Sonographic imaging of the stellate ganglion in healthy adults: An observational study.

The aim of this study is to estimate the normal cross-sectional area and diameter of the stellate ganglion (SG) by ultrasound (US) in healthy adults. The study sample included 80 stellate ganglia in 40 participants (15 males, 25 females), mean age 38 years, mean height 162.5 cm, mean weight 67.8 kg, mean body mass index 25.4 kg/m2. Two radiologists separately obtained US images of the bilateral SG. Each participant was scanned 3 times bilaterally to assess for intra-observer reliability. The mean diameter of the SG was 1 mm (range: 0.1-2). The mean CSA of the bilateral SG was 1.3 mm2 (range: 0.6-3.9). The SG diameter positively correlated with age. Our study demonstrates the ability of US to image the SG and estimate its normal diameter and CSA. Knowledge of how to identify and measure the SG during ultrasound-guided procedures would be expected to decrease the risk of associated complications and help establish normal reference values.

Ultrasound diagnosis of bowler's thumb in a 60-year-old man.

Bowler's thumb is an uncommon traumatic neuropathy of the thumb ulnar digital nerve. We present a case of bowler's thumb in an individual who is an avid bowler, however, only manifesting following an unrelated injury. We describe the clinical and imaging findings, differential diagnostic considerations, and the treatment options. Knowledge of this entity and its sonographic features is important in order to identify this uncommon entity.

Investigating the multifactorial etiology of supraspinatus tendon tears.

The purpose of this study was to develop a multivariable model to determine the extent to which a combination of etiological factors is associated with supraspinatus tendon tears. Fifty-four asymptomatic individuals (55 ± 4 years) underwent testing of their dominant shoulder. Diagnostic ultrasound was used to assess for a supraspinatus tendon tear. The etiological factors investigated included demographics (age and sex), tendon impingement during shoulder motion (via biplane videoradiography), glenohumeral morphology (via computed tomography imaging), family history of a tear (via self-report), occupational shoulder exposure (via shoulder job exposure matrix), and athletic exposure (via self-report). Univariate relationships between etiological predictors and supraspinatus tears were assessed using logistic regression and odds ratios (ORs), while multivariable relationships were assessed using classification and regression tree analysis. Thirteen participants (24.1%) had evidence of a supraspinatus tear. Individuals with a tear had a higher critical shoulder angle (OR 1.2, p = 0.028) and acromial index (OR 1.2, p = 0.016) than individuals without a tear. The multivariable model suggested that a tear in this cohort can be explained with acceptable accuracy (AUROC = 0.731) by the interaction between acromial index and shoulder occupational exposure: a tear is more likely in individuals with a high acromial index (p < 0.001), and in individuals with a low acromial index and high occupational exposure (p < 0.001). The combination of an individual's glenohumeral morphology (acromial index) and occupational shoulder exposure may be important in the development of supraspinatus tears.

The vagus nerve cross-sectional area on ultrasound in patients with type 2 diabetes.

Diabetic neuropathy, including autonomic neuropathy is a serious complication related to type 2 diabetes mellitus (T2D). The vagus nerve (VN) is the longest nerve in the autonomic nervous system, and since diabetic neuropathy manifests first in longer nerves, the VN is commonly affected in early diabetic autonomic neuropathy. The use of high-resolution ultrasound for peripheral and cranial nerve imaging has significantly increased over the past 2 decades. The aim of the study is to compare the cross-sectional area of the VN in patients with T2D to that of a control cohort without T2D. A total of 52 VN cross-sectional areas were recorded from patients with T2D. A total of 56 VN cross-sectional areas were also recorded from asymptomatic subjects without T2D. In each subject, high-resolution ultrasound imaging of the bilateral VNs was performed in the short-axis between the common carotid artery and the internal jugular vein. The VN cross-sectional areas were recorded and compared. In the patients with T2D, HbA1c and fasting blood glucose levels were obtained as well as the duration of T2D in years and correlated with the cross-sectional areas. The bilateral VN cross-sectional areas were similar in both cohorts. Additionally, no correlation was seen between the VN cross-sectional areas, demographics, or clinical data of T2D. Our study demonstrated normal VN cross-sectional areas in patients with T2D without any significant relation with the patients' demographic or clinical data.

