Pain Medicine Ultrasonography

Ovarian torsion (OT) is a gynecological emergency that can have diverse clinical presentations makings its diagnosis especially challenging. Few studies exist in the literature describing the clinical presentation as well as the management of OT in the emergency department (ED). This study aims to describe the clinical presentation, physical examination, emergency management, radiographic and intraoperative findings, histopathology reports and the time-to-intervention metrics of OT cases presenting to the emergency room of our tertiary care center...

CONTEXT: Repeated ankle sprains can lead to injuries, including those of the anterior talofibular ligament; however, the extent to which these ligament injuries are associated with symptoms of chronic ankle instability remains unclear. OBJECTIVE: To examine the influence of anterior talofibular ligament injury and ankle anterior displacement on symptoms of chronic ankle instability. DESIGN: Case-Control Study. SETTING: A university laboratory...

Mediastinal masses present a diagnostic challenge due to their similar imaging characteristics, making distinguishing between noninfectious and infectious processes or malignancies difficult. A mediastinal abscess can result in severe life-threatening infections if left untreated. Traditional treatment approaches involve surgical debridement and drainage; however, emerging endobronchial techniques, such as endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA), offer a less-invasive means of diagnosing and managing abscesses...

We herein present a rare case of acute central serous chorioretinopathy (CSC) associated with nonspecific orbital inflammation (NSOI). A 38-year-old woman presented with a 3-day history of ocular pain, reduced vision, periorbital swelling, proptosis, conjunctival chemosis, and restricted eye movements. Optical coherence tomography of the affected eye confirmed signs of CSC. Additionally, a computed tomography scan revealed enlargement of intraconal soft tissues and the lacrimal gland. Ocular ultrasonography detected posterior sclera thickening, indicating posterior scleritis...

RESEARCH QUESTION: What is the prevalence of adenomyosis at ultrasonography among adolescents and young women reporting dysmenorrhoea and/or heavy menstrual bleeding (HMB)? DESIGN: This observational cohort study involved adolescents and young women referred for dysmenorrhoea and/or HMB to the Adolescent Medicine Unit at Careggi University Hospital, Italy. Patients with endometriosis and bleeding disorders were excluded. Transvaginal ultrasonography or transrectal sonography using a transvaginal probe was performed...

OBJECTIVES: We sought to determine the association between intrauterine device (IUD) malposition and previous cesarean delivery (CD) and related uterine anatomical changes. METHODS: A retrospective cohort of all persons with an IUD presenting for two- and three-dimensional pelvic ultrasonography over 2 years, for any gynecologic indication, was compiled. IUD malposition was defined as IUD partially or completely positioned outside the endometrial cavity. Uterine position, uterine flexion, and cesarean scar defect (CSD) size were assessed...

BACKGROUND: The test dose or hydrolocation technique allows rapid detection of spread location. Though its primary aim is to enhance safety in peripheral nerve blocks, evidence on the potential risks of an intraneural test aliquot is lacking. We conducted a cadaveric study to evaluate the risk of fascicular injury following a low-volume (<1 mL) intraneural injection of the median nerve. METHODS: Ten upper limbs from fresh unembalmed human cadavers were studied...

BACKGROUND: Vaginal bleeding is the most common cause of presentation at the emergency department in the first trimester. Clinical presentation helps determine the likely cause of first-trimester vaginal bleeding. However, ultrasound imaging is required to reach a definitive diagnosis. OBJECTIVE: To determine the relationship between clinical diagnosis and ultrasonographic findings in women with first-trimester vaginal bleeding. METHODS: A prospective longitudinal study was conducted on 94 pregnant patients with a history of bleeding per vagina (PV) in the first trimester by using transvaginal ultrasound...

INTRODUCTION: Calcific tendinosis is a common condition caused by the deposition of hydroxyapatite crystals within the tendons that can impact any tendinous insertion. In this situation, ultrasound (US) may be a viable imaging modality in addition to radiography. CASE PRESENTATION: A 56-year-old Iranian male presented with left elbow pain. US evaluation at the lump site revealed a subcutaneous lipoma. Ultrasonography showed a thickened and diffusely heterogeneously hypoechoic pronator teres tendon...

BACKGROUND AND OBJECTIVES: The subcostal transversus abdominis plane block (scTAPB) provides analgesia to the anterior abdominal wall but analgesic spread following a single injection remains modest and variable. The oblique scTAPB, which is performed with a continuous injection during needle progression into the TAP along the oblique subcostal line, may extend the block to the whole anterior abdominal wall but needle progression by hydrodissection may be difficult, explaining why this block is not widely used...

BACKGROUND: Real-time ultrasound guidance (USG) has been applied for lower thoracic epidural access, but the more challenging mid-thoracic epidural (MTE) access remains underexplored. This report presents a technique of real-time US guidance with a novel paramedian cross view, termed "the PX view," for securing MTE catheters, along with an outcome analysis from a retrospective case series. METHODS: Medical records of patients who underwent USG-MTE catheter placement with the PX view and drip infusion technique from January to December 2022 were reviewed...

