US PATHOLOGY - ABD REGISTRY

wolman disease

autosomal recessive disorder that causes excessive lipid storage in the liver, spleen and adrenal glands. most patients die in the first 6 mo of life > hepatosplenomegaly and massive adrenal gland enlargement

what is splenosis

autotransplantation of splenic tissue in the peritoneal cavity when the spleen ruptures either traumatically or spontaneously

what syndrome is hepatoblastomas associated with?

beckwith wiedemann syndrome (fetal syndrome)

what is pheochromocytoma? how will is displace the ipsilateral kidney?

benign tumor in adrenal gland will displace ipsilateral kidney inferiorly

hamartoma

benign tumorlike malformation

unilateral renal agenesis is associated with what anomaly in women? and in men?

bicornuate uterus; agenesis of the seminal vesicles in men

a duplicated collecting system will demonstrate what

circumferential cortex at the mid pole with upper and lower hilums

the hepatic vein in advances cirrhosis would show what kind of phasic pattern

cirrhosis causes compression of hepatic veins due to liver tissue fibrosis normal triphasic pattern become MONOPHASIC with minimal respiratory phasicity

case study: pt reports with RLQ pain, diarrhea, low grade fever. US shows: prominent lymph node and haustra

colitis

what is peribiliary fluid

collection of bile that forms around a perforated gb

malignancy ascites appearance

complex fluid collection with matted bowel loops

what causes schistosomiasis?

most common parasitic infection in humans caused by fluke parasite found in polluted waters and infested shellfish/snails portal vein carries ova to the liver narrowing and occlusion of smaller portal vessels causing portal HTN

how would acute hepatitis present

hepatomegaly with decreased echogenicity and scattered bright portal reflections within the parenchyma (starry night)

glycogen storage disease is associated with

hepatomegaly, increased echogenicity similar to fatty liver and hepatic adenoma formation

how does a yolk sac tumor present sonographically? what labs would be increased or decreased?

most common testicular tumor in pts under 2 yrs labs: elevated AFP sonographically: areas of hemorrhage and nercrosis - complex appearance

distal cholangiocarcinoma usually occurs

most commonly extrahepatic CBD near porta hepatis

describe transitional cell carcinoma

most commonly presents as diffuse bladder wall thickening with multiple masses within the wall

primary sclerosing cholangitis

most pts have inflammatory bowel disease or ulverative colitis causes chornic inflammation and fibrosis of the biliary ducts

MCKD (uni or bi?, caused by?)

multicystic kidney disease usually unilateral, if bilateral then fatal caused by insult during 14-18 weeks in fetal development

infectious vs non infectious causes for hepatitis

infectious: bacteria, fungus and virus non infectious: anabolic steroids (human made testosterone/androgens) (chronic use)

what is the key anatomic landmark in differentiating direct, indirect and spigelian hernias

inferior epigastric artery direct- herniated structures medial to the IEA indirect - lateral to the IEA spigelian - lateral to where the spigelian fascia is penetrated by the IEA

thyroiditis will display what sign

inferno sign - hypervascularity

what is bladder cystitis

inflammation of the bladder sonographically: bladder demonstrated thickened, irregular inferior wall w/ floating debris. represents urinary tract infection manifested as cystitis

what is epiploic appendagitis

inflammation of the thick fatty strands that attach to the serosal surface of the colon

schistosomiasis is an ??? cause of portal HTN. budd chiari syndrome is an ??? cause of portal HTN

intrahepatic PRESINUSOIDAL; intrahepatic POSTSINUSOIDAL

pseudomyxoma peritonei

intraperitoneal accumulation of a gelatinous ascites secondary to rupture of a mucinous tumor - most common cause is a rupture mucinous tumor of the appendix sonographically: mucinous secretions and tumor formation within lower abdomen causes bowel to be matted down against posterior abdominal wall

increased thyroid volume is associated with

iodine deficiency, acute hepatitis and chronic renal failure

most commonly found in the pancreatic body or tail and secretes hormones

islet cell tumors. two types: insulinomas and gastrinomas.

what are the 3 pancreatic endocrine tumors

islet cell tumors; insulinoma, gastrinoma, and glucagonoma

most common finding with congestive hepatomegaly is

ivc dilatation

??? is the most common malignncy of the liver seen in a pt with AIDS ?? is the most common infection of the liver seen in a pt with AIDS

kaposi sarcoma; pneumocystis carinii

most common type of cholangiocarcinoma

klatskin tumor

what would the labs be for pancreatitis ? what is a common complication?

