Point-of-Care Ultrasound in Japanese Mamushi ( Gloydius blomhoffii ) Bites: Presence of Deep Subcutaneous Hypoechoic Bands.
Riu Homma, Yoshihiro Aoki
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Case in brief
Three children aged 7–9 years presented with clinically diagnosed Japanese mamushi bites to the fingers and Grade III envenomation, with swelling extending to the elbow. Point-of-care ultrasound showed a hypoechoic band in the deep subcutaneous tissue, just above the muscle fascia, most prominent at the bite site and tapering distally. The band extended beyond clinically visible swelling and progressively thinned before disappearing on serial scans as the children improved after cepharanthine and anti-mamushi serum. All recovered without sequelae.
What made this case unusual
The ultrasound abnormality was a distinct deep subcutaneous band immediately superficial to the muscle fascia, an anatomic location that may differ from previously described snakebite ultrasound findings.
Diagnostic / clinical pearl
In these cases, ultrasound detected subcutaneous changes beyond visible swelling, and serial band resolution tracked clinical improvement; interpret this finding alongside the overall clinical assessment.
Why it matters
The authors suggest the band may help monitor response and inform decisions such as fasciotomy or antivenom use, while noting that its value and species specificity require further validation.