SIÊU ÂM CƠ VÂN LY GIẢI [DO CHẤN THƯƠNG]

Sonographic appearance of rhabdomyolysis – a systematic review of the literature 

Łukasz Sein Anand, Wojciech Kosiak

Abstract 

Rhabdomyolysis is the process of striated muscle cell lysis, during which proteins and microelements such as myoglobin are released into the bloodstream. It is important to diagnose rhabdomyolysis as soon as possible and start the treatment according to severity, as it is a state that significantly increases the mortality of the patients. The current gold standard of rhabdomyolysis diagnosis is the creatine kinase plasma concentration test, but it can be also diagnosed with imaging techniques, such as ultrasound (US). This review aims to gather previously published information regarding sonographic appearance of rhabdomyolysis. We searched through PubMed and ScienceDirect databases for studies using designed queries. After the selection process we were left with 13 studies containing a description of US appearance of rhabdomyolysis confirmed with a CK plasma level test. Findings described in the majority of the cases were muscle thickening, ground glass opacity, traits of edema and anechoic areas. Other than these, there were several less often reported findings. As a conclusion, rhabdomyolysis seems to have its own US appearance, but for now it cannot be precisely specified and needs further research for clarification.

Keywords: ultrasonography; rhabdomyolysis; point-of-care

Rhabdomyolysis seems to have its own US appearance, mostly in a form of muscle thickening, ground glass opacity, traits of edema, anechoic areas and various less often reported lesions. Due to the small number of published cases the typical aspect of rhabdomyolysis is not clear and needs further research for clarification.

FDA relaxes rules on ultrasound in COVID-19

The FDA carved out a special section of the guidance for ultrasound systems, which have become useful in diagnosing patients with COVID-19. The agency said that because ultrasound scanners do not emit ionizing radiation, the FDA believes users can have "additional flexibility," with modifications allowed under the following circumstances:

• Modifications that would allow an ultrasound scanner to be used outside of the environment for which it is cleared, such as a general practitioner's office or a field hospital
• Changes that would enable the acquisition of images by healthcare practitioners who are not trained in sonography, under appropriate supervision
• The addition of lung scanning clinical applications, as long as labeling is included that is based on established practice guidelines, such as from the American Institute of Ultrasound in Medicine (AIUM)
• The availability of probes and machine settings that are suitable for lung scanning, such as probes at a frequency of 3 MHz and higher, and with linear, curvilinear, and phased-array technologies
• The use of a mechanical index (MI) < 1.4 as an indicator for potential biological effects on tissues containing gas bodies

The agency would frown on ultrasound modifications as follows:

• Changes that would result in an increase of the derated maximum acoustic output parameters
• Modifications that would exceed known safety limits in humans, such as a MI ≥ 1.4 for lung images
• Modifications that would allow lay users to acquire images without guidance of healthcare practitioners.