VRU 2019 Flashcards
What is the most common differentials for enlarged parathyroid?
- Adenoma
- Hyperplastic glands
- Adenocarcinomas are less likely
What echogenicity was adenocarcinoma in the parathyroid gland?
Heterogeneous rather than homogeneous.
Should size (3-4mm) be the cut off for parathyroid glands?
No… normals have been seen up to 7mm
Is it useful to repeat CTA when looking to see if pancreatitis has worsen in dogs?
No… nothing really changes.
This was because in humans pancreatic necrosis is usually noted 24-48 hours after first complaint and therefore repeating CTA can help with looking for necrosis in this window if the first CTA was performed immediately. Pancreatic necrosis holds a shitty prognosis so it is good to note this.
Is the frequency of gas in the pylorus and duodenum increased with three views in cats?
No it does not
What is the normal liver length:length of thoracic vertebrae in cats?
4.2 +/- 0.5
Does the liver length:length of thoracic vertebrae in cats correlate with CT liver volume?
Yes
Why should the length:length of thoracic vertebrae in cats not be performed in cats under 1 year old?
They have not attained full vertebral growth
Radiographs are more or less sensitive than CT when assessing patients for blunt thoracic trauma?
Less sensitive - For detecting rib fractures, pneumo, contusions and pleural effusion
Radiographs overestimated what when compared to CT when assessing patients for blunt thoracic trauma?
Severity of lung contusions.
What phase of contrast is best for visualizing thymomas on CT?
Delayed
What is the difference in appearance of large thymomas vs small?
Large thymoma - cystic, heterogenous and vascular invasive — more likely to reoccur
Small thymoma - homogeneous
What are post operative complications and incomplete tumor resection associated with what, when discussing thymomas?
Shorter outcomes (died earlier)
What is the HUs for the overall attenuation of a gallbladder mucocele vs sludge vs normal gallbladder?
Mucocele: 49HU
Sludge: 40 HU
Normal: 36 HU
This makes precontrast images the best to differentiated
Where is mineral commonly located in a gallbladder with a mucocele? Is this a common spot to see mineralization in a normal gallbladder or one with sludge?
In the center… no, only mucoceles have this distribution
What is the perioperative mortality with GB removal?
27%
How much more likely are ruptured gallbladder mucocele patients to die perioperatively than non-ruptured?
3x more
JVIM 2018: what was the sensitivity in US finding a ruptured gallbladder mucocele?
56%
Holland et al: Aortic./CVC ratio in dogs with systemic hypertension, what was the ratio for normal dogs vs hypertensive dogs?
- 0 for normal
- 5 for systemic hypertension dogs.
Lamb et al: Prevalence of pulmonary nodules on CT, What neoplastic etiology was most likely to have pulmonary mets on CT?
Hemangiosarcoma (41% of dogs with hemangio had mets)
Osteosarcoma (26% of dogs with osteosarc had mets)
Carcinoma (25%…)
Histiocytic (24%…)
STS (23%….)
Lamb et al: Prevalence of pulmonary nodules on CT, What neoplastic etiology was least likely to have pulmonary mets (nodules) on CT?
Mast cell tumor (4% of dogs with mast cell tumor had pulmonary nodules)
SCC (none)
Lamb et al: Prevalence of pulmonary nodules on CT, When only one nodule was found how many disappeared or did not change on follow up CT (out of 9 dogs)?
5/9 either disappeared of did not change
(median period of 188 days)
(range 14-1821)
Schlacks et al: CT Pulmonary cryptococcosis, What are differentials for pulmonary mineralized mass in a cat?
Neoplasia
Pyoggranulomatous (Coccidiodes, cryptococcus, toxo, parasitic and Mycoplasma)
Schlacks et al: CT Pulmonary cryptococcosis, What is the difference in distribution of cryptococcsis in cats vs horse?
Horse commonly have pulmonary granulomas while cats normal just infect the nasal passage.
Schlacks et al: CT Pulmonary cryptococcosis, what was interesting about this case?
The mass infiltrated the lumen of the trachea… This has not been reported.
What are the signs of a lung lobe torsion?
Increased lobar opacity
Vesicular gas
Displaced lung lobe
Bronchial opacification
Mediastinal shift
Tracheal displacement
Axial rotation of the carina
Pleural effusion
Youngest lung lobe torsion noted in a dog?
