Validity, reliability and measurement error of quadriceps femoris muscle thickness obtained by ultrasound in healthy adults: a systematic review / Validade, confiabilidade e erro da medida da espessura muscular do quadríceps femoral obtida pela ultrassonografia em adultos saudáveis: uma revisão sistemática

Abstract Due to its low cost and operational simplicity, ultrasound has been used to monitor muscle thickness in laboratory environments, rehabilitation clinics, and sports clubs. However, it is necessary to determine the measurement's quality to infer whether the possible changes observed are derived from the treatment or the measurement error. Therefore, we performed a systematic review to determine the validity, reliability, and measurement error of quadriceps femoris muscle thickness obtained by ultrasound in healthy adults. A search was conducted in the Pubmed, Scopus, and Web of Science databases until April 2022. The study selection process was carried out by two independent researchers, with the presence of a third researcher in case of disagreements. Twenty-six studies were eligible for the review, being 4 of validity, 4 of reliability only, and 18 of reliability and measurement error. The intraclass correlation coefficient ranged from 0.60 to 0.99 in validity studies and from 0.44 to 0.99 in reliability studies. The typical error of measurement ranged from 0.01 to 0.47 cm, and the coefficient of variation was from 0.5 to 17.9%. Four studies received "very good" classification in all the risk of bias analysis criteria. Therefore, it is concluded that the quadriceps femoris muscle thickness obtained by ultrasound was shown to be valid, reliable, and to have low measurement errors in healthy adults. The weighted average of the relative error was 6.5%, less than typical increases in resistance training studies. The raters' experience and methodological care for repeated measurements were necessary to observe low measurement errors.

Resumo Devido ao baixo custo e simplicidade operacional, a ultrassonografia tem sido utilizada para monitorar a espessura muscular em ambientes laboratoriais, clínicas de reabilitação e clubes desportivos. Porém, é necessário determinar a qualidade da medida para inferir se as possíveis modificações observadas são decorrentes do tratamento ou do erro da medida. Portanto, realizamos uma revisão sistemática para determinar a validade, confiabilidade e erro da medida da espessura muscular do quadríceps femoral obtida pela ultrassonografia em adultos saudáveis. Foi realizada busca nas bases de dados Pubmed, Scopus e Web of Science até abril de 2022. O processo de seleção dos estudos foi realizado por dois pesquisadores independentes, com a presença de um terceiro pesquisador em caso de divergências. Vinte e seis estudos foram elegíveis para a revisão, sendo 4 de validade, 4 apenas de confiabilidade e 18 de confiabilidade e erro de medida. O coeficiente de correlação intraclasse variou de 0,60 a 0,99 em estudos de validade e 0,44 a 0,99 em estudos de confiabilidade. O erro típico da medida variou de 0,01 a 0,47 cm e o coeficiente de variação foi de 0,5 a 17,9%. Quatro estudos receberam classificação "muito bom" em todos os critérios na análise de risco de viés. Portanto, concluiu-se que a espessura muscular do quadríceps femoral obtida pela ultrassonografia se mostrou válida, confiável e com baixos erros de medida em adultos saudáveis. A média ponderada do erro relativo foi de 6,5%, menor do que os aumentos típicos em estudos de treinamento resistido. A experiência dos avaliadores e o cuidado metodológico com as medidas repetidas foram necessários para observar baixos erros de medida.

The Importance of Radiological Patterns and Small Airway Disease in Long-Term Follow-Up of Postacute COVID-19: A Preliminary Study.

