Abdominal Vasculature

An AAA is present when the diameter of the abdominal aorta exceeds ____ _____.

3 cm

The common iliac arteries, which typically measure between ____ ____ - ____ ____, are considered aneurysmal if their diameter exceeds ____ ____

8 mm and 10 mm 2.0 cm

The left renal veiln should be noted posterior to the _____ and anterior to the _____ _____

SMA abdominal aorta.

Any dilation of a blood vessel, whether focal or diffuse, is referred to as an

aneurysm

The ____, the largest artery in the body, originates at the ____ ____ of the heart.

aorta left ventricle

thrombus

blood clot

The most common shape of an AAA is

fusiform.

Celiac Trunk branches into what three arteries:

the splenic artery, the common hepatic artery, and the left gastric artery.

The common hepatic artery and splenic artery are readily seen in the _____ scan plane.

transverse

the normal spectral Doppler findings of the infrarenal aorta should show a ____-phasic and ____ resistant flow pattern with ____ of flow in early diastole.

triphasic, high- reversal

IVC filter

vascular filter placed in the inferior vena cava to prevent pulmonary emboli

An aneurysm results from the

weakening of the vessel wall.

1. Celiac artery = _______ flow 2. Common hepatic artery = _______ flow 3. Common iliac artery = _______ flow 4. Splenic artery = _______ flow 5. Superior mesenteric artery = _______ flow 6. Renal arteries = _______ flow

1. Low-resistance flow 2. Low-resistance flow 3. High-resistance flow 4. Low-resistance flow 5. Fasting patient = high-resistance flow postprandial (30-90 min) = low-resistance flow 6. Low-resistance flow

2=CLINICAL FINDINGS OF A PSEUDOANEURYSM

1. Recent catheterization, surgical procedure, or trauma 2. Pulsatile mass in the area of the puncture location

The upper normal limit of the abdominal aorta just below the diaphragm is ____ ____ in diameter. In the midabdomen, it will measure ____ ____ or less, and the distal aorta should not exceed ___ ___

2.5 cm 2.0 cm 1.8 cm.

Normal Flow Pattern Abdominal aorta Suprarenal aorta = _____resistance flow Infrarenal aorta = ____-resistance flow

Low high

The third main visceral branches of the abdominal aorta are the paired renal arteries. They arise just below the level of the ______. The right renal artery originates from the right ____ aspect of the aorta and travels posterior to the _____ on its way to the right renal hilum

SMA anterolateral IVC

The true lumen denotes the _____ lumen of the aorta, including the thrombus, whereas the false lumen is the opening?

actual after the narrowing from the thrombus has occurred

The inferior mesenteric artery (IMA) arises from the ____ surface of the abdominal aorta. It supplies blood to the _____ _____, ______ _____, and ____.

anterior transverse colon descending colon rectum

The left renal artery originates from the left _____ aspect of the aorta and travels posterior to the left _____ _____ as it progresses to the left renal hilum.

anterolateral renal vein

pulmonary embolus

blood clot that has traveled to the lungs and is obstructing the pulmonary arterial circulation; most often the result of a deep venous thrombosis

The celiac trunk may also be referred to as the _____ _____ or ______ _____

celiac artery or celiac axis.

The IVC is the largest vein in the body. It is created by the union of the

common iliac veins, usually near the level of the umbilicus.

false aneurysm-a

contained rupture of a blood vessel that is most likely secondary to the disruption of one or more layers of that vessel's wall

Complications of an AAA include distal ______, _____, _____, and _____.

embolism infection dissection rupture

abdominal aortic aneurysm

enlargement of the diameter of the abdominal aorta to greater than 3 cm

low-resistance flow

flow pattern characterized by persistent forward flow throughout the cardiac cycle

high-resistance flow

flow pattern that results from small arteries or arterioles that are contracted, which produces an increase in the resistance to blood flow to the structure that is being supplied

One significant branch of the right hepatic artery is the cystic artery, which supplies blood to the _____.

gallbladder

The common hepatic artery travels in the direction of the right side of the patient, toward the liver. It branches into the _____ artery at the level of the _____ _____.

