Ultrasound Changes Research Articles

Musculoskeletal ultrasound findings of symptomatic joints in patients with systemic lupus erythematosus

OBJECTIVE To investigate the types and distribution of musculoskeletal ultrasonographic changes of the symptomatic joints, their correlations with clinical manifestations in systemic lupus erythematosus (SLE) patients, as well as the differences of ultrasonographic changes from Rhupus syndrome [SLE overlapping with rheumatoid arthritis (RA)] patients. METHODS In the study, 114 SLE patients who complained of arthralgia or arthritis from May 2014 to August 2017 and 15 Rhupus syndrome patients were recruited for ultrasound evaluation. Ultrasound scans of the symptomatic joint areas were completed. The correlation between ultrasonographic changes and clinical characteristics was analyzed. Additionally, ultrasound changes of bilateral wrists and hands of the SLE patients were compared with those of the Rhupus syndrome patients. RESULTS In a total of the 114 SLE patients with 1 866 joints scanned, synovial hyperplasia, tenosynovitis, erosion, and osteophytes were all observed. Synovial hyperplasia was more often observed in wrists in 33.3% (23/69) patients, knees in 28.6% (12/42) patients, and ankles in 25.0% (7/28) patients. Tenosynovitis and erosion were most commonly found in shoulders in 35.0% (7/20) and 65.0% (13/20) patients. Osteophytes were more common in proximal interphalangeal (PIP) joints, elbows and knees. Among 69 patients with 22 joints (bilateral wrists and hands) scanned, 57 (82.6%) of them had ultrasonographic changes. Synovial hyperplasia was observed in 36.2% of the patients and erosion in 14.5% of the patients. The agreement between synovial hyperplasia and swollen joints in PIP was fair (κ=0.633, P<0.01), however poor in wrists between synovial hyperplasia and swollen/tender joints (κ=0.089, P=0.584). 18.4% patients with synovial hyperplasia had no tenderness or swollen clinically, while 15.8% patients with tenderness or swollen had no synovial hyperplasia on ultrasound. No correlation was found between ultrasonographic changes with the SLE disease activity index. Both synovial hyperplasia and erosion were more common in the Rhupus syndrome patients (73.3% vs. 36.2%, P=0.08; 66.7% vs. 14.5%, P=0.03) with significantly higher grey scale scores (7.4±6.4 vs. 1.6±4.1, P=0.04) than in the SLE patients. CONCLUSION Variety of changes could be observed by ultrasound in different joint areas of SLE patients. The ultrasonographic changes and clinical manifestations did not always correspond to each other. Synovial hyperplasia and erosion was more common in Rhupus syndrome patients.

Estimating the time of onset of testicular torsion using ultrasonography in an experimental rat model

PurposeWe aimed to document the time of onset of ultrasonographic and histologic changes in the testes of a rat model following testicular torsion.MethodsTwenty-five Sprague-Dawley rats were divided into four groups. All animals underwent preoperative Doppler ultrasonography. Groups 1, 2, and 3 underwent unilateral surgical torsion of the testis lasting for 72, 24, and 6 hours, respectively. Group 4 underwent a sham operation. The animals were followed with Doppler ultrasonography at 6, 24, 48, and 72 hours postoperatively. Histologic examinations were performed at the designated final time point for each group.ResultsAfter torsion, enlargement of the epididymal head and thickening of the spermatic cord over time were noted. Based on the ultrasonographic dimensions, the ratio of the epididymal volume increased with time following torsion (p=0.002). The torsed testes had an average weight gain of 0.27 g at 6 hours compared to the control testes, but an average weight loss of 0.22 g at 72 hours (P=0.006). Changes in testicular echotexture were noted as soon as 6 hours after torsion, but there was no consistent pattern of echotexture change thereafter. Histologically, viable tubules were seen 6 hours after torsion, while extensive hemorrhagic necrosis was found at 72 hours.ConclusionIn evaluating testicular torsion, the enlargement ratio of the epididymis and thickening of the spermatic cord on Doppler ultrasonography may be useful for determining the urgency of immediate surgery. Changes in testicular echotexture may not be a reliable indicator of the time of onset.

