Search Results (40)

Primary hyperparathyroidism is commonly caused by parathyroid adenomas, hyperplasia, or, rarely, carcinoma. In up to 20% of cases, parathyroid tissue may be ectopic, often located in the mediastinum due to aberrant embryologic migration. Ectopic parathyroid glands pose a diagnostic and therapeutic challenge, and an accurate preoperative localization is essential for an effective and safe resection. Imaging modalities such as CT scan, TC-sestamibi scintigraphy, PET/CT, ultrasonography and MRI are routinely employed, whereas combined techniques offer improved diagnostic accuracy. Emerging approaches, however, including PET/CT with choline tracers, have shown promise in enhancing sensitivity in complex or recurrent cases. When ectopic glands are in the mediastinum, thoracic surgical intervention is required. Traditional open approaches, such as sternotomy or thoracotomy, are associated with significant morbidity. The development and evolution of minimally invasive surgery (MIS) has become the preferred approach in selected cases. When MIS is performed, intraoperative assessment and parathyroid identification are crucial to ensure complete gland removal. Intraoperative parathyroid hormone (ioPTH) monitoring provides real-time confirmation of surgical success. The integration of advanced imaging, intraoperative monitoring, and minimally invasive techniques significantly improves surgical outcomes while minimizing complications and accelerating patient recovery. Ultimately, the effective treatment of ectopic parathyroid glands relies on a personalized approach, adapting both diagnostic and surgical strategies to the unique anatomical and clinical context of each patient. Integration of advanced imaging, intraoperative monitoring, and minimally invasive techniques, combined with a multidisciplinary team involving endocrinologists, radiologists, and thoracic surgeons, is key to optimizing outcomes and reducing patient morbidity. Full article

Background: Ultrasonography is commonly employed during thoracic regional anesthesia; however, its accuracy can be affected by factors such as obesity and poor penetration through the rib window. Needle-sized ultrasound transducers, known as intra-needle ultrasound (INUS) transducers, have been developed to detect the pleura and fascia using a one-dimensional radio frequency mode ultrasound signal. In this study, we aimed to use time-frequency analysis to characterize the pleural signal and develop an automated tool to identify the pleura during medical procedures. Methods: We developed an INUS system and investigated the pleural signal it measured by establishing a phantom study, and an in vivo animal study. Signals from the pleura, endothoracic fascia, and intercostal muscles were analyzed. Additionally, we conducted time- and frequency-domain analyses of the pleural and alveolar signals. Results: We identified the unique characteristics of the pleura, including a flickering phenomenon, speckle-like patterns, and highly variable multi-band spectra in the ultrasound signal during the breathing cycle. These characteristics are likely due to the multiple reflections from the sliding visceral pleura and alveoli. This automated identification of the pleura can enhance the safety for thoracic regional anesthesia, particularly in difficult cases. Conclusions: The unique flickering pleural signal based on INUS can be processed by time-frequency domain analysis and further tracked by an auto-identification algorithm. This technique has potential applications in thoracic regional anesthesia and other interventions. However, further studies are required to validate this hypothesis. Key Points Summary: Question: How can the ultrasound pleural signal be distinguished from other tissues during breathing? Findings: The frequency domain analysis of the pleural ultrasound signal showed fast variant and multi-band characteristics. We suggest this is due to ultrasound distortion caused by the interface of multiple moving alveoli. The multiple ultrasonic reflections from the sliding pleura and alveoli returned in variable and multi-banded frequency. Meaning: The distinguished pleural signal can be used for the auto-identification of the pleura for further clinical respiration monitoring and safety during regional anesthesia. Glossary of Terms: intra-needle ultrasound (INUS); radio frequency (RF); short-time Fourier transform (STFT); intercostal nerve block (ICNB); paravertebral block (PVB); pulse repetition frequency (PRF). Full article