gastroduodenal pancreatic head

The fourth branch of the abdominal alrta is the ____ arteries, arise from the ____ surface of the abdominal aorta, just below the ____ artery level.

gonadal anterior renal

The most common shape of an AAA is fusiform. A fusiform aneurysm is one that has a

gradual enlargement

A common site for pseudoaneurysm development is within the ____ at the level of the ____ artery following a _____ catheterization.

groin femoral heart

The AAA may include dilation of the _____ ____ as well.

iliac vessels

The wall of the aorta consists of three layers. The innermost layer, closest to the flowing blood, is the tunica _____. The middle layer, or muscular layer, is referred to as the tunica _____. The outermost layer is the tunica _____ and may also be referred to as the tunica ____

intima media adventitia, externa

Wilms tumor Aka

most common solid malignant pediatric abdominal mass; a malignant pediatric renal mass that may also be referred to as nephroblastoma

endovascular aortic stent graft repair

nonsurgical method for treating abdominal aortic aneurysms

Treatment for an AAA include what two treatmeant options

open surgery and endovascular aortic stent graft repair (EVAR).

The third main visceral branches of the abdominal aorta are the _____ _____ arteries.

paired renal

The historical treatment for pseudoaneurysms consisted of ______ _______. However, ultrasound-guided _______ ______ can also be used to treat pseudoaneurysms.

prolonged compression thrombin injections

the common hepatic artery becomes the _____ _____ artery. The proper hepatic artery enters the liver at the ____ ____ and branches further into the right and left hepatic arteries.

proper hepatic porta hepatis

A false aneurysm may also be called a

pseudoaneurysm.

In AAA Determination of whether the ____ arteries are involved in the aneurysm is vital because perfusion of the ____ may be compromised.

renal kidneys

Dissection of the abdominal aorta occurs when there is a

separation of the layers of the arterial wall, mostly disturbing the intima.

The SMA supplies blood to parts of the ____ ____, some of the ____, and the ____.

small intestines colon pancreas

the SMA is located posterior to the ____ ____and ______ and lateral to the ______

splenic vein pancreas SMV

The second main branch of the abdominal aorta is the ____.

superior mesenteric artery (SMA)

The subdivision of the aorta within the chest is referred to as the

thoracic aorta.

Sonographically, an AAA is present when the abdominal aorta measures greater than 3 cm in diameter. The lumen may contain mural _____ and varying amounts of _____ at the time of detection.

thrombus calcification

The aorta bifurcates into the Iliac Arteries near the level of the

umbilicus.

2 SONOGRAPHIC FINDINGS OF AN AORTIC DisSECTION

1. Possible AAA 2. Intimal flap may be noted within the aortic lumen

5/FINDINGS OF AN ABDOMINAL AORTIC CLINICAL ANEURYSM

1. Pulsatile abdominal mass 2. Abdominal bruit 3. Back pain 4. Abdominal pain 5. Lower extremity pain

One significant branch of the right hepatic artery is the ____ artery,

cystic

An AAA may also be saccular, which is described as the

sudden dilation of a vessel.

The main portal vein is created by the union of the:

Splenic vein and superior mesenteric vein

Two forms of AAA is

fusiform. saccular,

The most common location of an AAA is

infrarenal.

tunica intima

inner wall layer of a vessel

The IVC travels ______ through the abdomen.

superiorly

fusiform

-shaped like a spindle; wider in the middle and tapering toward the ends

The diameter of the IVC should never exceed:

2.5 cm

What branch and its tributaries of the abdominal aorta appears as a "seagull" in the transverse plane?

Celiac artery

Patients with the likelihood of having a pulmonary embolus often require the placement of an IVC filter, also referred to as the

Greenfield inferior vena cava filter.

What flow pattern would the postprandial SMA yield in small bowel ischemia? a. High resistance b. Low resistance

High resistance

What vessel can be often noted coursing between the SMA and the abdominal aorta in the transverse scan plane?

