Ultrasound Findings In Patients Research Articles

The impact of metabolic syndrome severity on racial and ethnic disparities in Metabolic Dysfunction-Associated Steatotic Liver Disease.

Previous studies have examined the effects of metabolic syndrome (MetS) rather than its severity on race and ethnic disparities in Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD). We used the MetS severity score, a validated sex-race-ethnicity-specific severity measure, to examine the effects of race/ethnicity on the association between MetS severity and MASLD. This study included 10,605 adult participants from the Third National Health and Nutrition Examination Survey. The MASLD diagnosis was based on ultrasound findings in patients without excessive alcohol intake or other liver diseases. MetS severity Z-scores were calculated and stratified into four categories low (1st-50th), moderate (>50th-75th), high (>75th-90th), and very high (>90th+)]. Multivariable adjusted logistic regression models with complex survey methods were used to test the effect of MetS severity on MASLD. The age-adjusted MASLD prevalence was 17.4%, 25.7%, 42.5, and 54.9% in adults with mild, moderate, high, and very high MetS severities, respectively (P-trend <0.001). MetS severity was significantly higher in patients with MASLD than in those without [mean percentile 60th vs. 44th, P<0.001]. Among patients with MASLD, Mexican-American and Black non-Hispanic females had significantly higher age-adjusted MetS severity (68th and 61st, respectively) than White non-Hispanic females 54th, while Black non-Hispanic males had significantly lower MetS severity (56th) than White non-Hispanic males (70th) (P-Interaction = 0.02). Adults with high and very high MetS severity had 2.27 (95% CI:1.70 to 3.03) and 3.12 (95% CI:2.20 to 4.42), respectively, higher adjusted odds of MASLD than those with mild MetS severity. Racial/ethnic disparities in MetS severity play a pivotal role in the risk of MASLD. Our findings highlight the potential clinical utility of the MetS severity score in identifying at-risk individuals, which will help guide targeted prevention and tailoring management strategies to mitigate the MASLD burden.

Point of care lung ultrasonographic findings in patients with clinical diagnosis of severe childhood community acquired pneumonia in the tropics

Objectives: This study aimed at defining the Lung ultrasonographic (LUS) features of severe Childhood community-acquired pneumonia (CAP) in under-5s with clinical pneumonia, as well as the correlation between clinical and ultrasonographic findings. Materials and Methods: A prospective descriptive study conducted at the Children Emergency Ward of the University College Hospital (UCH), Ibadan, Nigeria over a 1-year period. Children aged 1month to 59 months, with clinical features of severe pneumonia were recruited for the study. LUS was done at the bedside. Ethical approval was obtained for the study. Results: There were 86 children with mean age ± SD of 13.59 ± 15.55 and 50 (58.1%) males. The highest number of patients (56, 65.1%) were in the 1-12-month age group. Ultrasonographic signs of pneumonia were detected in 68 (79.1%) of the children; 55(64%) had consolidation, 29(23.3%) showed florid B-lines and 20 (23.3%) had pleural fluid. Duration of cough, and crackles on auscultation were the only features that showed significant association with the LUS diagnosis of pneumonia. Conclusion: LUS is a good point of care diagnosis of CAP in under-5 children and it can be safely done at the bedside. It is therefore recommended as a first line imaging modality in children with clinical suspicion of CAP in the Tropics.

Anti-centromere antibody positivity is an independent variable associated with salivary gland ultrasonography score in Sjögren’s syndrome

Sjögren’s syndrome (SS) is an autoimmune disease characterized by periductal lymphocytic infiltration of the salivary and lacrimal glands. SS also exhibits extra-glandular manifestations and specific autoantibodies. Salivary gland ultrasonography (SGUS) is a common procedure used to assess the severity of glandular involvement. However, the association between SGUS and extra-glandular lesions remains poorly understood. This study aimed to identify clinical indices, including disease activity, associated with glandular involvement using SGUS in patients with SS. We included 115 patients with SS and 90 without SS. Patients with SS had significantly higher ultrasonography (US) score than patients without SS. Multivariate analysis revealed focus score, Saxon test positivity, and anti-centromere antibody (ACA) positivity as independent variables associated with the US score in patients with SS. In addition, these results were similar to those obtained in patients with primary SS. Patients with SS and ACA positivity had higher US score and an increased prevalence of hyperechoic bands in the parotid glands and submandibular glands. In conclusion, this study indicated that ACA positivity is associated with the US score in patients with SS. These results suggest that US findings in patients with ACA positivity might show specific changes in the salivary glands, especially fibrosis.

