Sternocleidomastoid ultrasonography data for muscular torticollis in infants.

INTRODUCTION: This study was performed to obtain normative ultrasonographic data of the sternocleidomastoid (SCM) muscle in infants and to describe an ultrasound method for evaluating muscular torticollis. METHODS: The thickness and cross-sectional area (CSA) of the sternal and clavicular heads of the SCM in 84 subjects were analyzed retrospectively. The diagnostic performance of ultrasonography (US) was estimated using receiver-operating characteristic analysis. RESULTS: Muscle thickness increased with age until 10 months. There were no significant differences in thickness or CSA between the right and left sides (P > 0.05) in normal subjects. A ratio of the thickness of the affected side to the unaffected side for the sternal head of the SCM muscle of >1.19 showed a diagnostic sensitivity of 97.9% and specificity of 96.4%. CONCLUSIONS: Distinguishing the heads of the SCM muscle and comparing the thickness of the same head on both sides using US may be helpful for evaluating torticollis in infants.

Multivessel thromboembolism associated with dysfunction of protein s.

Protein S is a vitamin K-dependent coagulation factor that acts as an anticoagulant. Deficiency of protein S increases the risk of thromboembolic events. We report a case of isolated protein S deficiency in a 39-year-old woman suffering arterial occlusion in both lower legs. She underwent a surgical procedure using thrombectomy and balloon angioplasty of her left lower extremity. Later, she had right trans-tibial amputation because of the reperfusion injury. Throughout the evaluation of thromboembolic events, we diagnosed a large thrombus in the right atrium and an asymptomatic pulmonary thromboembolism. The patient was successfully treated with right atrial thrombectomy and systemic anticoagulation. Careful evaluation for protein S levels may be necessary in patients with arterial thromboembolic events, especially young adults.