Penny Ch. 14 - MSK, breast, and superficial structures

what is the echogenicity of the retromammary layer and what is it composed of?

hypoechoic and consists of fat as well

what is the subcutaneous layer composed of? echogenicity?

hypoechoic and mostly composed of fat

what are the sonographic signs of cellulitis?

hypoechoic, edematous strands within the soft tissue making a cobblestone appearance

a benign,fatty tumor

lipoma

what is the functional layer of the breast?

mammary layer

breast infection

mastitis

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

pilonidal cyst

where diffuse pain is seen more with mastitis, ________ will be seen with an abscess

possibly palpable, painful lump

the achilles tendon is located along the posterior ankle and connects the calf muscle to the ____________

posterior surface of the heel, or calcaneus

what position is the patient put in to evaluate the achilles tendon?

prone, both asymptomatic and symptomatic achilles tendons should be scanned for comparison

inflammation of the breast tissue that is related to pregnancy

puerperal mastitis

what is the type of mastitis associated with breast feeding called?

puerperal mastitis

what are the sonographic findings of melanoma?

solid, vascular hypoechoic mass

partial dislocation of the hip

subluxation

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

superficial epidermal cyst

at what ages are infants screened for DDH?

4 to 6 weeks

often, an abnormal hip joint capsule width exceeds ____ mm

5

evidence of less than _____% coverage of the femoral head by the acetabulum is is considered to be shallow.

50%. greater than 55% is normal and less than 45% is very shallow

what is the most commonly injured ankle tendon?

Achilles tendon

a synovial cyst located within the popliteal fossa; may be referred to as a popliteal cyst

Baker's cyst

what are the two clinical tests that can be performed to evaluate an infant for DDH?

Barlow and Ortolani test

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

Ortolani test

nonsurgical treatment of DDH can be performed with casting or by means of a ______ harness.

Pavlik

clinical test used to evaluate for a complete tear of the Achilles tendon

Thompson test

what is developmental dysplasia (DDH) of the hip?

a congenital anomaly where the hip socket is shallow

why should the term "sebaceous cyst" be used less often?

a sebaceous cyst implies that the cyst is sebaceous in origin, which is not always true. true sebaceous cysts are uncommon. superficial epidermal cysts are most likely found in the scalp, neck, face, trunk or back

what is DDH thought to be caused by?

abnormal fetal ligament development within the hip that is intensified with excessive levels of estrogen. fetal malposition such as breech and oligohydramnios also increase the risk for DDH

*KNOW* when cellulitis is identified, the sonographer should look carefully for a complex fluid collection that may represent _________ development

abscess

what are Baker's cysts caused by?

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

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

acetabulum

Tendon located along the posterior ankle that connects the calf muscle to the posterior surface of the heel

achilles tendon

what does a complete tear look like on ultrasound?

anechoic or heterogeneous area within the tendon, often indicative of a hematoma; may also be sonographically indentified as refractive shadowing in the area of the separated tendon, with fat, a hematoma, or granulomatous material filling the gap created by the tear

what are the sonographic findings of hip joint effusion?

anechoic or hypoechoic fluid that elevates the anterior capsule of the joint, width of the abnormal hip joint capsule will typically measure more than 5 mm

*KNOW* the barlow test requires for the leg to be ________, whereas the ortolani test requires the leg to be ________. choose from abducted and adducted

barlow is adduction, ortolani is abduction

inflammation and infection of the skin and subcutaneous tissues

cellulitis

tendon tears can either be _____ or ______

complete or partial

what are the sonographic signs of a pilonidal cyst?

complex, subcutaneous mass, hyperemia around the mass, hypoechoic tract may be seen extending from the cyst to the skin surface

what are epidermoid cysts a result of?

congenital, result of trauma, or result of obstructed hair follicle

in what plane is the Graf technique used?

coronal

what two planes are used to image the infant hip?

coronal and transverse

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

developmental dysplasia of the hip

what does diffuse versus focal tendonitis look like on ultrasound?

diffuse is overall thickened hypoechoic tendon, focal is a localized enlarged hypoechoic area. hyperemic flow may be noted in the tendon as well. fluid may be seen within the synovial sheath

what echogenicity is the epidermis and dermis?

echogenic

what are the clinical findings of a pilonidal cyst?

edema, warmth, and pain in the area of the cyst. bloody drainage from the cyst may be present

as with mastitis, the presence of ________ will be seen with an abscess as well.

enlarged lymph nodes

what is a superficial epidermal cyst also referred to as?

epidermal inclusion cyst, epidermoid cyst, or possibly a sebaceous cyst

what are the layers of tissue from superficial to deep?

epidermis, dermis, subcutaneous fat layer, fascia, and muscle

what gender and side is DDH most common in?

females, left

what is complete dislocation of the hip?

femoral head is completely outside the acetabulum

when cellulitis is identified, a thorough investigation for ____ should ensue

focal abscess

milk-filled breast cyst

galactocele

lactating patients may present to the emergency department with a palpable mass that may be painful. a _______ is a milk filled cyst that can develop after an abrupt termination to breast feeding or result from an obstruction to the lactiferous duct or ducts

galactocele. can become infected as well

a common cyst found adjacent to a joint or tendon, most commonly found along the dorsal aspect of the hand, wrist, ankle and foot

ganglion cyst

benign enlargement of the male breast

gynecomastia

the benign enlargement of the male breast; typically located posterior to the areola

gynecomastia

what is the primary role of sonography with mastitis?

