Sonographic features of dialysis-related amyloidosis of the shoulder

This study evaluated the diagnostic role of ultrasonography in dialysis-rel ated amyloidosis in shoulders of chronically hemodialyzed patients. Fourtee n shoulders of 12 long-term hemodialysis patients were examined. All patien ts had been on dialysis for at least 10 years. All patients had varying deg rees of pain and limitations of movement in the studied shoulders. Dialysis -related amyloidosis was the presumed diagnosis in all patients. Any patien t with a history of any disease, other than dialysis-related amyloidosis, c apable of producing a pathologic shoulder condition was excluded. The follo wing parameters were studied: supraspinatus and biceps tendon thickness, te ndon tears, synovial thickening, and the presence of hypoechoic material ar ound tendons and within bursae. All shoulders had a nonhomogeneous thickeni ng, greater than 7 mm, of the supraspinatus tendon. Seven shoulders (50%) h ad abnormal thickening of the biceps tendon (4 mm or greater), and two shou lders had abnormal thickening of the subscapularis tendon. Hypoechoic depos its were seen in the subdeltoid bursae and biceps sheaths in five and six s houlders, respectively. Three shoulders showed partial tears of the suprasp inatus tendon, one shoulder showed a tear in the biceps tendon, and one sho ulder had a tear in the subscapularis tendon, Ultrasonography is an excelle nt imaging modality in diagnosing the presence of dialysis-related amyloido sis in symptomatic shoulders of long-term hemodialysis patients, without ha ving to resort to invasive procedures. The results of previous studies have been confirmed and new ultrasonographic findings described. Of particular interest is the involvement of the subscapularis tendon in dialysis-related amyloidosis. Repeat ultrasonography can become an important way to follow- up progression of shoulder dialysis-related amyloidosis in hemodialyzed pat ients.