Can you see inflammation ultrasound

Abdominal ultrasounds are safe procedures. The risk of any complications or adverse effects is very low in comparison with other types of medical imaging. The method offers a quick way to examine structures within the abdomen that can aid the diagnosis or monitoring of health conditions. In this article, we look at the types of hernia repair herniorrhaphy, hernioplasty , including when to see a doctor, and the risk factors involved. A bowel obstruction occurs when something blocks part of the small or large intestine.

This blockage can be a serious problem if it is left untreated…. Appendix cancer is very rare, and many people experience no symptoms in the early stages. Doctors often diagnose this cancer when it spreads to other…. Chemicals in the gallbladder or a nearby bile duct can solidify, forming a large stone or several small ones. In this article, learn about removal…. By inserting a scope into the vaginal…. What can we see with an abdominal ultrasound?

Medically reviewed by Saurabh Sethi, M. Purpose Procedure Risks Takeaway Abdominal ultrasounds use sound waves to create images of structures and blood flow in the abdomen. Share on Pinterest A doctor may recommend an abdominal ultrasound to diagnose the cause of abdominal pain. Share on Pinterest A technician will place gel on the abdomen before an ultrasound.

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Medically reviewed by Andrew Gonzalez, M. What is bowel obstruction? If the test results appear abnormal, your doctor may order further tests. In an emergency, the results of an ultrasound can be available quickly. Otherwise, they're usually ready in days. In most cases, results can't be given directly to the patient or family at the time of the test. No risks are associated with an abdominal ultrasound. Unlike X-rays, radiation isn't involved with this test.

Some younger children may be afraid of the machinery used for the ultrasound. Explaining in simple terms how the abdominal ultrasound will be conducted and why it's being done can help ease any fears. You can tell your child that the equipment takes pictures of the belly, and encourage him or her to ask the technician questions.

Tell your child to try to relax during the procedure, as tense muscles can make it more difficult to get accurate results. If you have questions about the abdominal ultrasound, speak with your doctor. You can also talk to the technician before the exam. Reviewed by: KidsHealth Medical Experts.

Larger text size Large text size Regular text size. What It Is An abdominal ultrasound is a safe and painless test that uses sound waves to make images of the abdomen belly. Why It's Done Doctors order an abdominal ultrasound when they're concerned about symptoms such as abdominal pain, repeated vomiting, abnormal liver or kidney function tests, or a swollen belly.

Ultrasound, a nonionizing imaging technique, is often preferred because many musculoskeletal structures can be examined, it can be performed at the point-of-care, and it can be used on patients for whom MRI is contraindicated.

In patients with inflammatory arthritis, ultrasound can detect important clues such as subclinical synovitis, asymptomatic entheseal inflammation, bone erosions, and crystal deposits, which could otherwise be missed in physical examinations [ 4 , 22 , 23 , 24 , 25 , 26 , 27 , 28 ]. Use of ultrasound in diagnostic decision making. This algorithm was developed by the authors and was not based on a clinical study. Ultrasound can be used to generate high-resolution images of joints, tendons, entheses, synovia, cartilage, bursae, bony cortex, nails, and soft-tissue vascularity.

Structures can be imaged in a dynamic, multiplanar fashion, allowing for visualization of synovial changes, joint effusions, tendon tears, and bone erosions [ 24 , 31 , 32 ]. Musculoskeletal ultrasound can be used to differentiate trauma-related injuries that can initially mimic arthritis, including muscle lesions, occult fractures, and tendon rupture or subluxation [ 28 ].

Power Doppler ultrasound PDUS imaging is used to assess soft tissue and nerve lesions, tissue vascularization, and hyperemia of synovial structures, tendons, and entheses [ 4 , 33 , 34 ].

The inability of ultrasound to penetrate bone surface and, hence, visualize bone structures is an important limitation to bear in mind, which may be addressed using correlative plain X-rays.

Additionally, only a small number of studies have examined how ultrasound should be integrated to the process of diagnosis for inflammatory arthritis. This manuscript provides an in-depth review of how ultrasound—a portable, convenient, noninvasive, and cost-effective imaging technique—can be used in the differential diagnosis of early inflammatory arthritis phenotypes Table 1 and also assesses any important limitations of the technique.

The authors also propose an algorithm Fig. Among the key features in diagnosing inflammatory arthritis is the presence of synovitis as well as the distribution of joints involved. In mild or early-onset inflammatory arthritis, it may be difficult to discern clinical synovitis. Similarly, mild tenosynovitis may not be clinically apparent. Synovitis is characterized on grayscale ultrasound by intra-articular tissue that is abnormally thickened, hypoechoic or anechoic relative to subdermal fat , nondisplaceable, and poorly compressible [ 26 ].

As synovial proliferation progresses, articular cartilage becomes disrupted, and erosions can be observed at the osteochondral junction [ 4 ]. Ultrasound imaging of synovitis and tenosynovitis.

