Ultrasound-guided Cyst Aspiration Research Articles

SAT486 A Case of Superior Vena Cava Syndrome Caused by Untreated Multinodular Goiter

Abstract Disclosure: K. Blanchard: None. C. Musurakis: None. A. Ojha: None. C.P. Barsano: None. A. Havrylyan: None. A 92-year-old female with heart failure, COPD, obstructive sleep apnea, longstanding exertional dyspnea, and a 15-year history of a toxic multinodular thyroid on methimazole presented to our emergency department with one week of right arm swelling. Physical exam showed a 4 cm midline goiter with right-sided jugular venous distention and right upper extremity pitting edema. On admission, TSH, free T4 and free T3 levels were within normal limits on methimazole 5 mg daily. PTT, PT and INR were normal. Thyroglobulin antibodies and TSI measured two years prior were normal. Right arm venous duplex was negative for acute deep venous thrombosis (DVT) but showed heterogenous structures in the right neck with collateral vessels, likely related to a large multinodular thyroid gland with substernal extension. Left arm venous duplex showed chronic sequela of DVT in the left central subclavian vein. Chest x-ray revealed right-sided tracheal deviation due to goiter. A CT chest performed 6 months prior revealed a massive multinodular goiter with mass effect on the trachea, narrowing the tracheal opening to only 7 mm (ref 10-21 mm in females) and significant mass effect upon adjacent venous structures with resultant collateralized flow. Of note, the patient has a 15-year documented history of this goiter and repeatedly declined aggressive surgical intervention. We recommended ENT consultation for minimally invasive treatment options. ENT recommended thoracic surgery evaluation at a tertiary center and suggested tracheal stenting as a possible solution. Regarding the chronic left subclavian vein thrombosis, the patient opted to forego anticoagulation therapy after discussion of risk versus benefit. She again declined surgical evaluation and was discharged home with primary care and Endocrinology outpatient follow-up. Superior vena cava (SVC) syndrome is the result of either a partial or complete obstruction of the SVC, resulting in symptoms such as upper extremity swelling, dyspnea, cough, face or neck swelling, and dilated venous collaterals in the chest. Compression of the SVC by a mediastinal malignancy is the most common cause of SVC syndrome. However, retrosternal goiter as a cause is extremely rare, with only a few cases previously reported in the literature. Interestingly, the incidence of malignancy in retrosternal goiters is reported to be as high as 35 percent. Large intrathoracic goiters are primarily seen in long periods of neglected disease, as in our patient. The presence of a substernal goiter, regardless of symptoms, is an indication for thyroidectomy, as this is the only way to prevent mediastinal enlargement of the goiter. Non-surgical treatment options documented in the literature include temporary tracheal stent placement followed by radiofrequency thyroid ablation and ultrasound-guided needle aspiration of a dominant thyroid cyst. Presentation Date: Saturday, June 17, 2023

POS-034 MICROBIOLOGICAL PROFILE OF CYST INFECTION IN AUTOSOMAL DOMINANT POLYCYSTIC KIDNEY DISEASE IN NORTH INDIA

Autosomal dominant polycystic kidney disease (ADPKD) is most common inherited kidney disorder. Cyst infection is common in ADPKD and could be fatal in some cases. There is limited evidence on management of these case and most cases are treated with empirical antibiotics. We conducted this study to identify the causative microorganisms and determine antibiotic susceptibility to these organisms in our region. This study was conducted between May 2015 to January 2022 at a tertiary care center in Rajasthan. Suwabe criteria was applied to diagnose cyst infection. Abdominal computed tomography (CT) was done in all ADPKD patients with clinical and laboratory features suggestive of cyst infection. Non contrast CT was performed in cases with renal dysfunction. Ultrasound guided percutaneous needle aspiration of infected renal cyst was performed in cases with persistent fever for more than 1 week despite empirical antibiotic therapy. Cyst aspirate was subjected to culture and sensitivity to conventional lipid soluble antibiotics (Fluoroquinolones/ trimethoprim-sulfamethoxazole) using BD BACTEC™ automated blood culture systems (Figure 1). Twenty-seven patients with features suggestive of cyst infection on CT abdomen were subjected to ultrasound guided cyst aspiration. Clinical characteristics of the patients has been depicted in Figure 2. Simultaneous pyuria was present in five (18.5%) cases while urine culture was positive only in two (7.4%) cases. Cyst aspirate culture was positive in eighteen (66.7%) cases. Microbiological profile has been depicted in Figure 3. Escherichia coli was the most common isolated organism. There was low sensitivity to conventional lipid soluble antibiotics with 38.9% (7/18) patients sensitive to fluoroquinolones (Ciprofloxacin/ Levofloxacin) and 50% (9/18) patients sensitive to trimethoprim-sulfamethoxazole. Gram negative bacteria are the most common cause of cyst infection in ADPKD patients. There is high resistance to conventional lipid soluble antibiotics in our region and we should reconsider their empirical use in these patients. We also want to reiterate that cyst aspiration should be considered early as diagnostic modality to find out the causative organisms and their drug sensitivity.

