Final Abdomen Review
Cirrhosis
Hepatocellular carcinoma risk increases with ____________
1. Cystic: changes shape, posterior enhancement, round/oval, anechoic, well defined borders, 2. Lesions: spiculated, taller than wider, ...
How can you differentiate cystic vs solid lesions?
Echinococcal cyst
Hydatid disease, caused by parasitic worm, can also be found in lung, bone, and brain
-Non-specific Appearance -Liver parenchyma distortion -Variable Echogenicity [hypoechoic, hyperechoic, isoechoic, or complex] -Hepatomegaly -Ascites
84. Hepatocellular disease - know US appearance
Up to 10 mm
85. Know upper limit of normal for the CBD after cholecystectomy
yes
9. Following trauma to the spleen, would you see fluid in perinephric fluid collection?
Fibroadenoma
most common benign tumor of the breast -> excess estrogen, women 18-30, associated with FCC and fibroadenosis -> discrete mobile encapsulated nodule -> may enlarge in later part of menstrual cycle/pregnancy -> regresses during menopause
Mirizzi syndrome
stones become stuck in the infundibulum of the GB which blocks the cystic duct.
An odd shaped hypoechoic area
10. With focal sparing of the liver, the area that is sparred will appear as
They provide support for the breast as well as shape the breast
83. Functions of Cooper's suspensory ligaments
Courvoisier GB
Gb is enlarged due to bile build up / blockage of bile duct from GB to small intestine
Pancreatic cyst, pancreatic carcinoma (specially on the area of the head) stones in duct & pancreatitis
4. What are the causes of pancreatic duct dilation?
Benign Prostatic Hypertrophy (BPH)
1. Transabdominal ultrasound imaging of the prostate gland is most useful in diagnosing what type of condition?
Cholelithiasis (gall gallstones) - appears as 2 parallel curved echogenic lines separated by a thin and a quick space with distal shadowing AKA: -west triad -wall echo shadow -double arc shadow sign -Do not see lumen of GB only stones visible
11. The WES sign is indicative of what condition
-Elevated serum creatinine -chronic kidney disease (CKD) - very echogenic, smaller in size -cannot distinguish between cortex & sinuses
12. End stage kidneys (renal failure) are characteristically associated with
SHAPE: Hypertrophied Column of Bertin: prominent cortical tissue Dromendary Hump: bulge in capsule of L kidney from compression by spleen NUMBER: Bilateral Renal Agenesis: no kidneys present; fatal Unilateral Renal Agenesis: one kidney present; check pelvis and other side for secondary kidney Supranumerary Kidney: duplicated kidney; 3 instead of 2 LOCATION: Pelvic Kidney: located in the pelvis area instead of the flank Crossed Fused Renal Ectopia: on the same side of the body and fused together Thoracic Kidney: located in the thorax due to diaphragmatic hernia in utero FUSION: Horseshoe Kidney: kidneys are fused together at the lower poles, most common Cake/Lump Kidney: kidneys are fused on the medial surfaces; a variant of horseshoe kidney, located in the pelvis Sigmoid Kidney: upper pole of one kidney is fused to the lower pole of the other; shaped like an S HYPOPLASTIC: Unilateral Hypoplasia: one kidney is abnormally small and the other is larger to compensate Persistent Fetal Lobulation: lobulation in the contour of the kidney after 5 years of age Double Collecting System: 2 ureters coming out of 1 kidney