Postacute COVID-19 has become a relevant public health problem, and radiological and pulmonary function tests are tools that help physicians in decision-making. The objectives of this study are to characterize the findings and patterns on a chest radiograph (CXR) and computed tomography (CT) that are most important in the postacute phase and to evaluate how these changes correlate with clinical data, spirometry, and impulse oscillometry (IOS). This was a retrospective study of 29 patients who underwent CXR, CT, spirometry, and IOS. The inclusion criteria were age >18 years and persistent respiratory symptoms after four weeks. The exclusion criteria were radiological exams with low technical quality and non-COVID-19 acute lung diseases. The inferential analysis was carried out with the chi-square (χ 2) or Fisher's exact test to evaluate the interrelationships between the clinical and COVID-19 variables according to spirometry, IOS, CT, and CXR. In our sample, 19 patients were women (65.5%). The predominance of abnormal spirometry was associated with CT's moderate/severe degree of involvement (p = 0.017; 69.2%, CI 95%: 44.1%-94.3%). There was no significant association between IOS and tomographic and radiographic parameters. A significant association was found between the classifications of the moderate/severe and normal/mild patterns on CT and CXRs (p = 0.003; 93.3%, CI 95%: 77.8%-100%). Patients with moderate/severe impairment on CXR were associated with a higher frequency of hospitalization (p = 0.033; 77.8%, CI 95%: 58.6%-97.0%) and had significantly more moderate/severe classifications in the acute phase than the subgroup with normal/mild impairment on CXR (p = 0.017; 88.9%, CI 95%: 74.4%-100%). In conclusion, the results of this study show that CXR is a relevant examination and may be used to detect nonspecific alterations during the follow-up of post-COVID-19 patients. Small airway disease is an important finding in postacute COVID-19 syndrome, and we postulate a connection between this pattern and the persistently low-level inflammatory state of the lung.

Ultrasonography as a diagnostic tool for Neural Pain in Leprosy.

Leprosy is still a prevalent disease in Brazil, representing 93% of all occurrences in the Americas. Leprosy neuropathy is one of the most worrying manifestations of the disease. Acute neuropathy usually occurs during reaction episodes and is called neuritis. Twenty-two leprosy patients were included in this study. These patients had neural pain associated with ulnar sensory neuropathy, with or without adjunct motor involvement. The neurological picture began within thirty days of the clinical evaluation. The patients underwent a nerve conduction study and the demyelinating findings confirmed the diagnosis of neuritis. Ultrasonographic study (US) of the ulnar nerve was performed in all patients by a radiologist who was blinded to the clinical or neurophysiological results. Morphological characteristics of the ulnar nerve were analyzed, such as echogenicity, fascicular pattern, transverse cross-sectional area (CSA), aspect of the epineurium, as well as their anatomical relationships. The volume of selected muscles referring to the ulnar nerve, as well as their echogenicity, was also examined. Based on this analysis, patients with increased ulnar nerve CSA associated with loss of fascicular pattern, epineurium hyperechogenicity and presence of power Doppler flow were classified as neuritis. Therefore, patients initially classified by the clinical-electrophysiological criteria were reclassified by the imaging criteria pre-established in this study as with and without neuritis. Loss of fascicular pattern and flow detection on power Doppler showed to be significant morphological features in the detection of neuritis. In 38.5% of patients without clinical or neurophysiological findings of neuritis, US identified power Doppler flow and loss of fascicular pattern. The US is a method of high resolution and portability, and its low cost means that it could be used as an auxiliary tool in the diagnosis of neuritis and its treatment, especially in basic health units.

Chikungunya Fever: Comparison Study of Synovitis and Tenosynovitis of the Hands and Wrists Using Physical Examination, Ultrasound, and MRI Findings.

OBJECTIVES: To compare musculoskeletal changes on a physical examination (PE), ultrasound (US) and magnetic resonance imaging (MRI) of the hands and wrists of patients with Chikungunya fever (CF). METHODS: The sample consisted of 30 patients in the chronic phase of CF. The sites analyzed were the interphalangeal (IP), metacarpophalangeal (MCP) and wrist/mediocarpal (WMC) joints and periarticular soft tissue. The interval between the PE and imaging tests was 7 days, and the interval between US and MRI was 2 days. The kappa coefficient was calculated to estimate the agreement between the PE and US and MRI findings and between the US and MRI findings. RESULTS: Significant agreement was observed between PE and US in the diagnosis of synovitis. The only statistically significant agreement between US and MRI was the finding of flexor tenosynovitis; the agreement was moderate. CONCLUSIONS: US has great potential for use in diagnosing synovitis suspected based on a PE. The limited agreement observed between US and MRI, in turn, may suggest a complementary role of these methods.

