ABD: CTL Pathology 42% Pancreas and Spleen
massive splenomegaly is defined as a spleen that exceeds ____________ in length a. 18 cm b. 13 cm c. 15 cm d. 23 cm
a. 18 cm
which of the following is an expected finding with asplenia? a. IVC on the left side of the body b. aorta on the left side of the body c. presence of multiple spleens d. liver on the right, GB on the left
a. IVC on the left side of the body (this is a type of heterotaxia that causes double right-sidedness. it involves the absence of the spleen, right sided aorta, left sided IVC, midline liver and GB, horseshoe kidney and congenital heart defects are common)
a 56yr old male presents with acute onset of epigastric pain that has persisted for about 2 days. his lab tests demonstrate elevated amylase and lipase. multiple mobile echogenic foci are present in the GB with a wall thickness of 2.4mm. the CBD measures 6 mm and appears patent. the panc is mildly enlarged with posterior enhancement. which of the following best describes these findings? a. acute pancreatitis with cholelithiasis b. adenomyomatosis with cholelithiasis and cholecystitis c. cystic fibrosis with cholelithiasis d. chronic pancreatitis with cholelithiasis
a. acute pancreatitis with cholelithiasis (increased amylase and lipase alone with inflammation and fluid within the panc which causes posterior enhancement are all signs of acute pancreatitis. increased bilirubin can be related to the cholelithiasis)
which of the following statements is true regarding the image displayed of the pancreas? a. amylase and lipase will be increased in this patients lab values b. the pancreas is decreased in size and echogenicity c. the pancreas is increased in size and echogenicity d. amylase levels will be increased and lipase levels will be decreased
a. amylase and lipase will be increased in this patients lab values (the pancreas has increased in size but decreased in echogenicity due to fluid accumulation with the acute infection, which would increase amylase and lipase levels)
what congenital anomaly of the pancreas results in duodenal obstruction? a. annular pancreas b. aberrant pancreatic tissue c. pancreatic sequestration d. pancreatic divisum
a. annular pancreas (panc head surrounds 2nd portion of duodenum resulting in complete or partial obstruction of duodenum)
when a pancreas transplant has enteric drainage: a. bowel should be evaluated for obstruction b. it is common for the stomach to be dilated with pancreatic juices c. the allograft will be located in the chest d. the urinary bladder should be evaluated for abnormalities
a. bowel should be evaluated for obstruction (the main common drainage routes for panc juices in a transplant are into the bowel, enteric, and into the bladder. images of bowel to look for obstruction with enteric drainage are important. with bladder drainage, images of the bladder should be obtained)
retrograde flow in the splenic artery would most likely indicate: a. celiac axis occlusion b. chronic systemic HTN c. mild portal HTN d. left gastric artery occlusion
a. celiac axis occlusion (if the celiac axis is occluded, the splenic artery will receive no blood because it is distal to the celiac origin. the lack of blood in the splenic artery will cause a significantly low pressure within the vessel that will allow collateral flow to occur. as the blood enters the empty splenic artery from a point distal to its origin from the celiac, it will flow back towards the origin to the point of obstruction)
what are the two most common causes for the abnormality displayed? a. choledocholithiasis and alcoholism b. hepatitis and cholecystitis c. cirrhosis and gastric carcinoma d. steroid and ibuprofen abuse
a. choledocholithiasis and alcoholism (biliary tract disease and alcoholism are the most common causes for acute pancreatitis)
a splenic _________________ is a cartilaginous tumor a. chondroma b. hamartoma c. fibroma d. osteoma
a. chondroma (b is a hypervascular tumor associated with tuberous sclerosis or wiskott-aldrich syndrome c. is composed of fibrous tissue d. is related to bone disease)
alcohol abuse is the most common cause for: a. chronic pancreatitis b. renal failure c. acute pancreatitis d. cholecystitis
a. chronic pancreatitis (alcohol consumption is the most common cause for micronodular cirrhosis and chronic pancreatitis)
all of the following are potential malignant features of a pancreatic cyst, except? a. cyst size <3 cm b. increase in cyst size on serial examinations c. internal nodule d. thickened septations