Ultrasonographic Changes in Stage II and Stage III of Chronic Kidney Disease in Dogs

Ultrasonographic Changes in Stage II and Stage III of Chronic Kidney Disease in Dogs

Thyroid hormone levels and ultrasonographic changes in thyroid gland of patients on long-term lithium treatment for affective disorders: A controlled study

Background: Although lithium is known to cause thyroid dysfunction and increased thyroid gland volume, clinical examination and biochemical assessment are fundamental to thyroid workup of patients on lithium treatment. We aimed to determine the thyroid gland volume and the thyroid hormone levels of patients who have been receiving lithium treatment for affective disorders in comparison to voluntary healthy controls. Materials and Methods: This was a cross-sectional, hospital-based observational study, performed in 43 patients on long-term lithium treatment for bipolar disorder, major depressive disorder, and schizoaffective disorder. Patients with documented continuous and adequate serum lithium levels for more than or equal to 6 months recruited consecutively underwent ultrasonographic examination of the thyroid gland. Ultrasonographic examinations were also done in all gender- and age-matched healthy controls. All cases and controls underwent biochemical thyroid function tests. Results: There were no statistically significant differences in gender (P = 0.198; χ2 = 1.654) of cases and controls. Most of the cases were married; maximum number of them unemployed and belonged to the lower socioeconomic status. Total thyroid volume was significantly greater in the lithium-treated group than the control group (9.40 ± 1.41 vs. 4.79 ± 0.45). Clinical inspection and palpation only detected goiter in six (n = 6, 13.95%) of patients on lithium and none among controls. The mean triiodothyronine (T3), mean thyroxine (T4), and mean scores for thyroid-stimulating hormone were significantly increased in patients receiving lithium therapy as compared to controls. Conclusion: It would seem wise from a clinical point of view to include ultrasonographic examination of the thyroid gland as part of the standard thyroid workup before initiating lithium treatment.

Ultrasonographic changes associated with the healing process in a fracture of the distal phalanx in a cow.

A female Holstein cow presented with lameness in the left hind-limb, having suffered a fracture within the distal phalanx distal to the distal interphalangeal joint. The lesion was visualized as a radiolucent gap on a lateral radiograph and a hypoechoic gap on an ultrasonogram in which the hyperechoic bony line disappeared. Using regular ultrasonographic examinations, the healing of the fracture could be characterized by increased echogenicity inside the gap and the formation of a hyperechoic bony bridge. Ultrasonography can provide earlier evidence compared with that provided by radiography of the healing process of a fractured distal phalanx.

Thyroid hormone levels and Thyroid Hormone Levels and Ultrasonographic Changes in the Thyroid Gland of Patients on Long-Term Lithium Treatment for Affective Disorders: A Controlled Study.

Background:Although lithium is known to cause thyroid dysfunction and increased thyroid gland volume, clinical examination and biochemical assessment are fundamental to thyroid workup of patients on lithium treatment. We aimed to determine thyroid gland volume and the Thyroid hormone levels of patients who have been receiving lithium treatment for affective disorders in comparison to voluntary healthy controls.Methods:This was a cross-sectional, hospital-based observational study which was performed in 43 patients on long-term lithium treatment for bipolar disorder, major depressive and schizoaffective disorders. Patients with documented continuous and adequate serum lithium levels for more than or equal to 6 months recruited consecutively underwent the ultrasonographic examination of the thyroid gland. Ultrasonographic examinations were also done in all gender- and age-matched healthy controls. All cases and controls underwent biochemical thyroid function tests.Results:There were no statistically significant differences in gender (P = 0.198; Chi-square = 1.654) of cases and controls. Most of the cases were married, maximum number of them unemployed and belonged to the lower socioeconomic status. Total thyroid volume was significantly greater in the lithium-treated group than the controls (9.40 ± 1.41 vs. 4.79 ± 0.45). Clinical inspection and palpation only detected goiter in six (n = 6, 13.95%) of patients on lithium and none among controls. The mean triiodothyronine, mean thyroxine, and mean scores for thyroid-stimulating hormone were significantly increased in patients receiving lithium therapy as compared to controls.Conclusion:It would seem wise from a clinical point of view to include ultrasonographic examination of the thyroid gland as part of the standard thyroid workup before initiating lithium treatment.