7wks old
Benavides et al: Lung lobe torsion, What was the most common lung lobes affected?
Right middle
Left Cranial
Benavides et al: Lung lobe torsion, what was the most common radiographic sign?
Consolidation
Pleural effusion
Benavides et al: Lung lobe torsion, Does not having pleural effusion rule out lung lobe torsion?
NO
Benavides et al: Lung lobe torsion, what type of dog had significantly improved survival?
Small breed dogs.
Hamlin et al: US characteristics of feline TCC, Where is Tcc commonly located in cats?
Mid-body or apex of the bladder (70%)
Hamlin et al: US characteristics of feline TCC, What was less likely to happen in cats than in dogs with TCC?
Cats are less likely to have urethral extension than dogs
More likely to be single mass
Otherwise the characteristics are pretty much the same.
Hamlin et al: US characteristics of feline TCC, Was sublumbar lymphadenopathy common in cats?
Yes, similar to dogs
Williamson et al: MRI syringobulbia, What is syrringobulbia?
One or more fluid-filled cavitties within the brainstem (medulla).
Slits and Bulbous (congential) - and acquired
Williamson et al: MRI syringobulbia, Where does syringobulbia usually occur? And what age of dogs? And what size of dog?
Medulla Oblongata
Young
Small breed dogs
Williamson et al: MRI syringobulbia, What two types were seen?
Slit-like
Bulbous
Williamson et al: MRI syringobulbia, What MRI signal characteristics is the syringobulbia?
Same as CSF
Williamson et al: MRI syringobulbia, what did most syrinobulbias communicate with?
Fourth ventricle
Williamson et al: MRI syringobulbia, Can syringobulbia cause clinical signs?
Most dogs presented with vestibular disease that was attributed to the syringobulbia - attributed to medualla region
Thierry et al: CT appearance of canine tonsillar neoplasia, What is the most frequent type of neoplasia in the tonsils?
- SCC
- Melanoma
- Lymphoma
Thierry et al: CT appearance of canine tonsillar neoplasia, What is a common concomitant feature of tonsilar neoplasia regarding the lymph nodes?
Marked enlargment (>18mm in width on transverse CT)
Heterogeneity
Loss of hypoattenuating hilus (picture is normal hilus)
Thierry et al: CT appearance of canine tonsillar neoplasia, Does having little or no enlargemnt of the tonsil rule out tonsillar neoplasia?
NO… 5/12 dogs had little or no tonsillar enlargement despite having metastatic lymphadenopathy..
Lymphadenopathy is key to this disease process and if you see it you need to have tonsillar neoplasia on the list.
Thierry et al: CT appearance of canine tonsillar neoplasia, What lymph nodes are commonly affected?
Medial retropharyngeal - most common
Mandibular
Deep cervical
Recommend sampling all in suspect tonsillar neoplasm
Thierry et al: CT appearance of canine tonsillar neoplasia, What differentials should be considered for tonsillar enlargement without lymphadenopathy?
Tonsilar polyp
Hyperplasia
Tonsillitis
Neoplasia
Kadic et al: Rare Osteochondrosis lesion of DIRT; What view is needed to pick out the medial aspect of the distal intermediate ridge of the tibia to look for OCD?
D10L-PMO
Kadic et al: Rare Osteochondrosis lesion of DIRT; What is the normal radiographic projection that a normal DIRT lesion is picked up at?
LM
D45M-PL0.
Kadic et al: Rare Osteochondrosis lesion of DIRT; What are the most common sites for OC in the tarsus?
DIRT
Lateral trcohlear ridge of the talus
Medial malleolus
Others - Medial trochlear ridge of the talus, Lateral malleolus and proximal tubercle of the talus.
Kadic et al: Rare Osteochondrosis lesion of DIRT; In retrospect what could be seen on the D45MPLO and LM that indicated the medial DIRT lesion?
Reduced opacity of the medial aspect of the distal intermediate ridge.
Kadic et al: Rare Osteochondrosis lesion of DIRT; What part of the DIRT is most commonly affected by OC?
Lateral
Craniodistal.
Hughes et al: CT Splenic torsions Dog; What is contrast enhancement defined as?
>10HU increase
Hughes et al: CT Splenic torsions Dog; What is this sign called?
Whirl-sign = splenic torsion.
