Abdominal Registry

superior border

base of prostate

classically bilateral-congenital condition without proper fixation of testis to scrotal wall

bell-clapper deformity

appears as an enlarged epididymitis, with decreased echogenicity and inhomogeneous echo texture. reactive hydrocele formation and skin thickening are associated findings

describe the sonographic findings associated with acute epididymitis.

sudden** onset of pain, N/V

clinical symptoms of testicular torsion

umbilical (congenital or acquired), epigastric, inguinal, femoral, and at the separation of the rectus abdominis

common locations for hernias

carpel tunnel syndrome (CTS)

entrapment or compression neuropathy of the median nerve

scrotal pearls

extratesticular calculi; mobile

portal vein flow toward the liver

hepatopetal

epididymitis

inflammation of the epididymis

orchitis

inflammation of the testes

vascular supply of the penis

internal pudenal artery

no

is bowel seen in a incarcerated hernia?

peripheral zone

largest amount of malignancies found in the prostate

1. kidney size less than 9cm in length 2. peak main renal artery velocity > 180 cm/sec 3. renal artery / aorta ratio >3.5 4. intrarenal parvus tardus waveform

list 4 sonographic criteria determining renal artery stenosis

1. cysts of varying shape and size 2. absence of communication between cysts 3. absence of renal sinus 4. absence of renal parenchyma

list 4 sonographic features of multicystic dysplastic kidney disease.

1. dilated thromboses renal vein 2. absence of venous flow within the kidney 3. enlarges hypoechoic kidney 4. high resistive renal artery waveform

list 4 sonographic indications for acute renal vein thrombosis

seminiferous tubules tubuli recti rete testis efferent ductules ductus epididymis vas deferens (Someone Tell Rachel Everyone Does Venous Scans)

list the order of normal anatomy of the scrotum

inner layer- covers testis and epididymis outer layer- lines scrotal chamber

list the two layers of the tunica vaginalis and what they cover/line

reverberation

multiple delayed reflections from strong tissue boundaries, such as bone, result in a linear artifact that decreases in intensity with depth

microcalcifications

multiple echogenic foci with no acoustic shadowing within the testes

1. hepatocellular carcinoma 2. metastatic liver disease 3. hepatoblastoma

name 3 abdominal masses associated with the elevation of alpha-fetoprotein

column of Bertin; dromedary hump; fetal lobation

name 3 anatomic anomalies that appear as psuedotumors of the kidney.

1. diaphragm 2. quadratus lumborum muscle 3. psoas muscle

name 3 notable structures posterior to the kidneys.

1. hepatocellular disease, which is destruction of hepatocytes that interfere with the excretion of bilirubin. (i.e. hepatitis, cirrhosis) 2. hemolytic disease, which occurs when the hepatocytes can not conjugate bilirubin fast enough to keep up with an increase in red blood cell destruction. this creates an increase in indirect or unconjugated bilirubin. (i.e. sickle cell anemia) 3. surgical jaundice, which is the mechanical obstruction of the biliary tree causing increases in direct or conjugated bilirubin. (i.e. choledocholithiasis, cholangiocarcinoma, pancreatic disease)

name and describe three causes of jaundice.

4x3x3cm epi head: 10-12mm

normal measurements of the testicles

2-8mm

scrotal wall thickness ranges between

superior

seminal vesicles located _____ to prostate

cryptorchidism

the testicles can become trapped anywhere along the path, and consequently never completely descend into the scrotum

fourth

the testicles develop in the upper abdomen near the kidneys and do not descend into the pelvis until the ______ week gestation

epigastric hernia

these hernias are found in the widest part of the linea alba between the xiphoid process and the umbilicus; usually filled with fat, which over the years may carry a piece of momentum along with it

main renal artery segmental arteries interlobar arteries arcurate arteries Interlobular arteries

trace the sequence of branching renal arteries from the aorta to the real capsule.

vascular incompetence

vascular compromise to or within the penis that results in the inability to obtain or maintain an erection

renal transplantation and posterior urethral valve obstruction; sonographically similar to lymphoceles

what 2 conditions are commonly associated with urinomas?

the superior mesenteric vein and splenic vein

what 2 veins join to form the main portal vein?

1. multiple thick septations 2. irregular walls 3. large solid components

what 3 criteria suggest that a cyst is atypical and possibly malignant?

liver matastases, lymphadenopathy, bile duct dilatation

what 3 other findings should be investigated to confirm the diagnosis of gallbladder carcinoma?

the shotgun sign and parallel channel sign both describe the appearance of a dilated bile duct adjacent to a portal vein.

what are 2 signs that indicate intrahepatic bile duct dilatation?

1. dependent echoes within a dilated pelvocaliceal system 2. shifting urine-debris level 3. gas shadowing from infection

what are 3 sonographic features of pyonephrosis?

1. round or ovoid shape 2. thin wall thickness 3. anechoic 4. acoustic enhancement

what are 4 sonographic criteria for a simple cyst?

diverticula within the wall of the gallbladder

what are Rokitansky-Ascholff sinuses (RAS)?

small well circumscribed masses, usually found within the pancreatic body and tail.

what are islet cell tumors?

collections of pancreatic fluid encapsulated by fibrous tissue

what are pancreatic pseudocysts?

1. acute pancreatitis 2. chronic pancreatitis 3. trauma 4. pancreatic cancer

what are some causes of pancreatic pseudocysts?

renal trauma, renal surgery or an obstructing lesion

what are some possible causes of urinomas?

1. small echogenic gland 2. calcifications 3. pancreatic duct dilatation 4. pseudocyst formation

what are sonographic signs are chronic pancreatitis?

aortic aneurysms are typically either fusiform, a spindle-shaped dilatation, or (rarely) saccular, a localized spherical outpouching of the vessel wall

what are the 2 different types of true aneurysms?

torsion of the spermatic cord epididymo-orchitis

what are the 2 most common causes of acute scrotal pain?

