Olgu Sunumu
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Diagnosis of Muscle Injuries by Point of Care Ultrasonography in Emergency Department: A Case Report

Yıl 2020, Cilt: 3 Sayı: 2, 58 - 61, 30.06.2020

Öz

Aim: In this case report, we describe a patient who presented with the complaint of walking difficulties to the emergency department and an ecchymosis on his leg, and found partial rupture in the semitendinosus muscle by bedside point of care ultrasonography.


Case Report: A 31-year-old male patient applied to the emergency department with complaints of pain and bruising on his left leg. It was learned from the anamnesis of the patient that he was a dancer, suddenly felt severe pain and burning in his left leg during a movement called "spagat position" during the dance show, and a bruise developed in the leg the next day. The patient also stated that he had increased pain during walking and had difficulty walking. In the physical examination of the patient, swelling, ecchymosis and palpation sensitivity were found in the region near the middle point on the back of the left leg, and the pain in the lesion area described during the abduction of the leg and knee was increased. Following obtaining verbal and written consent from the patient, bedside point of care ultrasonography was performed on the left leg of the patient by the emergency physician. The point of care ultrasonography examination revealed fluid collection compatible with hematoma between the left leg semitendinosus muscle fibers and partial rupture in the semitendinosus muscle. On the tenth day of the trauma, magnetic resonance images of the patient reported that a partial rupture was observed in the semitendinosus muscle, measuring antero-posterior diameter of 25 mm, covering more than 50% of the muscle, and hematoma in the rupture region was observed in the subacute period in the rupture region and fluid collection were observed in the rupture region.


Conclusion: Muscle injuries are among the common applications to the emergency department. Point of care ultrasonography can be used in the emergency department as an alternative imaging method for the evaluation, grading and treatment decision of hamstring muscle injuries.

Kaynakça

  • Svensson K, Alricsson M, Eckerman M, et al. The Correlation Between the Imaging Characteristics of Hamstring Injury and Time Required Before Returning to Sports: A Literature Review. J Exerc Rehabil. 2016;12(3):134-42.
  • Ernlund L, Vieira LA. Hamstring Injuries: Update Article. Rev Bras Ortop. 2017;52(4):373-382. Linklater JM, Hamilton B, Carmichael J, et al. Hamstring İnjuries: Anatomy, Imaging, and Intervention. Semin Musculoskelet Radiol. 2010;14(2):131-61
  • Orlandi D, Corazza A, Arcidiacono A, et al. Ultrasound-Guided Procedures To Treat Sport-Related Muscle Injuries. Br J Radiol. 2016;89(1057):20150484.
  • Draghi F, Zacchino M, Canepari M, et al. Muscle Injuries: Ultrasound Evaluation in the Acute Phase. Journal of Ultrasound 2013;16:209–214 DOI 10.1007/S40477-013-0019-8
  • Lee JC, Mitchell AWM, Healy JC. Imaging of muscle injury in the elite athlete. Br J Radiol. 2012;85(1016):1173-85
  • Kozaci N, Avci M, Ayhan G, et al. The Visualization Of A Foreign Body In A Patient's Subglottic Region Using Point-Of-Care Ultrasonography. Pediatr Emerg Care. 2019;35(9):659-660.
  • Kozaci N, Ay MO, Akcimen M, Turhan G, et al. Evaluation of The Effectiveness of Bedside Point-Of-Care Ultrasound in The Diagnosis And Management Of Distal Radius Fractures. Am J Emerg Med. 2015;33(1):67-71. Doi: 10.1016/J.Ajem.2014.10.022.
  • Kozaci N, Ay MO, Avci M, Beydilli I, et al. The Comparison Of Radiography and Point-Of-Care Ultrasonography in The Diagnosis And Management Of Metatarsal Fractures. Injury. 2017;48(2):542-547.
  • Maffulli N, Del Buono A, Oliva F, et al. Muscle Injuries: A Brief Guide To Classification And Management. Transl Med Unisa. 2015; 12: 14–18.
  • Flores DV, MejíaGómez C, Estrada-Castrillón M, et al. MR Imaging Of Muscle Trauma: Anatomy, Biomechanics, Pathophysiology, And Imaging Appearance. Radiographics. 2018;38(1):124-148.
  • Crema MD, Yamada AF, Guermazi A, et al. Imaging Techniques For Muscle Injury in Sports Medicine And Clinical Relevance. Curr Rev Musculoskelet Med. 2015 Jun; 8(2): 154–161.
  • Shah F, Patel H, Shah D, et al. Study Of 90 Cases of Pathology Involving Muscle and Tendon By Ultrasonography and Magnetic Resonance Imaging. BJR. 2015;2(4):107-121
  • Grassı A, Quaglı A, Canata GL, et al. An Update On The grading of Muscle Injuries: A Narrative Review From Clinical to Comprehensive Systems Joints 2016;4(1):39-46
  • Peetrons P. Ultrasound of muscles. Eur Radiol. 2002 Jan;12(1):35-43.