(1) Background: This study evaluated the quality of medical imaging acquired using radiography, ultrasonography, and computed tomography (CT) in canine cadavers prepared with formalin solution, Thiel solution (TS), and saturated salt solution (SS). Additionally, the duration whereby image quality could be properly reproduced was investigated. (2) Methods: Nine dog cadavers, divided into three groups per embalming solution, were imaged pre- and post-embalming at 6 and 12 weeks using three different imaging modalities. Image quality was qualitatively scored based on human medicine guidelines criteria. The score was assigned as follows: “0 = not invisible, 1 = poorly invisible, 2 = adequately reproduced, 3 = very well reproduced”. (3) Results: On plain radiography, most scores were > 1.34, although the quality of all embalming solutions in thoracic and abdominal images decreased over time. Using ultrasound to image the liver, spleen, and kidney, the SS group was evaluated as poorly visible and scored < 0.82 at 6 and 12 weeks. CT images showed a tendency to degrade over time, but all solution groups had properly implemented images and scored > 1.62. (4) Conclusions: Regarding image quality and ease of application, TS is considered the most suitable embalming solution for medical imaging acquisition and is usable over time in all imaging modalities. Full article

The respiratory health of preweaned calves is an important determinant of their health, welfare, and future performance. This prospective cohort study measured bovine respiratory disease (BRD) on 16 dairy farms, including 476 calves in South-west England. Wisconsin and California respiratory scoring and thoracic ultrasonography were performed repeatedly at 7 ± 0.89 day intervals (mean ± SD) at 0–56 days of age (n = 3344 examinations). Cases were localized to the upper or lower respiratory tract, or both, and classified as new, repeat, or chronic. Prevalence and incidence were calculated. Multivariate modeling of factors associated with repeated measurements was performed. Increasing age (OR = 1.05, 95% CI 1.04–1.06) and fecal score (Score 2, OR = 1.78, 95% CI 1.14–2.77) were associated with a lower odds of a healthy BRD subtype, whereas increasing serum total protein (OR = 0.97, 95% CI 0.96–0.99) was protective. Older (OR 1.08, 95% CI 1.06–1.09), male (OR 1.69, 95% CI 1.01–2.84) calves with elevated Wisconsin respiratory scores (≥5, OR 5.61, 95% CI 3.38–9.30) were more likely to have elevated thoracic ultrasound scores. BRD remains common in calves born in UK dairy herds, requiring precise identification and management if preweaning health is to be optimized. Full article

Thoracic point-of-care ultrasound (T-POCUS) has grown in popularity and usage in small animal emergencies and critical care settings due to its non-invasive nature, mobility, and ability to acquire images in real time. This review summarizes current understanding about T-POCUS in dogs and cats with respiratory illnesses, including normal thoracic ultrasonography appearance and numerous pathological situations. The basics of T-POCUS are covered, including equipment, scanning procedures, and picture settings. Practical applications in patients with respiratory distress are discussed, with an emphasis on pleural space abnormalities and lung diseases. Ultrasound results define pulmonary disorders such as pneumonia, atelectasis, cardiogenic and non-cardiogenic pulmonary edema, lung lobe torsion, pulmonary fibrosis, pulmonary thromboembolism, pulmonary neoplasms, and pulmonary bleeding. The evaluation focuses on T-POCUS diagnostic skills in a variety of clinical settings. Limitations and the need for more study to standardize techniques, establish agreed terminology, and create specialized educational routes are highlighted. Full article

Background/Objectives: Point-of-care lung ultrasonography (LUS) represents an accurate diagnostic tool in older patients with respiratory failure. The integration of LUS with ultrasonographic assessment of diaphragm thickness and excursion, right vastus lateralis (RVL) muscle thickness and cross-sectional area (CSA) could provide real-time information on frailty and sarcopenia. The primary aim of this proof-of-concept prospective study was to evaluate clinical correlates of thoracic, diaphragmatic, and muscular ultrasound to characterize the associations between frailty, respiratory failure, and sarcopenia in older patients hospitalized for acute respiratory complaints. Methods: Each of 52 participants (age median 84, IQR 80–89 years old) underwent integrated LUS, diaphragm and RVL ultrasound examination upon admission (T0) and after 72 h of hospitalization (T1). LUS score was used to estimate lung interstitial syndrome severity. Diaphragm excursion, thickness, RVL thickness and CSA were measured following a standardized protocol. Frailty was assessed with the PC-FI (Primary Care-Frailty Index). Results: All patients exhibited multifactorial causes of respiratory symptoms. The LUS score on T0 predicted 3-month rehospitalization. Frail patients exhibited higher LUS scores on T1. Diaphragm excursion on T0 was reduced in patients with COPD and heart failure and in those developing delirium during hospitalization. Diaphragm excursion on T1 was negatively associated with PC-FI. Diaphragm thickness, RVL thickness, and CSA exhibited a positive association with obesity. Right vastus lateralis CSA on T1, however, was also negatively associated with PC-FI. Conclusions: Integrated lung, diaphragm, and RVL ultrasound shows clinical correlations with several aspects of frailty that may help to improve the management of geriatric patients with respiratory illness. Full article

