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