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Nakatani S, Andoh M, Okita Y, Yamagishi M, Miyatake K. Prosthetic valve obstruction with normal disk motion: usefulness of transesophageal echocardiography to define cause. J Am Soc Echocardiogr 1999; 12:537-9. [PMID: 10359927 DOI: 10.1016/s0894-7317(99)70092-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
We describe a rare case of Björk-Shiley prosthetic valve obstruction with normal motion of the tilting disk. The cause of obstruction was the annular pannus ingrowth and was well defined by transesophageal echocardiography, but not by cardiac catheterization nor cineradiography.
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Abstract
This study in a large inner city Accident & Emergency (A&E) department investigated the awareness of new Senior House Officers (SHO's) of the major symptoms and signs of significant trauma to the knee. They were able to identify a knee effusion clinically but were unable to differentiate a haemarthrosis from a reactive effusion. An acute haemarthrosis is suggestive of significant damage such as fracture, cruciate ligament rupture, major meniscal tear, synovial tear or patella dislocation (Maffulli N, Binfield PM, King JB, Good CJ. J Bone Joint Surg [Br] 1993;75(6):945-949 [1]; Noyes FR, Basset RW, Grood ES, Butler DL. J Bone Joint Surg [Am] 1980;62-A:687-695 [2]; Jain AS, Swanson AJG, Murdoch G. Injury 1983;15:178-181.] [3]). In many cases a haemarthrosis may be the only abnormality demonstrable in the acute setting (Dehaven KE. Am J Sports Med 1980;8:9-14 [4]; Visuri T, Koskenvuo M, Dahlstrom S. Milit Med 1993;158(6):378-381 [5]). If this diagnosis is missed then patients may be inappropriately sent home without suitable treatment and follow up. Greater emphasis should be placed on the differentiation between reactive effusion and haemarthrosis in the knee during the teaching of orthopaedics both at medical school and also on arrival at the A&E department.
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Kalman PG, Rappaport DC, Merchant N, Clarke K, Johnston KW. The value of late computed tomographic scanning in identification of vascular abnormalities after abdominal aortic aneurysm repair. J Vasc Surg 1999; 29:442-50. [PMID: 10069908 DOI: 10.1016/s0741-5214(99)70272-7] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
PURPOSE The purpose of this study was to determine the prevalence of late arterial abnormalities after aortic aneurysm repair and thus to suggest a routine for postoperative radiologic follow-up examination and to establish reference criteria for endovascular repair. METHODS Computed tomographic (CT) scan follow-up examination was obtained at 8 to 9 years after abdominal aortic aneurysm (AAA) repair on a cohort of patients enrolled in the Canadian Aneurysm Study. The original registry consisted of 680 patients who underwent repair of nonruptured AAA. When the request for CT scan follow-up examination was sent in 1994, 251 patients were alive and potentially available for CT scan follow-up examination and 94 patients agreed to undergo abdominal and thoracic CT scanning procedures. Each scan was interpreted independently by two vascular radiologists. RESULTS For analysis, the aorta was divided into five defined segments and an aneurysm was defined as a more than 50% enlargement from the expected normal value as defined in the reporting standards for aneurysms. With this strict definition, 64.9% of patients had aneurysmal dilatation and the abnormality was considered as a possible indication for surgical repair in 13.8%. Of the 39 patients who underwent initial repair with a tube graft, 12 (30.8%) were found to have an iliac aneurysm and six of these aneurysms (15.4%) were of possible surgical significance. Graft dilatation was observed from the time of operation (median graft size of 18 mm) to a median size of 22 mm as measured by means of CT scanning at follow-up examination. Fluid or thrombus was seen around the graft in 28% of the cases, and bowel was believed to be intimately associated with the graft in 7%. CONCLUSION Late follow-up CT scans after AAA repair often show vascular abnormalities. Most of these abnormalities are not clinically significant, but, in 13.8% of patients, the thoracic or abdominal aortic segment was aneurysmal and, in 15.4% of patients who underwent tube graft placement, one of the iliac arteries was significantly abnormal to warrant consideration for surgical repair. On the basis of these findings, a routine CT follow-up examination after 5 years is recommended. This study provides a population-based study for comparison with the results of endovascular repair.