DEFOCUSED AND RADIAL SHOCK WAVE THERAPY, MESOTHERAPY, AND KINESIO TAPING EFFECTS IN PATIENTS WITH LIPEDEMA: A PILOT STUDY

The aim of this pilot study was to investigate the effects of defocused and radial shock wave therapy, mesotherapy, and kinesio taping on pain, circumferences of lower limbs, echographic/ elastosonographic pattern of subcutaneous adipose tissue (SAT), and quality of life in patients with lipedema. Fifteen women affected by lower limb lipedema in stage II were treated with shock wave therapy, mesotherapy, and kinesio taping on thighs and legs (eight sessions, twice a week). The primary outcome was pain, as assessed by Numeric Rating Scale (NRS). Secondary outcomes included the limb circumferences measurements, the SF-12 Health Survey for quality of life, the International Classification of Functioning (ICF) for disability, and echographic/ elastosonographic changes of SAT. Significant reductions of pain and circumference measurements were seen in patients at each follow up. This was associated with significant reduction of thickness, echographic pattern improvement, and increased elasticity of SAT, with consequent positive impact on the quality of life and disability reported by the patients. The results demonstrate improved clinical and functional ultrasound findings in patients affected by lipedema in the early stages of lower limbs, and this combination therapy needs to be investigated in larger

Predictive factors of lymph node metastasis in papillary thyroid cancer.

This study aimed to evaluate factors that predict lymph node metastasis (LNM) in papillary thyroid cancer (PTC). This retrospective cross-sectional study compared the demographic, clinical, and ultrasonographic findings of patients with PTC with and without LNM. Subgroup analysis was conducted for micro-PTCs (<1 cm). Among total (n = 512; mean age, 47.3 ± 12.7 years) and micro-PTC patients (n = 312), 35.7% and 19.6% had LNM, respectively. Younger age, male sex, tumor size, bilaterality, and suspicious ultrasound features of the tumor were associated with LNM. In multiple logistic regression analysis, among all patients, age, tumor size, and extrathyroidal extension were independent risk factors for LNM (all p<0.05). In the micro-PTC subgroup, age, extrathyroidal extension, bilaterality of tumor, and presence of autoimmune thyroid disease were independent risk and protective factors for LNM (all p<0.05). In the receiver operating characteristic analysis, the accuracy of the multivariable logistic regression model for predicting LNM among all patients and micro-PTC was acceptable (area under the curve = 0.729 and 0.733, respectively). Age, sex, tumor size, and extrathyroidal extension can assist in predicting LNM in PTC patients. Additionally, the bilaterality of tumors and presence of autoimmune thyroid disease can assist in predicting LNM in micro-PTCs.

Volume Status Assessed by Physical Examination Correlates with Lung Ultrasound Findings in Patients with CKD

Volume Status Assessed by Physical Examination Correlates with Lung Ultrasound Findings in Patients with CKD

Spectrum of ultrasound findings in patients with history of breast conservative treatment.

Breast conservative treatment (BCT) is currently accepted as the standard treatment option for breast cancer. Targeted ultrasound helps detect recurrent lesions, postoperative changes, and scarring tissue. In this pictorial essay, we review the ultrasound features of benign (seroma, hematoma, fat necrosis, traumatic neuroma, fibrosis/scarring) and malignant (recurrence, new primary cancer) causes of palpable lumps after BCT and provide images from our patients to illustrate some typical findings of common pathologies. Ultrasound, especially as an adjunct to mammography, can make a specific diagnosis in most cases.