Ultrasound imaging of the phrenic nerve at the scalene muscle level.

The aim of this study is to utilize ultrasound to evaluate the normal cross-sectional area (CSA) of the phrenic nerve (PN), at the level of the anterior scalene muscle. The study included 62 PNs in 31 healthy subjects (13 men, 18 women); mean age, 36.6 years; mean height, 161.1 cm; mean weight, 69.6 kg; and mean body mass index 25.8 kg/m2. High-resolution ultrasound images of the bilateral PNs were obtained by a radiologist with 15 years of experience in neuromusculoskeletal ultrasound. Three separate CSA measurements for the bilateral PNs bilaterally were obtained. Images were also reviewed by an experienced neurologist to evaluate for inter-rater variability. The mean CSA of the right PN was 0.54 mm2 ± 0.16. The mean CSA of the left PN was 0.53 mm2 ± 0.18. We believe that the reference values for the normal CSA of the PNs obtained in our study could help in the sonographic evaluation of PN enlargement, as it relates to the diagnosis of various diseases affecting the PN. Furthermore, knowledge of its location and size, at the level of the scalene muscle, could help prevent PN-related complications during interventional procedures in that area. Additionally, for each participant, demographic information of age and gender as well as body mass index, weight, and height were documented.

Ultrasound of the normal vagus nerve cross-sectional area in the carotid sheath.

The aim of this article is to utilize ultrasound to evaluate the normal cross-sectional area (CSA)of the vagus nerve (VN) in the carotid sheath. This study included 86 VNs in 43 healthy subjects (15 men, 28 women); mean age 42.1 years and mean body mass index 26.2 kg/m2. For each subject, the bilateral VNs were identified by US at the anterolateral neck within the common carotid sheaths. One radiologist obtained 3 separate CSA measurements for each of the bilateral VNs with complete transducer removal between each measurement. Additionally, for each participant, demographic information of age and gender as well as body mass index, weight, and height were documented. The mean CSA of the right VN in the carotid sheath was 2.1 and 1.9 mm2 for the left VN. The right VN CSA was significantly larger than the left VN (P < .012). No statistically significant correlation was noted in relation to height, weight, and age. We believe that the reference values for the normal CSA of the VN obtained in our study, could help in the sonographic evaluation of VN enlargement, as it relates to the diagnosis of various diseases affecting the VN.

Liquid silicone filler migration following illicit gluteal augmentation.

The illicit use of fillers has significantly increased, especially among transgender women (transwomen) attempting to fulfill unmet gender affirmation needs. We present a case of liquid silicone filler migration to the distal lateral thigh, multiple years following an illicit gluteal augmentation, and mimicking a neoplasm. Initial clinical and imaging findings were inconclusive necessitating advanced imaging, an orthopedic oncology surgical consultation, and finally an ultrasound-guided biopsy. Knowledge of the increasing use of fillers, their complications, and imaging findings is critical as these patients commonly choose not to disclose this history. A radiologist suggesting this diagnosis may assist the clinician, who is often unaware of this history which could help prevent unnecessary imaging and invasive procedures.

Ultrasound-guided joint interventions of the lower extremity.

The purpose of this article is to better understand the role ultrasound plays in lower extremity joint interventions. Ultrasound is an important and reliable tool diagnostically and therapeutically. Real-time feedback, lack of ionizing radiation, and dynamic maneuverability make ultrasound an important tool in the proceduralist's armament. This article will touch upon the important anatomic considerations, clinical indications, and technical step-by-step details for lower extremity ultrasound interventions. Specifically, we will look at interventions involving the hip, knee, ankle, and foot. In addition, this article will discuss the roles corticosteroid and platelet-rich plasma may play in certain interventions.