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Johnson CD, Shah SS, Wallace E, Ahuja C. Renal Ewing sarcoma with extensive metastasis diagnosed via pulmonary thrombus. BMJ Case Rep 2024; 17:e263370. [PMID: 40017418 DOI: 10.1136/bcr-2024-263370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2025] Open
Abstract
Primary Ewing sarcoma of the kidney (ESK) is a rare and aggressive malignancy often misdiagnosed as renal cell carcinoma (RCC) due to non-specific radiological features. Accurate diagnosis requires histology, immunohistochemistry (IHC) and molecular studies. We report the case of a female in her 20s presenting with abdominal pain, haematuria and weight loss, initially diagnosed with RCC. Imaging revealed a large renal mass and pulmonary embolus. Mechanical thrombectomy (MT) was performed, and biopsy of the pulmonary thrombus confirmed metastatic ESK through IHC and next-generation sequencing, identifying the EWSR1-FLI1 gene fusion. The patient was treated with neoadjuvant chemotherapy (NAC) and interventional procedures. This case highlights the importance of considering ESK in differential diagnoses of renal masses and the utility of MT in obtaining diagnostic tissue, which allowed for the timely initiation of NAC and improved clinical management.
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Affiliation(s)
- Coplen D Johnson
- Department of Radiology, LSU Health Shreveport School of Medicine, Shreveport, Louisiana, USA
| | - Shivam S Shah
- Department of Radiology, LSU Health Shreveport School of Medicine, Shreveport, Louisiana, USA
| | - Eric Wallace
- Department of Radiology, Ochsner LSU Health Shreveport-Academic Medical Center, Shreveport, Louisiana, USA
| | - Chaitanya Ahuja
- Department of Interventional Radiology, Ochsner LSU Health Shreveport-Academic Medical Center, Shreveport, Louisiana, USA
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Ryu H, Kim H. The usefulness of stellate ganglion block with ultrasound-guided lateral paracarotid approach in ventricular arrhythmias: A case series. Saudi J Anaesth 2024; 18:276-279. [PMID: 38654862 PMCID: PMC11033875 DOI: 10.4103/sja.sja_657_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 07/31/2023] [Accepted: 08/01/2023] [Indexed: 04/26/2024] Open
Abstract
Ventricular arrhythmias are life-threatening cardiac events. Sympathetic nervous system blockade represents a crucial therapeutic method for refractory ventricular arrhythmias. Ultrasound (US) imaging for stellate ganglion block (SGB) suggests potential for its application to safer and more accurate methods. We had thirteen patients diagnosed with refractory ventricular arrhythmia and referred to the pain clinic for SGB. We visited the intensive care unit (ICU) and performed SGB with the lateral paracarotid approach technique in the ICU. Using a new approach, we easily performed SGB and felt the convenience of the procedure in the ICU. In eleven cases, we also confirmed that the effect of the block with the new technique was satisfactory. SGB, with the new technique, revealed efficiency in the recovery process of the patients. We recommended the lateral paracarotid approach technique for SGB when a patient in an ICU showed ventricular arrhythmias and should be treated with SGB.
