The conservative management of abdominal lesions in both adults and children is increasingly widespread but requires accurate follow-up over time. As a noninvasive, versatile, easy to perform and repeatable technique with a low rate of adverse reactions, CEUS is ideally suited for this purpose and allowed us to reduce the number of CT scans, especially in the follow-up of young patients.

The aim of this study was to assess safety and efficacy of ultrasonography (US)-guided intra-articular injections using tumor necrosis factor (TNF) blockers compared to corticosteroids in rheumatoid arthritis (RA) or psoriatic arthritis (PsA) patients, experiencing refractory monoarthritis despite the current systemic therapy. Eighty-two patients were randomized to receive three intra-articular injections monthly of either corticosteroid or TNF blockers. Primary endpoints were the safety and an improvement greater than 20% for visual analogic scales of involved joint pain in patients injected with anti-TNFα. Further clinical, US, and magnetic resonance imaging (MRI) evaluations were considered secondary endpoints. Intra-articular TNF blockers are a safe strategy, determining a significant reduction of patient and physician reported clinical outcomes and US/MRI scores, in RA and PsA patients, when compared to intra-articular injections of corticosteroids. US guidance excluded the possibility to inject the drug in the wrong site, maximizing local effects, reducing systemic effects, and increasing the safety of the procedure. Patients with inflammatory monoarthritis could be successfully treated with US-guided intra-articular TNF blockers that are a safe and well tolerated procedure, to achieve a longstanding clinical and radiological good clinical response and/or disease remission.

When large cerebrospinal fluid loss is observed during spinal surgery, brain imaging study should be carried out. The pathogenetic hypothesis of microcirculation vessels tearing, the role of previous spinal surgery and of cerebellar atrophy should be considered and validated with further investigation.

A 65-year-old man came to our hospital for an outpatient neurological assessment. He had a 20-year history of hemifacial atrophy associated with hemitongue atrophy ( Figure 1A), intermittent unilateral jaw spasms leading to frequent tongue bites, unilateral alopecia ( Figure 1B), parotid and submandibular gland atrophy, and tooth loss. Despite the extreme discomfort experienced by the patient, he had never received a full evaluation and diagnosis. On neurological assessment, myokymias of the jaw-closing muscles (massetez and temporalis) were detected (video) and confirmed by the presence of myokymic discharges during an electromyographic study. No other neurological signs were recognized. Laboratory and neuroimaging investigations were normal. A diagnosis of Parry-Romberg syndrome was made. This is a rare neurological disorder, mostly sporadic, and characterized by hemifacial atrophy involving the skin, the fat, the connective tissue, and sometimes the bone.