Does Ovarian Reserve Change after Endometrioma Management? Comparison of Two Treatment Regimens

Background: The endometriosis-mediated damage to ovarian re- serve beyond the stretching of ovarian cortex that can lead to loss of primordial follicles is supported by many studies.Laparoscopy represents the first-line treatment in sub fertile women with endo- metriotic ovarian cysts. The primary benefit of surgical treatment of endometriosis is the relief o f pelvic pain. The effect of laparoscopic cystectomy of an endometrioma on the antral follicle count has been conflicting. Objective: is to estimate effects of laparoscopic ovarian cystectomy on ovarian reserve and ICSI outcome. Methodology: 100 patients with unilateral ovarian endometrioma (size from 2.5-5 cm) were selected for ICSI, divided into two equal groups, group1 (underwent laparoscopic cystectomy) and group2 (underwent ultrasound guided cyst aspiration). Both groups were compared regarding ICSI outcome (number of oocytes, number of embryos transferred, pregnancy rate) as well as change in AMH as a marker of ovarian reserve 6 months after the procedures. Outcome measures: the outcomes were the ovarian reserve changes after the two procedures as well as the Intracytoplasmic Sperm Injection out- comes. Results: There is a remarkable reduction in the level of AMH in group1(43% reduction) compared to group2 (5.7%) with no signifi- cance (P=0.393). Conclusion: In view of the hazardous effect of laparoscopic ovarian cystectomy on ovarian reserve, ultrasound guided aspiration may be a good alternative procedure for treatment of endometrioma in view of preserving the ovarian tissues without compromising ICSI outcomes

Takotsubo cardiomyopathy following ultrasound-guided renal cyst aspiration.

Interventional radiology plays a critical role in offering minimally invasive procedures, resulting in increased patient comfort. However, of the millions of patients undergoing interventional procedures each year, many suffer from pre-procedural psychological stressors related to fear of discomfort and diagnostic uncertainty. We describe a case of Takotsubo cardiomyopathy, also called broken heart syndrome or stress cardiomyopathy, following ultrasound-guided renal cyst aspiration in a patient with severe anxiety in anticipation of the interventional radiology procedure.