a. cyst size <3 cm (cysts that have all the other features and are LARGER than 3 cm would be cause for malignancy)
a pseudocyst has no _______________, which helps to differentiate it from a true pancreatic cyst a. epithelial lining b. pancreatic enzymes within it c. posterior shadowing d. posterior enhancement
a. epithelial lining (a simple cyst is formed with an epithelial lining. a pseudocyst has no capsule and fills available spaces as it forms, commonly in the lesser sac)
which of the following is considered a direct sign of pancreatic adenocarcinoma? a. hypoechoic mass in the panc head b. liver mets c. palpable GB d. biliary ductal dilatation
a. hypoechoic mass in the panc head (that is a direct sign, an indirect sign occurs in. other organ systems when an abnormality is present. the other choices are indirect results of a mass in the pancreatic head)
if a peripheral, wedge-shaped, hypoechoic lesion is identified in the spleen, what should be the first diagnosis considered? a. infarction b. hamartoma c. tuberculosis d. Hodgkins lymphoma
a. infarction (classic appearance of an infarction. b. is a benign mass that is round or oval c and d cause diffuse changes in the splenic tissue)
the image demonstrates the most common form of pancreatic endocrine tumor (PET) of the pancreas. what type of PET is displayed? a. insulinoma b. pseudocyst c. adenoma d. fibroma
a. insulinoma (3 types of PET (islet cell tumors); insulinomas ((#1)), gastrinomas, glaucomas)
a patient suffers from multiple endocrine neoplasm syndrome. the findings on the image are most suggestive of: a. islet cell tumor b. cystadenocarcinoma c. lymphoma d. pheochromocytoma
a. islet cell tumor
which of the following is most commonly found in the pancreatic body or tail and secretes hormones? a. islet cell tumors b. pseudocysts c. macrocystic adenoma d. microcystic adenoma
a. islet cell tumors (insulinomas and gastrinomas are types of islet cell tumors that secrete hormones. insulinomas secrete insulin and gastrinomas secrete gastrin)
asplenia is associated with all of the following, except: a. liver on the right, GB on the left b. aorta on the right side of the body c. absence of the spleen d. congenital heart defect
a. liver on the right, GB on the left (this is a type of heterotaxia that causes double right-sidedness. it involves the absence of the spleen, right sided aorta, left sided IVC, midline liver and GB, horseshoe kidney and congenital heart defects are common)
which of the following correctly describes the findings on the image? a. lymphadenopathy b. portal thrombosis c. normal anatomy d. Klatskin tumor
a. lymphadenopathy (the image demonstrates an abnormally large periportal lymph node anterior to the IVC)
which of the following is a malignant splenic neoplasm? a. lymphoma b. hamartoma c. hemangioma d. granuloma
a. lymphoma (all of the other options are benign masses)
a patient presents with LUQ pain, loss of appetite and elevated levels of lactate dehydrogenase. the findings on the image are most suggestive of: a. non-hodgkins lymphoma b. mononucleosis c. granulomas d. hamartomas
a. non-hodgkins lymphoma (multiple hypoechoic nodules throughout the spleen, enlarged spleen, perisplenic lymph nodes visible outside the spleen as rounded hypoechoic masses. this indicates malignancy. non-hodgkins causes elevated LDH and is the most common lymphoma seen in the spleen)
which of the following results from embryonic failure of fusion of the pancreas tissues? a. pancreas divisum b. Whipple pancreas c. ectopic pancreas tissue d. annular pancreas
a. pancreas divisum
biliary atresia and congenital absence of the GB are associated with which complex congenital defect? a. polysplenia b. asplenia c. pancreas divisum d. annular pancreas
a. polysplenia (double-left sidedness. associated with the formation of multiple spleens, and right sided defects such as interrupted IVC, biliary atresia and absence of GB)
all of the following are associated with gastrinoma formation in the pancreas, except: a. significantly decreased levels of amylase production b. increased serum levels of gastrin c. associated with Zollinger-Ellison syndrome d. symptoms include indigestion and esophageal reflux
a. significantly decreased levels of amylase production (Z.E. syndrome refers to the formation of gastrinomas in the panc or duodenum and can lead to b and d.)
