MSK ultrasound cases Jan 2021

MSK ultrasound cases Jan 2021

These are some of the cases I usually gets in a day when I do the MSK, abdominal, small parts sonography. For those who want to learn MSK hands on please let me know so I can send you the proposal to teach you and your staff at your own clinic of centre.

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A cyst rising from the EDL 5th left foot 

 credit to steve ramsey

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Achilles peri tendon sheath mass ;The Achilles tendon does not have a true synovial sheath but instead has a paratenon. The paratenon is a connective tissue sheath that surrounds the entire tendon and is able to stretch 2 to 3 cm with movement, which allows maximal gliding action.

credit to steve ramsey

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credit to steve ramsey

 The Achilles tendon has been shown to thicken in response to increased activity. The morphologic changes such as decreased cell density, decreased collagen fibril density, and loss of fiber waviness that occur with aging predispose the tendon to injury

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credit to steve ramsey

Increased vascularity in the thyroid lobes ; In conclusion, thyroid hypervascularization at onset of Graves’ disease is an important sonographic feature.

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credit to steve ramsey

Isthmus in sagittal scan , it can help you to find other nodules that you might miss with transverse section scan only.

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credit to steve ramsey

Changing you color setting from 2d , angio power to different color enhancement setting can help you to outline nodules and see the extend of the flow.

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credit to steve ramsey

Posterior rt lateral bladder wall , stone at the UVJ. The ureterovesical junction is located where the ureter (the tube that drains urine from the kidney) meets the bladder. Ureterovesical junction (UVJ) obstruction refers to a blockage to this area.

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credit to steve ramsey

The obstruction impedes the flow of urine down to the bladder, causing the urine to back up into and dilate the ureter and kidney Megaureter and hydronephrosis

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credit to steve ramsey

Unilateral UVJ obstruction is the second most common prenatally detected obstructive disease, often picked up on maternal ultrasounds during pregnancy. Each year, we treat nearly 100 children who have a UVJ obstruction.

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credit to steve ramsey

Right kidney lower pole anterior mass, was missed in other clinic in Calgary, the abdominal ultrasound was normal 3 weeks before I scanned her .

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credit to steve ramsey

Appendicitis is an inflammation of the appendix, a finger-shaped pouch that projects from your colon on the lower right side of your abdomen. Appendicitis causes pain in your lower right abdomen. However, in most people, pain begins around the navel and then moves . A case of large dilated appendix, you can see the appendix at the cecum with hyperemia, patient have pain, lymph nodes was seen

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credit to steve ramsey

Small mass at the palmers side right hand , webspace 2 at mcp level, neuroma? vs flexor tendon sheath cyst . Most soft tissue mass lesions of the hand are benign. Ganglia are the commonest lesions encountered, followed by giant cell tumors of the tendon sheath. Malignant tumors are rare. Often a specific diagnosis can be achieved on imaging by considering the location and anatomical relations of the lesion within the hand or wrist, and assessing its morphology.

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credit to steve ramsey

Ultrasound plays a complementary role to MRI. It is often the initial modality used for assessing masses as it is cheap and available, and allows reliable differentiation of cystic from solid lesions, along with a real time assessment of vascularity

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credit to steve ramsey

Giant cell tumor of tendon sheath is the second commonest mass in the hand and wrist following ganglia. The etiology of GCTTS has been variously attributed to a synovial inflammatory process, recurrent hemorrhage, repetitive trauma or a disorder of lipid metabolism. However, consistent cytogenetic abnormalities and its potential for autonomous growth and malignant transformation suggest that the disease should be considered a neoplastic process. There is a slight female predominance. These lesions usually affect the volar aspect of the first three digits, much less commonly affecting the wrist.

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credit to steve ramsey

Pedunculated fibroids are benign (noncancerous) growths in the uterus. These fibroids are attached to the uterine wall by a stalk-like growth called a peduncle. The main difference between pedunculated fibroids and other fibroids is the peduncle.

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These fibroids can grow both inside and outside the uterus. Inside the uterus, this type of growth is called a pedunculated submucosal fibroid. Outside the uterus it’s called a pedunculated subserosal fibroid. There are three major types of uterine fibroids. Intramural fibroids grow within the muscular uterine wall. Submucosal fibroids bulge into the uterine cavity. Subserosal fibroids project to the outside of the uterus.

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credit to steve ramsey

The superficial location of the bursa, between the ulna and the skin at the posterior tip of the elbow, makes it susceptible to inflammation from acute or repetitive (cumulative) trauma. Less commonly, inflammation results from infection (septic bursitis). A bursa is a fluid-filled synovial pouch that can be deep or superficial and functions as a cushion to reduce friction between structures such as tendons, bone, or skin.1 Superficial bursae are located in the subcutaneous tissue between bone and overlying skin.