Knee Pain - Exercise

HISTORY: A 58-year-old male presented with a 4-week history of spontaneous knee pain. One year prior to presentation, he had bariatric surgery and increased his exercise regimen resulting in a 100 lb weight loss. He denies trauma or inciting injury. His pain localized to the posterolateral knee and is described as a 5/10 cramping pain. He describes a popping sensation and experiences a snapping moment in the lateral knee with deep squatting. He denies swelling and ecchymosis. He has tried ice, physical therapy and ibuprofen without relief. PHYSICAL EXAMINATION: Focused left knee exam revealed a palpable cystic structure in the lateral popliteal fossa. There is tenderness over the lateral joint line with no instability of the proximal tibiofibular joint or biceps femoris tendon. Range of motion was 0-140° with pain greater than 120° of flexion. When the knee is brought into deep flexion, there is an audible pop over the lateral aspect of the knee. When the knee is then brought into extension, there is reproduction of an audible pop and snapping moment of the lateral knee at end range extension. Flexion McMurray’s test is positive. Strength, reflexes, sensation, and pulses are normal throughout. DIFFERENTIAL DIAGNOSIS: 1. Snapping biceps femoris tendon 2. Snapping popliteus tendon 3. Lateral meniscus tear 4. Iliotibial band friction syndrome 5. Proximal tibiofibular joint instability TEST AND RESULTS: Three view x-rays of left knee: • Medial joint space narrowing. No acute fracture. Dynamic ultrasound of the left knee: • Normal biceps femoris tendon. Popliteal cyst noted. MRI of left knee without contrast: – Incomplete discoid lateral meniscus and small multiseptated popliteal cyst noted. FINAL WORKING DIAGNOSIS: Left knee discoid lateral meniscus with subluxation of the meniscus TREATMENT AND OUTCOMES: 1. Patient counseled on activity modification. 2. Dynamic ultrasound revealed no evidence of hamstring irregularities. 3. Unsuccessful ultrasound-guided aspiration of popliteal cyst attempted followed by an intra-articular corticosteroid injection. 4. After MRI evaluation, orthopedic surgery performed an arthroscopic partial meniscectomy of subluxing torn posterior horn and midbody saucerization of lateral meniscus. 5. He tolerated surgery well with no further subluxation of his meniscus in physical therapy.

Bakers Cyst Occurrence Following Arthroscopic Medial Meniscal Debridement in a Recreational Athlete: Some Potential Indications for Ultrasound Guided Needle Aspiration

Objectives: Though identification of underlying anatomical causation and surgical management of is the mainstay of treatment, needle aspiration with or without injection of corticosteroid is a common conservative management for enlarged and painful Baker's cysts (BC). This report explores some of the circumstances in which ultra-sound guided BC aspiration may be a first-line option. Methods: A 46 year-old recreational athlete developed marked posterior knee pain and swelling several years after arthroscopic medial meniscal debridement. Needle aspiration of a large & symptomatic BC was performed under ultrasound guidance, and the patient commenced rehabilitation. Results: Posterior knee pain completely abated post procedure. Increased knee joint flexion, and squatting was sustained, without cyst recurrence on 6 month follow-up. Conclusion: Ultrasound-guided aspiration of painful or enlarged Bakers cyst may have sustained benefits after knee arthroscopy in the older athlete, particularly in cases when no further surgery is indicated or planned. Diagnostic ultrasound differentiates BC from other types of masses, provides real-time dynamic visualization of the popliteal neurovascular bundle, guides needle placement, and helps to insure complete BC aspiration, accurate injection, and fenustration. BC aspiration, may also be indicated in cases of operative delay, comorbidities contraindicating surgery, to facilitate rehabilitation, or when the underlying causation of BC is indeterminate. Large cysts causing neurovascular compression may require more emergent aspiration. As this case report illustrates, symptomatic relief and functional improvements may be sustained for several months.

Ultrasound-guided aspiration and steroid injection of a posterior cruciate ligament ganglion cyst: report of a case.

Ganglion cysts are benign masses that originate from mucinous degeneration of the connective tissues and are quite rare when arising from the knee joint. Symptoms are often represented by pain, joint tenderness, effusion and occasional swelling with a palpable mass in the popliteal region of the knee. Percutaneous aspiration followed by a corticosteroid injection of a ganglion cyst has either a diagnostic or therapeutic meaning and its guidance through ultrasound allows the operator to make more accurate the procedure, ensuring the correct placement of the needle inside the lesion. We report our experience in the treatment of a voluminous ganglion cyst of the posterior cruciate ligament performed through the ultrasound guidance in a symptomatic young patient.

Ultrasound-Guided Aspiration of Ovarian Cysts : Our Experience

Results: Out of 45 patients who successfully underwent aspiration, all experienced relief from symptoms immediately after aspiration. At follow up, overall cyst resolution was observed in 39 out of the 45 patients (86.7%) and symptoms persisted in 6 (13.3%). The cyst size was statistically significant factor in the persistence of the cyst (P < 0.05). No evidence of malignancy was reported in the cytologic examination in any of the patients. No major complications were observed in our study. Conclusion: Ultrasound-guided cyst aspiration is a very simple, quick, and safe procedure, which can achieve complete ovarian cyst resolution and is an alternative to surgery.