the bright band sign is characteristic of: a. splenic infarction b. rectus abdominus hematoma c. hepatitis d. biliary tree dilatation
a. splenic infarction (bright band sign= hyperechoic linear shaped bands within splenic infarct lesions of different ages)
a fluid collection between the diaphragm and splenic capsule may represent: a. subphrenic abscess b. subcapsular hematoma c. pericardial effusion d. pleural effusion
a. subphrenic abscess (sub means below and phrenic means below the diaphragm. a would be an abscess located under the diaphragm adjacent to the capsule b. would be between the splenic tissue and capsule c. would be located above the diaphragm d. would be around the heart)
which of the following statements is true regarding pancreatic masses? a. the location of a mass in the head of he panc usually indicates a malignant process b. the location of a mass in the tail of the panc usually indicates a malignant process c. a pancreas tail mass is commonly mistaken for a mass in the caudate lobe d. a round mass with smooth boarders is usually a malignant process
a. the location of a mass in the head of he panc usually indicates a malignant process (masses in the tail are usually benign masses near the tail are commonly mistaken for splenic pathology smooth round masses are usually benign)
the splenic vein measures 5 mm in diameter. if the diameter increases to 10 with deep inspiration: a. the response is normal b. duodenal obstruction should be suspected c. portal HTN should be suspected d. the celiac axis should be evaluated for obstruction
a. the response is normal (normal splenic diameter is 5-10 mm. the diameter normally increases 50-100% from respiration, and go from 5 mm to 2.5 to 5 mm with deep inspiration. if diameter increases less than 20% portal HTN should be suspected)
what do pancreatic adenocarcinoma and focal pancreatitis have in common? a. they both most commonly occur in the pancreatic head b. they both cause a significant increase in alpha-fetoprotein levels c. they both are usually treated using the Whipple procedure d. they both most commonly occur in the pancreatic tail
a. they both most commonly occur in the pancreatic head (b. would increase in certain types of tumors but would not demonstrate any change with pancreatitis c. is a surgical resection for panc cancer d. they both do not occur in the tail)
gastrinomas are the most common islet cell tumors seen with: a. cystic fibrosis b. MEN syndrome c. epstein barr syndrome d. kasbach-merritt syndrome
b. MEN syndrome (MEN= multiple endocrine neoplasia. other findings include parathyroid adenoma and pituitary adenoma)
______________________ refers to a rare genetic disorder characterized by visceral cysts, renal and pancreatic cysts, benign masses, and the potential for malignant transformation in multiple organ systems. a. Osler-Weber-Rendu syndrome b. Von Hippel Lindau syndrome c. Edwards syndrome d. Polycystic disease
b. Von Hippel Lindau syndrome
RCC, insulinoma, and pancreatic cystadenoma are associated with what syndrome? a. multiple endocrine neoplasia syndrome b. Von Hippel Lindau syndrome c. Beckwith-Wiedmann syndrome d. Gaucher disease
b. Von Hippel Lindau syndrome (associated with formation of tumors and cysts in many different parts of the body)
which of the following correctly describes angiosarcoma of the spleen? a. very responsive to chemo with good prognosis b. arises from the vascular endothelium and demonstrates increased vascularity c. usually presents as a homogeneous hyperechoic mass near the periphery of the spleen d. most common primary malignancy of the spleen
b. arises from the vascular endothelium and demonstrates increased vascularity (angiosarcoma is a primary malignant neoplasm of the spleen. it is very rare and aggressive with high rates of mets and poor prognosis. the tumor arises from the vascular endothelium. us feats. are splenomegaly with heterogeneous echotexture, complex mass with cystic and solid components with increased vascularity)
why does the spleen have an increased risk of infarction compared to the other abdominal organs? a. because of the small size of the splenic vein and increased risk fo stasis thrombosis b. because the intrasplenic arteries do not have communicating branches c. because there is only one intrasplenic artery d. because it is non-encapsulated
b. because the intrasplenic arteries do not have communicating branches (other organs and extremities have smaller connects between the different arteries supplying the part and allows for collateral circulation when needed. the lack of anastomoses in the intrasplenic arterial circulation eliminates the possibility of collateral formation when infarction occurs.)
