ULTRASOUND OF THE KNEE
Pathology Flash Cards
Emma Kan
1. IDENTIFY AND NAME THE PATHOLOGY
A
E
D
C
B
Gilani, 2010; available http://www.aiumcommunities.org/
• Identify the structures
indicated.
1. ANSWER: JOINT EFFUSION – FLUID WITHIN
THE SUPRAPATELLAR RECESS
A
A
B
D
D
•
The effusion must be
assessed for homogeneity
and loose intraarticular
bodies, and the
suprapatellar plica must be
noted if present1-2.
•
Anechoic fluid collections
often indicate acute
pathological processes while
hyperechoic effusion may be
a result of haemorrhage or
debris1-2.
E
E
C
C
B
Image 1. Anechoic fluid collection within the suprapatellar recess.
(Gilani, 2010; http://www.aiumcommunities.org/photo/knee-joint-effusion)
Structures: A. Quadriceps femoris tendon. B. Prefemoral fat pad. C. Anechoic joint effusion
within the suprapatellar recess. D. Suprapatellar fat pad. E. Patella.
2. NAME THE ABNORMALITY INDICATED BY THE
ARROW
• Identify the
structures indicated
B
A
(Geertsma, 2015; http://www.ultrasoundcases.info/Slide-View.aspx?cat=387&case=1659)
2. ANSWER: SYNOVIAL THICKENING IN THE
SUPRAPATELLAR RECESS
• The epiphyseal growth
plate of the distal femur
is indicated by the red
arrow.
B
A
Image 2. Synovial thickening within the
suprapatellar recess (yellow arrow).
(Geertsma, 2015; http://www.ultrasoundcases.info/Slide-View.aspx?cat=387&case=1659)
Structures: A. Distal
femoral shaft. B. Distal
femoral epiphysis.
3. IDENTIFY AND NAME THE PATHOLOGY
INDICATED BY THE ARROW
A
C
B
(Geertsma, 2015; http://www.ultrasoundcases.info/Slide-View.aspx?cat=387&case=2610)
• Identify the
structures
indicated
3. ANSWER: LIPOHAEMARTHROSIS
•
A
C
B
Observe the blood/fat
interface within the
suprapatellar recess
(arrow) indicating cortical
breach. In this case,
tibial plateau fracture.
Structures: A. Quadriceps
tendon. B. Patella. C.
Suprapatellar fat pad.
Image 3. Lipohaemarthrosis.
(Geertsma, 2015; http://www.ultrasoundcases.info/Slide-View.aspx?cat=387&case=2610)
4. IDENTIFY AND NAME THE PATHOLOGY
INDICATED BY THE ARROW
(Geertsma, 2015; http://www.ultrasoundcases.info/Slide-View.aspx?cat=394&case=4503)
4. ANSWER: PARTIAL TEAR OF DISTAL
QUADRICEPS TENDON
Image 4. Partial tear of the distal quadriceps femoris tendon
(yellow arrow).
(Geertsma, 2015; http://www.ultrasoundcases.info/Slide-View.aspx?cat=394&case=4503)
•
Rupture of the
superficial component
of the quadriceps
tendon (yellow arrow)
results in a hypoechoic
defect and
discontinuity in tendon
fibres3.
•
Deeper fibres appear
in tact and continuous
(red arrow).
•
Partial flexion of the
knee may assist in
demonstrating the
extent of the partial
tear4.
5. IDENTIFY AND NAME THE PATHOLOGY
• Identify the
structures
indicated
A
B
C
(Geertsma, 2015; http://www.ultrasoundcases.info/Slide-View.aspx?cat=388&case=1709)
5. ANSWER: PREPATELLAR BURSITIS
A
B
C
Image 5. Prepatellar Bursitis.
(Geertsma, 2015; http://www.ultrasoundcases.info/Slide-View.aspx?cat=388&case=1709)
•
Thickening of the prepatellar bursa with intrabursal fluid is seen anterior to the patella and
patella tendon (arrow).
