Superficial structures: Breast, abdominal wall, and musculoskeletal sonography

CHAPTER 15


Superficial structures: Breast, abdominal wall, and musculoskeletal sonography




Key terms


abdominal hernia 


protrusion of peritoneal contents through a defect in the abdominal wall.


Achilles tendon 


attaches the gastrocnemius and soleus muscles.


acini 


smallest functional unit of the breast.


anisotropy artifact 


hypoechoic sonographic artifact caused when the ultrasound beam is not perpendicular to the fibrillar structure of a tendon.


Baker cyst 


a synovial cyst adjacent and posterior to the knee joint.


Barlow maneuver 


determines if hip can be dislocated. Hip is flexed and the thigh adducted while gently placing posterior pressure on the femoral head.


bursa 


a fibrous sac found between the tendon and bone; lined with a synovial membrane and secretes synovial fluid; facilitates movement of the musculoskeletal structures.


Cooper ligament 


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.


fibril 


a small filamentous fiber that is often a component of a cell.


fibrocystic disease 


the presence of a single or multiple palpable cysts in the breast.


galactocele 


a cyst caused by obstruction of a lactating duct.


ganglion cyst 


small tumor or fluid collection that can occur at the connection of any tendon


gynecomastia 


an abnormal enlargement of a male breast or breasts.


lactiferous duct 


one of many channels that carry milk for the lobes of each breast to the nipple.


lactiferous sinus 


an area of enlargement in a lactiferous duct near the areola.


ligament 


a flexible band of fibrous tissue binding joints together; provides flexibility to a joint.


linea alba 


a midline tendon of the anterior abdominal wall extending from the xiphoid process to the symphysis pubis.


lobe 


a collection of lobules within the breast parenchyma; approximately 15 to 20 lobes per breast.


lobule 


the simplest functional unit of the breast.


mammary zone 


breast parenchyma lying within the superficial fascia.


Morton’s neuroma 


a nonneoplastic fusiform enlargement of a digital branch of the medial or lateral plantar nerves.


muscle 


tissue composed of fibers and cells that are able to contract, causing movement of the body parts or organs.


musculoskeletal system 


consists of all the muscles, bones, joints, ligaments, and tendons that function in the movement of the body and organs.


Ortolani maneuver 


relocates the femoral head within the acetabulum. Hip is flexed and abducted while gently pulling anteriorly. Demonstrates whether the dislocated hip is reducible.


rectus abdominis muscle 


one of a pair of anterolateral abdominal wall muscles located lateral to the linea alba.


retromammary zone 


located between the posterior margin of the mammary zone and the pectoralis muscles.


sprain 


a painful wrenching or laceration of the ligaments of a joint.


strain 


to injure or impair by overuse or overexertion; wrench.


synovial sheath 


double-walled tubular structures surrounding some tendons.


tendon 


bands of dense, fibrous connective tissue that attach muscle to bone.


tendinosis 


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.


Thompson test 


a test used to evaluate the integrity of the Achilles tendon where the toes are pointing down while squeezing the calf.




The breast




Breast anatomy and location (fig. 15-1)






Fibrous planes of the breast













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





Benign Breast Pathology





























































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Jun 15, 2016 | Posted by in GYNECOLOGY | Comments Off on Superficial structures: Breast, abdominal wall, and musculoskeletal sonography

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PATHOLOGY FINDINGS ETIOLOGY CLINICAL FINDINGS SONOGRAPHIC FINDINGS DIFFERENTIAL CONSIDERATIONS
Cyst Obstruction of a duct
Infection
Common around 35-50 yrs of age
Asymptomatic
Breast pain or tenderness
Palpable mass
Anechoic round or oval mass
Smooth, thin wall margins
Posterior acoustic enhancement
No internal vascular flow
Compresses with transducer pressure
Mass does not breach fascial plane(s)
May demonstrate internal echoes
Lactiferous duct
Fibroadenoma
Carcinoma
Cystosarcoma phyllodes Uncommon benign fibroepithelial neoplasm
May undergo malignant transformation
Sudden onset of a palpable nontender breast mass
Mobile mass
Oval mass demonstrating a low- to medium-level echo pattern
Unilateral mass
May demonstrate cystic spaces within the mass
Smooth wall margins
Width of mass is larger than the height
Mass does not breach fascial plane(s)
Internal blood flow may be demonstrated
Complex cyst
Fibroadenoma
Carcinoma
Normal breast fat
Fibroadenoma Tumor composed of dense epithelial and fibroblastic tissue
Influenced by estrogen levels
Asymptomatic
Palpable nontender breast mass
Mobile mass
Firm or rubbery on palpation
Solid oval-shaped breast mass
Low- to medium-level echo pattern
Posterior acoustic enhancement
Mass does not breach the fascial plane
Width of mass is larger than the height
Can degenerate or calcify
Internal blood flow may be demonstrated
Complex cyst
Normal breast fat
Carcinoma
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 menses
Increase in pain intensity closer to the start of menses
Hyperechoic breast parenchyma
Dense breast tissue
Prominent ducts
Numerous breast cysts
Multiple breast cysts
Mastitis
Hamartoma Proliferation of normal tissues Asymptomatic
Palpable mass
Heterogeneous complex mass
Smooth wall margins
May demonstrate posterior acoustic shadowing
Mass does not breach fascial plane(s)
Mass compresses with moderate transducer pressure
Complex cyst
Carcinoma
Fibroadenoma
Galactocele Obstruction of a lactating duct Palpable retroareolar mass Round or oval hypoechoic retroareolar mass
Smooth wall margins
Posterior acoustic enhancement
Fibroadenoma
Complex cyst
Abscess
Gynecomastia Abnormal proliferation of ductal, glandular tissue, and stroma
Increased amount of subcutaneous fat
Hormone disorders
Endocrine disorders
Neoplasms
Abnormal enlargement of the male breast(s)
Painful or tender breast(s)
Hypoechoic to hyperechoic tissue beneath the areola
Ducts converging toward the areola
Increased amount of breast fat
Unilateral or bilateral
Neoplasm
Mastitis
Lipoma Mature adipose tissue Soft, mobile mass Homogeneous hyperechoic mass within the subcutaneous fat
Oval in shape
Smooth wall margins
May appear similar to breast fat
Glandular breast tissue
Fibroadenoma
Complex cyst
Mastitis