Chapter 14 - MSK Imaging, Breast, and Superficial Structures
Clinical findings of a superficial hemangioma
(1) Asymptomatic (2) Red or reddish-purple, raised mass on the skin
Sonographic findings of a pilonidal cyst
(1) Complex, subcutaneous mass (2) hyperemia, around the mass (3) Hypoechoic tract may be seen extending from the cyst to the skin surface
Clinical findings of a Pilonidal cyst
(1) Edema, warmth, and pain in the area of the cyst (2) Bloody drainage from the cyst may be present
Sonographic findings of a superficial hemangioma
(1) Hypoechoic (2) Blood flow may be detectable with color Doppler
Sonographic findings of gynecomastia
(1) Hypoechoic mass posterior to the areola (2) May have a triangular shape
Sonographic findings of cellulitis
(1) Hypoechoic, edematous strands within the soft tissue [cobblestone appearance]
Sonographic findings of mastitis
(1) Ill-defined areas of echogenicity (2) Diffuse Edema (3) Hypoechoic fluid within the subcutaneous tissue that outlines the fat lobules (4) breast skin thickening greater than 2 mm (5) Enlarged lymph nodes may be present
Sonographic findings of a superficial lipoma
(1) Most likely an isoechoic mass as compared to the surrounding tissues (2) typically have an oval shape
Sonographic findings of a ganglion cyst
(1) Noncompressible, anechoic mass with acoustic enhancement (2) May contain debris or septations
Clinical findings of mastitis
(1) Pain (2) Swelling (3) Warmth and redness in the area (4) fever (5) leukocytosis
Clinical findings of a galactocele
(1) Palpable, periareolar mass (2) Possible pain
Sonographic findings of a breast abscess
(1) Palpable, tender lump (2) Complex, focal mass that contains debris
Sonographic findings of galactocele
(1) Round, complex mass (2) May contain a fluid-fluid level
Sonographic findings of metastatic melanoma
(1) Solid, vascular hypoechoic mass
Clinical findings of gynecomastia
(1) Tender, palpable retro areolar breast mass that is firm to touch
Sonographic findings of a Baker cyst
(1) anechoic mass with posterior enhancement (2) complicated bakers cyst may contain echogenic fluid, debris, or sepatations (do not confuse w/ DVT)
Sonographic findings of a superficial epidermal cyst
(1) anechoic, hypoechoic, complex, or hyperechoing cyst or mass (2) Pseudotestis appearance
Clinical findings of a Baker cyst
(1) asymptomatic (2) focal tenderness in the popliteal fossa
clinical findings of achilles tendon rupture
(1) audible snap may be heard (2) posterior ankle and leg pain (3) positive Thompson test
sonographic findings of tendonitis
(1) diffuse: enlarged, hypoechoic tendon (2) focal: localized, enlarged hypoechoic area within the tendon (3) fluid may be noted (4) hyperemic flow may be noted
sonographic findings of DDH of the infant hip
(1) femoral head located completely outside the acetabulum [complete dislocation] (2) partially coverage of the femoral head by the acetabulum [subluxation] (3) evidence of a shallow acetabulum [<50% coverage of femoral head] (4) small alpha angle [Graf technique] (5) large beta angle [Graf technique]
clinical findings of DDH of the infant hip
(1) history of breech birth (2) family history of DDH (3) asymmetric skinfolds on the legs (4) leg length discrepancy (5) limited limb abduction (6) positive barlow or ortolani test
Sonographic findings of a superficial abscess
(1) hypoechoic, edematous strands within the soft tissue [cobblestone appearance] (2) focal fluid collection that is often complex, denoting the abscess (3) a peripheral rim of hyperemia may be detectable with color Doppler
clinical findings of a tendon rupture
(1) pain (2) edema (3) audible snap may be heard
clinical findings of tendonitis
(1) pain (2) painful region may be swollen (3) painful region may be warm to touch
Inflammation and infection of the skin and subcutaneous tissues
Cellulitis
—— can occur at any time, but is most commonly encountered just after birth, during puberty, and during mid to late adulthood between 50 and 80 years of age -can be bilateral -Can be associated with high levels of HCG
Gynecomastia
A benign tumor composed of blood vessels
Hemangioma
Buildup of fluid within the hip secondary to inflammation
Hip joint effusion
Characteristics of the subcutaneous layer of the breast
Hypoechoic Composed mostly of fat
The largest and most superiorly located pelvic bone
Ilium [pelvis]
How do you determine the epidermis from the dermis on ultrasound?
