Chapter 14: Musculoskeletal Imaging & Superficial Structure (Penny)

True or false. superficial abscesses have a wide range of sonographic features and are often complex with a peripheral rim of hyperemia that is detected with color doppler.

True

may also be referred to as a tear

tendon rupture

inflammation of a tendon that can be focal or diffuse

tendonitis

achilles tendon should be assessed for signs of __________ and __________

tendonitis and rupture

6. The achilles tendon connects the: a. ankle to knee b. heel to ankle c. heel to calf muscle d. knee to calf muscle

c. heel to calf muscle

20. sonographically, normal muscle appears as: a. hyperechoic tissue that contains linear, echogenic strands b. complex tissue that contains linear, hypo echoic strands c. hypoechoic tissue that contains linear, echogenic strands d. echogenic tissue that contains linear, hypo echoic strands

c. hypoechoic tissue that contains linear, echogenic strands

25. hyperemic flow within or around a structure is often indicative of: a. malignancy b. benignancy c. inflammation d. rupture

c. inflammation

3. what test can be performed to determine a torn achilles tendon? a. mcburney test b. mcdonald test c. thompson test d. baker test

c. thompson test

how do hemangioma appear on ultrasound?

heterogeneous blood flow detectable with color doppler

what type of transducers are utilized to images superficial structures?

high frequency, linear array transducers

sonographic appearance of ganglion cyst

incompressible, anechoic mass acoustic enhancement

acoustic shadowing caused by a bending of a sound beam at the edge of a curved reflector

refractive shadowing

what is associated with popliteal cysts?

rheumatoid arthritis

how do tendons appear sonograpically?

echogenic fibrous structures connecting muscle to bone

cellulitis is often caused by a __________ or ___________ infection

staph or strep (staphylococcus aureus, streptococcus pyogenes)

15. fluid within the synovial sheath is indicative of: a. hyperemic flow b. tendosynovitis c. cartilaginous inflammation d. cartilaginous extension

b. tendosynovitis

benign mass that is comprised of vascular channels

hemangioma

benign, fatty tymor

lipoma

12. Which of the following would be best described as a benign tumor comprised of blood vessels? a. hemangioma b. lipoma c. hamartoma d. oncocytoma

a. hemangioma

13. Which of the following transducers would be best suited to sonographically assess for a splinter in a patients hand? a. high frequency, linear array transducer b. low frequency, curved array transducer c. high frequency, sector transducer d. low frequency, linear array transducer

a. high frequency, linear array transducer

29. bullets, shrapnel, and other metallic objects may cause: a. acoustic enhancement b. comet tail artifact c. edge enhancement d. mirror image artifact

b. comet tail artifact

True or False. A channel may be seen connecting the bakers cyst to the joint space.

True

4. a cystic mass located within the popliteal fossa is most likely a: a. baker cyst b. thompson cyst c. ganglion cyst d. lipoma

a. baker cyst

23. tendons sonographically appear as: a. echogenic, fibrous structures connecting muscle to bone b. echogenic, fibrous structures connecting bone to bone c. hypoechoic, linear arrangements within hyper echoic tissue d. hyperechoic tissue that contains linear, echogenic strands

a. echogenic, fibrous structures connecting muscle to bone

What is a bakers cyst?

accumulation of synovial fluid from a weakening in the joint capsule of the knee

located posterior to and connects the calf muscle to the posterior surface of the heel or calcaneus

achilles tendon

most commonly injured ankle tendon

achilles tendon

8. Which of the following best describes the thompson test? a. patient lies prone and performs plantar-flexion b. patient lies prone while symptomatic calf is squeezed c. patient lies supine and performs plantar-flexion d. patient lies prone and performs dorsi-flexion

b. patient lies prone while symptomatic calf is squeezed

how are ganglion cysts treated?

corticosteroid injection

sonographic findings of a partial tendon tear

focal hypo echoic area within the tendon

common mass found along the dorsal aspect of the hand and wrist

ganglion cyst

clinical findings of ganglion cyst

hard to touch painful

patient position for scanning

lie prone with feet hanging off the end of the bed

sonographic finding of a complete tendon tear

-anechoic or heterogeneous area within the tendon indicating a hematoma -sonographically may appear as refractive shadowing in the area of the separated tendon with fat, hematoma, or granulomatous material filling in the gap created by the tear

clinical findings of tendonitis:

-pain -painful area may be swollen -painful area may be warm to touch

How is the Thompson test performed?

-patient in prone position -while calf is squeezed the foot should plantar flex in a patient w/o a complete tear of the achilles tendon

21. all of the following are true of ganglion cysts except: a. a ganglion cyst is a common mass found along the anterior aspect of the hand and wrist between the carpals b. ganglion cysts typically appear monographically as an incompressible, anechoic mass with acoustic enhancement c. clinically, ganglion cysts may be hard to the touch and painful d. ganglion cysts are often treated with an injection of corticosteroids

a. a ganglion cyst is a common mass found along the anterior aspect of the hand and wrist between the carpals

11. Which of the following would be best described as a benign tumor comprised of fat? a. hemangioma b. lipoma c. hamartoma d. oncocytoma

b. lipoma

30. Which of the following at the site of a foreign body may produce bright echoes and therefore cause some ambiguity about the correct orientation of the object? a. fluid b. enhancement c. dust d. air

d. air

What transducer is used to image musculoskeletal structures?

linear array

hanging flap of tissue

pannus

What test is used to see if there is a complete tear the tendon?