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credit to steve ramsey

Osteoma is the most frequent benign tumour in adults and is most commonly seen in men between the fourth and fifth decades of life. It is a juxta-cortical tumour made up of well-differentiated compact or cancellous bone. Osteomas usually arise from the outer table and rarely from the inner table and can be sessile or pedunculated . Inner table osteomas can be misdiagnosed as ossified meningiomas; however, unlike meningioma, osteomas do not have a soft tissue component and do not enhance

Calvarial lesions are often asymptomatic and are usually discovered incidentally during computed tomography or magnetic resonance imaging of the brain. Calvarial lesions can be benign or malignant. Although the majority of skull lesions are benign, it is important to be familiar with their imaging characteristics and to recognise those with malignant features where more aggressive management is needed. Clinical information such as the age of the patient, as well as the patient’s history is fundamental in making the correct diagnosis.

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credit to steve ramsey

Nonmelanoma skin cancer, which includes basal cell carcinoma and squamous cell carcinoma, is the most common cancer in the United States. Approximately 80 percent of nonmelanoma skin cancers are basal cell carcinoma and 20 percent are squamous cell carcinoma. Although the National Cancer Institute does not formally track the incidence and prevalence of nonmelanoma skin cancers, multiple longitudinal studies indicate that the incidence has risen sharply over the past two decades

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The triangular fibrocartilage complex (TFCC) is a load-bearing structure between the lunate, triquetrum, and ulnar head. The function of the TFCC is to act as a stabilizer for the ulnar aspect of the wrist. Ultrasound above is for a calcification in the TFCC.

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credit to steve ramsey

This ultrasound picture of a tear in the tfcc. The TFCC is at risk for either acute or chronic degenerative injury. Forced ulnar deviation and positive ulnar variation carry associations with injuries to the TFCC. Patients with TFCC injury will present with ulnar-sided wrist pain that may present with clicking or point tenderness between the pisiform and the ulnar head.

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credit to steve ramsey

Muscle injuries in the calf are a relatively common clinical condition, and are also termed “tennis leg” in general because of the prevalence in that sport. However, middle-aged or older patients, usually over the age of 40, often present with lower leg muscle injuries following strenuous exercise or sometimes innocuous activity.

There is a consensus to classify myotendinous strains as first degree (stretch injury), second degree (partial tear), and third degree (complete rupture). This type of classification takes into consideration the physical findings and pathological correlation as described above, and the disabilities that is, absent, mild, or complete loss of muscle function. 

The term strain does not accurately reflect the structural characteristics of injuries of muscles; rather it is more of a biomechanical description of the mechanism of injury, and as such, the term tear should be used as it more accurately describes the structural injuries of muscle fibres. Mueller-Wohlfahrt et al. discusses the use of a classification system that describes four types of indirect (acute) muscle injuries, and recommends the use of the term tear to describe the injuries of muscle fibres and bundles .

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credit to steve ramsey

An adrenal tumor/ mass above ; is a benign (noncancerous) or malignant (cancerous) growth that develops on an adrenal gland. There are two adrenal glands in the body, one situated above each kidney. Adrenal tumors are common. A tumor simply means a mass. This picture shows a classic adrenal tumor growing within the cortex . Tumors can be either benign or malignant. In fact, the vast majority of adrenal tumors are benign (not cancer). The older we get, the more likely we are to develop an adrenal tumor. In a 20-year-old only about 0.2% of all individuals have an adrenal tumor, whereas when we get to 70 years old, almost 7% have an adrenal tumor. The good news is that over 95% of adrenal tumors are benign. 

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credit to steve ramsey

A lipoma is a benign tumor made of fat tissue. They are generally soft to the touch, movable, and painless. They usually occur just under the skin, but occasionally may be deeper. Most are less than 5 cm in size. Common locations include upper back, shoulders, and abdomen . Lipomas are soft, fatty accumulations just beneath the skin. They tend to appear in middle-aged people but can be found in people of all ages. They are nearly always harmless and can often just be left alone, although you might wish to remove them for aesthetic reasons. In some cases, they can become very large and can be numerous, and surgery may be required to remove them if they are severe enough.

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credit to steve ramsey

A hip labral tear involves the ring of cartilage (labrum) that follows the outside rim of your hip joint socket. Besides cushioning the hip joint, the labrum acts like a rubber seal or gasket to help hold the ball at the top of your thigh bone securely within your hip socket.It can be full with fluid, hematoma or a cyst.

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credit to steve ramsey

Ultrasound of the right anterior thigh for a person who have an injury at that spot and the exam done 1 year later . The subcutaneous fat injury with calcification. Mimiking a lipoma.

