Ultrasound Findings of Delayed-Onset Muscle Soreness.

The purpose of this series was to retrospectively characterize the ultrasound findings of delayed-onset muscle soreness (DOMS). The Institutional Review Board approved our study, and informed consent was waived. A retrospective search of radiology reports using the key phrase delayed-onset muscle soreness and key word DOMS from 2001 to 2015 and teaching files was completed to identify cases. The sonograms were reviewed by 3 fellowship-trained musculoskeletal radiologists by consensus. Sonograms were retrospectively characterized with respect to echogenicity (hypoechoic, isoechoic, or hyperechoic), distribution of muscle involvement, and intramuscular pattern (focal versus diffuse and well defined versus poorly defined). Images were also reviewed for muscle enlargement, fluid collection, muscle fiber disruption, and increased flow on color or power Doppler imaging. There were a total of 6 patients identified (5 male and 1 female). The average age was 22 years (range, 7-44 years). Of the 6 patients, there were a total of 11 affected muscles in 7 extremities (1 bilateral case). The involved muscles were in the upper extremity: triceps brachii in 27% (3 of 11), biceps brachii in 18% (2 of 11), brachialis in 18% (2 of 11), brachioradialis in 18% (2 of 11), infraspinatus in 9% (1 of 11), and deltoid in 9% (1 of 11). On ultrasound imaging, the abnormal muscle was hyperechoic in 100% (11 of 11), well defined in 73% (8 of 11), poorly defined in 27% (3 of 11), diffuse in 73% (8 of 11), and focal in 27% (3 of 11). Increased muscle size was found in 82% (9 of 11) and minimal hyperemia in 87.5% (7 of 8). The ultrasound findings of DOMS include hyperechoic involvement of an upper extremity muscle, most commonly appearing well defined and diffuse with increased muscle size and minimal hyperemia

Tumors and Tumor-like Abnormalities of the Midfoot and Forefoot.

The differential diagnosis for a midfoot or forefoot mass or mass-like abnormality includes several common benign and malignant pathologies. Evaluation with imaging can often provide a diagnosis, or at least several likely etiologies, and guide management. Determining if a mass is cystic or solid with ultrasound or MRI can limit the differential diagnosis. Identifying the abnormality at a specific anatomical site, such as a bursa, peripheral nerve, plantar aponeurosis, or tendon, can often suggest a correct diagnosis. Correlation with radiography is essential to determine potential osseous origin or involvement and further characterize matrix mineralization. Imaging evaluation can effectively characterize a mass or mass-like abnormality of the midfoot or forefoot, which can provide a precise or limited differential diagnosis and guide further management for biopsy or other treatment

Dilemmas in distinguishing between tumor and the posttraumatic lesion with surgical or pathologic correlation.

This article discusses the most common diagnostic dilemmas when trying to distinguish between tumor and sports injury or other trauma. Bone tumors frequently occur in the same young active patients who experience sports injuries. If the pain persists longer than expected, imaging studies should be obtained to prevent a delay in diagnosis or an inappropriate arthroscopy. A history of spontaneous fracture or a fracture after minor trauma should raise suspicion for underlying lesion as the cause. Occasionally necrosis and/or hemorrhage within a soft tissue sarcoma is so extensive that only a small cuff of viable tumor tissue is present