This is what it looks like on transverse images
Hughes et al: CT Splenic torsions Dog; What are the CT signs of splenic torsion?
Homogeneous and round spleens
C-shape with no predication for direction or lateralization
No splenic enhancement (Mean average +1.15)
Median precontrast attenuation of 51.1HU
Whirl sign
Abdominal free fluid (31 HU = hemoabdomen)
Normal LN
Hughes et al: CT Splenic torsions Dog; what differentiated partial torsions from torsions?
Partial enhancement.
Edwards et al: Cholesterinic granuloma CT horse; what percentage of the scanned population had these cholesterinic granulomas?
16%
Edwards et al: Cholesterinic granuloma CT horse; were neurologic signs associated with the presence of these granulomas or the lateral ventricle height?
NO
Edwards et al: Cholesterinic granuloma CT horse; What was found in 1/3 of the population of horses with cholesterinic granulomas?
Mineralization of the fourth ventricle.
Edwards et al: Cholesterinic granuloma CT horse; This is a young or old horse disease?
Old <15 yo
Edwards et al: Cholesterinic granuloma CT horse; What signs in the lateral ventricle is associated with presumed cholesterinic granulomas?
Increased size median 7.3 vs 4.9mm
Miles et al: Canine nasal septum deviation: What was statistically greater in dogs with neoplasia compared to dogs with rhinitis or normal dogs?
Mean longitudinal extent
Max distance of deviation
Miles et al: Canine nasal septum deviation: What was NOT statistically greater in dogs with nasal disease compared to normal dogs?
Prevalence of nasal septal deviation… Therefore the presence of this cannot be used as a marker for a mass in the nose.
Miles et al: Canine nasal septum deviation: Longitudinal extent of deviation was related how to the cranial, facial and skull index? What about the angle of deviation?
Longitudinal extent of deviation = inversely proportional
angle of deviation = proportional
Miles et al: Canine nasal septum deviation: what was not associated with the indices?
Prevelance… so no breed prediclect.
Von Sade et al: Canine thymomas CT: How can you tell the difference from thymic lymphoma and thymoma?
Thymomas tend to be more cystic (heterogenous CE) vs lymphoma is homogeneous
Von Sade et al: Canine thymomas CT: What is associated with invasion of vascular in thymomas?
Size of mass
Von Sade et al: Canine thymomas CT: Size and vascular invasion were correlated with prognosis…T/F?
False. None were associated with prognosis.
Von Sade et al: Canine thymomas CT: When was the best contrast enhancement of thymomas?
Venous or delayed phases
Von Sade et al: Canine thymomas CT: What LN drains the thymus?
Sternal.
Tanaka et al: CECT staging gastric tumors: What CT findings should make you think of lymphoma when looking at features of gastric tumors?
Lower early and delayed CE (30’s and 40’s HU in lymphoma vs 60 and 90 HU in other tumors)
Diffuse and bigger lymphadenopathy
Oh et al: CT evaluation of bronchial collapse: Some bronchi were seen collapsing what percentage in normal dogs? What was the normal mean collapsibility?
>50% some collapsed to.
Normal mean was ~36%
Oh et al: CT evaluation of bronchial collapse: What segmental bronchi saw the most collapsibility?
Left cranial and caudal lobar bronchus.
What is the description of an R2A?
Single right ostium with an anomalous prepulmonic left coronary branch
Image - both show a prepulmonic left coronary branch.
What can be done to increase the likelyhood of seeing the coronary arteries on regular CTA and not ECG gated CTA?
Multiple back and forth scanning to catch the heart at rest (3-6 times)
What were the three most common artifacts incountered when looking for coronary arteries on normal CTA and not ECG gated CTA?
Motion
Beam hardening
Lack of contrast in the aorta
An et al: Evaluation of the radiographic liver length/11th thoracic vertebral length ratio in cats: What was the Liver length/T11 ratio in normal cats?
4.2 - this was not affected by obesity or sex.
Length was the crossing point between the cranail most point of the diaphrgam and the caudal vena cava - to the apex of the caudal hepatic border
What type of urinary bladderr diverticula are there?
Congenital and acquired (trauma)
Auger et al: Administration of certain sedative drugs are associated with variation in US and rad splenic size in cats: What sedation did not show a significant change in size in etiher US or rad examinations?