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credit to steve ramsey

Shoulder lipoma anterior shoulder lump area of fat/ lipoma. A lipoma is a knot of fatty tissue that is usually found just below the skin (subcutaneous). Lipomas can occur almost anywhere on the body, but are most commonly found on the trunk, shoulders, neck, and armpits. Lipomas can rarely form in muscles and internal organs. A lipoma can be described as a rubbery bulge that feels like it can move. Lipomas tend to grow slowly, often over a period of months or years. They are usually small (usually less than 2 inches across). Sometimes larger lipomas do occur, with some reaching almost 8 inches across. Lipomas are fairly common, occurring in 1 in every 1,000 people. People with a lipoma usually have only 1, though about 20% of those affected can have several. Lipomas affect all age groups and can even be present at birth; however, they usually form in people who are between the ages of 40 and 60

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credit to steve ramsey

An umbilical hernia creates a soft swelling or bulge near the navel. It occurs when part of the intestine protrudes through the umbilical opening in the abdominal muscles. Umbilical hernias in children are usually painless. Umbilical hernias are common in young infants, but the exact rate is not known because many cases go unreported and resolve themselves without the need for treatment. They are particularly common in infants born preterm. Up to 75% of newborns with a birth weight of less than 1.5 kilograms (kg) have an umbilical hernia. While the developing fetus is in the womb, the umbilical cord passes through an opening in the abdominal wall. This should close soon after birth However, the muscles do not always seal completely, leaving a weak spot through which an umbilical hernia can push.

In most cases, an umbilical hernia experienced by an infant closes on its own by the age of 3 to 4 years. If a hernia is still present by the time the child is 4 years old, a doctor may recommend surgery.

In adults – Umbilical hernias can also develop in adults, especially if they are clinically overweight, lifting heavy objects, or have a persistent cough. Women who have had multiple pregnancies have a higher risk of developing an umbilical hernia. In adults, hernias are much more common in females. Among infants, the risk is about the same for males and females.

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credit to steve ramsey

Diastasis recti of the rectus abdominis muscle by ultrasound ; During pregnancy, your body does a lot of incredible things to accommodate your growing baby. One of them is the expansion of the muscles in your abdomen — the right and left sides of the abdominis rectus muscle separate as your linea alba (the tissue between that set of muscles) stretches to make room for baby. Because of this, after pregnancy, many women will notice an indentation in the middle of their bellies, right down the center of the “six-pack” area. But for some moms, that gap is wide and needs help being repaired. A wider separation is called diastasis recti.

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credit to steve ramsey

Diastasis recti is the partial or complete separation of the rectus abdominis, or “six-pack” muscles, which meet at the midline of your stomach. Diastasis recti is very common during and following pregnancy. This is because the uterus stretches the muscles in the abdomen to accommodate your growing baby.

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credit to steve ramsey

Diastasis recti abdominis (DRA) is an impairment characterized by an increase in midline separation of the rectus abdominis muscles due to the widening and thinning of the linea alba (LA).This separation results in an increase in the distance between the two rectus abdominis muscles, commonly referred to as the inter-rectus distance (IRD). DRA is present when the IRD increases and exceeds normal values, which can be measured at 1 or more regions along the LA. It should be noted, that the increase in midline “separation” of the rectus abdominis muscles involves stretching of the LA rather than a true separation.DRA can occur in both males and females as well as across all age groups

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credit to steve ramsey

PVT -Portal vein thrombosis

Portal vein thrombosis may be seen in a variety of clinical contexts, and when acute can be a life-threatening condition. It is a major cause of non-cirrhotic presinusoidal portal hypertension, Portal vein thrombosis may be either bland and/or malignant (i.e. tumor thrombus), and it is a critical finding in liver transplant candidates, as it precludes transplantation. The demographics of patients with portal venous thrombosis will match those of the underlying condition. Portal vein thrombosis, like thrombosis elsewhere, can occur due to disturbance of any one of the Virchow triad, and causes can be thought of in these terms 

Reduced flow / portal hypertension , Cirrhosis: most common, Hepatobiliary malignancies, carcinoma -HCC, Pancreatic ductal carcinoma , Cholangiocarcinoma , Stomach cancer, Extrinsic compression by an adjacent tumor (bland thrombus)

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credit to steve ramsey

Swollen lymph nodes usually occur as a result of infection from bacteria or viruses. Rarely, swollen lymph nodes are caused by cancer. From shaving the groin with razor or plug the hair out. same with the armpit lymph nodes.,the result will be reactive lymph nodes as above . Your lymph nodes, also called lymph glands, play a vital role in your body’s ability to fight off infections. They function as filters, trapping viruses, bacteria and other causes of illnesses before they can infect other parts of your body. Common areas where you might notice swollen lymph nodes include your neck, under your chin, in your armpits and in your groin. In some cases, the passage of time and warm compresses may be all you need to treat swollen lymph nodes. If an infection causes swollen lymph nodes, treatment depends on the cause.