Thoracic ultrasonography (TUS) has emerged as a critical tool in the diagnosis and management of respiratory diseases in cattle, particularly bovine respiratory disease (BRD), which is one of the most economically significant health issues in feedyard operations. The objective of this review is to explore TUS in veterinary medicine, including the historical development, methodologies, and clinical applications for diagnosing and prognosing respiratory diseases. This review also emphasizes the importance of operator training, noting that even novice operators can achieve diagnostic consistency with proper instructions. Ultrasound was introduced in the mid-20th century for back-fat thickness measurements; TUS has evolved to offer a non-invasive, real-time imaging modality that allows for the detection of lung and pleural abnormalities such as consolidations, pleural effusions, and B-lines. These features are vital indicators of respiratory disease, and their early identification through TUS can significantly improve clinical outcomes. Compared to traditional diagnostic methods like auscultation or radiography, TUS provides superior accuracy in detecting both subclinical and advanced respiratory conditions, particularly in high-risk populations. Furthermore, TUS has demonstrated strong prognostic value, with studies showing that the extent of lung consolidation correlates with higher relapse risk, reduced growth performance, and increased mortality. Full article

Objective: This study aims to investigate the possible effects of gestational diabetes mellitus (GDM) on fetal heart structure and the relationship of this effect with maternal blood sugar control. Materials and Methods: In this cross-sectional study, 19 women with GDM at 24–36 weeks of gestation (case group) and 21 healthy pregnant women at the same weeks of gestation (control group) were examined. Fetal heart structure was evaluated by ultrasonography; interventricular septum (IVS) thickness, right and left ventricular sphericity indices, global sphericity index (GSI) and cardio-thoracic ratio were also measured. In addition, mothers’ HbA1c values (an indicator of blood sugar control) were recorded. Result: An increase in IVS thickness was observed in the fetuses of mothers with GDM. A more rounded trend was observed in the right ventricular structure, but this did not create a significant difference. No significant relationship was found between maternal blood sugar control and fetal heart structure. Conclusions: This study examined the effects of gestational diabetes on fetal cardiac morphology and the relationship of this effect with maternal glycemic control. Babies of mothers with GDM had a significantly thicker interventricular septum. A more rounded trend was detected in the right ventricular structure. However, this change was not found to be statistically significant. In addition, no significant correlation was found between maternal glycemic control and fetal cardiac morphology. Full article

Primary pulmonary sarcoma and mesothelioma are rare malignancies. The review article discusses the appearance of these tumors in B-mode ultrasound (US), color Doppler ultrasound and contrast-enhanced ultrasound (CEUS). In particular, the article is intended to inspire the examination of thoracic wall tumors and pleural masses with the possibilities of ultrasonography and to obtain histologically evaluable material using US or CEUS-guided sampling. Full article

Our study aimed to compare Bovine Respiratory Disease (BRD) morbidity, mortality, and growth in dairy and dairy beef cross-bred calves during the commingle period, 81–120 days of age, using two different BRD prevention strategies. The calves (n = 1799) were randomly assigned into groups: (1) Control (CON; received no vaccine or metaphylaxis); (2) Tulathromycin metaphylaxis (TUL; Increxxa^TM, Elanco Animal Health Inc., Greenfield, IN, USA); and (3) Mannheimia haemolytica vaccine (VACC; Nuplura^® PH, Elanco Animal Health Inc., Greenfield, IN, USA). Calves were individually weighed three times during the study to estimate average daily gain (ADG). Deep nasopharyngeal swabs, thoracic ultrasonography, health scores, and treatment records were collected during the study. Ultrasound and health score results were not different across treatments. In this study, the TUL group had a lower cumulative BRD incidence than CON. The cumulative incidence and 95% CI of BRD during the commingle period, 81–120 days of age for CON, TUL, and VACC were 0.43 (0.38 to 0.47), 0.36 (0.38 to 0.40), and 0.39 (0.35 to 0.43), respectively. The ADG for CON, TUL, and VACC were 0.25 ± 0.15, 0.32 ± 0.15, and 0.17 ± 0.15 kg, respectively. There was no difference among the treatment groups for ADG. Management and environmental conditions were variable at this operation throughout the study period and likely impacted the calves. Earlier interventions may be needed when the BRD incidence is elevated in high-risk calves. Full article

