Diagnostic ultrasound ( PDFDrive )

862 PART III Small Parts, Carotid Artery, and Peripheral Vessel Sonography
A
B
FIG. 23.10 Partial Tear of the Distal Achilles Tendon. (A) There is focal anechoic clefting of the anterior ibers of the Achilles distal insertion
(arrows) although the posterior ibers remain intact. (B) Color Doppler imaging in the same patient demonstrates marked hyperemia in the injured
tendon.
FIG. 23.11 Achilles Tendon Rupture. A panoramic view of the Achilles tendon demonstrates a rupture within the midportion of the tendon.
The proximal aspect of the tendon is chronically thickened and hypoechoic (arrows). Refraction artifact (arrowheads) is caused by the interfaces
between the ruptured tendon edges and hemorrhage. C, Calcaneus.
A
B
FIG. 23.12 Tenosynovitis. In this patient with rheumatoid arthritis and ankle pain, the peroneus brevis tendon (*) in long-axis (A) and short-axis
(B) views is thickened and heterogeneous. The tendon sheath contains a large amount of echogenic synovium (arrows), hypoechoic luid, and
hyperemia on color Doppler imaging.
as an increase of luid volume around a tendon within its sheath
(Fig. 23.12). he tendon sheath itself can thicken and demonstrate
hypervascularity on Doppler evaluation. 24 In patients with imaging
indings of tenosynovitis and a history of penetrating injury or
foreign body, septic tenosynovitis should be considered. 25
LIGAMENTS
Ultrasound is an excellent technique for the evaluation of ligamentous
injuries, with some advantages over MRI in this regard.
Ultrasound permits high-resolution imaging of small ligaments