13. Normal variance of the kidney?
-AKA: RCC, Hypernephroma, Renal Adenocarcinoma, Von Grawitz Tumor -most common malignancy of kidney, -Most common in adult males over 40, -located unilaterally -mets to renal veins, IVC, contralateral kidney, adrenals, paraaortic nodes, lung, liver, brain, long bones
14. Renal cell carcinoma
-AKA: TCC -Found in the kidneys, pelvis, ureter, and bladder. The bladder is the most common site. -Originates from transitional cells of the urinary tract
15. Transitional cell carcinoma of the kidney may be found in
AKA: Renal Hamartoma Ultrasound Appearance: Homogeneous, well-circumscribed, hyperechoic (due to fat presence), and posterior acoustic shadowingIt is benign. Signs & Symptoms: Asymptomatic Associated with Tuberous Sclerosis
16. Angiomyolipoma - US appearance, symptoms and signs
-AKA: ARPKD -Kidneys Appear: bilaterally enlarged, echogenic, and loss of corticomedullary distinction (hard to distinguish the cortex from the medulla) -multiple cysts
17. In infantile polycystic kidney disease, the kidneys appear
Weak urinary stream, urinary urgency, nocturia, leaking and dribbling of urine.
18. Signs and symptoms of benign prostatic hypertrophy
Wilson's disease
19. Is a rare inherited disorder that involves faulty metabolism of copper. copper accumulates in the liver and is slowly released in other areas of the body. it results in severe liver and brain damage. patient symptoms may manifest as early as 6 years of age, to as late as 50 years of age. The definitive diagnosis is made through blood, urine, and liver biopsy. treatment is through use of penicillamine, a drug that binds copper and allows it to be excreted. patient signs and symptoms include a brownish green ring around the iris of the eyes, due to copper deposits in the cornea. In ultrasound, the effect on the liver may range from hepatomegaly initially, with progression to cirrhosis.
Pancreatic carcinoma. (carcinoma of the head of Pancreas)
2. The courvoisier sign is closely related to which type of pathology?
Grave's disease
20. a toxic goiter is associated with a complex autoimmune disease called graves disease. the gland is diffusely enlarged with an overall decrease in the gland's echogenicity. using doppler ultrasound, a marked increase in vascularity will be seen. this is sometimes referred to as the "thyroid inferno". thyrotoxcosis is a toxic condition due to hyperactivity of the thyroid gland. patient signs and symptoms with this condition include tremors, rapid heart beat, elevated metabolic levels, nervous symptoms and weight loss. exophthalmos may also be seen in patients with graves disease.
Cholesterolosis- accumulation of triglycerides & sterols in GB wall
21. A "strawberry gallbladder" refers to which condition
US appearance of hemangiomas: round, hyper echoic, well defined, posterior enhancement. Some patients have symptoms and some don't. Usually an incidental finding.
22. Hemangioma-review us appearance, symptoms and signs
Hemorrhage of the adrenal glands in the neonate is most common from 2-7 days after birth.
23. Adrenal hemorrhage is most common in which population
A fluid collection between the layers of the tunica vaginalis and the lining of the scrotum is called a hydrocele. It is the most common cause of painless scrotal swelling. The cause may be idiopathic, congenital, or related to inflammation or neoplastic involvement.
24. Cause of a fluid collection around the testicle
- Dilated portal vein (greater than 13 mm) - Dilated splenic vein (greater than 10 mm) - Dilated SMV (greater than 10 mm) - Recanalized umbilical vein - Splenomegaly - Portosystemic venous collaterals & varices - Ascites -Hepatofugal or portafugal flow
39. Portal hypertension- US appearance
-enlarged -decreased echogenicity -skin thickening -hydrocele -reduced arterial flow The ultrasound appearance is varied and not specific. within the first 24 hours of torsion, the testicle may be enlarged and demonstrate decreased echogenicity. scrotal skin thickening and a hydrocele may also be present. if the condition is a chronic one, the testicle may appear small and inhomogeneous. doppler ultrasound will demonstrate a lack of, or reduced arterial flow. it is necessary to compare blood flow in the symptomatic testicle with flow characteristics of the contralateral non symptomatic testicle.
25. US appearance of testicular torsion
-seminoma The most common type of malignancy found in the testicle is seminoma. seminomas are among the least aggressive of the testicular malignancies and have the best prognosis. usually, they appear as homogeneous, hypoechoic masses. the size and shape of a seminoma is variable. seminomas respond well and are very sensitive to radiation therapy.