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Affiliation(s)
- Hansung Ryu
- Department of Anesthesiology and Pain Medicine, College of Medicine, Yeungnam University, Daegu, Republic of Korea
| | - Hyuckgoo Kim
- Department of Anesthesiology and Pain Medicine, College of Medicine, Yeungnam University, Daegu, Republic of Korea
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Sun L, Wu G, Zhou Y, Deng A, Chen Z. Prospective study on ultrasound-guided stellate ganglion block improves cerebral blood flow in patients with stroke. J Stroke Cerebrovasc Dis 2024; 33:107593. [PMID: 38290686 DOI: 10.1016/j.jstrokecerebrovasdis.2024.107593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 01/16/2024] [Accepted: 01/22/2024] [Indexed: 02/01/2024] Open
Abstract
OBJECTIVES The effect of routine internal medicine and stroke rehabilitation treatment was not good. To confirm that ultrasound-guided stellate ganglion block (SGB) can improve cerebral blood flow in patients with stroke, Transcranial Doppler (TCD) and carotid ultrasound were used to monitor the cerebral blood flow parameters of ultrasound-guided SGB in patients with stroke. METHODS A prospective study of 40 patients with stroke from January 2021 to October 2022 randomly divided into two groups (group SGB: undergoing ultrasound-guided SGB and standard medical procedures, control group: undergoing standard medical procedures) with 20 cases in each was conducted in People's Hospital of Chongqing Liang Jiang New Area. TCD and carotid artery ultrasound were monitored before and after treatment. There were no significant differences in general data on age, gender, disease course, and stroke type between two groups (P>0.05). RESULTS After treatment, the bilateral ACA Vm of group SGB was significantly higher, the bilateral internal carotid artery RI and left VA RI were significantly lower than in control group (P<0.05). In group SGB, the Vm of bilateral MCA, bilateral PCA, right ACA, bilateral VA, and BA after treatment were significantly (P<0.05) increased compared to before treatment. PI of bilateral MCA, right ACA, and left VA after treatment were significantly (P<0.05) decreased compared to before treatment. RI of bilateral MCA, bilateral PCA, and bilateral VA after treatment were significantly (P<0.05) decreased compared to before treatment. Right internal carotid artery D after treatment was significantly (P<0.05) higher than before treatment. RI of bilateral internal carotid artery after treatment was significantly (P<0.05) lower than before treatment. CONCLUSIONS Ultrasound-guided stellate ganglion block could improve local cerebral blood flow and vascular compliance in patients with stroke, and reduce vascular resistance.
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Affiliation(s)
- Lin Sun
- Department of anesthesiology and pain, People's Hospital of Chongqing Liang Jiang New Area; Liangjiang New Area Chongqing 401121, China
| | - Gu Wu
- Department of anesthesiology and pain, People's Hospital of Chongqing Liang Jiang New Area; Liangjiang New Area Chongqing 401121, China
| | - Yuan Zhou
- Department of anesthesiology and pain, People's Hospital of Chongqing Liang Jiang New Area; Liangjiang New Area Chongqing 401121, China
| | - Ansong Deng
- Department of anesthesiology and pain, People's Hospital of Chongqing Liang Jiang New Area; Liangjiang New Area Chongqing 401121, China
| | - Zongjie Chen
- Department of anesthesiology and pain, People's Hospital of Chongqing Liang Jiang New Area; Liangjiang New Area Chongqing 401121, China.
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Mo K, Qian L, Tian J, Liao J, Tan F, Kong W, Yu X, Chi X. Ultrasound-guided stellate ganglion blockade - patient positioning is everything: a case report demonstrating the efficacy of a modified out-of-plane approach. Front Neurosci 2024; 17:1288484. [PMID: 38292894 PMCID: PMC10825014 DOI: 10.3389/fnins.2023.1288484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 12/30/2023] [Indexed: 02/01/2024] Open
Abstract
Background Insomnia has become increasingly prevalent in modern society and is notoriously difficult to treat. Many patients exhibit a poor response to pharmacological interventions. Stellate ganglion block (SGB) has emerged as an effective method for managing insomnia; however, its efficacy may be compromised in some patients, primarily due to a variant vertebral artery anatomy. Case presentation This case report describes a patient with severe insomnia accompanied by anxiety. Through cervical ultrasound scanning, we identified richly branched cervical arteries at the C6-C7 segment of the vertebral artery, along with anatomical variations, which could pose a heightened risk for the traditional SGB procedure. Therefore, after carefully adjusting the patient's positioning, we proceeded with ultrasound-guided SGB using a lateral paravein out-of-plane approach. Clinical signs of successful insomnia symptoms alleviation were consistently observed after each block utilizing this alternative technique multiple times in a single patient. Conclusion Our report reveals a new lateral paravein out-of-plane approach for ultrasound-guided SGB to treat insomnia, which might be considered an alternative method. More studies should be carried out to confirm the efficacy of this new approach.
