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1) Tear of Medial Cruciate
Ligament
2) Epidermoid cyst
3) Sebaceous cyst with leak
4)
Ultrasound image of transient synovitis of hip joint in a child
5) Ultrasound image of
olecranon bursitis
6) Ultrasound images of
inguinal hernia
7)
Sonography and Color Doppler imaging of Hemangioma in infant
8)
Hypertrophy of the Abductor Hallucis muscle of the foot
9) Rib fracture
10) Fracture radius with
hematoma formation
11)
Intracranial mass/ Intracranial dermoid or epidermoid
12) Baker cyst
13) Rupture
of the Achilles Tendon or Tendo achilles tear
14) Bicipital tendonitis
or Biceps tendonitis
15) Glomus tumor
16)
Jersey finger or rupture of the tendon of the flexor digitorum profundus muscle
17) Full thickness
tear of supraspinatus tendon
18) Myositis ossificans
19) Suprapatellar
effusion (suprapatellar hematoma)
20)
Tuberculous lymph node enlargement (tuberculous lymphadenitis)
These are ultrasound images of the right knee joint following a motorcycle
accident. There is a curvilinear echogenic structure within the medial part of
the right knee joint cavity. Diagnosis: traumatic rupture of the distal
insertion of the medial cruciate ligament, which now floats within the fluid
distended (possible hemorrhagic) joint space. Images courtesy of Mr. Shlomo
Gobi, Israel.
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Sonography of a mass on the dorsal part of the chest was done to study a mass
of 2.5 cms. Images reveal a hypoechoic mass of inhomogenous appearance measuring
2.5 x 1.3 cms. It is cutaneous in location and shows no vascularity within on
color doppler imaging (image on right). No calcification is seen. These
ultrasound images suggest a diagnosis of epidermoid cyst or what was often
called a sebaceous cyst. Images by Dr. Joe Antony, Cochin, India, using Toshiba, Nemio XG color doppler
machine.
Reference: E-medicine
article on epidermoid cyst (free article).. rated excellent
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This patient has a large sebaceous cyst seen in the ultrasound images above
as an inhomogeneous hypoechoic mass in the skin. But more importantly, the right
of the image shows an extravasation of the keratinous material from the
epidermoid cyst, into the surrounding subcutaneous tissue. Keratin being highly
irritative to the subcutaneous tissue can provoke a strong inflammatory response
and even result in abscess formation. Ultrasound images are courtesy of Dr. Ravi
Kadasne, MD, UAE.
Sonography of the hip joints was done in this 5 yr. old child to c/o pain and
swelling in the right hip. Ultrasound images show anechoic fluid collection
around the right hip diagnostic of synovitis. The synovial fluid collection here
measures 3 x 0.8 cms. The normal left hip joint is also shown for comparison.
Ultrasound images courtesy of Dr. Ravi Kadasne, who used a Philips iU 22
machine.
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This patient had pain and swelling of the left elbow. Sonography of the elbow
shows a cystic lesion containing clear fluid over the tip of the elbow. The
lesion is located between the skin and the underlying olecranon process of the
left ulna. This ultrasound image is diagnostic of olecranon bursitis. Image
courtesy of Dr. Ravi Kadasne, UAE. The machine used here is the Philips IU 22.
Reference: 1)
http://www.jultrasoundmed.org/cgi/content/full/26/6/857 (free article and
images).
2)
http://www.emedicine.com/pmr/TOPIC91.HTM (free article).
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These ultrasound images show echogenic, linear/ tubular structures
(intestine) within the left scrotal sac, just above the left testes, extending
to the left inguinal canal s/o left inguinal hernia. (Images taken using a
Philips iU 22 Ultrasound machine, by Dr. Ravi Kadasne, MD, UAE.
Reference:
http://www.medscape.com/viewarticle/527887_8 (free article).
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An infant present with a large reddish patch in the right lumbar region.
Ultrasound image (left) shows a hyperechoic lesion of about 2.3 cms.
in the subcutaneous layer. Color Doppler image (right) shows the lesion to be
markedly vascular. These ultrasound and color Doppler images are diagnostic of
Hemangioma, possibly cavernous type. Images courtesy of Dr. Ravi Kadasne, UAE.
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Ultrasound images showing hypertrophied muscle on medial part of plantar
aspect of the foot:
This patient presented with persistent pain in the sole of the Rt. foot.
Sonography of the plantar aspect of the right foot showed markedly thickened
muscle along the medial aspect of the plantar region. The left foot was also
imaged and showed the normal Abductor Hallucis muscle. It was concluded that the
ultrasound images (above) showed a hypertrophy of the right abductor Hallucis
muscle. The right abductor Hallucis showed a thickness of 2.1 cms. while the
normal left side showed a thickness of about 0.7 cms. Ultrasound images are
courtesy of Dr. Ravi Kadasne, MD, UAE.