labs: increased serum levels of amylase and lipase common complication: pseudocyst (complicated cyst) in the left pararenal space

where does staghorn calculus occur?

largus calculus located in the renal pelvis area common finding with Xanthogranulomatous Pyelonephritis

vessels that are common source for a type 2 endoleak

leak at the branch vessels potential sources include: IMA, Internal iliacs, lumber arteries, and accessory renal arteries

parasitic cholangitis involves?

liver flukes or ascariasis >may see worms in the inflamed ducts as echogenic tortuous strands in the lumen

what is the most common liver malignancy

liver mets

liver mets vs hepatocellular carcinoma

liver mets is more likely if the pt has a hx of primary cx in body as well as a liver mass with halo hepatocellular carcinoma is more likely if the pt has a hx of chronic liver disease (i.e. hep c) and a liver mass with a halo

what is zenker diverticulum? it can by mistaken for

located at the back of the throat, protrudes posterior or midline - a thyroid mass

what causes mucocele

long standing obstruction of cystic duct (remainder of biliary system is normal and jaundice would not occur)

most common primary carcinomas to metastasize to thyroid

lung, breast, and renal cell cancers

most common secondary malignancy of the testicles

lymphoma

which type of pancreatic mass has a strong risk of malignant conversion

macrocystic type of serous cystadenoma of the pancreas

alpha fetoprotein levels will increase with

malignancy and pregnancy

bladder carcinoma will appear as

mass infiltration into the wall of the bladder loss of definition of the affected wall thrombus accumulation limited to internal lumen of bladder

what is a common complication of cystic fibrosis

meconium ileus mucous production of the pancreas causing blockage of the ileum

what is caroli disease assoc with?

medullary sponge kid and hepatic fibrosis (-defect of bile ducts that leads to numerous cysts in the biliary tree)

what is the second most common primary malignancy of the testicles

non seminomatous tumors

an epidermoid cyst will have what lab values? will appear sonographically as?

normal lab values will appear as a avascular mass with rings of alternating hyperechoic and hypoechoic tissue giving the mass an "onion" appearance

retroperitoneal lymph nodes: normal vs abnormal

normal: no posterior enhancement (composed of fatty tissue and lymphatic tissue that absorbs and scatters sound) abnormal: posterior enhancement due to increased fluid within inflamed tissues

where does rectus abdominus hematoma occur?

occurs below the arcuate line can extend to the Space of Retzius in the pelvis sonographically: anechoic or mildly hypoechoic to surrounding tissues

what is the most common parasitic infection in humans?

schistosomiasis

when do you see spontaneous splenic rupture

seen in pts with malaria, hep a, cytomegalovirus, mononucleosis and HIV

how to differentiate a thyroid adenoma from a parathyroid adenoma

thyroid adenomas are hypovascular vs parathyroid adenomas are hypervascular

what is a primary reason a retroperitoneal lymph node dissection (RLND) is performed?

to determine if systemic chemotherapy is needed >> removed for eval for signs of mets

ectopic thyroid tissue can migrate

to the chest

what zone does BPH usually affect

transitional zone

sonographic appearance of hepatoma

usually solitary, solid masses of varied echogenicity. can grow large

tumor invasion into bladder most commonly caused by ??? females vs males

uterine cancer vs prostate cancer

vascular vs. nonvascular gb wall thickening

vascular: caused by cholecystitis or hepatitis non vascular: caused by CHF, renal failure, and cirrhosis

what is the pampiniform plexus? what is a normal and abnormal measurement?

venous drainage system of the testicle and scrotum normally should appear as less than 2mm in diameter abnormally it will appear as more than 2mm, then it will be diagnosed as varicocele

how does adenomyomatosis appear sonographically?

wall thickness sinuses can fill with bile or cholesterol deposits and can collect sludge or stones. comet tail and twinkle artifacts are seen with deposits in the diverticula

what causes a wandering spleen? what increased risk does it have?