A woman in her fifth month of pregnancy presented to the outpatient department with vomiting, generalised itching and yellowish discolouration of the skin for 1 week. No history of rashes, fever, pain abdomen or altered stools. In view of four pregnancy losses previously, she was evaluated to have antiphospholipid antibody syndrome and was advised low molecular weight heparin. She was a known type-II diabetic on insulin. Prophylactic oral dydrogesterone and natural micronised progesterone were started at a local hospital 2 months prior, in view of threatened abortion...

BACKGROUND: The optimal limb position during stress ultrasound (SUS) evaluation of elbow valgus laxity has not been standardized. PURPOSE: To compare 2 elbow positions (at 90° and 30° of flexion) and report which position method better represents the increased valgus laxity characteristics of baseball players. STUDY DESIGN: Controlled laboratory study. METHODS: Eighteen college baseball players with no history of elbow pain or elbow disorders who belonged to a college baseball club between April and November 2021 participated in this study...

BACKGROUND: Individuals with serum antibodies to citrullinated protein antigens (ACPA), rheumatoid factor, and symptoms, such as inflammatory joint pain, are at high risk of developing rheumatoid arthritis. In the arthritis prevention in the pre-clinical phase of rheumatoid arthritis with abatacept (APIPPRA) trial, we aimed to evaluate the feasibility, efficacy, and acceptability of treating high risk individuals with the T-cell co-stimulation modulator abatacept. METHODS: The APIPPRA study was a randomised, double-blind, multicentre, parallel, placebo-controlled, phase 2b clinical trial done in 28 hospital-based early arthritis clinics in the UK and three in the Netherlands...

RATIONALE: Uterine perforation is a serious complication of intrauterine contraceptive device (IUD) placement. However, as complete uterine perforation and extrauterine migration may remain asymptomatic, thorough localization of the IUD is important prior to reinsertion. PATIENT CONCERNS: A 33-year-old patient who has had 4 IUD insertions, wherein the location of the first IUD (inserted 14 years ago) was not identified prior to reinsertion and replacement of the subsequent three...

Thrombosis and thrombophlebitis of the facial vein represent exceptionally rare diagnoses, particularly when occurring as complications of acute sialadenitis of the submandibular gland. This case report details the experience of a middle-aged man initially presenting at a tertiary care ear, nose and throat department with right submandibular gland sialadenitis. Despite initiating outpatient treatment involving oral antibiotics and sialagogues, the patient returned after a week with persistent and worsening pain, accompanied by swelling of the right submandibular gland and cheek...

Previous studies have compared levobupivacaine versus ropivacaine in various peripheral nerve blocks in terms of block duration, quality of analgesia, and onset time, but this has not occurred in the PENG block. Here, a single-center, randomized, and controlled clinical trial is presented. One hundred and twenty patients older than 65 years suffering from hip fractures and surgically treated at our institution under spinal anesthesia were eligible for participation; of them, one hundred and eight were analyzed...

INTRODUCTION AND IMPORTANCE: Splenic epidermoid cysts are rare primary congenital cysts composed of an epithelial lining that represent a small proportion of nonparasitic splenic cysts. Despite their infrequency, there is a lack of uniform diagnostic and treatment guidelines for these cysts, emphasizing the need for further research and standardized reporting. CASE PRESENTATION: A 45-year-old female presented with left upper quadrant abdominal pain, characterized by a pressing sensation...

Ectopic pregnancy, characterized by the aberrant implantation of blastocysts outside the uterine endometrial lining, typically occurs within the fallopian tube. Clinical presentation of tubal pregnancy ranges from asymptomatic cases to a spectrum of symptoms, including amenorrhea, pelvic pain, vaginal bleeding, and, critically, hemorrhagic shock resulting from tubal rupture. Utilizing serum beta-human chorionic gonadotropin levels and ultrasound examinations is pivotal in confirming the diagnosis. Diagnosing tubal pregnancy during the first trimester is feasible and crucial to prevent rupture, yet reports of fatal cases persist due to delays in diagnosis or misdiagnosis...

Patients with diarrhea-predominant irritable bowel syndrome (IBS-D) show excessive peristalsis, and antispasmodic agents may be useful therapeutic agents. There are few reports on the use of Kampo medicines for the treatment of IBS-D. Shakuyakukanzoto (SKT) is a Kampo medicine that is effective against abdominal pain. We examined the relationship between SKT and intestinal peristalsis in an animal model and a prospective study. In the animal model, SKT and its components were administered from the serosal side of the colon and colonic peristalsis was evaluated using intraluminal pressure and spatiotemporal mapping before and after the administration of SKT and its components...