Adnexal torsion: a single-center retrospective study of diagnosis and treatment

Aims: This study was conducted to review the clinical, laboratory, and ultrasound findings of patients with a confirmed post-operative adnexal torsion diagnosis in a tertiary university hospital and to reflect the management of adnexal torsion.&#x0D; Methods: 44 patients (ages [15,44] with a median of 30 yr) who had an operation at Ankara University Hospital Gynecology and Obstetrics Clinics between October 2013 and February 2021 and in whom the preoperative diagnosis of adnexal torsion was confirmed intraoperatively were included in this retrospective study. Patients’ complaints, existing risk factors, physical examination, laboratory, and radiological findings were evaluated.&#x0D; Results: 26 (65%) of the patients complained about acute abdominal pain isolated on one side. Torsion was observed on the right side in 29 (66%) patients. Risk factors: History of ovarian torsion in 1 patient (2%), in vitro fertilization treatment in 5 (11%) patients, 4 (9%) of which also had ovarian hyperstimulation syndrome and 2 (5%) of them had polycystic ovary syndrome, and finally, 28 (65%) patients had increased ovarian size on ultrasound. Ovarian blood flow was not observed in 25 (81%) of 31 patients who underwent transvaginal Doppler ultrasound. Preoperative blood examination showed anemia (Hb10000/mm³) in 26 (59%), and an increase of neutrophil-lymphocyte ratio (NLR) (&gt;3) in 36 (82%). Laparoscopy was performed in 37 (84%) patients and laparotomy in 7 (16%).&#x0D; Conclusion: There is no objective diagnostic tool that can definitively lead to the diagnosis of adnexal torsion. It may be recommended to use ultrasound, Doppler, and NLR in addition to clinical findings and anamnesis. Considering the consequences of delay in the treatment, the most appropriate approach would be to perform a laparoscopy if torsion is suspected. Additionally, the patient’s age, menopausal status, ovarian pathology, and desire for fertility are factors that should be considered in the treatment decision, and ovarian protection should be the primary goal.

Frequency of Breast Ultrasound Findings in patients presenting with Mastalgia

Aim: To determine the frequency of different Mastalgia findings on breast ultrasound. Methodology: This was a prospective, cross-sectional study, conducted at Radiology department of Shalamar Hospital, Lahore from 1st September 2021 to 29 February 2022. This study includes all patients having breast pain with at least one month of duration presenting to OPD or breast clinic of Shalamar Hospital. All patients were referred breast ultrasound after taking history and examination. The results of their breast ultrasound were recorded on Performa. Results: A total of 95 female patients of age above 18 years were included. Mean age of patients, was 35.4 ±10.7years. Mean duration of breast pain was 4.27±3.9 months. The ultrasound findings which showed benign pathologies include, Benign lesion 10(10.5%), Fibroadenoma 13(13.7 %), Simple cyst 8(8.4%), and Duct ectasia 7(7.4%). Abscess in the breast also diagnosed in 5(5.3%) patient. 52 (54.7%) females had normal breast ultrasound from which 37(71.2%) were with cyclic pain and 15(28.8%) were with non cyclic pain. Conclusion: Females presenting with complaint of breast pain have different ultrasound findings. In the majority of patient, there was no abnormality found (normal ultrasound). Ultrasound helps to determine the cause of breast pain so that in case of any disease, specific treatment or further investigation advised and normal report provides reassurance to the patients by reducing fear and anxiety. Key words: Breast ultrasound, Mastalgia, breast pain

Association Between Age, Gender, HbA1c Level, Fasting Plasma Glucose Level, and the Ultrasonographic Findings in Patients With Shoulder Tendinosis

Association Between Age, Gender, HbA1c Level, Fasting Plasma Glucose Level, and the Ultrasonographic Findings in Patients With Shoulder Tendinosis

Determination of Liver Function Tests and Liver Ultrasonographic Findings in Patients with Leptospirosis in a Tertiary Hospital