weakened splenic ligaments: gastrosplenic and splenorenal ligaments increased risk for torsion

a mass that present with a bulls eye appearance within the liver tissue is most likely

mets

SMA is identified to the right of the SMV in apt with acute abd symptoms. what should you suspect

midgut malrotation

thyroglossal duct cyst location

midline neck superior to the thyroid gland

expected waveform from the hepatic waveform from the HV in pt with cirrhosis

monophasic, continuous antegrade flow

how does graves disease present symptomatically and sonographically? what labs would be increased or decreased?

most common cause of hyperthyroidism labs: increase t3 and t4 clinical symptoms: weight loss, night sweats, and exophthalmos (protruding eyeballs) sonographically: enlarged gland, diffuse decrease in echogenicity, coarse and heterogeneous texture and increased vascularity.

what is embryonal cell carcinoma? what are its lab values? how does it appear sonographically?

most common in men 25-35 years most aggressive malignancy with invasion of tunica albuginea in most patients labs: AFP and b-HCG are elevated sonographically: heterogeneous with solid and cystic portions and coarse calcifications. will have distorted organ contour

what is caroli disease? what does it cause? what is it assoc with?

congenital defect of bile ducts that leads to numerous cysts in the biliary tree. malformation causes bile stasis and impairs liver function associated with med sponge kid and hep fib

diffuse gb wall thickening with an irregular lumen contour and comet tail artifacts

adenomyomatosis

most common cause of small bowel obstruction in adults vs infants

adhesions; intussusception

cx assoc with cushing syndrome and hirsutism?

adrenal cortical cancer - causes elevated androgen levels complex sonographically

what is pneumobilia? how does it appear sonographically?

air in biliary tree air/tissue interface will cause reverberation or ring down artifact, as well as dirty shadowing posterior to the echogenic ducts

what happens after a transjugular intrahepatic shunt

air is retained within shunt after placement, limiting US eval for 3-5 days

what is the most common cause for multinodular cirrhosis and chronic pancreatitis

alcohol consumption

ADPKD (uni or bi?, caused by?)

autosomal polycystic kidney disease adult pkd is bilateral can reduce kidney function inherited genetic disorder

CHD obstruction would affect other biliary structures such as

contracted gb and dilater intrahepatic ducts

creeping fat is a sign of

crohns disease

patients with ? have a significantly increased risk of developing a seminoma

cryptorchidism

testicular seminomas are associated with

cryptorchidism, trisomy 21, klinefelter syndrome, and smoking

what is a choledochocele

cyst of intraduodenal portion of duct

how do embryonal cell tumors and testicular teratomas appear sonographically

cystic areas and coarse calcifications

a disorder that affects the pancreas by causing it to excrete a thick mucus like substance that inhibits the exocrine function is called

cystic fibrosis

sonographic appearance of a pancreas with chronic cystic fibrosis

decreased size and increased overall echogenicity

what sonographic appearance does oncocytomas and RCC have in common

demonstrate a central scar

adenoma of the thyroid sonographically appears

demonstrates halo sign (usually) thin, echolucent rim

the best way to image the patellar tendon with US

the patellar tendon connects the patella to the tibial tuberosity. imaging is performed from the anterior approach. when detached the pt is unable to extend their leg and patella is displaced superiorly

what is a tardus parvus waveform

"late and low" with late peaking and low velocity flow -will appear distal to significant stenosis where the flow will be dampened -refers to absence of early systolic peak and prolonged acceleration time

how would an abdominal wall hernia present

"mushroom cloud" of intestine through opening of peritoneum and muscular fascia valsalva maneuver will cause an increase in intra abdominal pressure, forcing bowel through the opening and peristalsis should occur upon release

congestive splenomegaly is an expected finding in patients with

(banti syndrome) is caused by excessive blood in the splenic tissues. commonly caused by portal HTN, CHF or splenic vein thrombosis.

adrenal cortical cancer causes? labs? clinical symptoms? contrast results? sonographical presentation? associated syndrome?

- causes neoplasm formation due to proliferation of cortical cells; very aggressive; can invade renal vein and ivc - larger than 6cm - elevated androgen levels - hirsutism - assoc with cushing syndrome - no contrast washout - sono: complex with hypoechoic solid components and cystic changes

what are 3 pleural effusion signs

- diaphragm sign: fluid above diaphragm and peripherally - displaced crus sign: fluid displaces crus away from spine - bare area sign: will extend behind liver at level of bare area

what are the different types of hernias and where do they occur

- femoral hernia - usually lies medial to the common femoral vein below the inguinal ligament - umbilical and spigelian hernias are abd hernias - direct inguinal hernias - occur superior to inguinal ligament and inferior and medial to inferior epigastric artery origin

what are the two difference liver tx anastomosis?