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Donnelly LF, Frush DP, Bisset GS. The appearance and significance of extrapleural fluid after esophageal atresia repair. AJR Am J Roentgenol 1999; 172:231-3. [PMID: 9888773 DOI: 10.2214/ajr.172.1.9888773] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The objective is to describe the appearance and evaluate the significance of postoperative extrapleural fluid collections in neonates who have undergone esophageal atresia repair in which an extrapleural surgical approach was used. CONCLUSION Extrapleural effusion in a neonate who has undergone repair of esophageal atresia by an extrapleural approach is associated with a high incidence of anastomotic leakage. Such patients may also be at increased risk for developing a delayed esophageal stricture. On chest radiography, these extrapleural effusions look like fluid in the pleural space.
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80
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Leekam RN, Agur AM, McKee NH. Using sonography to diagnose injury of plantaris muscles and tendons. AJR Am J Roentgenol 1999; 172:185-9. [PMID: 9888765 DOI: 10.2214/ajr.172.1.9888765] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Rupp S, Seil R, Kohn D. [Significance of the hypoechoic area around the long biceps tendon in shoulder sonography--underlying pathology]. ZEITSCHRIFT FUR ORTHOPADIE UND IHRE GRENZGEBIETE 1999; 137:7-9. [PMID: 10327554 DOI: 10.1055/s-2008-1037028] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE The objective was to evaluate the sonographic sign of a hypoechoic area ("halo-sign") around the long biceps tendon as an equivalent of intraarticular effusion. METHODS Part 1: Ten patients scheduled for shoulder arthroscopy underwent ultrasonography immediately before surgery. If there was no hypoechoic area around the long biceps tendon 30 ml of NaCl-solution (0.9%) were injected into the joint. After repetitive passive motion the patient underwent a second ultrasonography. Part 2: Ten consecutive patients with a hypoechoic area around the long biceps tendon underwent shoulder arthroscopy. During this procedure they were examined for intraarticular effusion. Patients with rheumatoid disease were excluded from the study. RESULTS Part 1: In 9 of 10 patients a hypoechoic area around the long biceps tendon was induced by injection into the joint. The area was 1.07 +/- 0.13 cm2. In one case we could not induce the described phenomenon. Part 2: In all patients with a hypoechoic area around the long biceps tendon an intraarticular effusion was found at arthroscopy. CONCLUSION A hypoechoic area around the long biceps tendon correlates with fluid in the synovial sheet and indicates effusion within the glenohumeral joint.
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Hashimoto M, Okane K, Hirano H, Watarai J. Pictorial review: Subperitoneal spaces of the broad ligament and sigmoid mesocolon--imaging findings. Clin Radiol 1998; 53:875-81. [PMID: 9867270 DOI: 10.1016/s0009-9260(98)80213-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
In this report, we illustrate the imaging findings of diseases in the subperitoneal space of the broad ligament and sigmoid mesocolon and discuss the pathways of subperitoneal spread of disease. The subperitoneal space of the broad ligament and sigmoid mesocolon is continuous with that of the parietal peritoneum overlying the pelvic wall. Extraperitoneal diseases originating in the pelvis can extend, via the abdominopelvic vasculature or fascial-defined compartment, superiorly into the retroperitoneal compartments of the abdomen.
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83
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Chatterton BE, Spyropoulos P. Colour Doppler induced streaming: an indicator of the liquid nature of lesions. Br J Radiol 1998; 71:1310-2. [PMID: 10319007 DOI: 10.1259/bjr.71.852.10319007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
As sound waves traverse tissue, interaction with reflecting or absorbing obstacles results in a transfer of momentum from the wave to the medium. This generates a local force in the direction of propagation. If this occurs in a fluid medium, sufficient pressure may be generated to cause flow--"streaming". Generally, it is difficult to demonstrate this streaming in images using the usual diagnostic B-mode intensities, but the increased intensities in a colour Doppler (or power) region of interest enhance the phenomenon. This allows streaming to be both visualized by the motion of small particles and detected by colour change on the colour Doppler B-mode image. Borders of streaming between the simple grey scale image and the colour region may be easily seen, with retrograde flow in the regions subjected to a lower intensity. This phenomenon has been demonstrated in ocular, scrotal, thyroid, breast, ovarian and inflammatory collections or lesions, confirming the liquid nature, occasionally of fluid which is very echogenic due to contained debris. The technique is recommended as another tool which is available to most general ultrasound departments and will assist in the characterization of tissue.
