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