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credit to steve ramsey

Fibroma and giant-cell tumor (GCT) of the tendon sheath are lesions that occur typically in the extremities and belong to a heterogeneous group of fibrohistiocytic lesions. These lesions present similar clinical and histological features; however, researchers describe different views on the origin of these two entities.

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credit to steve ramsey

According to some authors, they may correspond to different stages of the same pathologic process, and others suggest that the fibroma and GCT are distinct tumors.

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credit to steve ramsey

a patient presenting a benign fibrohistiocytic hemosiderotic lesion that demonstrated transitional morphological characteristics between the GCT and fibroma of the tendon sheath. 

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credit to steve ramsey

Flexor Carpi Ulnaris Tendonitis is inflammation of the wrist flexor tendon at the pinky side of the wrist. It is common for patients to experience inflammation in their tendons, which can lead to tightness and pain when the tendon is subjected to excessive tension. FCU tendinitis originates within the tendon itself, but it may occur at the musculotendinous junction, or in the muscle. The flexor carpi ulnaris reaches from your elbow to the pinky side of your wrist, and it is mostly used when flexing your wrist. This condition is known to cause pain and discomfort, especially when flexing or rotating the wrist. It’s not uncommon for flexing your fingers or even holding cups of coffee to become painful activities if you have flexor carpi ulnaris tendonitis .

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credit to steve ramsey

Soft tissue tumors involving the hand are common and most often benign. It is important to know the spectrum of soft tissue tumors of the hand and understand the typical as well as atypical imaging features are seen on different imaging modalities . The second most common hand tumor is a giant cell tumor of tendon sheath. Unlike the fluid-filled ganglion cyst, these tumors are solid masses. They can occur anywhere there is a nearby tendon sheath. They are benign, slow-growing masses that spread through the soft tissue underneath the skin. Some believe that they may be caused by trauma that stimulates the tendon sheath to start growing abnormally. They are not cancer. 

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credit to steve ramsey

Gynecomastia is an enlargement or swelling of breast tissue in males. It is most commonly caused by male estrogen levels that are too high or are out of balance with testosterone levels. It is an Enlarged Male Breast Tissue (Gynecomastia). Gynecomastia) is an increase in the amount of breast gland tissue in boys or men, caused by an imbalance of the hormones estrogen and testosterone.

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Gynecomastia can affect one or both breasts, sometimes unevenly. Newborns, boys going through puberty and older men may develop Gynecomastia as a result of normal changes in hormone levels, though other causes also exist. Generally, Gynecomastia isn’t a serious problem, but it can be tough to cope with the condition. Men and boys with Gynecomastia sometimes have pain in their breasts and may feel embarrassed.

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An engaging Hill-Sachs lesion is a humeral head defect that the glenoid rim falls into with the shoulder in a functional position and leads to symptoms of recurrent instability. Whether any Hill-Sachs lesion engages, however, must be determined by both the orientation and the size of the defect.

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credit to steve ramsey

A Hill-Sachs defect is a poster lateral humeral head depression fracture, resulting from the impaction with the anterior glenoid rim, therefore indicative of an anterior glenohumeral dislocation. It is often associated with a Bankart lesion of the glenoid. A Hill-Sachs defect is the terminology of preference over other terms, such as Hill-Sachs lesions, and Hill-Sachs fractures 14.  Repeat dislocations lead to larger defects, which can result in an “engaging” Hill-Sachs defect , which engages the anterior glenoid when the shoulder is abducted and externally rotated .

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When the pectoralis muscle ruptures, you will have sudden severe pain and a tearing sensation in the chest. You may also have pain in the upper arm, weakness, bruising, and a dimpling, or pocket formation above the armpit. Initial treatment includes application of ice and immobilization of the shoulder, arm and chest.

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Duodenal atresia results from a congenital malformation of the DUODENUM and requires prompt correction in the neonatal period. It is considered to be one of the commonest causes of a FETAL BOWEL OBSTRUCTION . The prevalence of duodenal atresia is ~1 in 5,000-10,000 newborns, and there is no sex-associated difference in prevalence.

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An anal, or rectal, abscess occurs when a cavity in the anus becomes filled with pus. It causes extreme pain, fatigue, rectal discharge, and fever. In some cases, anal abscesses can result in painful anal fistulas. This occurs when the abscess doesn’t heal and breaks open on the surface of the skin. If the abscess or a cyst at the distal posts sacrum area it could be anal pilonidal sinus is a very rare condition in clinical practice. When diagnosed, abscesses such as perianal abscess should be drained and the cavity should be cleaned by a doctor.

Thank you for reading

Steve Ramsey, PhD. Okotoks , Alberta – Canada

For many other articles ,please visit my blog at www.moleopedia.com

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