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Affiliation(s)
| | | | | | | | | | | | | | - Xinjin Chi
- Department of Anesthesiology, The Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen, Guangdong, China
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Yu B, Hou S, Xing Y, Jia Z, Luo F. Ultrasound-guided stellate ganglion block for the treatment of migraine in elderly patients: A retrospective and observational study. Headache 2023; 63:763-770. [PMID: 37314033 DOI: 10.1111/head.14537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 04/25/2023] [Accepted: 04/28/2023] [Indexed: 06/15/2023]
Abstract
OBJECTIVES This study aimed to assess the effectiveness and safety of ultrasound-guided stellate ganglion block (SGB) in the prophylactic treatment of migraine in the elderly. BACKGROUND Treatment of migraine in the elderly is often difficult and troublesome due to multiple comorbidities, drug interactions, and adverse effects (AEs). SGB may be an effective treatment approach for migraine in the elderly as its clinical use is rarely limited by concomitant diseases and age-related physiological changes; however, no studies have evaluated the effectiveness of SGB in the treatment of migraine in the elderly population. METHODS This is a retrospective observational case series study. We retrospectively analyzed patients with migraine aged ≥65 years, who underwent ultrasound-guided SGB for headache management between January 2018 and November 2022. Pain intensity using the numerical rating scale (NRS, 0-10), number of days with headache per month, duration of headache, and the consumptions of acute medications were recorded before SGB treatment, and at 1, 2, and 3 months after the last SGB. Safety assessment included thorough documentation of serious and minor AEs related to SGB. RESULTS Of 71 patients, 52 were analyzed in this study. After the final SGB, the NRS scores decreased significantly from a mean (± standard deviation [SD]) of 7.3 (1.2) at baseline to 3.3 (1.4), 3.1 (1.6), and 3.6 (1.6) at 1, 2, and 3 months, respectively (vs. baseline, p < 0.001). The mean (SD) number of headache days per month significantly reduced from 23.1 (5.5) to 10.9 (7.1) (p < 0.001), 12.7 (6.5) (p = 0.001), and 14.0 (6.8) days (p = 0.001) at the 1-, 2-, and 3-month follow-ups, respectively. The values of headache duration were also significantly lower at the 1-month (mean [SD] 12.5 [15.8] h, p = 0.001), 2-month (mean [SD] 11.3 [15.9] h, p = 0.001), and 3-month follow-ups (mean [SD] 14.3 [16.0] h, p = 0.001) compared to pre-treatment baseline (mean [SD] 22.7 [17.1] h). There were 33/52 (64%) patients experiencing at least a 50% reduction in acute medications consumption 3 months after the final SGB treatment. The overall AEs rate associated with ultrasound-guided SGB was 9.0% (26/290 SGBs). There were no serious AEs; all reported AEs were minor and transient. CONCLUSIONS Stellate ganglion block treatment could reduce pain intensity, headache frequency, and duration of migraine, thereby reducing the need for adjunctive medications in elderly patients. Ultrasound-guided SGB might be a safe and effective intervention for the treatment of migraine in elderly patients.
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Affiliation(s)
- Bin Yu
- Department of Day Surgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Siyu Hou
- Department of Education, Fuxing Hospital, Capital Medical University, Beijing, China
| | - Yan Xing
- Department of Day Surgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Zipu Jia
- Department of Day Surgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Fang Luo
- Department of Day Surgery and Pain Management, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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Fan Z, Zheng X, Li D, Chen H, Li L. Comparison of lidocaine and ropivacaine stellate ganglion blockade in treating upper limb postherpetic neuralgia. Medicine (Baltimore) 2022; 101:e29394. [PMID: 35687777 PMCID: PMC9276270 DOI: 10.1097/md.0000000000029394] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 04/13/2022] [Indexed: 01/04/2023] Open
Abstract
To provide a basis for treating postherpetic neuralgia (PHN), we compared the efficacy of lidocaine and ropivacaine stellate ganglion block (SGB) in PHN treatment in the upper limbs.Data from 252 patients with upper-limb PHN were retrospectively analyzed. The lidocaine group (n = 118) was treated with oral pregabalin capsules 75 mg twice a day, tramadol hydrochloride sustained release tablets 100 mg twice a day, and amitriptyline 25 mg once at night combined with ultrasound-guided lidocaine SGB; the ropivacaine group (n = 134) was orally administered the same medicines combined with ultrasound-guided ropivacaine SGB. The visual analog scale (VAS), self-rating anxiety scale (SAS), and adverse reactions were compared between the groups before treatment and at 1 week, 1 month, and 3 months after treatment.There were no significant differences between the lidocaine and ropivacaine groups in terms of sex, age, height, weight, and pain duration (P > .05). There was no significant difference between the groups in VAS and SAS scores before treatment (P > .05). At 1 week, 1 month, and 3 months after ultrasound-guided SGB treatment, the VAS and SAS scores were significantly lower in the ropivacaine group than in the lidocaine group (P < .05). There were no significant differences between the groups in terms of adverse reactions (P > .05).For ultrasound-guided SGB treatment of upper limb PHN, ropivacaine is superior to lidocaine. Ultrasound-guided ropivacaine SGB is safe and effective for the treatment of upper limb PHN.