Introduction. Leptospirosis is an important zoonotic disease commonly found in tropical or sub-tropical countries. The most severe form is Weil's syndrome which presents with jaundice, renal failure, and bleeding diatheses. Although jaundice occurs in 38% of patients with leptospirosis, no studies in Asia have focused on the liver biochemical profile of these patients. Characterization of liver biochemical profile and ultrasonographic findings may shed more light on the disease process. Identification of liver biochemical parameters that portend a poor prognosis may also allow for early aggressive intervention.Objective. To describe the liver biochemical profile and liver ultrasonographic findings in adult patients with laboratoryconfirmed leptospirosis, admitted at a tertiary hospital in Manila, Philippines. The association of clinical and laboratory features with clinical outcomes (i.e., severe liver injury, Weil’s syndrome, and mortality) was also investigated.Methods. This retrospective cross-sectional study reviewed all available cases of adult patients with laboratoryconfirmed leptospirosis admitted in the Philippine General Hospital from January 2009 to August 2018. The clinical features, liver biochemical profiles, and ultrasound findings were recorded and analyzed. Comparison between the means of each group based on clinical outcome (i.e., mortality, Weil’s syndrome) was done via Students’ t-test for continuous variables, and calculation of the Odds Ratio for categorical variables.Results. Total and direct bilirubin levels were elevated in patients with leptospirosis compared to serum aminotransferases and alkaline phosphatase levels which were only mildly elevated. Abdominal ultrasound showed typically un-enlarged livers with normal parenchymal echogenicity, normal spleens, and non-dilated biliary trees. Dyspnea was associated with an increased odds for mortality. Although jaundice was present in 39.5% of patients and significantly associated with severe liver injury, this was not associated with mortality. Liver biochemical test values did not differ among patients who expired and those who survived to discharge. The presence of myalgia and abdominal pain increased the odds for Weil's syndrome.Conclusion. To date, no local studies have fully described the liver biochemical profile of patients with leptospirosis. Our findings are compatible with previous studies showing that leptospirosis typically presents with predominantly elevated direct bilirubin from cholestasis and systemic infection. Contrary to previous literature, however, our study found no association between jaundice and mortality. &nbsp

Reliability of Ultrasound Findings in Patients with Lumbar Multifidus Myofascial Pain Syndrome.

Lumbar multifidus muscle provides stability to the spine. The present study aimed to evaluate the reliability of ultrasound findings in patients with lumbar multifidus myofascial pain syndrome (MPS). A total of 24 cases (7 females, 17 males, mean age: 40.13± 5.69, BMI: 26.48±4.96) with multifidus MPS were assessed. The variables were muscle thickness in rest and contraction, thickness changes, and cross-sectional area (CSA) in rest and contraction. Two examiners performed the test and retest sessions. The active trigger points of lumbar multifidus on the right and left side of the cases were 45.8 % and 54.2%, respectively. The intraclass correlation coefficient (ICC) values for muscle thickness and thickness changes showed moderate to very high reliability for both within and between intra-examiner measurements. (ICC, 1st examiner: 0.78-0.96; ICC, 2nd examiner: 0.86-0.95). In addition, the ICC values of within and between-session intra-examiner for CSA were high. (ICC, 1st examiner: 0.83-0.88; ICC, 2nd examiner: 0.84-0.89). The ICC and standard error of measurement (SEM) of inter-examiner reliability ranged between 0.75 to 0.93 and 0.19 to 0.88 for multifidus muscle thickness and thickness changes. The ICC and SEM of inter-examiner reliability ranged between 0.78 to 0.88 and 0.33 to 0.90 for CSA of the multifidus muscle. The within and between-session reliability of multifidus thickness, thickness changes, and CSA was moderate to very high in patients with lumbar MPS when taken by two examiners. Furthermore, the inter-examiner reliability of these sonographic findings was high.

GALLBLADDER POLYPS: CORRELATION AND AGREEMENT BETWEEN ULTRASONOGRAPHIC AND HISTOPATHOLOGICAL FINDINGS IN A POPULATION WITH HIGH INCIDENCE OF GALLBLADDER CANCER.

