cubital tunnel of the elbow and Guyon's canal at the wrist. The deep branch of the radial nerve can be compressed at the supinator muscle at the elbow, and the superficial radial nerve may be compressed at the dorsal wrist (Wartenberg's syndrome). In addition to compression at the carpal tunnel, the median nerve may be compressed at the elbow, related to a supracondylar process or by the pronator teres. Knowledge of these key anatomical sites of potential nerve compression is essential for accurate diagnosis of entrapment neuropathies.

High-Resolution Sonography of the Palmar Cutaneous Branch of the Median Nerve

The aim of this study was to describe the potential value of high-resolution sonography for evaluation of the palmar cutaneous branch of the median nerve (MN). The volar wrists of 12 healthy volunteers and 22 consecutive patients with sensory deficit in the palmar triangle and thenar eminence suggesting neuropathy of the palmar cutaneous branch of the MN were examined with high-frequency sonography. Nine patients underwent carpal tunnel release, five had a history of penetrating trauma, six had symptoms suggesting concurrent carpal tunnel syndrome, one received surgery for palmaris tendon transfer, and one underwent resection of a ventral carpal ganglion cyst. Correlative 1.5-T MRI was performed in six patients. In 83% of the healthy volunteers, 17-5-MHz sonography was able to identify the palmar cutaneous branch of the MN from its origin down to slightly distal to the wrist crease. In the patient group, sonography allowed detection of nerve abnormalities in 55% of the cases. Focal hypoechoic swelling of the nerve at the fascial crossing was observed in patients who had either concurrent carpal tunnel syndrome (four cases) or previous carpal tunnel release (three cases). Sonography performed after a penetrating trauma revealed nerve encasement by scar tissue (two cases) or complete transection of the nerve ending in a terminal neuroma (one case). Nerve transection secondary to resection of a ventral carpal ganglion cyst (one case) or to carpal tunnel release (one case) was also observed. Sonography can identify the palmar cutaneous branch of the MN and characterize its abnormalities, providing unique information about this small nerve branch.

Effect of perineural anesthesia on the ultrasonographic appearance of equine palmar metacarpal structures.

The purpose of this study was to describe ultrasonographic changes of the equine palmar metacarpal area attributed to the infiltration of local anesthetic solution and to determine whether these changes were noted immediately or at 24 h. The palmar metacarpal region of one forelimb in each of six horses was examined ultrasonographically with a 10-MHz linear array transducer and a 7.5-MHz curvilinear transducer. Transverse and longitudinal images were recorded at 5-cm intervals distal to the accessory carpal bone. High and low palmar and palmar metacarpal nerve blocks were performed with a 2% mepivacaine hydrochloride solution. Ultrasonographic examinations similar to the initial examination then were performed immediately, 1 h and 24 h postinjection. Cross-sectional area and mean pixel value were determined for the superficial and deep digital flexor tendons, the accessory ligament of the deep digital flexor tendon, the suspensory ligament, and the suspensory branches at each level and time period. Subjective ultrasonographic changes also were noted. No significant difference was noted in the cross-sectional area or mean pixel value of any structure at any level or time period compared to baseline. Subjective changes in the tendons and ligaments were not noted. There was mild hypoechoic swelling of the surrounding soft tissues and gas in the region of the injections. Gas could interfere with the evaluation of the origin of the suspensory ligament and the proximal portion of the accessory ligament of the deep digital flexor tendon within the first hour but was not detectable ultrasonographically at 24 h. Based on these findings, if gas interferes with an ultrasonographic examination performed temporally close to perineural anesthesia, a repeat examination at 24 h is recommended.

Abdominal ultrasonogram of autoimmune pancreatitis: Five cases of pancreatic lesions accompanied by Sjögren syndrome.