1. gallstones (choledocholihiasis) 2. pancreatic head mass

what are the 2 most common causes of biliary tract obstruction?

alcohol abuse and biliary calculi

what are the 2 most common causes of pancreatitis?

divides into the left gastric, common hepatic and splenic arteries

what are the branches of the celiac axis?

divides into the hepatic proper and the gastroduodenal arteries

what are the branches of the common hepatic artery?

ascites, splenomegaly and varices

what are the clinical signs of portal hypertension?

pyloric muscle thickness > 4mm pyloric channel length > 1.2 cm pyloric cross section > 1.5 cm

what are the sonographic criteria for hypertrophic pyloric stenosis?

hepatic vein thrombosis, ascites, hepatomegaly-acute phase, caudate lobe enlargement-chronic phase, portal hypertension

what are the sonographic finding associated with Buud-Chiari syndrome?

enlarged transplant; decreased cortical echogenicity; indistinct corticomedullary boundary; prominent hypoechoic medullary pyramids; peritransplant fluid collections

what are the sonographic findings associated with acute rejection of a renal transplant?

intralumnial thrombus, increased vein diameter, cavernous transformations

what are the sonographic findings of portal vein thrombosis?

dilated urinary bladder, hydroureter, hydroenphrosis and possibly a urinoma

what are the sonographic findings of urinary obstruction in male neonates?

infection associated with gas-forming bacteria within the wall of the gallbladder.

what is emphysematous cholecystitis?

dysplastic cystic dilatation of the collecting tubules of the medullary pyramids

what is medullary sponge kidney?

compression of the left renal vein between the superior mesenteric artery and the aorta. it is evident by the markedly dilated left renal vein as compared to the right renal vein. associated symptoms include: left-sided hematuria, abdominal pain, varicocele formation and possibly infertility

what is nutcracker syndrome?

an enzyme that increases with age and prostate volume

what is prostate specific antigen? (PSA)

presence of pus in a dilated renal collecting system, secondary to infected hydroenphrosis

what is pyonephrosis?

associated with appendix teste torsion

what is the "blue dot" sign?

detached efferent duct, which is seen as a small stalk projecting off the epididymis

what is the appendix epididymis?

remnant of the Mullerian duct. it appears sonographically as a small ovoid structure near the head of the epididymis

what is the appendix testis?

believed to be caused by incompetent valves in the internal spermatic vein

what is the cause of varicoceles?

hepatomegaly, jaundice and ascites

what is the classical clinical presentation of a patient with cirrhosis?

dilatation which involves all three layers of the aorta. most aortic aneurysms are in the distal aorta, and usually do not involve the renal arteries.

what is the definition of a true aortic aneurysm?

islet cells of Langerhans which secretes insulin

what is the endocrine function of the pancreas?

a remnant of the ductus venosus, which prenatally conducts blood from the left portal vein to the inferior vena cava. the ligamentum venous and the proximal portion of the left portal vein separate the medial segment of the left lobe of the liver from the caudate lobe.

what is the ligamentum venosum?

malignancies, infertility, klinefelter syndrome, and cryptorchidism

microcalfications in the testes has been associated with

umbilical area and the femoral and inguinal rings

most common areas of weakness in abdominal wall

epididymis

most common cause of acute testicular pain in adults

varicocele

most common cause of male infertility

neruoblastoma

most common childhood adrenal mass?

wilm's tumor

most common childhood renal mass?

seminoma

most common malignant neoplasm of the testicles

multicystic dysplastic kidney

most common neonatal abdominal mass?

adrenal hemorrhage

most common neonatal adrenal mass?

multicystic dysplastic kidney

most common neonatal renal mass?

acute tubular necrosis; causes include shock, trauma, sepsis and drug toxicity. renal enlargement and increased resistive index may be seen associated with ATN

what is the most common cause of acute renal failure?

muticystic dysplastic kidney disease

what is the most common cause of an abdominal mass in the newborn?

clamydia

what is the most common cause of epididymoorchitis in teens

posterior urethral valves are the most common cause of urinary obstruction in the male neonate. this obstruction results from a flap of mucosa with a slit-like opening in the area of the prostatic urethra

what is the most common cause of urinary obstruction in male neonates?

Wilm's tumor (nephroblastoma). the mean age at diagnosis is 3.5 years

what is the most common childhood renal tumor?

commonly located within the anterior pararenal space of the retroperitoneum and the lesser sac of the peritoneum

what is the most common location of a pancreatic pseudocysts?

direct

conjugated

<4ng/mL is normal 4-10ng/mL benign/potential malignancy >10ngmL most likely cancer

PSA levels

Focal hypoechoic area within the tendon

Partial tendon tears/rupture appears

Skinfolds, legs aren't the same length, limited limb abduction

Patients with DDH appear clinically

Fluid within the synovial sheath. Patients will present with pain, swelling, and possibly fever in the troubled area

Tendosynovitis

Inflammation of a tendon. Caused by overuse or strain

What is tendonitis

Transient synovitis

What is the most common cause of a painful hip and joint effusion in children

Thompson test

What test can be performed to see if there is a compete tendon tear

Linear array

What type transducer for MSK ultrasound?

Between the buttocks

Where is a pilonidal cyst located?

females First born Breech Left side Oligo

Who is more at risk for DDH?

Excess copper

Wilson's disease

calcifications seen in prostate

corpora amylacea

malignancy and infertility

cryptochidism has an increased risk of

the percentage of red blood cells per volume of blood. in other words, it is the percentage of blood that is made up of red blood cells. a normal hematocrit ranges from 40-50% indicates red blood cell loss; can be caused by many factors including internal bleeding, iron deficiency and external blood loss

define hematocrit. what is the significance of a low hematocrit level?

hyperechoic- echogenicity that is greater than reference structure hypoechoic- echogenicity that is less than reference structure anechoic- absence of echoes isoechoic- echogenicity that is equal to the reference structure

define hyperechoic, hypoechoic, anechoic & isoechoic

a prolonged or delayed early systolic acceleration. a decreased amplitude and rounding of the systolic peak. an intrarenal tarsus-parvus waveform suggests a certain degree of main renal artery stenosis. also the loss of the normal early systolic peak of the intrarenal waveform is an indication of a hemodynamically significant stenosis of the main renal artery.

define the term tardus. define the term parvus. what is the association of the trades-parvus waveform with renal artery stenosis?

precipitated by a stone obstructing the cystic duct. the situation results in an obstruction of venous drainage, and inflammation of the gallbladder wall with variable degrees of necrosis and infection.

describe acute cholecystitis

Partial dislocation of the hips

subluxation

to produce insulin. the cells that produce insulin are the islets of Langerhans to produce amylase, lipase, carboxypepidase, trypsin, and chymotypsin. the cells that produce these enzymes are called acinar cells.

the pancreas is divided into endocrine and exocrine functions. what is the product of the endocrine gland? what is the product of the exocrine gland? what cells carry out the exocrine function of the pancreas?

1. pubic bone 2. rectum 3. bladder 4. urogenital diaphragm

the prostate is situated in the retroperitoneum and is bordered: 1. anteriorly by the ________. 2. posteriorly by the __________. 3. superiorly by the ___________. 4. inferiorly by the ___________.