- piggyback anastomosis: hepatic confluence of tx liver attached to native IVC; single anastomosis site - interposition anastomosis: donor IVC segment replaces a segment of the native IVC; two anastomosis sites

what are the 3 types of debakey classification

- type 1: involves ascending and descending aorta - type 2: involves ascending aorta; associated with Marfan syndrome; least common - type 3: involves the descending aorta; lowest mortality rate

what is liver elastography used for ? how is it performed? an increase indicates?

- used to stage degree of liver fibrosis - box must be at least 2cm from skin surface and 2cm from glisson capsule. pt performs neutral breath. record 10 measurements from the same area - increase indicated more severe fibrosis

what is emphysematous cholecystitis?

-common form of acute cholecystitis in elderly diabetic males -secondary infection of gallbladder wall with gas-forming bacteria and necrosis

what are some vascular complications with pancreatitis

-thrombosis of the splenic vein or pseudoaneurysm of the splenic artery - related to pancreatic enzymes causing vascular erosion of the vessels near the pancreas

Non-seminomatous germ cell tumors

-yolk sac -choriocarcinoma -embryonal carcinoma more aggressive than seminoma tumor second most common primary malignancy of the testicles >usually contain cystic areas and calcs to differentiate from seminomatous tumors

what are the number one and two causes of acute pancreatitis

1) biliary tract disease 2) alcohol abuse

a portal vein that is greater or equal to ? indicated portal HTN

13mm

massive splenomegaly is defined as a spleen that exceeds >

18cm in length

achilles tendon most commonly ruptures

4cm from the distal insertion point at the calcaneus

what labs will be affected with ductal obstruction

ALP, GGTP, and bilirubin level will be increased (AST is not affected)

what lab values will increase with cirrhosis

ALT, AST and alkaline phosphatase -if hepatocellular carcinoma develops with the cirrhosis, then AFP levels will rise

what is wilsons disease? what is it caused by? what symptoms will present? labs? sonographic appearance?

Autosomal recessive disorder of copper overload in which copper in the liver, brain and other tissues caused by: hepatic dysfunction, hepatitis, cirrhosis, and or liver failure symptoms: jaundice, hematemesis, portal htn, ascites, rusty ring around the iris of the eye. (kayser-fleischer rings) labs: increased AST, ALT, bilirubin, PT. decreased albumin sonographically: echogenic fatty liver, fibrotic periportal thickening, nodular cirrhotic changes

What is a Klatskin tumor?

Cholangiocarcinoma occuring at the confluence of the hepatic ducts

most sensitive enzyme indicator for alcoholism

GGTP

most common cause of spread of hepatitis in the US is

IV drug users sharing needles

most common cause for an abd mass in a newborn

MCKD

what are the two cystic congenital abnormalities in kidneys?

MCKD, and ADPKD

which of the following vessels will be abnormally dilated with significant portal HTN

MPV and left gastric vein (coronary vein); left gastric vein normally drains into the splenicvein near the portal confluence

biliary hamartomas are also known as

Meyenburg Complexes - multiple well defined hypoechoic solid nodules <1cm in diameter. associated with hepatic fibrosis, autosomal dominant polycystic disease and cholangiocarcinoma

most common extratesticular neoplasm

adenomatoid tumor

most common location for the pancreatic allograft

right iliac fossa

case study: pt has chronic cirrhosis, a tubular vessel connecting to teh left portal vein and exiting the liver coursing inferiorly with low velocity flow indicates that it is

a dilated, patent umbilical vein. this is a sign of significant portal HTN

papillary thyroid cx appears as

a hypoechoic mass with calcifications also associated with enlarged cervical lymph nodes but is highly curable

how would a fungal liver abscess present

a mass with internal septations similar to the spokes of a wheel

mirizzi syndrome

a stone in the cystic duct causes extrinsic compression of the CBD, very painful

most common cause of scrotal pain in postpubertal men

acute epididymitis

what is epididymo-orchitis and how does it present sonographically

acute infection assoc w/ RI <.5 in testes >uncomplicated: RI < .5 >complicated: will present diastolic flow reversal

what can cause intrinsic (infrarenal) renal failure

acute tubular necrosis, nephritic syndrome, interstitial nephritis, autoimmune diseases

what is the most common gi tract cx

adenocarcinoma

what is the most common malignant neoplasm found in the prostate

adenocarcinoma

what is milk of calcium bile

also known as limey bile in chronic cholecystitis sludge like material with a high concentration of calcium

cholangitis

an acute inflammation of the bile duct

priapism

an unwanted, persistent, painful erection that lasts more than 4 hours.