Ultrasound-Guided Aspiration and Injection of an Intraneural Ganglion Cyst of the Common Peroneal Nerve

Intraneural ganglion cysts are rare, benign, mucinous lesions that occur within neural sheaths and are thought to involve cystic fluid exiting from nearby synovial joints. They often present as tender masses causing paresthesias in the distribution of the involved nerve, muscle weakness or cramping, or localized or referred pain. We present a case of a patient who initially presented with foot drop due to an intraneural ganglion cyst of the common peroneal nerve. This cyst was successfully treated using ultrasound guidance to aspirate the cyst and inject corticosteroid to prevent further inflammation. Standard of care has previously involved surgical resection, but this has been associated with a high frequency of recurrence. Due to the risks of nerve and vessel damage, there have been efforts to find alternative ways of resolving these cysts. Aspiration and injection of corticosteroid is a useful and minimally invasive alternative to surgery for managing intraneural ganglion cysts.

Comparative study on the pregnancy outcomes of in vitro fertilization–embryo transfer between long-acting gonadotropin-releasing hormone agonist combined with transvaginal ultrasound-guided cyst aspiration and long-acting gonadotropin-releasing hormone agonist alone

ObjectiveTo retrospectively analyze the effects of long-acting gonadotropin-releasing hormone agonist (GnRH-a) combined with transvaginal ultrasound-guided cyst aspiration on the pregnancy outcomes of in vitro fertilization–embryo transfer (IVF–ET) in the infertile patients with ovarian endometriosis. MethodsThe 134 patients with ovarian endometriosis who underwent GnRH-a combined with transvaginal ultrasound-guided cyst aspiration and IVF–ET were served as experimental group. The 102 patients with ovarian endometriosis who underwent GnRH-a and IVF–ET were served as control group. After treatment, the cyst size, follicle stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E2), number of ovum pick-up, fertility rate, cleavage rate, high-quality embryo rate, implantation rate, clinical pregnancy rate and abortion rate were compared between the two groups. ResultsIn the 134 patients of experimental group, 138 cysts disappeared after GnRH-a combined with three times of transvaginal ultrasound-guided cyst aspiration. In the 102 patients of control group, of the 114 cysts, 34 disappeared after GnRH-a, 67 were decreased and 13 were unchanged. The abortion rate was significantly lower in experimental group than in control group. The level of serum E2 on HCG day, the number of ovarian follicles with 14mm or more, the number of retrieved oocytes, high-quality embryo rate, implantation rate and clinical pregnancy rate were higher in experimental group than in control group (all P<0.05). ConclusionGnRH-a combined with transvaginal ultrasound-guided cyst aspiration can obtain better therapeutic effects and pregnancy outcomes in infertile patients with ovarian endometriosis who underwent IVF–ET.

Ultrasound-Guided Aspiration of Symptomatic Intraneural Ganglion Cyst Within the Tibial Nerve

Ultrasound Quarterly: March 2012 - Volume 28 - Issue 1 - p 42-43 doi: 10.1097/01.RUQ.0000412976.57318.fd

Ultrasound-guided aspiration of symptomatic intraneural ganglion cyst within the tibial nerve

Ultrasound-guided aspiration of symptomatic intraneural ganglion cyst within the tibial nerve

Recurrence of ovarian torsion in a multiple pregnancy: conservative management via transabdominal ultrasound–guided ovarian cyst aspiration

To report a case of recurrent ovarian torsion during a multiple-gestation pregnancy and successful treatment via transabdominal ultrasound-guided ovarian cyst aspiration. Case report and literature review. Tertiary care fertility center. A 33-year-old gravida 2, para 1 woman with a history of ovarian torsion in a previous pregnancy, who presented with recurrent ovarian torsion in the 13th week of a multiple pregnancy. Ultrasound-guided transabdominal ovarian cyst aspiration and body repositioning to allow for spontaneous detorsion. Resolution of the ovarian torsion, as well as preservation of the pregnancy without surgical intervention. After transabdominal ultrasound-guided cyst aspiration, ovarian detorsion was observed, accompanied by resolution of the patient's acute pain. The remainder of the patient's pregnancy was uncomplicated, culminating in the delivery of healthy infants. Conservative treatment of ovarian torsion via ultrasound-guided transabdominal cyst aspiration and body repositioning represents a reasonable alternative to surgical intervention in the pregnant patient.