splenic torsion is most commonly associated with: a. accessory spleen b. ectopic spleen c. gaucher disease d. asplenia
b. ectopic spleen (aka wandering spleen, spleen moves in different positions in the abdomen. weak spleen ligaments lead to the organ migrating to unusual locations and can be mistaken for a mass. the abnormal location can lead to an increase risk of torsion resulting in significant pain)
which of the following usually affects the pancreatic head? a. cystadenoma and islet cell tumors b. focal pancreatitis and adenocarcinomas c. adenocarcinoma and cystadenoma d. pseudocyst and focal pancreatitis
b. focal pancreatitis and adenocarcinomas (cause biliary duct dilatation and Courvoisier GB)
a 56yr old male presents with epigastric pain, nausea and a chronic history of alcoholism. lab values demonstrate increased levels of amylase and lipase. hematocrit levels are below normal values. the US exam demonstrates a hypoechoic, enlarged pancreas with periglandular fluid. which of the following best describes the finding? a. phlegmon b. hemorrhagic pancreatitis c. acute pancreatitis d. chronic pancreatitis
b. hemorrhagic pancreatitis (decreased hematocrit levels and periglandular fluid are the keys to this question. the enzymes have damaged the panc tissue and vessels causing bleeding around the organ. a bleed will present with dropped hematocrit levels)
all of the following are considered indirect signs of pancreatic adenocarcinoma, except? a. palpable GB b. hypoechoic mass in the pancreatic head c. liver mets d. biliary ductal dilation
b. hypoechoic mass in the pancreatic head (that is a direct sign, an indirect sign occurs in. other organ systems when an abnormality is present. the other choices are indirect results of a mass in the pancreatic head, like a cause and effect)
which of the following is a common complication of cystic fibrosis a. renal calculi b. meconium ileus c. portal HTN d. AAA
b. meconium ileus (cystic fibrosis causes an increase of echogenicity of the pancreas with mucus production and gland fibrosis. this mucus can cause meconium ileum)
the most likely primary malignancy to the spleen is __________________. the most common malignancies that metastasize to the spleen are _____________________ a. RCC, breast and thyroid adenocarcinoma b. melanoma, lung and breast cancer c. lung cancer, breast and parathyroid adenocarcinoma d. breast cancer, melanoma and HCC
b. melanoma, lung and breast cancer (melanoma is the most likely primary cx to spread to the spleen but it occurs less frequently than other primary cx mets from the lungs and breast are the most common primary cx with splenic mets)
a patient presents for an abdominal US due to a history of elevated amylase. she was dx 5 years ago with Von Hippel Lindau syndrome. you identify a round, lobulated hyperechoic mass in the body of the pancreas. mild posterior enhancement is present. these findings are most suggestive of: a. adenocarcinoma b. microcystic cystadenoma c. pseudocyst d. sphincter of Oddi carcinoma
b. microcystic cystadenoma (V.H.L. refers to the formation of tumors and cysts in many different parts of the body, including the panc that may be benign or malignant. b. would appear as a mass of very tiny cysts the is hyperechoic with mild post. enhancement with larger masses a. is most commonly hypoechoic and can cause post. shadowing near the head of the panc c. is a primarily cystic mass seen near the tail d. would be seen near the head of the panc
a patient presents with a recent history of a histoplasmosis infection. the referencing doctor would like to evaluate the abdomen for residual effects from the infection. which sonographic findings in the abdomen wold be consistent with this type of infection? a. mild to moderate ascites and splenomegaly b. multiple echogenic foci in the liver and or spleen parenchyma c. dilated ductal system of the liver with inflammation (cholangitis) d. significant amount of lobulated ascites in the belated paracolic gutters
b. multiple echogenic foci in the liver and or spleen parenchyma (histoplasmosis is a type of granulomatous infection that leads to the formation of echogenic foci throughout the spleen or liver)
a patient presents with a recent diagnosis of lymphoma. which of the following is an expected finding on the US? a. multiple splenic varices at the hilum b. multiple solid tumors are present causing marked increase in splenic size c. mildly enlarged spleen due to fluid accumulation d. solitary hyperechoic mass with peripheral hypervascularity
b. multiple solid tumors are present causing marked increase in splenic size (leukemia, lymphoma or myelofibrosis would cause a severe splenomegaly with multiple solid tumors causing increased spleen size aids, portal HTN and infection would cause mild to moderate splenomegaly due to increased blood pooling or edema with infection)
what is the most common abdominal lesion seen with Von Hippel Lindau syndrome? a. liver adenoma b. pancreatic cysts c. fatty liver sparing d. RCC
b. pancreatic cysts (panc cysts are the most common type of lesion seen with VHL disease. multiple cysts are more common with VHL disease than ADPKD)