An emergency system for monitoring pulse oximetry, peak expiratory flow, and body temperature of patients with COVID-19 at home: Development and preliminary application.

BACKGROUND: COVID-19 is characterized by a rapid change in the patient's condition, with major changes occurring over a few days. We aimed to develop and evaluate an emergency system for monitoring patients with COVID-19, which may be useful in hospitals where more severe patients stay in their homes. METHODOLOGY/PRINCIPAL FINDINGS: The system consists of the home-based patient unit, which is set up around the patient and the hospital unit, which enables the medical staff to telemonitor the patient's condition and help to send medical recommendations. The home unit allows the data transmission from the patient to the hospital, which is performed using a cell phone application. The hospital unit includes a virtual instrument developed in LabVIEW® environment that can provide a real-time monitoring of the oxygen saturation (SpO2), beats per minute (BPM), body temperature (BT), and peak expiratory flow (PEF). Abnormal events may be fast and automatically identified. After the design details are described, the system is validated by a 30-day home monitoring study in 12 controls and 12 patients with COVID-19 presenting asymptomatic to mild disease. Patients presented reduced SpO2 (p<0.0001) and increased BPM values (p<0.0001). Three patients (25%) presented PEF values between 50 and 80% of the predicted. Three of the 12 monitored patients presented events of desaturation (SpO2<92%). The experimental results were in close agreement with the involved pathophysiology, providing clear evidence that the proposed system can be a useful tool for the remote monitoring of patients with COVID-19. CONCLUSIONS: An emergency system for home monitoring of patients with COVID-19 was developed in the current study. The proposed system allowed us to quickly respond to early abnormalities in these patients. This system may contribute to conserving hospital resources for those most in need while simultaneously enabling early recognition of patients under acute deterioration, requiring urgent assessment.

Chest computed tomography in COVID-19 pneumonia: a retrospective study of 155 patients at a university hospital in Rio de Janeiro, Brazil.

OBJECTIVE: To define diagnostic criteria for coronavirus disease 2019 (COVID-19) on computed tomography (CT); to study the correlation between CT and polymerase chain reaction (PCR) testing for infection with severe acute respiratory syndrome coronavirus 2; and to determine whether the extent of parenchymal involvement and the need for mechanical ventilation are associated with the CT findings and clinical characteristics of patients with COVID-19. MATERIALS AND METHODS: This was a retrospective study of 155 patients with COVID-19 treated between March and May 2020. We attempted to determine whether the CT findings correlated with age and clinical variables, as well as whether the need for mechanical ventilation correlated with the extent of the pulmonary involvement. RESULTS: On average, the patients with COVID-19 were older than were those without (mean age, 54.8 years vs. 45.5 years; p = 0.031). The most common CT finding (seen in 88.6%) was ground-glass opacity, which correlated significantly with a diagnosis of COVID-19 (p = 0.0001). The CT findings that correlated most strongly with the need for mechanical ventilation were parenchymal bands (p = 0.013), bronchial ectasia (p = 0.046), and peribronchovascular consolidations (p = 0.012). The presence of one or more comorbidities correlated significantly with more extensive parenchymal involvement (p = 0.023). For the diagnosis of COVID-19, CT had a sensitivity of 84.3%, a specificity of 36.7%, and an accuracy of 73.5% (p = 0.012 vs. PCR). CONCLUSION: The patterns of CT findings are useful for the diagnosis of COVID-19 and the evaluation of disease severity criteria. The presence of any comorbidity is associated with greater severity of COVID-19.

