Aspiration of sterile post-operative spinal fluid collections using low-dose computed tomography guidance.

Sterile postoperative seromas can develop after posterior spinal surgery and cause pain, weakness, and numbness. Management typically involves operative evacuation. We propose that these collections can be managed with percutaneous computed tomography (CT) guided aspiration, potentially saving the patient an additional surgery. Here, we evaluate the safety and efficacy of this approach. Patients who developed symptomatic postoperative seromas within 60 days following surgery for spinal canal stenosis and had stable neurologic exams were considered for CT-guided percutaneous aspiration. To be considered for this approach, patients had to have pre-procedural evidence of radiographic spinal cord or cauda equina compression, hemodynamic stability, and low suspicion for infection. A total of 16 symptomatic collections were aspirated among 15 patients. The mean volume of fluid removed was 32.0 mL. There were no peri- or post-procedural complications. Eight (50%) had resolution or substantial improvement of their symptoms (p = 0.0002 when compared to the null hypothesis). One patient had short interval improvement but return of their initial symptoms 12 h following aspiration, 3/16 (19%) had minimal improvement, and 4/16 (25%) had no change in symptoms. Fluid collections that appeared denser on the pre-procedural CT were associated with retrieval of more sanguineous appearing fluid (p = 0.08). Neither the amount nor quality of fluid aspirated was associated with outcome. We conclude that percutaneous CT-guided aspiration of postoperative seromas is safe and should be considered as an alternative to open surgical evacuation in patients with stable neurologic exams.

Partial splenic artery embolization in cirrhotic patients.

Splenomegaly is a common sequela of cirrhosis, and is frequently associated with decreased hematologic indices including thrombocytopenia and leukopenia. Partial splenic artery embolization (PSE) has been demonstrated to effectively increase hematologic indices in cirrhotic patients with splenomegaly. This is particularly valuable amongst those cirrhotic patients who are not viable candidates for splenectomy. Although PSE was originally developed decades ago, it has recently received increased attention. Presently, PSE is being utilized to address a number of clinical concerns in the setting of cirrhosis, including: decreased hematologic indices, portal hypertension and its associated sequela, and splenic artery steal syndrome. Following PSE patients demonstrate significant increases in platelets and leukocytes. Though progressive decline of hematologic indices occur following PSE, they remain improved as compared to pre-procedural values over long-term follow-up. PSE, however, is not without risk and complications of the procedure may occur. The most common complication of PSE is post-embolization syndrome, which involves a constellation of symptoms including fever, pain, and nausea/vomiting. The rate of complications has been shown to increase as the percent of total splenic volume embolized increases. The purpose of this review is to explore the current literature in regards to PSE in cirrhotic patients and to highlight their techniques, and statistically summarize their results and associated complications.

Value of ultrasound before joint aspiration.

OBJECTIVE: The purpose of this article is to illustrate and discuss the value of ultra-sound screening before joint aspiration. CONCLUSION: Before joint aspiration, ultrasound assessment of the overlying and surrounding soft tissues requires little time and is relatively inexpensive. Bursal fluid collections, soft-tissue abscesses, and other fluid collections that would be undetected with fluoroscopy or blind aspiration can thus be identified. Ultrasound screening before joint aspiration can aid diagnosis and decrease the risk of iatrogenic complications.

Comparative effectiveness of elastographic and B-mode ultrasound criteria for diagnostic discrimination of thyroid nodules: a meta-analysis.

OBJECTIVE: The purpose of this article is to present, through systematic review of recent literature, a comparative effectiveness analysis of ultrasound elastography versus B-mode ultrasound features for differentiating thyroid nodules. MATERIALS AND METHODS: We conducted an extensive literature search of PubMed and other medical and general purpose databases from January 1966 through March 2012. Eligible studies were published in English, reported diagnostic performance of elastography (using elasticity score or strain ratio) with or without B-mode ultrasound in differentiation of thyroid nodules, and used histology or cytology as the reference standard. Summary diagnostic performance measures were assessed for each of the elasticity measuring methods and ultrasound features by means of a bivariate random effects model. RESULTS: Twenty-four studies provided relevant information on more than 2624 patients and 3531 thyroid nodules (927 malignant and 2604 benign). Six ultrasound features (echogenicity, calcifications, margins, halo sign, shape, and color Doppler flow pattern) were compared with elasticity score and strain ratio. The respective sensitivities and specificities were as follows: elasticity score, 82% and 82%; strain ratio, 89% and 82%; hypoechogenicity, 78% and 55%; microcalcifications, 50% and 80%; irregular margins, 66% and 81%; absent halo sign, 56% and 57%; nodule vertical development, 46% and 77%; and intranodular vascularization, 40% and 61%. CONCLUSION: Evaluation of thyroid nodules with ultrasound elastography appears to be both more sensitive and specific than each of the ultrasound features. The former is a safe and effective technique that warrants further rigorous investigation or use in the clinical diagnosis of thyroid nodules.