•
Use light pressure to avoid displacing fluid 4.
Structures: A. Patella. B. Patellar
tendon. C. Tibial tuberosity.
6. IDENTIFY AND NAME THE PATHOLOGY
Proximal Tibia
(Geertsma, 2015; http://www.ultrasoundcases.info/Slide-View.aspx?cat=395&case=3873)
(Geertsma, 2015; http://www.ultrasoundcases.info/SlideView.aspx?cat=395&case=3873)
6. ANSWER: DISTAL PATELLAR TENDINOSIS
•
The distal patellar tendon appears
extremely thickened and hypoechoic with
loss of fibrillar echotexture 4 (yellow arrows).
•
There is a small amount of fluid within the
deep infrapatellar bursa likely representing
peri-tendinous fluid1 (red arrow).
Image 6. Tendinosis of the distal patellar tendon.
(Geertsma, 2015; http://www.ultrasoundcases.info/SlideView.aspx?cat=395&case=3873)
• Characteristic neovascularity may be
observed4 (right). Chronic tendinosis may
demonstrate calcifications, nodularity and
heterogenous scarring1.
Image 7. Neovascularity within the distal
patellar tendon. (Geertsma, 2015;
http://www.ultrasoundcases.info/Slide-View.aspx?cat=395&case=3873)
7. IDENTIFY AND NAME THE PATHOLOGY
INDICATED BY THE YELLOW ARROW
Proximal tibia
Medial femoral
condyle
(Geertsma, 2015; http://www.ultrasoundcases.info/Slide-View.aspx?cat=391&case=2746)
7. ANSWER: PARTIAL RUPTURE OF THE DISTAL MCL
Image 8. Partial tear of the deep part of the distal medial
collateral ligament.
(Geertsma, 2015; http://www.ultrasoundcases.info/Slide-View.aspx?cat=391&case=2746)
•
Observe the hypoechoic
defect with loss of normal
fibrillar pattern (green
dotted line) indicating
rupture of the deep layer of
the distal MCL 4. The
superficial layer is intact
(red arrow).
•
Chronic lesions may cause
the MCL to appear
thickened, heterogenous
and hyperechoic due to
scarring4.
8. IDENTIFY AND NAME THE PATHOLOGY
(Wildman, 2014; https://theultrasoundsite.co.uk/)
8. ANSWER: LATERAL MENISCAL CYST
Image 9. Lateral meniscal cyst seen at the lateral margin of the
knee joint. (Wildman, 2014; https://theultrasoundsite.co.uk/lateral-meniscal-cyst/)
•
Note the cystic lesion
immediately superficial
to the echogenic
lateral meniscus
(white dotted line).
•
Meniscal cysts most
commonly occur at the
lateral meniscus and
are often associated
with meniscal tears 4.
9. IDENTIFY AND NAME THIS PATHOLOGY OF
THE POSTERIOR KNEE
(Radiopaedia, 2015; http://radiopaedia.org)
9. ANSWER: BAKER’S CYST
Image 10. Baker’s cyst.
(Radiopaedia, 2015; http://radiopaedia.org/cases/baker-cyst-aspiration)
•
Fluid can be seen distending the
gastrocnemius-semimembranosus
bursa forming a Baker’s cyst (yellow
arrows).
•
The neck is clearly visible tracking
from the joint (blue arrow) between
the medial head of the gastrocnemius
muscle (X) and the
semimembranosus tendon (red
arrow)4.
•
Note the hyperechoic debris within
the cyst.
•
In longitudinal section, the cyst should
appear to have rounded margins. If
the inferior margins appear angular
and pointed, rupture may be
suspected3.
10. IDENTIFY AND NAME THE PATHOLOGY
INDICATED BY THE ARROW
Tibial tuberosity
(Geertsma, 2015; http://www.ultrasoundcases.info/Slide-View.aspx?cat=510&case=1706)
10. ANSWER: OSGOOD-SCHLATTER DISEASE
Image 11. Osgood-Schlatter disease in an infant.