Congestive heart failure in cattle; etiology, clinical, and ultrasonographic findings in 67 cases.

Background and Aim:Congestive heart failure (CHF) is a clinical disorder that results from cardiac dysfunction with subsequent fatal outcomes in most cases. Several diseases are incriminated in occurrence of CHF. Therefore, the aims of this study were to identify CHF etiology and associated clinical findings in 67 cows and to investigate the relationship between CHF and the other body organs using ultrasonographic examination.Materials and Methods:Sixty-seven cows affected by CHF admitted to the clinic with a history of loss of appetite, decrease in milk production, constipation, and brisket edema were thoroughly investigated clinically and ultrasonographically. In addition, ten apparently healthy cows were used as a control group.Results:Clinically, cows with CHF manifested jugular engorgement and pulsation (88.1%), brisket and/or intermandibular edema (77.6%), and muffled heart sounds (76.1%). Based on the ultrasonographic examination, traumatic pericarditis (82.1%) was the most prevalent etiology of CHF. Extracardiac etiology of CHF identified were exudative pleurisy (10.4%) and mediastinal abscesses (7.5%). Hepatomegaly (88.1%) and pleural effusion (61.2%) were the most documented consequences.Conclusion:Both cardiac and extracardiac diseases could be associated with CHF in cattle. Ultrasonographic changes in liver and pleura secondary to CHF were the most common findings. Ultrasonography is a good tool for the diagnosis of cardiac and extracardiac etiologies of CHF in cattle.

Small Intestine Ultrasound Findings on Horses Following Exploratory Laparotomy, Can We Predict Postoperative Reflux?

Simple SummaryPostoperative reflux is a well-recognized complication after exploratory laparotomy, particularly in horses that present with small intestine pathology. Even though much has been written about the pathophysiology and management of this postsurgical complication, we could not find a study that describes the monitoring of small intestine appearance after laparotomy via transcutaneous abdominal ultrasound. Therefore, the aim of the study was to provide clinical evidence of ultrasound finds in 58 horses over three days post exploratory laparotomy. The results from these exams were compared to the abdominal ultrasounds of 20 horses undergoing general anesthesia for an elective procedure, which were used as a control group. Differences were found between horses with versus without small intestinal pathology. Horses operated on because of large colon pathology had similar ultrasound findings to the control group during the postoperative period. In contrast, horses that were presented with small intestinal pathology had more visible small intestine loops, increased loop diameter, and wall thickness, before and after surgery, particularly those cases that had undergone a resection and anastomosis. A quick abdominal ultrasound in horses, during the postoperative period after colic surgery, was a useful method to identify horses with abnormal small intestinal parameters, both pre- and post-surgery. Further investigation as to whether these parameters can be used to predict postoperative reflux (POR) in a larger population is warranted.Postoperative reflux (POR) is a well-recognized complication after colic surgery in horses, particularly when presenting small intestinal pathology. Even though much has been written about the pathophysiology and management of POR, additional clinical studies are needed to better understand and anticipate this complication. The aim of the study was to provide clinical evidence of ultrasound findings in the postoperative period (three days). The study is based on transcutaneous abdominal ultrasounds of the caudoventral abdomen during the postoperative period (three days), in 58 horses, presented for an exploratory laparotomy, and compared to 20 horses that underwent general anesthesia for an elective surgical procedure. Small intestine (SI) images and videos were analyzed for loop number, loop diameter, wall thickness, motility, and echogenic type of loop contents. Ultrasound findings of horses that had a large colon pathology were similar to those of the control group. Interestingly, horses that presented an SI pathology had significantly thicker SI walls, increased loop diameter, slower motility, and hypoechoic contents, particularly in horses that had undergone small intestinal resection and anastomosis. Although the number of horses that developed POR in our study was too small for statistical analysis, they all had the aforementioned ultrasonographic changes. Abdominal ultrasound, during the postoperative period (three days), was a useful method to identify horses with abnormal small intestinal parameters. Further investigation as to whether these parameters can be used to predict POR in a larger population is warranted.