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84
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Mohammad JA, Warnke PH, Stavraky W. Ultrasound in the diagnosis and management of fluid collection complications following abdominoplasty. Ann Plast Surg 1998; 41:498-502. [PMID: 9827952 DOI: 10.1097/00000637-199811000-00008] [Citation(s) in RCA: 47] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
A 6-year prospective study of 80 abdominoplasties is reported. Type and incidence of complications are presented with particular attention toward the incidence of fluid collection following abdominoplasty, such as seroma and hematoma. Ultrasound was performed in 56 patients (70%), with normal findings in 27 patients (48%). Accurate diagnosis of fluid collection in 29 patients (51.8%), seroma in 24 (42.8%), and hematoma in 5 (9%) was confirmed with the aid of ultrasound. The advantage of early radiological diagnosis alerted the surgeon for positive findings of fluid collection areas in the abdominal wall, which resulted in close observation and early intervention whenever indicated. Ultrasound of the abdominal wall following abdominoplasty provides a noninvasive, accurate, and low-cost method of diagnosing fluid collection in the abdominal wall. This method, if performed routinely postabdominoplasty, will aid the surgeon in managing potential complications such as wound-healing problems, infection, and patient discomfort.
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Khalifé S, Falcone T, Hemmings R, Cohen D. Diagnostic accuracy of transvaginal ultrasound in detecting free pelvic fluid. THE JOURNAL OF REPRODUCTIVE MEDICINE 1998; 43:795-8. [PMID: 9777619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
OBJECTIVE To evaluate the diagnostic accuracy of transvaginal ultrasonography in detecting and measuring free pelvic fluid. STUDY DESIGN Eighty-two patients undergoing diagnostic or therapeutic laparoscopy at a tertiary care center were prospectively assessed before surgery by transvaginal ultrasound. Free pelvic fluid was measured in two ultrasonographic planes. These measurements were compared to the volume of fluid aspirated during laparoscopy. RESULTS The mean volumes reported for transvaginal ultrasound were significantly lower than those observed at laparoscopy (mean milliliters +/- SEM, 2.54 +/- 0.5 versus 9.42 +/- 1.3, P < .001). The smallest volume of free pelvic fluid that was consistently detected by ultrasound was 8 mL. Whenever no fluid or < 1 mL was detected by transvaginal ultrasound, a small volume of fluid was found at laparoscopy (mean milliliters +/- SEM, 1.6 +/- 0.47). The sensitivity of transvaginal ultrasound was 83% and specificity was 69%. CONCLUSION Transvaginal ultrasound is a sensitive method of detecting the presence of > 8 mL of free pelvic fluid and therefore is an important diagnostic tool in the assessment of pelvic pathology associated with increased peritoneal fluid.
