Role of shear wave elastography ultrasound in patients with systemic sclerosis.

PURPOSE: A study of shear wave elastography (SWE) for evaluation of skin stiffness in systemic sclerosis (SSc) patients. The purpose of this study was to measure the skin stiffness and thickness in patients with scleroderma using shear wave elastography. METHODS: Prospective data collections of skin stiffness and thickness using SWE in SSc and control groups. RESULTS: Skin stiffness and thickness were done in 29 patients with SSc and a 29 control population using SWE on bilateral forearms. The SSc patients had thicker skin and higher stiffnesses than the control group. The mean of skin thickness and stiffness using SWE of SSc are 1.74 mm and 47.32 kPa while normal subjects were 1.5 mm and 19.5 kPa. Mean differences were 0.023 mm (95% CI 0.15-0.3, p < 0.001) and 27.82 kPa (95% CI 22.63-33.01, p < 0.001). The dorsal forearms tend to have a higher SWE than the volar forearms in SSc. No statistically significant differences between gender, age or dominancy of skin stiffness were found. SWE has a good correlation with clinical manual palpation of forearms (mRSS) with Spearman rho's of 0.550 (p = 0.002) and 0.508 (p = 0.005) of dominant and non-dominant forearms. CONCLUSION: The application of SWE can be used for evaluation of skin involvement in scleroderma patients with good correlations with the mRSS that was used in the current patients. Furthermore, SWE is a safe technique for either diagnosis or follow up.

Incidence and risk factors of pulmonary atelectasis in mechanically ventilated trauma patients in ICU: a prospective study.

AIM: The aim of the study was to obtain information about the incidence and risk factors for pulmonary atelectasis in mechanically ventilated patients in the trauma ICU (TMICU). Pulmonary atelectasis is a common complication leading to serious lung dysfunction in patients in the TMICU and early identification of patients at risk is important for their effective management. METHODS: All trauma patients admitted to the TMICU with mechanical ventilation for more than 1 day were included in a prospective 12-month study. Pulmonary atelectasis was diagnosed from chest radiographs by a critical care doctor and radiologist. RESULTS: A total of 405 trauma patients were identified and data from 338 patients analyzed showing the incidence of pulmonary atelectasis to be 14%. Multivariate analysis revealed significant risk factors to be chest injury with an adjusted odds ratio (AOR) of 102.8, abdominal injury (AOR: 4.6), surgical intervention (AOR: 8.4), comorbidity (AOR: 13.7), Acute Physiology and Chronic Health Evaluation II score (APACHE II) of at least 15 (AOR: 4.8), sedation of at least 7 days (AOR: 7.5) and mechanical ventilation of at least 9 days (AOR: 3.43). Patients with chronic pulmonary disease tended to have higher risk for pulmonary atelectasis (AOR: 8.8). Patients with pulmonary atelectasis had longer stays in TMICU (P < 0.001) and higher mortality (P = 0.013). CONCLUSION: The incidence of pulmonary atelectasis in TMICU in Thailand is comparable with that of the developed world. Pulmonary atelectasis is particularly associated with chest trauma, whereas abdominal injury, APACHE II of at least 15, surgery, comorbidity and prolonged mechanical ventilation are also significant risk factors. Early interventions to prevent or treat pulmonary atelectasis in these patients may improve outcome and shorten their stay in the TMICU and hospital.

Mediastinal Lymphadenopathy in Patients with Systemic Sclerosis.

BACKGROUND: There are few studies regarding the characteristics of mediastinal lymphadenopathy (MN) in patients with systemic sclerosis (SSc). Understanding its features could help radiologists interpret lung imaging more confidently. OBJECTIVE: To determine the prevalence and characteristics of MLN in patients with SSc and factors associated with MLN. MATERIAL AND METHOD: A retrospective review of medical records and high resolution computed tomography (HRCT) of the lungs of all patients with SSc at Srinagarind Hospital, Khon Kaen University, Thailand between 2009 and 2011 was done. Univariate and multivariate logistic regressions were used to analyze the outcomes. RESULTS: Sixty patients were eligible for the present study; the majority of them was women (71.7%) and had diffuse SSc (71.7%). The prevalence of MLN was 56.7% (36 in 60 cases). The distribution of MLN was mainly found in two or more locations (47.1%) and had isodensity on imaging (61.3%). The median size of nodes was 1.2 cm (inter-quartile range 1, 1.4 cm). Only the pulmonary fibrosis score was significantly associated with MLN with the adjusted odds ratio of 1.2 (95% confidence interval 1.1, 1.4, p = 0.03). There was no association between MLN with other factors. CONCLUSION: MLN was prevalent in patients with SSc. The pulmonary fibrosis score was an independent factor associated with MLN.

Role of chest radiography in the diagnosis and follow-up of pulmonary metastasis in differentiated thyroid cancer.

BACKGROUND: Post-treatment I-131 whole body scan (WBS) is known to be a very sensitive test in detecting metastasis in differentiated thyroid cancer (DTC). Therefore, in the presence of this sensitive method, the role of chest radiography (CXR) in the diagnosis of pulmonary metastasis has been questioned. OBJECTIVE: The present study aimed to find the prevalence of pulmonary metastasis found on CXR in DTC patients who had negative post-treatment WBS. MATERIAL AND METHOD: Retrospective comparison was undertaken of CXR and post-treatment WBS routinely performed in 300 DTC patients during the time of I-131 treatment from January 2003 to December 2006 in the Department of Radiology. Radiographic patterns of pulmonary metastasis classified as single nodule, multiple nodules, lymphangitic metastasis and pleural metastasis were also recorded. RESULTS: Of the 300 DTC patients, 36 pulmonary metastases (12.0%) were diagnosed based on CXR and post-treatment I-131 WBS. Of these 36 cases, 11 (30.6%) were detected by both CXR and WBS, whereas 16 (44.4%) were detected by WBS alone and 9 (25.0%) by CXR alone. Seven of these 9 cases (77.8%) had lymphangitic pattern of pulmonary metastasis. CONCLUSION: Although routine CXR has a limited role in the diagnosis of pulmonary metastasis in DTC patients being treated with I-131, it is helpful in detecting pulmonary metastasis in patients with negative post-treatment WBS.

Helical CT assessment on hilar cholangiocarcinoma: comparison value of arterial phase and portovenous phase correlation.

OBJECTIVE: To study the correlation between the findings of hilar cholangiocarcinoma in hepatic arterial phase and portal venous phase. Attention will focus on whether the arterial phase imaging shows more detail than portal phase imaging. MATERIAL AND METHOD: Descriptive study design with retrospective data collection in Srinagarind Hospital, Khon Kaen University. CT scans of the upper abdomen of 34 patients with pathologically proven hilar cholangiocarcinoma between 2002 and 2004 were reviewed for: (1) characteristic of the tumor; (2) adenopathy, (3) arterial involvement, (4) venous involvement, and (5) degree of biliary involvement on both the hepatic arterial and portal venous phases. RESULTS: The correlation was high for characteristics of the tumor, the tumor enhancement pattern, and detection of adenopathy, degree of biliary involvement, and arterial involvement, but low for portal venous involvement which the portal venous phase detected better than the hepatic arterial phase. CONCLUSION: In hilar type cholangiocarcinoma, the portal venous phase yielded the best findings. Furthermore, it showed all findings that were seen in the hepatic arterial phase. According to the present study, the authors suggest doing a pre-contrast study then a portal venous phase imaging for evaluation and diagnosis of hilar type cholangiocarcinoma. There is no necessity to perform hepatic arterial phase in hilar cholangiocarcinoma.