OBJETIVO: Definir os critérios diagnósticos da COVID-19 na tomografia computadorizada (TC), estudar a concordância entre a TC e o PCR e determinar a associação da extensão do envolvimento parenquimatoso e ventilação mecânica com os achados tomográficos e características clínicas da amostra. MATERIAIS E MÉTODOS: Estudo de 155 pacientes com COVID-19 atendidos entre março e maio de 2020. Tentamos determinar se os achados da TC se correlacionavam com a idade e variáveis clínicas, bem como se a necessidade de ventilação mecânica se correlacionava com a extensão do envolvimento pulmonar. RESULTADOS: A faixa etária dos pacientes com COVID-19 (54,8 anos) foi maior do que a dos pacientes sem a doença (45,5 anos) (p = 0,031). Opacidades em vidro fosco foram as alterações mais frequentes (88,6%; p = 0,0001). Bandas parenquimatosas (p = 0,013), ectasia brônquica (p = 0,046) e consolidações peribroncovasculares (p = 0,012) foram mais frequentes nos pacientes que necessitaram de ventilação mecânica. Pacientes com comorbidades apresentaram envolvimento parenquimatoso mais extenso (p = 0,023). A TC apresentou sensibilidade de 84,3%, especificidade de 36,7% e acurácia de 73,5% (p = 0,012). CONCLUSÃO: Os padrões de TC são úteis para o diagnóstico de COVID-19 e avaliação dos critérios de gravidade da doença. Pacientes com comorbidades estão associados a condições clínicas mais graves.

Chest computed tomography in COVID-19 pneumonia: a retrospective study of 155 patients at a university hospital in Rio de Janeiro, Brazil / Tomografia computadorizada de tórax na pneumonia por COVID-19: estudo retrospectivo de 155 pacientes em um hospital universitário no Rio de Janeiro, Brasil

Abstract Objective: To define diagnostic criteria for coronavirus disease 2019 (COVID-19) on computed tomography (CT); to study the correlation between CT and polymerase chain reaction (PCR) testing for infection with severe acute respiratory syndrome coronavirus 2; and to determine whether the extent of parenchymal involvement and the need for mechanical ventilation are associated with the CT findings and clinical characteristics of patients with COVID-19. Materials and Methods: This was a retrospective study of 155 patients with COVID-19 treated between March and May 2020. We attempted to determine whether the CT findings correlated with age and clinical variables, as well as whether the need for mechanical ventilation correlated with the extent of the pulmonary involvement. Results: On average, the patients with COVID-19 were older than were those without (mean age, 54.8 years vs. 45.5 years; p = 0.031). The most common CT finding (seen in 88.6%) was ground-glass opacity, which correlated significantly with a diagnosis of COVID-19 (p = 0.0001). The CT findings that correlated most strongly with the need for mechanical ventilation were parenchymal bands (p = 0.013), bronchial ectasia (p = 0.046), and peribronchovascular consolidations (p = 0.012). The presence of one or more comorbidities correlated significantly with more extensive parenchymal involvement (p = 0.023). For the diagnosis of COVID-19, CT had a sensitivity of 84.3%, a specificity of 36.7%, and an accuracy of 73.5% (p = 0.012 vs. PCR). Conclusion: The patterns of CT findings are useful for the diagnosis of COVID-19 and the evaluation of disease severity criteria. The presence of any comorbidity is associated with greater severity of COVID-19.

Resumo Objetivo: Definir os critérios diagnósticos da COVID-19 na tomografia computadorizada (TC), estudar a concordância entre a TC e o PCR e determinar a associação da extensão do envolvimento parenquimatoso e ventilação mecânica com os achados tomográficos e características clínicas da amostra. Materiais e Métodos: Estudo de 155 pacientes com COVID-19 atendidos entre março e maio de 2020. Tentamos determinar se os achados da TC se correlacionavam com a idade e variáveis clínicas, bem como se a necessidade de ventilação mecânica se correlacionava com a extensão do envolvimento pulmonar. Resultados: A faixa etária dos pacientes com COVID-19 (54,8 anos) foi maior do que a dos pacientes sem a doença (45,5 anos) (p = 0,031). Opacidades em vidro fosco foram as alterações mais frequentes (88,6%; p = 0,0001). Bandas parenquimatosas (p = 0,013), ectasia brônquica (p = 0,046) e consolidações peribroncovasculares (p = 0,012) foram mais frequentes nos pacientes que necessitaram de ventilação mecânica. Pacientes com comorbidades apresentaram envolvimento parenquimatoso mais extenso (p = 0,023). A TC apresentou sensibilidade de 84,3%, especificidade de 36,7% e acurácia de 73,5% (p = 0,012). Conclusão: Os padrões de TC são úteis para o diagnóstico de COVID-19 e avaliação dos critérios de gravidade da doença. Pacientes com comorbidades estão associados a condições clínicas mais graves.