Abdominal ultrasonographic findings in dogs with mammary tumors: association with tumor characteristics and survival

Abdominal ultrasound is frequently performed as part of initial staging of canine mammary tumors. The aims of this study were to describe abdominal ultrasonographic findings present at diagnosis of mammary tumors in dogs and to assess their value for associations with histopathological results and treatment outcome. The medical records of 201 female dogs diagnosed with mammary tumors that had abdominal ultrasonography performed as part of their initial clinical evaluation were reviewed. Histopathological diagnosis of malignant mammary tumors was obtained in most cases (86%; 172 cases). One hundred and fifty-seven animals (78%) had some ultrasonographic abnormality. A total of 338 ultrasonographic changes were identified, and the spleen was the organ with the highest frequency of ultrasonographic changes (20%), followed by the uterus (18%) and the liver (16%). Abdominal ultrasonography abnormalities were not associated with mammary tumor malignancy (OR = 1.7; P = 0.27). Ultrasonographic evidence of enlarged intraabdominal lymph nodes was associated with metastases in surface regional lymph nodes (P < 0.05). Dogs with regional metastasis were more likely to present some abdominal ultrasonographic change (OR = 6.1; P = 0.04). Animals with ultrasonographic evidence of intraabdominal lymph node enlargement presented shorter survival after mastectomy. Abdominal ultrasonographic abnormalities are common in dogs with mammary tumors and are not associated with malignancy. However, the presence of intraabdominal lymph node enlargement identified by ultrasound may be associated with regional metastasis and shorter survival rates.

Zika virus infection: A correlation between prenatal ultrasonographic and postmortem neuropathologic changes

This study presents a correlation between prenatal ultrasonographic images and neuropathologic findings of postmortem tissue samples from five confirmed cases of perinatal Zika virus (ZIKV) infection belonging to the cohort of the ZEN Initiative in Bucaramanga, Colombia. Deaths occurred between June 2016 and March 2017. Mothers consulted with ZIKV infection clinical manifestations or fetal central nervous system (CNS) abnormalities or both. A detailed ultrasound scan and neurosonographic protocol was performed by maternal fetal specialists. Perinatal autopsies were performed following the Colombian National Health Institute's ZIKV protocol. The autopsies were from two fetal deaths, and three early neonatal deaths. Gestational age was between 262/7 and 382/7 weeks. Two cases were classified as mild microcephaly. Few findings by ultrasound and pathology were found in case 1 because it was a late infection; the other cases presented findings corresponding to congenital Zika syndrome: craniofacial malformations, cerebellar hypoplasia, anomalies of the corpus callosum and ventriculomegaly, all confirmed in autopsy specimens. By ultrasonography, hyperechogenicities were seen in several brain structures, which correspond to cortical and periventricular calcifications, subependymal glial reactivity and perivascular rings. The ultrasound and pathological findings show a wide spectrum of CNS anomalies that confirm the neurotropic effect of the ZIKV, recognizing the neuroimaging findings of this disease (unilateral ventriculomegaly, alterations in the corpus callosum and cerebellum, and calcifications) are highly suggestive of ZIKV infection.

Evaluation of an echocardiogram in the preclinical stage of valve endocardiosis in dogs using an angiotensin converting enzyme inhibitor and an aldosterone antagonist

The article presents the results of a study of the dynamics of ultrasonographic changes in dogs with endocardial atrioventricular valve endocardiosis during therapy with an angiotensin converting enzyme inhibitor and aldosterone antagonist. The authors also propose a new method for estimating the cubic volume of the left atrium based on the "area-length" method borrowed from humane medicine and correlation with the routine estimation method for measuring the size of the aorta and left atrium with further calculation of the dynamic index for assessing the remodeling processes. It has shown that the appearance of diastolic dysfunction by the type of slowing down the relaxation of the transmitral flow in the left apical four-chamber projection characterized by a decrease in the ratio of early diastolic filling (peak E) and filling due to systole of the left atrium (peak A) and an increase in the time of early diastolic filling (DTE) were determined at the beginning of the disease. However, changes in the transmitral diastolic flow after 6 months took the form of "pseudonormalization", which was seen in the Dopplerogram as normalization of the ratio of early diastolic filling (peak E) and an increase in filling due to left atrial systole (peak A) and time of early diastolic filling (DTE) . After 12 months of therapy, the diastolic flow through the mitral valve in the Group 1 and partly in the Group 2 became "restrictive", characterized by an increase in the ratio of early diastolic filling (peak E) and filling due to systole of the left atrium (peak A) and a decrease in the time of early diastolic filling (DTE). However, in Group 3, "pseudo-normalization" of the transmitral diastolic flow was still observed. Also, the contractility and ejection fraction being determined did not change during the transition of the disease from the preclinical stage to the clinical one. Based on the treatment of 75 animals, the authors found that the appearance of diastolic dysfunction, an increase in the left atrium and a dynamic remodeling index directly correlate with the onset of the clinical manifestation of endocardiosis.