A 6-year-old castrated male mixed dog presented with a rapidly growing mass at the right chest wall two weeks after initial detection. A mesenchymal origin of the malignancy was suspected based on fine-needle aspiration. Computed tomography (CT) revealed that the mass originated from the right chest wall and protruded externally (6.74 × 5.51 × 4.13 cm³) and internally (1.82 × 1.69 × 1.50 cm³). The patient revisited the hospital because of breathing difficulties. Radiography confirmed pleural effusion, and ultrasonography-guided thoracocentesis was performed. The effusion was hemorrhagic, and microscopic evaluation showed no malignant cells. Before surgery, CT without anesthesia was performed to evaluate the status of the patient. The 7–10th ribs were en bloc resected at a 3-cm margin dorsally and ventrally, and two ribs cranially and caudally from the mass. After recovering the collapsed right middle lobe of the lung due to compression from the internal mass with positive-pressure ventilation, a 3D-printed bone model contoured titanium mesh was tied to each covering rib and surrounding muscles using 2-0 blue nylon and closed routinely. The thoracic cavity was successfully reconstructed, and no flail chest was observed. The patient was histo-pathologically diagnosed with extraskeletal osteosarcoma. A CT scan performed 8 months after surgery showed no evident recurrence, metastasis, or implant failure. This is the first case report of chest wall reconstruction using titanium mesh in a dog. The use of a titanium mesh allows for the reconstruction of extensive chest wall defects, regardless of location, without major postoperative complications. Full article

Background: Ultrasound is an attractive modality for the confirmation of sternal fractures in patients with trauma because of its easy, quick, and accurate nature, as well as its increased availability for focused assessment with sonography for trauma at the bedside. We aimed to confirm the diagnostic value of ultrasonography for sternal fractures in patients with trauma, anterior chest wall pain, and tenderness. Methods: This retrospective observational study included patients visiting a single regional trauma center from March 2022 to February 2023, diagnosed with sternal fractures via chest CT and bone scans, who underwent sternal ultrasound. Results: Twenty-six patients were divided into two groups: those with sternal fractures diagnosed with an initial chest CT scan (n = 19) and those without fractures (n = 7). Using ultrasound, 23 patients (88.5%) were diagnosed with sternal fractures. In the initial CT scan (+) group, all 19 patients (100%) were diagnosed using ultrasound. In the initial CT scan (−) group, four (57.1%) of the seven patients were diagnosed using ultrasound. In the initial CT scan (+) group, 14 (73.7%) of the 19 patients underwent bone scans and all 14/14 (100%) were diagnosed with sternal fractures. In the initial CT scan (−) group, seven (100%) patients underwent bone scans, and all were diagnosed with sternal fractures. Conclusions: Ultrasound is useful for the diagnosis of sternal fractures, with sensitivity of 88.5%. Therefore, in patients with blunt trauma experiencing anterior chest wall pain and tenderness, sternal ultrasonography might be helpful in diagnosing sternal fractures as an adjunct to chest CT and bone scans. Full article

This study evaluated the significance and predictive value of ultrasonographic and physical examination on arrival at an Austrian fattening farm. Treatment frequency and average daily weight gain (ADG) were related to physical and ultrasonographic examination results. Additionally, the effect of an intranasal vaccination in half of the examined calves was studied. The clinical and ultrasonographic health status 600 calves was recorded at the beginning and end of fattening. Half of the calves received an intranasal vaccination (Bovalto^® Respi Intranasal). Overall, 44.5% showed an abnormal respiratory scoring (RS) and 56.0% showed signs of respiratory diseases in transthoracic ultrasonography (TUS) at arrival on the farm. For both RS and TUS, a categorization between ILL and HEALTHY was conducted. Results showed lower ADG in ILL calves (RS median: 0.93 kg/d; TUS median: 0.96 kg/d) compared to HEALTHY calves (RS median: 1.01 kg/d; TUS median: 1.01 kg/d). The median ADG was lower in not treated and ILL calves (RS median 0.90 kg/d; TUS: 0.93 kg/d) compared to treated and ILL calves (RS median 1.01 kg/d; TUS: 1.02 kg/d). Vaccination did not affect growth performance or occurrence of ILL, though treatment frequency was lower in VAC calves (17.0% in NVAC; 11.3% in VAC). The implementation of examination protocols for respiratory diseases may have a positive impact on production parameters (e.g., treatment frequency and ADG). Full article