1. central zone 2. superior/posterior 3. superior 4. inferior 5. surgical capsule

1. the ejaculatory ducts pass through the ____________ and empties into the urethra 2. seminal vesicles are two sac-like-out-pouchings of the vas deferens situated adjacent to the _________ aspect of the prostate between the urinary bladder and rectum. 3. the base of the prostate is the ___________ portion of the gland. 4. the apex of the prostate is the ___________ portion of the gland. 5. the demarcation between the inner gland and the outer gland is called the __________.

1. anterior 2. inferior 3. medial 4. posterior

1. the pancreatic head is ___________ to the inferior vena cava. 2. the pancreatic head is ___________ to the portal vein. 3. the pancreatic head is ___________ to the second portion of the duodenum. 4. the uncinate process of the process is ___________ to the superior mesenteric vein.

1. superior/anteromedial 2. posterior 3. anterior 4. posterior 5. anterior

1. the right adrenal gland is ___________ to the kidney. 2. the right adrenal gland is ___________ to the inferior vena cava. 3. the right adrenal gland is ___________ to the crus of the diaphragm. 4. the left adrenal gland is ___________ to the tail of the pancreas. 5. the left adrenal gland is __________ to the crus of the diaphragm.

1. inferior 2. anterior 3. anterior 4. right 5. mesenteric and splenic

1. the superior mesenteric artery arises from the aorta __________ to the pancreas. 2. the superior mesenteric artery and vein are _________ to the uncinate process of the pancreas. 3. the superior mesenteric artery and vein are ___________ to the third portion of the duodenum. 4. the superior mesenteric vein is to the ________ of the superior mesenteric artery. 5. the portal vein is the result fo the combination of the __________ and the ___________.

Greater than 55%

Alpha angle

Less than 45%

Beta angle

with a complete testicular torsion, there will be an absence of intratesticular flow. orchitis is an inflammatory disease which would cause hypervascularity. using color flow imaging, increased vascular flow should be noted within the testicle

Both orchitis and testicular torsion sonographically appear as an enlarged hypoechoic testicle. How would you differentiate between these two diagnoses?

Infection and subsequent inflammtion of the skin and subcutaneous tissue; skin is red, tender, and warm

Cellulitis

Anechoic or heterogenous area within the tendon

Complete tendon tears/rupture appears

Congenital anomaly that may be described as as a shallow hip socket; femoral head cannot lay in the acetabulum

DDH

Used to evaulate for dislocation; hip is flexed and adducted

Describe how the Barlow test is performed

Evaluates for relocation of a dislocated hip; abducting and lifting the thigh; listen for audible click

Describe how the ortolani test is performed

Thickened and hypoechoic tendon

Diffuse tendonitis

Localized, enlarged hypoechoic area within the tendon

Focal tendonitis

3mm

Gallbladder wall thickening is diagnosed when the wall is greater than _________________.

Excess amounts of copper

Hemochromatosis

Buildup of fluid within the hip secondary to inflammation

Hip joint effusion

Noncompressible, anechoic mass, with acoustic enhancement; may contain debris or sepations

How do ganglion cysts appear on ultrasound

Echogenic Bone to bone

How do ligaments appear on ultrasound? What do ligaments connect?

Hypoechoic tissue with echogenic, linear strands

How do muscles appear on ultrasound?

Echogenic Muscle to bone

How do tendons appear on ultrasound? What do tendons connect?

Hypoechoic, edematous strands of tissue; cobblestone appearance

How does cellulitis appear sonographically?

Benign fatty tumor; can appear hypoechoic or hyperechoic

Lipoma

S- stomach A- appendix L- liver T- transverse colon D- duodenum (1st part) S- small intestines P- pancreas (only tail) R- rectum S- sigmoid colon S- spleen

List the Peritoneal cavity organs

S- suprarenal glands (adrenal) A- AO and IVC D- duodenum (all but the first part) P- panreas (all but the tail) U- ureter and bladder C- colon (ascending and descending) K- kidneys E- esophagus R- rectum (lower two-thirds)

List the retroperitoneal organs

HCC (starts out in the liver)

Most common primary liver cancer

METS to the liver

Most common secondary liver cancer

Trauma or obstructive hair follile; can be congenital

Superficial epidermal are the result of

Scalp, face, neck, trunk, or back

Superficial epidermal cysts are most likely found

Achilles

The most common ankle tendon injured

Barlow and ortolani

Two clinical tests used to evaluate for DDH

Loose hairs and skin debris

What are pilonidal cysts comprised of?

Complex mass, and hypoechoic tract may be noted extending from the cyst to the external surface of the skin

What do pilonidal look like on ultrasound?

this mass is a branchial cleft cyst. a branchial cleft cyst arises in the lateral aspect of the neck, commonly from epithelial remnants of the second branchial cleft. this is the most common explanation for a cyst in the lateral aspect of the neck.

a 6-year old patient presents with a lateral neck mass. the mass is anterior to the sternocleidomastoid muscle and lateral to the thyroid near the angle of the mandible. the mass is predominantly cystic, with enhanced through-transmission. what is the most likely diagnosis for this mass?

incarcerated hernia

a hernia that cannot be reduced or pushed back into the abdominal cavity

the mass is most likely an islet cell tumor (insulinoma). this tumor, which is usually seen in the body or tail of the pancreas, causes hypersecretions of insulin, which causes hypoglycemia.

a patient presents with hypoglycemia and a hypoechoic mass in the tail of the pancreas. what is the mass in the pancreas?

the inner penis is comprised of 3 cylindrical tissue components. name them

a single corpus spongiosum and paired corpus cavernosa

spigelian hernia

a variant of the ventral hernia, which is found more laterally in the abdominal wall

the sac, contents of the sac, and the covering of the sac

abdominal wall hernia consists of three parts

normal mediastinum testis

an echogenic linear structure within the testis in the sagittal plane or as a triangular surface in the transverse plane

embryonal cell carcinoma, teratomas, and yolk sac tumors

an elevated AFP level (testicular) is most often associated with

clinical findings of crampy intermittent abdominal pain, vomitting, and the passage of blood through the rectum, are classic symptoms

an intussusception is the most common cause of obstruction in infants. what are the symptoms of an intussusception

1. anterior and medial 2. posterior 3. inferior 4. anterior

anatomic spatial relationships 1. the stomach is __________ to the splenic hilum 2. the tail of the pancreas is __________ to the stomach. 3. the left kidney is ___________ to the spleen. 4. the tail of the pancreas is __________ to the upper pole of the left kidney.

1. posterior 2. posterior 3. superior 4. posterior 5. posterior

anatomic spatial relationships 1. the uncinate process is ___________ to the superior mesenteric artery and vein. 2. the aorta is __________ to the body of the pancreas. 3. the celicac axis arrises from the aorta ___________ to the pancreas. 4. the gastroduodenal artery and common bile duct run ____________ to the first portion of the duodenum. 5. the splenic vein is ____________ to the pancreas.