EP02.13: Ultrasonographic placental changes in women with gestational diabetes: a pilot study

EP02.13: Ultrasonographic placental changes in women with gestational diabetes: a pilot study

Predominant ultrasonographic extracapsular changes in symptomatic psoriatic dactylitis: results from a multicenter cross-sectional study comparing symptomatic and asymptomatic hand dactylitis.

Despite diffuse digital swelling, dactylitis may sometimes be asymptomatic. The objective of this study was to compare the clinical and ultrasonographic features of symptomatic with asymptomatic psoriatic arthritis (PsA) dactylitis. One hundred and twenty-five hand dactylitis were evaluated in a multicenter cross-sectional study for the presence of pain, subjective functional limitation, and tenderness (4-points scale) with the calculation of a Leeds Dactylitis Index (LDI) score. Fingers were subsequently investigated using high-frequency ultrasound (US) both in gray-scale (GS) and power Doppler (PD), for the presence and grading of flexor tenosynovitis, soft tissue edema, subcutaneous PD signal (PDUS), extensor tendon involvement, and joints synovitis. Clinical and US characteristics of symptomatic dactylitic fingers were compared with the asymptomatic dactylitic ones. Symptomatic fingers (n = 80) had a significantly lower dactylitis duration compared to asymptomatic fingers (n = 36) (p < 0.001). Values of LDI, patient VAS-pain, and VAS-functional score were significantly higher in fingers with symptomatic dactylitis (p < 0.001 and p = 0.010, respectively). Symptomatic dactylitis had a higher prevalence of flexor tenosynovitis of grade >2, soft tissue edema and subcutaneous PDUS signal (p < 0.001). Asymptomatic dactylitis showed a greater prevalence of joint synovitis (both in GS and in PD) than symptomatic dactylitis (p < 0.001). Digital tenderness and pain are linked to US tenosynovitis of grade >2 and extra synovial abnormalities and conversely asymptomatic dactylitis is associated with joint-based synovitis.Key Points• Digital tenderness and local pain in psoriatic arthritis dactylitis are strongly associated with flexor tenosynovitis of grade>2, soft tissue edema, and subcutaneous PD signal.• In psoriatic arthritis, asymptomatic dactylitis showed a greater prevalence of joint synovitis than symptomatic dactylitis.• In psoriatic arthritis, ultrasound inflammatory abnormalities are present in about 70% of cold dactylitis which is linked for disease chronicity.• In psoriatic arthritis, the flexor tendon and adjacent soft tissues play a significant role in symptomatic dactylitis.

Effects of Allopurinol on Inflammation and Ultrasonographic Changes in People With Elevated Uric Acid But no Symptoms

Effects of Allopurinol on Inflammation and Ultrasonographic Changes in People With Elevated Uric Acid But no Symptoms

Necrose multifocal pancreática em gata: relato de caso

Pancreatitis is the inflammatory process of the exocrine pancreas, with necrosis and fibrosis as the main structural alterations. Felines may present the acute and chronic forms of the disease. A domestic, female, undefined feline (srd) was taken to a Private Veterinary Hospital in the city of Guarulhos, state of São Paulo. The animal had signs of apathy, prostration, inappetence, anorexia and bilateral exposure of the third eyelid. After the physical examination, blood was collected for haematological and biochemical exams. Abdominal ultrasonography was also requested, where reverberation was detected in the region of the intestinal loop, hyperechogenicity of the duodenal wall and reverberation of the pancreas. According to the results of the blood tests and ultrasonographic findings, we opted for exploratory laparotomy. During the surgical procedure a pancreatic fragment was collected for histopathological analysis. The histopathologic result was compatible with moderate multifocal pancreatic necrosis. Therefore, was instituted antibiotic therapy with Enrofloxacin (5 mg / kg, BID, IM for 5 days), analgesia with Tramadol Hydrochloride (2 mg / kg, BID, IV for 4 days) and Betamethasone (0.3 mg / kg, SID, IV). After the beginning of treatment with corticosteroid, the animal began to improve and eat. Many cases are diagnosed as acute or chronic pancreatitis only due to changes in pancreatic enzymes and ultrasonographic changes in the pancreas, using histopathological examination, which is a more instructive technique. It is very likely that pancreatic necrosis is not a pathology of low incidence, but rather poorly diagnosed due to difficulties in performing a biopsy.

