Self-Assessment: Challenging Imaging Cases | NMUS in Children-Session recording- Challenging Imaging Cases

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Video Summary

This video presents expert discussions on challenging neuromuscular imaging cases, highlighting the critical role of neuromuscular ultrasound alongside electrodiagnostic testing in diagnosis and management. <br /><br />The first case involves a middle-aged woman with severe unilateral scapular pain and winging. Despite initial inconclusive EMGs, comprehensive ultrasound revealed trapezius and sternocleidomastoid atrophy consistent with left spinal accessory nerve neuropathy. MRI later identified a possible schwannoma at C1-C2 nerve root, correlating with symptoms. This case underscores the value of ultrasound for precise muscle assessment and guiding needle EMG.<br /><br />The second case describes a patient with a gunshot injury causing diffuse upper limb neuropathy. Ultrasound identified an enlarged ulnar nerve segment with suspected traumatic neuroma and nerve discontinuity, prompting early surgical cable nerve graft repair for complete transection. Postoperative progress showed functional recovery, illustrating ultrasound’s impact on timing of nerve injury interventions.<br /><br />The third case discusses a young runner’s acute foot drop. Ultrasound and MRI detected a rare intraneural ganglion cyst compressing the common peroneal nerve at the fibular neck. Surgical drainage and articular branch ligation were performed, preventing recurrence. This case highlights ultrasound’s ability to identify treatable structural causes of neuropathy often missed clinically.<br /><br />Another case involves a 21-year-old with late-onset Krabbe disease, initially misdiagnosed as ALS. Ultrasound showed diffuse nerve enlargement consistent with demyelinating polyneuropathy. Genetic testing confirmed GALC mutations, and stem cell transplant was pursued, showing how imaging and genetics guide diagnosis of complex neurodegenerative conditions.<br /><br />A further case of isolated brachialis atrophy following trauma illustrates suspected neuralgic amyotrophy with characteristic ultrasound findings of nerve constriction (“hourglass-like” fascicle), confirming disease despite unclear electrodiagnostics.<br /><br />Finally, an iatrogenic complete ulnar nerve transection after elbow arthroscopy was diagnosed with ultrasound, revealing marked nerve enlargement and discontinuity. Surgical repair with sural nerve graft was performed, demonstrating ultrasound’s vital role in identifying severe nerve injuries and informing prompt surgical management.<br /><br />Overall, the session emphasizes ultrasound's indispensable role in diagnosing neuromuscular disorders, directing precise electrodiagnostic studies, distinguishing etiologies such as neuropathies, nerve injuries, tumors, and cysts, and optimizing patient outcomes through timely interventions.

Keywords

neuromuscular imaging

ultrasound

nmus

sono

US

electrodiagnostic testing

spinal accessory nerve neuropathy

schwannoma

ulnar nerve traumatic neuroma

nerve graft repair

intraneural ganglion cyst

common peroneal nerve compression

Krabbe disease

demyelinating polyneuropathy

neuralgic amyotrophy

iatrogenic nerve injury