wk 3-5. Pathology concepts for sonography

Question 1

2 categories for muscle and tendon injury

Answer 1

1. acute

2. chronic

Question 2

acute muscle injury grade 1 presents with

Answer 2

no fiber disruption

Question 3

acute muscle injury grade 2 presents with

Answer 3

partial tear or moderate fiber disruption

-decreased muscle strength

Question 4

acute muscle injury grade 3 presents with

Answer 4

complete fiber disruption

Question 5

name the 4 types of tears

Answer 5

1. intrasubstance tear
2. partial thickness tear
3. full thickness tear
4. complete tear or rupture

Question 6

tear with no communication wth sides or edges, all surrounding tissue is in tact

Answer 6

intrasubstance tear

Question 7

tear with communication to one surface either the articulate surface or the bursal surface

Answer 7

partial thickness tear

Question 8

anisotropy makes tendons appear ____

Answer 8

hypoechoic

Question 9

tendons, if images at the appropriate angle (90 degrees) there will be no anisotropy and will appear

Answer 9

hyperechoic

Question 10

t/f: in a normal tendon there is little vascularity

Answer 10

true

Question 11

surface of tendon in contact with cartilage of bone

Answer 11

articulate side of the tendon

Question 12

from articulate to bursal surface there is a disruption of the fiber

Answer 12

full thickness tear

Question 13

tear separate tendon form bone

Answer 13

complete/ rupture

Question 14

separation of bursal and articular lamina

Answer 14

delaminating tears

Question 15

appearance of ___:

• hypoechoic or heterogeneous
• loss of fibular architecture
• calcification
• disorganized/ fiber separation

Answer 15

tendonitis

Question 16

inflammation of the fibrous tissue (plantar fascia) along the bottom of your foot that connects your heel bone to your toes

Answer 16

fasciitis

Question 17

inflammation of the bursa, becomes fluid filled and hypoechoic

Answer 17

bursitis

Question 18

increase of the cellularity of the synovial membrane and leads to synovial thickening

Answer 18

synovial hypertrophy

Question 19

extra fluid surrounds the joint

Answer 19

joint effusion

Question 20

jelly-fluid filled lumps commonly occurs around joints of wrist

Answer 20

ganglion cyst

Question 21

the flow of arthrographic contrast or joint fluid from the glenohumeral joint across the acromioclavicular joint (ACJ) to form a supraclavicular collection.

Answer 21

geyser sign

Question 22

hypoechoic fluid collection above the AC joint

Answer 22

geyser sign

Question 23

abnormal hypoechoic, poorly compressible and non-displaceable intra-articular tissue which may exhibit doppler signal.

Answer 23

hyperemic synovial hypertrophy

Question 24

During the healing of the bruise, Calcium can become deposited in the bruise causing a hard bone like structure within the muscle.

Answer 24

myosititis ossificans

Question 25

ill defined heterogeneous/ hypoechoic fluid collection

Answer 25

hematoma

Question 26

a spherical or oblong structure that is largely anechoic or hypoechoic. Containing hyperechoic debris

Answer 26

abscess

Question 27

enlargement of the bursa with fluid collection. Fluid filled anechoic structure lines with hyperechoic wall

Answer 27

bursitis

Question 28

well defined collection of fluid with rounded inferior margin in the pop fossa

Answer 28

bakers cyst

Question 29

multiple echogenic foci superficial and deep to a tendon represent

Answer 29

foreign bodies

Question 30

linear hypoechoic area within tendon represents

Answer 30

laceration

Question 31

non-infective causes of inflammation (resemble infection)

Answer 31

arthritis

Question 32

characteristics of ____: - worn down cartilage with narrowed joining space - inflammatory cells - swelling around the joint - over growth of synovial membrane

Answer 32

rheumatoid arthritis

Question 33

cartilage-capped bony proliferations (spurs) that most commonly develop at the margins of a synovial joint as a response to articular cartilage damage

Answer 33

osteophytes

Question 34

synovial proliferation (thickening) as seen in rheumatoid arthritis

Answer 34

pannus

Question 35

osteophytes (bony proliferations at tendon and ligament attachments) are a distinguishing feature of ____

Answer 35

psoriatic

Question 36

appear heterogeneously hyperechoic, surrounded by hypoechoic halo caused by the zone of chronic inflammation

Answer 36

tophi

Question 37

The presence of synovial monosodium urate monohydrate (MSU) crystals is the gold standard for diagnosing

Answer 37

gout

Question 38

cartilage loss and osteophyte formation are common findings associated with

Answer 38

Osteoarthritis

Question 39

____ cysts have a fibrous lining

Answer 39

ganglion

Question 40

___ cysts have a cubodial/ flattened cell lining

Answer 40

synovial

Question 41

t/f: ganglion cysts can originate from the tendon sheath

Answer 41

true

Question 42

ganglion cysts are commonly ___-loculated and ____-lobar

Answer 42

MULTI

Question 43

5 types of infection

Answer 43

1. cellulitis 2. abscess 3. necrotizing fasciitis 4. Other ST infections 5. Hematogeneous infections