to determine the presence of a focal abscess

what is another 2 names for transient synovitis?

toxic synovitis or irritable hip

what is a hip joint effusion most likely the result of?

transient synovitis

sonography can aid in the localization and removal of some objects, particularly ________ which may not be recognized with radiography.

wooden fragments

are lipomas usually compressible?

yes

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

Barlow test

a technique used to measure the relationship of the femoral head and acetabulum by evaluating the alpha and beta angles created by the relationships of these structures

Graf technique

what sonographic artifact is seen with a complete tear that is not seen with a partial tear?

refractive shadowing

a congenital disorder associated with severe joint contractures

arthrogryposis

what causes gynecomastia?

high levels of hCG, which may be produced by some testicular tumors, high levels of estrogen, adrenal tumors, hepatoblastoma, Klinefelter syndrome, and some drugs including steroids and weed

buildup of fluid in the joint secondary to inflammation

hip joint effusion

what are the clinical findings of developmental dysplasia of the infant hip?

history of breech birth, family history of DDH, asymmetric skinfolds on the legs, leg length discrepancy, limited limb abduction, positive Barlow or Ortolani test

what is the echogenicity of fascia?

hyperechoic layer of varying thickness

what is the echogenicity of the mammary layer and what is it composed of?

hyperechoic, contains ducts and glandular tissue

*KNOW* tendonitis may yield ______ flow with color Doppler

hyperemic

inflammation around a foreign body will appear as a _________ area adjacent to the structure

hypoechoic

what are the sonographic findings of gynecomastia?

hypoechoic mass posterior to the areola, may have a triangle shape

what are the sonographic signs of a superficial abscess?

hypoechoic, edematous strands within the soft tissue making a cobblestone appearance, focal fluid collection that is often complex, denoting abscess, and a peripheral rim of hyperemia may be detectable with color Doppler

what echogenicity is the the subcutaneous layer

hypoechoic, with hyperechoic linear echoes representing connective tissue septa.

the largest and most superiorly located pelvic bone

ilium

what are the sonographic findings of mastitis?

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 may be present

in what ages does a hip joint effusion most commonly occur?

in children between 5 and 10 years of age

a channel may be seen connecting the baker's cyst to the _______

joint space

when is gynecomastia most commonly encountered?

just after birth, during puberty, and during mid to late adulthood between 50 and 80 years old

what is mastitis most often associated with?

lactation

what are the clinical findings of hip joint effusion?

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

what connects bone to bone?

ligaments. they are echogenic as well

_______ is the most likely primary tumor to metastasize to the subcutaneous fat

melanoma

hypoechoic tissue that contains linear, echogenic strands

muscle

area located between the buttocks

natal cleft

where are pilonidal cysts most commonly found?

natal cleft, which means the intergluteal cleft or gluteal cleft and is located between the buttocks. they can also be sen within the fingers or toes

what does pilonidal mean?

nest of hair. consequently, these cysts are composed of loose hairs and skin debris

are lipomas symptomatic?

no, but patients may complain of an unsightly bulging of the skin in the area of the lipoma

the position of the head of the femur can be described as either _____, _____ or _________.

normal, subluxed, or dislocated

a hidden abscess is termed an _____ abscess

occult

superficial lipomas are usually what shape and echogenicity?

oval shaped and isoechoic, but can be hypoechoic or hyperechoic

what are clinical signs of a tendon rupture?

pain, edema, audible snap may be heard, in an achilles tendon rupture - a positive Thompson test

what are the clinical signs of tendonitis?

pain, painful region may be swollen, painful region may be warm to the touch

what are the clinical findings of mastitis?

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

what are the sonographic findings of a breast abscess?

palpable tender lump, complex focal mass that contains debris

what are the clinical findings of a galactocele?

palpable, periareolar mass

a hanging flap of tissue

pannus

partial or complete tear: appearing as a focal hypoechoic area within the tendon

partial

What does a subluxation cause?

partial dislocation of the hip

How is the Thompson test performed?

patient lies prone and can be performed prior to ultrasound. the calf is squeezed, the foot should plantarflex in a patient who does not have a complete tear of the Achilles tendon

in most situation the transducer needs to be placed perpendicular or parallel to the tendon for it to be appropriately imaged?

perpendicular, however, occasionally altering the angle of insonation can help differentiate the tendon from adjacent fat

what type of cyst is most commonly found in the natal cleft?

pilonidal cyst

acoustic shadowing caused by bending of a sound beam at the edge of a curved reflector; may be referred to as edge artifact or edge shadowing

refractive shadowing

what are the sonographic findings of a galactocele?

round, complex mass, may contain a fluid-fluid level

*KNOW* the ______ the alpha angle and the _____ the beta angle, the more likely the infant is suffering from DDH

smaller, larger

*KNOW* patients with a torn Achilles tendon may have heard an audible _____ when the tendon ruptures

snap

what disorders is DDH linked with?

spina bifida and arthrogryposis, familial as well

what is cellulitis caused by?

strep, Staph

what are the three breast tissue layers from superficial to deep?

subcutaneous layer, mammary layer, and retromammary layer

what type of cyst has a pseudotestis appearance?

superficial epidermal cyst

tendon rupture may also be known as a _____

tear. it most likely occurs from some manner of recreational sport

what are the clinical findings of gynecomastia?

tender, palpable retroareolar breast mass that is firm to the touch

echogenic, fibrous structures, that connect muscle to bone

tendons

inflammation of the tendon and synovial tendon sheath

tendosynovitis