Superficial Strucutures

Question 1

Muscles appearance ?

Answer 1

Hypoechoic with linear echogenic strands

Question 2

Tendons appearance ?

Answer 2

Echogenic fibrous structures connecting muscle to bones

Question 3

Ligaments appearance ?

Answer 3

Echogenic
Connects bone to bone

Question 4

Tendinitis ?

Answer 4

Inflammation of a tendon, termed tendonitis
diffuse or focal
May be caused by overuse or strain
Hyperemic flow may be noted within the tendon as well
Patients will present with pain, swelling, and possibly warm to the touch in the area affected

Question 5

focal tendinitis appearance ?

Answer 5

localized, enlarged hypochoic area within the tendon.
Hyperemic flow may be noted

Question 6

diffuse tendinitis appearance ?

Answer 6

Whole tendon will appear more thick, hypoechoic and enlarged
Hyperemia may be present

Question 7

Indicative sign tenosynovitis is present ?

Answer 7

Fluid within the synovial sheath

Question 8

Tendon rupture/ tear ?

Answer 8

Partial / complete types
Usually caused by some form of recreational sport
Patient will suffer from edema and significant pain in the wounded region

Question 9

Partial tendon tear appearance ?

Answer 9

Hypoechoic focal area within the tendon

Question 10

Complete tendon tear appearance ?

Answer 10

Anechoic or heterogenous appearing region within the tendon surrounded by edematous tissue (often indicative of hematoma)
The partition of the tendon causes refractive shadowing from the body’s attempt to repair the damage with fat, hematoma, or granulomatous material filling in the “gap”

Question 11

Achilles tendon location?

Answer 11

Along the posterior ankle
Connecting the calf muscle and surface of the heel/ calcaneus

Question 12

Achilles tendon tear test ?

Answer 12

Thompson test
Patient is prone with feet hanging over edge of bed
Calf is squeezed and the foot should PLANTARFLEX in a patient who has an intact tendon

Question 13

Most commonly injured ankle tendon ?

Answer 13

Achilles

Question 14

Achilles tendon can be assessed with sonography for ?

Answer 14

Tendonitis
Rupture

Question 15

Achilles tendon rupture/ tear ?

Answer 15

Patients suffer from ankle and leg pain, patients may hear an audible snap when the tear occurs

Question 16

Developmental Dysplasia of the infant Hip ? (DDH)

Answer 16

Congenital anomaly defined as shallow hip socket
Thought to be caused by abnormal fetal limb development within the hip that is intensified by the excessive levels of
circulating maternal estrogen
Commonly seen in FEMALE - LEFT side

Infants should be assessed between 4 to 6
weeks after birth

Asymmetric leg skinfolds, discrepancy between leg lengths, and have limited limb abduction

BARLOW/ ORTOLANI tests /
GRAF technique

Coaverage of the femoral head by the acetabulum of greater > 55% considered normal

Question 17

Increased risks and links associated with DDH?

Answer 17

Breech fetal position
Oligohydramnios

Linked;
Spina Bifida
Arthrogryposis
And a familial link as well

Question 18

Barlow test ?

Answer 18

Used to evaluate for hip dislocation

Hip is flexed and abducted
Knees are pushed posteriorly and superiorly

Question 19

Ortolani test ?

Answer 19

Evaluates for the reduction or relocation of a dislocated hip

Performed by abducting and lifting the thigh,
Relocating the hip back into the acetabulum

Audible click may be heard and a palpable click felt as the head to the femur passes over the acetabulum

Question 20

Sonographic infant hip techniques ?

Answer 20

Should be evaluated while the hip is examined in both flexion and at rest

The femoral head and its relationship to the acetabulum should be examined in both stressed and relaxed state as well

Normal / subluxation/ or dislocated hip

The hip is examined in both a neutral or resting coronal view and a transverse view of the flexed hip

Question 21

Subluxation ?

Answer 21

Partial dislocation of the infant hip
Will rest more laterally, although it’s partially covered by the acetabulum

Question 22

Femoral head sonographic appearance ?

Answer 22

Hypoechoic round structure that contains echogenic stripes throughout

Question 23

Ilium appearance ?

Answer 23

Seen extending from the femoral head as an echogenic linearly structure producing shadowing

Question 24

Graf Technique ?