1. anterior 2. medial 3. posterolateral 4. anteriolateral 5. posterior

anatomic spatial relationships: 1. the head of the pancreas is ___________ to the inferior vena cava. 2. the head of the pancreas is ___________ to the second portion of the duodenum. 3. the common bile duct is _________ to the head of the pancreas. 4. the gastroduodenal artery is __________ to the head of the pancreas. 5. the superior mesenteric artery and vein are _________ to the neck of the pancreas.

inferior portion

apex of prostate

although they are considered the most common benign tumors of the pancreas, they can also be malignant

are islet cell tumors benign or malignant?

autosomal dominant (adult) polycystic kidney disease; associated cysts may also be seen in the liver, pancreas and spleen. ADPKD is also associated with aneurysm development, especially cerebral (berry) aneurysms of the circle of Willis

bilateral enlargement of the adult kidney caused by numerous cysts of varying sizes is seen with which disease?

uterine duplication (bicornuate uterus) in females, and seminal vesicle agenesis in males

bilateral renal agenesis associated with oligohydramnios and pulmonary hypoplasia is incompatible with life. what is associated with unilateral renal agenesis?

hematocele

blood located within the scrotum

inferior vesicle artery

blood supply of the prostate

centripetal artery

blood supply of the testicles

the penis is covered with skin, and subsequently a dense fibrous tissue termed

buck fascia

peyronie's disease

buildup of fibrous plaque (scar tissue) and calcifications within the penis that results in a painful curvature. the area of scar tissue can usually be palpated

small, well-defined, hyperechoic mass with possible posterior acoustic enhancement

cavernous hemangiomas are the most common benign tumors of the liver. the majority are small and asymptomatic. hemangiomas may enlarge during pregnancy or with estrogen replacement therapy. what is the typically appearance of a cavernous hemangioma?

where is the urethra housed in males?

centrally; in the corpus spongiosum

1. two cyst-like structures in the right upper quadrant. these are the gallbladder and the dilated common bile duct. 2. dilated intrahepatic biliary tree

choledochal cysts usually occur in Asian women. symptoms of pain, jaundice and an abdominal mass may be present. what are the sonographic features associated with a choledochal cyst?

torsion that has lasted more than 10 days; epididymis, testis, and spermatic cord will become enlarged and heterogenous. areas of necrosis may be noted within the testis and there may be hyperemic flow around the testis

chronic testicular torsion

usually solitary, and occur in the right lobe of the liver. they are caused by a bacteria which reach the liver via the bile ducts, portal veins, hepatic arteries or lymphatic channels.

describe how pyogenic (bacterial) abscesses develop in the liver.

intrahepatic bile duct dilatation, a normal-sized CBD, and a large stone in the cystic duct of the gallbladder.

describe sonographic finidings associated with Mirizzi's syndrome.

1. anterior to the aorta 2. superior to the celiac axis 3. posterior to the inferior vena cava 4. medial and posterior to the adrenal glands

describe the anatomical relationships between the crus of the diaphragm and the aorta, celiac axis, inferior vena cava and the adrenal glands.

common variant of cortical thickening of the lateral aspect of the left kidney

describe the appearance of a dromedary hump.

common anomaly which occur when the renal pelvis protrudes outside the renal hilum. sonographically this is seen as a cystic collection medial to the renal hilum.

describe the appearance of an extrarenal pelvis.

hypertrophy of renal cortical parenchyma located between two medullary pyramids. this may give the appearance of a mass effect although the echogenicity is equal to the peripheral cortical tissue.

describe the appearance of the a column or Bertin.

an autoimmune disease; occurs as a painless diffuse enlargement of the thyroid gland in young or middle-aged women, and is often associated with hypothyroidism. appears as a diffusely enlarged thyroid, with a homogenous but coarse parenchymal echo texture. the thyroid is generally more hypoechoic than the normal thyroid

describe the clinical presentation of patients with chronic lymphocytic (Hashimoto's) thyroiditis describe the sonographic presentation of chronic lymphocytic (Hashimoto's) thyroiditis.

composed of cholesterol, calcium bilirubinate, and calcium carbonate

describe the composition of gallstones.

occurs when the lower poles fuse and the kidneys ascend in the retroperitoneum. the lower poles are closer to the midline in a u-shaped configuration, opposed to the normal inverted v-shaped. the isthmus is anterior to the distal abdominal aorta, and sonographically can mimic lymphadenopathy on a longitudinal image

describe the development and sonographic appearance of a horseshoe kidney.

may be congenital or acquired. acquired hydroceles are often idiopathic, or they may result from trauma, torsion, neoplasm, epididmitis or epididymoorchitis

describe the etiology of hydroceles.

an incomplete sonographic boundary which can be located by an imaginary line from the gallbladder fossa to the inferior vena cava. this boundary separates the right and left lobes of the liver. the middle hepatic vein is a landmark of this fissure.

describe the location of the main lobar fissure

distended, non-inflamed gallbladder due to total obstruction of the cystic duct. the trapped bile is reabsorbed and the gallbladder is filled with a clear mucinous secretion derived from the mucosa. is asymptomatic and may present as a palpable, right upper quadrant mass. the diagnosis should be suspected on ultrasound when an obstructing stone is noted in an enlarged, but non-tender, gallbladder.

describe the mechanism of hydros of the gallbladder.

seen as a septation dividing the aorta into a true lumen and a false lumen

describe the sonographic appearance of a dissecting aneurysm.

the US appearance of a hematoma is variable, and depends on the age of the collection. most hematoma are initially seen as echogenic collections because of rapid fibrin invasion. gradual hemolysis eventually creates an anechoic appearance. calcifications are often associated with long-standing hematomas

describe the sonographic appearance of a hematoma.

wedge shaped; hypoechoic lesion

describe the sonographic appearance of a splenic infarct.

round, cystic structures that project into the bladder lumen at the ureterovesical junction

describe the sonographic appearance of a ureterocele

(starry night sign) appears as: hypoechoic liver parenchyma liver enlargement hyperechoic portal vein walls

describe the sonographic appearance of acute hepatitis.

a round or oval-shaped hypoechoic mass absence of a prominent wall fine low-level internal echoes distal enhancement contiguous with diaphragm

describe the sonographic appearance of an amoebic abscess within the liver.

bilaterally enlarged echogenic kidneys with loss of the cortical medullary boundary

describe the sonographic appearance of autosomal recessive infantile polycystic kidney disease.