The concept of autoimmune pancreatitis has recently been established, and ultrasonographic findings we obtained from five cases consistent with autoimmune pancreatitis are reported here. Case 1, a 77-year-old man, was admitted complaining of loss of body weight. Serum hepatobiliary enzymes and γ-globulin levels were elevated, and antinuclear antibody was positive, Abdominal ultrasonography showed dilatation of the intrahepatic bile duct, wall thickening of the common bile duct and hypoechoic swelling of the pancreatic head and body. ERCP revealed multiple stenosis of the intra-and extra-hepatic bile ducts, and diffuse irregular narrowing of the main pancreatic duct. The patient complained of thirst, and the minor salivary gland was examined histologically. Our diagnosis was Sjögren syndrome accompanied by sclerosing cholangitis and a pancreatic lesion. Obstructive jaundice also developed, and PTCD was therefore performed. Both the pancreatic swelling and multiple stenosis of the bile duct improved after steroids were administered. Case 2, a 71-year-old man, was admitted with jaundice. Abdominal ultrasonography showed hypoechoic swelling of the pancreas. ERCP showed stenosis of the common bile duct in the pancreatic head region and diffuse irregular narrowing of the main pancreatic duct. Histological examination of the minor salivary gland suggested Sjögren syndrome. Steroids were therefore administered because the presence of both hyper-γ-globulinemia and positive antinuclear antibody suggested involvement of the autoimmune mechanism. Steroid therapy improved the jaundice as well as the findings from the cholangiograms and pancreatograms. We also encountered three similar cases, all consistent with the concept of autoimmune pancreatitis. The ultrasonographic findings of the pancreatic lesion (1) showed them as homogeneous and markedly hypoechoic areas and, (2) visualized the main pancreatic duct in the lesion, which facilitated a differential diagnosis of the neoplastic lesions. (3) Steroid therapy effectively decreased the hypoechoic area; in some cases, however, a hypoechoic area remained around the main pancreatic duct.

A case of autoimmune pancreatitis

A 38-year-old male was admitted to our hospital because of jaundice. 18 months before admission, he was diagnosed as insulin-dependent diabetes mellitus. Then we could detect no abnormalities of abdominal CT scan. On this admission abdominal US revealed hypoechoic swelling of pancreas. ERCP demonstrated focal narrowing of the main pancreatic duct and constriction of the common bile duct in the pancreas with dilatation of upstream. Pathological finding of pancreas was infiltration of inflammatory cells (lymphocytes, eosinophils and plasma cells) and fibrosis. Pathological findings of gall bladder and lymphnode were similar to that of pancreas. We diagnosed his illness as autoimmune pancreatitis. After surgery jaundice improved but swelling of pancreas continued. Though we recommended steroid therapy, he refused it. We are carefully following.

Neurophysiological and ultrasound findings in sural nerve lesions following stripping of the small saphenous vein

We describe the neurophysiological and ultrasound (US) findings in two patients with right sural nerve lesions following stripping of the small saphenous vein for varicose vein treatment. In the first case, US showed a tear of the nerve proximal to the lateral malleolus and a hypoechoic swelling of the proximal stump, likely related to a terminal bulb neuroma. A sural conduction study performed distally and proximally to the lesion through a near-nerve needle technique showed absent responses. In the second case, US showed a deep subcutaneous extension of a postsurgical scar placed behind the lateral malleolus close to the sural nerve, but no nerve discontinuity. Sural conduction study showed absent responses distal to the scar. Sural stimulation immediately above the scar yielded a small response at the sciatic nerve. A subsequent investigation performed 15 months after the operation showed absent proximal and distal responses. The combination of US and sural conduction study, including recording at the sciatic nerve, to our knowledge has not been described previously, and may yield important complementary information in the diagnosis of sural nerve lesions. © 1999 John Wiley & Sons, Inc. Muscle Nerve 22: 1724–1726, 1999

