A 72-year-old man admitted to our hospital due to severe pain and drop hand in the left arm. MRI and CT of the head and neck at an outside hospital showed no abnormality. Neurological findings revealed distal weakness in the left upper extremity, vague pain between the radial aspect of the left hand and the middle of the digits 1–3, as well as brisk reflexes in the left extremities. Small masses were palpable in the posterior neck, the lower jaw, and the left neck. Clinically, left radial neuropathy and cervical radiculopathy were suspected. We performed ultrasound of the nerve roots, brachial plexus, and the radial nerve. There was a mass compressing the left brachial plexus from the caudolateral direction. Additionally, nerve swelling in the left arm was identified. Skin biopsy over the mass suggested metastatic adenocarcinoma. Chest CT scan showed a mass in the upper right lobe suggestive of a lung cancer. We concluded that the pain was due to radial neuropathy and upper and middle trunk disturbance of the left brachial plexopathy, of which neuromuscular ultrasound was useful in diagnosis.
Transthoracic ultrasonography suprasternal long axis view is a powerful tool for evaluating aortic arch lesions. It can be performed with ultrasound equipment in many facilities and can be repeated quickly at bedside or outpatients, without anesthesia and painless. It can also depict the aortic arch well. Transesophageal echocardiography (TEE) is highly necessary in patients with suspected aortogenic embolism, but there are some patients who cannot perform it. Transthoracic ultrasonography suprasternal long axis view can supplement some of the role of TEE. We could really evaluate a mobile aortic atheromatous plaque in a stroke patient who had right aortic arch using by this technique. Evaluation of aortic arch by transthoracic ultrasonography suprasternal long axis view is useful in embolic source search of cerebral embolism patients.
Transoral pharyngeal ultrasonography (TOPU) is a new ultrasound technique for otorhinolaryngology. TOPU is applicated from transoral carotid ultrasonography, and useful for delineation of pharyngeal lesions. Peritonsillar abscesses is well known as common disease in otorhinolaryngology, and often needed a puncture drainage of abscesses. This procedure usually is performed blindly into the inside of pharynx, thus, it has a risk of fatal complications and low success rate. TOPU-guided needle aspiration appears to be useful for safe drainage of peritonsillar abscesses. We report a case of peritonsillar abscess whom we performed puncture drainage with TOPU guiding.