Reference:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2565658/ (free article and
images)
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Ultrasound image of rib fracture:
This patient had a history of trauma to the chest. Sonography of the thorax
(chest) showed a breach in continuity of the rib shown above (arrow). 3-D
ultrasound image (image on right) shows fracture of the rib with small hematoma
collecting anterior to the fracture site. The hematoma is seen as an anechoic
collection. High resolution sonography/ ultrasound is now increasingly being
used in imaging the skeletal system, especially when in a superficial location.
Ultrasound images are taken using Philips IU22 system and are courtesy of Dr.
Ravi Kadasne, MD, UAE.
Reference:
http://www.ajronline.org/cgi/reprint/173/6/1603 (free article and images)
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This X-ray of the wrist and forearm shows a fracture of the distal end of
radius. Ultrasound image on right shows large hyperechoic collection
(arrowheads) anterior to the fracture site. X-ray image also shows the soft
tissue swelling caused by hematoma (blue arrows). This child had a history of
bleeding disorder. Images courtesy of Ravi Kadasne, MD, UAE.
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Dermoid mass or CNS Dermoid:
This middle aged female patient presented with a mass in the parieto-occipital
region. Sonography of the skull was done to image the mass which was close to
the midline. Ultrasound images show a mass of mixed echogenicity with both solid
and cystic components within the cranial vault (intracranial region), which has
eroded the cranial vault to bulge outward. Particulate matter was seen floating
the fluid component of the mass. The cerebral hemishperes appear to be
compressed upon by the mass (M) via the dura mater. The meninges appear to be
preserved though displaced inward by the mass. Color Doppler image (top row-
left) suggests poor vascularity of the intracranial mass. These ultrasound and
Color Doppler images suggest a dermoid tumour inside the cranium (CNS dermoid).
Dermoids are known to occur in such locations though, are rare. The other
diffferential diagnoses are meningioma and epidermoid cyst. But the midline
location favors a diagnosis of dermoid cyst. Ultrasound images are courtesy of
Dr. Ravi Kadasne, UAE.
Reference:
http://emedicine.medscape.com/article/339797-imaging (free article and
images).
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Large cystic lesion in left popliteal fossa:
This middle aged female patient presented with a large mass in the left
popliteal region which was seen on extension of the knee joint. Ultrasound
images of the popliteal fossa show a large cystic mass of 5.7 x 2.8 cms. with
few echogenic particles within a primarily clear fluid. The cyst is in close
relation to the left knee joint; however, these images did not reveal clear
communication with the synovial space of the knee joint. The popliteal artery
was visualized on Color Doppler imaging, and was clearly separate from the cyst,
ruling out the possibility of aneurysm of this vessel. Final diagnosis: Baker
cyst (also called Baker's cyst).
Reference:
http://emedicine.medscape.com/article/387399-overview
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This patient had severe pain in the lower calf. Ultrasound examination of the
tendo-achilles showed a full thickness tear of the Achilles tendon. This is seen
as the linear anechoic area extending through the tendon (long section
ultrasound images of Achilles tendon). Transverse section (image on top left)
shows fluid and blood around the tendon, seen as anechoic area. All above images
are courtesy of Shlomo Gobi, Israel.
Reference:
http://emedicine.medscape.com/article/85024-overview
http://www.emedicinehealth.com/achilles_tendon_rupture/article_em.htm
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Axial section:
Long section:
Axial section:
Long section:
This patient presented with pain and tenderness in the left shoulder.
Ultrasound images show the tendon of the long head of biceps which is thickened
and nodular due to inflammation with surrounding fluid (anechoic space around
the tendon). These findings suggest biceps tendonitis. The axial section
ultrasound images show considerable fluid within the bicipital groove. Images
courtesy of Shlomo Gobi, Israel.
References:
http://emedicine.medscape.com/article/96521-diagnosis
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14) Glomus tumor (subungual location):
The fourth finger of this patient shows a subungual soft tissue mass (between
the fingernail and the distal phalanx). This mass appears very vascular on color
Doppler ultrasound imaging. Transverse and longitudinal ultrasound/ Color
Doppler images show the vascular mass very clearly, increasing the width between
the nail and the underlying phalangeal bone. These findings are typical of
glomus tumor of the finger. The normal 3rd finger (distal part) is shown for
comparison. Glomus tumor is a vascular mass arising from the glomus body, a
nervous tissue nodule, that is important to sense temperature. The glomus tumor
commons occurs in the tips of the first 4 fingers, usually in the subungual
location as described above. All above images are courtesy of Shlomo Gobi, Israel.
Reference:
Ultrasound imaging of glomus tumor (good article and images).