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Aikawa H, Tanoue S, Okino Y, Tomonari K, Miyake H. Pelvic extension of retroperitoneal fluid: analysis in vivo. AJR Am J Roentgenol 1998; 171:671-7. [PMID: 9725294 DOI: 10.2214/ajr.171.3.9725294] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purposes of this study were to describe the pathway of fluid flow from the retroperitoneal space into the pelvic extraperitoneal space on CT in vivo, to clarify the relation between its occurrence and the site or amount of retroperitoneal fluid, and to delineate the anatomic relation between the retroperitoneal spaces and the pelvic extraperitoneal space. MATERIALS AND METHODS We reviewed the CT scans of 37 patients with retroperitoneal fluid collections. Patients who had undergone pelvic laparotomy and patients who had either fascial thickening alone or fluid within muscle (such as the psoas muscle or iliac muscle) alone were excluded. RESULTS Fluid extension into the pelvic extraperitoneal space was seen in six patients (16%). Extension by the infrarenal extraperitoneal space was seen in all six of these patients, but extension by properitoneal fat was seen in only one of the six patients. In patients with large amounts of fluid in the infrarenal extraperitoneal space, we frequently saw extension into the pelvic extraperitoneal space. Extension of pancreatic fluid into the infrarenal extraperitoneal space occurred in only 15% of the 37 patients. However, it occurred in both patients with ruptured abdominal aortic aneurysms. Three pathways from the infrarenal extraperitoneal space into the pelvic extraperitoneal space were seen: extension dorsally medial to the iliac vessels (n = 6), extension dorsally lateral to the iliac vessels (n = 1), and extension medially into the prevesical space (n = 2). Coexistence of two of these three pathways was seen in three patients. CONCLUSION In vivo, extension of retroperitoneal fluid into the pelvic extraperitoneal space is not rare and occurs more often by the infrarenal extraperitoneal space than by properitoneal fat. Extension of retroperitoneal fluid to the infrarenal extraperitoneal space can be attributed less frequently to sources distant to the pelvic cavity such as pancreatic fluid. Such extension often derives from sources that can produce large amounts of retroperitoneal fluid such as ruptured abdominal aortic aneurysms. Of the three pathways from the infrarenal extraperitoneal space to the pelvic extraperitoneal space, dorsal extension medial to the iliac vessels is the most common, and multiple pathways often coexist.
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Sickler GK, Chen PC, Dubinsky TJ, Maklad N. Free echogenic pelvic fluid: correlation with hemoperitoneum. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 1998; 17:431-435. [PMID: 9669301 DOI: 10.7863/jum.1998.17.7.431] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Echogenic fluid is an important extrauterine finding of ectopic pregnancy. The purpose of this study was to determine how accurately echogenic fluid correlates with hemoperitoneum at surgery. Transvaginal sonography was performed in 831 consecutive patients referred to rule out ectopic pregnancy over a 36 month period. Scans were retrospectively evaluated for the presence or absence and echogenicity of free pelvic fluid. Subsequently, 185 patients had a laparotomy or laparoscopy and had documentation of the presence or absence of hemoperitoneum. On transvaginal sonography 125 patients had echogenic fluid, 30 patients had anechoic fluid, and 30 patients had no fluid. Of the 125 patients with echogenic fluid, 122 (98%) patients had hemoperitoneum; none of the patients with anechoic fluid or no detected fluid had hemoperitoneum (0%). Echogenic fluid had a sensitivity of 100%, specificity of 95%, positive predictive value of 98%, and an accuracy of 98% for detecting hemoperitoneum. This study demonstrates that echogenic fluid detected by transvaginal ultrasonography accurately correlates with hemoperitoneum detected at surgery in patients with suspected ectopic pregnancy.
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88
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Wisotsky BJ, Magat-Gordon CB, Puklin JE. Angle-closure glaucoma as an initial presentation of systemic lupus erythematosus. Ophthalmology 1998; 105:1170-2. [PMID: 9663217 DOI: 10.1016/s0161-6420(98)97015-4] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
PURPOSE To study a patient with bilateral uveal effusions and secondary glaucoma as an initial manifestation of systemic lupus erythematosus. DESIGN A case report. METHODS The patient presented with bilateral uveal effusions and angle-closure glaucoma. A detailed ocular examination with ultrasonography and a comprehensive medical evaluation with laboratory testing were performed. RESULTS The ocular examination revealed bilateral uveal effusions with angle-closure and elevated intraocular pressures. A systemic evaluation revealed bilateral pleural effusions and laboratory values consistent with systemic lupus erythematosus. After medical and laser therapy failed to lower the intraocular pressure, partial thickness sclerectomies, linear sclerostomies, and choroidal drainage were successful in controlling the glaucoma. CONCLUSIONS Uveal effusion with secondary glaucoma can be a presenting sign for systemic lupus erythematosus. If antecedent ocular abnormalities are not present, a systemic evaluation is warranted in assessing a patient with uveal effusions and secondary angle-closure glaucoma. Partial-thickness sclerectomies, linear sclerostomies, and choroidal drainage may be effective in lowering intraocular pressure.