Gallbladder polyps are becoming a common finding in ultrasound. The management has to consider the potential risk of malignant lesions. The aim of this study was to analyze the ultrasound findings in patients undergoing cholecystectomy due to gallbladder polyps and compare them for histopathological findings (HPs). Patients with an ultrasonographic diagnosis of gallbladder polyp and who underwent cholecystectomy from 2007 to 2020 were included in the study. A total of 447 patients were included, of whom 58% were women. The mean age was 45±12 years. The mean size of polyps in US was 7.9±3.6 mm. Notably, 9% of polyps were greater than 10 mm, and single polyps were significantly larger than the multiple ones (p=0.003). Histopathological findings confirmed the presence of polyps in 88.4%, with a mean size of 4.8±3.4 mm. In all, 16 cases were neoplastic polyps (4.1%), 4 of them being malignancies, and all were single and larger than 10 mm. We found a significant correlation between ultrasound and histopathological findings polyp size determination (r=0.44; p<0.001). The Bland-Altman analysis obtained an overestimation of the US size of 3.26 mm. The receiver operating characteristic (ROC) curve analysis between both measures obtained an area under the receiver operating characteristic curve (AUC) of 0.77 (95%CI 0.74-0.81). Ultrasound polyps size larger than 10 mm had an odds ratio (OR) of 8.147 (95%CI 2.56-23.40) for the presence of adenoma and malignancy, with a likelihood ratio of 2.78. There is a positive correlation and appropriate diagnostic accuracy between ultrasound size of gallbladder polyps compared to histopathological records, with a trend to overestimate the size by about 3 mm. Neoplastic polyps are uncommon, and it correlates with size. Polyps larger than 10 mm were associated with adenoma and malignancy.

Clinical, Electrophysiological, and Sonographic Findings in Patients With Nerve Injury After Vessel Puncture.

This study aimed to describe the clinical, electrophysiological, and ultrasonographic findings of patients with nerve injury after vessel puncture. Data on ten patients (three males and seven females) with nerve injury after vessel puncture were reviewed. Demographic and clinical data were analyzed retrospectively. Bilateral electrophysiological studies were performed based on clinical findings. Ultrasonographic examinations were performed on both the affected and unaffected sides of the injured nerve. The nerves of nine patients were injured following vein puncture, and injury occurred following arterial sampling in one patient. Seven patients had superficial radial sensory nerve injury: five medial, one lateral, and one at both branches. One patient had injury to the dorsal ulnar cutaneous nerve, one to the lateral antebrachial cutaneous nerve, and one to the median nerve. Nerve conduction studies produced abnormal findings in 80% of patients, whereas ultrasonographic examinations produced abnormal findings in all of the patients. Spearman's coefficient for the correlation between the amplitude ratio and nerve cross-sectional area ratio was not significant, at -0.127 (95% confidence interval=-0.701 to 0.546, p=0.721). Ultrasonography supported by electrodiagnosis was found to be a useful method for identifying the lesion location and structural abnormalities of vessel-puncture-related neuropathy.

Ultrasonographic findings in patients with chronic kidney disease with asymptomatic hyperuricemia

BackgroundMusculoskeletal ultrasound is a useful, noninvasive tool to detect anatomical damage in the hyaline cartilage, synovial tissue, and tendons of individuals with asymptomatic hyperuricemia. This study aimed to determine the frequency of musculoskeletal ultrasonographic findings related to hyperuricemia among CKD patients and its relation to chronic musculoskeletal pain and their quality of life.ResultsDouble contour (DC) was found in12%,18%, and 22% of the knee, ankle, and 1st MTPs joints, respectively. Hyper-echoic cloud was present in 2% and 6% of the knee and 1st MTPs, respectively. Synovitis was seen in 8%, 4%, and 16% of the knee, ankle, and 1st MTPs joints, respectively. Patellar tendon showed enthesopathy in 14% and tophus in 8% of cases. Tibialis posterior tenosynovitis was in 2% and peroneii tenosynovitis in 2%. Achilles tendon showed calcific foci in 24%, enthesopathy in 20%, and tophi in 4%. First MTPs showed erosion in 10% and tophi in 4%. There were statistically significant relations of pain index to DC, synovial thickening at the knee and at ankle joint. There were statistically significant relations of serum uric acid level to DC.There were statistically significant correlations of serum uric acid level to the 36-Item Short Form Survey (SF-36).ConclusionsUntreated hyperuricemia might cause musculoskeletal ultrasonographic changes that could cause chronic musculoskeletal pain and decrease quality of life in chronic kidney disease patients.