Sonographic findings in tuberculous epididymitis and epididymo-orchitis

This paper presents the sonographic findings in scrotums of patients affected with tuberculous epididymitis or epididymo-orchitis. Eighteen patients with a total of 22 abnormal hemiscrotums (4 patients had bilateral lesions) underwent scrotal sonography. Pathologic confirmation was obtained via epididymectomy in 10 cases, epididymo-orchiectomy in 7 cases, and scrotal exploration and biopsy in 3 cases. The histopathologic diagnosis was tuberculous epididymitis in 12 cases and epididymo-orchitis in 8 cases. Lesions involved the head of the epididymis in 8 cases, the tail in 5 cases, and the entire epididymis in 9 cases. The enlarged epididymis was hypoechoic in 13 cases, hyperechoic in 2 cases, and of mixed echogenicity in 7 cases. The echotexture was heterogeneous in 17 cases and homogeneous in 5 cases. Testicular involvement in 7 cases appeared as a diffusely enlarged hypoechoic testis in 2 cases, an ill-defined hypoechoic lesion in 1 case, a well-demarcated hypoechoic lesion in 2 cases, and multiple small hypoechoic nodules in an enlarged testis in 2 cases. Hydrocele, sinus tract, and extratesticular calcifications were seen in 12, 4, and 2 cases, respectively. The heterogeneous and hypoechoic swelling of the epididymis or the concomitant hypoechoic lesion of the testis with associated sinus tract or extratesticular calcifications may be helpful in the diagnosis of tuberculous epididymitis or epididymo-orchitis, especially in patients with known genitourinary tuberculosis.

Sonographic findings in tuberculous epididymitis and epididymo‐orchitis

Purpose This paper presents the sonographic findings in scrotums of patients affected with tuberculous epididymitis or epididymo-orchitis. Methods Eighteen patients with a total of 22 abnormal hemiscrotums (4 patients had bilateral lesions) underwent scrotal sonography. Pathologic confirmation was obtained via epididymectomy in 10 cases, epididymo-orchiectomy in 7 cases, and scrotal exploration and biopsy in 3 cases. The histopathologic diagnosis was tuberculous epididymitis in 12 cases and epididymo-orchitis in 8 cases. Results Lesions involved the head of the epididymis in 8 cases, the tail in 5 cases, and the entire epididymis in 9 cases. The enlarged epididymis was hypoechoic in 13 cases, hyperechoic in 2 cases, and of mixed echogenicity in 7 cases. The echotexture was heterogeneous in 17 cases and homogeneous in 5 cases. Testicular involvement in 7 cases appeared as a diffusely enlarged hypoechoic testis in 2 cases, an ill-defined hypoechoic lesion in 1 case, a well-demarcated hypoechoic lesion in 2 cases, and multiple small hypoechoic nodules in an enlarged testis in 2 cases. Hydrocele, sinus tract, and extratesticular calcifications were seen in 12, 4, and 2 cases, respectively. Conclusions The heterogeneous and hypoechoic swelling of the epididymis or the concomitant hypoechoic lesion of the testis with associated sinus tract or extratesticular calcifications may be helpful in the diagnosis of tuberculous epididymitis or epididymo-orchitis, especially in patients with known genitourinary tuberculosis. © 1997 John Wiley & Sons, Inc. J Clin Ultrasound 25: 390–394, 1997.

Die Wertigkeit der Sonographie beim Skrotaltrauma

65 patients with penetrating or blunt scrotal trauma underwent scrotal ultrasound. High-resolution real-time sonography was able to differentiate testicular from extratesticular lesions in all cases. Lesions of the epididymis were diagnosed in 14 cases. In epididymal haematoma sonography revealed an hyperechoic enlarged epididymis whereas posttraumatic epididymitis was demonstrable as hypoechoic swelling. 14 testicular ruptures and 6 testicular haematomas without disruption of the tunica albuginea were correctly diagnosed. Diagnosis could be confirmed at operation in 12 cases and by clinical and sonographic follow-up in 8 cases. A heterogeneous parenchymal pattern, contour abnormalities, poorly defined margins and obvious fragmentation of the testicle strongly suggest testicular rupture.