The ultrasonographic and pathomorphological markers of liver steatosis in patients with non-alcoholic fatty liver disease depending on the presence of comorbid chronic kidney disease (chronic pyelonephritis) and obesity

Objective — to establish the peculiarities of ultrasonographic and pathomorphological changes of liver parenchyma in patients with non-alcoholic liver steatosis (NAS) and non-alcoholic steatohepatitis (NASH) depending on the presence of comorbid chronic kidney disease (CKD) and obesity Materials and methods. The examinations involved 384 patients with non-alcoholic fatty liver disease (NAFLD), from them 84 subjects with I degree obesity (1 group) were divided into 2 subgroups: 32 patients with NAS and 52 patients with NASH. The second group consisted of 270 patients with NAFLD with comorbid I degree obesity and CKD І—ІІІ stage and included 110 patients with NAS and 160 patients with NASH. The control group consisted of 90 patients with CKD of the І—ІІІ stage with normal body weight (group 3). The mean age of patients was (45.8 ± 3.81) years. Results and discussion. The study demonstrated that the comorbidity of obesity and NASH with CKD increases the degree of steatosis (the area of hepatocytes affected by fatty liver dystrophy), the degree of ballooning degeneration, hyaline-drop dystrophy; the dystrophic changes in the centrilobular zone (3) deepen in the middle of the lobe with the development of panacinar injury and the involvement of zone 1. The course of NASH with CKD is characterized by a significantly higher incidence and intensity of clinical syndromes and the degree of biochemical and histological activity, which leads to the progression of fibrotic changes in the liver F2—F3. Conclusions. The NASH and CKD comorbidity is characterized by a higher degree of liver steatosis (LSD) (hepatorenal index 1.3 times higher than in the group of patients with NASH, p < 0.05) and the higher diagnostic threshold of values of the hepatotoxic index, which in strong interdependence correlates with the degree of steatosis of the liver, determined by Steato-test (r = 0.87; p < 0.001). In patients with NAS and NASH without comorbid pathology, a significant degree of LSD was found, with NASH it exceeds the reference values by 3.3 times (p < 0.05) and with NAS — by 1.8 times (p < 0.05). In comorbidity with CKD in patients with NAS, LSD was 3.5 times higher (p < 0.05) and in patients with NASH — 4.6 times higher (p < 0.05) than the reference values (p < 0.05).

Ultrasonographic changes of labrum morphology in patients with developmental dysplasia of the hip: a preliminary report on 74 dysplastic and unstable hips.

The aim of the study was to verify the labrum's morphological changes in unstable and dysplastic hips during treatment. Between January 2013 and April 2015, 74 dysplastic hips were divided into type D (n=12), type III (n=40), and type IV (n=22). The labrum was evaluated on ultrasonography (US) for echogenicity and dimensions with interobserver/intraobserver tests: test 1 (US at diagnosis and control group), test 2 (US at diagnosis and 6 weeks post-treatment), and test 3 (US at diagnosis and at end of treatment). Statistical analysis was performed. The labrum was less echogenic in test 1 and more echogenic in test 3, and the labrum was smaller in test 1 and larger in test 3. The labrum undergoes statistically significant increase of echogenicity and dimensions after treatment, suggesting a stabilizing role. Level of Evidence: Level II, Oxford Center for Evidence-based Medicine.