26. The most common malignancy of the testicle
In acute pancreatitis, there is an acute inflammatory reaction in the pancreas. The digestive juices from the ducts actually leak out and begin to digest the pancreatic tissue. The causes of pancreatitis are varied. the five b s help us to remember the 5 main causes. They are birth, bug, bile, blood, and booze. In adults, the most common causes are biliary disease and etoh abuse. In children, the most common causes are drug related and trauma. amylase is an important lab value to be considered when imaging the pancreas. two times the normal level, or more, indicates a condition called acute pancreatitis. lipase is another important laboratory marker in relation to pancreatic function. elevated levels of lipase may indicate acute pancreatitis Blood & urinary amylase elevated within first 24 hours, stay elevated for 48-72 hours Blood lipase elevated within 24-48 hours, stays elevated 5-14 days Elevated WBC count Elevated bilirubin
27. Acute pancreatitis- know amylase and lipase rise rate
Neuroblastoma
28. Malignant tumor of the adrenal medulla ● May displace renals inferiorly and anteriorly ● Peak incidence is 2 months through 4 years ● Virulent( harmful) ● Difficult to distinguish from Wilms Tumor ● Mets usually present by time of diagnosis Syndromes associated with neuroblastoma ● Beckwith-Wiedemann Syndrome ● Klippel Feil Syndrome ● Fetal Alcohol Syndrome ● Hirschsprung's Disease Signs and Symptoms : pg 679 in book ● Palpable mass ● Clinically systemic signs and symptoms such as fever, weight loss, abdominal distension, irritability, hypertension and anemia are sometimes seen.
SPERMATOCELE: cyst containing sperm fluids and debris, usually small and simple but can be complex and large, usually in epididymal head, usually asymptomatic. POSTERIOR SUPERIOR PORTION OF HEAD CYST IN EPIDIDYMAL HEAD: usually found in epididymal head, but can be found elsewhere in epididymal.
29. A cyst in the epididymal head cannot be differentiated by ultrasound from a
Portal hypertension secondary to alcoholic cirrhosis
3. What is the most common cause of splenomegaly in adults?
MLO: medial-lateral oblique Most Valuable view Localizes the mass as superior or inferior to nipple
30. What is the MOST commonly used view in mammography?
Solitary adenoma is a benign lesion and may involve any one of the four parathyroids 80 -85 % primary hyperparathyroidism Caused by genetic mutations Sign & Symptoms: hyperparathyroidism Hypercalcemia Lab values: ELEVATED SERUM CALCIUM (hypercalcemia) and high levels of PTH (parathyroid hormone) Associated with kidney stones and medullary calcifications Hormones: excess secretion of PTH US appearance: hypoechoic homogeneous solid masses Less echogenic than thyroid gland Hypoechoic as it simulates a cyst Homogeneously solid Oval and teardrop shaped
31. Parathyroid adenomas, the lab value associated with this lesion is
CYSTIC: (as per Mike, anything that is anechoic is fluid filled and cystic) common in women 30-50 years, caused by obstruction of lactiferous ducts ultrasound appearance -ROUND or OVAL -ANECHOIC -SHARP WELL DEFINED BORDERS -POSTERIOR ENHANCEMENT possibly edge shadowing SOLID: (as per Mike, if it produces and echo its solid) Ultrasound appearance Benign round, oval, or ellipsoid in shape wider than tall horizontal orientation do not cross tissue planes smooth well defined borders macrolobulations
32. Know parameters in differentiating a cystic from solid lesion BREAST
● Microlobulations ● Taller than wide ● Irregular shape ● Ductal extension ● Branching pattern ● Ill defined borders ● Thickened borders with halo ● Spiculated appearance
