General Sono 2, Soft Tissue
Barlow Test
clinical test for developmental hip dysplasia that is used to evaluate the hip for dislocation
pilonidal cyst definition
cyst located along the natal cleft that is comprised of loose hairs and skin debris
Thompson test
clinical test used to evaluate for a complete tear of the Achilles tendon
20 Which of the following transducers would be best suited to sonographically assess for a splinter in a patient's hand? High-frequency linear array transducer Low-frequency curved array transducer High-frequency sector transducer Low-frequency linear array transducer
high-frequency linear array transducer
what is a cyst
sac like pocket of fluid, is not make up of living material
Myoma, Neuroma, Sarcoma (layer dependent)
Clinical Signs and Symptoms - hard mass within the soft tissue - not painful Sonographic appearance - hypoechoic mass within muscle, nerve, or bone
15. All of the following are keys to identifying foreign bodies with sonography except: Most foreign bodies appear hypoechoic. A linear array transducer should be used. Most foreign bodies are better visualized using a standoff pad. Comet-tail artifact may be seen posterior to metallic objects.
most foreign bodies appear hypoechoic
describe bone
- supports the body - protects our organs - produces red blood cells - provides a place for muscle attachment - stores minerals and salts
19. Which of the following would be best described as a benign tumor comprised of blood vessels? Hemangioma Lipoma Hamartoma Oncocytoma
hemangioma
30 . Sonographically, normal muscle appears as: Hyperechoic tissue that contains linear, echogenic strands Complex tissue that contains linear, hypoechoic strands Hypoechoic tissue that contains linear, echogenic strands Echogenic tissue that contains linear, hypoechoic strands
hypoechoic tissue that contains linear, echogenic strands
31. All of the following are true of ganglion cysts except: A ganglion cyst is a common mass found along the superior aspect of the hand and wrist, between the tarsals. 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 superior aspect of the hand and wrist, between the tarsals.
Cellulitis
Clinical Signs and Symptoms - localized skin erythema / red skin - tender/pain - warm to touch - edema - leukocytosis / elevated WBC Sonographic appearance - cobblestone / edematous strands within the soft tissue - diffuse thickening of soft tissue - hypoechoic - IF ABSCESS FORMS: varying appearance of an abscess can also be seen, they are focal fluid collections that are often complex and have a peripheral rim of hyperemia on color doppler
Achilles Tendon Rupture
Clinical signs and symptoms - posterior ankle and leg pain - audible snap - failure of the Thompson test sonographic appearance - partial tears: focal hypoechoic areas within the tendon - complete tears: 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
33. Tendons sonographically appear as: Echogenic, fibrous structures connecting muscles to bone Echogenic, fibrous structures connecting bone to bone Hypoechoic, linear arrangements within hyperechoic tissue Hyperechoic tissue that contains linear, echogenic strands
Echogenic, fibrous structures connecting muscles to bone
32. A partial tear of a tendon typically appears as: Focal hypoechoic areas within the tendon A focal echogenic area within the tendon A diffusely heterogeneous area within the tendon Edema and refractive shadowing in the area of the divided tendon
Focal hypoechoic areas within the tendon
Pilonidal Cyst
Location - natal cleft / intergluteal cleft / gluteal cleft / between the buttocks - Pilonidal means nest of hair - Jeep Disease Clinical Signs and Symptoms - asymptomatic - can get infected and become and abscess - skin edema - warmth in area - pain in area - bloody drainage Sonographic appearance - complex, subcutaneous mass - hypoechoic tract may be seen extending to the external surface of the skin - hyperemia around mass if infected -
hemangioma definition
a benign tumor composed of blood vessels
lipoma definition
a benign, fatty tumor
Ganglion cyst definition
a common cyst found adjacent to a joint or tendon; most often found along the dorsal aspect of the hand, wrist, ankle, or foot
developmental dysplasia of the hip
a congenital anomaly in which the ball of the hip is prohibited from resting appropriately in the natural socket for it on the pelvis
Arthrogryposis
a congenital disorder associated with severe joint contractures
What are some examples of superficial cystic pathologies
- Epidermal Inclusion cysts - Hematoma-injury and post surgery - Abscess- infection post surgical - Edema-heart failure and fluid overload - Cellulitis- infection - Ganglion cyst
describe tendons
- a highly organized connective tissue joining muscle to bone - the dense, regularly arranged collagenous tissue is made up of many fibers
