Sommer R, Valen G J, Ori Y, Weinstein T, Katz M, Hendel D, Korzets A
Department of Radiology, The Rabin Medical Center, Petach Tikva, Israel.
J Ultrasound Med. 2000 Nov;19(11):765-70. doi: 10.7863/jum.2000.19.11.765.
This study evaluated the diagnostic role of ultrasonography in dialysis-related amyloidosis in shoulders of chronically hemodialyzed patients. Fourteen shoulders of 12 long-term hemodialysis patients were examined. All patients had been on dialysis for at least 10 years. All patients had varying degrees of pain and limitations of movement in the studied shoulders. Dialysis-related amyloidosis was the presumed diagnosis in all patients. Any patient with a history of any disease, other than dialysis-related amyloidosis, capable of producing a pathologic shoulder condition was excluded. The following parameters were studied: supraspinatus and biceps tendon thickness, tendon tears, synovial thickening, and the presence of hypoechoic material around tendons and within bursae. All shoulders had a nonhomogeneous thickening, greater than 7 mm, of the supraspinatus tendon. Seven shoulders (50%) had abnormal thickening of the biceps tendon (4 mm or greater), and two shoulders had abnormal thickening of the subscapularis tendon. Hypoechoic deposits were seen in the subdeltoid bursae and biceps sheaths in five and six shoulders, respectively. Three shoulders showed partial tears of the supraspinatus tendon, one shoulder showed a tear in the biceps tendon, and one shoulder had a tear in the subscapularis tendon. Ultrasonography is an excellent imaging modality in diagnosing the presence of dialysis-related amyloidosis in symptomatic shoulders of long-term hemodialysis patients, without having to resort to invasive procedures. The results of previous studies have been confirmed and new ultrasonographic findings described. Of particular interest is the involvement of the subscapularis tendon in dialysis-related amyloidosis. Repeat ultrasonography can become an important way to follow-up progression of shoulder dialysis-related amyloidosis in hemodialyzed patients.
本研究评估了超声检查在慢性血液透析患者肩部透析相关淀粉样变中的诊断作用。对12例长期血液透析患者的14个肩部进行了检查。所有患者均已透析至少10年。所有患者在所研究的肩部均有不同程度的疼痛和活动受限。所有患者均假定诊断为透析相关淀粉样变。排除任何有除透析相关淀粉样变以外的、能够导致病理性肩部疾病病史的患者。研究了以下参数：冈上肌和肱二头肌腱厚度、肌腱撕裂、滑膜增厚以及肌腱周围和滑囊内低回声物质的存在情况。所有肩部的冈上肌腱均有大于7mm的不均匀增厚。7个肩部（50%）肱二头肌腱有异常增厚（4mm或更厚），2个肩部肩胛下肌腱有异常增厚。分别在5个和6个肩部的三角肌下滑囊和肱二头肌腱鞘中见到低回声沉积物。3个肩部显示冈上肌腱部分撕裂，1个肩部显示肱二头肌腱撕裂，1个肩部肩胛下肌腱撕裂。超声检查是诊断长期血液透析患者有症状肩部透析相关淀粉样变存在的一种极好的成像方式，无需采用侵入性检查。先前研究的结果得到了证实，并描述了新的超声检查发现。特别值得关注的是肩胛下肌腱在透析相关淀粉样变中的受累情况。重复超声检查可成为随访血液透析患者肩部透析相关淀粉样变进展的重要方法。
