Superficial Structures and Other Sonographic Procedures
Thyroid and neck
The thyroid is assessed for size, echotexture, and nodules. Suspicious nodule features include hypoechogenicity, microcalcifications, irregular margins, and a taller-than-wide shape. Parathyroid glands are normally not identified unless enlarged, and neck cysts are characterized by location relative to the thyroid and carotid.
Breast and scrotum
Breast lesions are described using BI-RADS: simple cysts are anechoic with posterior enhancement, fibroadenomas are typically oval and wider-than-tall, and suspicious findings include spiculation, shadowing, and angular margins. In the scrotum, homogeneous testicular echotexture is normal; absent or reduced flow with acute pain suggests torsion, a surgical emergency. Varicoceles are dilated veins that enlarge with Valsalva and show slow flow requiring low PRF and low wall filter settings.
Vascular and musculoskeletal
Venous duplex relies on complete compressibility for DVT exclusion, with spectral augmentation. Tendons are echogenic and fibrillar but show anisotropy - falsely hypoechoic when the beam is not perpendicular.
Procedures
Ultrasound-guided biopsy requires confirmed consent, coagulation review, sterile preparation, and local anesthetic. Keep the needle in the imaging plane so the shaft and tip remain visible; use a standoff or needle guide as needed.
Trap: mistaking anisotropy for tendinopathy, or using color settings too high to detect slow varicocele flow.
Rule of thumb: if you cannot see the needle tip, do not advance the needle.