wk 3-5. Pathology concepts for sonography Flashcards
2 categories for muscle and tendon injury
- acute
2. chronic
acute muscle injury grade 1 presents with
no fiber disruption
acute muscle injury grade 2 presents with
partial tear or moderate fiber disruption
-decreased muscle strength
acute muscle injury grade 3 presents with
complete fiber disruption
name the 4 types of tears
- intrasubstance tear
- partial thickness tear
- full thickness tear
- complete tear or rupture
tear with no communication wth sides or edges, all surrounding tissue is in tact
intrasubstance tear
tear with communication to one surface either the articulate surface or the bursal surface
partial thickness tear
anisotropy makes tendons appear ____
hypoechoic
tendons, if images at the appropriate angle (90 degrees) there will be no anisotropy and will appear
hyperechoic
t/f: in a normal tendon there is little vascularity
true
surface of tendon in contact with cartilage of bone
articulate side of the tendon
from articulate to bursal surface there is a disruption of the fiber
full thickness tear
tear separate tendon form bone
complete/ rupture
separation of bursal and articular lamina
delaminating tears
appearance of ___:
- hypoechoic or heterogeneous
- loss of fibular architecture
- calcification
- disorganized/ fiber separation
tendonitis
inflammation of the fibrous tissue (plantar fascia) along the bottom of your foot that connects your heel bone to your toes
fasciitis
inflammation of the bursa, becomes fluid filled and hypoechoic
bursitis
increase of the cellularity of the synovial membrane and leads to synovial thickening
synovial hypertrophy
extra fluid surrounds the joint
joint effusion
jelly-fluid filled lumps commonly occurs around joints of wrist
ganglion cyst
the flow of arthrographic contrast or joint fluid from the glenohumeral joint across the acromioclavicular joint (ACJ) to form a supraclavicular collection.
geyser sign
hypoechoic fluid collection above the AC joint
geyser sign
abnormal hypoechoic, poorly compressible and non-displaceable intra-articular tissue which may exhibit doppler signal.
hyperemic synovial hypertrophy
During the healing of the bruise, Calcium can become deposited in the bruise causing a hard bone like structure within the muscle.
myosititis ossificans
ill defined heterogeneous/ hypoechoic fluid collection
hematoma
a spherical or oblong structure that is largely anechoic or hypoechoic. Containing hyperechoic debris
abscess
enlargement of the bursa with fluid collection. Fluid filled anechoic structure lines with hyperechoic wall
bursitis
well defined collection of fluid with rounded inferior margin in the pop fossa
bakers cyst
multiple echogenic foci superficial and deep to a tendon represent
foreign bodies
linear hypoechoic area within tendon represents
laceration
non-infective causes of inflammation (resemble infection)
arthritis
characteristics of ____:
- worn down cartilage with narrowed joining space
- inflammatory cells
- swelling around the joint
- over growth of synovial membrane
rheumatoid arthritis
cartilage-capped bony proliferations (spurs) that most commonly develop at the margins of a synovial joint as a response to articular cartilage damage
osteophytes
synovial proliferation (thickening) as seen in rheumatoid arthritis
pannus
osteophytes (bony proliferations at tendon and ligament attachments) are a distinguishing feature of ____
psoriatic
appear heterogeneously hyperechoic, surrounded by hypoechoic halo caused by the zone of chronic inflammation
tophi
The presence of synovial monosodium urate monohydrate (MSU) crystals is the gold standard for diagnosing
gout
cartilage loss and osteophyte formation are common findings associated with
Osteoarthritis
____ cysts have a fibrous lining
ganglion
___ cysts have a cubodial/ flattened cell lining
synovial
t/f: ganglion cysts can originate from the tendon sheath
true
ganglion cysts are commonly ___-loculated and ____-lobar
MULTI
5 types of infection
- cellulitis
- abscess
- necrotizing fasciitis
- Other ST infections
- Hematogeneous infections
infections adjacent to bone
-osteomyelitis
