Pennys Book Chapter 14- Musculoskeletal Imaging, Breast, and Superficial Structures

patients with an __________ ____________ rupture pay present with posterior ankle and leg pain and may state that they heard an audible snap as the tendon ruptured

Achilles tendon

clinical features of an ___________ ___________ __________ presents as an audible snap may be heard, posterior ankle/leg pain, and a positive Thompson test

Achilles tendon rupture

where diffuse pain may be seen more with mastitis, a patient with _________ will have a palpable, painful lump

abscess

the ______________ is the recessed region of the pelvis where the femoral head should rest

acetabulum

what can the ultrasound appearance of the mammary layer vary based on?

age and distribution of the various functional elements

the smaller the ________ angle and the larger the ________ angle, the more likely the infant is suffering from DDH

alpha, beta

air at the site of the foreign object may cause ___________ about the correct ____________ of the object when viewed with ultrasound

ambiguity, orientation

what may be heard and felt during an Ortolani test?

an audible "click" and a palpable "clunk" felt as head of femur passes over the acetabulum

what is the term for a hidden abscess?

an occult abscess

a seroma will likely appear as an __________ fluid filled collection

anechoic

although ganglion cyst most often appear on the dorsal aspect of the hand and wrist, the can also arise from ______ _________ and are thus discovered in the _______, ________ and ________ as well

any joint knee foot ankle

where is the natal cleft?

area located between the groove of the buttocks

_________________ is a congenital disorder associated with severe joint contractures

arthrogryposis

when scanning for DDH, how can the position of the head of the femur as it relates to the acetabulum be described?

as normal, subluxed, or dislocated

Baker cysts can be _______________ under ultrasound guidance, ______________ injection, arthroscopic _____________ or _____________ of unidirectional valvular slits

aspirated corticosteroids cystectomy enlargement

clinically, patient with DDH will have what physical features?

asymmetrical skin folds on legs, leg length discrepancy, and limited limb abduction

lipomas are ________, _________ tumors

benign, fatty

what is the recommended time frame infants should be scanned after birth?

between 4 and 6 weeks

what age does a hip joint effusion typically occur?

between 5 and 10

gynecomastia can be _____________

bilateral

gynecomastia can occur at any time, but is most commonly encountered just after _________, during __________, and during mid-to-late adulthood between _____ and ______ years of age

birth puberty 50 and 80

for a DDH exam, it is recommended that ______ ______ are examined and a _____________ or _________ coronal view and transverse view of the ________ hip with and without __________

both hips neutral or resting flexed stress

patients with a ________ ________ will present clinically like someone suffering from mastitis

breast abscess

ultrasound findings of a ________ _________ presents as a palpable, tender lump in the breast, a complex, focal mass that contains debris, peripheral hyperemia, possible enlargement of lymph nodes the presence of it

breast abscess

what is a hip joint effusion?

buildup of fluid within the hip secondary to inflammation

__________ ______________ such as _____________ and __________________ greatly increase the risk of developing DDH

fetal malposition, breech, oligohydramnios

some facilities may use __________ from the nipple or __________ to be precise in localization of _______ ___________ for breast ultrasound

finger measure breast pathology

in the Barlow test, the hip is ____________ and __________ and the knee is pushed ______________ and _____________

flexed, adducted, posteriorly, superiorly

what is indicative of tendosynovitis?

fluid within the synovial sheath

___________ tendonitis appears as localized, enlarged hypoechoic area within the tendon

focal

a ______________ is a milk-filled cyst that can develop after an abrupt termination to breastfeeding or result from an obstruction to the lactiferous ducts or ducts

galactocele

clinical findings of a _______________ present as a lactating patient with a palpable mass that may be painful, the mass are typically painful and located near the areola or have a preareolar mass, and they can become infected

galactocele

ultrasound findings of a ______________ present as a round, complex mass that may contain a fluid-fluid level in lactating patients

galactocele

clinical findings of a ___________ cyst present as a mass most often located along the dorsal aspect of hand or wrist and can be painful

ganglion (cyst)

ultrasound appearance of a _____________ cyst presents as a non-compressible, anechoic mass with acoustic enhancement most often on the wrist, and may contain debris or septations

ganglion (cyst)

what is another name for the calf muscle?

