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Following the innovations and new discoveries of the last 10 years in the field of lung ultrasound (LUS), a multidisciplinary panel of international LUS experts from six countries and from different fields (clinical and technical) reviewed and updated the original international consensus for point-of-care LUS, dated 2012. As a result, a total of 20 statements have been produced. Each statement is complemented by guidelines and future developments proposals. The statements are furthermore classified based on their nature as technical (5), clinical (11), educational (3), and safety (1) statements.

Triathlon’s popularity is rapidly increasing, and epidemiological data relating to its related medical conditions is crucial to the development of proper medical plans and safety guidelines for it. This study examined the data from the medical reports collected during three consecutive editions of Ironman Italy, from 2017 to 2019. Out of 10,653 race-starters, 3.3% required medical attention sustaining 472 medical conditions. A significantly higher injury risk was found for females versus males (χ2 = 9.78, p = 0.02) and in long-distance (IR: 4.09/1,000hours) rather than in Olympic/middle distance races (IR: 1.75/1,000hours). Most (68.4%) conditions (including muscular exhaustion, hypothermia, and dehydration) were systemic, whilst only 10.2% were acute traumatic injuries. Of a total of 357 triathletes requiring medical assistance, 8.1% were a candidate for hospitalisation. The equipment and personnel that are required for the medical assistance in future triathlon events were estimated based on Maurer’s algorithm, and ten practical recommendations for triathlon medical support were formulated.

International audience; For the general public, BASE jumping is considered the ultimate extreme activity. Among BASE jumpers, those using wingsuits are generally perceived as the most experienced but also as the most risk-taking. Starting from this observation, we wanted to know whether wingsuit users differed in their psychological characteristics from other BASE jumpers. More specifically, we hypothesized that wingsuit users would be characterized by higher levels of mental toughness and by lower levels of harm avoidance. We also expected them to use more mental training techniques than the other jumpers. To this end, we conducted a vast survey on a sample of 183 BASE jumpers. Contrary to our hypotheses, the results did not reveal any significant difference in psychological characteristics between wingsuit users and other BASE jumpers. This absence of significant differences is discussed and recommendations for the use of mixed or multi-methods in the study of extreme sports are proposed.

Purpose This study aimed to conduct a diagnostic and cost-effective analysis of the cytopathology assistance in the ultrasound (US)-guided fine-needle aspiration biopsy (FNAB) for characterising thyroid nodules. Materials and methods We reviewed the reports relative to 9061 US-guided FNABs for the histologic definition of the nature of thyroid nodules: 45.4% completed with the cytopathologist assistance and 54.6% by the radiologist alone. We also performed the cost-effectiveness analysis (CEA) of the procedure with and without the cytopathologist assistance. Results We found a significant positive correlation between the adoption/non-adoption of cytopathologist assistance and the number of indeterminate (TIR1) (Chi-square; z-score, Z = 10.22; critical value 5%, C = 1.96; p r = 0.059; critical value 5%, C = 0.008; p The total cost of the model's cytopathologist-assistance branch is 109.87€, while the total cost of the non-cytopathologist-assistance branch is 95.08€. Conclusion The cytopathologist assistance resulted in fewer nondiagnostic results, thus excluding the procedure's repetition but involved a higher expense, mainly due to the professional cost of the pathologist's participation. These data may provide decision-makers in healthcare with a practical evidence based on the opportunity to include the cytopathologist assistance in the thyroid nodule's FNAB depending on the available resources and the population's expectance.

Adventure and extreme sports (AESs) are associated with high risk of injury and even death. This has important ramifications for sport, education, medical and health professions and has led to disc...

Pneumothorax (PTX) represents accumulation of the air in the pleural space. A large or tension pneumothorax can collapse the lung and cause hemodynamic compromise, a life-threatening disorder. Traditionally, neonatal pneumothorax diagnosis has been based on clinical images, auscultation, transillumination, and chest X-ray findings. This approach may potentially lead to a delay in both diagnosis and treatment. The use of lung US in diagnosis of PTX together with US-guided thoracentesis results in earlier and more precise management. The recommendations presented in this publication are aimed at improving the application of lung US in guiding neonatal PTX diagnosis and management.

