basic soft tissue

recognising normal tissue types and layers on ultrasound is fundamental to identifying pathology.

the ultrasound image is a cross-section beginning at the probe face, extending down into the tissues below.

layers

  • in most instances, the probe is on the skin, so that is the uppermost layer of the image.
  • subcutaneous fat beneath the skin.
  • fascia separating the fat and the muscle

fat

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fat will vary in appearance relative to:

  • the surrounding tissue.
  • the ratio of adipocytes to connective tissue and extra cellular matrix.
  • there even are some cultural differences to subcutaneous fat appearance and attenuation. 

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muscle

normal muscle

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tendons

normal ultrasound appearance of tendons

  • tendons join muscle to bone.
  • if normal,  should be echogenic and fibrillar.
  • vary in length and shape.
  • very subject to anisotrophy.
  • avascular

longitudinal muscle:

  • hypoechoic (myoctes).
  • striated with echogenic lines of collagen fibres.

transverse muscle

  • non-fibrillar
  • hypoechoic
  • scattered echogenic foci/loose bands (short axis of the collagin fibres).

nerves

normal ultrasound appearance of nerves

  • nerves are also fibrillar, but less fibrillar than tendons.
  • longitudinal: alternating echogeniv/hypoechoic lines.
  • transverse: echogenic margins (perineureum) and central matrix with central hypoechoic ‘spots’ (fascicles).

longitudinal muscle:

  • hypoechoic (myoctes).
  • striated with echogenic lines of collagen fibres.

transverse muscle

  • non-fibrillar
  • hypoechoic
  • scattered echogenic foci/loose bands (short axis of the collagin fibres).

artery versus vein

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lymph nodes

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