Combined ultrasound/endoscopy-assisted vocal fold injection for unilateral vocal cord paralysis: a case series.

OBJECTIVE: Transcutaneous vocal cord injection is a popular treatment choice for patients suffering from unilateral vocal cord paralysis. Transcutaneous transcartilaginous (through the thyroid cartilage) approach abolishes any anatomical constraint to reach the vocal cord. However it is a largely blind procedure as the needle should stay submucosal. Herein we report our experience in employing ultrasound guidance to circumvent this problem. METHODS: Retrospective review of a series of 8 patients who underwent combined ultrasound/endoscopy-assisted vocal cord injection for unilateral vocal cord paralysis. RESULTS: Vocal cord injections were successfully completed in all but one patient. There were no associate complications. CONCLUSION: The use of ultrasound in aiding transcutaneous transcartilaginous vocal cord injection is safe and feasible. KEY POINTS: • Vocal cord injection is effective in treating unilateral vocal cord paralysis • A number of transcutaneous approaches with the patient awake have been described • Transcutaneous transcartilaginous approach theoretically has minimal anatomical restraint to reach the vocal cord • Disadvantage of that approach is the difficulty to accurately position the needle • Our experience of using ultrasound to circumvent this problem is positive.

Evaluation of real-time qualitative sonoelastography of focal lesions in the parotid and submandibular glands: applications and limitations.

OBJECTIVE: To evaluate qualitative ultrasound elastography for focal salivary gland masses identified during routine clinical practice. METHODS: Sixty-five parotid or submandibular masses in 61 patients underwent real-time qualitative ultrasound elastography and were scored on colour-scaled elastograms in terms of their stiffness relative to adjacent normal salivary parenchyma from ES 1 (soft) to ES 4 (stiff). This was correlated with diagnosis from aspiration cytology or histology. RESULTS: There were 29 Warthin's tumours (WTs), 23 pleomorphic adenomas (PAs), 2 adenoid cystic carcinomas, 1 adenosquamous carcinoma, 1 nodal metastasis from nasopharyngeal carcinoma, 1 lymphoma (2 deposits), 3 Kuttner tumours and 4 cases of Kimura's disease. ES scores showed clustering according to pathological condition. In this respect, PAs were firmer than WTs (P < 0.004, Fisher's exact test). Nine, 19, 14 and 17 of the benign masses and 0, 1, 2 and 3 of the malignant masses were ES 1, 2, 3 and 4 respectively. All three primary salivary malignancies were ES 4 compared with 1/29 WTs and 16/23 PAs. CONCLUSION: These preliminary findings suggest that qualitative real-time ultrasound elastography, although an ancillary technique to conventional ultrasound in the salivary glands, is likely to have a poor ability to discriminate benign lesions (particularly PAs) from malignant disease.

Sonography of diffuse thyroid disease.

INTRODUCTION/PURPOSE: This article aims to review of the common diffuse thyroid disease. METHODS: Thorough literature search and review was performed for each diffuse thyroid disease. The most recent and updated ultrasound images were obtained. RESULTS: Diffuse thyroid diseases discussed include multinodular goitre, Graves' disease, Hashimoto thyroiditis, de Quervain thyroiditis, acute suppurative thyroiditis, anaplastic carcinoma, thyroid metastases, chronic lymphocytic leukaemia/small lymphocytic lymphoma, Langerhans cell histiocytosis, tuberculosis, plasmacytoma, IgG4-related disease and thyrolipoma. DISCUSSION: The major clinical features and the sonographic features of each diffuse thyroid disease are reviewed. CONCLUSION: This article serves as a synopsis of diffuse thyroid disease.

External jugular vein vascular malformation: sonographic and MR imaging appearances.

Vascular malformations arising from the wall of the external jugular vein are rare. This case series discusses the sonographic and MR imaging appearances of four such cases and reviews the literature. The diagnosis should be suggested preoperatively particularly because of the close relationship such malformations to the external jugular vein, as this helps surgeons to plan the operative procedure. The imaging appearances are similar to those of other vascular malformations elsewhere in the head and neck.

Hepatic tuberculosis: a rare cause of fluorodeoxyglucose hepatic superscan with background suppression on positron emission tomography.

Fluorodeoxyglucose (FDG) hepatic superscan refers to the diffuse intense uptake of 18F-FDG in the liver on positron emission tomography (PET), with reduced physiological activity in the brain and heart. The common causes include lymphoma and metastasis. In this case report, we describe the imaging features of tuberculosis as a rare cause of FDG hepatic superscan. PET imaging may be the only clue to a diagnosis of hepatic tuberculosis, as other imaging modalities may demonstrate only nonspecific hepatomegaly. It is important to consider this entity in the differential diagnosis of patients presenting with FDG hepatic superscan and proceed with liver biopsy for a definitive diagnosis.