Avances en el empleo del ultrasonido muscular en miopatías inflamatorias / Advances in the use of muscle ultrasound in inflammatory myopathies

Aunque los métodos de imágenes aún no se han introducido en los criterios de clasificación de la miositis, el uso de imágenes musculares en la evaluación de las miopatías inflamatorias idiopáticas (MII) ha crecido a lo largo de los años. Las diferentes técnicas de imagen han demostrado ser útiles, pero la RM sigue siendo el estándar de oro para la imagen muscular. Sin embargo, el alto costo y las contraindicaciones en algunos pacientes, hacen considerar otros métodos como el ultrasonido muscular. Esta revisión tiene el objetivo de ofrecer una visión general de las diferentes técnicas de ultrasonido que se han estudiado y proporcionar información a los reumatólogos sobre el papel actual del ultrasonido para diagnosticar las MII. Existen diversos factores que pueden influir en la medición de los parámetros musculares: estandarizar la configuración de la máquina, el plano de visión y la posición del paciente, ya que pueden afectar la medición de la intensidad del eco y el grosor muscular. En el caso de las miopatías inflamatorias influyen otros factores en los resultados de la imagen: sexo, edad, escala de grises de la imagen, cambios en la calidad muscular, intensidad del eco, grosor, tamaño y ecogenicidad muscular. La ecografía muscular es una herramienta próxima en la evaluación de los trastornos neuromusculares y las miopatías inflamatorias. Es fácilmente aplicable en diversos entornos clínicos, no tiene contraindicaciones y proporciona una alternativa rentable a otras modalidades de imágenes como la resonancia magnética(AU)

Although imaging methods have not yet been introduced into the myositis classification criteria, the use of muscle imaging in the evaluation of IIMs has grown over the years. Different imaging techniques have proven helpful, but MRI remains the gold standard for muscle imaging. In this review, the objective is to provide an overview of the different ultrasound techniques that have been studied and to provide information to rheumatologists about the current role of ultrasound in the field of IIM. Development: There are multiple factors that can influence the measurement of muscle parameters that must be considered. First, it is important to standardize the machine configuration, the plane of vision and the position of the patient, as these can affect the measurement of echo intensity and muscle thickness. Conventionally, a linear ultrasound probe is used with sufficient frequency (at least 6-12 MHz) to obtain images of the peripheral skeletal muscle. Magnetic resonance imaging remains the gold standard for muscle imaging. However, the role as a diagnostic tool in the field of IIMs has grown over the years, and the promising results of new advanced imaging techniques suggest that it has not yet reached its full potential(AU)

Sonographic Demonstration of a Gastrocnemius Fascial Defect: A Rare Cause of Calf Pain / Demostración sonográfica de un defecto fascial del gastrocnemio: una causa rara del dolor de pantorrilla

ABSTRACT Fascial defects with muscular herniation are an uncommon, treatable cause of calf pain. Differential diagnosis includes deep vein thrombosis, compartment syndrome, soleus strain/tear, and muscle or subcutaneous tumour. In this case, sonography was more sensitive for diagnosis than magnetic resonance imaging.

RESUMEN Los defectos fasciales con herniación muscular son una causa poco frecuente y tratable del dolor de pantorrilla. El diagnóstico diferencial incluye trombosis venosa profunda, síndrome compartimental, distensión o desgarro del sóleo, y tumor subcutáneo o muscular. En este caso, la sonografía resultó más sensible para el diagnóstico que la tomografía por resonancia magnética.

Muscular cysticercosis: Case report and imaging findings / Cisticercose muscular: relato de caso e aspectos de imagem

Summary Cysticercosis is a parasitic disease caused by a worm of the Cestoda class. The most prevalent form affects the nervous system. This case report is from a 78-year-old female patient evaluated at Clínica Mult Imagem, in the city of Santos, Brazil, who presented a form of the disease that differed from the classic neurocysticercosis, in this case muscular cysticercosis. This and other forms of manifestation justify further studies to ensure adequate recognition, diagnosis and treatment of this parasitic disease.

Resumo A cisticercose é uma parasitose causada pela classe Cestoda. A forma mais prevalente acomete o sistema nervoso. Este relato de caso, obtido da Clínica Mult Imagem, em Santos, é de uma paciente do sexo feminino de 78 anos que apresentou uma forma diversa de neurocisticercose, a muscular. Outras formas de manifestação da doença, como a apresentada neste relato, justificam a realização de mais estudos para assegurar o reconhecimento, o diagnóstico e o tratamento adequados dessa parasitose.

Imaging in the Diagnosis of Symptomatic Forearm Muscle Herniation.

Symptomatic muscle herniations are an unusual cause of upper extremity pain that is rarely reported in the literature. Out of 18 reported cases of upper extremity herniations, only 3 were caused by strenuous exertion6. Dynamic ultrasound and Dynamic MRI test are the very good tool for diagnosis of muscle herniation, FNAC and biopsy are rarely needed. This article describes a successful repair of a 22yr old manual worker’s ventral forearm herniation with polypropylene mesh. Prevalence Muscle herniation in an extremity is a well-known cause of pain, even though there have been extremely few documented cases. In a 2009 report published by the “Journal of Hand and Microsurgery,” only 200 cases of herniated muscles of the extremities had been reported since the mid-1800s, and only 17 cases of muscle herniation in the upper limb have been described10. Characteristics A herniated muscle in the forearm can cause mild to severe localized pain, affect grip, cause nerve pain or have no physical symptoms at all. Causes of documented cases include sporting or occupational activities, or an unrelated primary medical condition. Patients usually have a swollen mass that increases in size when the affected muscle is engaged and decreases when the muscles are relaxed. One differential diagnosis for a herniated forearm muscle is a tumor. Muscle herniation in the forearm typically affects males in their adolescent or young-adult years1. We report a case of a disappearing forearm nodule that appeared with muscle contraction. This is characteristic of a transfascial muscle hernia. Ultrasound and MRI are the key to identifying an area of fascial alteration. Treatment alternatives of this unusual condition are discussed.

Cysticercosis of the masseter.

Cysticercosis of the oral cavity is a very rare soft tissue lesion and very few cases have been reported worldwide. Here we report a case of a cysticercous cellulosae within the masseter muscle which was diagnosed with the help of high resolution ultrasonography (USG) and ultrasound guided fine needle aspiration cytology (FNAC) and managed conservatively using oral antiparasitic medication. Cysticercosis is not commonly considered in the diagnosis of swellings of the head and neck and this is the reason why they are of utmost interest to the practitioner and have to be studied.

Cysticercosis of masseter.

Cysticercosis is a parasitic infestation caused by the larval stage of Taenia solium, a cestodic paratise. It is a common disease in developing countries where it is also endemic. The most commonly infested body organs include subcutaneous tissues, brain and skeletal muscles. It is interesting to note that oral lesion of cysticercosis is a rare event. Here we report an isolated lesion of cysticercosis in the masseter muscle.