Extreme sports, those activities that lie on the outermost edges of independent adventurous leisure activities, where a mismanaged mistake or accident could result in death, have developed into a significant worldwide phenomenon. Extreme sport activities are continually evolving, typical examples include BASE (an acronym for Buildings, Antennae, Span, Earth) jumping and related activities such as proximity flying, extreme skiing, big wave surfing, waterfall kayaking, rope free solo climbing and high-level mountaineering. While participant numbers in many traditional team and individual sports such as golf, basketball, and racket sports have declined over the last decade or so, participant numbers in so called extreme sports have surged. Although extreme sports are still assumed to be a Western pastime, there has been considerable uptake in other parts of the world. Equally, the idea that adventure sports are only for the young is also changing as participation rates across the generations are growing. Baby boomers are enthusiastic participants of adventure sports more generally. Arguably, extreme sports now support a multi-billion dollar industry and the momentum seems to be intensifying. Traditional explanations for why extreme sports have become so popular are varied. For some, the popularity is explained as the desire to rebel against a society that is becoming too risk averse, for others it is about the spectacle and the merchandise that is associated with organized activities and athletes. For others it is just that there are a lot of people attracted by risk and danger or just want to show off. For others still it is about the desire to belong to sub-cultures and the glamour that goes with extreme sports. Some seek mastery in their chosen activity and in situations of significant challenges. This confusing array of explanations is unfortunate as despite their popularity there is still a negative perception about extreme sports participation. There is a pressing need for clarity. The dominant research perspective has focused on positivist theory-driven perspectives that attempt to match extreme sports against predetermined characteristics. For the most part empirical research has conformed to predetermined societal perspectives. Other ways of knowing might reveal more nuanced perspectives of the human dimension of extreme sport participation.

Ultrasound artefacts are ubiquitous; some depend on ultrasound system settings, others are influenced by the position of the probe and the patient, while still others depend solely on the intrinsic characteristics of ultrasounds. Although many artefacts are unwanted, others provide crucial information for interpreting the ultrasound image, and some, such as A- and B-line artefacts, are even essential semiological signs in thoracic ultrasound.

This chapter focuses on thoracic ultrasound as a noninvasive technique for diaphragm morphological and functional assessment, that can be used as an alternative to traditional, more challenging and uncomfortable methods, such as the fluoroscopic sniff test, nerve conduction studies, and electromyography. This chapter firstly focuses attention on the techniques that can be used and on the measurements that can be obtained. Lastly the pathophysiological significance and the potential clinical applications for diagnostic and prognostic purposes are described.

While in order to read an ultrasonic image correctly it is necessary to understand how ultrasounds interact with biological tissues and how the ultrasound system constructs the image, this is even more true when studying the thorax due to pulmonary air and the bones of the ribcage that alter the propagation of ultrasounds.

The aim of this article is to describe the role of second-level imaging techniques after an initial ultrasonography evaluation in the assessment of scrotal diseases. While ultrasonography remains central as the primary imaging modality for the evaluation of pathologic conditions of the scrotum, the role of magnetic resonance imaging continues to evolve: it can actually be valuable as a problem-solving tool when sonographic findings are equivocal or inconclusive. Magnetic resonance imaging of the scrotum may provide accurate detection and characterization of scrotal diseases, well depicting the precise location of scrotal masses (intratesticular or extratesticular) and reliably characterizing benign conditions simulating neoplastic processes, thus preventing unnecessary radical surgery. Advanced magnetic resonance techniques, most of all diffusion weighted imaging and magnetic resonance spectroscopy, play in the meanwhile a more significant role in evaluating scrotal diseases. • Multiparametric ultrasonography usually represents the initial imaging modality for approaching scrotal diseases. • MRI is well established as a problem-solving tool for inconclusive sonographic findings. • Advanced MRI techniques can be successfully applied in scrotal pathology assessment. • MRI is valuable in differentiating benign conditions from neoplastic processes. • CT plays a role in trauma assessment and cancer staging alongside PET/CT.