Comparison Between Lung Ultrasound and Computed Tomographic Findings in Patients With COVID-19 Pneumonia.

OBJECTIVES: The aim of this study was to describe findings from lung ultrasound (LUS) and computed tomography (CT) in health professionals with coronavirus disease 2019 pneumonia and to evaluate the associations of the findings of both tests. METHODS: This cross-sectional observational study evaluated 45 health professionals who were initially seen in screening tents and had a diagnosis of coronavirus disease 2019 as confirmed by a reverse transcription polymerase chain reaction and lung involvement diagnosed by LUS. Subsequently, these individuals were admitted to the hospital, where chest CT was performed. Aeration scores were obtained for the LUS examinations based on the following findings: more than 2 B-lines, coalescent B-lines, and subpleural consolidations. A subjective assessment of the extent of lung disease on CT was performed on the basis of the percentage of lung parenchyma involvement as follows: 25% or less, 25% to 50%, and greater than 50%. RESULTS: Regarding LUS signs, more than 2 B-lines, coalescent B-lines, and subpleural consolidations were present in 73.3%, 68.2%, and 24.4% of cases, respectively. The main findings on CT were ground glass opacities, a crazy-paving pattern, and consolidations (66.7%, 20%, and 20% of cases); 17.8% of cases had examinations without abnormalities. Patients with more than 2 B-lines on LUS had more ground glass opacity areas on CT (P = .0007), whereas patients with subpleural consolidations on LUS had more consolidations on CT (P < .0001). In addition, patients with higher LUS aeration scores had more extensive disease on CT (P < .0001). CONCLUSIONS: Lung ultrasound can detect lung injury even in the presence of normal CT results. There are associations between the abnormalities detected by both methods, and a relationship also exists between LUS aeration scores and the disease extent on CT.

Diaphragm ultrasonography in adults with sickle cell anemia: evaluation of morphological and functional aspects.

OBJECTIVES: To assess morphological and functional aspects of the diaphragm by ultrasonography (US) in adults with sickle cell anemia (SCA) and evaluate if the diaphragmatic musculature can play a role in changes found in pulmonary function tests (PFTs) of these patients. METHODS: This is a cross-sectional observational and single-center study involving 40 adults with SCA who underwent diaphragm US and PFTs with a maximum of 1 month between the two tests. Diaphragm US was performed in B and M modes, and echogenicity, thickness and movement of the muscle was assessed in different respiratory maneuvers. RESULTS: Diaphragms had preserved echogenicity and the thickness was not significantly different between the groups. The SCA group exhibited significantly higher movement of the right hemidiaphragm during deep breathing (p = 0.004) and the sniff test (p = 0.0008) and lower movement of the left hemidiaphragm during quiet breathing (p = 0.009). There was a predominance of restrictive pattern (65%) and a global reduction in respiratory muscle strength (RMS) (70%). CONCLUSIONS: This study shows that adults with SCA had normal morphostructural aspects and absence of diaphragm dysfunction. Otherwise, they presented greater movement of the right hemidiaphragm during deep breathing and sniff test maneuvers. Despite the restrictive pattern and the reduction in RMS found in PFTs, the diaphragm of young adults with SCA did not have weakness or paralysis.

Clinical and epidemiological characteristics of M. kansasii pulmonary infections from Rio de Janeiro, Brazil, between 2006 and 2016. / Características clínicas e epidemiológicas de casos de infecção pulmonar por Mycobacterium kansasii no Rio de Janeiro, no período de 2006 a 2016.