(Geertsma, 2015; http://www.ultrasoundcases.info/Slide-View.aspx?cat=510&case=1706)
•
Osgood Schlatter disease
demonstrated by cartilage
swelling and
fragmentation (yellow
arrow) at the tibial
tuberosity.
•
The distal patellar tendon
also appears hypoechoic
and there is an effusion of
the deep infrapatellar
bursa (red arrow).
REFERENCES
1. Friedman, L., K. Finlay and E. Jurrians. 2001. “Ultrasound of the Knee”. Skeletal Radiology.
30:361-377
2. Court-Payen, Michel. 2004. “Sonography of the Knee: Intra-articular Pathology”. Journal of
Clinical Ultrasound. 32:481-490
3. Bianchi, Stefano and Carlos Martinoli. 2007. Ultrasound of the Musculoskeletal System.
Berlin: Springer.
4. Paczesny Lukasz and Jacek Kruczynski. 2011. “Ultrasound of the Knee”. Seminars in
Ultrasound, CT and MRI. 32:114-124
IMAGES
1.
Gilani, Syed. 2010. Knee joint effusion. American Institute of Ultrasound in Medicine. Available at
http://www.aiumcommunities.org/photo/knee-joint-effusion
2.
Geertsma, T.S.A. 2015. Effusion in the suprapatellar recess with synovial thickening in a child. Ultrasoundcases-info. Accessed May 17.
Available: http://www.ultrasoundcases.info/Slide-View.aspx?cat=387&case=1659
3.
Geertsma, T.S.A. 2015. Lipohaemarthrosis in the superior recess in a child with a tibia fracture. Ultrasoundcases-info. Accessed May
17. Available: http://www.ultrasoundcases.info/Slide-View.aspx?cat=387&case=2610
4.
Geertsma, T.S.A. 2015. Rupture of the superficial part of the distal quadriceps tendon. Ultrasoundcases-info. Accessed May 17.
Available: http://www.ultrasoundcases.info/Slide-View.aspx?cat=394&case=4503
5.
Geertsma, T.S.A. 2015. Prepatellar bursitis with thickened fluid-filled bursa anterior to the patellar tendon. Ultrasoundcases-info.
Accessed May 17. Available: http://www.ultrasoundcases.info/Slide-View.aspx?cat=388&case=1709
6.
Geertsma, T.S.A. 2015. Tendinosis of the distal patellar tendon with a thickened hypoechoic patellar tendon with neovascularity.
Ultrasoundcases-info. Accessed May 17. Available: http://www.ultrasoundcases.info/Slide-View.aspx?cat=395&case=3873
7.
Geertsma, T.S.A. 2015. Tendinosis of the distal patellar tendon with a thickened hypoechoic patellar tendon with neovascularity.
Ultrasoundcases-info. Accessed May 17. Available: http://www.ultrasoundcases.info/Slide-View.aspx?cat=395&case=3873
8.
Geertsma, T.S.A. 2015. Partial rupture of the deep layer of the distal part of the medial collateral ligament. Ultrasoundcases-info.
Accessed May 17. Available: http://www.ultrasoundcases.info/Slide-View.aspx?cat=391&case=2746
9.
Wildman, Stuart. 2014. Lateral Meniscal Cyst. The Ultrasound Site. Accessed May 17. Available: https://theultrasoundsite.co.uk/lateralmeniscal-cyst/
10.
Stephenson, Susan. 2015. Baker’s cyst aspiration. Radiopaedia.org. Accessed May 17. Available: http://radiopaedia.org/cases/bakercyst-aspiration
11.
Geertsma, T.S.A. 2015. Osgood Schlatter on both sides with cartilage swelling and fragmentation of the apophysis. Ultrasoundcasesinfo. Accessed May 17. Available: http://www.ultrasoundcases.info/Slide-View.aspx?cat=510&case=1706