which of the following is commonly associated with pancreatitis? a. annular pancreas b. pancreatic divisum c. low fat diet d. high fat diet
b. pancreatic divisum (occurs when the panc forms in two separate pieces. this leads to abnormal drainage paths and leakage of the enzymes which is why it typically causes pancreatitis. c. leads to bile stasis sludge and stones d. leads to steatosis)
a patient presents with a history of fever and vomiting with increased serum levels of amylase and lipase. while scanning the abdomen you note a complicated cyst in the anterior pararenal space on the left side. these findings are most consistent with: a. GI tract mass b. pancreatic pseudocyst c. splenic aneurysm d, splenic varicies
b. pancreatic pseudocyst (pt suffers from pancreatitis consistent with the lab values. pseudocyst formation in the left pararenal space is a common complication)
pseudoaneurysm formation, biliary obstruction and phlegmon are complications of: a. insulinomas b. pancreatitis c. non-alcoholic steatosis d. alcoholic cirrhosis
b. pancreatitis (pancreatitis is related to pseudocyst, abscess phlegmon, hemorrhage, pseudoaneurysm, and ascites. biliary obstruction can occur due to extrinsic compression of the ducts within the head of the panc with inflammation)
which of the following statements regarding insulinomas is true? a. commonly associated with a peptic ulcer b. patients are usually hypoglycemic c. most patients require an insulin pump to counteract the effects of the tumor on the serum glucose levels d. they commonly occur in the head of the pancreas
b. patients are usually hypoglycemic (insulinomas lead to an increase of insulin in the blood leading to hypoglycemia they are usually found in the body and tail of the pancreas c. would be for pts not producing enough insulin and d is a tumor)
gamma-gandy bodies result in: a. aneurysm formation in the aorta b. splenic calcifications c. aneurysm formation in the splenic artery d. hypothyroidism
b. splenic calcifications (organized foci of hemorrhage in the spleen seen with portal HTN. they contain hemosiderin, fibrous tissue, and calcium and appear as calcs on US)
chronic infection in soft tissue organs typically leads to: a. the development of cavernous transformation b. the formation of calcs c. there is a small bowel obstruction at the duodenum resulting in fecalith formation around the head of the panc d. the development of systemic hypertension
b. the formation of calcs (chronic infection in a soft tissue organ typically leads to calc formation.)
a patient presents with LUQ pain after a fall. which of the following describes the findings seen on the image? a. the spleen is surrounded by ascites b. the spleen capsule is intact but there is an intraparenchymal and subcapsular hematoma present c. the spleen capsule has ruptures and hematoma formation has occurred d. splenic veins are dilated at the hilum and within the spleen, most likely related to portal HTN
b. the spleen capsule is intact but there is an intraparenchymal and subcapsular hematoma present (the splenic capsule is intact. there is fluid present within the capsule area near the hilum and within the splenic tissue)
which of the following statements is true regarding the image displayed? a. there is a cyst in the posterior left lobe of the liver b. there is a simple cyst in the body of the panc c. there is a spotted cyst in the tail of the panc d. the SMA is dilated to a size similar to the aorta
b. there is a simple cyst in the body of the panc (it is located in the anterior aspect of the body of the panc.)
which of the following are vascular complications seen with pancreatitis? a.portal HTN and biliary stricture b. thrombosis of the splenic vein or pseudoaneurysm of the splenic artery c. cholecystitis and phlegmon formation d. progression of Budd Chiari syndrome and the development of congestive heart failure
b. thrombosis of the splenic vein or pseudoaneurysm of the splenic artery (those are the most important vascular complications seen with pancreatitis. these issues are related to the pancreatic enzymes causing vascular erosion of the vessels near the pancreas)
weakened gastrosplenic and splenorenal ligaments can lead to: a. asplenia b. wandering spleen c. situs inverses d. polysplenia
b. wandering spleen (caused by weakened ligaments and can lead to an ectopic spleen in an abnormal position in the abdomen. if the spleen is absent from the LUQ, scan the rest of the abdomen for a mass of tissue with the expected size and echotexture of the spleen. this condition can increase risk for splenic torsion)
splenic calcifications are commonly seen with what type of infection? a. parasitic b. echinoccoal c granulomatous d. AIDS
c granulomatous (caused by bacteria. chronic infection can lead to calcification formations within the spleen)
a patient presents with congenital absence of the spleen this condition is called: a. hamartoma b. accessory spleen c. asplenia d. splenomegaly
c. asplenia (a is a benign vascular mass that forms within the splenic tissue b is normal splenic tissue located outside the main organ d. is enlargement of the spleen)
