The hypoechoic normal tendon. A pitfall.

Varying results have been reported concerning the echogenicity of normal superficial tendons. Our recent results using high-resolution real-time linear-array equipment indicate that the normal tendons display a specific echogenic longitudinally oriented fibrillar pattern. However, the visualization of this normal texture requires a perfect technique of examination. The obliquity of the ultrasound beams in relation to the tendon in longitudinal scans as well as the nonrespect of the strict perpendicularity of the scanning plane in transverse sections result in an artifactual hypoechogenicity of the normal tendon. Since hypoechogenicity has been shown a diagnostic criterion for inflammatory changes in tendons, the awareness of this pitfall is instrumental in preventing a false-positive diagnosis of tendinitis.