They are indistinguishable and appear collectively as a hyperechoic linear structure
A clinical test used to evaluate for a compete test of the Achilles' tendon
Thompson test
what test can be performed to see if there is a complete tear of the achilles tendon?
Thompson test - patient lies prone - the calf is squeezed and the foot should plantarflex in a patient who does not have a complete tear of the achilles tendon
Superficial lipomas are typically —— in shape
Oval
sonographic findings of achilles tendon rupture
(1) partial tears: appear as focal hypoehoic areas within the tendon (2) complete tears: seen as anechoic or heterogeneous area within the tendon, often indicative of a hematoma; may also be sonographically 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
Clinical findings of cellulitis
(1) red, tender, warm area of the skin (2) possible elevated WBC count [especially with abscess development]
Clinical findings of a superficial epidermal cyst
(1) visible, palpable mass just under the skin (2) Pain and redness in the area
Clinical findings of a ganglion cyst
(1.) Palpable mass most often located along the dorsal aspect of the hand or wrist (2.) Can be painful
Clinical findings of a superficial lipoma
(1.) asymptomatic (2.) obvious mass under the skin (3.) compressible
Clinical findings of hip joint effusion
(1.) leg and knee pain (2.) reluctance to walk (3.) irritability (4.) low grade fever (5.) mild leukocytosis
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 typically exceeds 5 mm
explain the ortolani test
-evaluates for the reduction or relocation of a dislocated hip -performed by abducting [moving outward/away from the body] and lifting the thigh, essentially relocating the hip back into the acetablum -during this test an audible click may be heard and a palpable clunk felt as the head of the femur passes over the acetablum
tendon tears can be partial or complete
-partial tears appear as focal hypoechoic areas within the tendon -complete tears appear as an anechoic or heterogeneous area within the tendon, often indicative of a hematoma; may also be sonographically 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
explain barlow test
-used to evaluate the hip for dislocation -the hip is flexed and adducted [inward], and the knee is pushed posteriorly [down] and superiorly [up]
Clinical test for developmental hip dysplasia that is used to evaluate the hit for dislocation
Barlow test
The bowl shaped surface of the pelvis were 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
A congenital disorder associated with severe joint contractures
Arthrogryposis
A synovial cyst located within the popliteal fossa
Baker cyst a.k.a. popliteal cyst
Large ganglion cysts in the wrist have been referred to as ——
Bible bumps, because individuals in the past have used large books, like the Bible, to reduce assessed by slamming the large book against it it
-a congenital anomaly that may be described as a shallow hip socket; -the ball of the hip - the femoral head - is prohibited from resting appropriately in the natural socket - the acetablum; -thought to be caused by abnormal fetal ligament development within the hip that is intensified by the excessive levels of circulating maternal estrogen
Developmental dysplasia of the hip [DDH]
Name the two layers of the skin
Epidermis and dermis
A common cyst found adjacent to a joint or tendon; most often found along the dorsal aspect of the hand, wrist, ankle, or foot
Ganglion cyst
What is the most common mass found along the dorsal aspect of the hand and wrist, although they can arise from any joint, and are those discovered in the foot and ankle as well?