Objective To evaluate clinical, tomographic, and microbiological characteristics of pulmonary disease caused by M. kansasii (MKPD) in patients treated at an outpatient unit from 2006-2016. Methods We studied thirty eight patients, and analyzed socio-demographic, clinical-radiological, laboratory, and therapeutic characteristics. Results The mean age was 64 years (SD = 10.6; IIQ = 57-72; median = 65.0), and 22 (57.9%) male patients. Pulmonary comorbidity was present in 89.5% of the patients. The most frequent comorbidity was bronchiectasis (78.9%). Previous treatment for pulmonary tuberculosis (PTB) was found in 65.9%. The most used therapeutic regimen was rifampicin, isoniazid and ethambutol (44.7%). Chest tomography (CT) showed bronchiectasis (94.1%), architectural distortion (76.5%), septum thickening (67.6%), and cavities (64.7%). Disease was bilateral in 85.2%. We observed 10.7% resistance to rifampicin, 67.9% resistance to ethambutol, and sensitivity to clarithromycin. Conclusion In patients with structural lung disease, it is important to search for NTM, the main differential diagnosis with PTB. Chest CT showed different patterns that overlapped with structural disease caused by PTB or other lung diseases. We observed resistance to ethambutol, a drug component of the recommended regimen.

Pulmonary Densitovolumetry Using Computed Tomography in Patients with Nontuberculous Mycobacteria: Correlation with Pulmonary Function Tests.

BACKGROUND: Since nontuberculous mycobacterial pulmonary disease (NTM-PD) is a condition with increasing morbidity, a more detailed knowledge of radiological aspects and pulmonary function plays a relevant role in the diagnosis and appropriate therapeutic management of these patients. OBJECTIVES: The purpose of this study was to evaluate changes in lung parenchyma through computed tomography (CT) densitometry and, secondarily, to analyze its correlation with pulmonary function testing (PFT) in patients with NTM-PD. METHODS: This is a cross-sectional study in which 31 patients with NTM-PD and 27 controls matched by sex, age, and body mass index underwent CT pulmonary densitovolumetry and pulmonary function tests including spirometry and body plethysmograph. RESULTS: Based on the total lung volume (TLV) and total lung mass (TLM) measurements, the cumulative mass ratios were calculated for 3% (M3), 15% (M15), 85% (M85), and 97% (M97) of the TLV. We also calculated the complement, which is represented by TLM (100%) minus the mass of 15% (C85) or 3% (C97) of the TLV. Patients with NTM-PD presented lower values of M3 and M15 than controls, with greater significant differences in the apical third and middle third measurements. Compared to controls, patients with NTM-PD showed higher values of C85 and C97, although significant differences were observed only in the basal third measurements. There were negative correlations of total lung capacity with M3 and M15 in the middle third and apical third measurements. There were positive correlations of residual volume and airway resistance with M3 at the apical third measurement. CONCLUSIONS: Patients with NTM-PD show reduced lung mass and increased lung mass in the apical and basal regions of the lungs, respectively. Furthermore, there is a relationship between lung mass measurements and pulmonary function parameters.

The Role of Multidetector Computed Tomography and the Forced Oscillation Technique in Assessing Lung Damage in Adults With Cystic Fibrosis.

BACKGROUND: With increased survival rates and the consequent emergence of an adult population with cystic fibrosis (CF), developing novel tools for periodic evaluations of these patients has become a new challenge. Thus, we sought to determine the contribution of lung-volume quantification using multidetector computed tomography (CT) in adults with CF and to investigate the association between structural changes and functional abnormalities. METHODS: This was a cross-sectional study in which 21 adults with CF and 22 control subjects underwent lung-volume quantification using multidetector CT. Voxel densities were divided into 4 bands: -1,000 to -900 Hounsfield units (HU) (hyperaerated region), -900 to -500 HU (normally aerated region), -500 to -100 HU (poorly aerated region), and -100 to 100 HU (non-aerated region). In addition, all participants performed pulmonary function tests including spirometry, body plethysmography, diffusion capacity for carbon monoxide, and the forced oscillation technique. RESULTS: Adults with CF had more non-aerated regions and poorly aerated regions with lung-volume quantification using multidetector CT than controls. Despite these abnormalities, total lung volume measured by lung-volume quantification using multidetector CT did not differ between subjects and controls. Total lung capacity (TLC) measured by body plethysmography correlated with both total lung volume (rs = 0.71, P < .001) and total air volume (rs = 0.71, P < .001) as measured with lung-volume quantification using multidetector CT. While the hyperaerated regions correlated with the functional markers of gas retention in the lungs (increased residual volume (RV) and RV/TLC ratio), the poorly aerated regions correlated with the resistive parameters measured by the forced oscillation technique (increased intercept resistance and mean resistance). We also observed a correlation between normally aerated regions and highest pulmonary diffusion values (rs = 0.68, P < .001). CONCLUSIONS: In adults with CF, lung-volume quantification using multidetector CT can destimate the lung volumes of compartments with different densities and determine the aerated and non-aerated contents of the lungs; furthermore, lung-volume quantification using multidetector CT is clearly related to pulmonary function parameters.