Answer 24

Used to measure the relationship of the femoral head and acetabulum by evaluating alpha and beta angles created by the relationships of these structures

Smaller the alpha angle < larger the beta angle more likely the infant is suffering from DDH

Question 25

Nonsurgical treatment of DDH?

Answer 25

Casting or by means of a Pavlik harness

Question 26

Hip joint effusion ?

Answer 26

Buildup of fluid within the hip secondary to inflammation Typically occurs in children between age 5 to 10 years, Most likely the result of transient synovitis Ultrasound guided hip aspiration can be done to relieve the pain and to differentiate the disorder from the more worrisome diagnosis of septic arthritis

Question 27

Most common cause of a painful hip and joint effusion in children?

Answer 27

Transient synovitis

Question 28

Hip joint effusion appearance ?

Answer 28

Appears as hypoechoic fluid that elevates the anterior capsule of the joint Width exceeding > 5 mm

Question 29

Transient synovitis ?

Answer 29

Most common cause of painful hip and joint effusion in children Cause is unknown, although viral causes, infection, allergic reaction have been suspected Leg and knee pain, reluctance to walk, irritability, low grade fever, mild leukocytosis

Question 30

Three layers of breast tissue (superficial to deepest layer)?

Answer 30

Subcutaneous Mammary Retromammary

Question 31

Subcutaneous layer ?

Answer 31

Superficial layer of breast Typically appears hypoechoic and composed mostly of fat

Question 32

Subcutaneous layer of the breast?

Answer 32

Hypoechoic most superficial layer Composed mostly of fat

Question 33

Mammary layer of breast?

Answer 33

Typically hyperechoic and contains the ducts and glandular tissue Functional layer Can vary sonographically based on age and other factors

Question 34

Retromammary layer of the breast ?

Answer 34

Deepest layer Typically hypoechoic and contains fat as well

Question 35

Mastitis ?

Answer 35

Breast infection Most often associated with lactation Caused by the staphylococcus or streptococcus organisms Suffer from ; Pain, swelling, and warmth and redness in the area Also may suffer from leukocytosis and fever Appear as ill defined areas of echogenicity with diffuse edema and hypoechoic fluid within the subcutaneous tissue that may outline the fat lobules Affective skin may be thickened greater than > 2 mm Reactive enlarged lymph nodes may be seen as well

Question 36

Breast abscess ?

Answer 36

Focal area of pus Patient suffer from diffuse pain, may have a palpable painful lump, Typically appearing as focal, complex fluid collection that can contain debris Enlargement of lymph nodes may be seen

Question 37

Puerperal mastitis?

Answer 37

Mastitis associate with lactation

Question 38

Galactocele ?

Answer 38

Associated with lactating patients may present to the emergency department with a palpable mass that may be painful Milk filled cyst that can develop after an abrupt termination to breast feeding or result from an obstruction of lactiferous duct/ducts Typically palpable, painful and located near the areola Appear as a round mass with good borders, can be seen as complex or also have fluid- fluid level present

Question 39

Gynecomastia ?

Answer 39

Benign enlargement of the male breast Seen anytime during life, but most commonly seen just after birth, during puberty, and during mid - late life stages (50 to 80 years old) Can be bilateral and can be associated with high levels of HCG (Testicular tumors, high levels of estrogen, adrenal tumors, hepatoblastoma, Klinefelter syndrome, drugs (weed and steroids)) Most often presents as tender palpable retroareolar breast mass Firm to touch Appearing as a triangular hypoechoic mass posterior to the areola

Question 40

Skin layers ?

Answer 40

Epidermis Dermis Appears as a indistinguishable collective hyperechoic linear structure

Question 41

Subcutaneous layer appearance ?

Answer 41

Hypoechoic with interspersed hyperechoic linear echoes representing connective tissue septa

Question 42

Fascia appearance ?

Answer 42

Hyperechoic layer of varying thickness

Question 43

Superficial epidermal cyst ?

Answer 43

Sebaceous cyst Uncommon Most likely found in the scalp, face, neck, trunk, or back Can be congenital or result from trauma, or potentially the result of an obstructed hair follicle Varying sonographic appearance including anechoic / hypoechoic / hyperechoic/ complex appearing - pseudotestis appearance Patient will have a palpable mass that raises the skin and most likely asymptomatic Infection can result in pain and oozing of fluid however

Question 44

Ganglion cyst ?

