Abdominal Vasculature
A 38-year-old female has been referred for a Doppler study of the liver with a history of ETOH abuse and cirrhosis. What vascular condition is associated with this history?
Portal hypertension
You have been asked to perform a Doppler study on a patient with a new TIPS. This shunt connects which two vessels?
Portal vein Hepatic vein
You are having difficulty identifying the pancreas in an elderly patient. You can identify the splenic vein. What is the relationship of the splenic vein to the pancreas?
Posterior and inferior
A patient has been referred for a Doppler study with symptoms of chronic mesenteric ischemia. What are the symptoms of this disease?
Postprandial abdominal pain and weight loss
You are imaging the common hepatic artery and detect its division into two branches. What are these two branches?
Proper hepatic artery Gastroduodenal artery
Dilatation of an artery caused by damage to one or more layers of the arterial wall describes a(n):
Pseudoaneurysm
You are performing an ultrasound exam on a patient with a history of chronic pancreatitis and abdominal bruit. What vascular abnormality is associated with this history?
Pseudoaneurysm of the hepatic or splenic artery
A 54-year-old man has been referred for an abdominal Doppler ultrasound with a history of uncontrollable high blood pressure. What pathology are you searching for?
Renal artery stenosis
The inferior vena cava empties blood into which of the following?
Right atrium
Which of the following vascular structures courses posterior to the IVC?
Right renal artery
Which of the following vessels courses posterior to the IVC?
Right renal artery
You are performing a follow-up ultrasound exam in a patient with a known AAA. You cannot obtain a clear image of the aorta in a midline sagittal view due to overlying bowel gas. What should you do?
Roll the patient into either decubitus position and image the aorta from a coronal plane
You are imaging a patient with an anatomic variant called "replaced" hepatic artery. In this anatomic variant, the right hepatic artery originates from what artery?
SMA
A patient is referred to rule out the presence of portal vein thrombosis. You must evaluate the portal vein and other pertinent veins. What vessels form the portal vein?
SMV Splenic vein
The contour of a mycotic aneurysm is most commonly described as:
Saccular shaped
Which of the following arteries are branches of the celiac trunk?
Splenic Left gastric Common hepatic
Which of the following arteries gives rise to the gastroepiploic artery?
Splenic artery
Which of the following vascular structures is most commonly mistaken as a dilated pancreatic duct?
Splenic artery
Which visceral artery is most commonly involved with aneurysmal formation?
Splenic artery
Direct extension of thrombus into the IVC may originate in all of the following venous structures EXCEPT: Renal vein Femoral vein Hepatic vein Splenic vein Right gonadal vein
Splenic vein
Which of the following does NOT drain directly into the IVC? Renal vein Right hepatic vein Common iliac vein Splenic vein Middle hepatic vein
Splenic vein
You have been asked to include an evaluation of the SMV in a Doppler study of the portal system. What vessel does the SMV join?
Splenic vein
Which artery supplies the small intestine, right colon, and most of the transverse colon?
Superior mesenteric artery
Which of the following describes the anatomic course of the GDA?
The GDA has a caudal course, anterior to the pancreatic head
You are performing an ultrasound study to rule out abdominal aortic aneurysm. Which part of the following is true regarding the normal abdominal aorta?
The abdominal aorta normally tapers in diameter from its cranial to its caudal extent
Which of the following statements most accurately describes the left renal vein?
The left renal vein may appear dilated due to compression from the mesentery.
A patient presents with a history of pulmonary embolism. A SAG image of the inferior vena cava demonstrates an intraluminal mass. On the basis of the clinical history, the mass is most suspicious for a(n):
Thrombus
Which of the following describes the normal flow pattern in the hepatic veins?
Triphasic
What is the most significant clinical consequence of portal hypertension?
Variceal hemorrhage
A 57-year-old-woman has been referred for abdominal ultrasound with a history of an abdominal bruit. What pathology are you searching for?
