Abdominal Vasculature
What object is placed in the inferior vena cava to prevent the ascension of lower extremity thrombus into the lungs?
Inferior vena cava filters (Greenfield)
What is the most common cause of aneurysms?
atherosclerosis
The ascending lumbar veins are branches of the common iliac veins. What is the thoracic continuation of the right ascending lumbar vein?
azygos vein
The first main visceral branch of the abdominal aorta is the:
celiac artery
The _____ will most likely have a high-resistance flow pattern.
common iliac artery
What is nutcracker syndrome?
compression of the left renal vein between the superior mesenteric artery and the aorta
What are the sonographic signs of the nutcracker syndrome?
dilated left renal vein compared to the right renal vein
What is the definition of a pseudoaneurysm?
disruption of the arterial wall resulting in an adjacent communicating pocket
What is a dissecting aneurysm?
dissection of the intima away from the aortic wall
Abnormal serum laboratory results related to atherosclerosis include what?
elevated cholesterol
Which pathology is most likely seen in a nongravida 25-year-old?
fibromuscular dysplasia
Retrograde portal vein flow is termed?
hepatofugal
Where does the left gonadal vein drain?
inserts into the left renal vein which drains into the inferior vena cava
What vessel travels anterior to the left renal artery?
left renal vein
The hepatic artery should demonstrate:
low-resistance flow
An aneurysm associated with infection is termed:
mycotic
Define hepatofugal
portal vein flow away from the liver
Define hepatopetal
portal vein flow toward the liver
Prehepatic portal hypertension
portal vein thrombosis
What three vessels make up the portal triad?
portal vein, hepatic artery, bile duct
Name two clinical symptoms associated with mesenteric ischemia.
postprandial intestinal angina, weight loss
The IVC is located _____ of the abdominal aorta.
right
Out of the renal veins and renal arteries, which vessel is the shortest in length?
right renal vein
The gonadal arteries originate symmetrically from the aorta, and are below the origin of the renal arteries. Where does the right gonadal vein drain?
right side of the inferior vena cava, below the right renal vein
Enlargement of the IVC, with subsequent enlargement of the hepatic veins, is seen in cases of:
right sided heart failure
Which vascular structure may be confused for the main pancreatic duct?
splenic artery
What are the branches of the celiac axis?
splenic artery, common hepatic artery, left gastric artery
In which vessel is there an increase in diastolic blood flow after eating?
superior mesenteric artery
Which vessels are considered intersegmental within the liver?
thin-walled hepatic veins
The outer wall layer of a vessel is the:
tunica adventitia
The inner wall layer of a vessel, closest to the passing blood, is the:
tunica intima
The upper limit of normal diameter of the main portal vein in a 30-year-old is:
13mm
The diameter of the IVC should never exceed:
2.5cm
Sonographic diagnosis of mesenteric ischemia can be made if the IMA is turbulent and the superior mesenteric artery has a velocity greater than:
280cm/sec
An abdominal aortic aneurysm is present when the diameter of the abdominal aorta exceeds:
3cm
An infrarenal abdominal aortic aneurysm is diagnosed when the diameter is equal to or greater than?
3cm
Type A and Type B dissecting aneurysm
A: ascending thoracic aorta (more common) B: left subclavian artery
Occlusion of the hepatic veins describes what syndrome?
Budd-Chiari
Posthepatic portal hypertension
Budd-Chiari syndrome
True or false. Most aneurysms located within the abdominal aorta are false aneurysms.
False. Most are true.
What are two different types of true aneurysms?
Fusiform (spindle-shaped) or saccular (spherical outpouching)
In small bowel ischemia, the postprandial superior mesenteric artery will yield what flow pattern?
High resistance
A disorder of the connective tissue characterized by tall stature and aortic and mitral valve insufficiency is:
Marfan syndrome
What is the definition of a false aneurysm?
Pseudo, injury to the vessel wall where blood extravasates from the vessel and the blood surrounding the vessel is retained and walled off by the surrounding tissue
Why are the walls of the portal triad echogenic?
Surrounded by fibrofatty tissue
An outpatient with a history of back pain and hypertension presents to the ultrasound department for an abdominal aortic sonogram. You visualize a 6cm infrarenal aortic aneurysm with an echogenic linear structure noted gently swaying in the aortic lumen. What is the most likely diagnosis?
aortic dissection
What is the definition of a true aortic aneurysm?
dilatation of all three layers of the aorta, mainly in the distal portion
The most common shape of an abdominal aortic aneurysm is:
fusiform
Where are pseudoaneuryms (false) more commonly found?
groin from catheters introduced into the common femoral artery
What is the thoracic continuation of the left ascending lumbar vein?
hemiazygos
The gastroduodenal artery originates from the:
hepatic artery
The veins seen attaching to the IVC just below the diaphragm are the:
hepatic veins
What are the associated symptoms with the nutcracker syndrome?
left-sided hematuria, abdominal pain, varicocele formation, possible infertility
Where should the correct placement of the IVC filter be?
location inferior to the renal veins
What should the postprandial flow pattern by within the superior mesenteric artery?
low resistance
Waveform characteristics of the arterial side of an arteriovenous fistula
low resistive
Budd Chiari is considered a _______ cause of portal hypertension.
posthepatic
What are the 5 clinical findings of an abdominal aortic aneurysm?
pulsatile abdominal mass, abdominal bruit, back pan, abdominal pain, lower extremity pain
The IVC terminates at the:
right atrium
What are the sonographic findings of a dissecting aneurysm?
septation dividing the aorta into a true lumen and false lumen
The second main branch of the abdominal aorta is the:
superior mesenteric artery
Which vessel will show a different flow pattern after eating?
superior mesenteric artery
Where do the azygos and hemiazygos vein drain into?
superior vena cava
What is the flow pattern of the hepatic veins?
pulsatile, triphasic
The main portal vein is created by the union of the:
splenic vein and superior mesenteric vein join at the confluence adjacent to the head of the pancreas
A normal Doppler waveform of the aorta, from a suprarenal location, should appear:
biphasic
Intrahepatic portal hypertension
cirrhosis, schistosomiasis
Budd-Chiari syndrome is characterized by occlusion of the hepatic veins. What are the 5 sonographic findings associated with this syndrome?
hepatic vein thrombosis, ascites, hepatomegaly (acute), caudate lobe enlargement (chronic), portal hypertension
Waveform characteristics of the venous side of an arteriovenous fistula
increased velocity, pulsatility, spectral broadening due to turbulence
What is the last major branch to originate from the aorta prior to the aortic bifurcation?
inferior mesenteric artery
Portal vein thrombosis has been associated with hepatocellular carcinoma, metastatic liver disease, pancreatic carcinoma, and pancreatitis. What are the 3 sonographic findings of portal vein thrombosis?
intraluminal thrombus, increased vein diameter, cavernous transformatons
The aorta is located ______ of the midline.
left
Which vessel does not empty into the inferior vena cava?
left gonadal vein
What vessel travels posterior to the superior mesenteric artery and anterior to the abdominal aorta?
left renal vein
The aorta originates at the:
left ventricle
What three sonographic factors define mesenteric ischemia?
peak systolic velocity of the SMA >275 cm/sec peak systolic velocity of the celiac axis >200cm/sec two of the three arteries are occluded (SMA, IMA, celiac axis)
Which vessels are considered intrasegmental within the liver?
portal vein, hepatic artery, bile duct