Ultrasonography of Hands and Wrists in the Diagnosis of Complications of Chikungunya Fever.

The purpose of this series was to describe the ultrasonographic and radiographic manifestations of changes to the hands and wrists in 50 patients with chronic musculoskeletal symptoms secondary to Chikungunya fever during the 2016 outbreak that occurred in Rio de Janeiro, Brazil. Most of the plain radiographs were normal (62%). The most common ultrasonographic findings were small joint synovitis (84%), wrist synovitis (74%), finger tenosynovitis (70%), and cellulitis (50%). In most cases, power Doppler did not show an increase in synovial vascular flow. The plain radiographs showed no specific findings, whereas the ultrasound images revealed synovial compromise and neural thickening.

Ultrasound of ankles in the diagnosis of complications of chikungunya fever.

OBJECTIVE: To describe the main ultrasound findings of chikungunya fever in the ankle. MATERIALS AND METHODS: This was a cross-sectional observational study involving 52 patients referred to the Hospital Universitário Pedro Ernesto and presenting with clinical and biochemical evidence of chikungunya fever. The examinations were performed by a radiologist with more than 20 years of experience in ultrasound. RESULTS: The predominant gender was female (in 88.5%), and the mean age was 58.4 years. The majority (61.5%) of the patients came from the northern part of the city of Rio de Janeiro, and 46.2% were using corticosteroids to treat inflammatory symptoms. The most common alterations observed by ultrasound were joint effusion (in 69.2%), tenosynovitis (in 59.6%), cellulitis (in 46.2%), Kager's fat pad thickening (in 29.9%), myositis (of the soleus or flexor hallucis longus muscle) (in 17.3%), retrocalcaneal bursitis (in 5.8%), tendon ruptures (in 3.8%), and increased vascular flow on power Doppler (in 3.8%). CONCLUSION: Signs of synovitis and tenosynovitis were the main ultrasound findings in a predominantly female population with a mean age of 58.4 years. Further studies are needed in order to define the role of ultrasound in the follow-up of such patients.

OBJETIVO: Descrever os principais achados ultrassonográficos da febre chikungunya no tornozelo. MATERIAIS E MÉTODOS: Estudo transversal e observacional com 52 pacientes encaminhados ao Hospital Universitário Pedro Ernesto com quadros clínico e laboratorial compatíveis com febre chikungunya. Os exames foram realizados por um radiologista com mais de 20 anos de experiência no método. RESULTADOS: Houve predomínio do sexo feminino (88,5%) e média de idade dos pacientes de 58,4 anos. A maioria dos doentes (61,5%) era proveniente da zona norte da cidade do Rio de Janeiro e fazia uso de esteroides (46,2%) para o tratamento dos sintomas inflamatórios. As alterações ultrassonográficas mais comuns foram: derrame articular (69,2%), tenossinovites (59,6%), celulite (46,2%), espessamento da gordura de Kager (29,9%), miosite (sóleo e/ou flexor longo do hálux) (17,3%), bursite retrocalcânea (5,8%), roturas tendíneas (3,8%) e hiperfluxo vascular pelo Doppler de amplitude (3,8%). CONCLUSÃO: Predominaram os sinais ultrassonográficos de sinovite e tenossinovite numa população majoritariamente do sexo feminino e com idade média de 58,4 anos. Sugere-se a realização de outros estudos para definição do papel da ultrassonografia no acompanhamento desses doentes.