what is the sonographic appearance of ligaments
- connect bon to bone - echogenic
what is the sonographic appearance of tendons
- echogenic - fibrous structures connecting muscle to bone
What are some labs that may be off when you have something wrong with your soft tissue
- elevated WBC's in infections - decreased hematocrit in hemorrhage
describe fat
- helps insulate the body from heat and cold - provides protective padding, and serves as an energy storage area - fat is contained in living cells called fat cells, and is held together by fibrous tissue
What is the sonographic appearance of muscles
- hypoechoic tissue - linear, echogenic strands
what are some important clinical history questions
- infection/pain symptoms - injury - foreign body - post-surgical collections - palpable masses
refraction shadowing
acoustic shadowing caused by bending and a sound beam at the edge of a curved reflector. May be referred to as edge artifact or edge shadowing
28.Which of the following is also referred to as a Bible bump? Ganglion cyst Superficial endodermal cyst Superficial epidermal cyst Epidermoid
ganglion cyst
cellulitis definition
inflammation and infection of the skin and subcutaneous tissues
Rheumatoid Arthritis
- inflammatory process - hot joint if it has lots of vascularity, it means its inflammatory
Primary and Metastatic Melanomas
Melanoma: hypoechoi, increased vascularity with color doppler, the most likely primary metastasis is to the subcutaneous fat and will appear solid, vascular and hypoechoic mass
12. Which of the following best describes the Thompson test? The patient lies prone and performs plantarflexion The patient lies prone while the symptomatic calf is squeezed The patient lies supine and performs plantarflexion The patient lies prone and performs dorsiflexion
The patient lies prone while the symptomatic calf is squeezed
6. A cystic mass located within the popliteal fossa is most likely a: Baker cyst Thompson cyst Ganglion cyst Lipoma
Baker cyst
Baker's Cyst
Causes - accumulation of synovial fluid from a weakening in the joint capsule of the knee - Rheumatoid arthritis - osteoarthritis Clinical Signs and Symptoms - popliteal space swelling - pain / focal tenderness in the popliteal fossa - asymptomatic Sonographic appearance - anechoic to debris filled teardrop mass extending from joint space - cyst connected to the joint space - posterior enhancement in the popliteal fossa - complicated ones can have echogenic fluid, debris, pannus, or septations
Hemangioma
Clinical Signs and Symptoms - asymptomatic - raised, red or reddish-purple mass on the skin Sonographic appearance - blood flow detected on color doppler - if superficial will be hypoechoic
Ganglion cyst
Clinical Signs and Symptoms - hard mass by any joint space - usually dorsal wrist - AKA Bible bumps if in wrist - hard to touch - painful - palpable mass Sonographic appearance - taught cystic structure along a tendon or joint space - noncompressible - anechoic mass - acoustic enhancement - may contain debris and septations Treatment - corticosteroids - surgical removal
Ruptured muscle and hematoma
Clinical Signs and Symptoms - injury - pain to calf and thigh - bruising - swelling Sonographic appearance - disruption of the muscle striations with fluid collection - Hematoma: anechoic to complex, hypoechoic margins, well-defined, lobulated, collection of blood
Bursitis
Clinical Signs and Symptoms - pain - ever - leukocytosis - painful joint Sonographic appearance - fluid within the joint space bursa
Tenosynovitis
Clinical Signs and Symptoms - post injury or from overuse - painful tendon - swelling at joint - leukocytosis / infection Sonographic appearance - fluid collection around painful tendon
8. A common mass found along the dorsal aspect of the hand and wrist is the: Baker cyst Thompson cyst Ganglion cyst Lipoma
Ganglion cyst
1. Which of the following techniques is used to measure the relationship of the femoral head and acetabulum by evaluating the alpha and beta angles? Graf Ortolani Barlow Thompson
Graf Technique
7. A patient presents with a palpable, oozing mass at the level of the natal cleft. What is the most likely etiology of this mass? Pannus cyst Epidermoid Hemangioma Pilonidal cyst
Pilonidal cyst
37. Which of the following best describes the Thompson test? The calf is squeezed and the foot should plantarflex in a patient who does not have a complete tear of the Achilles tendon. The calf is squeezed and the foot should not plantarflex in a patient who does not have a complete tear of the Achilles tendon. The Achilles tendon is squeezed and the foot should plantarflex in a patient who does not have a complete tear of the Achilles tendon. The Achilles tendon is squeezed and the foot should not plantarflex in a patient who does not have a complete tear of the Achilles tendon.