Left renal vein

What vessel travels directly anterior to the left renal artery? a. Left renal vein b. Hepatic artery c. Right renal vein d. Superior mesenteric vein

Left renal vein

____ resistance flow should be noted within the normal splenic artery.

Low-

A disorder of the connective tissue characterized by tall stature and aortic and mitral valve insufficiency is: a. Wilms syndrome b. Meckel-Gruber syndrome c. Marfan syndrome d. Kleinman syndrome

Marfan syndrome

The IVC terminates at the:

Right atrium

Which vessel would be the shortest in length? a. Right renal vein b. Right renal artery c. Left renal vein d. Left renal artery

Right renal vein

The inner wall layer of a vessel, closest to the passing blood, is the:

Tunica intima

The second main branch of the abdominal aorta is the:

a. SMA

hepatopetal

blood flow toward the liver

true aneurysm

enlargement of a vessel that involves all three layers of the wall

The IVC can be separated into four sections from superior to inferior:

hepatic, prerenal, renal, and postrenal.

Distal aneurysm may also include the ____ arteries.

iliac

Because the aorta is located on the _____ side of the abdomen, the ____ renal artery is much longer than the___ renal artery.

left right left

transitional cell carcinoma

malignant tumor of the urinary tract that is often found within the urinary bladder or within the renal pelvis

An aneurysms caused by infection is referred to as a

mycotic aneurysm.

Enlargement of the hepatic veins and IVC is often seen with

right-sided heart failure.

Budd-Chiari syndrome

syndrome described as the occlusion of the hepatic veins, with possible coexisting occlusion of the inferior vena cava

The gonadal veins are referred to as ______ veins in the male and ______ veins in the female.

testicular ovarian

A true aneurysm involves all _____ layers of the vessel wall.

three

Arteriovenous fistulas can result from____ or ____

trauma or biopsy.

The diameter of the portal vein can vary with respiration, although typically it is less than __ __.

13 mm

Occlusion of the hepatic veins describes: a. Marfan syndrome b. Klinefelter syndrome c. Morrison syndrome d. Budd-Chiari syndrome

Budd-Chiari syndrome

Normal renal arteries typically demonstrate ____-resistance flow.

low

The hepatic artery should yield ____-resistance and hepatopetal flow.

low

tunica adventitia

outer wall layer of a vessel

false lumen

residual channel of a vessel created by the accumulation of a clot within that vessel

The IVC travels superiorly through the abdomen. It is considered ______ and located anterior to the _____ and right lateral to the abdominal aorta

retroperitoneal spine

Arteriovenous malformations may be congenital or caused by

surgery, malignancy, biopsy, or trauma.

true lumen

true or original channel within a vessel

The IVC travels through the _____ ______ ______ of the diaphragm and ultimately terminates in the ____ _____ of the heart.

vena caval foramen right atrium

1 SONOGRAPHIC FINDINGS OF AN AORTIC RUPTURE

1. Abdominal aneurysm with an adjacent hematoma

7 CLINICAL FINDINGS OF AN AORTIC RUPTURE

1. Decreased hematocrit 2. Hypotension 3. Pulsatile abdominal mass 4. Abdominal bruit 5. Back pain 6. Abdominal pain 7. Lower extremity pain

3 SONOGRAPHIC FINDINGS OF AN ABDOMINAL AORTIC ANEURYSM

1. Diameter of the abdominal aorta measures greater than 3 cm 2. Thrombus within the lumen of the aorta 3. Calcifications, along with the thrombus, may produce acoustic shadowing

6 CLINICAL FINDINGS OF AN AORTIC DISECTION

1. Intense chest pain 2. Hypertension 3. Abdominal pain 4. Lower back pain 5. Neurologic symptoms 6. Marfan syndrome

2 SONOGRAPHIC FINDINGS OF A PSEUDOANEURYSM

1. Perivascular hematoma containing swirling blood and has a neck connecting it to the vessel 2. Color Doppler demonstration of turbulent flow within the mass

The most common cause of AAA in the United States is

Atherosclerosis

The hepatic veins may become narrowed with

Budd- Chiari syndrome.

The first main visceral branch of the abdominal aorta is the:

Celiac artery

______ ______ is the first main visceral branch of the abdominal aorta,

Ciliac trunk

Which of the following would most likely yield a high-resistance flow pattern? a. Celiac artery b. Common iliac artery c. Splenic artery d. Right renal artery

Common iliac artery

The veins seen attaching to the IVC just below the diaphragm are the:

Hepatic veins

Which of the following would have a pulsatile, triphasic blood flow pattern? a. Renal veins b. Hepatic veins c. Gonadal veins d. Common iliac veins

Hepatic veins

The _____ is the largest vein in the body.

