Rotator cuff tears are often associated with synovitis, but the ability of noninvasive ultrasonography to predict the severity of synovitis remains unclear. We investigated whether ultrasound parameters, namely peak systolic velocity in the anterior humeral circumflex artery and Doppler activity in the glenohumeral joint and subacromial space, reflect synovitis severity. Methods: A total of 54 patients undergoing arthroscopic rotator cuff repair were selected. Doppler ultrasound was used to measure peak systolic velocity in the anterior humeral circumflex artery and Doppler activity in the glenohumeral joint and subacromial space, and these values were compared with the intraoperative synovitis score in univariate and multivariate analyses. Results: Univariate analyses revealed that tear size, peak systolic velocity in the anterior humeral circumflex artery, and Doppler activity in the glenohumeral joint were associated with synovitis in the glenohumeral joint (P=0.02, P<0.001, P=0.02, respectively). In the subacromial space, tear size, peak systolic velocity in the anterior humeral circumflex artery, and Doppler activity in the subacromial space were associated with synovitis severity (P=0.02, P<0.001, P=0.02, respectively). Multivariate analyses indicated that tear size and peak systolic velocity in the anterior humeral circumflex artery were independently associated with synovitis scores in both the glenohumeral joint and the subacromial space (all P<0.05). Conclusions: These findings demonstrate that tear size and peak systolic velocity in the anterior humeral circumflex artery, which can both be measured noninvasively, are useful indicators of synovitis severity. Level of evidence: IV.

Persistent massive air leak after pediatric cardiac surgery is a rare and possibly life-threatening complication which is difficult to treat. We report a 3-month-old boy with hypoplastic left heart syndrome that underwent Glenn take-down, suffered from pulmonary hemorrhage during surgery and needed mechanical ventilation with high airway pressure that caused bilateral pneumothorax. After pulmonary hemorrhage improved, pneumothorax with persistent air leaks did not resolve under prolonged chest tubes. This patient underwent an autologous “blood patch” pleurodesis on postoperative day 32. The procedure was repeated a second time 48 h after the application of the first blood patch. After these procedures, air leaks dramatically ceased. The patient was successfully weaned from the ventilator on postoperative day 70. Pleurodesis with an autologous blood patch is a safe and an effective technique for the treatment of persistent air leaks, even for a 3-month-old boy with hypoplastic left heart syndrome.