Vascular compromise involving the aorta or its branches
All of the following statements accurately describe the venous system EXCEPT: Venous walls are thicker than arterial walls. Lower extremity veins contain valves Venous valves extend inward toward the intima Veins carry blood toward the heart Perforator veins connect the superficial system with the deep system
Venous walls are thicker than arterial walls
A 65 yr old local farmer presents with a history of leukocytosis and an enlarging, pulsatile abdominal mass. The anterior, posterior, and lateral borders of the distal aorta are outlined by the calibers. On the basis of the clinical history, the sonogram is most likely demonstrating which of the following pathologies?
mycotic abdominal aortic aneurysm
Normal diameter of the splenic vein should not exceed:
1.0 cm
The normal diameter of the main portal vein should not exceed:
1.3 cm
Duplication of the main renal arteries is demonstrated in approximately:
10-20% of the population
The risk of rupture in an abdominal aortic aneurysm measuring 6.0cm in diameter is approximately:
15% within 5 years
The common iliac artery is considered enlarged once the diameter exceeds:
2.0cm
The IVC generally measures less than:
2.5 cm
The IVC is considered enlarged once the diameter exceeds:
3.7cm
The abdominal aorta usually bifurcates into the right and left common iliac arteries at the level of the:
4th lumbar vertebra
You are performing a Doppler study on a patient with a TIPS stent. What is the greatest Doppler angle of incidence you should use to get accurate velocity measurements in this exam?
60 degrees
The amount of blood supplied to the liver from the portal venous system is approximately:
70%
You are performing an ultrasound on a patient with suspected aortic aneurysm. Which of the following defines an aortic aneurysm?
A dilatation of the aorta exceeding 3cm in any dimension
You are performing a Doppler study of the portal vein and detect that the flow direction in the main portal vein is the same as the hepatic artery. What does this indicate?
A normal flow direction in the portal vein
A fusiform aneurysm is best described as:
A uniform dilatation of the arterial walls
Which of the following conditions most commonly coexist with a popliteal aneurysm?
Abdominal Aortic Aneurysm
The gonadal arteries arise from the:
Abdominal aorta
Patients with Marfan syndrome have a predisposing risk factor for developing a(n):
Abdominal aortic aneurysm
A patient is referred for an abdominal Doppler ultrasound to rule out the presence of Budd-Chiari syndrome. What vessels will you evaluate?
All three hepatic veins IVC Portal vein
Which of the following is the biggest risk factor for rupture of AAA?
Aneurysm size
What is the relationship of the left renal vein to the aorta and SMA?
Anterior to the aorta and posterior to the SMA
You are scanning a patient with Marfan's syndrome. Ultrasound findings reveal a linear band throughout the length of the abdominal aorta that is mobile in relation to the cardiac cycle. What pathology is most likely present?
Aortic dissection
Development of an abdominal aortic aneurysm is most commonly caused by:
Arteriosclerosis
The presence of a palpable "thrill" within an artery is suspicious for a(n):
Arteriovenous fistula
You are examining the IVC to rule out obstruction. Within the liver, the IVC lies along the posterior surface of what lobe?
Caudate lobe
The first visceral branch of the abdominal aorta is the:
Celiac axis
You are performing a Doppler study on a patient with Median arcuate ligament syndrome. What vessels are you studying?
Celiac trunk
What vessels will you study in the patient referred for mesenteric ischemia?
Celiac trunk SMA IMA
Berry-shaped aneurysms primarily affect which of the following arteries?
Cerebral
All of the following conditions may demonstrate abnormal blood flow patterns within the hepatic artery EXCEPT: Jaundice Cirrhosis Cholecystitis Lymphoma Metastases
Cholecystitis
The celiac axis branches into which of the following arteries?
Common Hepatic, Left Gastric, Splenic arteries
What vessel is anterior to the uncinate process and posterior to the neck of the pancreas?
Confluence of portal and splenic vein
You are performing a Doppler study of the hepatic venous system and cannot obtain a color Doppler signal from the main portal vein. What should you do?
Decrease the system pulse repetition frequency
You are imaging a patient with a fusiform AAA. Which of the following describes the fusiform aneurysmal shape?
Dilatation with a gradual transition between the normal and abnormal segment
A dilatation of an artery when compared with a more proximal segment describes which of the following abnormalities?
Ectatic aneurysm
You have detected an abdominal aortic aneurysm. Considering this finding, you should tailor your exam to include which of the following?
Evaluation of the common iliac arteries Measurement of the transverse and anteroposterior diameter Assessment of intraluminal thrombus Location of the aneurysm in relation to the renal arteries
Which of the following is NOT a direct branch of the abdominal aorta? Celiac trunk Superior mesenteric artery External iliac artery Inferior mesenteric artery Renal artery
External iliac artery
Which of the following vessels lies between the duodenum and the anterior portion of the pancreatic head?