Shoulder Pain - Triathlon

HISTROTY: A 35-year-old male triathlete presented with a six-week history of right posterior shoulder pain and weakness. He had originally injured his shoulder while reaching behind his head to elevate the head-rest on a car seat. At that time, he experienced the sudden onset of posterior shoulder pain, which has continued with minimal improvement. He has been training for an upcoming triathlon and notices the pain most when running. He is relatively pain-free with cycling and swimming, though he feels the shoulder is weak during swimming. He has also noted profound weakness with external rotation of the right shoulder during daily activities. He denies previous shoulder problems, numbness/tingling, or other weakness in the right upper limb. PHYSICAL EXAMINATION: Slight infraspinatus atrophy. Mild tenderness over the posterior glenohumeral joint. Shoulder motion was normal and non-provocative. Moderate (3/5) weakness with resisted external rotation. Negative Hawkins Neer's, O'Brien's, Speed's, and Scarf tests. Negative Spurling's maneuver. Multidirectional laxity present in the shoulders bilaterally. Neurovascular examination was normal. DIFFERENTIAL DIAGNOSIS: Spinoglenoid notch cyst (secondary to labral tear) causing partial suprascapular neuropathy Infraspinatus tear Cervical radiculopathy Parsonage Turner Syndrome/Brachial plexopathy TEST AND RESULTS: Ultrasound of right shoulder: -Moderate spinoglenoid notch cyst deforming the infraspinatus. No evidence of rotator cuff tear. EMG: -Subacute right suprascapular neuropathy distal to the branch to the supraspinatus, with minimal uncompensated denervation. MRI (post-triathlon): -Moderate-sized posterior labral tear with a small adjacent paralabral cyst. 2.5 × 0.9 cm lobulated ganglion cyst in the spinoglenoid notch with mild edema along the anterior belly of the infraspinatus muscle. FINAL WORKING DIAGNOSIS: Right posterior shoulder spinoglenoid notch cyst (secondary to posterior labral tear) with suprascapular neuropathy. TREATMENT AND OUTCOMES: Ultrasound-guided aspiration of right shoulder spinoglenoid notch cyst for symptomatic relief prior to triathlon. Subsequent right shoulder arthroscopic cyst decompression with posterior superior labral repair (after triathlon).

3289: A case of ultrasound-guided cyst aspiration and sclerotherapy with acetic acid for the management of intractable abdomino-pelvic pseudocyst

3289: A case of ultrasound-guided cyst aspiration and sclerotherapy with acetic acid for the management of intractable abdomino-pelvic pseudocyst

Cervical Thoracic Duct Cyst

Thoracic duct cysts are rare lesions presenting as mediastinal or supraclavicular masses. We report a case of a 77-year-old female who presented with a left supraclavicular mass. A cervical thoracic duct cyst was suspected after contrast-enhanced computed tomography (CT) of the neck and chest. Diagnosis was confirmed by ultrasound-guided cyst aspiration and lymphangiography. Therapeutic embolization of the thoracic duct was unsuccessful. Definitive treatment was achieved with thoracic duct ligation using video-assisted thoracoscopic surgery (VATS) followed by surgical excision of the cyst. This is believed to be the first report of using minimally invasive surgery for thoracic duct ligation in the treatment of a thoracic duct cyst.

Changes in cytokine levels of patients with ovarian endometriosis after treatment with gonadotropin-releasing hormone analogue, ultrasound-guided drainage, and intracystic recombinant interleukin-2

To determine the changes in cytokine levels from women with endometriomas who are treated with recombinant interleukin-2 after ultrasound-guided cyst aspiration, and to relate these changes to the clinical results observed in these patients. A double-blind randomized controlled trial. University hospital. Twenty-four women with endometriosis-related symptoms and endometriomas. Endometriomas in women receiving GnRH analogues and undergoing transvaginal ultrasound-guided cyst aspiration were injected with dextrose that did or did not contain recombinant interleukin-2 (IL-2). Serum samples were collected before and after treatment. Serum samples were analyzed by enzyme immunoassay to determine the levels of IL-1beta, IL-2, IL-6, IL-8, IL-10, IL-12, IL-13, and IL-17. The cytokine levels after treatment with GnRH analogues and recombinant IL-2 were similar to the initial levels. The patients receiving GnRH analogues without IL-2 had higher IL-1, IL-2, IL-8, and IL-13 levels. Good clinical results were observed in 90% of the patients in the first group but in only 30% of the second one. Administration of recombinant IL-2 intracystically decreases cytokine production in women with endometriomas. These results have important implications for the design of future therapies based on immunomodulation, such as using higher or repeated doses of recombinant IL-2 in the cysts.