(1) Background: The aortic arch (AA) branching model is challenging, considering the multiple anatomical variations documented in existing research. The bovine aortic arch (BAA) is the most prevalent anatomical variation among these. This variant of AA branching has long been considered a nonsymptomatic malformation, having been discovered incidentally during imaging investigations for other causes. However, more recent studies have demonstrated that BAA shows a frequent association with coarctation of the aorta (CoA), thoracic aortic disease (TAD), and stroke. At the same time, given the current context of increasing activity in the fields of interventional and surgical procedures in the aorta and its branches, it is very important to know the medical–surgical implications of this anatomical variant. (2) Methods: We conducted a comprehensive review using PubMed and Embase, focusing specifically on randomized trials and cohort analyses that examined the medical–surgical implications of BAA. We assessed information related to studied groups, medical procedures, and study outcomes. Initially, we identified 8454 studies, and after rigorous evaluation, we narrowed down our review to 25 articles. (3) Discussions: The intervention consisted of assessing the risks associated with BAA through different imaging investigation methods such as computer tomographic angiography (CTA), magnetic resonance imaging (MRI), or ultrasonography (US). The following results were evaluated: the prevalence of the BAA, the importance of imaging investigations in establishing the diagnosis and the therapeutic management and monitoring the evolution of patients with the BAA, the association of the BAA with CoA, TAD, and stroke, and the potential risks of interventional treatment in patients with the BAA. (4) Conclusions: The prevalence of the BAA differs both between different ethnic groups and between genders. Advanced imaging methods such as CTA and 4D flow MRI allow detailed descriptions of supra-aortic vascular anatomy and information about blood flow velocities, direction, and turbulence in the AA. US remains an easy and valuable imaging investigation, with the potential to detect and correctly diagnose the BAA and its hemodynamic implications. Anatomical variations in the AA are associated with increased rates of TAD, CoA, and stroke, necessitating early diagnosis and increased supervision of patients with such incidentally observed abnormalities. In addition, there is a need to further develop and refine the surgical techniques used and personalize them to the individual characteristics of patients with the BAA. Full article

Background/Objectives: Chest X-ray (CXR) is currently the most used investigation for clinical follow-up after major noncardiac thoracic surgery. This study explores the use of lung ultrasound (LUS) as an alternative to CXR in the postoperative management of patients who undergo major thoracic procedures. Methods: The patients in our cohort were monitored with both a CXR and a lung ultrasonography after surgery and the day after chest drain removal. The LUS was performed by a member of the medical staff of our unit who was blinded to both the images and the radiologist’s report of the CXR. Findings were compared between the two methods. Results: In the immediate postoperative evaluation, 280 patients were compared, finding general agreement between the two procedures at 84% (kappa statistic, 0.603). The LUS showed a sensibility of 84.1%, a specificity of 84.3%, a positive predictive value (PPV) of 60.9%, and a negative predictive value (NPV) of 94.8%. We evaluated 219 out of 280 patients in the postdrainage-removal setting due to technical issues. Concordance between the methods in the postdrainage-removal setting was 89% (kappa statistic, 0.761) with the LUS demonstrating an 82.2% sensibility, a 93.2% specificity, a PPV of 85.7%, and an NPV of 91.3%. Conclusions: The results of this study showed a substantial agreement between LUS and CXR, suggesting that the LUS could reduce the number of X rays in certain conditions. The high NPV allows for the exclusion of PNX and pleural effusion without the need to expose patients to radiation. Discrepancies were noted in cases of mild pneumothorax or modest pleural effusion, without altering the clinical approach. Full article