Gastroduodenal artery
Which of the following structures is located anterior to the inferior vena cava?
Head of the pancreas
Which three structures compose the portal triad?
Hepatic artery Portal vein Bile duct
A 49-year-old male is referred for abdominal Doppler with a history of cirrhosis and portal hypertension. Ultrasound findings related to portal hypertension include all of the following EXCEPT: Splenomegaly Portosystemic varices and collaterals Hepatofugal flow in the portal vein Hepatic cysts Dilated portal vein
Hepatic cysts
You have been asked to identify the lobes of the liver in a patient with a hepatic mass. Which vessels course intersegmental in the liver?
Hepatic veins
You are performing a Doppler study of the mesenteric arteries in a fasting patient. Which of the following describes the waveform you expect to see in a normal study?
High resistance
You are performing an ultrasound study on a patient with an aortoiliac graft and suspect the presence of a pseudoaneurysm at the graft site. What is the typical waveform in the neck of a pseudoaneurysm?
High velocity, bidirectional
Development of an arteriovenous fistula may be caused by all of the following conditions EXCEPT: Trauma Surgery Neoplasm Hypertension Inflammation
Hypertension
Dissection of the abdominal aorta is linked to all of the following EXCEPT: Trauma Pregnancy Hypotension Marfan syndrome Dissection of the thoracic aorta
Hypotension
The hepatic veins drain into what vessel?
IVC
You are performing an ultrasound on a patient with a mass in the pancreatic head. In order to be sure you are imaging the entire pancreatic head, you must identify the vessel that lies immediately posterior to the pancreatic head. What vessel is this?
IVC
While performing a Doppler evaluation of the abdominal vessels, you detect a stenosis in the right renal artery. Which of the following is NOT a sign of stenosis with spectral analysis? Spectral broadening distal to the stenosis Increased peak systolic velocity at the stenosis Increased peak diastolic velocity proximal to the stenosis Increased pulsatility proximal to the stenosis Dampening of the waveform distal to the stenosis
Increased peak diastolic velocity proximal to the stenosis
Which of the following arteries supplies the left transverse colon, descending colon, and the sigmoid?
Inferior mesenteric artery
You are performing an ultrasound to rule out the presence of AAA. What is the most common location of AAA?
Infrarenal
A true aortic aneurysm is defined as a dilatation of the abdominal aorta when:
It measures 3.0 cm or greater
An infiltrating neoplasm within the IVC most commonly originates from which of the following structures?
Kidney
The left renal vein receives tributaries from which of the following veins?
Left Suprarenal and Left Gonadal veins
The main portal vein bifurcates at the hepatic hilum into the:
Left and Right Portal veins
Which of the following vessels course anterior to the abdominal aorta and posterior to the superior mesenteric artery?
Left renal vein
You are imaging the pancreas and detect a vessel posteriorly, coursing between the SMA and the aorta. What vessel are you imaging?
Left renal vein
Which of the following veins courses in an oblique plane between the right and left lobes of the liver?
Middle hepatic vein
You have been requested to perform a Doppler analysis of the portal venous system. Which of the following describes the waveform you will see in the portal vein in a normal study?
Mildly undulating
A patient has been referred for a Doppler study to rule out the presence of renal artery stenosis. A thorough knowledge of the renal vasculature is required to perform this study. Which of the following is NOT true regarding the renal vasculature? Multiple renal arteries are rare, occurring in less than 5% of individuals The renal arteries lie posterior to the renal veins The renal arteries branch off the aorta immediately below the SMA The right renal vein is shorter than the left renal vein The renal veins drain into the inferior vena cava
Multiple renal arteries are rare, occurring in less than 5% of individuals
A patient is referred for ultrasound evaluation of possible cavernous transformation of the portal vein. Which of the following describes this condition?
Network of vessels replacing obliterated portal vein
Which of the following vessels normally follows a retroaortic course? Left renal vein Right renal vein Superior mesenteric vein Inferior mesenteric vein None of the above
None of the above
You are performing an abdominal Doppler study and suspect the presence of Median arcuate ligament syndrome. To rule out this condition, which of the following should be done?
Obtain Doppler readings during both inspiration and expiration and in both the supine and upright positions