splenic vein thrombosis is a common finding in patients with: a. pancreatic divisum b. splenic infarct c. chronic pancreatitis d. splenic hemangioma
c. chronic pancreatitis
glandular atrophy, dilated main duct and intraductal calculi are hallmarks signs of: a. cholangitis b. chronic renal failure c. chronic pancreatitis d. chronic cholecystitis
c. chronic pancreatitis (these are all hallmark signs of chronic pancreatitis)
which of the following describes the sonographic appearance of the pancreas with chronic cystic fibrosis? a. increased size with mottled echogenicity, no definite nodules b. decreased size with hypoechoic modularity throughout the gland c. decreased in size and increased overall echogenicity d. increased size with nodule and calcification formation
c. decreased in size and increased overall echogenicity as the panc continues to produce the mucous substance, the gland becomes fibrotic. these changes lead to an increase in echogenicity and decrease in size)
what causes pseudopancreatitis? a. hepatitis b. cholecystitis c. fatty liver d. polycystic liver disease
c. fatty liver (fatty liver can cause the panc to look hypoechoic due to sound attenuation in the liver. lab values and evaluating the GB and biliary system can help to determine pancreatitis)
what effect does polycythemia vera have on the sonographic appearance of the spleen? a. multiple hypoechoic masses less than 1 cm in diameter b. diffuse increase in echogenicity and hypervascularity c. marked splenomegaly with normal echogenicity d. multiple echogenic foci in an atrophied spleen
c. marked splenomegaly with normal echogenicity (polycythemia is a rare type of blood cancer that causes bone marrow to make too many RBCs. this leads to marked splenomegaly and the spleen remains normal echogenicity)
what congenital anomaly of the pancreas results in two separate ductal systems that drain the pancreas? a. pancreatic sequestration b. aberrant pancreatic tissue c. pancreas divisum d. annular pancreas
c. pancreas divisum
which of the following is the cause of the findings on the images? a. portal thrombosis b. cholelithiasis c. pancreatic adenocarcinoma d. Klatskin tumor
c. pancreatic adenocarcinoma (pancreatic carcinoma would lead to a dilated biliary tree
it may be difficult to differentiate a ________________ from a splenic disease process at the hilum a. liver mass in the caudate lobe b. duodenal tumor c. pancreatic pseudocyst d. right renal cyst in the upper pole
c. pancreatic pseudocyst (these are most commonly located near the tail of the panc, adjacent to the splenic hilum. the other findings would be in the RUQ or midline in the liver not near the spleen)
splenic vein thrombosis and splenic artery pseudoaneurysm formation are vascular complications seen with: a. Zollinger Ellison syndrome b. cirrhosis c. pancreatitis d. renal artery stenosis
c. pancreatitis (these complications are associated with pancreatitis. the pancreatic enzyme escape the ductal system and can have a negative affect on surrounding vasculature leading to thrombus and/or pseudoaneurysm formation)
a patient tells you they have undergone the Whipple procedure. what did they have done? a. renal transplant b. liver resection c. partial removal of the pancreas d. thyroidectomy
c. partial removal of the pancreas (aka pancreaticduodenectomy, most commonly performed operation to tx pancreatic cancer but can also be done for chronic pancreatitis or benign tumors. the panc head is removed and sometimes the body, duodenum, GB, part of the jejunum, stomach, bile duct and lymph nodes near the panc)
the most common cause of splenomegaly is ________________ a. mononucleosis infection b. malignant HTN c. portal HTN d. AIDS
c. portal HTN
a patient presents for a post-transplant evaluation of the pancreas. where is the most common location for the allograft? a. epigastric area b. LLQ c. right iliac fossa d. periumbilical area
c. right iliac fossa
splenic atrophy in adults is often associated with: a. splenitis b. tuberculosis c. sickle cell anemia d. typhoid fever
c. sickle cell anemia (sickle cell is determined by abnormally shaped RBCs that carry abnormal forms of hemoglobin. these abnormal cells can cause pooling of the blood in the spleen. the spleen will first become enlarged and painful from the increase of blood volume, then eventually become scarred and permanently damaged from the continuous strain leading to atrophy)
a patient presents with LUQ pain and no lab findings. he had a splenectomy 4 years ago after a car accident. there are 2 homogenous masses with smooth boarders measuring <3cm located lateral and anterior to the panc tail. internal vascularity is identified. these findings are most suggestive of: a. circumscribed hematomas b. lymphatic adenopathy c. splenosis d. abscess formation
c. splenosis (these are all signs of splenosis which can happen after splenectomy or splenic rupture due to autotransplantation. this condition is better evaluated with nuclear medicine exams because of the ability to assess function)
the double duct sign refers to the dilatation of: a. the main pancreatic duct and accessory pancreatic duct b. the CBD and cystic duct c. the CBD and duct of Wirsung d. right and left hepatic ducts