gastrocnemius

_______________ is benign enlargement of the male breast

gynecomastia

clinical findings of ______________ present as a tender, palpable retroareolar breast mass that is firm to touch in men

gynecomastia

ultrasound findings of _______________ present as a hypoechoic mass posterior to the areola in men and may have a triangular shaped

gynecomastia

gynecomastia can be associated with high levels of what?

hCG

a superficial ______________ is a benign mass that is composed of vascular channels

hemangioma

blood flow may be detected with color doppler and superficial _______________ are typically sonographically hypoechoic in appearance

hemangioma

clinical findings of superficial _______________ present as asymptomatic or a red or reddish purple raised mass on the skin

hemangioma

superficial _______________ are typically asymptomatic and appear as raised, red or reddish purple mass on skin

hemangioma

ultrasound findings of a superficial ______________ present as hypoechoic and detectable blood flow with color doppler

hemangioma

a breast ____________ should especially be considered following trauma or surgery

hematoma

a breast _____________ will often appear complex and disappear with time as it is reabsorbed into the body

hematoma

what probe should be used for a DDH exam?

high frequency linear probe

soft tissue ultrasound typically requires the use of a _______ frequency _________ probe

high, linear

ultrasound guided ____ ____________ may be helpful for a patient with hip joint effusion to relieve pain and differentiate the disorder from the more worrisome diagnosis of septic arthritis

hip aspirations

clinical findings of _____ _______ _________ presents was leg and knee pain, reluctancy to walk, irritability, low-grade fever, and mild leukocytosis

hip joint effusion

ultrasound presentation of _____ ______ ___________ is seen as anechoic or hypoechoic fluid that elevates the anterior capsule of the joint, width of the abnormal hip joint capsule typically exceeds 5 mm

hip joint effusion

how will most foreign objects appear with ultrasound?

hyperechoic structures with some degree of posterior shadowing

with tendonitis, what may be denoted within the tendon

hyperemic flow

muscles appear sonographically as what?

hypoechoic tissue that contains linear, echogenic, fibrous structures connecting muscle to bone

primary melanomas classically appears _____________ with increased ____________ ______ noted with color doppler

hypoechoic, vascular flow

in the coronal plane of a DDH exam, the _________ can be noted appearing to extend from the femoral head as an echogenic linear structure producing an acoustic shadow

ilium

to assess the depth of the acetabulum from the coronal view, a line can be drawn from along the __________ and through the ____________ _________

ilium, femoral head

where are Baker cyst located?

in the popliteal fossa, behind the knee

the epidermis and dermis are ________________ and appear collectively as a ________________ ________ structure

indistinguishable, hyperechoic linear

cellulitis is ___________ and subsequent ____________ of the skin and subcutaneous tissue

infection, inflammation

what is tendonitis?

inflammation of a tendon

what is mastitis?

inflammation of the breast due to an infection

what is transient synovitis?

inflammation of the hip joint

what is the common treatment for a ganglion cyst?

injection of corticosteroids or surgical removal

what is another name for the natal cleft?

intergluteal cleft or gluteal cyst

what is most often associated with mastitis?

lactation, but may be seen following trauma or surgery

a ____________ image of the entire length of the torn Achilles tendon may be useful

landscape

a subluxed hip will sit more _____________ within the acetabulum, but still partially ______________ by the acetabulum

laterally, covered

normal ultrasound appearance of the breast tissue __________ should be visible

layers

what side of the hip does DDH affect more?