Neanderthal foot bone proportions and morphology are mostly indistinguishable from those of Homo sapiens, with the exception of several distinct Neanderthal features in the talus. The biomechanical implications of these distinct talar features remain contentious, fueling debate around the adaptive meaning of this distinctiveness. With the aim of clarifying this controversy, we test phylogenetic and behavioral factors as possible contributors, comparing tali of 10 Neanderthals and 81 H. sapiens (Upper Paleolithic and Holocene hunter-gatherers, agriculturalists, and postindustrial group) along with the Clark Howell talus (Omo, Ethiopia). Variation in external talar structures was assessed through geometric morphometric methods, while bone volume fraction and degree of anisotropy were quantified in a subsample (n = 45). Finally, covariation between point clouds of site-specific trabecular variables and surface landmark coordinates was assessed. Our results show that although Neanderthal talar external and internal morphologies were distinct from those of H. sapiens groups, shape did not significantly covary with either bone volume fraction or degree of anisotropy, suggesting limited covariation between external and internal talar structures. Neanderthal external talar morphology reflects ancestral retentions, along with various adaptations to high levels of mobility correlated to their presumably unshod hunter-gatherer lifestyle. This pairs with their high site-specific trabecular bone volume fraction and anisotropy, suggesting intense and consistently oriented locomotor loading, respectively. Relative to H.sapiens, Neanderthals exhibit differences in the talocrural joint that are potentially attributable to cultural and locomotor behavior dissimilarity, a talonavicular joint that mixes ancestral and functional traits, and a derived subtalar joint that suggests a predisposition for a pronated foot during stance phase. Overall, Neanderthal talar variation is attributable to mobility strategy and phylogenesis, while H. sapiens talar variation results from the same factors plus footwear. Our results suggest that greater Neanderthal body mass and/or higher mechanical stress uniquely led to their habitually pronated foot posture.

Participation rates in extreme sports have grown exponentially in the last 40 yr, often surpassing traditional sporting activities. The purpose of this study was to examine injury rates in foot-launched flying sports, i.e., sports in which a pilot foot-launches into flight with a wing already deployed.This paper is based on a retrospective analysis of the reports of incidents that occurred between 2000 and 2014 among the British Hang Gliding and Paragliding Association members.The majority of the 1411 reported injuries were in the lower limb, followed by the upper limb. The most common lower limb injury was to the ankle and included fractures, sprains, and dislocations. The distribution of injures was different in each discipline. The calculated yearly fatality rate (fatalities/100,000 participants) was 40.4 in hang gliding, 47.1 in paragliding, 61.9 in powered hang gliding and 83.4 in powered paragliding; the overall value for foot-launched flight sports was 43.9.Significant differences in injury rates and injury patterns were found among different sport disciplines that can be useful to steer research on safety, and adopt specific safety rules about flying, protective clothing and safety systems in each of these sports.Feletti F, Aliverti A, Henjum M, Tarabini M, Brymer E. Incidents and injuries in foot-launched flying extreme sports. Aerosp Med Hum Perform. 2017; 88(11):1016-1023.

Objective To evaluate, via a multidisciplinary approach, a distinctive paleopathological condition believed to be fibrous dysplasia, found on a 19th/20th century skeleton from Certosa Monumental Cemetery, Bologna, Italy. Materials A skeletonized cranium and mandible recovered from an ossuary in 2014. Methods Pathological alterations were analysed by radiological examination, dental macrowear, histopathological and genetic analyses. Result The skeleton is believed to be an adult male. Differential diagnoses include Paget's disease, McCune-Albright syndrome, osteochondroma and osteosarcoma. The radiographic findings, along with the solitary nature of the lesions, are strong evidence for the diagnosis of fibrous dysplasia (FD). Genetic analysis further revealed a frequency of ˜1% of mutant alleles with the R201C substitution, one of the post-zygotic activating mutation frequently associated with FD. Conclusions The multi-analytical method employed suggests a diagnosis of monostotic form of FD. The diagnostic design incorporates multiple lines of evidence, including macroscopic, histopathological, and genetic analyses. Significance Through the use of a multi-analytic approach, robust diagnoses can be offered. This case serves as one of the oldest examples of FD from an historical context. The genetic mutation detected, associated with FD, has not been previously reported in historical/ancient samples.

