CHAPTER 14 - MUSCULOSKELETAL IMAGING, BREAST AND SUPERFICIAL STRUCTURES

Tendosynovitis

Fluid within the synovial sheath is indicative of;

lactiferous ducts

transport milk to the nipple

Puerperal mastitis

Inflammation of the breast that is related to pregnancy is referred to as;

Tendosynovitis

Inflammation of the tendon and synovial tendon sheath is referred to as;

occult abscess

A hidden abscess is termed an;

Focal hypoechoic areas within the tendon

A partial tear of a tendon typically appears as;

Superficial abscess

A patient presents to the sonography department with a history of cellulitis on his abdomen. The pt has fever, edema and complains of focal tenderness in a specific region affected by cellulitis. Sonographically, you identify a localized complex collection of fluid. What is the most likely diagnosis?

Pilonidal cyst

A patient presents with a palpable, oozing mass at the level of the natal cleft. What is the most likely etiology of this mass?

Refractive shadowing

Acoustic shadowing caused by bending of a sound beam at the edge of a curved reflector is referred to as;

Comet tail artifact.

Bullets, shrapnel, and other metallic objects may cause;

DVT

Clinical findings of a baker cyst may mimic those of a;

leg and knee pain reluctance to walk irritability low grade fever mild leukocytosis

Clinical findings of hip joint effusion

pain, swelling, warmth and redness in the area. fever, leukocytosis.

Clinical findings of mastitis

Pain Edema The area is warm to touch

Clinical findings of tendonitis include;

Ganglion cysts typically appear sonographically as an incompressible, anechoic mass with acoustic enhancement. Clinically, ganglion cysts may be hard to touch and painful. Ganglion cysts are often treated with an injection of corticosteroids. A ganglion cyst is a common mass found along the dorsal aspect of the hand and wrist.

Ganglion cysts;

between 50-80 years. high levels of hCG which may be produced by some testicular tumors, high levels of estrogen, adrenal tumors, hepatoblastoma, klinefelter syndrome, and with some drugs including steroids and marijuana.

Gynecomastia occurs most commonly

Inflammation

Hyperemic flow within or around a structure is often indicative of;

Prone

In what position should the pt placed to better evaluate the achilles tendon?

Cellulitis

Inflammation and infection of the skin and subcutaneous tissue is termed;

-The pt lies prone, with his or her feet hanging off the end of the bed. -Both the symptomatic and asymptomatic tendons should be scanned for comparison. -The entire tendon should be evaluated in SAG and TRANS -Thompson test

Sonographic assessment of an Achilles tendon;

Hypoechoic tissue that contains liner, echogenic strands.

Sonographically, normal muscle appears as;

Partial hip dislocation

Subluxation denotes;

Anechoic to the surrounding tissue. They can be hypoechoic, isoechoic, hyperechoic.

Superficial lipomas are not;

Graf

Technique that is used to measure the relationship of the femoral head and acetabulum by evaluating the alpha and beta angles?

hemangioma

a benign tumor made up of blood vessels

refractive shadowing

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

Partial tendon rupture

appear as focal hypoechoic areas within the tendon.

palpable, periareolar mass. possible pain. Round complex mass may contain a fluid-fluid level.

clinical and sonographic findings of galatocele

subluxation

partial dislocation of the hip

Transient synovitis

referred to as toxic synovitis or irritable hip; most common cause of a painful hip and joint effusion in children.

ortolani test

test for developmental hip dysplasia that is used to evaluate the hip for reduction or relocation of a dislocated hip

puerperal mastitis

Inflammation of the breast in connection with pregnancy

A linear array transducer should be used. Most foreign bodies are better visualized using a stand off pad. Comet tail artifact may be seen posterior to metallic objects.

Keys to identifying foreign bodies with sonography;

Echogenic, fibrous structures connecting muscles to bone.

Tendons sonographically appears as;

Sound OFF

The Barlow test requires for the leg to be adducted, whereas the Ortolani test requires the leg to be abducted.

Baker cyst

The accumulation of synovial fluid from a weakening in the joint capsule of the knee, as seen in conditions such rheumatoid arthritis can result in a;

Heel to the calf muscle

The achilles tendon connects the;

The calf is squeezed and the foot should plantarflex in pt who doesn't have a complete tear of the achilles tendon.