____ infections are common in children, IV drug useres, pt with sepsis, steroid users
hematogeneous
strep A is a popular cause of ___
necrotizing fasciitis
anechoic perifascial fluid and gas at the deep fascia
necrotizing fasciitis
necrotizing fasciitis contain hyperechoic foci with ___ artifacts
commet tail & dirty shadow
a wound or skin ulcer is considered what type of infection
cellulitis
___ cellulitis appears as hyperechoic and thickened subq fat
acute
___ cellulitis appears as hypoechoic or anechoic, branching channels, distorted ST (soft tissue) , with possible hyperemia
later
fluid distention of a joint recess, anechoic to hyperechoic, with hypo or isoechoic synovial hypertrophy. Requires aspiration to diagnose
sepetic arthritis
hematogeneous, subperiosteal abscess, commonly seen in children where periosteum is loosely adherent
bone infection
tissue death or necrosis
infarction
myositis & diabetic muscle infarction are inflammatory processes that early on appear___ and later appear____
Early
-hyperechoic with hyperemia
Later
-atrophy (increased muscle echogenicity and diminished volume)
hypoechoic masses/ nodules
sarcoidosis
sarcoidosis is a disease caused by ___ commonly occurring in the lungs and lymph nodes
inflammation
nerves get trapped with certain anatomy and by certain movements
peripheral nerve entrapment
carpal tunnel is ___ nerve entrapment
median
guyon canal is ___ nerve entrapment
ulnar
level of supinator muscle is ___ nerve entrapment
deep branch of radial
tibial nerve- tarsal tunnel syndrome affects the
ankle
common plantar digital nerve- morton neuroma (nerve entrapment) affecets thr
mid foot
common findings of nerve entrapment
hypoechoic swelling at entrapment site
-signs of denervation in muscle atrophy (increased echogenicity)
loss of nerve connection to the muscle resulting in atrophic muscle
denervation
denervation can compromise the ___ or ___ nerves
central
local
ST gas can simulate __ on ultrasound
Foreign body
related complications of foreign bodies (3)
- tenosynovitis
- periostitis
- abscess
Benign soft tissue masses (5)
- Lipoma
- Vascular anomalies
- Ganglion cyst
- Lymph nodes
- Nerve tumors
ST foreign bodies become (more/less) echogenic over time
less
thick layer of gel or standoff pad is the best way to assess
foreign bodies
shoulder, upper extremety, trunk, back are common sites for ___
lipoma
tumor located just below the skin. Well defined, palpable, echogenic (depending on surrounding tissue)
lipoma
lipoma echogenicity is related to amount of ___ and ____
fat & CT
differential diagnosis of lipoma (3)
- angiolipoma or “hemartoma”
- subQ fat necrosis
- dermatofibrosarcome protuberans
solid ST masses, continuous with nerves- hypoechoic, low level homogeneous internal echoes, round or oval shaped and well definied. require doppler to confirm flow
peripheral nerve sheath tumors
peripheral nerve sheath tumor differential diagnosis
complex cyst
–> show doppler flow to confirm it is PNST
over production of schwann cells (coat nerve fibers)
schwannoma
overgrowth of nerve tissue, intimately attached to nerve
neuroma
schwannoma is ___ to treat surgically than Neuroma
easier (not directly attached to never, just covers it)
vascular anomalies can be separated into 2:
- vascular tumors
2. vascular malformations
2 types of vascular tumors
- infantile hemangioma
2. intramuscular hemangioma
vascular tumor that shows INCREASED flow on colour/ power doppler
infantile hemangioma
vascular tumor that shows SLOW flow on colour/ power doppler
intramuscular hemangioma
a benign (noncancerous) tumor made up of blood vessels.
hemangioma
what gives the “tangles vessel” appearance
AVM
atriovenous malformation
lymph nodes are oval with a ___ peripheral cortex and ___ hilum
- hypoechoic
- hyperecoic
cortex of lymph node should have a thin wall or have ____ thickness
uniform
indicators of malignant lymph node
- loss of echogenic hilum
- enlarged, asymmetrical cortex
- rounded shape
- increased vascularity
- cystic areas in cortex
indicators of malignant ST tumors
- increased vascularity
- anechoic necrotic regions
- “outside” or not related to joint
- calcifications
example of malignant ST tumor
sarcoma