Question 44

infections adjacent to bone

Answer 44

-osteomyelitis

Question 45

____ infections are common in children, IV drug useres, pt with sepsis, steroid users

Answer 45

hematogeneous

Question 46

strep A is a popular cause of ___

Answer 46

necrotizing fasciitis

Question 47

anechoic perifascial fluid and gas at the deep fascia

Answer 47

necrotizing fasciitis

Question 48

necrotizing fasciitis contain hyperechoic foci with ___ artifacts

Answer 48

commet tail & dirty shadow

Question 49

a wound or skin ulcer is considered what type of infection

Answer 49

cellulitis

Question 50

___ cellulitis appears as hyperechoic and thickened subq fat

Answer 50

acute

Question 51

___ cellulitis appears as hypoechoic or anechoic, branching channels, distorted ST (soft tissue) , with possible hyperemia

Answer 51

later

Question 52

fluid distention of a joint recess, anechoic to hyperechoic, with hypo or isoechoic synovial hypertrophy. Requires aspiration to diagnose

Answer 52

sepetic arthritis

Question 53

hematogeneous, subperiosteal abscess, commonly seen in children where periosteum is loosely adherent

Answer 53

bone infection

Question 54

tissue death or necrosis

Answer 54

infarction

Question 55

myositis & diabetic muscle infarction are inflammatory processes that early on appear___ and later appear____

Answer 55

Early -hyperechoic with hyperemia Later -atrophy (increased muscle echogenicity and diminished volume)

Question 56

hypoechoic masses/ nodules

Answer 56

sarcoidosis

Question 57

sarcoidosis is a disease caused by ___ commonly occurring in the lungs and lymph nodes

Answer 57

inflammation

Question 58

nerves get trapped with certain anatomy and by certain movements

Answer 58

peripheral nerve entrapment

Question 59

carpal tunnel is ___ nerve entrapment

Answer 59

median

Question 60

guyon canal is ___ nerve entrapment

Answer 60

ulnar

Question 61

level of supinator muscle is ___ nerve entrapment

Answer 61

deep branch of radial

Question 62

tibial nerve- tarsal tunnel syndrome affects the

Answer 62

ankle

Question 63

common plantar digital nerve- morton neuroma (nerve entrapment) affecets thr

Answer 63

mid foot

Question 64

common findings of nerve entrapment

Answer 64

hypoechoic swelling at entrapment site | -signs of denervation in muscle atrophy (increased echogenicity)

Question 65

loss of nerve connection to the muscle resulting in atrophic muscle

Answer 65

denervation

Question 66

denervation can compromise the ___ or ___ nerves

Answer 66

central | local

Question 67

ST gas can simulate __ on ultrasound

Answer 67

Foreign body

Question 68

related complications of foreign bodies (3)

Answer 68

- tenosynovitis - periostitis - abscess

Question 69

Benign soft tissue masses (5)

Answer 69

1. Lipoma 2. Vascular anomalies 3. Ganglion cyst 4. Lymph nodes 5. Nerve tumors

Question 70

ST foreign bodies become (more/less) echogenic over time

Answer 70

less

Question 71

thick layer of gel or standoff pad is the best way to assess

Answer 71

foreign bodies

Question 72

shoulder, upper extremety, trunk, back are common sites for ___

Answer 72

lipoma

Question 73

tumor located just below the skin. Well defined, palpable, echogenic (depending on surrounding tissue)

Answer 73

lipoma

Question 74

lipoma echogenicity is related to amount of ___ and ____

Answer 74

fat & CT

Question 75

differential diagnosis of lipoma (3)

Answer 75

1. angiolipoma or "hemartoma" 2. subQ fat necrosis 3. dermatofibrosarcome protuberans

Question 76

solid ST masses, continuous with nerves- hypoechoic, low level homogeneous internal echoes, round or oval shaped and well definied. require doppler to confirm flow

Answer 76

peripheral nerve sheath tumors

Question 77

peripheral nerve sheath tumor differential diagnosis

Answer 77

complex cyst | --> show doppler flow to confirm it is PNST

Question 78

over production of schwann cells (coat nerve fibers)

Answer 78

schwannoma

Question 79

overgrowth of nerve tissue, intimately attached to nerve

Answer 79

neuroma

Question 80

schwannoma is ___ to treat surgically than Neuroma

Answer 80

easier (not directly attached to never, just covers it)

Question 81

vascular anomalies can be separated into 2:

Answer 81

1. vascular tumors | 2. vascular malformations

Question 82

2 types of vascular tumors

Answer 82

1. infantile hemangioma | 2. intramuscular hemangioma

Question 83

vascular tumor that shows INCREASED flow on colour/ power doppler

Answer 83

infantile hemangioma

Question 84

vascular tumor that shows SLOW flow on colour/ power doppler

Answer 84

intramuscular hemangioma

Question 85

a benign (noncancerous) tumor made up of blood vessels.

Answer 85

hemangioma

Question 86

what gives the "tangles vessel" appearance

Answer 86

AVM | atriovenous malformation

Question 87

lymph nodes are oval with a ___ peripheral cortex and ___ hilum

Answer 87

- hypoechoic | - hyperecoic

Question 88

cortex of lymph node should have a thin wall or have ____ thickness

Answer 88

uniform

Question 89

indicators of malignant lymph node

Answer 89

- loss of echogenic hilum - enlarged, asymmetrical cortex - rounded shape - increased vascularity - cystic areas in cortex

Question 90

indicators of malignant ST tumors

Answer 90

- increased vascularity - anechoic necrotic regions - "outside" or not related to joint - calcifications

Question 91

example of malignant ST tumor

Answer 91

sarcoma