Butorphanol
Auger et al: Administration of certain sedative drugs are associated with variation in US and rad splenic size in cats: What sedation did show a significant change in size in etiher US or rad examinations?
Acepromazine
Auger et al: Administration of certain sedative drugs are associated with variation in US and rad splenic size in cats: What sedation did show a significant change in size in rad examinations but not US?
- Dexmedetomidine
- Midazolam and torb
- Dex, torb and ketamine
Does gadolinium contrast affect T2*W GRE sequence?
NO… so you can run it at any time.
Bergamino et al: Improved visualization of lumbar spine nerve roots in dogs using water excitation as opposed to STIR: Which fat suppression technique was the best in evaluating the lumbar spine nerve roots?
Water excitation
What is the difference in how water excitation is applied vs STIR?
Water excitation is a slice selective technique.
STIR is applied to the whole volume of tissue at the same time
What is one of the advantages of STIR over water excitation?
Low sensitivity to field inhomogenicities and therefore good for postsurgical imaging.
HOWEVER, it will null everything with short T1 including melanin, methemoglobin, gadolinium and proteinaceous material.
Bertram et al: Congenital malformations of the lumbosacral vertebral column are common in normal Frenchies, E. bulldogs and pugs: Pugs have significantly higher prevalence of what type of malformation compared to E. bulldogs and Frenchies…. they have significantly lower prevalence of what?
Pugs have significantly more transitional vertebrae
and
Significantly less hemivertebrae.
Bertram et al: Congenital malformations of the lumbosacral vertebral column are common in normal Frenchies, E. bulldogs and pugs: Tail malformation was significantly more severe in dogs with what?
Evidence of a hemivertebrae.
Cushiod dogs may have an acuumulation of fat in their liver on CT which will cause what to happen with there HUs?
HU will become negative (-20)
Carnevale et al: CT and pathology in detecting DJD of the sacroiliac joint in dogs: What is a subarticular cleft?
A perpendicular, linear lucent defect
Carnevale et al: CT and pathology in detecting DJD of the sacroiliac joint in dogs: what are the signs of DJD in the SI joint?
- Subchondral sclerosis
- Subchondral erosion
- Subchondral cyst
- Intra-articular anklyosis - bridging the internal protion of the joint space (focal loss of visualization of the joint space
- Para-articular ankylosis - bridging outside the joint
- Subchondral cleft
Carnevale et al: CT and pathology in detecting DJD of the sacroiliac joint in dogs: What lesion did pathology and CT disagree on the detection of them?
Subchondral cyst
Paraarticular ankylosis
Subarticular clefts.
Radiographs underestimate and overestimate what when relating to pulmonary contusion seen on CT?
Underestimate the presence
Overestimate the size.
Didonato et al: Hypoechoic tissue changes in malignant prostatic lymphoma: what were the US signs of malignant prostatic lymphoma?
- Hypoechoic nodules or completely hypoechoic prostate
- Difffuse features of infiltrative disease
- Prostatomegaly with irregular margins
- NO mineralization
Edwards et al: CT findings of headshaking in horses: what nerve is headshaking thought to come from?
Trigeminal nerve. - Sensory input.
Edwards et al: CT findings of headshaking in horses: Where were ~50% of changes noted on CT in horses with headshaking?
The infraorbital canal. specifically increased mineralization and disruption of the canal.
3D (volumetric) MRI technique provides significantly better what than 2D images?
Grey-white matter differentiation.
Fleming et al: CTA and MRI features do not predict tumor type and grade of feline injection site sarcoma: Peritumoral projections were detected in what amount of cats?
All cats these projections were noted.
MOST WERE BENIGN
Fleming et al: CTA and MRI features do not predict tumor type and grade of feline injection site sarcoma: High grade feline injection site sarcomas tended to be what?
Larger.
Gallastegui et al: MRI has limited aggrement with CT in evaluation of vertebral fractures in dogs: Up to what percentage of fracture were missed by MRI?
79%
Gallastegui et al: MRI has limited aggrement with CT in evaluation of vertebral fractures in dogs: What agreement percentage was noted between MRI and CT?
15-30%
Which breed and weight of dog had higher stifle OA at the time of diagnosis of CCL injury on rads? Where was the OA most severe?
Boxers and dogs over 35kg
OA was most severe in the proximal, lateral and caudal aspect of the joint.