left

with cellulitis, there may be evidence of _____________, especially if an abscess is present

leukocytosis

what probe is typically used for musculoskeletal structures?

linear array

patients with a __________ are typically asymptomatic, but may complain of an unsightly budging of the skin

lipoma

clinical findings of a superficial _________ presents as an asymptomatic obvious mass under the skin and are compressible

lipomas

ultrasound findings of superficial _________ presents most likely as an hypoechoic or isoechoic mass as compared to the surrounding tissues and typically have an oval shape

lipomas

ultrasound can aid in the ______________ and ___________ of some foreign objects, particularly __________ fragments or other _______________ objects

localization removal wooden radiolucent

the entire Achilles tendon should be analyzed in what planes during an ultrasound scan of it?

long and transverse

what are pilonidal cysts composed of?

loose hairs and skin debris

the ______________ layer of the breast is typically hyperechoic and contains the ducts and granular tissue

mammary

what is the gold standard for breast imaging?

mammography

clinical features of ___________ present as pain, swelling, warmth and redness in the area (erythema), fever, and leukocytosis

mastitis

ultrasound findings of ___________ presents as ill-defined areas of echogenicity, diffuse edema, hypoechoic fluid within the subcutaneous tissue that outlines the fat lobule, breast skin thickening of affected skin greater than 2mm, enlarged lymph nodes may be present, and reactive, enlarged lymph nodes possibly seen as well

mastitis

ultrasound findings of ______________ presents a malignant, solid vascular hypoechoic mass

melanoma

what is the most likely primary cancer to metastasize to the subcutaneous fat?

melanoma

clinical findings of a ___________ cyst presents as previous trauma, focal knee pain, knee swelling, a palpable mass within the knee joint, and popping, stiffness or locking of the knee joint

meniscal (cyst)

ultrasound appearance of a ___________ cyst is an anechoic or hypoechoic mass with posterior enhancement in the knee

meniscal (cyst)

the __________ is a thin, fibrocartilaginous tissue between the surfaces of some joints, like between the knee

meniscus

dorsal ganglion cysts are the _______ __________ form of ganglion cysts

most common

for breast ultrasound, a patient should be in a slight __________ position to ________ ____________ breast tissue over the chest

oblique, evenly distribute

superficial epidermal cysts are potentially the result of an ____________ _____ __________

obstructed hair follicle

superficial lipomas are typically _______ in shape and ___________ to the surrounding fat, but can also appear hyperechoic or hypoechoic

oval, isoechoic

tendonitis can be caused by what?

overuse or strain

a patient suffering from a breast hematoma will likely have _______ in the region and ______ ______________

pain, skin discoloration

clinical findings of a ____________ ___________ cyst presents as a visible, palpable mass just under the skin, pain and redness in the area, if infection occurs, fluid oozing or solid material may leak from the cyst

superficial epidermal (cyst)

ultrasound appearance of a _____________ ___________ cyst may vary, but can present as an anechoic, hypoechoic, complex or hyperechoic cyst or mass, and can appear like a pseudocyst

superficial epidermal (cyst)

both the ___________________ and __________________ Achilles tendons should be analyzed with ultrasound for comparison

symptomatic, asymptomatic

Baker cysts typically result from the accumulation of _____________ fluid from a _____________ in the joint capsule in the knee as seen in conditions such as rheumatoid arthritis or osteoarthritis

synovial, weakening

what is another name for a tendon rupture

tendon tear

patients with _____________ will present with pain and swelling of affected area as well as a fever

tendonitis

when scanning a torn Achilles tendon, it should be assessed for the sonographic signs of ____________ and ___________

tendonitis, rupture

hCG may be produced by some ___________ tumors, high levels of __________, ___________ tumors, ________________, ____________ syndrome, and with some drugs including ___________ and _____________

testicular estrogen adrenal hepatoblastomas Klinefelter steroids marijuana

what is the most commonly injured ankle tendon?

the Achilles tendon

what are the two clinical tests for DDH?