hyperechoic liver parenchyma small liver decreased echogenicity of portal vein walls

describe the sonographic appearance of chronic hepatitis.

as gas shadowing from the wall of the gallbladder

describe the sonographic appearance of emphysematous cholecystitis

regions of increased echogenicity present within a background of normal liver parenchyma. the extent of fatty infiltration is variable, but is commonly seen at the portal hepatis.

describe the sonographic appearance of focal fatty infiltration.

islands of normal liver parenchyma, which appear as hypoechoic masses within a dense fatty infiltrated liver. commonly seen adjacent to the gallbladder.

describe the sonographic appearance of focal fatty sparing.

appears as a fluid collection surrounding the testicle. low-level echoes from fibrin or cholesterol crystals may be visualized within hydrocele.

describe the sonographic appearance of hydrocele.

due to the dysplastic collecting tubules of the medullary pyramids, calcium tend to deposit within them. equally spaced hyperechoic medullary pyramids

describe the sonographic appearance of medullary sponge kidney.

pneumobilia is characterized by variable length echogenic foci in the distribution of the biliary tree, resulting in acoustic shadowing and reverberation (comet-tail) artifacts

describe the sonographic appearance of pneumobilia (air in the biliary tree)

1 to 6 hours after the onset of torsion, the testicle becomes enlarged, inhomogeneous, and hypoechoic when compared to the contralateral normal testis. extratesticular findings associated with torsion include an enlarged epididymis, skin thickening and reactive hydrocele formation. the presence of blood flow within the testicle would theoretically exclude the diagnosis of acute torsion; although the presence of flow does not exclude a partial torsion. at least 540 degrees or torsion is considered necessary to completely occlude testicular blood flow

describe the sonographic findings associated with torsion of the spermatic cord

appears as a large (pericyst) cyst, containing one or more smaller daughter cysts (endocysts). fine, internal echoes (hydatid sand) are also found within these cysts.

describe the typical sonographic appearance of an echinococcal cyst.

demonstrates an abnormally low resistive arterial flow pattern. this means a waveform with increase and sustained diastolic flow.

describe the waveform characteristics of the arterial side of an arteriorvenous fistula.

demonstrates a waveform with increased velocity, pulsatility and with spectral broadening due to turbulence

describe the waveform characteristics of the venous side of an arteriorvenous fistula.

yes. portal venous gas is seen within the periphery of the liver, while biliary gas is located closer to the liver hilum

does the sonographic portal venous gas differ from that of biliary gas?

prostate cancer, PBH, and prostatitis

elevation of PSA occurs with

solitary mass, usually less than 5cm in diameter, that may have a central fibrous scar. it may be difficult to differentiate from the adjacent liver parenchyma and has been described as the central scar. tumor hemorrhage is uncommon.

focal nodular hyperplasia is a common benign liver mass. what is the sonographic appearance of a focal nodular hyperplasia?

Found along the dorsal aspect of the hand and wrist

ganglion cyst

seminoma

germ cell tumor that is typically found in males between 30 and 50 years of age; unilateral and may actually replace the entire testicle; patients will present with a painless scrotal mass, hardening of the testis, and an elevated hCG level; will appear as a solid, hypoechoic mass

prehepatic = portal vein thrombosis intrahepatic = cirrhosis; schistosomiasis prostehepatic = Budd-Chiari syndrome

give examples of prehaptic, intrahepatic, and postehepatic portal hypertension.

hepatic adenomas; they are also linked to the usage of oral contraceptive agents. due to the increase incidence of tumor hemorrhage and risk of malignant transformation, surgical resection is usually recommended. it is often difficult to distinguish hepatic adenomas from focal nodular hyperplasia.

glycogen storage disease results in large quantities of glycogen being deposited in the hepatocytes of the liver and convoluted tubules the kidney. what liver mass is associated with glycogen storage disease?

portal vein flow away from the liver

hepatofugal

an interruption of the peritoneal line separating the muscles and abdominal contents; peristalsis may also be noted in a hernia.

how do hernias appear on ultrasound?

valsalva

how manuever is used to see a hernia if not readily visualized?

between the two layers of the tunica vaginalis

hydroceles most commonly found

1. inferior vena cava or renal vein extrinsic compression 2. nephrotic syndrome 3. renal tumors 4. renal allografts 5. trauma

identify causes of renal vein thrombosis

1. flow within the shunt itself 2. the presence of hepatofugal flow direction within the right and left portal veins

in patients with portal hypertension, transjuglar intrhepatic portosystemic shunts (TIPS) decompress the portal system. how is the functionality of the TIPS assessed?

lung hypoplasia; periortal hepatic fibrosis; oligohydraminos

infantile polycystic kidney disease results in renal dysfunction. what other anomalies are associated with infantile polycystic kidney disease?

pseudocysts and cystadenomas pseudocysts are formed in association with acute of chronic pancreatitis. they are encapsulated collections of pancreatic enzymes. sonographically, pseudocysts are predominantly anechoic masses that may or may not contain dependent debris. commonly displace or invade adjacent structures such as the liver, lesser sac, stomach left kidney or spleen. cystadenomas are rare fluid collections that arise from the epithelium of the pancreatic duct. they are primarily cystic, with separations and thick walls. cystadenomas are easily confused with pseudocysts. both pseudocysts and cystadenomas are associated with increased levels of serum amylase.

name and describe two cystic masses associated with the pancreas in patients without a history of autosomal dominant (adult) polycystic kidney disease.

1. echogenic thrombus within vessel lumen 2. an increase in portal vein diameter 3. portosystemic collateral circulation 4. cavernous transformation

name four sonographic indications or portal vein thrombosis.

hemangiomas, hepatic lipomas, echogenic metastasis and focal fatty infiltration

name four well-defined hyperechoic liver masses.

1. kidney and ureters 2. adrenal glands 3. inferior vena cava 4. aorta 5. pancreas 6. portions of the duodenum 7. ascending & descending colon 8. prostate 9. lymph nodes 10. uterus 11. bladder

name structures that are retroperitoneal in location. (eleven structures appear in our answer)

insulinoma and gastronoma insulinoma- characterized by hyperinsulinism an hypoglycemia gastrinomas- are associated with gastric hypersecretions and peptic unclear disease (zollinger-ellison syndrome)

name the 2 most common islet cell tumors and describe the symptoms related to each.