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89
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Alasaarela E, Leppilahti J, Hakala M. Ultrasound and operative evaluation of arthritic shoulder joints. Ann Rheum Dis 1998; 57:357-60. [PMID: 9771210 PMCID: PMC1752618 DOI: 10.1136/ard.57.6.357] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To assess the diagnostic value of ultrasonography (US) in the evaluation of arthritic shoulder joints. METHODS Twenty shoulders of 20 inpatients with arthritis were evaluated by US one day before the shoulder operation. Changes in the subacromial-subdeltoid bursa, biceps tendon and tendon sheath, rotatof cuff, and glenohumeral joint were recorded and compared with findings at operation. RESULTS In the detection of effusion/hypertrophy in the subacromial-subdeltoid bursa, US had a sensitivity of 93% and a specificity of 83%. For a biceps tendon rupture US had a sensitivity of 70% and a specificity of 100%. US missed three intraarticular biceps tendon ruptures. For effusion/hypertrophy in the biceps tendon sheath US had a sensitivity of 100% and a specificity of 83%. For a rotator cuff tear US had a sensitivity of 83% and a specificity of 57%. US missed two small longitudinal rotator cuff tears. Three thin membranous, but intact, rotator cuff tendons were classified as full thickness tears by US. Synovial effusion/hypertrophy was detected by US and at operation in all of the 12 glenohumeral joints that were evaluable at surgery. CONCLUSION US is a reliable method in experienced hands for the evaluation of inflammatory changes of an arthritic shoulder. In advanced stages of rheumatoid shoulder joints, however, US is not useful, because destructive bone changes and tendon ruptures change the normal anatomy and restrict shoulder motions, limiting the visibility of US.
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Wolek R, Mason BJ, Reeser P, Zins JH. Pleural fluid: accuracy of computed tomography in differentiating exudates from transudates. CONNECTICUT MEDICINE 1998; 62:259-65. [PMID: 9639957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE To determine the accuracy of computed tomography in differentiating pleural exudates from transudates when reviewed subjectively by two experienced radiologists in a community hospital. METHODS Computed tomography scans of 55 consecutive patients who had a thoracenteses within 10 days of the study were retrospectively reviewed independently by two experienced staff radiologists. They were asked to evaluate subjectively parietal pleural thickness (anterior, lateral, posterior), attenuation of extra-pleural fat, and categorize pleural fluid as loculated or free flowing. Radiographic findings were correlated with biochemical results of thoracentesis (Light's criteria) to assess the accuracy of computed tomography in differentiating pleural exudates from transudates. RESULTS For the diagnosis of an exudate, pleural thickening alone had the best sensitivity and specificity (50%, 100%, respectively) with an accuracy of 55%. CONCLUSION Subjective evaluations for increased pleural thickness have a high accuracy for diagnosing pleural exudates.
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Abstract
There are controversies over the anatomical communications between the perirenal space and the adjacent extraperitoneal spaces. Clinical studies, mainly based on CT, show fluid collections extending into the adjacent space; into the bare area of the liver on the right, into the superior extraperitoneal space on the left, towards the midline from each perirenal space, and into the lower retroperitoneal space of the abdomen and pelvis. There are certain constant anatomical barriers limiting free extension of fluid or pathology. The pattern of fluid collection in the perirenal space and extension into the adjacent extraperitoneal space is relatively consistent although it varies with the amount and nature of the pathological fluid collection. This pictorial review illustrates anatomical barriers and CT findings of perirenal fluid collections and their extension into adjacent extraperitoneal spaces.