Thompson test

10. All of the following are keys to identifying foreign bodies with sonography except: a. most foreign bodies appear hypo echoic b. a linear array transducer should be used c. most foreign bodies are better visualized with a standoff pad d. comet tail artifact may be seen posterior to metallic object

a. most foreign bodies appear hypo echoic

18. a complicated baker cyst may contain a thin flap of tissue referred to as: a. pannus b. plicae c. septation d. lipoma

a. pannus

7. To better evaluate achilles tendon, the patient should be placed in what position? a. prone b. supine c. RLD d. LLD

a. prone

17. inflammation of the tendon and synovial tendon sheath is referred to as: a. tenosynovitis b. tendonitis c. cellulitis d. pannus

a. tenosynovitis

27. Which of the following best describes a negative thompson test? a. the calf is squeezed and the foot should plantar flex in a patient who does not have a complete tear of the achilles tendon b.the calf is squeezed and the foot should not plantar flex in a patient who does not have a complete tear of the achilles tendon c. achilles tendon is squeezed and the foot should plantar flex in a patient who does not have a complete tear of the achilles tendon d. the achilles tendon is squeezed and the foot should not plantar flex in a patient who does not have a complete tear of the achilles tendon

a. the calf is squeezed and the foot should plantar flex in a patient who does not have a complete tear of the achilles tendon

aka popliteal cyst

bakers cyst

where is a popliteal cyst located?

behind the knee

14. the accumulation of synovial fluid from a weakening joint capsule of the knee as seen in conditions such as rheumatoid arthritis can result in a : a. hemangioma b. lipoma c. baker cyst d. ganglion cyst

c. baker cyst

1. Inflammation and infection of the skin and subcutaneous tissue is termed: a. ascites b. retroperitoneal fibrosis c. cellulitis d. subcutaneous edema

c. cellulitis

5. A common mass found along the dorsal aspect of the hand and wrist is the: a. baker cyst b. thompson cyst c. ganglion cyst d. lipoma

c. ganglion cyst

28. superficial lipomas may appear as all of the following except: a. hypoechoic to the surrounding tissue b. isoechoic to the surrounding tissue c. hyperechoic to surrounding tissue d. anechoic to the surrounding tissue

d. anechoic to the surrounding tissue

16. acoustic shadowing caused by bending of a sound beam at the edge of a curved reflector is referred to as: a. mirror image artifact b. indirect artifact c. reflective shadowing d. refractive shadowing

d. refractive shadowing

24. a standoff pad is most useful in imaging: a. deep structures that produce acoustic enhancement b. deep structures that produce acoustic shadowing c. structures that produce refractive shadowing d. superficial structures

d. superficial structures

9. Which of the following is true concerning patients with a lipoma? a. they often complain of pain the area of the mass b. they are often obese c. they are slightly tender in the area of the mass d. they feel no pain in the area of the mass

d. they feel no pain in the area of the mass

foreign bodies below the skin surface may require a _________ pad for better visualization

standoff

inflammation of the tendon and fluid within the synovial sheath

tendosynovitis

how do muscles appear sonographically?

hypoechoic tissue contains linear, echogenic strands

how do superficial lipomas appear?

hypoechoic, isoechoic, hyper echoic when compared to surrounding tissues

sonographic findings of a bakers cyst:

1. anechoic mass with posterior enhancement 2. complicated baker cysts may contain echogenic fluid, debris, pannus, or septations

clinical findings of a bakers cyst:

1. asymptomatic 2. focal tenderness in the pop fossa

Sonographic findings of tendonitis

1. diffuse: enlarged, hypoechoic tendon 2. focal: localized, enlarged hypo echoic area within the tendon 3. fluid may be noted 4. hyperemic flow may be noted

Clinical findings of a tendon rupture

1. pain 2. swelling 3. edema

19. clinical finding of a baker cyst may mimic those of a/an: a. AVM b. DVT c. knee fracture d. ganglion cyst

b. DVT

infection and subsequent inflammation of the skin and subcutaneous tissue

cellulitis

26. All of the following will aid in the sonographic assessment of an Achilles tendon except: a. patient lies prone, with his or her feet hanging off the end of the bed b. both the symptomatic and asymptomatic achilles tendon should be scanned for comparison c. entire tendon should be evaluated in sagittal and transverse scan planes d. the patient is scanned in the erect position, with a small amount of pressure placed on the symptomatic side

d. the patient is scanned in the erect position, with a small amount of pressure placed on the symptomatic side

how do ligaments appear sonographically?

echogenic connect bone to bone

2. Clinical findings of tendonitis include all of the following except: a. itching in the area of the tendon b. pain c. edema d. warm to touch

a. itching in the area of the tendon

22. A partial tear of a tendon typically appears as: a. focal hypoechoic areas within the tendon b. focal echogenic area within the tendon c. diffiusely heterogeneous area within the tendon d. edema and refractive shadowing in the area of the divided tendon

a. focal hypoechoic areas within the tendon