Ultrasound Findings Evaluating Post Operative Fever, abdominal pain & distention @Dr.SaimaKhan

Описание: Ultrasound Findings Evaluating Post Operative Fever, abdominal pain & distention @Dr.SaimaKhan

Presentation of case of road traffic accident with neck muscle injuries
In this presentation we will study details of grading muscle injuries-

"Lateral Neck Muscle Injuries: Ultrasound Assessment & Grading"

Neck Anatomy Overview
Lateral Neck Muscles Involved:
Sternocleidomastoid (SCM) — superficial & commonly injured
Trapezius — posterior-lateral, prone to whiplash injury
Scalene muscles (anterior, middle, posterior) — deeper, near brachial plexus
Infrahyoid muscles (omohyoid, sternohyoid, sternothyroid, thyrohyoid)

Structures Spared:
Thyroid gland (medial)
Carotid artery, jugular vein, vagus nerve (lie deeper & more medial
Clinical Presentation
Localized pain, swelling, and tenderness
Restricted neck mobility
Ecchymosis or hematoma over lateral neck
Sometimes associated shoulder weakness if spinal accessory nerve is involved
No dysphagia, hoarseness, or stridor if thyroid & airway are spared

Ultrasound Role
High-frequency linear probe (7–15 MHz) is preferred.

Normal Findings:
Parallel echogenic muscle fibers
Intact fascial planes
Normal vascular flow on Doppler

Injury Evaluation Points:
Muscle fiber continuity
Presence of hematoma or edema
Vascular integrity (to confirm sparing of carotid & jugular)
Thyroid echotexture & margins intact
Slide 6 — Grading of Neck Muscle Injury
Grade Muscle Fiber Damage Ultrasound Findings Clinical Severity
Grade I (Mild) Micro-tears, minimal fiber disruption Focal hypoechoic edema, intact fibers, no hematoma Mild tenderness, no functional loss
Grade II (Moderate) Partial tear, hematoma may form Hypoechoic/mixed echogenicity, fascial swelling, small fluid pocket Restricted neck motion, moderate pain
Grade III (Severe) Complete tear or rupture Muscle discontinuity, large hematoma, fiber retraction Severe deformity, loss of neck stability

Vascular injury (ruled out with Doppler
Slide 8 — Management
Grade I & II Injuries:
Rest & neck immobilization
NSAIDs & anti-inflammatory therapy
Ultrasound follow-up in 7–10 days
Physiotherapy after acute swelling resolves

Grade III Injuries:
Surgical exploration & repair if complete tear
Drainage of large hematomas compressing airway
Exclude vascular injury before surgery
35-year-old male, RTA, lateral neck swelling

Ultrasound:
SCM hypoechoic with focal edema
No hematoma
Thyroid margins intact
Carotid & jugular flows normal
Diagnosis: Grade II lateral neck muscle injury
Lateral neck muscle injuries commonly involve SCM & trapezius.
Ultrasound is first-line for diagnosis and grading.
Preservation of thyroid & vessels must be confirmed.
Early identification prevents missed hematomas and nerve injuries.


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