c. the CBD and duct of Wirsung (a mass in the head of the panc can cause this. this will cause dilatation of both ducts that begins at the mass and moves outward in both ductal systems. this is commonly associated with pancreatic adenocarcinoma)
which statement best describes the images displayed? a. the mass in the pancreas is most likely a pseudocyst because of the adjacent infection identified in the liver b. the mass in the pancreas is most likely thrombosis of the splenic vein because of portal branch thrombosis seen in the liver c. the mass in the pancreas is most likely adenocarcinoma because of the mets identified in the liver d. the mass in the pancreas is most likely a pancreatic endocrine tumor because of the adenomas also identified in the adjacent liver
c. the mass in the pancreas is most likely adenocarcinoma because of the mets identified in the liver (a hypoechoic mass is present in the panc and two are seen in the liver. liver mets is more common than a primary malignancy. the panc mass is most likely malignant cancer spreading to the liver through the portal system)
where is the abnormality located within the spleen, if the image displayed is a left lateral approach with a coronal view? a. there is a splenic infarct present in the anterior, medial splenic tissue b. there is a splenic infarct present in the anterior, superior splenic tissue c. there is a splenic infarct present in the lateral, inferior splenic tissue d. there is a splenic infarct present in the superior, medial splenic tissue
c. there is a splenic infarct present in the lateral, inferior splenic tissue (in the lateral approach with a coronal view, the top of the image is lateral and the bottom is medal. the left side is cephalic and the right side is caudal)
spontaneous splenic rupture is associated with all of the following except: a. splenosis b. mononucleosis c. trauma d. HIV
c. trauma (while the spleen can rupture from trauma, it will not be spontaneous. spontaneous splenic rupture is associated with a, b or d due to a delay or dx of an underlying condition)
a patient presents for abdominal US with a hx of a renal and pancreatic transplant. what chronic medical condition is the primary reason for the double transplant? a. hypertension b. chronic pancreatitis c. type 1 diabetes d. pancreatic adenocarcinoma
c. type 1 diabetes (type 1 diabetes can lead to renal failure. panc transplants are performed to reduce insulin dependency caused by diabetes)
which of the following patients would most likely demonstrate a 10 cm spleen with homogenous echotexture? a. 65yr old female with mononucleosis b. 30yr old female with lymphoma c. 5'10" 250 lb male born with homozygous sickle cell anemia d. 50yr old with a splenic artery aneurysm
d. 50yr old with a splenic artery aneurysm (in most case, an aneurysm in the splenic artery will not affect spleen size. c would demonstrate a very small spleen a and b would show an enlarged spleen >12 cm in length)
splenic vein thrombosis can lead to what life threatening condition? a. splenic artery stenosis b. congestive heart failure c. splenic artery pseudoaneurysm d. GI bleed from gastric varices
d. GI bleed from gastric varices
a pseudocyst most commonly forms in which retroperitoneal space? a. posterior pararenal space b. perinephric space c. omental bursa d. anterior pararenal space
d. anterior pararenal space (this is the area that holds the pancreas)
congestive splenomegaly is an expected finding in patients with: a. ADPKD b. lymphoma and leukemia c. multicystic kidney disease d. congestive heart failure and splenic thrombosis
d. congestive heart failure and splenic thrombosis (congestive splenomegaly, aka Banti syndrome, is caused by excessive pooling of blood in the splenic tissues, commonly caused by d.)
a disorder that affects the pancreas by causing it to excrete a thick-mucus like substance that inhibits the exocrine function is called: a. pancreatitis b. tuberculosis c. insulinoma d. cystic fibrosis
d. cystic fibrosis
the X indicates what structure? a. dilated splenic vein b. dilated duct of Santorini c. dilated CBD d. dilated duct of Wirsung
d. dilated duct of Wirsung
which of the following is a common cause of a splenic abscess? a. portal HTN b. Gaucher disease c. cholecystitis d. endocarditis
d. endocarditis (endocarditis, septicemia, and trauma are the most common causes for splenic abscess. endocarditis is an infection of the lining of the heart and valves. the infection can spread through the arterial system to the spleen)
which of the following splenic tumors is associated with tuberous sclerosis or wiskott-alderich syndrome? a. chondroma b. hemangioma c. cystic lymphangioma d. hamartoma
d. hamartoma (associated with the two disorders, is a benign mass that usually compress and displace adjacent normal splenic tissue. b. is the most common benign tumor of the spleen composed of vascular tissue c. is a congenital benign splenic tumor that is composted of lymphatic tissues/ vessels a. is a cartilaginous tumor)