33. Know ultrasound characteristics that are suspicious for malignancy in the breast?
Increased age, cystic fibrosis, chronic pancreatitis
34. Know conditions that are related to a hyperechoic appearance of the pancreas
Ultrasound appearance -DILATED CBD -DILATED WIRSUNG DUCT -HYPERECHOIC MASS IN HEAD OF PANCREAS -DILATED BILIARY TREE/COURVOISIER SIGN/ METS IN LIVER
35. Know sonographic findings in which are compatible with the diagnosis of carcinoma of the pancreatic head
COMMON HEPATIC DUCT OBSTRUCTION caused by extrinsic compression of an impacted STONE IN CYSTIC DUCT or INFUNDIBULUM of the GB Patients can present with jaundice fever RUQ pain
36. Mirizzi syndrome- which duct is involved in it
Peripheral zone
37. In which zone is the majority of prostate cancer found
-HEPATITIS -MIRIZZI SYNDROME -CHOLANGIOCARCINOMA -ECHINOCOCCAL CYSTS
38. Jaundice can be attributed to which conditions
Sonographic appearance: - Variable - Focal wall thickening - Irregular wall borders - Solid mass with GB lumen - Fungating mass within lumen - Gallstones may be trapped within mass - Regional lymphadenopathy may also be present Signs and symptoms: Asymptomatic, loss of appetite, nausea, vomiting, belching, RUQ pain, and possible jaundice (if biliary tree is infiltrated
40. Carcinoma of the gallbladder- US appearance, symptoms and signs
Yes, THE CLASSIC ADENOMA HAS AN ECHOLUCENT HALO SURROUNDING IT. HOWEVER, THIS APPEARANCE IS NOT SPECIFIC TO BENIGN LESIONS, AND THEREFORE ITS PRESENCE DOES NOT RULE OUT THE POSSIBILITY OF THYROID CARCINOMA.
42. Does a halo sign in the thyroid gland typically (most likely) represent an adenoma?
A MASS IN THE THYROID GLAND OR PARATHYROID GLAND
43. The longus colli muscle can mimic what pathology.
NO. THE WATER LILY SIGN RESULTS FROM ECHINOCOCCAL CYST AKA HYDATID DISEASE. CAUSED BY A PARASITIC WORM & FOUND 50% OF THE TIME IN THE LIVER THROUGH THE PORTAL VEIN.
44. Is amebic abscess is associated with the "floating water lily sign".
FALSE, IT IS ISOECHOIC TO THE REST OF THE LIVER
45. T/F The normal caudate lobe is less echogenic than the right and left lobes of the liver.
True ELEVATED DIRECT SERUM BILIRUBIN USUALLY INDICATES MECHANICAL OBSTRUCTION TO THE FLOW OF BILE OUTSIDE THE LIVER. THE DIRECT BILIRUBIN IS BLOCKED FROM ITS FLOW FROM THE LIVER & INSTEAD FLOWS INTO THE BLOODSTREAM.
46. T/ F Elevated levels of direct bilirubin usually indicate biliary obstruction outside the liver.
NO. ADENOMYOMATOSIS (DIVERTICULOSIS OF THE GALLBLADDER) IS A BENIGN PROLIFERATION OF THE GALLBLADDER WALL TISSUE. THE ASSOCIATED WALL THICKENING MAY BE DIFFUSE OR FOCAL. COMET TAIL ARTIFACTS MAY BE PRESENT DUE TO SMALL TRAPPED STONES IN THE RA SINUSES. THE PT W/ ADENOMYOMATOSIS IS USUALLY ASYMPTOMATIC. (extra side note) BUT JAUNDICE IS ASSOC. W/ CLINICAL SIGNS AND SYMPTOMS OF GB CARCINOMA. POSS. JAUNDICE (IF BILIARY TREE IS INFILTRATED).
47. Is jaundice associated with Adenomyomatosis of the gallbladder.
False (PPT 21 SLIDE 18). Infertility and cancer is associated with Cryptorchidism.