MC, metacarpal. Tenosynovitis is characterized by hypoechoic or anechoic thickened tissue with or without fluid in the tendon sheath [ 26 ] and is not a specific lesion. Presence of synovial hypertrophy should prompt the use of PDUS or color Doppler to establish vascularity and, hence, inflammation of the tissue.

Doppler imaging findings need to be taken into context with the overall clinical picture, and the operator should recognize the pitfalls of false positive and false negative results. Doppler sensitivity can be gauged by the degree of vascularity of the distal finger pulp Fig. Thus, sonographic signs of synovitis should include both synovial hypertrophy and vascularity. The value of ultrasound in identifying subclinical synovitis has been demonstrated by finding synovitis in asymptomatic joints of patients with early oligoarthritis that led to the reclassification of oligoarthritis as polyarthritis for many patients [ 4 , 22 , 23 ].

Features of RA that can be visualized on ultrasound include rheumatoid nodules and synovial cysts, as well as common secondary complications, such as median nerve entrapment in the carpal tunnel [ 36 ]. Additionally, the distribution of joint involvement may help differentiate RA from PsA as, for example, synovitis of the distal interphalangeal joints is characteristic of PsA rather than RA [ 33 ].

Synovial hypertrophy in the finger joints of patients with RA can be particularly well characterized with ultrasound by comprehensively examining palmar and dorsal aspects of proximal interphalangeal and metacarpophalangeal joints. In RA, synovial hypertrophy is most often detected at the dorsal metacarpophalangeal joints and palmar aspect of the proximal interphalangeal joints [ 37 ].

However, if the diagnosis is in question, then both dorsal and palmar aspects should be examined to evaluate signs of tendonitis and palmar plate enthesitis. MRI studies of patients with dactylitis have shown increased signal at the palmar plate and there is some discussion that this may be a form of enthesitis [ 38 ].

In patients with early PsA, periarticular soft-tissue edema, metacarpophalangeal joint peri-extensor tenonitis, and proximal interphalangeal joint extensor tendon enthesitis were found more often [ 39 ]. Palmar plate inflammation Fig. Diffuse extensor paratenonitis and flexor tenosynovitis Fig. Ultrasound findings for differentiation of psoriatic arthritis from rheumatoid arthritis.

These features can serve as additional differentiating factors between early SpA and RA [ 24 , 39 ]. Paratenonitis defined as the lack of a sheath on the extensor tendon above the metacarpophalangeal joint with accompanying inflammatory changes to the extensor tendon consisting of increased thickness, loss of fibrillar architecture, and increased power Doppler signal may also be found in established RA [ 39 , 40 ].

Other reported dactylitic tissue changes visible by ultrasound include soft-tissue thickening or edema, osteoproliferation, and sesamoid abnormalities [ 42 ]. Although these sonographic features have been well documented in patients with clinically obvious dactylitis, their presence in a patient with early inflammatory arthritis may help differentiate early PsA from RA.

Imaging findings need to be correlated with clinical presentation and suspected differential diagnoses. For example, synovitis can be the result of lupus, gout, or osteoarthritis [ 27 , 43 , 44 , 45 ], but imaging findings can narrow the differential diagnoses considerably.

An important limitation is the awareness of findings in apparently normal populations. Further, because this was a cross-sectional study, it is not clear if these individuals had onset of early inflammatory arthritis. Thus, care needs to be exercised in interpreting imaging findings in patients with minimal symptoms and should be considered in the overall clinical context. Enthesitis is a hallmark clinical feature of SpA, especially PsA, and is observed less frequently in other inflammatory arthritides, such as RA.

Entheseal inflammation is often asymptomatic and may be overlooked on clinical examination [ 24 ]. Ultrasound examination has also been used to demonstrate that nail disease in PsA and psoriasis is associated with distal interphalangeal enthesopathy [ 48 ]. Sonography can depict not only echotexture changes such as loss of fibrillar echotexture and tendon thickening at the enthesis but also peri-entheseal Doppler signal.

It can also demonstrate pathologic changes in the adjacent tissues, such as proximal tendinopathy, bone erosions, and bursitis. In many cases, ultrasound can be used to visualize subclinical enthesitis that cannot be detected with physical examination [ 49 ].

Inactive or chronic enthesitis may manifest as tendon thickening, bulky enthesophytes, intratendinous calcification, and bone erosions [ 26 , 32 ]. Further, in PsA, the severity of sonographic enthesitis is associated with peripheral and axial joint damage [ 50 ].

Entheseal ultrasound assessment should include longitudinal and transverse scans with tendons in both neutral and flexed positions [ 25 ]. A flexed position may provide better visualization of grayscale abnormalities, but may create tension that diminishes a Doppler signal [ 51 ].

Although there is some controversy about which entheses should be evaluated by ultrasound when a diagnosis of SpA is suspected, inclusion of the Achilles tendon and selection of the knee quadriceps and patellar and plantar fascia entheses are typically recommended Fig. Assessment of Achilles entheses, however, should be approached with caution as age, body mass index, and regular physical exercise have all been associated with structural damage on ultrasound in PsA [ 53 ]. Ultrasound imaging of enthesitis.