which of the following describes the sonographic appearance of acute pancreatic allograft rejection? a. small atrophied gland with numerous cals within the parenchyma b. small atrophied gland with numerous cysts within the parenchyma c. high resistance flow in the transplant arteries with numerous cals within the parenchyma d. high resistance flow in transplant arteries and heterogeneous appearance of the gland
d. high resistance flow in transplant arteries and heterogeneous appearance of the gland (acute would not allow time for the gland to atrophy, cyst formation, and calc formation. similar to the renal allograft, increased RI within the parenchyma would indicate rejection)
which type of pancreatic mass has a strong risk of malignant conversion? a. insulinoma b. gastrinoma c. microcystic adenoma d. macrocystic adenoma
d. macrocystic adenoma (serous cystadenoma of the panc is dividend into micro and macrocystic types. micro is always benign and macro has a strong risk for malignant conversion)
which of the following correctly describes non-hodgkins lymphoma a. more commonly affects lymph nodes in the arms, upper chest, and neck b. usually affects the retroaortic and pelvic lymph nodes first c. average patient age is 20yrs old d. much less responsive to treatment than hodgkins type
d. much less responsive to treatment than hodgkins type (non hodgkins is most common, less responsive ((NON=NOT GOOD)), average pt age is 60, no pattern for LN involvement, occurs in any LNs throughout the body
when inflammation from pancreatitis extends into the tissues surrounding the pancreas, this is called: a. biloma b. pseudocyst c. cystadenoma d. phlegmon
d. phlegmon (this can form a mass of inflamed tissues. a pseudocyst is a leakage of pancreatic enzymes into the peritoneal space)
the splenic vein measures 5 mm in diameter. if the diameter remains constant with deep inspiration: a. the response is normal b. duodenal obstruction should be suspected c. the celiac axis should be evaluated for obstruction d. portal HTN should be suspected
d. portal HTN should be suspected (normal splenic diameter is 5-10 mm. the diameter normally increases 50-100% from respiration, and go from 5 mm to 2.5 to 5 mm with deep inspiration. if diameter increases less than 20% portal HTN should be suspected)
when pancreatic enzymes leak into the peritoneal space, a __________________ forms a. phlegmon b. cystadenoma c. biloma d. pseudocyst
d. pseudocyst (a is a spread of inflammation from the pancreas to surrounding tissues. d is a leakage of pancreatic enzymes)
tuberculosis and __________________ will demonstrate similar US findings in the spleen. a. hemangioma b. infarction c. hamartoma d. sarcoidosis
d. sarcoidosis (they will both demonstrate multiple hypoechoic nodules in the spleen with active disease. after the nodules heal, they become echogenic foci that can demonstrate posterior shadowing)
which of the following is associated with an autosplenectomy? a. wandering spleen b. splenic hamartoma c. splenic lymphoma d. sickle cell anemia
d. sickle cell anemia (can lead to spleen enlargement and then atrophies as time passes as it becomes "clogged" with abnormal cells and stops working.the spleen atrophies and becomes very difficult to visualize. autosplenectomy refers to the process where the spleen fibrosis/atrophy occurs with loss of function)
splenosis is a complication of: a. portal HTN b. splenic infection c. sickle cell anemia d. splenic trauma
d. splenic trauma (splenosis autotransplantation of splenic tissue in peritoneal cavort when spleen rupture or splenectomy occurs. they are small masses of homogenous tissue that can be identified in various locations)
which of the following is an acquired abnormality of the spleen? a. splenunculi b. agenesis c. ectopic spleen d. splenomegaly
d. splenomegaly (an acquired condition commonly caused by infection and portal HTN. the rest are conditions you would potentially be born with)
which of the following describes splenomegaly? a. the spleen extends below the upper pole of the left kidney b. the spleen extends below the mid pole of the left kidney c. the spleen extends to a portion immediately adjacent to the panc tail d. the spleen extends below the lower pole of the left kidney
d. the spleen extends below the lower pole of the left kidney
a patient presents with a recent diagnosis of AIDS. which of the following statements is true regarding the sonographic appearance of spleen in this patient? a. multiple hypoechoic tumors will be present casing marked increase in size b. splenic hilum should be evaluated for varices c. the spleen will be severely enlarged with numerous punctate calcs d. the spleen will be moderately enlarged with a homogenous texture
d. the spleen will be moderately enlarged with a homogenous texture (leukemia, lymphoma, and myelofibrosis = severe splenomegaly AIDS, portal HTN and infection = mild to moderate splenomegaly
what are the two most common infections that cause granuloma formation in the spleen? a. mononucleosis and syphilis b. colitis and cholecystitis c. tuberous sclerosis and mononucleosis d. tuberculosis and histoplasmosis
d. tuberculosis and histoplasmosis (two most common infections that result in granuloma formation in the spleen)
