Superficial structures: Breast, abdominal wall, and musculoskeletal sonography
protrusion of peritoneal contents through a defect in the abdominal wall.
attaches the gastrocnemius and soleus muscles.
smallest functional unit of the breast.
hypoechoic sonographic artifact caused when the ultrasound beam is not perpendicular to the fibrillar structure of a tendon.
a synovial cyst adjacent and posterior to the knee joint.
determines if hip can be dislocated. Hip is flexed and the thigh adducted while gently placing posterior pressure on the femoral head.
a fibrous sac found between the tendon and bone; lined with a synovial membrane and secretes synovial fluid; facilitates movement of the musculoskeletal structures.
strands of connective tissue serving as a support structure of the breast; provides shape and consistency to the breast parenchyma.
Development Displacement of the Hip (DDH)
preferred term to describe the abnormal relationship of the femoral head to the acetabulum; a congenital or acquired deformation or misalignment of the hip joint.
a small filamentous fiber that is often a component of a cell.
the presence of a single or multiple palpable cysts in the breast.
a cyst caused by obstruction of a lactating duct.
small tumor or fluid collection that can occur at the connection of any tendon
an abnormal enlargement of a male breast or breasts.
one of many channels that carry milk for the lobes of each breast to the nipple.
an area of enlargement in a lactiferous duct near the areola.
a flexible band of fibrous tissue binding joints together; provides flexibility to a joint.
a midline tendon of the anterior abdominal wall extending from the xiphoid process to the symphysis pubis.
a collection of lobules within the breast parenchyma; approximately 15 to 20 lobes per breast.
the simplest functional unit of the breast.
breast parenchyma lying within the superficial fascia.
a nonneoplastic fusiform enlargement of a digital branch of the medial or lateral plantar nerves.
tissue composed of fibers and cells that are able to contract, causing movement of the body parts or organs.
consists of all the muscles, bones, joints, ligaments, and tendons that function in the movement of the body and organs.
relocates the femoral head within the acetabulum. Hip is flexed and abducted while gently pulling anteriorly. Demonstrates whether the dislocated hip is reducible.
one of a pair of anterolateral abdominal wall muscles located lateral to the linea alba.
located between the posterior margin of the mammary zone and the pectoralis muscles.
a painful wrenching or laceration of the ligaments of a joint.
to injure or impair by overuse or overexertion; wrench.
double-walled tubular structures surrounding some tendons.
bands of dense, fibrous connective tissue that attach muscle to bone.
term used to describe degenerative changes in a tendon without signs of tendon inflammation; associated with overuse injuries.
terminal ductal lobular unit (TDLU)
small lobular unit formed by the acini and the terminal ducts.
a test used to evaluate the integrity of the Achilles tendon where the toes are pointing down while squeezing the calf.
The breast
Sonographic appearance of the breast
• Skin line appears hyperechoic.
• Superficial and deep fascial planes appear hyperechoic.
• Glandular breast parenchyma appears moderately hyperechoic.
• Fat breast lobules should demonstrate a medium-gray echo pattern.
• Retromammary layer appears hypoechoic.
• Pectoralis muscles appear moderately hyperechoic.
• Cooper ligaments appear as hyperechoic linear structures; may demonstrate posterior acoustic shadowing.
• Lactiferous ducts appear as nonvascular, anechoic tubular structures coursing toward the nipple.
Technique
Examination technique and image optimization
• 7.5-MHz or higher linear transducer to obtain optimal resolution for penetration depth.
• Proper image depth with focal zone(s) at or below the place of interest.
• Gain settings demonstrating breast fat as a medium shade of gray and a simple cyst as an anechoic mass.
• Increase in dynamic range setting.
• Sufficient imaging depth to visualize structures immediately posterior to the region of interest.
• Harmonic imaging can be used to reduce artifactual echoes within anechoic structures.
• Spatial compounding can be used to improve visualization of structures posterior to a highly attenuating structure.
• Proper Doppler controls for low-flow velocity (pulse repetition frequency [PRF], gain, wall filters).
