108. Electromyography integrated with neuromuscular ultrasound evaluation in pediatric age: Description of two clinical cases

Pediatric neuromuscular diseases, clinically heterogeneous, are a diagnostic challenge, and can require invasive and expensive investigations. Two clinical cases studied with integrated electromyography (EMG) and Neuro-Muscular UltraSound (NMUS) are reported: Case 1: A 5 years-old female developing a left equinus-foot within the last year, without any trauma or infection. NMUS-examination shows selective Soleus muscle involvement with increased echogenicity and alterated architecture. The EMG-study is negative for neuropathic/myopathic disorders; the biopsy finds a Soleus’s vascular malformation. Case 2: A 12 years-old male, agonistic karateka, with pes-cavus and right lower limb’s hypometria noted in the last year following an increase in height. NMUS-study shows bilateral involvement of lower limb’s posterior loggias, mainly right, with echogenicity homogeneously increased and preserved architecture. The EMG shows a distal asymmetric polyneuropathy, predominant in the Tibial nerve. Genetic and immunological investigations are in progress. In both clinically similar cases, (paucisymptomatic, monolateral, late-onset presentation), integrated-NMUS-EMG study guided the diagnosis toward: a selective damage with muscle’s morphostructural alteration and negative EMG (case 1); a prevalent chronic damage with muscular structure preserved and EMG-detection of asymmetric neuropathy (case 2). The combined morpho-functional evaluation with integrated NMUS-EMG facilitates pediatric neuromuscular diagnosis, improving the spatial resolution with limited costs and invasiveness.