case studies
this scan over the pts RUQ was made in a pt with a history of chronic pain. these sonographic images are representative of what disease?
Anechoic structure at porta hepatis c/w choledocal cyst
describe the following image. what abnormalities are seen here? does the pt show signs of acute cholecystitis
Atrophied liver with coarse texture consistent w/ cirrhosis. ascites is seen surrounding the liver. gallbladder wall is thickened. the thickened wall could be due to ascites or due to cholecystitis. the diagnosis of choleycystitis cant be made but it can't be ruled out either
describe the images below. how could you determine whether the masses seen in these images are sludge or tumors
Change the position of the pt to see if the sludge moves. the bile can be very viscous and the movement may be very slow
Describe the following images. what liver disease is present in the following images
Echogenic liver. hard to Penetrate. fatty liver
A 60 year old female presents with a history of cholecystectomy several years ago. the pt was known to have had previous hepatic calculi and now present with RUQ pain. what questions should the sonographer ask before starting the exam? describe the sonographic findings and what additional organ(s) should be imaged.
How long has the pt experienced pain? where does the pain occur? does position change help the pain? has the pt noticed yellow coloration in the whites of the eyes or skin? there is dilation of the intrahepatic ducts. the liver and pancreas should be carefully evaluated to rule out hepatic or pancreatic masses
describe the clinical signs and sonographic findings of the pt without choleycystitis as shown in these images. what complications should the sonographer be aware of
RUQ pain and fever are signs of acute choleycystiti. images show enlarged GB, pos Murphys sign, thick irregular wall, stones, and pericholecystic fluid. complications would include rupture of gb, empyema, emphysematous or gangrenous, cholecystitis or perforation
a pt with a history of cirrhosis shows evidence of hepatomegaly. describe these sonographic images.
a large heterogeneous mass in the R lobe of the liver. extends from the dome of the liver almost filling the entire R lobe with the history of cirrhosis, this most likely represents a hepatocellular carcinoma
multiple images of the RUQ demonstrate what abnormality of the liver? what other areas should the sonographer investigate
multiple cysts seen throughout the liver consistent with polycystic liver disease. the sonographer should also investigate the kidneys
describe the sonographic finding and position alteration that should be made with this pt
small echogenic structure appears to be attached to the anterior gb we and most likely represents a polyp. alterations in position will show the lesion firmly attached to the wall without movement. no shadow is seen
describe the lesion seen in these scans of the RUQ. list the most likely differentials in an asymptomatic pt.
well defined echogenic mass seen in the dome of the rt lobe. color doppler shows increased flow within the lesion. probably a cavernous hemangioma.