1. lung 2. breast 3. melanoma

name the 3 most common primary sources of carcinoma that metastasize to the adrenal gland.

peripheral zone; transition zone; central zone;fibromuscular stroma the peripheral zone is the location for approximately 70% of all prostate cancers. the classic appearance of prostate cancer on ultrasound is a hypoechoic, peripherally-oriented lesion the fibromuscular storm is the non-glandular, anterior portion of the prostate. therefore it is not affected by cancer, prostatitis, or hyperplasia

name the 4 zones of the prostate what zone of the prostate is the source of most prostate cancers? what zone of the prostate is not affected by cancer?

head, neck, body, tail and uncinate process

name the 5 different parts of the pancreas.

1. gallstones 2. sonographic Murphy's sign 3. diffuse wall thickening 4. gallbladder dilatation 5. sludge

name the 5 sonographic criteria that define acute cholecystitis

Gerota's fascia or the perirenal space

name the fascia which encloses the kidneys, adrenal glands and perinephric fat

hepatocellular carcinoma; etiologic factors include alcoholic cirrhosis, chronic hepatitis B & C infections. there is a propensity toward portal vein invasion. although the sonographic appearance is variable, hepatocellular carcinoma typically is seen as a hypoechoic mass.

name the most common primary malignant tumor of the liver.

1. inflammatory bowel 2. echinococcal cysts 3. intrahepatic duct dilatation 4. duodenal atresia 5. hypertrophic pyloric stenosis

name the pathology associated with the sonographic sign. 1. pseudo kidney sign 2. water lily sign 3. parallel channel sign 4. double bubble sign 5. olive sign

mobile, echogenic structure with posterior acoustic shadowing

name the sonographic criteria for gallstones.

inferior vena cava

name the structure posterior to the head of the pancreas.

aorta

name the structure posterior to the third portion of the duodenum.

the median umbilical ligament (urachus) suspends the bladder by connecting the bladder's apex to the umbilicus. the urachus lies in the space of Retzius

name the structure that connects the apex of the bladder to the umbilicus

1. hepatic lipoma 2. angiomyolipoma 3. adrenal myelolipoma (common denominator= fatty tumors)

name thee masses that produce a propagation speed artifact

adenomyomatosis, emphysematous cholecystitis, pneumobilia

name three abdominal examples that produce a comet-tail or reverberation artifact.

1. common hepatic duct 2. cystic duct 3. common bile duct

name three extrahepatic biliary ducts.

conjugated bilirubin, alkaline phosphatase, and gamma glutamyl transpeptidase will elevate in the presence of a biliary tree obstruction

name three laboratory values that will elevate in association with a biliary obstruction.

alpha-fetoprotein and carcinoembryonic antigen (CEA)

name two laboratory values utilized as tumor markers and will elevate in association with a malignancy.

common bile duct and the gastrodudenal artery

name two structures posterior to the first portion of the duodenum.

right renal artery and right adrenal gland

name two structures posterior to the inferior vena cava.

time-of-flight artifact

occurs when the returning sound wave has passed between two tissues with markedly different speeds

anisotrophy

occurs when the sound beam misses the transducer on the return because of the curve of the structure

1. dilated biliary system 2. dilated pancreatic duct 3. liver metastases 4. ascites 5. lymphadenopathy 6. pseudocyst formation

pancreatic adenocarcinoma is sonographically seen as a solid focal hypoechoic mass typically (70%) in the head of the pancreas. What additional findings are associated with pancreatic adenocarcinoma?

numbness of the middle and index fingers, weakness or clumsiness of the hand, and pain

patient suffering from CTS typically presents with

catecholamines (dopamine, norepinephrine, and epinephrine)

pheochromocytomas cause hypersecretion of what substances?

1. fatty liver infiltration 2. hepatomegaly 3. hepatitis 4. non-Hodgkin's lymphoma 5. candidiasis 6. cholangitis 7. cholecystitis 8. Kaposi's sarcoma

pneumocystic carinii is the most common organism causing an infection in AIDS patients. name 8 other disorders associated with AIDS patients

on the left and are palpable

primary varicoceles are most often found

hernia

protrusion of a peritoneal-lined sac through a defect in the weakened abdominal wall

1. ureterovesical junction 2. ureteropelvic junction 3. ureteric obstruction at level of pelvic inlet ureterovesical junction

renal calculi are the most common cause of obstruction in patients with actor flank pain. name 3 common locations within the urinary tract for obstruction from a renal calculi? which is the most common location for an obstruction?

1. adult polycystic kidney disease 2. acquired cystic disease 3. Von-Hippel-Lindau syndrome 4. tuberous sclerosis

renal cell carcinoma is associated with what four diseases?

peak systolic. freq. - end diastolic freq. ______________________________________________________ peak systolic freq.

resistive index is a measurement used to evaluate renal transplants, assess hydronephrosis, evaluate medical renal disease, and evaluate suspected renal neoplasms. what is the formula fro resistive index?

1. demonstration of an abdominal wall defect 2. presence of bowel loops or mesenteric fat within a lesion 3. exaggeration of the lesion with strain (valsalva) 4. reducibility of the lesion by gentle pressure

sonographic criteria for a hernia

obstructive nephropahthy: intrarenal resistivity index (RI) threshold of greater than 0.7. nonobstructive nephropathy: have resistivity index value of less than 0.7

sonographically, how is obstructive nephropathy differentiated from nonobstructive nephropathy?

comet-tail artifact

sound bouncing between two closely placed reflectors within the imaged structure

anechoic, well-defined with few or no internal echoes filled with sperm "cyst in the head of epi"

spermatocele

sonographic appearance of peyronie's disease

the area will appear as thickening of the tunica albuginea, which may also contain areas of calcifications

refractile shadowing (edge artifact)

the bending of the transmitted sound beam to an oblique path

autosomal dominant (adult) polycystic kidney disease; Von-Hippel-Lindau syndrome

true pancreatic cysts are uncommon. multiple pancreatic cysts are associated with what two syndromes?

saccular extension of peritoneum into the scrotal chambers

tunica vaginalis

1. the periaortic region should be evaluated for lymphadenopathy. 2. the inferior vena cava and the renal veins should be evaluated for tumor extension. 3. the liver should be evaluated for metastatic disease, to verify the malignant nature of the gallbladder mass. 4. additional areas of evaluation should include the liver for metastatic disease, the biliary tree and pancreatic duct for dilatation, regional lymphadenopathy, and the portal vein and splenic vein for thrombsis.

ultrasound findings or malignant tumors can lead to further ultrasound evaluation. describe the area of further evaluation when presented with the following primary malignancies: 1. solid testicular mass 2. solid renal mass 3. solid mass filling gallbladder 4. solid pancreatic mass

indirect

unconjugated

80% of undescended testes lie at the level of the inguinal canal. infertility and cancer; infertility results from pathologic changes that develop in both the undescended and contralateral normal testis after the age of one year. the risk of malignancy is increased in both the undescended testis after orchiopexy, and the normally descended testis

undescended testis (cryptorchidism) is a common genitourinary anomaly. complete descent is necessary for full testicular maturation. where is the undescended testicle normally found? what are 2 complications of cyrptorchidism?

