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?