Acil Serviste Odaklanmış Kas-İskelet Ultrasonografisi ile Kas Yaralanmalarının Tanısı: Bir Olgu Sunumu

Yıl 2020, Cilt: 3 Sayı: 2, 58 - 61, 30.06.2020

Öz

Amaç: Bu sunumda, acil servise yürüme güçlüğü ve bacağında morluk şikâyeti ile başvuran, odaklanmış kas-iskelet ultrasonografisi ile semitendinosus kasında parsiyel rüptür saptanan bir olgu anlatılmıştır.


Olgu Sunumu: Otuz bir yaşında erkek hasta sol bacağında ağrı ve morarma şikâyeti ile acil servise başvurdu. Hastanın anamnezinden dansçı olduğu, dans gösterisi esnasında "spagat pozisyonu" ismi verilen bir hareket sırasında sol bacağında aniden şiddetli bir ağrı ve yanma hissettiği ve ertesi gün bacağında morluk oluştuğu öğrenildi. Hasta ayrıca, yürüme sırasında ağrısının arttığını ve bu yüzden yürümekte zorluk çektiğini ifade etti. Hastanın fizik muayenesinde sol bacak arka yüzünde orta noktaya yakın bölgede şişlik, ekimoz ve palpasyonda hassasiyet saptandı, bacak ve diz abduksiyonu esnasında tarif edilen lezyon bölgesinde hastanın ağrısı artıyordu. Hastadan sözel ve yazılı onam alındıktan sonra, hastanın sol bacağına acil hekimi tarafından odaklanmış kas-iskelet ultrasonografisi yapıldı. Odaklanmış kas-iskelet ultrasonografisi muayenesi ile sol bacak semitendinosus kas lifleri arasında hematom ile uyumlu sıvı koleksiyonu ve semitendinosus kasında parsiyel rüptür saptandı. Hastaya ait, travmanın onuncu günü manyetik rezonans görüntülerinde semitendinosus kasında antero-posterior çapı 25 mm olarak ölçülen ve kasın %50’sinden fazlasını kapsayan parsiyel rüptür izlendiği, rüptür bölgesinde 1 cm boyutlarında subakut dönemde hematom olduğu ve fasyalar arasında yer yer sıvı birikimleri gözlendiği raporlandı.


Sonuç: Sonuç olarak, hastalar kas yaralamaları ile acil servise sıklıkla başvurmaktadırlar. Odaklanmış kas-iskelet ultrasonografisi, semitendinosus kas yaralanmalarının değerlendirilmesi, derecelendirilmesi ve tedavi kararı için alternatif bir görüntüle yöntemi olarak acil serviste kullanılabilir. 