48. T/F Cryptorchidism is associated with a previous episode of the Mumps.
NO. PORCELAIN GB CONDITION IS NOT CONGENITAL. IN PORCELAIN CONDITION THE GALLBLADDER'S WALL IS CALCIFIED. THIS MAY BE DUE TO STAGNATION OF BILE, CHRONIC LOW GRADE INFECTION, OR CHRONIC IRRITATION OF THE WALL BY A STONE.
49. Porcelain gallbladder is it congenital condition?
-Round even borders -Anechoic -Demonstrate posterior enhancement
5. Know the ultrasound appearance of a simple renal cyst
YES, SPICULATED, LOBULATED, IRREGULAR, MICROLOBULATED, ILL DEFINED & ANGULAR ARE ALL ASSOCIATED WITH MALIGNANCY OF BREAST.
50. Is a spiculated mass in the breast is suspicious for malignancy?
No it is a benign liver tumor
51. Is hemangioma of the liver a malignant condition?
Yes, RCC can mets to renal veins, IVC, contralateral kidney, adrenals, para aortic nodes, lung, liver, brain, long bones
52. Renal cell carcinoma may invade the renal vein?
False, they are usually benign
53. T/F A breast fibroadenoma has a strong potential for malignancy.
True
54. T/F A simple breast cyst will most likely change shape with compression.
False, it affects women between the ages of 20 -40 years old
55. T/F Fibrocystic breast disease is most common in women over 50 years of age.
congenital cyst- like dilation of the CBD
56. A choledochal cyst -is it congenital, know location of this cyst, which duct is involved in it.
upper outer quadrant
57. The majority of breast carcinomas occur in
not vibrate and will not generate color on doppler
58. Using the fremitus maneuver in ultrasound examination of breast tissue, the suspected mass (if real) should
Benign solid tumor
59. A fibroadenoma of the breast -is it benign or malignant, solid or cystic.
Hepatoblastoma
6. In children, the counterpart of hepatocellular carcinoma is ____________________
Peri-renal transplant fluid collections is a collection of fluid that develops in the space surrounding a renal transplant. The collections can be present at any point at any time from the immediate post transplant period to several months post transplant. This can cause dysfunction of the transplanted kidney ALSO SEE LYMPHOCELE, URINOMA, HEMATOMA, & SEROMA, ALL CAN BE SEEN AFTER A RENAL TRANSPLANT
60. Know post -renal transplant fluid collections
Milk filled cyst, ALSO CALLED COMPLEX CYST, DIRTY SHADOWING, HYPOECHOIC, RED & PAINFUL, ILL DEFINED
61. What is galactocele?
● Well marginated borders ● Hypoechoic to isoechoic ● Homogenous ● Without through transmission ● Thin echogenic pseudocapsule ● Wider than tall ● May compress ● Edge shadowing
62. Which of the following is a more ominous finding when visualizing a solid breast lesion?
COMPLEX CYSTS, DIRTY SHADOWING, HYPOECHOIC WITH INTERNAL ECHOES, REDNESS PAIN, IRREGULAR BORDERS, ILL DEFINED BORDERS
63. Abscess- know US appearance, signs & symptoms (BREAST )
IN A LONG SONAGRAM IT IS SEEN AT THE POSTERIOR- SUPERIOR (POSTEROSUPERIOR) OF THE TESTICLE AT THE HEAD OF THE EPIDIDYMIS.
64. A spermatocele would most likely be visualized on a LONG sonogram as
GENDER (females more than males) Most important risk factor THE PT IS FEMALE, BREAST CANCER IS 100 TIMES MORE COMMON IN WOMEN THAN IN MEN. SECOND MOST COMMON IS AGE, RISK INCREASES WITH AGE AGE (higher with advanced age) 2nd most important risk factor FAMILY HISTORY PRIOR HISTORY OF BREAST CANCER MENSTRUAL HISTORY CHILD BEARING HISTORY HORMONAL FACTORS ATYPICAL HYPERPLASIA RADIATION THERAPY OBESITY
65. Highest risk factor for malignant breast disease is
-Prostate cancer -Prostatitis -BPH -Surgical manipulation
66. Elevated levels of Prostate Specific Antigen (PSA) are found in
(HARTMANN'S POUCH) - fold between the body and infundibulum (neck) of gallbladder ; most frequent variation