the Barlow test and Ortolani test

during an ultrasound for a DDH scan, what landmarks should be evaluated while the hip is examined in both flexion and at rest?

the femoral head and position of the femur as it relates to the acetabulum

what is the functional layer of the breast tissue?

the mammary layer

the Graf technique is used to measure what?

the relationship of the femoral head and acetabulum by evaluating alpha and beta angles created by the relationship of these structures

where are superficial epidermal cysts most likely found?

the scalp, face, neck, trunk and back

what type of patients are more prone to pilonidal cysts?

those who sit for an extended period of time and hairdressers

what is the primary role of ultrasound in the case of a patient with mastitis?

to determine the presence of focal abscess

what does the Ortolani test used for?

to evaluate for the reduction or relocation of a dislocated hip

what is the Barlow test used for?

to evaluate the hip for dislocation

what are two other names for transient synovitis?

toxic synovitis or irritable hip

the cause of __________ ___________ is unknown, although viral causes, trauma, and an allergic reaction have been suspected

transient synovitis

what is hip joint effusion likely the result of?

transient synovitis

what is the most common cause of a painful hip and joint effusion in children?

transitent synovitits

a meniscal tear is typically the result of _______ or _____________ changes within the knee

trauma, degenerative

true sebaceous cyst are ___________

uncommon

what is the nonsurgical treatment for DDH?

using a Pavlik harness

what are ganglion cyst located near the radial artery referred to as?

volar ganglion cysts

abscess can have a _______ range of ultrasound appearances

wide

besides the natal cleft, where else may pilonidal cysts be seen?

within the fingers or toes

where are pilonidal cysts most often found?

within the natal cleft

what is cellulitis most often caused by?

Staphylococcus aureus and Streptococcus pyogenes

which test can be performed to see if there is a complete tear of the Achilles tendon?

Thompson test

what does pilonidal mean?

"nest of hair"

malignant melanomas account for ____% of skin cancers

11%

when measuring the relationship of the angle between the ilium and acetabulum, an angle of _____% or less is said to be shallow and less than _____% is considered to be very shallow

50%, 45%

coverage of the femoral head by the acetabulum of _____% is said to be normal

55%

ultrasound features of an ____________ __________ ___________ present as focal hypoechoic area within tendon in the case of a partial tear and an anechoic or heterogeneous area within the tendon, often indicative of a hematoma; may also be sonographically identified as a refractive shadow in the area of separated tendon with fat, a hematoma, or granulomatous material filling in the gap created by the tear in the case of a complete tear

Achilles tendon rupture

clinical findings of a __________ cyst presents as asymptomatic, or may present with focal tenderness secondary to hemorrhage, rupture or impingement on adjacent structures

Baker (cyst)

ultrasound appearance of a _________ cyst presents as an anechoic mass with posterior enhancement behind the knee, a complicated one may contain echogenic fluid, debris, or septations or pannus

Baker (cyst)

large ganglion cysts in the wrist have been referred to as ________ bumps

Bible

clinical findings of _______ presents as a history of breeched birth, family history, asymmetric skin folds on legs, leg length discrepancy, limited limb abduction, and a positive Barlow or Ortolani test

DDH

ultrasound findings of _______ present as femoral head located completely outside the acetabulum (complete dislocation), partial coverage of the femoral head by the acetabulum (subluxation),evidence of a shallow acetabulum (<50% coverage of femoral head), small alpha angle and large beta angle (Graf technique)

DDH

clinical findings of a Baker cyst may mimic what?