unilateral multi cystic dysplastic kidney

ureteropelvic junction (UPJ) obstruction is a common congenital anomaly. what genitourinary tract anomaly is commonly associated with a contralateral UPJ obstruction?

characterized as thyroid hyperfunctioning, causing diffuse glandular hyperplasia. patients may present with exophthalmos, palpable lymph nodes, muscle atrophy, localized myxedema, weight loss, tremors and nervousness sonographically, the thyroid is diffusely enlarges and appears identical to a multinodular goiter. color flow doppler will show increased vascularity due to hyperfunctioning of the gland.

what are the symptoms of Graves' disease? describe the sonographic features of Graves' disease.

patients present with periumbilical pain, leukocytosis, fever and right lower quadrant pain with rebound tenderness sonographic visualization of either an appendix greater than 6mm in diameter, or an appendicolith, is highly suggestive of acute appendicitis

what are the symptoms of acute appendicitis? what are the sonographic signs of an inflamed appendix?

characterized by hypertrophy of the circular pyloric muscle, resulting in elongation and constriction of the intestines between the stomach and the first portion of the duodenum. neonates present with projectile vomiting, and a palpable "olive-like" abdominal mass.

what are the symptoms of hypertrophic pyloric stenosis?

1. common hepatic artery 2. left gastric artery 3. splenic artery

what are the three branches of the celiac axis?

hepatocelluar death, fibrosis and regeneration

what are the three major pathologic mechanisms of cirrhosis?

juctional fold- folding of the gallbladder neck phrygian cap- folding of the gallbladder fundus

what are the two types of gallbladder folding?

renal enlargement; hypoechoic parenchyma; absence of sinus echoes

what are the ultrasound findings associated with significant scute pyelonephritis?

dilated, tortuous veins or the pampiniform plexus, located posterior to the testis; associated with male infertility the left gonadal vein drains into the left renal vein, thus varicoceles are more commonly seen on the left side. they distend when the patient is upright, when performing a valsalva or with abdominal compression

what are varicoceles? where do they commonly appear?

all fat-containing tumors have the ability to create a propagation speed artifact. this common sonographic finding is created because sound travels slower in fat than in soft tissue. thus, a sound pulse in a fat containing tumor is delayed and objects that are behind the tumor are artificially placed further from the transducer.

what common sonographic artifact is demonstrated with renal angiomyolipoma, hepatic lipoma and adrenal myelolipoma?

a sagittal, superior-inferior, mid-clavicular dimension measurement of greater that 20cm. this dimension correlated with an enlarged left lobe, should prevent a Reidel's lobe from being mistaken for hepatomegaly.

what consititues hepatomegaly?

obstructive jaundice (e.g. hepatitis) intrahepatic cholestasis biliary tree obstruction

what does a significant elevation of conjugated bilirubin levels indicate?

indication of bowel infarction, as seen in ulcerative colitis or necrotizing enterocolitis

what does the presence of portal venous gas indicate?

vas deferens, cremasteric, deferential , testicular arteries, paampiniform plexus of vein, lymphatics, nerves

what does the spermatic cord consist of?

lymphoceles lymphoceles are caused by leakage of lymph from a renal allograft, or by surgical disruption of the lymphatic channels

what finding is a common complication of renal transplantation and gynecologic, vascular, or urological surgery? what causes this complication?

an enlarged, nondiseased gallbladder, associated with an extrinsic obstruction (i.e. pancreatic carcinoma) of the distal common bile duct

what is Courvoisier gallbladder?

extra hepatic bile duct obstruction due to a stone within the cystic duct. the stone causes extrinsic mechanical compression of the common hepatic duct.

what is Mirizzi's syndrome?

a collection of synovial fluid which is found in the popliteal fossa. although it can be found from the popliteal fossa to the ankle, it is commonly located in the medial aspect of the popliteal fossa. may be caused by trauma or rheumatoid arthritis. the synovial fluid is very inflammatory and can cause a great deal of pain. complications include infection, venous thrombosis or compression of venous structures causing calf swelling

what is a Baker's cyst?

an inferior tongue-like projection of the right lobe of the liver. it increases the superior/inferior dimension. typically seen in the right lobe of the liver extending beyond the lower pole of the right kidney. more common in women than men.

what is a Reidel's lobe?

seen in nuclear medicine thyroid scintigraphy, indicates an area of hypofucntioning. benign thyroid nodules, such as adenomas, commonly appear as hypofucntioning or cold thyroid nodules on a nuclear medicine thyroid scintigram. although thyroid imaging by nuclear medicine can give a probability that a nodule is benign or malignant, it cannot truely differentiate benign or malignant nodules and usually should not be used as the only basis for recommending treatment.

what is a cold nodule? what mass commonly appears as a cold nodule in a nuclear medicine thyroid scintigram?

result from the dissection of the intima away from the aortic wall. they usually start in the thoracic aorta. type A involves the ascending thoracic aorta and type B starts at the origin of the left subclavian artery

what is a dissecting aneurysm?

a collection of serous fluid within the tunica vaginalis lining in the scrotum. hydroceles within the tunica vaginalis are designated based on the contents of the collection (ie. serous fluid for a hydrocele, blood for a hematocele, pus for a pyocele.)

what is a hydrocele?

abnormal bowel wall thickening. this appears as a hypoechoic external rim representing the thickened intestinal wall and an echogenic center relating to the residual gut lumen or mucosal ulceration

what is a target or pseudo kidney sign?

congenital anomaly that appears as a superficial cyst in the midline of the neck anterior to the trachea and superior to the thyroid. it is commonly diagnosed in preschool-aged children or during mid-adolescence, and often appears following an upper respiratory infection.

what is a thyroglossal duct cyst?

papillary carcinoma (accounting for 75 to 90% of all cases) papillary carcinoma spreads through the lymphatics to nearby cervical lymph nodes. sonographically, all patients with papillary thyroid cancer present with a hypoechoic thyroid mass and adjacent enlarged cervical nodes

what is the most common malignancy of the thyroid gland? what is the usual presentation of patients with this malignancy?

at the hilum of the kidney: the vein exits anteriorly; the artery enters between the vein and ureter and the ureter exits posteriorly

what is the orientation of structures that enter and exit the renal hilum?

helpfule in assessing biliary obstruction. an obstructed bile duct should increase in size following administration of a fatty meal. on the other hand, a non-obstructed bile duct should decrease in size after administration of a fatty meal.

