Correspondence  |   May 2018
In Ultrasound Images, All That Is Black Is Not Always Fluid
Author Notes
  • Medical College of Wisconsin, Milwaukee, Wisconsin (H.S.). hshankar@mcw.edu
  • This letter was sent to the authors of the original article referenced above, who declined to respond.—Evan D. Kharasch, M.D., Ph.D., Editor-in-Chief.
    This letter was sent to the authors of the original article referenced above, who declined to respond.—Evan D. Kharasch, M.D., Ph.D., Editor-in-Chief.×
  • (Accepted for publication February 8, 2018.)
    (Accepted for publication February 8, 2018.)×
Article Information
Correspondence
Correspondence   |   May 2018
In Ultrasound Images, All That Is Black Is Not Always Fluid
Anesthesiology 5 2018, Vol.128, 1047-1048. doi:10.1097/ALN.0000000000002171
Anesthesiology 5 2018, Vol.128, 1047-1048. doi:10.1097/ALN.0000000000002171
We read with interest the “Images in Anesthesiology” section article entitled “Ultrasound-guided Intraarticular Knee Injection” in the September 2017 issue discussing the utility of local anesthetic injection into the suprapatellar bursa for minor arthroscopic knee surgery via an alternative position for better visualization.1  The authors claim that placing the knee in 90° of flexion accentuates the suprapatellar bursa, thus improving the image quality and overall success of the block. However, the hypoechoic strip labeled as suprapatellar bursa in their ultrasound image could also be interpreted as hyaline cartilage overlying the femoral condyles. This usually happens when the transducer is moved more distally over the femoral condyles (fig. 1), hence the need for video clips and dynamic scanning, which will facilitate better appreciation as opposed to static images. Besides the location in the femur to aid in differentiating between the hyaline cartilage and bursa, the cartilage is uniformly regular and is not compressible, which is again difficult to assess from static images. Injecting the hyaline cartilage, or even a minor trauma from the needle, has the potential to worsen the patient’s condition as cartilage heals with fibrosis.
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