Critical Thinking Midterm

You have identified a single homogeneous hyperechoic lesion measuring 2.4 cm in the posterior aspect of the right lobe of the liver. What ts the most common etiology of a mass fitting this description? Select one: a. Cavernous hemangioma b. Hepatic adenoma c. Hepatocellular carcinoma d. Cyst e. Focal Fatty Sparing

a. Cavernous hemangioma

A 32-year-old female patient presents to the sonography department with a history of fever, leukocytosis, and right upper quadrant pain. Sonographically, you visualize dilated bile ducts that have thickened walls and contain sludge. What is the most likely diagnosis? Select one: a. Cholangitis b. Biliary atresia c. Mirizzi syndrome d. Choledocholithiasis

a. Cholangitis

Patient 87 year old male with RUQ pain. Make the diagnosis. Select one: a. Gallstone, rolls when patient changes position b. Gallstone stuck in neck c. Mobile sludge ball d. Polyp

a. Gallstone, rolls when patient changes position

A patient in the intensive care unit because of a spinal cord injury with a long hospitalization complains of intermittent RUQ pain, and a sonographic evaluation of the RUQ is ordered. Sonography reveals a gallbladder containing low-level echoes that layer and are gravity dependent. This finding is most consistent with which of the following? Select one: a. Sludge b. Cholelithiasis c. Abscess d. Emphysematous cholecystitis e. Cholecystitis

a. Sludge

A patient presents with severe abdominal pain, nausea, vomiting, abdominal distention, increased serum amylase and lipase, with a drop in hematocrit. The sonographer should be suspicious for Select one: a. Cystic fibrosis b. Acute cholecystitis c. Hemorrhagic pancreatitis d. Phlegmon

b. Acute cholecystitis

An 82-year-old woman presents with RUQ pain, jaundice, nausea, and vomiting. She also reports unexplained weight loss. Ultrasound of the gallbladder reveals cholelithiasis. In addition, an irregular focal thickening of the gallbladder wall is seen in the fundus. These findings are most suggestive of which of the following? Select one: a. Gallbladder perforation b. Gallbladder carcinoma c. Gangrenous cholecystitis d. Abscess e. Cholecystitis

b. Gallbladder carcinoma

81-year-old male with flank pain. What is the diagnosis and what is the artifact depicted? Select one: a. Oncocytoma; edge shadow artifact b. Kidney stone: Twinkle artifact c. Complex cyst; Twinkle artifact d. RCC; Kidney stone

b. Kidney stone: Twinkle artifact

Middle age female presents with RUQ pain. Image one and two are obtained with the patient supine. Image three and four are taken with the patient LPO. What is the probable diagnosis? Select one: a. Gallstone b. Sludge c. Gallbladder carcinoma d. Large polyp

b. Sludge

45 year-old-male presents with severe RUQ pain. Onset one day ago. Patient has pain after eating fatty food, jaundiced and has a fever. You perform the ultrasound and document a grossly thickened gallbladder wall and pericholecystic fluid. Select one: a. Renal carcinoma b. Gallbladder is absent. Exam is normal. c. Acute cholecystitis d. Liver Abscess

c. Acute cholecystitis

A 57-year-old man with long-standing diabetes presents to the emergency department with signs and symptoms of severe, acute cholecystitis. The sonographic findings include gallbladder wall thickening and multiple comet-tail artifacts emanating from the wall. The gallbladder lumen contains low-level echoes from which comet-tail artifacts are also seen; however, there is no evidence of cholelithiasis. What is the most likely diagnosis? Select one: a. Acute cholecystitis b. Chronic cholecystitis c. Emphysematous cholecystitis d. Gallbladder perforation e. Adenomyomatosis

c. Emphysematous cholecystitis

You are scanning a patient with a history of fever, abnormal liver function tests, and right upper quadrant tenderness. The liver is enlarged with decreased echogenicity, the gallbladder wall is thickened and thick echogenic bands are noted surrounding the portal veins. Which of the following conditions is most likely? Select one: a. Normal liver b. Cirrhosis c. Hepatitis d. Fatty liver e. Budd-Chiari syndrome

c. Hepatitis With hepatitis, the liver parenchyma may appear normal or have a decreased echogenicity with increased echogenicy of the portal veins. Bright bands seen surrounding the portal veins are known as "periportal cuffing." Hepatomegaly may be present as well as thickening of the gallbladder wall.

A 62-year-old man who recently moved to the United States from Southeast Asia undergoes an abdominal sonogram. His chief complaint is abdominal discomfort, and his clinician notes low-grade fever and suspicion of hepatomegaly. Recent laboratory tests reveal elevated alpha fetoprotein. The sonogram shows a 6-cm heterogeneous mass occupying the left lobe of the liver. What is the mostly likely diagnosis for this mass? Select one: a. Solitary metastatic lesion b. Schistosomiasis c. Hepatocellular carcinoma d. Focal Nodular hyperplasia e. Hemangioma

c. Hepatocellular carcinoma

A patient is referred for a liver ultrasound with the clinical history of a raised serum level of alpha-fetoprotein (AFP) level. What should you look for? Select one: a. Focal nodular hyperplasia b. Hydatid disease c. Hepatocellular carcinoma d. Increased alpha-fetoprotein levels are not associated with liver disease e. Fatty liver

c. Hepatocellular carcinoma A non pregnant person with elevated levels of serum alpha-fetoprotein (AFP) may have hepatocellular carcinoma. However, low levels of AFP do not rule out the presence of hepatocellular carcinoma. Other abnormalities associated with high levels of AFP include germ cell tumor of gonadal, retroperitoneal, or mediastinal origin. Occasionally, serum AFP levels may be abnormally high with cancer of the pancreas, stomach, or biliary system. Hepatitis and cirrhosis may produce modest serum AFP elevations.

23-year-old presented with pelvic pain and frequency voiding. Pt was scanned previously and it was stated that it was a normal exam and bladder was seen. Pt has returned with the same symptoms. What is this cystic structure? Select one: a. Abnormal exam, cystic structure appears to be cystadenoma b. Finding is pelvic kidney with hydro c. Normal exam, cystic structure is bladder d. A large degenerating fibroid is seen coming of the anterior border of the uterus

c. Normal exam, cystic structure is bladder

A recannalized paraumbilical vein may be seen as a result of which of the following? Select one: a. Liver biopsy b. Hepatic trauma c. Hepatic adenoma d. Portal hypertension e. Hepatitis

d. Portal hypertension

A patient is referred for abdominal ultrasound with a high fever and right upper quadrant pain. You document the presence of a large, rounded, homogeneous mass with low-level internal echoes and poorly defined borders. The mass is located in the right lobe of the liver, adjacent to the capsule and shows increased through transmission. This most likely represents. Select one: a. Choledochal cyst b. Hemorrhagic cyst c. Hematomoa d. Loculated ascites e. Abscess

e. Abscess These characteristics describe an amebic abscess within the liver. A hemorrhagic cyst could have a similar appearance, but the wall would be clearly defined rather than poorly distinguished .

A patient is referred with right upper quadrant tenderness and a history of oral contraceptive use. A solid, hypoechoic mass is identified in the right lobe of the liver. Color Doppler reveals hypervascularity of the mass. Which of the following scenarios is most likely? Select one: a. Hepatocellular carcinoma b. Hepatic lipoma c. Hydatid liver disease d. Hepatic abscess e. Hepatic adenoma

e. Hepatic adenoma