DVT

in the coronal view of DDH scanning, the _______ technique can be obtained

Graf

what might a ganglion cyst within wrist be referred to as?

a dorsal ganglion cyst

meniscal cysts are most often thought to occur because of what?

a fluid collection following a meniscal tear in the knee

when cellulitis is identified, a thorough investigation for what should ensue?

a focal absess

what is the most common mass found along the dorsal aspect of the hand and wrist?

a ganglion cyst

what is pannus?

a hanging flap of tissue

following a surgery or an invasive procedure, the breast could develop an abscess or mastitis, but other possible complications can include what?

a hematoma, seroma or lymphedema

what kind of probe should be used to visualize foreign bodies

a high frequency linear array probe

how will inflammation around a foreign object appear with ultrasound?

a hypoechoic area adjacent to the structure

what probe is used for breast ultrasound?

a linear probe

when performing a soft tissue ultrasound exam, you typically use a high frequency linear probe, but if the area of interest is deep, you can use what?

a low frequency probe

DDH is a congenital anomaly that may be described as what?

a shallow hip socket

to better visualize a superficial epidermoid cyst, what could be used?

a standoff pad

what might be a helpful tool to visualize a foreign body located just below the surface of the skin?

a standoff pad

what tool may be helpful to better visualize a pilonidal cyst?

a standoff pad

what can be se to help visualize superficial pathology in breast ultrasound?

a standoff pad or a large amount of mounded gel

what does subluxed mean?

a term used to denote partial dislocation of the hip

the Ortolani test is performed by _____________ and ____________ the thigh, essentially ___________ the hip back into the ______________

abducting, lifting, relocating, acetabulum

what is thought to be the cause of DDH?

abnormal fetal ligament development within the hip that is intensified by excessive levels of circulating maternal estrogen

ultrasound findings of a superficial ___________ presents as hypoechoic, edematous strands within the soft tissue (cobblestone appearance), focal fluid collection that is often complex denoting it, and a peripheral rim of hyperemia may be detectable with color doppler

abscess

what is another name for the Achilles tendon?

calcaneal tendon

what is another name for the heel?

calcaneus

in ___________, the skin is often red, tender and warm

cellulitis

ultrasound findings of _____________ presents as hypoechoic, edematous strands within the soft tissue (cobblestone appearance)

cellulitis

a ____________ or ________ may be seen connecting the cyst to the joint space

channel, tract

Baker cysts are ___________

common

______________ tendon tears are sen as an anechoic or heterogeneous area within the tendon, often indicative of a _____________

complete, hematoma

lipomas are usually ______________ and may be observed during a physical examination

compressible

superficial epidermal cyst can be ______________ or result from __________

congenital, trauma

what two scanning planes are infant hips examined in for a DDH scan?

coronal and transverse

what two positions might an infant be placed in for a DDH exam?

decubitus or supine

what does DDH stand for?

developmental dysplasia of the infant hip

____________ tendonitis appears as a thickened and hypoechoic tendon

diffuse

tendonitis can be __________ or __________

diffuse or focal

sometimes the 123 ABC annotation method may be used for breast imaging. it further describes the breast tissue based on what?

distance from the nipple and depth

to aid in the removal of a foreign body, a _________ can be obtained from the surface of the skin to the foreign body using ___________ __________

distance, electronic calipers

ligaments appear ____________ on ultrasound

echogenic

a patient with torn tendon will be suffering from ___________ and _______________ _______ in the wounded region

edema, significant pain

what are three other names for superficial epidermal cysts

epidermal inclusion cysts epidermal cysts subcutaneous cysts

what are the two layers of the skin?

epidermis and dermis

when scanning for DDH, how should you visualize the femoral head and its relationship to the acetabulum?

examine it in both stressed and relaxed state

what will most likely surround the area of a tendon rupture?

extensive edema, with corresponding fluid accumulation

__________ tissue appears as a hyperechoic layer of varying thickness

fascia

what gender is DDH more common in?