What causes horner syndrome?
Loss of sympathetic innervation to the eye.
Young cat with chronic vomiting.
Long segment structure - this is what is it (though to be secondary to ischemia)
DDX: Fungal (Histoplasmosis), neoplasia (lymphoma), FIP, eosiniophilic enteritis, IBD, compensatory hypertrophy secondary to obstruction.
Is CT able to stage liver and spleen for mast cell tumors?
Nope… normal CT still could have spleen
Mesenteric volvulus are more common in what breeds of dogs (2)?
GSD
English pointers
10-week old GSD with acute vomiting.
Congenital segmental dilation of the intestine.
DDX: Mechanical ileus, mesenteric volvulous.
2yo Stafford terrier, chronic cough.
Mixed bronchointestitial lung pattern with perbronchial thickening
TB lymphadenopathy
DDX: Fungal, Eosinophilic bronchopneumopathy and neoplasia
Answer: Pythiosis
Von stade: CT imaging of canine thymomas: What was larger size of the thymoma associated with?
Recurrance. - not shorter outcomes.
Von stade: CT imaging of canine thymomas: Larger tumors were associated with what CT characteristics?
Vascular invasion
Cystic structures - making them more heterogeneous compared to smaller homogeneous tumors.
Spoor et al: Intracranial coccidiomycosis in dogs: What distribution was found in all the dogs in this study?
- Bilateral symmetrical
- Frontal lobe, caudate nucleus, rostral internal capsule
Spoor et al: Intracranial coccidiomycosis in dogs: What was the outcome like for these dogs?
Good outcome… >80% recovery.
Later scans showed atrophy of the effected areas.
Duplication cyst occur where?
Anywhere from the esophagus to the anus
Duplication cysts are divided into what two types?
Communicating
Non-communicating
Duplication cysts are named by what?
Anatomy location.
Duodenal duplication cyst for example.
Joostens et al: Unipodal stance influences radiographic evaluation of foot balance in horses: What is the effect of unipodal stance on rads of a horse foot?
- Lateral Distal interphalangeal joint space is reduced
- Mediolateral jt imbalance is increased
- Medial DIPJ width were increased.
Plested et al: Survey of surgeons on rad reports for EPSS: what did surgeons believe should be in a rad report?
- Insertion
- Origin
- Course
- Diameter of insertion
- Presence of urolithiasis, peritoneal effusion, renomegaly.
Lodzinska et al: Vascular ultrasound characteristics of phlebitis: What are the US characteristics of phlebitis?
- Wall thickening
- Compressibility - decreased
- Fill defects - thrombus
- Vessel wall hyperechoic
- abnormal Doppler flow.
Manfredi et al: US differentiation between parenchymal gas and portal venous gas in cats: Why is it important to differentiate portal venous gas vs hepatic parenchymal emphysema?
Hepatic parenchymal gas has a much higher mortality at 90% vs 21% in dogs with portal gas.
Manfredi et al: US differentiation between parenchymal gas and portal venous gas in cats: What were the clinical diagnosis categories found in this study?
- Sepsis
- GI disease
- Iatrogenic
- Trauma
- Neoplasia
Manfredi et al: US differentiation between parenchymal gas and portal venous gas in cats: What category was associated with elevated liver enzymes… portal gas or parenchymal gas?
Parenchymal gas
Cole et al: Sentinel lymph node mapping of the canine anal sac using lymphoscintigraphy: Why was 99mTc sulfur colloid used?
Sulfur colloid is taken up by special cells in the lymphatics along with the liver, spleen and bone marrow.
Cole et al: Sentinel lymph node mapping of the canine anal sac using lymphoscintigraphy: What was a surprising finding in this study?
A inguinal lymph node was a sentinel lymph node.
Cole et al: Sentinel lymph node mapping of the canine anal sac using lymphoscintigraphy: Was there a difference between perimural and intramual injection?
Yes
Intramural was a better image with more count density and uptake was faster.
Also, different lymph nodes were seen as sentinel lymph node between the two techniques 50% of the time.
Morgan et al: Equine odontogenic tumors CT: What differentiated complex odontomas from the other odonttogenic tumors?
They contained enamel (high HU)
Morgan et al: Equine odontogenic tumors CT: What was commonly different between ameloblastic fibroma and ameloblastic carcinoma?
Carcinomas contained mineral.