Accuracy of lung ultrasonography in the diagnosis of respiratory distress syndrome in newborns

Objectives: Lung ultrasonography has become an important tool in the diagnosis and follow-up of lung diseases in the newborn period in recent years. Lung diseases such as pneumonia, transient tachypnea of the newborn and respiratory distress syndrome (RDS) can be diagnosed with lung ultrasound. Lung USG is a simple, practical and low-cost method in diagnosing neonatal RDS. Methods: This study was performed in Hacettepe University Neonatal Intensive Care Unit From December 2015 to February 2017. Forty patients who were diagnosed as RDS and given surfactant [200 mg/kg poractant alfa (CUROSURF®, Chiesi, Italy) intratracheal Suspension] were included in the study. Lung ultrasonography was performed at the bedside by a single expert, once before surfactant treatment and three times after surfactant treatment. Post-treatment ultrasonographic examinations were carried out at 2, 4 and 6 h after surfactant treatment. Results: Before surfactant treatment, lung USG findings of patients were as follows: lung consolidation with air bronchograms (40/40), B-pattern (36/40), pleural line abnormalities (37/40), severe B-pattern (12/40) and disappearance of A-lines in all USG of patients. In the second hour of treatment, we did not see any valuable change or difference in lung USG findings of patients. The only change was the disappearance of air bronchograms and lung consolidation in five patients. Four hours after treatment we saw a reduction in lung consolidation in 14 patients, B-pattern had decreased in 15 patients, the appearance of A-lines and spared areas. But after 6 h, we started to see A-lines clearly, loss of B-pattern, an appearance of pleural line, and lung sliding in nearly all patients except three. Conclusion: Ultrasound is nonionizing and gives no hazard to the patient. Also, making it bedside is feasible and comfortable than other methods. Responsive and unresponsive patients to surfactant treatment can be determined in the early course of the disease and the cases needing re-treatment can be diagnosed easily by performing lung USG. This review focuses on ultrasonographic changes of the lung after surfactant treatment in premature newborns

33. Management of Gonadal Cysts in Patients Without Gonadectomy in Complete Androgen Insensitivity Syndrome

Complete Androgen Insensitivity Syndrome (CAIS), is an X-linked genetic disease, where female-appearing 46XY patients have testes located in the internal inguinal ring or in the labia majora. In the past, prophylactic gonadectomy has been performed, given risks of germ cell tumor development. However, gonadal surveillance algorithms have been proposed as an alternative, due to challenges with replacement therapy (HRT) and ethical concerns. In this case study, we review ultrasonographic changes in gonads of 3 patients with CAIS, and pathology results with one patient who elected for laparoscopic cystectomy as part of her surveillance.

Association of Physical Activity and Medication with Enthesitis on Ultrasound in Psoriatic Arthritis

Enthesitis is a manifestation of psoriatic arthritis (PsA), but its symptoms are difficult to interpret clinically. We investigated the associations of ultrasonographic changes in entheses with clinical characteristics in patients with PsA, and compared enthesis changes of patients aged 35 to 60 years with healthy volunteers of that age. Consecutive patients with PsA participated in this cross-sectional study, irrespective of enthesitis complaints and age. We collected data about complaints, physical activity and activity avoidance, medication, and clinical enthesitis. Inflammatory and structural enthesis changes were scored with the modified MAdrid Sonographic Enthesitis Index (MASEI). Among all patients, associations between ultrasound (US) scores and clinical characteristics were investigated using linear regression. We compared US scores of healthy volunteers and patients with PsA aged 35-60 years using Wilcoxon rank-sum tests. Eighty-four patients with PsA and 25 healthy volunteers participated. In patients with PsA, we found a small association between higher inflammatory-modified MASEI score and older age (β 0.07, 95% CI 0-0.13) and current use of biologics (β 1.56, 95% CI 0.16-2.95). Patients who reported avoiding activities had significantly lower inflammatory-modified MASEI scores (β -1.71, 95% CI -3.1 to -0.32) than those who did not. The patients with PsA aged 35-60 years (n = 50) had similar inflammatory scores as healthy volunteers but higher structural scores (median 6 vs 2; p = 0.01). Within patients with PsA, avoiding physical activity, younger age, and not using biologics were associated with less enthesis inflammation. Patients with PsA and healthy volunteers aged 35 to 60 years displayed similar levels of inflammatory changes of the entheses, but patients had more structural damage.