Answer 44

Bible bumps Noncompressible anechoic mass with posterior enhancement that may contain debris or septations Common mass found along the dorsal aspect of the hand, wrist, can arise from a joint and even the ankle and foot as well May be hard to touch and painful Often treated with corticosteroid injection and surgical removal

Question 45

Superficial lipoma ?

Answer 45

Benign fatty tumor Typically oval shaped and can appear hypoechoic or hyperechoic Usually compressible and may be observable Typically asymptomatic but may complain of unsightly bulging of the skin in the area of the mass

Question 46

Superficial hemangioma ?

Answer 46

Benign mass comprised of vascular channels typically asymptomatic Appear as a raised red or reddish - purple mass on the skin Blood flow may be detectable with color doppler Typically appear sonographically as hypoechoic mass

Question 47

Baker cyst ?

Answer 47

Popliteal cyst located in the popliteal fossa Common and a result of an accumulation of synovial fluid from weakening in the joint capsule of the knee Seen in conditions such as RA / rheumatoid arthritis or osteoarthritis Channel may be seen connecting the cyst to the joint space May be asymptomatic, but May present with focal tenderness secondary to hemorrhage, rupture, or impingement on adjacent structures. Clinical findings may mimic those of a deep venous thrombosis.

Question 48

Accumulation of synovial fluid from a weakening in the joint capsule of the knee is associated with ?

Answer 48

Bakers cyst Osteoarthritis Rheumatoid Arthritis

Question 49

Complex appearance of bakers cysts ?

Answer 49

Bakers cysts containing echogenic fluid, debris, pannus, or septations

Question 50

Sonographic appearance of Bakers Cyst ?

Answer 50

Anechoic mass with posterior enhancement

Question 51

Pilondial cyst?

Answer 51

“Nest of hair” Most often found within the natal / gluteal cleft, but can be seen between the fingers/ toes Asymptomatic and associated with long extended amount of time sitting, hairdressers and “jeep disease”

Question 52

Pilondial cyst appearance ?

Answer 52

Complex mass with a hypoechoic tract may be noted extending from the cyst to the external surface of the skin

Question 53

Cellulitis ?

Answer 53

Infection and subsequent inflammation of the skin and subcutaneous tissue Most commonly caused by staphylococcus and streptococcus Often the skin is red, tender and warm May be evidence of leukocytosis present, especially if an abscess is present Appearing as hypoechoic edematous strands within the soft tissue - cobblestone appearance

Question 54

Cobblestone appearance sign indicative of ?

Answer 54

Cellulitis

Question 55

Abscess sonographic findings ?

Answer 55

Hyperemia around the periphery Complex appearing mass Focal fluid collections present

Question 56

hidden abscess ?

Answer 56

Occult abscess

Question 57

Melanoma ?

Answer 57

Most likely primary tumor to metastasize to the subcutaneous fat Hypervascularity and will be solid and a hypoechoic mass

Question 58

Metallic foreign object produce what type of artifact ?

Answer 58

Ring down or comet tail artifact

Question 59

Inflammation around a foreign body will appear as ?

Answer 59

Hypoechoic area adjacent to the foreign structure

Question 60

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?

Answer 60

Air

Question 61

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?

Answer 61

Superficial abscess

Question 62

Inflammation of the tendon and synovial tendon sheath is referred to as ?

Answer 62

Tendosynovitis

Question 63

What is the most likely cause of a hip joint effusion in infants?

Answer 63

Transient Synovitis

Question 64

A 6-year-old female patient presents to the sonography department for a hip sonogram with irritability, unwillingness to walk, and low-grade fever. Sonographically, you visualize a hypochoic fluid collection that elevates the joint capsule. What is the most likely diagnosis?

Answer 64

Joint effusion

Question 65

transducer must be placed _____________ to the tendon for it to be appropriately imaged with sonography, occasionally altering the angle of insonation can help differentiate the tendon from adjacent fat

Answer 65

Perpendicular

Question 66

Anisotropy ?

Answer 66

Occurs when the sound beam strikes a structure in a nonperpendicular manner, resulting in a loss of the true echogenicity of the structure.