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This young boy suffered a sports injury to the 4th finger whilst playing
basketball. The result was inability to flex the distal phalanx of the 4th
finger of the right hand. The snap of the boy's right hand shows the affected
4th finger. The ultrasound images of the 4th finger show the rupture or avulsion
of the tendon of the flexor digitorum profundus muscle just at the site of its
insertion into the palmar aspect of the distal phalanx. This condition is called
a Jersey finger and is the result of acute injury to the distal phalanx
resulting in sudden forced extension of the affected finger (distal phalanx)
when the finger was in a flexed condition. The picture in lower right shows the
normal anatomy of the finger.( FDP= flexor digitorum profundus tendon; DP=
distal phalanx. PIP= proximal interphalangeal joint; DIP= distal interphalngeal
joint).(Ultrasound images and case study of Jersey finger are courtesy of Shlomo
Gobi, Israel).
Reference:
http://en.wikipedia.org/wiki/Jersey_Finger
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This patient had severe pain in the shoulder. Sonography of the shoulder was
done. Ultrasound images show anechoic region within the supraspinatus tendon,
just above the shoulder joint. The anechoic region extends through the full
thickness of the supraspinatus tendon. This appearance is typical of full
thickness supraspinatus tear. Ultrasound images of supraspinatus tear are
courtesy of Mr. Shlomo Gobi, Israel. (SDB= subdeltoid bursa; SS= supraspinatus
muscle).
Reference:
http://emedicine.medscape.com/article/401595-overview
http://www.ajronline.org/cgi/reprint/184/1/180.pdf
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Long section- left hamstring muscles
Transverse section:
Long section: myositis ossificans
Long section- left hamstring
Zoomed in view of myositis ossificans
Color Doppler - myositis ossificans
This patient had a blunt injury to the posterior part of left thigh. There
was persistent pain and tenderness in this region for a few months. Ultrasound
images of the left hamstrings show multiple calcific, echogenic lesions in the
region, within the muscles. There is posterior acoustic shadowing behind the
lesions which totally measure 4.8 cms. in length. These ultrasound findings are
diagnostic of myositis ossificans of the left hamstrings. Myositis ossificans is
the formation of bone within a long standing hematoma in the soft tissues,
usually the result of trauma. Certain individuals are genetically susceptible to
the formation of bone (ossification) of a hematoma. Color Doppler did not reveal
any vascular changes in this lesion. Ultrasound images of myositis ossificans
are courtesy of Mr. Shlomo Gobi, Israel.
References:
http://orthopedics.about.com/od/sportsinjuries/g/myositis.htm
http://www.nejm.org/doi/full/10.1056/NEJMicm1005605
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This child had a knee injury following which he had swelling and pain around
the knee joint. He underwent sonography which showed a large collection of
echogenic fluid (H) in the suprapatellar region; this collection measured 3 x 3
cms. with poor communication with the right knee joint synovial cavity. Knee
injuries frequently result in the formation of hemorrhagic effusions which may
extend into the suprapatellar bursa. In most cases, the suprapatellar bursa
communicates freely with the synovial cavity of the knee joint. In a minority of
patients, the suprapatellar bursa is separate from the knee joint resulting in
loculation of fluid following trauma. These ultrasound images suggest
suprapatellar hemaotma (H) or hemorrhagic effusion. The hematoma (H= hemorrhagic
effusion) is seen deep to the quadriceps tendon and just above the patella,
superficial to the distal end of femur. Ultrasound images are courtesy of Dr.
Ravi Kadasne, MD, UAE.
References:
http://www.ajronline.org/cgi/reprint/175/5/1313.pdf (free article and
images).
Imaging of bursae (clinical imaging science)
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Case-1: Enlarged submental and middle cervical lymph nodes:
The above color Doppler and B mode ultrasound images show multiple (three in
number) enlarged submental lymph nodes in a child. The nodes appear rounded and
are in close relation (attached or matted) to each other. The lymph nodes are
markedly hypoechoic and show peripheral vascularity on color Doppler ultrasound.
In addition, these nodes also show echogenic margins. These ultrasound findings
favor a diagnosis of tuberculous lymphadenitis. In addition this child also had
enlarged middle group of deep cervical lymph nodes (see ultrasound and color/
Power Doppler images below):
 
These sonographic images show 2 markedly enlarged lymph nodes with poor
vascularity and cystic changes within them. These findings are seen mainly in
tuberculous lymphadenitis and occasionally in metastases to lymph nodes. Very
often, it may not be possible to accurately distinguish the main differential
diagnoses of lymph node enlargement- ie: tuberculosis, lymphoma and
metastases. It is here that clinical history and symptoms can help to
diagnose the cause. In such cases biopsy of the lymph node may be indicated. The
snap of the child's neck shows the swelling in the left lateral region anterior
to the sternomastoid muscle. In this case, the diagnosis based on these
ultrasound images was tuberculous lympadenitis.
References:
http://www.jultrasoundmed.org/content/20/5/533.full.pdf+html (free article
on sonographic differentiation of lymphadenitis)
http://www.droid.cuhk.edu.hk/web/specials/lymph_nodes/lymph_nodes.htm#conclusion
(excellent free article on cervical lymph node enlargement and sonographic
diagnosis)
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