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Affiliation(s)
- Zhouhong Fan
- Department of Pain, Yichun People's Hospital, Yichun, Jiangxi Province, PR China
| | - Xin Zheng
- Department of Pain, The Second Hospital of Dalian Medical University, Dalian, PR China
| | - Dongbai Li
- Department of Pain, The Second Hospital of Dalian Medical University, Dalian, PR China
| | - Haopeng Chen
- Department of Pain, The Second Hospital of Dalian Medical University, Dalian, PR China
| | - Lingchao Li
- Department of Pain, The Second Hospital of Dalian Medical University, Dalian, PR China
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Wang Y, Wang AZ, Wu BS, Zheng YJ, Zhao DQ, Liu H, Xu H, Fang HW, Zhang JY, Cheng ZX, Wang XR. Chinese Association for the Study of Pain: Experts consensus on ultrasound-guided injections for the treatment of spinal pain in China (2020 edition). World J Clin Cases 2021; 9:2047-2057. [PMID: 33850924 PMCID: PMC8017500 DOI: 10.12998/wjcc.v9.i9.2047] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 01/31/2021] [Accepted: 03/16/2021] [Indexed: 02/06/2023] Open
Abstract
Spinal pain (SP) is a common condition that has a major negative impact on a patient’s quality of life. Recent developments in ultrasound-guided injections for the treatment of SP are increasingly being used in clinical practice. This clinical expert consensus describes the purpose, significance, implementation methods, indications, contraindications, and techniques of ultrasound-guided injections. This consensus offers a practical reference point for physicians to implement successfully ultrasound-guided injections in the treatment of chronic SP.
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Affiliation(s)
- Yun Wang
- Department of Anesthesiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China
| | - Ai-Zhong Wang
- Department of Anesthesiology, The Sixth Affiliated People's Hospital, Shanghai Jiao Tong University, Shanghai 200233, China
| | - Bai-Shan Wu
- Department of Algology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Yong-Jun Zheng
- Department of Algology, Huadong Hospital Affiliated to Fudan University, Shanghai 200040, China
| | - Da-Qiang Zhao
- Department of Anesthesiology, Jiahui International Hospital, Shanghai 200233, China
| | - Hui Liu
- Department of Algology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Hua Xu
- Department of Anesthesiology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 200437, China
| | - Hong-Wei Fang
- Department of Algology, East Hospital, Tongji University, Shanghai 200120, China
| | - Jin-Yuan Zhang
- Department of Algology, East Hospital, Tongji University, Shanghai 200120, China
| | - Zhi-Xiang Cheng
- Department of Algology, The Second Affiliated Hospital, Nanjing Medical University, Nanjing 210011, Jiangsu Province, China
| | - Xiang-Rui Wang
- Department of Algology, East Hospital, Tongji University, Shanghai 200120, China
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Liu Q, Zhong Q, Tang G, Ye L. Ultrasound-Guided Stellate Ganglion Block for Central Post-Stroke Pain: A Case Report and Review. J Pain Res 2020; 13:461-464. [PMID: 32161490 PMCID: PMC7049743 DOI: 10.2147/jpr.s236812] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Accepted: 02/20/2020] [Indexed: 02/05/2023] Open
Abstract
Background Central post-stroke pain (CPSP) is refractory to pharmacotherapy (eg, NSAIDs, opioids, antidepressants, and anticonvulsants), and may require transcranial or deep brain stimulation. Case Presentation A 67-year-old woman presented with severe paroxysmal cramp-like pain on the right side, including the head and both upper and lower extremities. The pain started 5 years earlier, was initially mild and occasional, but gradually intensified to an unbearable degree with an average of 10–15 daily episodes, each lasting for 5–10 mins. The patient disclosed “hemorrhagic stroke” 10 years ago that resulted in hemiplegia on the right side. CT examination verified the lesion. The patient received daily injection of 2-mL 2% lidocaine under ultrasound guidance to block the stellate ganglion. Pain subsided rapidly in both intensity and frequency. On the seventh day, the patient no longer had pain episodes. At the last follow-up, 9 months later, the patient was free from pain. Conclusion Ultrasound-guided stellate ganglion block is a viable alternative for CPSP that is refractory to pharmacotherapy.