Balance is a complex motor skill requiring fine central processing of vestibular, visual, and somatosensory information to control and produce postural actions (Pankanin, Dobosiewicz, & Mietkowska, 2018). Without balance, humans normal functioning could not take place. Thus in activity that requires coordination, fast actions, and complex motor skills, such as during sports, balance becomes extremely relevant. Postural control is essential key component in athletic performances. The participations to extreme sports have grown in the past years, thus with it also the development of extreme sport medicine. Professional athletes are required to constantly improve performances, and one aspect of focus is balance. Similarly, injured patients are often forced to rehabilitate their vestibular system through proprioceptive and somatosensory exercises. In this chapter, we will brief report some of the posturography that athletes could use in training and for rehabilitative purposes.

Extreme aerial sports are a large subgroup of extreme sports. Participation in these activities has grown exponentially in the last decades, often surpassing traditional sports. Although fatalities related to extreme aerial sports are often generically ascribed to polytrauma, an autopsy can reveal unexpected elements in many cases. Forensic studies may lead us to ascertain different causes of death, such as anaphylaxis or myocardial infarction and together with eyewitness reports, they may make it possible to clarify the chain of events that led to an accident. This review paper may be critical not only for medico-legal reasons but also to provide useful information for the development of preventive measures, specific recommendations and safety systems. The paper aims to review available data about fatality rates, causes and dynamics in extreme aerial sports and to draw some possible conclusions about the role of forensic examinations in these sports.

La dysplasie developpementale de la hanche (DDH) resulte d’un retard dans le developpement de la cavite acetabulaire conduisant a une alteration de l’inclinaison du toit acetabulaire. En consequence, la tete femorale et la cavite cotyloidienne n’interagissent pas normalement. L’identification de trois cas de DDH parmi les restes decouverts dans l’unite stratigraphique la plus recente de la crypte de Roccapelago (Modene, Italie) nous permet de discuter de la presence de DDH dans cette region au cours du 18e siecle. Dans les trois cas, identifies comme deux hommes et une femme, la pathologie est bilaterale et de classe Dunn I. Ces cas de DDH sont vraisemblablement principalement dus a des facteurs mecaniques tels que la position en siege du foetus, probablement associee au rang de naissance. Mais compte tenu de leur similitude globale, ils peuvent avoir ete causes par l’utilisation de langes chez les nouveau-nes. En outre, les donnees actuelles du ministere italien de la Sante suggerent que l’incidence de la DDH est demeuree stable dans cette region, du 18e siecle jusqu’a nos jours. L’etude en cours des restes des unites stratigraphiques anterieures favorisera une comprehension plus profonde de la particularite de la prevalence de DDH a Roccapelago.

Background. Traditional monitoring of athletes during sports has long been hampered by bulky, complicated and tethered systems. In the past decade, this has changed due to the miniaturization of sensors and improvement of systems to store and transmit data. These systems have been integrated into textiles to create ‘smart clothing’ which has been so ubiquitous that a review of the recent literature is crucial for understanding its full potential and potential use in extreme sports. Methods. An electronic data base search was performed from 2003 to April 2019 for full length articles including “Smart” AND “Clothing” OR “Clothing” AND “Sport(s)” written in English with human subjects. Articles were evaluated according to the Newcastle-Ottawa Scale. Results. Twenty-four studies resulted in 18 systems comprised of 22 types of clothing with various capabilities, including: monitoring heart rate, electromyography, respiratory rate, steps, GPS, energy expenditure, posture, body temperature and identifying the activity. Conclusions. Many types of smart clothing from socks and gloves, to pants, shirts and bras are increasingly utilized to monitor sports activity worldwide and gather previously unavailable, yet highly valuable data. This provides a unique opportunity to study athletes during training and competition, potentially providing more effective training and better safety protocols.

