A previously healthy 16-year-old female with no family history of neuromuscular disorders presented with a seven year history of hand incoordination. On examination, she had wasting of the intrinsic hand muscles bilaterally, right worse than left. There was no sensory loss, muscle cramping, or pain. Magnetic resonance imaging (MRI) of the cervical spine did not reveal any abnormal findings. Nerve conduction studies identified moderate slowing of the conduction velocity in the right ulnar nerve.One year later, the patient's complaint of hand incoordination continued. Repeat nerve conduction studies revealed conduction blocks in both median nerves in addition to the previously noted decreased conduction velocity in the right ulnar nerve. Followup cervical spine MRI was performed (Figures 1, 2).Magnetic resonance imaging in the neutral position demonstrated subjectively decreased volume and subtly increased T2 hyperintensity in the anterocentral portion of the cervical spinal cord from C5-7 (Figures 1, 2 DISCUSSIONHirayama disease (HD) was first reported in Japan by Dr. K. Hirayama in 1959 and initially labeled "juvenile muscular atrophy of a unilateral (later distal) upper extremity." 1 Hirayama disease is sporadic juvenile muscular atrophy of the distal upper extremities, which predominantly affects young men between 15 and 25 years-of-age. Hirayama disease is characterized by insidious onset of unilateral muscular atrophy and weakness of the hand and forearm, in the absence of sensory or pyramidal signs. Bilateral presentation, though less common, is also known to occur. 2 The clinical course is initially progressive for six to nine years, followed by spontaneous stabilization by the middle of the third decade.1 This disease has had a number of other names some of which include brachial monomelic amyotrophy, benign focal atrophy, benign focal amyotrophy, Sobue's disease, and juvenile segmental muscular atrophy.

We discovered a 1.6% frequency of catheter fracture and embolization associated with arm implantation of the Cook Vital Port. All the catheters fractured at the vein entry site and did not detach from the port housing. The cause for catheter fracture and embolization is uncertain. Pulmonary embolization of the fractured catheters puts the patients at risk for possible further complications. No patients had ancillary complications related to catheter embolization or to catheter extraction procedures. Further investigation is required in an attempt to determine the circumstances that may result in catheter fracture and embolization related to this venous access device.

Purpose: The objective of the study was to design and implement an electronic synoptic report for thyroid sonography that incorporates the thyroid imaging reporting and data system (TIRADS) and assess potential for reducing unnecessary fine needle aspiration biopsies (FNAB) of thyroid nodules. Methods: The electronic synoptic report was developed using a relational database based on elements from TIRADS and a multidisciplinary consensus statement for thyroid reporting. A retrospective analysis of 138 patients with previously reported thyroid sonographic exams was evaluated for the presence of these elements. The electronic synoptic report calculates the TIRADS score and generates a formal report. Using the TIRADS score the potential decrease in unnecessary FNAB was estimated. Results: Key TIRADS elements were variously reported ranging from 43% for the thyroid nodule's architecture as solid or cystic. Thyroid nodule echogenicity and calcification was commented in 27% and 23%, respectively. Other features of the TIRADS score were commented in 0% to 8% of the official reports. Estimated reduction for potentially reduced need for FNAB was 34.5%. Conclusions: This study is the first implementation of synoptic reporting using a relational database for sonography of thyroid nodules. Implementation of an electronic standardized synoptic reporting system may facilitate more accurate, and more comprehensive reporting for thyroid ultrasound scanning of thyroid nodules. The use of TIRADS was estimated to be able to potentially reduce the need for FNAB which was significant.

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