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Affiliation(s)
- Qian Liu
- Department of Anesthesiology, First People's Hospital, Zigong, Sichuan, People's Republic of China
| | - Qing Zhong
- Department of Anesthesiology, People's Hospital, Jianyang, Sichuan, People's Republic of China
| | - Guoqiang Tang
- Department of Anesthesiology, First People's Hospital, Zigong, Sichuan, People's Republic of China
| | - Ling Ye
- Department of Pain Management, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
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Baek J, Kim BS, Yu H, Kim H, Lim C, Song SO. Comparison of ultrasound-guided stellate ganglion block at 6th and 7th cervical vertebrae using the lateral paracarotid out-of-plane approach for sympathetic blockade in the upper extremity. Yeungnam Univ J Med 2019; 35:199-204. [PMID: 31620594 PMCID: PMC6784709 DOI: 10.12701/yujm.2018.35.2.199] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 11/07/2018] [Accepted: 11/09/2018] [Indexed: 11/21/2022] Open
Abstract
Background The authors have performed ultrasound-guided stellate ganglion block (SGB) in our clinic using a lateral paracarotid approach at the level of the 6th cervical vertebra (C6). Although SGB at C6 is a convenient and safe method, there are ongoing concerns about the weak effect of sympathetic blockade in the ipsilateral upper extremity. Therefore, ultrasound-guided SGB was attempted using a lateral paracarotid approach at the level of the 7th cervical vertebra (C7). This prospective study aimed to compare changes in skin temperature after SGB was performed at C6 and C7, and to introduce a lateral paracarotid approach for SGB. Methods Thirty patients underwent SGB twice: once at C6 and once at C7. For every SGB, the skin temperature of the patient’s hypothenar area was measured for 15 min at 1-min intervals. Skin temperatures before and after SGB and side effects were compared between C6 and C7 groups. Results The temperature of the upper extremity increased after SGB was performed at C6 and C7. There were significant differences between mean pre-SGB and the largest increases in post-SGB temperatures (0.50±0.38℃ and 1.41±0.68℃ at C6 and C7, respectively; p<0.05). Significantly increased post-SGB temperatures (difference >1℃) were found in 5/30 (16.7%) and 24/30 (80%) cases for C6 and C7, respectively (p<0.05). There were no significant differences in side effects between SGB performed at C6 or C7 (p>0.05). Conclusion The lateral paracarotid approach using out-of-plane needle insertion for ultrasound-guided SGB performed at C7 was feasible and more effective at elevating skin temperature in the upper extremity than SGB at C6.
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Affiliation(s)
| | | | - Hwarim Yu
- Department of Anesthesiology and Pain Medicine, Gangnam Severance Hospital, Seoul, Korea
| | - Hyuckgoo Kim
- Department of Anesthesiology and Pain Medicine, Yeungnam University College of Medicine, Daegu, Korea
| | - Chaeseok Lim
- Department of Anesthesiology and Pain Medicine, Yeungnam University College of Medicine, Daegu, Korea
| | - Sun Ok Song
- Department of Anesthesiology and Pain Medicine, Yeungnam University College of Medicine, Daegu, Korea
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