what is the purpose of administering a fatty meal to a patient?

renal sinus pancreas liver/spleen renal cortex

what is the sequence of echogenicity in normal abdominal structures (hyperechoic to hypoechoic)?

characterized by saccular, communicated intrahepatic bile duct dilatation.

what is the sonographic appearance of Caroli's disease?

candidiasis

what is the sonographic appearance of a fungal abscess?

usually diagnosed with clinical and laboratory findings. in mild acute pancreatitis, sonography may demonstrate a normal pancreas. with increasing severity, decrease echogenicity and increased gland size are noted.

what is the sonographic appearance of acute pancreatitis?

usually presents as an oval, pseudo kidney mass, with central echoes on longitudinal imaging, and a sonolucent doughnut or target configuration on cross-sectional imaging

what is the sonographic appearance of an intussusception?

appear as hypoechoic, rounded, fluid-filled masses with variable degrees of internal echoes or debris. as with any abscess, echogenic foci may be seen as a result of gas-producing organisms.

what is the sonographic appearance of pyogenic abscesses?

that of linear echogenic branches in the periphery of the liver. echogenic foci within the lumen of the portal vein is also seen.

what is the sonographic appearance or portal venous gas?

although uncommon, is can present as an intraluminal mass, asymmetric wall thickening or a mass-filled gallbladder.

what is the sonographic presentation of gallbladder carcinoma?

urachal cyst; seen as an echo-free tubular structure in the lower abdomen that extends from the umbilicus to the dome of the bladder.

what is the term that describes cystic dilatation of this structure?

acquired cystic disease

what is the term which refers to patients on chronic hemodyalysis that develop bilateral renal cysts?

embryologically, as primitive cels migrate from the pharyngeal floor to become the thyroid, a residual thyroglossal duct is formed; normally becomes obliterated in fetal life

what is the thyroglossal duct?

fibrous capsule that surrounds the testicle extension of the peritoneum into the scrotal chamber, which resides along side the testicle. the inner, or visceral layer of the tunica vaginalis covers the testis and epididymis. the outer, or parietal layer of the tunica vaginalis lines the walls of the scrotal chamber. a small amount of fluid is commonly seen in this space.

what is the tunica albuginea? what is the tunica vaginalis?

typically, it is located to the right pelvis within the retroperitoneum 1. urinoma 2. lymphocele 3. hematoma 4. abscess

what is the typical location of a transplanted kidney? name 4 fluid collections that may be seen around a transplant kidney.

1. alkaline phosphate 2. conjugated (direct) bilirubin 3. GGT

what lab values are most likely to be elevated due to biliary tract obstruction?

transitional cell carcinoma, although typically occurring in the bladder, can arise in the ureter and renal pelvis

what malignant tumor is associated with the urinary collecting system (renal pelvis, ureter and bladder)?

the majority of transitional cell carcinomas arise in the bladder. other bladder masses, such as, blood clots or fungal balls have a similar sonographic appearance

what mass should be suspected when a filling defect is noted in the bladder?

inferior vena cava filters (Greenfield filter) ultrasound can determine the location of the inferior vena cava filter, also allows detection of various complications, such as thrombosis around the filter of preforation through the IVC wall, which may be associated with a retroperitoneal hematoma

what object is placed in the inferior vena cava prevent the ascension of lower extremity thrombus into the lungs? what role can ultrasound play in the evaluation of these objects?

1. infantile polycystic kidney disease 2. congenital hepatic fibrosis 3. choledochal cysts 4. string of pearls

what other genetically acquired conditions are associated with Caroli's disease?

a Klatskin tumor causes intrahepatic biliary dilatation without extra hepatic biliary dilatation. a Klatskin tumor is a specific type of cholangiocarcinoma. it is located at the hepatic hilum at the juction of the right and left hepatic ducts

what pathology causes intrahepatic biliary dilation without extrahepatic biliary dilatation?

adenomyomatosis; sludge and stones accumulate within the sinuses, and present as focal wall thickening. Echogenic foci are visible within the thickened wall. this accumulation causes a characteristic comet tail reverberation artifact.

what pathology i associated with Rotikansky-Ashchoff sinuses?

diffuse lymphadenopathy of the abdomen will create a layered or mantle appearance around vessels of the abdomen. lymphadenopathy is visualized anterior and posterior to vessels of the abdomen (i.e. aorta, superior mesenteric artery, inferior vena cava), thus creating the sandwich sign

what pathology is described by the terms mantle sign and sandwich sign?

retroperitoneal lymphadenopathy typically appears posterior to the inferior vena cava, displacing it anteriorly. appear anechoic or hypoechoic masses without acoustic enhancement.

what pathology will displace the inferior vena cava anteriorly? what is the typical sonographic appearance of lymph nodes?

medullary pyramids; in adults they are not commonly imaged, but this depends on patients body habitus

what renal structure is a concentrated area of collecting tubules which is sonographically seen in newborns and infants as hypoechoic equally space triangles?

phalen's sign

what sign is associated with CTS?

a Courvoisier's sign is a palpable, nontender gallbladder due to an adenocarcinoma of the pancreatic head obstructing the biliary tract resulting in jaundice

what sign is associated with a adenocarcinoma of the pancreatic head resulting in extrinsic compression of the common bile duct and enlarged gallbladder?

right upper quadrant tenderness, guarding, fever, chills and leukocytosis

what symptoms accompany acute cholecystitis?

the splenic vein and the superior mesenteric vein join at the confluence adjacent to the head of the pancreas to form the main portal vein

what two vessels form the main portal vein?

an intraparenchymal or sub capsular hematoma occurs with splenic trauma in which the splenic capsule remains intact.

what type of hematoma is the result of splenic trauma in which the splenic capsule remains intact?

a perisplenic or intraperitoneal hematoma occurs with splenic trauma in which the splenic capsule ruptures.

what type of hematoma is the result of splenic trauma in which the splenic capsule ruptures?

secondary varicocele

when a varicocele is found on the right side

near the junction of the linea semilunaris and arcuate line in the paraumbilical area

where does a hernia usually originate

transitional zone

where is benign prostatic hyperplasia found

posterior lateral to the testicle

where is the epididymis located?

the right anterior segment of the right lobe from the left medial segment of the left lobe.

which 2 segments of the liver does the main lobar fissure separate?

the thin-walled hepatic veins course between the segments of the liver

which vessels are considered to be intersegmental within the liver?

the portal vein, hepatic artery and bile duct course together into the center of each hepatic segment. these 3 vessels form the portal triad

which vessels are considered to be intrasegmental within the liver?