Rheumatoid arthritis (RA) is a systemic autoimmune disease of unknown etiology that causes progressive and destructive inflammation in the joints. Superb microvascular imaging (SMI) is a new ultrasound technique that allows visualization of slow blood flow in synovitis. This study aimed to report on the clinical value and utility of the SMI technique and its grading for monitoring RA by determining the correlation with clinical disease activity scores (DAS 28) and power Doppler ultrasound (PDUS).All RA patients with clinically apparent synovitis were assessed using DAS 28. Synovitis was investigated with PDUS and SMI and each joint was graded semi-quantitatively. All assessments were carried out at baseline and repeated at least at the 4-month follow-up. Correlations between scores were investigated using Spearman’s correlation.60 RA patients with 552 affected joints were recruited. Clinical and sonographic scores were significantly improved at follow-up (p<0.001). SMI showed significantly more joint count and flow signal scores than clinical examination and PDUS. Moderate correlations were found between the SMI score and clinical scores (p<0.001, 0.586 for SMI score vs. DAS 28-CRP, p=0.001, 0.432 for SMI vs. DAS 28-ESR). There were also stronger correlations between the SMI score and PDUS score at both baseline and follow-up (p<0.001, r = 0.817, 0.842 respectively).SMI provides greater utility and ability to detect synovial vascularity and to monitor disease activity than PDUS. A new activity scoring system based on SMI and clinical objective findings is required to improve reliability and validity.

Ewing’s sarcoma (ES) is a rare and highly aggressive tumor belonging to a family of neoplasms of neuroectodermal origin, which primarily affects the bones or soft tissues. ES originating from lung parenchyma without chest wall involvement is extremely rare with less than 40 cases reported in the English literature. A 41-year-old man admitted to the thoracic surgery department presenting with intermittent non-productive cough, dyspnea, left-sided chest pain for two months for further evaluation and treatment with a preliminary diagnosis of pulmonary mass. Contrast-enhanced thorax CT and MRI revealed a large heterogeneous soft-tissue mass in the left lower lobe with no distant metastases or occult primary tumor. Following the percutaneous transthoracic biopsy, histopathological and immunohistochemical results were consistent with primary pulmonary ES. Though rare, primary pulmonary ES should be considered in the differential diagnosis of young patients presenting with a large heterogeneous soft tissue mass in the lung. This case report highlights the diagnosis, radiologic and pathologic findings, and management of primary pulmonary ES.

Original Article Palmaris longus tendon and its relationship with the median nerve: a population-based morphometric magnetic resonance imaging study Esin Kurtulus Ozturk, Saffet Ozturk, Sitki Safa Taflan