Superficial Strucutures Flashcards
Muscles appearance ?
Hypoechoic with linear echogenic strands
Tendons appearance ?
Echogenic fibrous structures connecting muscle to bones
Ligaments appearance ?
Echogenic
Connects bone to bone
Tendinitis ?
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
focal tendinitis appearance ?
localized, enlarged hypochoic area within the tendon.
Hyperemic flow may be noted
diffuse tendinitis appearance ?
Whole tendon will appear more thick, hypoechoic and enlarged
Hyperemia may be present
Indicative sign tenosynovitis is present ?
Fluid within the synovial sheath
Tendon rupture/ tear ?
Partial / complete types
Usually caused by some form of recreational sport
Patient will suffer from edema and significant pain in the wounded region
Partial tendon tear appearance ?
Hypoechoic focal area within the tendon
Complete tendon tear appearance ?
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”
Achilles tendon location?
Along the posterior ankle
Connecting the calf muscle and surface of the heel/ calcaneus
Achilles tendon tear test ?
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
Most commonly injured ankle tendon ?
Achilles
Achilles tendon can be assessed with sonography for ?
Tendonitis
Rupture
Achilles tendon rupture/ tear ?
Patients suffer from ankle and leg pain, patients may hear an audible snap when the tear occurs
Developmental Dysplasia of the infant Hip ? (DDH)
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
Increased risks and links associated with DDH?
Breech fetal position
Oligohydramnios
Linked;
Spina Bifida
Arthrogryposis
And a familial link as well
Barlow test ?
Used to evaluate for hip dislocation
Hip is flexed and abducted
Knees are pushed posteriorly and superiorly
Ortolani test ?
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
Sonographic infant hip techniques ?
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
Subluxation ?
Partial dislocation of the infant hip
Will rest more laterally, although it’s partially covered by the acetabulum
Femoral head sonographic appearance ?
Hypoechoic round structure that contains echogenic stripes throughout
Ilium appearance ?
Seen extending from the femoral head as an echogenic linearly structure producing shadowing
Graf Technique ?
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
Nonsurgical treatment of DDH?
Casting or by means of a Pavlik harness
Hip joint effusion ?
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
Most common cause of a painful hip and joint effusion in children?
Transient synovitis
Hip joint effusion appearance ?
Appears as hypoechoic fluid that elevates the anterior capsule of the joint
Width exceeding > 5 mm
Transient synovitis ?
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
Three layers of breast tissue (superficial to deepest layer)?
Subcutaneous
Mammary
Retromammary
Subcutaneous layer ?
Superficial layer of breast
Typically appears hypoechoic and composed mostly of fat
Subcutaneous layer of the breast?
Hypoechoic most superficial layer
Composed mostly of fat
Mammary layer of breast?
Typically hyperechoic and contains the ducts and glandular tissue
Functional layer
Can vary sonographically based on age and other factors
Retromammary layer of the breast ?
Deepest layer
Typically hypoechoic and contains fat as well
Mastitis ?
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
Breast abscess ?
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
Puerperal mastitis?
Mastitis associate with lactation
Galactocele ?
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
Gynecomastia ?
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
Skin layers ?
Epidermis
Dermis
Appears as a indistinguishable collective hyperechoic linear structure
Subcutaneous layer appearance ?
Hypoechoic with interspersed hyperechoic linear echoes representing connective tissue septa
Fascia appearance ?
Hyperechoic layer of varying thickness
Superficial epidermal cyst ?
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
Ganglion cyst ?
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
Superficial lipoma ?
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
Superficial hemangioma ?
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
Baker cyst ?
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.
Accumulation of synovial fluid from a weakening in the joint capsule of the knee is associated with ?
Bakers cyst
Osteoarthritis
Rheumatoid Arthritis
Complex appearance of bakers cysts ?
Bakers cysts containing echogenic fluid, debris, pannus, or septations
Sonographic appearance of Bakers Cyst ?
Anechoic mass with posterior enhancement
Pilondial cyst?
“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”
Pilondial cyst appearance ?
Complex mass with a hypoechoic tract may be noted extending from the cyst to the external surface of the skin
Cellulitis ?
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
Cobblestone appearance sign indicative of ?
Cellulitis
Abscess sonographic findings ?
Hyperemia around the periphery
Complex appearing mass
Focal fluid collections present
hidden abscess ?
Occult abscess
Melanoma ?
Most likely primary tumor to metastasize to the subcutaneous fat
Hypervascularity and will be solid and a hypoechoic mass
Metallic foreign object produce what type of artifact ?
Ring down or comet tail artifact
Inflammation around a foreign body will appear as ?
Hypoechoic area adjacent to the foreign structure
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?
Air
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 abscess
Inflammation of the tendon and synovial tendon sheath is referred to as ?
Tendosynovitis
What is the most likely cause of a hip joint effusion in infants?
Transient Synovitis
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?
Joint effusion
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
Perpendicular
Anisotropy ?
Occurs when the sound beam strikes a structure in a nonperpendicular manner, resulting in a loss of the true echogenicity of the structure.