What best describes the Thompson test?

Hypoechoic, retroareolar mass

What is the best description of the most common sonographic appearance of gynecomastia?

Developmental hip dysplasia

What is the most likely cause of a hip joint effusion in infants?

Hemangioma

What would be best described as a benign tumor comprised of blood vessels?

Lipoma

What would be best described as a benign tumor comprised of fat?

Ganglion cyst

Which of the following is also referred to as a Bible bump?

High frequency linear array transducer

Which transducer would be best suited to sonographically assess for a splinter in a patient's hand?

arthrogryposis

a congenital disorder associated with severe joint contractures

pannus

a hanging flap of tissu

galatocele

a milk filled breast cyst

Complete tendon rupture

anechoic or heterogeneous area within the tendon, indicative of hematoma, can be identified as refractive shadowing in the area of the separated tendon, with fat, a hematoma or granulomatous material filling in the gap created by the tear.

achilles tendon

attaches the gastrocnemius muscle to the heel bone

Developmental dysplasia of the infant hip

caused by abnormal fetal ligament development within the hip that is intensified by the excessive levels of circulating maternal estrogen. Fetal malposition; breech and oligohydramnios will increase the risk. DDH is more common on female on the left side.

tender, palpable retroareolar breast mass that is firm to touch. hypoechoic mass posterior to the areola. may have a triangular shape.

clinical and sonographic findings of gynecomastia

barlow test

clinical test for developmental hip dysplasia that is used to evaluate the hip for dislocation

superficial epidermal cyst

commonly found in scalp, face, neck, trunk or back. they can be congenital, the result of trauma or an obstructed hair follicle.

developmental dysplasia of the hip

congenital anomaly in which the ball of the hip is prohibited from resting appropriately in the natural socket provided for it on the pelvis

pilonidal cyst

cyst located along the natal cleft that is comprised of loose hairs and skin debris

palpable, tender lumo. complex, focal mass that contains debris.

sonographic findings of a breast abscess

noncompressible, anechoic mass with acoustic enhancement. may contain debris or septations.

sonographic findings of a ganglion cyst

hypoechoic, edematous strands within the soft tissue (cobblestone appearance)

sonographic findings of cellulitis

ill defined areas of echogenicity. diffuse edema. hypoechoic fluid within the subcutaneous tissue that outlines the fat lobules. breast skin thickening greater than 2 mm. enlarged lymph nodes.

sonographic findings of mastitis

Thompson test

test to evaluate. for a complete tear of the achilles tendon

acetabulum

the bowl shaped. surface of the pelvis where the head of femur normally rests.

ilium (pelvis)

the largest and most superiorly located pelvic bone

The patient lies prone while the symptomatic calf is squeezed

Best describes the Thompson test;

Joint effusion

A 6 year old female pt presents to the sonography department for a hip sonogram with irritability, unwillingness to walk and low grade fever. Sonographically you visualize a hypoechoic fluid collection that elevates the joint capsule. What is the most likely diagnosis?

Sound OFF

A baker cyst may be seen in the presence of rheumatoid arthritis or other knee joint issues.

Ortolani

A clinical test for developmental hip dysplasia that is used to evaluate the hip for the reduction or relocation of a dislocated hip?

Ganglion cyst

A common mass found along the dorsal aspect of the hand and wrist is the;

Pannus

A complicated baker cyst may contain a thin flap of tissue referred to as;

Bakers cyst

A cyst mass located within the popliteal fossa is mostly like a;

Tendosynovitis

fluid within the synovial sheath

anechoic or hypoechoic fluid that elevated the anterior capsule of the joint. width of the abnormal hip joint capsule typically exceeds 5 mm.

sonographic findings of hip joint effusion

Three layers of breast from superficial to deep

subcutaneous : hypoechoic mammary: hyperechoic - ducts and glandular tissue ( functional later of the breast ) retromammary : hypoechoic

They feel no pain in the area of the mass

Patients with a lipoma;

Air

What at the site of foreign body, can produce bright echoes and therefore cause some ambiguity about the correct orientation of the object?