Diagnostic errors in musculoskeletal ultrasound imaging and how to avoid them


Share / Export Citation / Email / Print / Text size:

Journal of Ultrasonography

Polish Ultrasound Society (Polskie Towarzystwo Ultrasonograficzne)

Subject: Medicine


ISSN: 2084-8404
eISSN: 2451-070X





Volume / Issue / page

Related articles

VOLUME 17 , ISSUE 70 (September 2017) > List of articles

Diagnostic errors in musculoskeletal ultrasound imaging and how to avoid them

Małgorzata Serafin-Król * / Artur Maliborski

Keywords : ultrasound, musculoskeletal system, artifacts, diagnostic mistakes

Citation Information : Journal of Ultrasonography. Volume 17, Issue 70, Pages 188-196, DOI: https://doi.org/10.15557/JoU.2017.0028

License : (CC BY 4.0)

Received Date : 05-December-2016 / Accepted: 07-March-2017 / Published Online: 29-September-2017



The article reviews the major challenges related to the principles of the correct tech­nique of musculoskeletal ultrasound (MSK US). All the crucial aspects of correct MSK soft tissue diagnosis have been discussed, including equipment settings, use of recent image software innovations and ultrasound standoff pads, and correct transducer po­sitioning. The importance of the fundamental principles of MSK US, facilitating good quality image and limiting the occurrence of artifacts, has been highlighted. The most common artifacts of the musculoskeletal system have been described, including those that diagnostically helpful, such as the presence of echo enhancement deep to a fluid-filled structure, or an acoustic shadow behind a calcification. The presence of acoustic shadow in the context of lesions of a different type has also been discussed. The common anisotropy-related artifacts, frequently leading to diagnosis of a pathological condition where none is present, have been elaborated on. The frequently encountered mirror reflection artifact has been described. Special attention has been paid to the means of either eliminating, or taking advantage of artifacts for the correct diagnosis of musculo­skeletal lesions. The possibilities and technique of correct differentiation of hypoechoic or anechoic foci, commonly found in the pathological conditions of the musculoskeletal system, have been analysed. Non-typical ultrasound findings leading to misdiagnosis of given pathological conditions have been discussed.

Content not available PDF Share



Nowicki A: Ultrasonografia: wprowadzenie do obrazowania i metod dopplerowskich. Wydawnictwo IPPT PAN, Warszawa 2016.


Derci LE, Rizzatto G: Technical requirements. In: Bianchi S, Martinoli C (eds.): Ultrasound of the Musculoskeletal System. Springer, Berlin 2007: 1–16.


Claudon M, Tranquart F, Evans DH, Lefèvre F, Correas M: Advances in ultrasound. Eur Radiol 2002: 12: 7–18.


Laing FC: Commonly encountered artifacts in clinical ultrasound. Se­min Ultrasound CT MR 1983; 4: 27–43.


Thickman DI, Ziskin MC, Goldenberg NJ, Linder BE: Clinical manife­stations of the comet-tail artifacts. J Ultrasound Med 1983; 2: 225–230.


Ziskin MC, Thickman DI, Goldenberg NJ, Lapayowker MS, Becker JM: The comet-tail artifact. J Ultrasound Med 1982; 1: 1–7.


Fornage BD: The hypoechoic normal tendon. A pitfall. J Ultrasound Med 1987; 6: 19–22.


Koski JM, Saarakkala S, Helle M, Hakulinen U, Heikkinen JO, Her­munen H: Power Doppler ultrasonography and synovitis: correlating ultrasound imaging with histopathological findings and evaluating the performance of ultrasound equipements. Ann Rheum Dis 2006; 65: 1590–1595.


Torp-Pedersen ST, Terslev L: Settings and artifacts in colour/power Doppler ultrasound in rheumatology. Ann Rheum Dis 2008; 67: 143– 149.


Kraushaar BS, Nirschl RP: Tendinosis of the elbow (tennis elbow). Cli­nical features and findings histological and electron microscopy stu­dies. J Bone Joint Surg Am 1999; 81: 259–278.


Kowalska B: Assessment of the utility of ultrasonography with high­-frequency transducers in the diagnosis of entrapment neuropathies. J Ultrason 2014; 14: 371–392.


Teh J: Ultrasound of soft tissue masses of the hand. J Ultrason 2012; 12: 381–401.