Pitfalls in the differential diagnosis of a pelvic cyst: Lessons from a post-menopausal woman with bladder diverticulum

We present a case of non-obstructive bladder diverticulum in a 75-year-old post-menopausal woman. An ovarian cyst was previously suspected, which resulted in a futile exploratory laparotomy without making any definite diagnosis, 1 year earlier. During this admission, transvaginal ultrasound-guided cyst aspiration was arranged to determine the nature of the presumed 'recurrent' cyst and to relieve the symptoms. Prior to cyst aspiration, up to 700 ml of urine through urinary catheterisation and the gradual disappearance of the 'cyst' alerted us to the possibility of a bladder diverticulum, which was later confirmed by retrograde cystography. This case illustrates the lessons that despite considerable researches having been done on enhancing sonographic accuracy, diagnosis based on imaging alone is likely to be associated with multiple pitfalls. Recognising the common pitfalls and integrating clinical information and alertness with ultrasonic features remains the mainstay of sonographic differential diagnosis.

Ultrasound guided aspiration in pathological adnexal processes

Objective: To establish the efficiency of ultrasonographically guided transvaginal adnexal cyst aspiration as a treatment and diagnostic method. Study Design: In 72 patients with an adnexal cystic mass, transvaginal ultrasound guided cyst aspiration was performed. Before the procedure, presence of primary malignant disease was excluded by gynecologic and ultrasound examination. Cyst content was sent for cytological analysis. Cytological findings were staged according to Papanicolaou. Patients were re-examined 3 and 6 months after the ultrasound intervention. Cysts measuring 3 cm or more in diameter were considered to be recurrence of the disease. Results: Recurrence of the disease appeared in 32 cases (44%) and was more common with larger cysts. Malignant cells were found in one case (1.5%), a recurrent ovarian cancer, previously treated by surgery and chemotherapy. Conclusion: In our study, ultrasound guided aspiration of adnexal cysts was not shown to be an efficient method of treatment because of the high recurrence rate. It may be used in selected patients at high anaesthesiologic risk for surgery as a therapeutic or a diagnostic procedure.

The Effect of Surgical Office-Based Thyroid Ultrasound on Clinical Decision Making

An important diagnostic tool for the evaluation of thyroid disease, thyroid ultrasound has recently become available for use in surgical offices. The purpose of this report is to determine the lesional sensitivity of office-based thyroid ultrasound and its impact on clinical decision making. Surgical office-based thyroid ultrasound was performed on 49 consecutive patients who presented with thyroid disease. Indications for sonography included a solitary palpable nodule (n = 32), multiple palpable nodules (n = 3), diffuse enlargement (n = 5), or other hormonal or radiologic abnormalities (n = 9). Thyroid ultrasound demonstrated 104 lesions compared with 38 lesions found on physical examination (P < 0.0001). In the subpopulation who underwent scintigraphy (n = 10), 24 nodules were identified by ultrasound and only 10 nodules were identified by scan (P < 0.01). Overall, office-based thyroid ultrasound impacted the clinical management of 40 patients (80%): in 16 patients, thyroid ultrasound was the only modality that demonstrated a multinodular condition, thus contributing to a decision to avoid surgery; 19 patients had ultrasound-guided fine-needle aspiration of vaguely palpable or nonpalpable lesions; and 5 patients underwent ultrasound-guided cyst aspiration and follow-up. Office-based thyroid ultrasound performed by surgeons is a highly accurate imaging modality that identified significantly more lesions than physical examination or scintigraphy. Clinical management was affected through the identification of a multinodular process or through facilitation of accurate image-guided biopsy.