IVC

A patient presents to the sonography department with a history of Marfan syndrome. The sonographic evaluation reveals a linear echo within the aortic lumen that extends from the celiac axis to the iliac arteries. Color Doppler reveals flow throughout the aorta on both sides of the linear echo. The patient has had no surgeries, and there is no AAA. What does the linear echo most likely represent? a. Calcific thrombus b. Intimal flap c. EVAR d. Aortic filter

Intimal flap

The left gonadal vein drains directly into the:

Left renal vein

Normally, the spectral waveform of the proximal aorta is considered ____ resistance, whereas the distal abdominal aorta is typically _____ resistance.

Low high

What should the postprandial flow pattern be within the SMA? a. High resistance b. Low resistance

Low resistance

What should the postprandial flow pattern be within the resistance SMA? a. High resistance b. Low resistance

Low resistance

An aneurysm associated with infection is termed:

Mycotic

In the sagittal plane, you recognize a circular, anechoic vascular structure posterior to the IVC. Which of the following would this structure be most likely? a. Abdominal aorta b. Left renal vein c. Right renal artery d. SMA

Right renal artery

Which of the following vessels show a different flow pattern after eating? a. Celiac artery b. Splenic artery c. Renal artery d. SMA

SMA

The hepatic artery should demonstrate: a. High-resistance flow b. Low-resistance flow

Low-resistance flow

Which vascular structure may be confused for the main pancreatic duct?

Splenic artery

Normal flow within the portal veins should be hepatopetal and ____-phasic

Mono

Which of the following is not true about the abdominal aorta? a. The abdominal bifurcates into the common iliac arteries. b. The proximal aorta is situated more anterior than the distal aorta. c. The aorta has a thicker tunica media than the IVC. d. The third major branches of the abdominal aorta are the renal arteries.

The proximal aorta is situated more anterior than the distal aorta.

The common hepatic artery and splenic artery are readily seen in the transverse scan plane. Combined with the celiac trunk, these vessels have a ______ or _____ appearance

a "seagull" or "T"-shaped

The right gonadal vein connects to the _____ aspect of the IVC

anterior

The celiac trunk arises from the ______ aspect of the abdominal aorta, between the _____ of the ______.

anterior crura diaphragm

aneurysm

any dilation of a blood vessel, whether focal or diffuse

Arteriovenous malformations (AVM) are direct communications between

arteries and veins

postprandial

after a meal

The outer wall layer of a vessel is the:

d. Tunica adventitia

atherosclerosis

disease characterized by the accumulation of plaque within the walls of arteries

Sonographically, the SMA is readily identified by the echogenic ____ ____ surrounding it

fat layer

The sonographic visualization of an _____ _____ is indicative of aortic dissection.

intimal flap

tunica media

middle, muscular layer of a vessel

the left gonadal vein drains into the left _____ vein,

renal

The main portal vein travels _____ ____ to the liver and enters the liver at the ______ ______.

right lateral porta hepatis

saccular aneurysm

saclike dilation of a blood vessel

Patients with pulmonary embolus often require the placement of an IVC filter, This filter is used to

trap emboli that could be traveling upstream, potentially preventing a pulmonary embolus.

embolism

-a blockage caused by an abnormal mass (embolus) within the bloodstream that hinders circulation downstream, leading to tissue damage

Clinical findings of an AAA include all of the following except: a. Lower extremity pain b. Back pain c. Abdominal bruit d. Elevated hematocrit

Elevated hematocrit

What abnormality would the failure of an EVAR to isolate an aneurysm from circulation most likely results in? a. Endoleak b. Aortic dissection c. Pulmonary embolism d. Deep venous thrombosis

Endoleak

Which of the following vessels would most likely yield a high-resistance flow pattern? a. Celiac artery b. Common hepatic artery c. Renal artery d. Fasting SMA

Fasting SMA

The most common shape of an AAA is:

Fusiform

Within the liver, the three hepatic veins-right, middle, and left-can be seen connecting to the

IVC.