Morgan et al: Equine odontogenic tumors CT: What were common characteristics shared by all odontogenic tumors?
Expansive
Alveolar and cortical bone lysis
Cortical bone thinning/thickening
Single mass
Perisoteal reaction
Mineralization in all
Wyatt et al: MRI findings in 12 dogs with multiple myeloma: What were the common features of multiple myeloma?
- Hyper-isointense on T2 and T1 images
- Homogeneous CE
- Mutliple expansile vertebral lesions without extension beyond the outer cortical limits
- All cases had extradural material extending into the vertebral canal causing variable spinal cord compression
Walczak et al: Insulinomas on MRI: What were the intensity patterns of this masses?
T2 hyperintense and T1 isointense with little contrast enhancement.
More heterogeneous in the mets than in the primary.
Walczak et al: Insulinomas on MRI: What percentage of insulinomas have macromets at the time of diagnosis?
50-100%
Most common sights = Liver, lymph nodes, peripancreatic mesenter and omentum
What is the difference between gastric pneumotosis and emphysematus gastritis?
Emphysematus gastritis - gas in the stomach wall secondary to gas producing bateria
Gastric penumotosis - gas in the stomach wall due to mechanical tear or infiltration of benign gas
What nerves are affected by temporhyoid osteotomy?
Facial and vestibulocochlear - It involves the petrous portion of the temporal bone.
Tanner et al: Prevalence of temporal bone fractures in horses: what breed was overrepresented when discussing fractures?
Quarter horses
Tanner et al: Prevalence of temporal bone fractures in horses: What was the orientation of ALL fractures?
Unilateral, minimally displaced
Rostrodorsal to caudoventral orientation
Tanner et al: Prevalence of temporal bone fractures in horses: What two types of fractures were noted in this study?
One extending through the full width petrous pyramid involving the cranial vault
One only extending through the lateral part of the petrous bone not involving the cranial vault
De Guio et al: Bone marrow lesions in the distal condyles of the 3rd metacarpal bone on MRI: Where were the most common lesions?
Dorsal aspect of the medial condyle
The sagittal ridge
De Guio et al: Bone marrow lesions in the distal condyles of the 3rd metacarpal bone on MRI: Were these lesions corrulated with lameness or severity of lameness?
NO
Zadelhoff et al: Thoracic spinous process scintigraphy: What is considered normal spacing between spinous processes? Where is the most affected area?
>4mm
T12 - T18
What are the advantages of TSE/FSE sequences over conventional?
Increase echo train length cause echos from different phase encoding gradients thus can fill k-space faster during one TR
Improved time
Improved spatial res
Improved NSR
Decreased suspectibility artifact.
Reetz et al: Nodules and masses associated with malignant pleural effusion in dogs and cats on CT: What CT features were significantly related to malignancy?
- Older patients
- Nodular diaphragmatic pleural thickening - image
- Costal pleural masses
- Pulmonary masses
Rick et al: CEUS of intrathoracic masses: The majority of neoplastic masses were supplied by what type of artery while the non-neoplastic masses are supplied by what?
Neoplastic bronchial artery
Non-neoplastic pulmonary artery.
Rick et al: CEUS of intrathoracic masses: What type of enhancement was noted in lymphoma vs thymoma?
Thymomas: heterogeneous and centripetal (outside)
Lymphoma: Uniform and centrifugal (inside)
Ryu et al: CT variants of caudal vena cava in 121: What were the types (4) of CVC variants seen in this study?
- Caudal partial split (just cranial to the aortic trifurcation)
- Partial duplication (Midway between the kidneys and aortic trifurcation)
- Complete duplication (Just caudal to the renal veins)
- Left-sideness
Where are the most common disc protrusions in the the cervical region of a horse?
C5-T1
Can osteolytic changes been seen with intracranial neoplasms?
Yes… meningomas and gliomas have been recorded.
Mattei et al: Renal US abnormalities associated with low GFR: What abnormalities were associated with low GFR?
- Abnormal kidney shape
- Cortical hyperechogenicity
- Medullary hyperechogenicity
- Low kidney volume
Hoaglund et al: Intermediate patellar ligament desmopathy: Where are the lesion most likley found in the ligament and what are they commonly?
In the midbody
Predominantly hypoechoic tears in the craniolateral to caudomedial direction.
