This review sets forth an approach to performing and interpreting shoulder ultrasound in patients with prior rotator cuff repair and presents a comprehensive review of normal expected findings, postsurgical complications and common artifacts encountered in clinical practice.

RATIONALE AND OBJECTIVES:Biopsy of lung nodules in the lower lung fields can be difficult because of breathing motion. Ipsilateral phrenic nerve block (PNB) before biopsy should make the biopsy safer, easier, and more precisely targeted. We describe the use of ultrasound-guided PNB before lung nodule biopsy, including relevant anatomy and variations, complications, and technique, along with our first 40 cases. MATERIALS AND METHODS:We retrospectively reviewed patients who underwent PNB before computed tomography (CT)- or ultrasound-guided lung nodule biopsy from April 2015 through March 2020. Patient demographics, CT fluoroscopy time, radiation dose, complications, diagnostic yield, and effectiveness of PNB were recorded. Effectiveness of PNB was based on direct observation of diaphragmatic motion. Control group data for biopsies during the same time frame were collected and matched with nodules ≤1 cm from the PNB group. RESULTS:Among 40 patients identified, no complications occurred related to the PNB. Mean (SD) nodule size was 12.4 (6.2) mm. True-positive results were obtained in 39 patients (98%), with 1 false-negative after an ineffective PNB. PNB was effective in 70%. When CT fluoroscopy was used for the biopsy, radiation dose was significantly lower after an effective PNB than an ineffective PNB (p < .001). Effective PNB was significantly more common with injection of ≥4 mL of local anesthetic (p = .01). Comparison with 19 matched controls showed significantly fewer instances of pneumothorax (p = .02) and greater diagnostic success (p = .03) for the PNB group. CONCLUSION:Ultrasound-guided PNB is safe and effective and can improve outcomes when used before lung nodule biopsy.

Renal artery anastomosis peak systolic velocity (RAA PSV) exceeding 250 cm/s and a ratio of the renal artery to the adjacent external iliac artery (RAA:EIA) exceeding 1.8 historically suggest significant transplant renal artery stenosis (TRAS). However, the range of RAA PSV in transplants without TRAS has not been established.

Endometriosis is a common condition with significant morbidity, including pain and subfertility, which is often subject to a delay in diagnosis. Ultrasound has been successfully utilized, mostly outside North America, to preoperatively stage deep endometriosis, but in these international settings, imaging is typically performed solely by expert radiologists and gynecologists. We outline a method for detailed sonographic survey of the lower abdomen and pelvis to ensure optimum detection and communication of disease extent that is geared to radiologists practicing ultrasound in the United States, with the use of diagnostic medical sonographers.

Pancreatic pseudocyst is a relatively common occurrence resulting from acute or chronic pancreatitis. However, a rare subset of these patients present with a pseudocyst fistulizing into the portal vein. We present the case of a 58 year-old woman with a rapidly expanding pancreatic pseudocyst with portal venous fistulization causing portal vein thrombosis, in addition to biliary and duodenal obstruction. The patient underwent surgical decompression with a cyst-gastrostomy and was well until one week post-operatively when she experienced massive gastrointestinal hemorrhage leading to her death. A review of the literature is presented and a treatment algorithm to manage patients with pancreatic pseudocyst to portal vein fistula is proposed.

Allergic contact dermatitis caused by Eriodictyon parryi, better known as poodle-dog bush, is a growing cause of contact dermatitis in California. Blooming after a large fire, E parryi is a threat to reforestation workers as well as countless outdoor enthusiasts across the state. This paper focuses on the epidemiology, identification, immunochemistry, pathophysiology, prevention, and treatment of contact dermatitis from this little-researched plant.