ULTRASOUND AS AN AID TO DIAGNOSIS IN DENGUE

Objective: To determine the ultrasound findings in patients with dengue fever and to evaluate their relationship with laboratory parameters. Study Design and Setting: This prospective cross-sectional study was conducted at –removed for blind review---from September 2020 to August 2021. Methodology: Total of 248 patients diagnosed with dengue fever, fulfilling the exclusion and inclusion criteria, were included in the study. Demographic data was recorded on a structured proforma. Serological confirmation along with complete blood counts and liver function tests were obtained. Abdominal and chest ultrasounds were conducted in all patients. The ultrasonographic features of these patients were analyzed with laboratory investigations through SPSS version 23. Student’s t-test and Chi-square tests were used assessingess the association between the ultrasonographic findings and laboratory features. A P-value of &lt;0.05 was considered significant. Results: The most common ultrasonographic feature among dengue patients was acalculous cholecystitis (49.6%) followed by hepatomegaly (47.2%), splenomegaly (46.8%), altered echotexture of the liver (46.4%), ascites (37.5%) and pleural effusion (7.3%). Acalculous cholecystitis and ascites were significantly associated with severe thrombocytopenia and increasing hematocrit. Acalculous cholecystitis, ascites, pleural effusion and altered echotexture of the liver were associated with raised transaminases. A low platelet count showed the strongest relationship with sonographic features of capillary leak syndrome. Conclusion: Ultrasound is a useful investigation to diagnose severe, critical dengue. The development of ultrasonographic features should prompt proactive management of these patients in order to prevent emergence of severe complicated dengue.

Multiorgan ultrasonographic findings in patients with pulmonary embolism at diagnosis and clinical follow-up: a proof of concept study.

The purpose of this descriptive feasibility study was to assess the clinical impact and feasibility of conducting a multiorgan ultrasound examination of patients with pulmonary embolism at both time of diagnosis and at clinical follow-up. Hemodynamically stable patients with pulmonary embolism verified by CT pulmonary angiography or ventilation perfusion scintigraphy were eligible for inclusion. Enrolled patients underwent multiorgan ultrasound investigation encompassing echocardiography supplemented with focused lung and deep venous ultrasound emphasizing right ventricular strain, subpleural consolidations and presence of deep venous thrombi. Identical investigations were conducted at 3months follow-up. The presence of ultrasonographic findings at diagnosis and follow-up was compared and the clinical impact of any remaining pathology or strain was described. Twenty-one patients were enrolled in the study of whom 20 survived to attend follow-up. Mean age was 62 ± 15years and 48% were female. At diagnosis, the most prevalent ultrasonographic findings were subpleural consolidations in 11 patients and right ventricular dilation in eight. At follow-up, signs of right ventricular strain had resolved in all patients. However, in one patient, no resolution was seen in a subpleural consolidation observed at the time of pulmonary embolism diagnosis, resulting in referral to a chest CT. Additionally, one patient exhibited residual deep venous thrombotic material, leading to prolongation of anticoagulative treatment. In patients with pulmonary embolism, multiorgan ultrasound is feasible in follow-up and adequately powered studies should determine the clinical utility of such an approach.

Ultrasound Findings in Patients with Normal Nerve Conduction despite Clinical Signs and Symptoms Consistent with Carpal Tunnel Syndrome.

Confirmatory methods such as nerve conduction studies are often performed to support a clinical carpal tunnel syndrome diagnosis and to rule out other upper extremity pathologies. Ultrasonography provides another diagnostic option, especially when nerve conduction studies are discordant with history and physical examination. The authors explored the correlation of ultrasound findings with clinical carpal tunnel syndrome diagnosis in patients with normal nerve conduction study results. A database of 220 patients with carpal tunnel syndrome was analyzed retrospectively to reveal 24 patients (28 hands) with a clinical diagnosis and normal nerve conduction study results. Patient demographics and nerve conduction study and ultrasound findings were compared with those of a control group of patients without carpal tunnel syndrome (42 patients, 52 hands). Median nerve cross-sectional area was recorded; values of 10 mm 2 or greater were considered positive for carpal tunnel. Statistical and correlation analyses were performed between control and carpal tunnel groups comparing key measures of interest. Mean cross-sectional area was significantly increased in patients with carpal tunnel syndrome with normal nerve conduction study results compared with controls. The proportion of carpal tunnel-positive, nerve conduction study-negative patients with cross-sectional area measurements greater than 10 mm 2 was significantly greater than the proportion for control patients. Neither age nor body mass index correlated with cross-sectional area measurements. Nerve conduction study latencies and amplitudes did not correlate with ultrasound abnormalities. Patients diagnosed clinically with carpal tunnel syndrome with normal nerve conduction study results were found to have clinically significant median nerve cross-sectional area on ultrasound (10.1 ±2.1 mm 2 , p < 0.001). Cross-sectional area measurements on ultrasound did not correlate with nerve conduction study measures. These results suggest that ultrasound holds a unique diagnostic utility in the evaluation of carpal tunnel syndrome, especially when nerve conduction studies are negative. Diagnostic, II.