• Patient is generally placed in a right or left posterior oblique position.
• Standoff pad should not exceed 1.0 cm in thickness.
• Evaluation and documentation of breast parenchyma in two imaging planes, remaining perpendicular to the chest wall.
• Proper annotation of the image location and scanning plane.
• Images are generally labeled by quadrant and/or the face of a clock.
• Distance from the nipple is described as 1, 2, or 3 (1 is closest to nipple).
• Depth of the area of interest is described as A, B, or C (C is closest to the chest wall).
• Documentation and measurement of any abnormality in two scanning planes should be included.
• Color Doppler imaging to evaluate abnormalities for internal and peripheral flow.
Indications for a breast examination
• Evaluate mass from a previous medical imaging study (i.e., mammogram).
• Ultrasound-guided interventional procedure.
• Evaluate male breast parenchyma.
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| PATHOLOGY FINDINGS | ETIOLOGY | CLINICAL FINDINGS | SONOGRAPHIC FINDINGS | DIFFERENTIAL CONSIDERATIONS |
| Cyst | Obstruction of a ductInfectionCommon around 35-50 yrs of age | AsymptomaticBreast pain or tendernessPalpable mass | Anechoic round or oval massSmooth, thin wall marginsPosterior acoustic enhancementNo internal vascular flowCompresses with transducer pressureMass does not breach fascial plane(s)May demonstrate internal echoes | Lactiferous ductFibroadenomaCarcinoma |
| Cystosarcoma phyllodes | Uncommon benign fibroepithelial neoplasmMay undergo malignant transformation | Sudden onset of a palpable nontender breast massMobile mass | Oval mass demonstrating a low- to medium-level echo patternUnilateral massMay demonstrate cystic spaces within the massSmooth wall marginsWidth of mass is larger than the heightMass does not breach fascial plane(s)Internal blood flow may be demonstrated | Complex cystFibroadenomaCarcinomaNormal breast fat |
| Fibroadenoma | Tumor composed of dense epithelial and fibroblastic tissueInfluenced by estrogen levels | AsymptomaticPalpable nontender breast massMobile massFirm or rubbery on palpation | Solid oval-shaped breast massLow- to medium-level echo patternPosterior acoustic enhancementMass does not breach the fascial planeWidth of mass is larger than the heightCan degenerate or calcifyInternal blood flow may be demonstrated | Complex cystNormal breast fatCarcinoma |
| Fibrocystic disease | Presence of palpable breast cyst(s)Not generally associated with future development of breast carcinoma | Painful or tender breasts frequently 7-10 days before the start of mensesIncrease in pain intensity closer to the start of menses | Hyperechoic breast parenchymaDense breast tissueProminent ductsNumerous breast cysts | Multiple breast cystsMastitis |
| Hamartoma | Proliferation of normal tissues | AsymptomaticPalpable mass | Heterogeneous complex massSmooth wall marginsMay demonstrate posterior acoustic shadowingMass does not breach fascial plane(s)Mass compresses with moderate transducer pressure | Complex cystCarcinomaFibroadenoma |
| Galactocele | Obstruction of a lactating duct | Palpable retroareolar mass | Round or oval hypoechoic retroareolar massSmooth wall marginsPosterior acoustic enhancement | FibroadenomaComplex cystAbscess |
| Gynecomastia | Abnormal proliferation of ductal, glandular tissue, and stromaIncreased amount of subcutaneous fatHormone disordersEndocrine disordersNeoplasms | Abnormal enlargement of the male breast(s)Painful or tender breast(s) | Hypoechoic to hyperechoic tissue beneath the areolaDucts converging toward the areolaIncreased amount of breast fatUnilateral or bilateral | NeoplasmMastitis |
| Lipoma | Mature adipose tissue | Soft, mobile mass | Homogeneous hyperechoic mass within the subcutaneous fatOval in shapeSmooth wall marginsMay appear similar to breast fat | Glandular breast tissueFibroadenomaComplex cyst |
| Mastitis |