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Mukand J, Sniger W, Kaufman J, Biener-Bergman S. Common causes of knee effusions in spinal cord injury: a random study. Am J Phys Med Rehabil 1998; 77:113-7. [PMID: 9558011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Patients with spinal cord injury are predisposed to knee effusions owing to osteoporosis, heterotopic ossification, trauma, and benign hydrarthrosis. This retrospective review discusses 11 patients with spinal cord injury and knee effusions seen during two years. One objective is to correlate the initial diagnosis based on clinical findings with the final diagnosis based on synovial fluid analysis and radiographic studies. Another is to describe the variety and complexity of clinical situations that involve knee effusions in spinal cord injury. The initial diagnosis was different from the final diagnosis in all of our cases. The final diagnoses were trauma (6 cases), pseudogout (2 cases), spasticity, fracture of the tibial plateau, septic joint, and tears of the anterior cruciate and lateral collateral ligaments. Knee effusions in this unique population must be carefully investigated to avoid erroneous diagnoses based on the initial clinical presentation, which can be complicated by multiple medical problems.
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Abstract
A case of an intraosseous ganglion with a fluid-fluid level visualised on MR imaging is presented. We discuss its possible pathogenesis and review other lesions that may exhibit this sign.
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94
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Vrabec JT, Driscoll BP, Chaljub G. Cricoarytenoid joint effusion secondary to rheumatoid arthritis. Ann Otol Rhinol Laryngol 1997; 106:976-8. [PMID: 9373090 DOI: 10.1177/000348949710601115] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Sardanelli F, Sabattini R, Talenti A, Zandrino F, Simoni G. [Perigastric fluid collection as an indirect sign of gastric perforation in computed tomography. A case]. LA RADIOLOGIA MEDICA 1997; 94:400-2. [PMID: 9465253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Alasaarela E, Tervonen O, Takalo R, Lahde S, Suramo I. Ultrasound evaluation of the acromioclavicular joint. J Rheumatol Suppl 1997; 24:1959-63. [PMID: 9330939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To evaluate the value of ultrasonography in assessing arthritic acromioclavicular (AC) joints. METHODS One hundred twenty-six AC joints of 63 healthy subjects (2 groups) were prospectively examined by ultrasound to determine the-normal limits of capsular distention and the width of the joint space. Thirty-three AC joints of 32 patients with chronic arthritis were evaluated by ultrasound and, for comparison, by radiography, computed tomography (CT), and magnetic resonance imaging (MRI). RESULTS The mean ultrasonographic distance of the joint capsule from the bone rim was 2.2 mm +/- standard deviation (SD) 0.5 mm in 21-32-year-old control subjects and 2.9 +/- 0.7 mm in 37-81-year-old control subjects. The mean width of the joint space was 4.1 +/- 0.9 mm and 3.5 +/- 0.9 mm in the same control groups, respectively. In detecting soft tissue changes in arthritic AC joints MRI was better than ultrasound. In revealing bony surface changes, CT was the best method and radiography was least sensitive but quite specific. Our most prominent finding was that ultrasound is able to exclude joint inflammation; when the ultrasonographic distance of the joint capsule from the bone rim was < 3 mm, there was no synovial hypertrophy or effusion on MRI scans. CONCLUSION Ultrasound can detect AC joint changes reliably. It is able to exclude joint inflammation. Effusion in the AC joint may reflect inflammation, but may also be a sign of degeneration.
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Fedrizzi MS, Ronchezel MV, Hilario MO, Lederman HM, Sawaya S, Goldenberg J, Sole D. Ultrasonography in the early diagnosis of hip joint involvement in juvenile rheumatoid arthritis. J Rheumatol 1997; 24:1820-5. [PMID: 9292810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To determine the value of ultrasonography in detection of early alterations and subsequent evolution of hip joint disease in patients with juvenile rheumatoid arthritis (JRA). METHODS Hip joints of 53 patients were evaluated clinically, by conventional radiography and ultrasound. Ten children free of signs/symptoms related to rheumatic diseases were chosen as a control group. Nine patients were followed up 28 months after baseline examinations. The clinical, radiological, and ultrasound evaluations were repeated. RESULTS Conventional radiography showed alterations in 10 patients (18.9%) who had shown clinical manifestations of advanced disease of the hip joint while ultrasound detected abnormalities in asymptomatic patients who had had normal radiographs. Ultrasound revealed the occurrence of 47.2% involvement in the hips of patients with JRA. Thus, ultrasound was apparently more sensitive than conventional radiographs in diagnosing changes in the hip joints of patients with JRA. Further, such involvement was found with greater frequency in the systemic and polyarticular types of JRA, in children less than 5 years of age, in those with longer duration of disease, and in those who belonged to a poorer functional class. In 3 of 9 patients who initially had normal radiographs and altered ultrasound, we found severe hip alterations upon reevaluation by radiography, after a period ranging from 21 to 39 months. CONCLUSION Ultrasonography is a method of diagnosis that must be considered in hip joint evaluation of patients with JRA.