67. Junctional fold - know what is it
Reproductive system
68. Many congenital anomalies of the urinary tract are linked with anomalies of what other body system?
3 mm head 2 mm body
69. Normal diameter of the pancreatic duct in the body of the pancreas in the young adults is
-Diaphragm -right kidney -pancreas
7. The liver can be used as a sonographic window for which of the following organs or structures?
Axilla
70. The Tail of Spence is located in
Duct of Wirsung-is the main pancreatic duct that extends from tail through the head of the pancreas. Also joins with CBD at ampulla of vater. ACCESSORY DUCT: DUCT OF SANTORINI
71. What is the main pancreatic duct?
Undersurface of medial left lobe; trapezoid in shape, located between the gallbladder fossa and falciform ligament
72. The quadrate lobe of the liver is a part of?
GDA
73. A major branch coming off of the common hepatic artery is the
-Follow up after mammogram -evaluation when mammography is not recommended -evaluation of dense breast tissue -evaluation of the male breast
74. Indications for a breast ultrasound examination:
Anterior and posterior segments
75. The two segments of the right lobe of the liver are named
left renal vein
76. The vessel, which courses between the aorta and superior mesenteric artery, is:
Thin echogenic line, posterior portion of testicle in SAG and ovoid in TRV
77. US appearance of mediastinum testis:
-Triangular shaped - echo poor(most hypoechoic) -surround sinus LOCATED BETWEEN RENAL CORTEX & RENAL SINUSES
78. US appearance of Medullary pyramids:
True
79. T/F Pampiniform plexus is a venous network posterior to the testicles
Seminal
8. The prostate gland produces _______________ fluid
3-5 cm SAG 2-4 cm TRV 3 cm AP size and weight decrease with age
80. Know normal size of testicle:
Thyroid Stimulation Treatment Patients with history/currently receiving neck radiation
81. Increased incidence of thyroid carcinoma is associated with
Check kidney for hydronephrosis and check post void residual volume BLADDER
82. If the prostate is judged to be enlarged, the sonographer should also check
Annular pancreas
A ring of extra pancreatic tissue covers the first part of the small intestine
Adult polycystic kidneys (APKD)
Bilateral enlargement of kidneys with cysts too numerous to count
Thyroglossal duct cyst
Cystic mass located ML ANTERIOR to TRACHEA, congenital anomaly
Varicocele
DILATED VEINS IN TESTES
1. Junctional fold: between neck and body 2. Phygerian cap: between funds and body
Different folds in the GB:
Hepatocellular CA
Increased risk with hepatitis B & C, Increased risk with cirrhosis, LFTs may be normal or elevated, AFP may be elevated
Hepatitis
Inflammation of the liver, usually caused by a viral infection, that causes fever, loss of appetite, jaundice, fatigue, and altered liver function.
Phyllodes tumor
Leaf like appearance
Transitional cell CA
Originates from transitional cells of urinary tract, bladder is most common place, may also be found in kidney, pelvis, ureter
Ureteropelvic junction
Partial or total blockage where the kidney and ureter are joined
lymphocele, urinoma, hematoma and seroma.
Post renal surgeries, (especially renal transplant) you will see _________________
Acute Cholecystitis
Stone blocking cystic duct, life threatening
the thyroid gland.
The halo sign represents adenoma in ______________
Staghorn calculus
Type of infective stone, fills entire renal pelvis to proximal ureter, oddly shaped
Splenomegaly, ascites, hyperechoic, poor penetration, distortion in the liver parenchyma
US characteristics of hepatocellular disease?
Left renal vein
Which vessel goes between the aorta and mesenteric artery?
Orchitis
inflammation of the testes