Ultrasound of the Month Diagnosis Index

Case 47 Diagnosis:

Costochondral junction fracture

Discussion:
Costal cartilage fractures may be a difficult clinical diagnosis.

Radiographs are generally normal in the absence of an associated rib fracture.

While, as demonstrated, the diagnosis may be made by either CT or ultrasound imaging (as well as MRI), ultrasound is less expensive, faster, and like MRI avoids the use of radiation.

Case 46 Diagnosis:

Ganglion cyst

Discussion:
Ganglion cyst extending from the tibial tunnel into the adjacent soft tissues in the setting of prior ACL reconstruction.

MRI is the examination of choice in evaluating the integrity of the ACL in the setting of prior reconstruction and easily demonstrates the presence of ganglion cysts

Ultrasound may be used to confirm the diagnosis and more importantly to guide the safe and complete aspiration of these ganglion cysts

Ganglion cyst fluid is often extremely thick, requiring the use of larger (16-18 gauge) needles for complete aspiration

As clinically indicated, the fluid may be sent for laboratory analysis to exclude the possibility of infection.

Case 45

Diagnosis:

Complete tear of the ulnar collateral ligament of the thumb with avulsion

Discussion:
While MRI has historically been the imaging study of choice for evaluating the ulnar collateral ligament, ultrasound will often quickly make the diagnosis and should be considered when this diagnosis is suspected.

It is important that complete tears are detected early so that prompt surgical correction may be performed.

Case 44 Diagnosis:

Temporal (giant cell) arteritis.

Case 43 Diagnosis:

Full-thickness tear of the anchilles tendon.

Case 42 Diagnosis:

Lateral Ankle Sprain.

Case 41 Diagnosis:

The interval elevation of the patella and increased patella-tibial tubercle distance as consistant with patellar tendon rupture.

Case 40 Diagnosis:

Giant Cell Tumor of Tendon Sheath involving the extensor tendon of the 2nd digit of the hand, also referred to as localized nodular tenosynovitis. Pathologically, the tissue is identical to PVNS. Lesions contain histiocyte-like multinucleated cells and fibroblastic cells. Frequently, they contain hemosiderin deposits.

Case 39 Diagnosis:

Calcium hydroxyapatite deposition disease.

Case 38 Diagnosis:

Sciatic nerve stump neuroma.

Case 37 Diagnosis:

Foreign bodies.

Case 36 Diagnosis:

Paralabral cyst extending posteriorly and impinging the sciatic nerve.

Case 35 Diagnosis:

Post-traumatic seroma interposed between the medial gastrocnemius and soleus muscles following partial medial gastrocnemius tear. Ultrasound-guided seroma aspiration may allow prompt resolution of symptoms and rapid improvement in patient mobility. The use of ultrasound during these procedures allows safe and accurate needle placement and ensures complete evacuation of the fluid collection.

Case 34 Diagnosis:

Immediately following aspiration of the ganglion cyst, the patient was able to painlessly perform the ballet maneuvers and great toe flexion that had previously elicited discomfort. As clinically indicated, cortisone injection into the ganglion could also be performed at the time of the initial cyst aspiration. Due to the relatively high recurrence rate of ganglion cysts, the patient will be monitored clinically for evidence of symptom recurrence.

Case 33 Diagnosis:

Osgood-Schlatter Disease.

Case 32 Diagnosis:

Moderately differentiated mucin-secreting adenocarcinoma, consistent with a pulmonary origin. This matched the previous pathology of the patient's primary lung tumor.

Case 31 Diagnosis:

Peripheral nerve sheath tumor of the ulnar nerve.

Case 30 Diagnosis:

Congenital Muscular Torticollis.

Case 29 Diagnosis:

Based on the clinical presentation, the diagnosis of meralgia paresthetica was considered most likely. Ultrasound evaluation of the lateral femoral cutaneous nerve was requested with peri-neural anesthetic injection to confirm the diagnosis.

Case 28 Diagnosis:

Calcific tendinosis of the proximal hamstring tendons.

Case 27 Diagnosis:

Infected Olecranon Bursitis.

Case 26 Diagnosis:

Tarsal tunnel syndrome secondary to tibial nerve compression from a perineural ganglion cyst.

Treatment of choice is ultrasound-guided aspiration of the cyst with resulting nerve decompression.

Case 25 Diagnosis:

Ganglion Cyst.

Case 24 Diagnosis:

Spinoglenoid notch cyst causing denervation atrophy and fatty replacement of the infraspinatus muscle.

Case 23 Diagnosis:

Partial thickness ear of the proximal patellar tendon.

Case 22 Diagnosis:

Nodular Pigmented Villonodular Synovitis arising from the lateral tibiotalar joint.

Case 21 Diagnosis:

Myxomatous tumors of the soft tissues are a heterogeneous group of lesions, both benign and malignant, that show an overproduction of mucopolysaccharide substances. Characterized by a mixture of primitive mesenchymal cells and myxomatous stroma.

Case 20 Diagnosis:

Following the ultrasound-guided aspiration of the paralabral cyst compressing the femoral nerve, the patient experienced symptomatic relief of her femoral nerve symptoms.

Case 19 Diagnosis:

Calcific tendinosis of the long head of the rectus femoris tendon at the Anterior Inferior Iliac Spine

Case 18 Diagnosis:

Schwannoma.

Case 17 Diagnosis:

Epidermoid inclusion cyst.

Case 16 Diagnosis:

Giant cell tumor with ABC formation.

Case 15 Diagnosis:

Sindig-Larson-Johansson syndrome.

Case 14 Diagnosis:

Right rectus abdominus hypertrophy with strain common in tennis players.

Case 13 Diagnosis:

Traumatic peroneus brevis tear status post ultrasound guided PRP injection with healing response.

Case 12 Diagnosis:

Glomus tumor of the terminal tuft.

Case 11 Diagnosis:

Lateral epicondylitis with deep surface tear of extensor tendon origin/lateral collateral ligament with seroma formation.Ultrasound guided seroma aspiration and platlet rich plasma injection.

Case 10 Diagnosis:

Early Osteoarthritis with Lateral Hip Impingement.

Case 9 Diagnosis:

Scar encasement/neuroma formation about ulnar nerve.

Case 8 Diagnosis:Lateral femoral cutaneous nerve entrapment

Initial imaging shows hypoechoic scarring surrounding the nerve near the Iliac crest and Sartorius origin. Ultrasound guided perineural injection was Performed resulting in symptomatic relief.

Case 7 Diagnosis:

Linear calcification in anterior joint capsule producing anterior impingement and pain.

Case 6 Diagnosis:

Large foreign body granuloma containing multiple foreign bodies.

Case 5 Diagnosis:

De Quervain’s tendinitis/tenosynovitis.

Large tendon sheath effusion, inhomogeneity of the first dorsal compartment tendons with marked hyperemia on power Doppler imaging.

Case 4 Diagnosis:

Isolated teres minor atrophy.

  • Atrophic muscle appears echogenic and and diminutive in size
  • Normal muscle is hypoechoic on ultrasound
  • Teres minor atrophy often due to injury of the axillary nerve as it passes through the quadrilateral space

Case 3 Diagnosis:

Peroneal tenosynovitis. Ultrasound shows fluid and nodular soft tissue surrounding the peroneal tendons giving rise to the soft tissue swelling seen on radiographs.

Case 2 Diagnosis:

Osteomylitis.

Case 1 Diagnosis:

Sonographic appearances suggestive of gout. Confirmed on ultrasound guided aspiration.

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