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98
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Chan YL, Cheng JC, Metreweli C. Sonographic evaluation of hip effusion in children. Improved visualization with the hip in extension and abduction. Acta Radiol 1997; 38:867-9. [PMID: 9332246 DOI: 10.1080/02841859709172426] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
PURPOSE To assess the difference in the sonographic appearance of hip effusions when the hip was placed in the extended and abducted position as compared to a neutral position. MATERIAL AND METHODS Twenty-one consecutive children (aged 2-14 years) with hip pain or limping were examined for hip effusions by means of ultrasound. The capsule-femoral-neck distance, the presence of joint fluid, and the shape of the anterior capsule were compared in hips in slight extension and abduction with those in hips in a neutral position. RESULTS Of the 11 positive hip effusions, the maximal distance between the capsule and femoral neck was significantly larger (p < 0.005) in the extended and abducted hip position than in the neutral hip position, with a mean difference of 1.6 mm. Convex bulging of the anterior capsule was more confidently diagnosed in 3 hip effusions in the extended and abducted hip, and better visualization of fluid between the capsule and femoral neck was achieved in 4 joint in this posture. CONCLUSION The study demonstrated an improvement in the sonographic detection of hip effusion in the extended and abducted position compared to the neutral position.
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Alasaarela E, Takalo R, Tervonen O, Hakala M, Suramo I. Sonography and MRI in the evaluation of painful arthritic shoulder. BRITISH JOURNAL OF RHEUMATOLOGY 1997; 36:996-1000. [PMID: 9376998 DOI: 10.1093/rheumatology/36.9.996] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
We evaluated 31 painful shoulders of 30 patients with chronic arthritis by ultrasonography (US) and compared the results with those of magnetic resonance imaging (MRI). Both US and MRI revealed effusion in the subacromial-subdeltoid (SA-SD) bursa, biceps tendon sheath (BTS) and glenohumeral (GH) joint, but MRI was more accurate in depicting joint inflammation because of its ability to visualize synovial hypertrophy. US visualized biceps tendon ruptures equally well as MRI. MRI was better able to reveal full-thickness tear of the supraspinatus tendon, whereas US showed better other changes of the supraspinatus tendon (degeneration or partial-thickness tear). Both of the imaging methods were able to depict erosions of the humeral head, but the locations occasionally differed. Inexpensive and easily available US can be recommended as the first imaging method for the detection of soft-tissue changes in the arthritic shoulder, but in rotator cuff problems both methods may be needed.
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Abstract
The finding of a pulmonary infiltrate on chest radiograph may represent a spectrum of pathologic entities in the acutely ill hospitalized adult. Timely intervention depends on the advanced practice nurse's ability to devise a differential diagnosis based on the characteristics of the infiltrate and the clinical setting. Pulmonary infiltrates are described as interstitial or alveolar, diffuse or focal. Their presentation may be chronic or acute in nature. Understanding the nuances of chest radiographic interpretation provides the foundation on which the infiltrate is described and is therefore the first step in establishing the differential diagnosis. Thorough clinical assessment and thoughtful requisition of diagnostic studies are used to discriminate the disorders found in the differential diagnosis. Using an organized approach to describe the radiographic abnormality and define its clinical context, the advanced practice nurse can efficiently establish a diagnosis so that the work of treatment may begin.
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