The calf is squeezed and the foot should plantarflex in a patient who does not have a complete tear of the Achilles tendon
what is a tumor or nodule
an abnormal growth of tissue
38. Superficial lipomas may appear as all of the following except: Hypoechoic to the surrounding tissue Isoechoic to the surrounding tissues Hyperechoic to the surrounding tissue Anechoic to the surrounding tissue
anechoic to the surrounding tissue
9. The Achilles tendon connects the: Ankle to the knee Heel to the ankle Heel to the calf muscle Knee to the calf muscle
heel to the calf muscle
35. Hyperemic flow within or around a structure is often indicative of: Malignancy Benignancy Inflammation Rupture
inflammation
mastitis
inflammation of the breast
puerperal mastitis
inflammation of the breast that is related to pregnancy
Tendosynovitis definition
inflammation of the tendon and synovial tendon sheath
3. Clinical findings of tendonitis include all of the following except: Itching in the area of the tendon Pain Edema The area is warm to touch
itching in the area of the tendon
10. In what position should the patient placed to better evaluate the Achilles tendon? Prone supine right later decubitus left lateral decubitus
prone
11. Inflammation of the breast that is related to pregnancy is referred to as: Puerperal mastitis Retromammary mastitis Chronic mastitis Emphysematous mastitis
puerperal mastitis
24. Acoustic shadowing caused by bending of a sound beam at the edge of a curved reflector is referred to as: Mirror image artifact Indirect artifact Reflective shadowing Refractive shadowing
refractive shadowing
gynechomastia
the benign enlargement of the male breast; typically located posterior to the areola
Tendonitis / tendinosis
- inflammation of a tendon Causes: overuse or strain Sonographic Appearance - Diffuse: thickened/enlarged, hypoechoic tendon - focal: localized, enlarged hypoechoic areas within the tendon - hyperemic flow - fluid may be noted - thickened tendon - decreased echogencity - chronic conditions may include calcifications and heterogeneous appearance Clinical signs and symptoms - pain - painful region may be swollen / swelling - painful region may be warm to the touch - lump along tendon
describe the skin
- largest organs in the body - consists of two layers, the epidermis and the dermis - 3 functions: protection, regulation, and sensation
describe muscle
- made up of protein filaments called actin and myosin that slide past one another - muscle function to produce force and motion
what are thy types of masses
- tumor/nodule - cyst
21. The accumulation of synovial fluid from a weakening in the joint capsule of the knee, as seen in conditions such as rheumatoid arthritis can result in a: Hemangioma Lipoma Baker cyst Ganglion cyst
Baker cyst
Abscess (soft tissue)
Clinical Signs and Symptoms - painful mass - fever - leukocytosis - red skin - tender - warm to the touch Sonographic appearance - mass like fluid collection with increased vascularity around it - fluid collection - irregular ecopenic borders in center of inflamed area - can be confused with tumors - increased blood flow around rim
Lipoma
Clinical Signs and Symptoms - slow-growing soft superficial mass - sometimes visible mass during physical exam / obvious mass under the skin - compressible - asymptomatic - bulging of skin Sonographic appearance - soft mass - isoechoic to surrounding adipose tissue, sometimes hyperechoic or hypoechoic - oval in shape - compressible
Joint Effusion
Clinical Signs and Symptoms - swollen joint - some tenderness Sonographic appearance - fluid around the joint space within the soft tissue
4. Which of the following is a clinical test for developmental hip dysplasia that is used to evaluate the hip for the reduction or relocation of a dislocated hip? Graf Ortolani Barlow Thompson
Ortolani
superficial epidermal cyst
cyst 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
17. Which of the following would be best described as a benign tumor comprised of fat? Hemangioma Lipoma Hamartoma Oncocytoma
lipoma
What is a mass
palpable abnormality, structure that is not normal
subluxation
partial dislocation of the hip
14 Subluxation denotes: Synovial joint obstruction Partial hip dislocation Rupture of the bursa Inflammation of the acetabulum
partial hip dislocation
ilium (pelvis)
the largest and most superiorly located pelvic bone
36. all of the following will aid in the sonographic assessment of an Achilles tendon except The patient lies prone, with his or her feet hanging off the end of the bed. Both the symptomatic and asymptomatic Achilles tendons should be scanned for comparison. The entire tendon should be evaluated in sagittal and transverse scan planes. The patient is scanned standing, with a small amount of pressure placed on the symptomatic side.
the patient is scanned standing, with a small amount of pressure placed on the symptomatic side.