Kaynakça

  • Svensson K, Alricsson M, Eckerman M, et al. The Correlation Between the Imaging Characteristics of Hamstring Injury and Time Required Before Returning to Sports: A Literature Review. J Exerc Rehabil. 2016;12(3):134-42.
  • Ernlund L, Vieira LA. Hamstring Injuries: Update Article. Rev Bras Ortop. 2017;52(4):373-382. Linklater JM, Hamilton B, Carmichael J, et al. Hamstring İnjuries: Anatomy, Imaging, and Intervention. Semin Musculoskelet Radiol. 2010;14(2):131-61
  • Orlandi D, Corazza A, Arcidiacono A, et al. Ultrasound-Guided Procedures To Treat Sport-Related Muscle Injuries. Br J Radiol. 2016;89(1057):20150484.
  • Draghi F, Zacchino M, Canepari M, et al. Muscle Injuries: Ultrasound Evaluation in the Acute Phase. Journal of Ultrasound 2013;16:209–214 DOI 10.1007/S40477-013-0019-8
  • Lee JC, Mitchell AWM, Healy JC. Imaging of muscle injury in the elite athlete. Br J Radiol. 2012;85(1016):1173-85
  • Kozaci N, Avci M, Ayhan G, et al. The Visualization Of A Foreign Body In A Patient's Subglottic Region Using Point-Of-Care Ultrasonography. Pediatr Emerg Care. 2019;35(9):659-660.
  • Kozaci N, Ay MO, Akcimen M, Turhan G, et al. Evaluation of The Effectiveness of Bedside Point-Of-Care Ultrasound in The Diagnosis And Management Of Distal Radius Fractures. Am J Emerg Med. 2015;33(1):67-71. Doi: 10.1016/J.Ajem.2014.10.022.
  • Kozaci N, Ay MO, Avci M, Beydilli I, et al. The Comparison Of Radiography and Point-Of-Care Ultrasonography in The Diagnosis And Management Of Metatarsal Fractures. Injury. 2017;48(2):542-547.
  • Maffulli N, Del Buono A, Oliva F, et al. Muscle Injuries: A Brief Guide To Classification And Management. Transl Med Unisa. 2015; 12: 14–18.
  • Flores DV, MejíaGómez C, Estrada-Castrillón M, et al. MR Imaging Of Muscle Trauma: Anatomy, Biomechanics, Pathophysiology, And Imaging Appearance. Radiographics. 2018;38(1):124-148.
  • Crema MD, Yamada AF, Guermazi A, et al. Imaging Techniques For Muscle Injury in Sports Medicine And Clinical Relevance. Curr Rev Musculoskelet Med. 2015 Jun; 8(2): 154–161.
  • Shah F, Patel H, Shah D, et al. Study Of 90 Cases of Pathology Involving Muscle and Tendon By Ultrasonography and Magnetic Resonance Imaging. BJR. 2015;2(4):107-121
  • Grassı A, Quaglı A, Canata GL, et al. An Update On The grading of Muscle Injuries: A Narrative Review From Clinical to Comprehensive Systems Joints 2016;4(1):39-46
  • Peetrons P. Ultrasound of muscles. Eur Radiol. 2002 Jan;12(1):35-43.
Toplam 14 adet kaynakça vardır.

Ayrıntılar

Birincil Dil Türkçe
Konular Klinik Tıp Bilimleri
Bölüm Vaka Takdimi
Yazarlar

Nalan Kozacı 0000-0001-7758-3839

Mustafa Avcı 0000-0002-5018-9070

Yayımlanma Tarihi 30 Haziran 2020
Yayımlandığı Sayı Yıl 2020 Cilt: 3 Sayı: 2

Kaynak Göster

AMA Kozacı N, Avcı M. Acil Serviste Odaklanmış Kas-İskelet Ultrasonografisi ile Kas Yaralanmalarının Tanısı: Bir Olgu Sunumu. Anatolian J Emerg Med. Haziran 2020;3(2):58-61.