© 2017, The Author(s). Previous research has considered action and adventure sports using a variety of associated terms and definitions which has led to confusing discourse and contradictory research findings. Traditional narratives have typically considered participation exclusively as the pastime of young people with abnormal characteristics or personalities having unhealthy and pathological tendencies to take risks because of the need for thrill, excitement or an adrenaline ‘rush’. Conversely, recent research has linked even the most extreme forms of action and adventure sports to positive physical and psychological health and well-being outcomes. Here, we argue that traditional frameworks have led to definitions, which, as currently used by researchers, ignore key elements constituting the essential merit of these sports. In this paper, we suggest that this lack of conceptual clarity in understanding cognitions, perception and action in action and adventure sports requires a comprehensive explanatory framework, ecological dynamics which considers person-environment interactions from a multidisciplinary perspective. Action and adventure sports can be fundamentally conceptualized as activities which flourish through creative exploration of novel movement experiences, continuously expanding and evolving beyond predetermined environmental, physical, psychological or sociocultural boundaries. The outcome is the emergence of a rich variety of participation styles and philosophical differences within and across activities. The purpose of this paper is twofold: (a) to point out some limitations of existing research on action and adventure sports; (b) based on key ideas from emerging research and an ecological dynamics approach, to propose a holistic multidisciplinary model for defining and understanding action and adventure sports that may better guide future research and practical implications.

Background The senile lung undergoes physiologic changes that are well known but have not been investigated with ultrasound (US). Thus, the aim of our study was to compare the US appearances of the lungs in a group of healthy, nonsmoker elderly subjects with those in a group of young subjects. Methods One hundred elderly subjects older than 65 years of age (mean age ± SD, 79 ± 7 years) and 50 younger subjects less than 56 years of age (mean age ± SD, 33 ± 12) underwent US examination of the lungs. We analyzed the anterior, midlateral, and posterobasal surface of each lung to evaluate the presence or absence of A-lines and B-lines. Fisher's exact test and Pearson's χ2 test were used to compare the findings in the two groups. Results A-lines were absent in 94/100 (94%) elderly subjects versus 2/50 (4%) young subjects (p 3 lines in 2/37 (5%); both ≤3 lines and >3 lines (depending on the region scanned) in 8/37 (22%). In contrast, only in 5/50 (10%) young subjects were B-lines visible (≤3 lines per field of view in all cases [p

The term foot-launched flying covers a number of sports, including hang gliding, paragliding, powered paragliding, and powered hang-gliding. The medical literature on injuries in these sports is scarce and fragmented, and these activities are often generically grouped together despite their differences in types of flight, equipment, and conditions of practice. Instead, these sports should probably be considered as sharply distinct due to their different injury dynamics and patterns. Most of the injury events in powered paragliding occur during takeoff, while in paragliding and hang-gliding they mainly occur during landing. In motorized sports, weather conditions seem to be implicated less often as a cause of incidents. Rather the engine and its thrust may be their primary cause, or may aggravate the outcome. In hang-gliding, the pilot stays in a prone position, while in paragliding the harness offers support in both standing and sitting positions. As a result, injuries to the head, the upper limbs, and cervical spine are more common in hang-gliding, while injuries to the ankle and thoracolumbar spine are more common in paragliding. Serious hand lesions caused by contact with the engine prop are specific to powered paragliding, while the head and face seem frequently affected by injuries in powered hang-gliding. These differences lead experts to believe that foot-launched flying sports should be considered separately in future studies.

Many features allow modern sailing to take place alongside other extreme sports, and these in particular mean challenging the laws of nature, pushing technology to the limit, spectacularity, and the need for its participants to possess technical skills and competencies in addition to physical fitness. The various sailing classes greatly vary in the demands they place on athletes, putting sailing crews at risk of different types of injuries and illnesses. Both recreational and novice dinghy sailors report mainly acute injuries: that are, in particular, head contusions from hitting the boom and spinnaker pole, cuts and lacerations to the hands and knee contusions due to falls and collisions with equipment. At the other extreme, prevailing injuries among Olympic-class athletes tend to overuse injuries, in particular, to the back and knees, due to specific activities such as hikingand also to a poor balance between work and recovery time. In America’s Cup crews, grinders, mastmen, and bowmen are mainly prone to injuries, that are mainly muscle contractures, tendinopathies, and sprains to the upper limbs and back. Intense training, psychological stress, cold and damp also expose these sailors to upper respiratory tract infections. In offshore and oceanic yacht racing, a large rate of medical conditions consists ofillnesses, that mainly affect the urinary and gastrointestinal tract and the skin. Acute injuries may be favoured by severe fatigue and sleep loss, especially during solo races.