Ganglion cyst
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
The benign enlargement of the mail breast; typically located posterior to the areola
Gynecomastia
Mastitis is most often associated with ——
Lactation/Breast-feeding
A benign, fatty tumor
Lipoma
Inflammation of the breast
Mastitis
Area located between the groove of the buttocks
Natal cleft
Clinical test for developmental hip dysplasia that is used to Evaluate the hip for the reduction or relocation of a dislocated hip
Ortolani test
These cysts are common and a result from the accumulation of synovial fluid from a weakening in the joint capsule of the knee, as seen in conditions such as rheumatoid arthritis or osteoarthritis - a channel may be seen connecting the cyst to the joint space
Popliteal cyst aka baker 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
Superficial epidermal cysts are most likely found in the ——
Scalp, face, neck, trunk, or back
Name the three layers of breast tissue from superficial to deep
Subcutaneous layer Mammary layer Retro-mammory later
Cysts commonly found in the scalp, face, neck, trunk, or back; they can be congenital, the result of trauma, or the result of an obstructed hair follicle
Superficial epidermal cyst A.k.a. epidermal inclusion cyst aka epidermoid cyst, or possibly a sebaceous cyst
This is the most common cause of a painful hip and joint a fusion in children
Transient synovitis aka Toxic synovitis or irritable hip
Characteristics of the mammory layer of the breast
Typically hyperechoic Contains ducts and glandular tissue Is the functional layer of the breast **The sonographic appearance of this Lair can vary based on many factors, including the age of the patient in the distribution of the various functional elements
Characteristics of the retromammary layer of the breast
Typically hypoechoic Contains fat as well
Are lipomas usually compressible ?
Yes
When cellulitis is identified, the sonographer should look carefully for a complex focal fluid collection that may represent ——
abscess development
what is the most commonly injured ankle tendon?
achilles
what are the 2 clinical tests that can be performed to evaluate infant for DDH?
barlow test ortolani test
ligaments connect ---- to ----
bones - bones
sonographically, the infant hip is examined in which two planes?
coronal and transverse in either the supine or lateral decubitus position
2 types of tendonitits
diffuse - appears as a thickened and hypoechoic tendon focal - appears as a localized, enlarged hypoechoic area within the tendon
ligaments appear sonographically as ----
echogenic linear structures as well
tendons appear sonographically as ----
echogenic, fibrous structures connecting muscle to bone
is DDH more common in males or females?
females
the sonographic diagnosis of DDH can be definitive when the ----
femoral head rests clearly outside the acetabulum
A milk filled breast cyst
galactocele
Buildup of fluid within the hip secondary to inflammation
hip joint effusion
tendonitis may yield ---- flow with color Doppler
hyperemic
muscles appear sonographically as ----
hypoechoic tissue that contains linear, echogenic strands
Superficial lipomas are typically —— to the surrounding fat
isoechoic -but they kind of hear hypoechoic or hyperechoic
The ducts of the breast used to transport milk to the nipple
lactiferous ducts
what side is DDH more common?
left
tendons connect ---- to ----
muscle - bones
what causes tendonitis?
overuse or strain
A hanging flap of tissue
pannus
in most situations the transducer must be placed ---- to the tendon for it to be appropriately imaged with sonography
perpendicular [occasionally altering the angle of insonation can help differentiate the tendon from adjacent fat]
Cyst located along the natal cleft that is comprised of loose hairs and skin debris
pilonidal cyst
what is the best position to view the achilles tendon sonographically?
prone - with his or her feet hanging off the end of the bed
Inflammation of the breast that is related to pregnancy
puerperal mastitis
complete ruptures of a tendon may be sonographically 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 - surrounding the area will most likely be edema with fluid accumulation
the ---- the alpha angle and the ---- the beta angle, the more likely the infant is suffering from DDH
smaller; larger
what has DDH been linked with?
spina bifida arthrogryposis and there is a familial link as well
partial dislocation of the hip
subluxation
this most likely results from some manner of recreational sport
tendon rupture aka tear
Inflammation of the tendon and synovial tendon sheath
tendosynovitis
inflammation of the tendon and synovial tendon sheath - fluid present within the synovial sheath
tendosynovitis
when looking at infant hip sonographically special attention should be given to the relationship of what?
the femoral head and its relationship to the acetabulum in both stress and relaxed states