What vessel may attach to the splenic vein before reaching the portal confluence? a. Left renal vein b. Inferior mesenteric vein c. Right renal vein d. Celiac vein

Inferior mesenteric vein

The aorta originates at the:

Left ventricle

small bowel ischemia

condition resulting in interruption or reduction of the blood supply to the small intestines

pseudoaneurysm Aka

false aneurysm

portal confluence collects blood from the _____ and _____

intestines and spleen.

Because of its small size, the _____ _____ artery is not typically seen with sonography.

left gastric

intimal flap

observation of the intimal layer of a vessel as a result of a dissection

mycotic aneurysm

aneurysm caused by infection

The Doppler waveform of the IVC is _____ near the heart and more _____ near the common iliac veins.

pulsatile phasic

With pulsed Doppler analysis, the hepatic veins will have a _____, ___-phasic blood flow pattern

pulsatile, triphasic

Tumor invasion of the IVC is often associated with

renal cell carcinoma.

A junction referred to as the portal splenic confluence or portal confluence is created by the union of

superior mesenteric vein and splenic vein.

The main portal vein is created by the union of the

superior mesenteric vein and splenic vein.

An AAA is present when the diameter of the abdominal aorta exceeds:

С. 3 cm

Once the aorta passes through the aortic hiatus of the diaphragm, it is referred to as the _____ ____.

abdominal aorta

The primary function of the IVC is to bring

deoxygenated blood from the lower extremities, pelvis, and abdominal organs back to the heart.

Marfan syndrome

disorder of the connective tissue characterized by tall stature and aortic and mitral valve insufficiency

The diameter of the IVC should not exceed

2.5 cm.

An outpatient with a history of back pain and hypertension presents to the ultrasound department for an abdominal aortic sonogram. Sonographically, you visualize a 6 cm infrarenal aortic aneurysm with an echogenic linear structure noted gently swaying in the aortic lumen. What is the most likely diagnosis? a. Aortic rupture b. Chronic aortic aneurysm c. Aortic dissection d. Aortic rupture

Aortic dissection

Patients having a pulmonary embolus often require the placement of an

IVC filter,

Which of the following statements about the abdominal aorta is not true? a. Most aneurysms located within the abdomi- nal aorta are false aneurysms. b. The abdominal aorta is located just left of the midline. c. The most common location of an AAA is infrarenal. d. The abdominal aorta is considered to be ret- roperitoneal in location.

Most aneurysms located within the abdominal aorta are false aneurysms.

Which of the following is not section of the IVC? a. Postrenal b. Pancreatic c. Prerenal d. Hеpatic

Pancreatic

All of the following are branches of the celiac axis except: a. Right gastric artery b. Hepatic artery c. Splenic artery d. Left gastric artery

Right gastric artery

Enlargement of the IVC, with subsequent enlargement of the hepatic veins, is seen in cases of:

Right-sided heart failure

A patient presents with unexplained abdominal pain for a vascular assessment of the SMA. Sonographically, you note that the patient's SMA yields a persistent high-resistive flow pattern. This is indicative of: a. Crohn disease b. Intussusception c. Bowel obstruction d. Small bowel ischemia

Small bowel ischemia

Which of the following statements about the IVC is not true? a. The diameter of the IVC is variable. b. Respiration can affect the size of the IVc. c. The IVC is located to the left of the abdominal aorta. d. The IVC is considered retroperitoneal in location.

The IVC is located to the left of the abdominal aorta.

The abnormal connection between arteries and veins is referred to as

arteriovenous fistulas.

Although its diameter should never exceed 2.5 cm, respiratory changes can alter the size of the IVC. Deep inspiration, sniffing, and the Valsalva maneuver will initially cause the IVC to_____, whereas sustained inspiration will eventually lead to an _____ of the IVC as blood begins to build up.

collapse enlargement

Where do the hepatic veins of the liver course?

courses posterior to the caudate lobe of the liver and through the bare area.

The next main venous connections to the IVC, just below the hepatic veins, are the _____ ____ veins.

paired renal

The splenic vein is located _____ to the pancreatic body and tail.

posterior