This chapter focuses on rehabilitation tactics specific to extreme sports participants and covers various aspects relative to the approach, type of exercises, and progression of the rehabilitative process.

In this chapter, the main features of BASE jumping and wingsuits flying are discussed, focusing in particular on those aspects which mainly influence risk, such as equipment, exiting, and jumped objects.

PURPOSE: In polytraumatized patients with active bleeding, the improvement of survival depends on control/early stoppage of bleeding. The purpose of our study was to define the role of MDCT in patients with hemothorax. MATERIALS AND METHODS: From January 2008 to December 2013, we performed thoraco-abdominal CT to 1352 patients with polytrauma or thoracic blunt trauma. We retrospectively reviewed CT of 93 patients (mean age 65 years) where MDCT showed hemothorax. Basing on CT findings, 12 patients have been treated with interventional radiology, 78 patients with surgical procedures (drainage tube, VATS, thoracotomy). RESULTS: CT showed rib fractures in 85 patients; an active bleeding in arterial phase, with associated hematic pleural effusion in 12 patients;2 pseudoaneurysm in 2 patients. Two patients with flail chest showed bleeding a few days after traumatic event. Nine patients underwent to percutaneous treatment with technical success in 9/10 (90%). CONCLUSIONS: MDCT demonstrates high value in the management of patients with thoracic blunt trauma, identifying and classifying the severity of injuries. It shows high accuracy in the diagnosis of active bleeding and precludes the occurrence of complications. In the detection of active bleeding CT allows correct selection and safe treatment planning. In polytraumatized patients the selective arteriography and transcatheter embolization provide a viable diagnostic and therapeutic alternative in the management of bleeding from arterial lesions.

Chest diagnostic imaging is essential when dealing with a critically ill patient. At present, direct visualization of the lung parenchyma is performed with a chest x-ray and computed tomography with the patient in the supine position. The relative ease of bedside ultrasound examination and the availability of user-friendly, inexpensive, portable equipment have made chest ultrasonography an interesting and alternative method in various situations, because it offers accurate information that is of therapeutic and diagnostic relevance. We describe equipment and examination technique, normal findings, and chest ultrasonography signs detected in some pathological situations, such as pneumothorax, consolidations, pleural effusions, ARDS, and pulmonary edema.

The aim of this study was to evaluate the usefulness of imaging for correct clinical and therapeutic management of patients with scrotal disease. Between 2000 and 2007, 801 patients with suspected scrotal disease underwent colour Doppler ultrasonography (CDUS) at our centre. In 46 patients, the CDUS study was followed by magnetic resonance imaging (MRI). CDUS revealed an inflammatory process in 277 patients (34.58%), testicular trauma in 112 (13.9%), funicular torsion or torsion of the vestigial remnant in 44 (5.4%), findings suggestive of testicular neoplasm in 35 (4.3%) and no abnormality in 41.5%. MRI, used to further investigate the CDUS findings in 46 cases, showed three cases of intraparenchymal haematoma, one of intrascrotal cavernous body rupture, one of testicular abscess with intrascrotal fistula, two of testicular infarction and 15 of neoplasm. MRI allowed the exclusion of focal abnormalities in ten patients with testicular microlithiasis, in three with chronic orchitis and in four with atrophic involution. MRI confirmed the finding of inguinal hernia in three cases. On the basis of our experience, CDUS is irreplaceable as an initial approach to patients affected by scrotal disease, whereas MRI is an ideal second-line investigation. MRI offers useful, and in some cases decisive, information, as it is capable of revealing unexpected findings and elucidating complex aspects. MRI helps improve patient management, with an overall reduction in costs.

There are at least 100 entities that present a significative conjunction between skin signs and skeletal or other bony changes that can be detected by radiological means (skin and bones and others). The aim of this article is to underline that sometimes a radiological examination could guide to a correct diagnosis in dermatology. In addition, bloody diagnostic procedures could be avoided in ambiguous skeletal lesions if the radiologist remembers that skin and bone diseases exist. We review the literature and suggest a practical classification, including skin markers of occult radiological changes, skin diseases often associated with skeletal or other bony changes that require a radiological evaluation for a diagnosis, radiological changes mimicking cutaneous diseases, skeletal side effects of dermatological therapies (topical and systemic) and skin lesions occurring as a consequence of bone injury.