Time course of lung ultrasound findings in patients with COVID-19 pneumonia and cardiac dysfunction

BackgroundLung ultrasound (LUS) is a valuable tool to predict and monitor the COVID-19 pneumonia course. However, the influence of cardiac dysfunction (CD) on LUS findings remains to be studied. Our objective was to determine the effect of CD on LUS in hospitalized patients with COVID-19 pneumonia.Material and methodsFifty-one patients with COVID-19 pneumonia participated in the study. Focused echocardiography (FoCUS) was carried out on day 1 to separate patients into two groups depending on whether they had FoCUS signs of CD (CD+ vs CD−). LUS scores, based on the thickness of the pleural line, the B-line characteristics, and the presence or not of consolidations, were obtained three times along the patient’s admission (D1, D5, D10) and compared between CD+ and CD− patients. A correlation analysis was carried out between LUS scores and the ratio of the arterial partial pressure of oxygen to the fraction of the inspired oxygen (P/F ratio).ResultsTwenty-two patients were CD+ and 29 patients were CD−. Among the CD+ patients, 19 were admitted to the intensive care unit (ICU), seven received invasive mechanical ventilation (IMV), and one did not survive. Among the CD− patients, 11 were admitted to the ICU, one received IMV and seven did not survive. CD+ patients showed a significantly lower P/F ratio than CD− patients. However, LUS scores showed no between-group differences, except for fewer subpleural consolidations in the upper quadrants of CD+ than on CD− patients.ConclusionIn patients with COVID-19, CD contributed to a worse clinical course, but it did not induce significant changes in LUS. Our findings suggest that pathophysiological factors other than those reflected by LUS may be responsible for the differences in clinical condition between CD+ and CD− patients.

Ultrasonographic findings in patients with abdominal symptoms or trauma presenting to an emergency room in rural Tanzania.

Frequencies of ultrasonographic findings and diagnoses in emergency departments in sub-Saharan Africa are unknown. This study aimed to describe the frequencies of different sonographic findings and diagnoses found in patients with abdominal symptoms or trauma presenting to a rural referral hospital in Tanzania. In this prospective observational study, we consecutively enrolled patients with abdominal symptoms or trauma triaged to the emergency room of the Saint Francis Referral Hospital, Ifakara. Patients with abdominal symptoms received an abdominal ultrasound. Patients with an abdominal or thoracic trauma received an Extended Focused Assessment with Ultrasound in Trauma (eFAST). From July 1st 2020 to June 30th 2021, a total of 88838 patients attended the emergency department, of which 7590 patients were triaged as 'very urgent' and were seen at the emergency room. A total of 1130 patients with abdominal symptoms received an ultrasound. The most frequent findings were abnormalities of the uterus or adnexa in 409/754 females (54.2%) and abdominal free fluid in 368 (32.6%) patients; no abnormality was found in 150 (13.5%) patients. A tumour in the abdomen or pelvis was found in 183 (16.2%) patients, an intrauterine pregnancy in 129/754 (17.1%) females, complete or incomplete abortion in 96 (12.7%), and a ruptured ectopic pregnancy in 32 (4.2%) females. In males, most common diagnosis was intestinal obstruction in 54/376 (14.4%), and splenomegaly in 42 (11.2%). Of 1556 trauma patients, 283 (18.1%) received an eFAST, and 53 (18.7%) had positive findings. A total of 27 (9.4%) trauma patients and 51 (4.5%) non-trauma patients were sent directly to the operating theatre. In this study, ultrasound examination revealed abnormal findings for the majority of patients with non-traumatic abdominal symptoms. Building up capacity to provide diagnostic ultrasound is a promising strategy to improve emergency services, especially in a setting where diagnostic modalities are limited.