Picture List

Representative examples of US pathological findings. Partial tear (arrow) of the achilles tendon in sero-negative spondyloarthritis (A) transverse and (B) longitudinal scans.t = achilles tendon. C. Sonographic guided aspiration of a popliteal cyst in knee osteoarthritis. (>) tip of the needle, g = gastrocnemius. D. 3D view of second metacarpal head with clearly defined erosions (asterisk) in rheumatoid arthritis. m = metacarpal head, p = proximal phalanx

Figure 1

Healthy subject

Knee

Grey scale US using a AU5 "Harmonic" (Esaote Biomedica, Genova, Italy) with a linear 7.5-10 MHz probe

Supra-patellar longitudinal scan in the midline

Normal bone profile of the femur (f) and upper pole of the patella (p) represent the landmark of this scanning plane. The distal tract of the quadriceps tendon is not clearly visualised since the direction of the US beam is not exactly perpendicular. t = quadriceps tendon.

Filippucci E, Iagnocco A, Meenagh G, Riente L, Delle Sedie A, Valesini G, Grassi W.

Figure 2

Healthy subject

Ankle

Grey scale US using a Logiq 9 (General Electrics Medical Systems, Milwaukee, WI) with a linear 14 MHz probe

Anterior longitudinal scan

Normal bone profile of the tibia (ti) and talus (ta). Note the normal aspect of the articular cartilage of the talus with its superficial margin showing differing degrees of echogenicity according to the angle of insonation.

Filippucci E, Iagnocco A, Meenagh G, Riente L, Delle Sedie A, Valesini G, Grassi W.

Figure 3

Healthy subject

Flexor pollicis longus tendon at the thenar eminence

Grey scale US using a Diasus (Dynamic Imaging, Livingstone, UK) with a linear 8-16 MHz probe

Longitudinal scan

Normal tendon exhibiting the typical "fibrillar" echotexture.

Filippucci E, Iagnocco A, Meenagh G, Riente L, Delle Sedie A, Valesini G, Grassi W.

Figure 4

Healthy subject

Wrist

Grey scale US using an Aplio (Toshiba, Japan) with a linear 14 MHz probe

Volar longitudinal scan at the carpal tunnel

Median nerve (n) and one of the finger flexor tendons (t).

Filippucci E, Iagnocco A, Meenagh G, Riente L, Delle Sedie A, Valesini G, Grassi W.

Figure 5

Acute gout attack

Ankle

Grey scale US using a Diasus (Dynamic Imaging, Livingstone, UK) with a linear 5-10 MHz probe

Anterior longitudinal scan

Marked anechoic joint cavity widening of the tibio-talar joint. ti = tibia; ta = talus.

Filippucci E, Iagnocco A, Meenagh G, Riente L, Delle Sedie A, Valesini G, Grassi W.

Figure 6

Psoriatic arthritis

Finger (proximal interphalangeal joint)

Grey scale US using a Diasus (Dynamic Imaging, Livingstone, UK) with a linear 8-16 MHz probe

Volar longitudinal scan

Synovitis of the proximal interphalangeal joint. Marked hypo-anechoic joint cavity widening, with evidence of pannus formation (*). t= finger flexor tendon, mp = middle phalanx; pp = proximal phalanx.

Filippucci E, Iagnocco A, Meenagh G, Riente L, Delle Sedie A, Valesini G, Grassi W.

Figure 7

Rheumatoid arthritis

First metatarsophalangeal joint

Power Doppler US using AU5 "Harmonic" (Esaote Biomedica, Genova, Italy) with a linear 10-14 MHz probe and a Doppler frequency of 7 MHz.

Dorsal longitudinal scan

Synovitis of the first metatarsophalangeal joint. Power Doppler demonstrating hyperperfusion of the synovial tissue. mt = metatarsal bone; pp = proximal phalanx.

Filippucci E, Iagnocco A, Meenagh G, Riente L, Delle Sedie A, Valesini G, Grassi W.

Figure 8

Seronegative spondyloarthropathy

Hip

Grey scale US using a Diasus (Dynaic Imaging, Livingstone, UK) with a linear 5-10 MHz probe

Anterior longitudinal scan

Right- left comparison. A. Synovitis of the left hip. B. Normal right hip . f = femoral neck; a = acetabulum.

Filippucci E, Iagnocco A, Meenagh G, Riente L, Delle Sedie A, Valesini G, Grassi W.