AT, Achilles tendon; C, calcaneus. Left, Doppler with abnormal intratendinous signal; right, enthesophyte. A hallmark of inflammatory peripheral enthesitis seen with PDUS is vascularization at cortical bone insertion. Other groups, such as Group for Research and Assessment of Psoriasis and Psoriatic Arthritis GRAPPA ultrasound committee, have proposed scoring separately in proximal and distal entheses as well as bursa and to test the relative specificity of site-specific Doppler signals in subjects with and without enthesitis [ 55 ].

This will enable a data-driven approach to establishing the most sensitive and specific combination of findings associated with a diagnosis of spondyloarthritis at the patient level. Regardless, detection of any vascularized entheses by PDUS is a sensitive and specific characteristic for diagnosis of SpA [ 56 ].

Nearby structures should also be evaluated because adjacent bursitis and tendon calcification are commonly observed by ultrasound at sites of enthesitis [ 52 , 57 ]. While not used in routine clinical practice, ultrasound enthesitis scoring systems have been studied as tools for diagnostic classification of SpA [ 57 , 58 ]. However, age and body mass index are significantly correlated with GUESS and MASEI scores, and degenerative or mechanical abnormalities in weight-bearing joints may be incorrectly identified as inflammatory arthritis, especially in obese patients for whom excess weight puts added mechanical stress on lower limb entheses [ 15 , 60 , 61 ].

Recent literature has focused on examination of hand entheses to differentiate between early RA and PsA. Zabotti et al. However, extensor slip abnormalities can also be seen in patients with osteoarthritis [ 62 ] and RA [ 40 ]. Ultrasonic detection of bone erosions is more feasible in hand and toe joints than in bones with poor ultrasound windows, such as carpal and tarsal bones [ 4 ]. In a recent study, joint erosions were predominantly found in patients with RA Although the mere presence of ultrasound-detected erosions may not be specific for RA, larger erosions at the second and fifth metacarpophalangeal joints, fifth metatarsophalangeal joint, and distal ulna may sway the diagnosis towards RA [ 64 ].

Further, in patients with RA whose PDUS synovitis activity and clinical disease activity are well controlled, the detection of bone erosion with ultrasound after discontinuation of biologic disease-modifying antirheumatic drugs may be a risk factor for relapse [ 65 ].

Ultrasound imaging of bone erosions and crystal deposits. Distinguishing between bone erosions from physiologic cortical breaks that are not caused by inflammation is important.

Another source of false-positive findings are pseudo-erosions formed by osteophytes in forceps-like arrangements, which are common in patients with PsA and can make it difficult to visualize the cortical bone surface [ 63 ].

Ultrasound can uniquely demonstrate the differential chondrosynovial deposition of urate in comparison to intra-cartilaginous chondrocalcinosis Fig. Tophi within soft tissues and tendons can be identified as heterogeneous collections with hyperechoic dots, and frequently with anechoic rims [ 4 , 66 ]. These may be clinically undetectable and yet cause significant symptoms when involved in a flareup.

Careful examination of the symptomatic areas may help in detecting these deposits and thus assist in diagnosing a patient with episodic arthralgia. In calcium pyrophosphate dehydrate crystal deposition disease, tendon calcifications can also be observed as well as classical chondrocalcinosis in multiple joints [ 4 , 67 ].

OMERACT ultrasound definitions of calcium pyrophosphate dehydrate crystal deposition disease provided reliable results in the hyaline cartilage and fibrocartilage of the knee—the most frequently involved site in the disease—however, the definitions were not as reliable at other anatomical sites [ 68 ].

In a subsequent study which evaluated a wider range of anatomical locations, OMERACT ultrasound definitions of calcium pyrophosphate dehydrate crystal deposition disease were reliable for the triangular fibrocartilage of the wrist and the acromioclavicular joint [ 69 ].

As with other imaging modalities, the presence of chondrocalcinosis does not imply calcium pyrophosphate dehydrate crystal deposition disease and careful clinical correlation needs to occur. Ultrasound plays an active role in many procedures, including guided needle placement for the location and safe aspiration of synovial fluid to obtain a definitive crystal analysis [ 70 ].

Further, in addition to helping diagnose crystal deposits, ultrasound is sensitive to changes in gout and can be used to monitor tophus burden [ 71 ]. In older patients presenting with shoulder and hip pain, a diagnosis of PMR should be considered.

Ultrasound features that are suggestive of a differential diagnosis of PMR include bilateral subacromial and subdeltoid bursitis, long biceps tendon tenosynovitis, trochanteric bursitis, and glenohumeral and hip effusion [ 7 , 28 , 72 ]. A subsequent systematic literature review by Sakellariou and colleagues [ 73 ] found that bilateral shoulder bursitis on ultrasound had the highest specificity of any individual finding for diagnosis of PMR.

Negative serologic testing for rheumatoid factor or anticitrullinated protein antibodies can also help rule out a diagnosis of EORA [ 7 ]. With increasing availability of biologic therapies that target specific disease pathogenesis, it is more important than ever for clinicians to be able to differentiate between different types of inflammatory arthritis.