Background: Age-associated changes in the pulmonary system could be detected with imaging techniques. Widespread use of lung ultrasonography (US) requires characterization of a normal pattern. Objectives: To compare US and computed tomography (CT) findings in healthy subjects undergoing both techniques (with CT as the gold standard). Methods: We prospectively selected 59 subjects undergoing chest CT and US on the same day, without a history of smoking, respiratory symptoms, or known pulmonary pathologies. There were 44 patients in group 1 (age =60 years - elderly) and 15 patients in group 2 (age =50 years - young). Lung US was performed with a convex and a linear probe, and 10 chest areas per patient were analyzed. Convex and linear probe agreement was evaluated by means of the Cohen κ statistic; Fisher's exact test was used to compare categorical variables between groups. Results: Isolated B-lines were frequent in both group 1 (54.5%) and group 2 (40.0%); the number of chest areas positive for B-lines increased with age (16.1% in group 1 vs. 5.3% in group 2, p = 0.0028). In group 2, we found that 37.5% of subjects with B-lines had at least 1 chest area with multiple B-lines, but only 2 subjects had 2 or more. Moreover, in group 1 the chest CT documented a reticular pattern (2.3%), areas of increased density (9.1%), ground glass (6.8%), cysts (2.3%), bronchiectasis (22.7%), and bronchial thickening (6.8%); in group 2, only cysts (6.7%) and bronchiectasis (6.7%) were found. Conclusions: The senile lung is characterized by mild changes on CT and US. Chest areas positive for B-lines increase with age, and focal multiple B-lines can be found. However, diffuse patterns, especially in symptomatic subjects, suggest a different diagnosis.

The purpose of managing acute respiratory distress syndrome (ARDS) is "to open a closed lung" by increasing the airway pressure or changing the patient's position. Assessment of recruitment of atelectatic lung regions is necessary to have a correct management of mechanical ventilation and to be sure of positive end-expiratory pressure or prone position efficacy before their application. In fact, both of them could have collateral effects. Sonographic approach allows a dynamic evaluation of lung recruitment in patients affected by ARDS and it is easy to perform bedside. In particular, it is useful for patients too unstable to be moved to the CT room. Sonography is fast, cheap, and radiation free; thus, it can be repeated in order to monitor the evolution of ARDS. To our knowledge, the use of this technique in the setting of ARDS was never reported before.

We report the case of a patient with a myocardial infarct whose clinical and multislice spiral computed tomography (MSCT) presentation could easily be mistaken for that of an acute aortic dissection (AAD) or an intramural hemorrhage (IMH). He had an aberrant high extended superior pericardial recess associated with an anomalous origin of the right coronary artery from the left sinus of Valsalva. It was absolutely necessary to exclude other mediastinal low attenuation masses immediately. At the best of our knowledge it is the first case reported in the literature of a congenital aberrant pericardial recess with these features.

Paramotoring is a sport clearly distinct from paragliding in which the pilot flies using a special wing and wearing a motor on his back to take off. Generally paramotoring is not considered a high risk sport but since it is a relatively new sport, there aren't any reports in literature about injuries associated with its practice. We report the case of a 48 year old healthy professional athlete which had an accident during takeoff in one of his training flights and received diffuse axonal injury, vertebral fractures and anterior shoulder sprain with associated humeral trochiter fracture. We compared injuries to those connected to the practice of other aerial sports: paragliding in particular. Probably in paramotoring, unlike in paragliding, take-off is the more critical phase of flight and the use of the motor may aggravate the dynamics of trauma in case of accident. Although the patient was wearing a helmet at the time of the incident, he suffered a diffuse axonal injury: probably the impact location and impact speed compromised the effectiveness of helmet. So more research about the biomechanics of traumatic brain injuries in paramotoring is necessary to improve protection systems, such as helmets, to reduce injury risks in this sport. Furthermore padded back protection should be made obligatory when flying with power paragliding.