Figure 9

Psoriatic arthritis

Finger (proximal interphalangeal joint)

Grey scale US using a Diasus (Dynamic Imaging, Livingstone, UK) with a linear 8-16 MHz probe

Dorsal longitudinal scan

Synovitis of the third proximal interphalangeal joint with a clear erosion (>) of the head of the proximal phalanx. mp = middle phalanx; pp = proximal phalanx.

Filippucci E, Iagnocco A, Meenagh G, Riente L, Delle Sedie A, Valesini G, Grassi W.

Figure 10

Rheumatoid arthritis

Finger (Second metacarpophalangeal joint)

Grey scale US using a Diasus (Dynamic Imaging, Livingstone, UK) with a linear 8-16 MHz probe

Lateral longitudinal scan

Synovitis of the second metacarpophalangeal joint with a large erosion (>)on the lateral aspect of the metacarpal head and invading pannus (*). mp = middle phalanx; pp = proximal phalanx.

Filippucci E, Iagnocco A, Meenagh G, Riente L, Delle Sedie A, Valesini G, Grassi W.

Figure 11

Rheumatoid arthritis

First metatarsophalangeal joint

Power Doppler US using AU5 "Harmonic" (Esaote Biomedica, Genova, Italy) with a linear 10-14 MHz probe and a Doppler frequency of 7 MHz.

Medial longitudinal scan

Erosive synovitis of the first metatarsophalangeal joint. Power Doppler demonstrating hyperperfusion of the pannus invading the metatarsal head. mt = metatarsal bone; pp = proximal phalanx.

Filippucci E, Iagnocco A, Meenagh G, Riente L, Delle Sedie A, Valesini G, Grassi W.

Figure 12

Osteoarthritis

Knee

Grey scale US using a Diasus (Dynamic Imaging, Livingstone, UK) with a linear 5-10 MHz probe

Supra-patellar transverse scan

Variable thickness of the cartilage layer, focal loss of the superficial cartilage margin and blurring of the subchondral bone. f = femur.

Filippucci E, Iagnocco A, Meenagh G, Riente L, Delle Sedie A, Valesini G, Grassi W.

Figure 13

CPPD disease

Knee

Grey scale US using a Diasus (Dynamic Imaging, Livingstone, UK) with a linear 8-16 MHz probe

Medial longitudinal scan

Multi-focal calcification of the internal meniscus which protrudes out of the articular rim. f = femur; t = tibia.

Filippucci E, Iagnocco A, Meenagh G, Riente L, Delle Sedie A, Valesini G, Grassi W.

Figure 14

Post-traumatic tendon lesion

Ankle

Grey scale US using a Diasus (Dynamic Imaging, Livingstone, UK) with a linear 8-16 MHz probe

Medial transverse (A) and longitudinal (B) scans

Anechoic defect of the posterior tibial tendon (arrows). mm = medial malleolus.

Filippucci E, Iagnocco A, Meenagh G, Riente L, Delle Sedie A, Valesini G, Grassi W.

Figure 15

Rheumatoid arthritis

Wrist

Grey scale US using a Diasus (Dynamic Imaging, Livingstone, UK) with a linear 8-16 MHz probe

Volar transverse scan

Tenosynovitis of the finger flexor tendons. n = median nerve; r = radius; u = ulna.

Filippucci E, Iagnocco A, Meenagh G, Riente L, Delle Sedie A, Valesini G, Grassi W.

Figure 16

Rheumatoid arthritis

Shoulder

Grey scale US using a Siemens Antares Sonoline with a linear 5-13 MHz probe

Transverse extended view

Large exudative subdeltoid bursitis (*). h = humeral head; d = deltoid; t = subscapularis tendon.

Filippucci E, Iagnocco A, Meenagh G, Riente L, Delle Sedie A, Valesini G, Grassi W.

Figure 17

Post-traumatic tendon lesion (KEYWORDS tendon, ankle)

Achilles tendon

Grey scale 3D US using a Logiq 9 (General Electrics Medical Systems, Milwaukee, WI) with a volumetric probe (RSP6-12)

Coronal views (video)

Coronal view at different levels, revealing an anechoic intra-tendineous loss of substance.

Filippucci E, Iagnocco A, Meenagh G, Riente L, Delle Sedie A, Valesini G, Grassi W.

Figure 18

Osteoarthritis

Knee

Grey scale US using a Diasus (Dynamic Imaging, Livingstone, UK) with a linear 5-10 MHz probe

Anterior transverse scan

Sonographic guided aspiration of an effusion within the supra-patellar pouch (A) prior to aspiration and (B) following aspiration. (>) tip of the needle, f = femur.

Filippucci E, Iagnocco A, Meenagh G, Riente L, Delle Sedie A, Valesini G, Grassi W.