Tendon Rupture / Tendon Tear
Clinical Signs and Symptoms - painful - injury - abnormal Thompson test of the Achilles - audible snap may be heard - edema Sonographic appearance - hypoechoic disruption of the tendon - complete separation of the tendon - partial: focal hypoechoic areas within the tendon - complete: anechoic or heterogeneous areas within the tendon, often indicative of a hematoma, refractive shadowing in the area of the separated tendon with fat, a hematoma, or granulomatous material filling in the gap - extensive edema - fluid accumulation
Foreign bodies (soft tissue)
Sonographic Appearance - most often hyperechoic with posterior shadowing - ring-down or comet-tail for metallic objects - inflammation around foreign body that is hypoechoic - air appears as bright echoes
26. A patient presents to the sonography department with a history of cellulitis on his abdomen. The patient has fever, edema, and complains of focal tenderness in a specific region affected by the cellulitis. Sonographically, you identify a localized complex collection of fluid. What is the most likely diagnosis? Superficial hemangioma Subcutaneous carcinoma Mastitis Superficial abscess
Superficial abscess
22. Fluid within the synovial sheath is indicative of: Hyperemic flow Tendosynovitis Cartilaginous inflammation Cartilaginous extension
Tendosynovitis
40. 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? Fluid Enhancement Dust air
air
Hip joint effusion
buildup of fluid within the hip secondary to inflammation
18. What is the most likely cause of a hip joint effusion in infants? Tendonitis Bursitis Developmental hip dysplasia Transient synovitis
bursitis
2. Inflammation and infection of the skin and subcutaneous tissue is termed: Ascites Retroperitoneal fibrosis Cellulitis Subcutaneous edema
cellulitis
Ortolani test
clinical test for developmental hip dysplasia that is used to evaluate the hip for the reduction or relocation of a dislocated hip
39. Bullets, shrapnel, and other metallic objects may cause: Acoustic enhancement Comet-tail artifact Edge enhancement Mirror image artifact
comet- tail artifact
what is the most common solid soft tissue tumor
lipoma
27. A complicated Baker cyst may contain a thin flap of tissue referred to as: Pannus Plicae Septation Lipoma
pannus
34. A standoff pad is most useful in imaging: Deep structures that produce acoustic enhancement Deep structures that produce acoustic shadowing Structures that produce refractive shadowing Superficial structures
superficial structures
Achilles tendon
tendon located along the posterior ankle that connects the calf muscle to the posterior surface of the heel
25. Inflammation of the tendon and synovial tendon sheath is referred to as: Tendosynovitis Tendonitis Cellulitis Pannus
tendosynovitis
Acetabulum
the bowl-shaped surface of the pelvis where the head of the femur normally rests
Lactiferous ducts
the ducts that the breast used to transport milk to the nipple
pannus
a hanging flap of tissue
Galactocele
a milk filled breast cyst
Bakers Cyst Definition
a synovial cyst located within the popliteal fossa, may also be referred to as a popliteal cyst
Graf Technique
a technique used to measure the relationship of the femoral head and acetabulum by evaluating the alpha and beta angles created by the relationship of these structures
examples of solid tumors
- lipoma - sarcoma - neuroma
29 . Clinical findings of a Baker cyst may mimic those of a(n): Arteriovenous malformation Deep venous thrombosis Knee fracture Ganglion cyst
Deep vein thrombosis
Superficial Epidermal Cyst / epidermal inclusion cyst /epidermoid cyst / sebaceous cyst (although sebaceous in origin)
Location - most often in the scalp, face, neck, trunk, or back Causes - congenital - trauma - obstructed hair follicle Clinical Signs and Symptoms - palpable mass that raises the skin / visible, palpable mass just under the skin - pain and redness in the area - asymptomatic - pain and oozing of fluid or solid material if infected Sonographic appearance - anechoic, hypoechoic, complex, or hyperechoic - "pseudotestis appearance"
Basic anatomy of soft tissue
SKIN •Bright, top layer FAT •Patient dependent MUSCLE •Striated TENDONS •Ruberband, Attach muscle to bone BONE •Bright linear LIGAMENTS •Connect bone to bone at freely moving joints CARTILAGE •Cushion between bones at freely moving joints JOINTS AND BURSA •Join some bones; can be immovable, slightly movable, freely movable ARTERIES, VEINS, NERVES
5. What test can be performed to determine a torn Achilles tendon? McBurney test McDonald test Thompson test Baker test
Thompson test
natal cleft
area located between the groove of the buttocks
what type of mass is sarcoma
cancerous mass
13. Which of the following is true about patients with a lipoma? They often complain of pain in the area of the mass. They are often obese. They are only slightly tender in the area of the mass. They feel no pain in the area of the mass.
they feel no pain in the area of the mass