females

in the coronal plane of a DDH exam, the ___________ _______ appears as a hypoechoic, rounded structure that contains echogenic stripes throughout

femoral head

the ultrasound diagnosis of DDH can be definitive when the ______________ _____ rests clearly ___________ the acetabulum, denoting ______________

femoral head outside dislocation

with DDH, the ___________ ______ is prohibited from resting properly in the _______________ which is provided for it on the pelvis

femoral head, acetabulum

besides the Graf technique, another way to evaluate the amount of coverage of the femoral head by the acetabulum is by obtaining a coronal image and drawing ____________ lines along the ilium and max __________ and _________ of the femoral head

parallel depth height

_____________ tendon tears appear as focal hypoechoic areas within the tendon

partial

tendon tears can be ___________ or ___________

partial, complete

most of the time for MSK imaging, the probe should be placed ___________________ to the tendon but you can occasionally alter the __________ ___ ______________ to differentiate the tendon from adjacent fat

perpendicular, angle of isonation

clinical findings of a ____________ cyst present as asymptomatic, or they can become infected and develop into an abscess that requires intervention, edema, warmth and pain in area of cyst, and bloody drainage from the cyst may be present

pilonidal (cyst)

ultrasound appearance of a ___________ cyst presents as a complex, subcutaneous mass, hyperemia flow around the mass, hypoechoic tract may be seen extending from the cyst to the skin surface

pilonidal (cyst)

during WWII, ____________ cyst were linked with soldier who had to endure long and bumpy jeep rides; thus they were termed "________ ___________"

pilonidal (cysts), Jeep disease

what is another name for a pilonidal cyst?

pilonidal sinus

what are two other names for Baker cysts?

popliteal cyst or synovial cyst

the ______-___________ breast can suffer from various complications that may require ultrasound investigation

post-surgical

the Achilles tendon is located along the _____________ ankle and connects the ________ muscle to the ____________ ____________ of the heel

posterior, calf, posterior surface

when doing the Thompson test for an Achilles tendon tear, the patient is placed in _________ and the ______ is squeezed. the foot should ________________ in a patients who does not have a complete tear of the Achilles tendon

prone, calf, plantarflex

to evaluate an Achilles tendon with ultrasound, what position should the patient be in?

prone, with their feet hanging off the end of the bed

mastitis associated with breast feeding is referred to as what?

puerperal mastitis

breast abscess is a focal area of _____

pus

sonographic annotations of the breast is typically based on the ______________ or ___________

quadrant, clockface

images for breast ultrasound can be obtained in both long and transverse, but the portion of the lactiferous ducts may require ____________ and ________________ imaging

radial, antiradial

large ganglion cyst have been referred to as Bible bumps in the past because individuals have used large books- like the Bible to _________ the cyst by ____________ the large book against it

reduce, slamming

complete tendon ruptures may also identify sonographically as _______________ _______________ in the area of the separated tendon, with fat, a hematoma, or granulomatous material filling in the gap created by the tear

refractive shadowing

the _____________ layer of the breast it typically hypoechoic and contain fat as well

retromammary

bullets, shrapnel, and other metallic objects may cause what artifact when visualized with ultrasound?

ring-down or comet tail

what might still remain after a breast hematoma is reabsorbed back into the body?

scar tissue and calcs

a ______________ cysts impasses that the cyst is sebaceous in origin, which is not always true for a superficial epidermoid cyst

sebaceous

a breast _________ typically results from surgery as in the case of a lumpectomy or complete mastectomy, when simple serous fluid fills the vacated region

seroma

a tendon rupture most likely results from what?

some manner of recreational sport

what has DDH been linked with?

spina bifida, arthrogryposis and familial links as well

what organisms typically cause puerperal mastitis?

staphylococcus or streptococcus

serous fluid is ________ and contains no ________

sterile, RBCs

the ______________ layer of the breast is typically hypoechoic and composed mostly of fat

subcutaneous

the ______________ layer of the skin appears hypoechoic with interspersed hyperechoic linear echoes representing ______________ tissue septa

subcutaneous, connective

what are the three layers of the breast tissue? (superficial to deep)

subcutaneous, mammary, retromammary