what is the most lethal type of thyroid malignancy

anaplastic thyroid, very aggressive

how does AML present sonographically

angiomyolipoma sonographically: hyperechoic to the renal cortex and isoechoic to renal sinus

the diaphragm crura is located ? to the AO?

anterior

a pseudocyst most commonly forms in which retroperitoneal spaces

anterior pararenal space (where the panc is located)

a right adrenal mass would displace the ivc ...?

anteriorly the right adrenal gland is posterior to the ivc. tumor formation could dipslace the ivc anteriorly

where does retroperitoneal fibrosis occur

at the level of aortic bifurcation (usually). ureters pass through this space to reach the bladder. if both ureters are impinged, bilateral hydro will occur

what causes postrenal failure

bilateral renal obstruction

testicular lymphoma presents as

bilateral swelling and pain bilateral solid masses in parenchyma

hutch diverticula are identified in the

bladder - congenital outpouchings of the bladder wall near the ureteral orifice

potential collateral pathway formed in pts with cirrhosis

blood moves from superior rectal vein to middle rectal vein

a vascular condition of the lier seen in women who take oral contraceptives is

budd chiari syndrome

what is angiosarcoma? where? sonographic appearance?

cancer that forms in the lining of blood vessels an lymph vessels primary malignant neoplasm of spleen > splenomegaly with heterogeneous echotexture, complex mass and solid components and increased vascularity

what causes a corticomedullary renal abscess

caused by ascending bacteria in the urinary tract

parathyroid gland adenomas cause?

causes serum hypercalcemia and potential renal stone formation bc intestines have decreased calcium excretion. High PTH levels means low calcitonin which means high calcium levels. constant filtration of excess calcium in kidneys can lead to stone formation

CCK - cholecystokinin

causes the gb to contract and expel bile

primary sclerosing cholangitis is the most common risk factor of

cholangiocarcinoma

because there is a risk of cholangiocarcinoma with all cases of ????, surgical resection is recommended

choledochal cysts

most common cause of cholangitis

choledocholithiasis

decreased thyroid volume is associated with

chronic hepatitis, thyroxine treatment and radioactive iodine treatment

what causes azygous veins

chronic moderate CHF can cause dilated IVC and then dilated azygous and hemiazygous veins these veins connect the upper abd IVC to SVC in the chest so that the blood can reach the right atrium sonographically: visualize collaterals connecting IVC to SVC

splenic vein thrombosis is a common finding in pts with

chronic pancreatitis

what is a pyloric stenosis

diagnosed when muscle wall thickness exceeds 4mm with the stomach demonstrated medially

acute renal vein thrombosis would cuase

diastolic flow reversal in the renal arteries

sonographic appearance of epididymal torsion

difference in blood flow indicated partial or complete torsion in the segment >pain, hydrocele, normal head of CF but not body or tail >> focal torsion of body and tail

schistosomiasis and chronic cystitis are commonly associated with

diffuse bladder wall calcification

what is prostatis

diffuse process affecting entire gland, increased size and vascularity

how does cystitis appear sonographically

diffuse thickening of the bladder wall

primary gb carcinoma most commonly presents as

diffusely thickened gb with stones

chronic cirrhosis, tubular vessel connecting to the splenic vein just prior to its confluence with the SMV

dilated coronary vein

what is caput medusa

dilated, tortuous vessels around the umbilicus caused by portal HTN

asplenia causes

double right sidedness. involves absent spleen, right sided aorta, left sided ivc, midline liver and gb, horseshoe kidneys and congenital heart defects

what is the most common congenital anomaly of the urinary system

duplicated collecting system

echinococcal infection

early infection: simple cyst with debris later: daughter cysts "honeycomb" formation >>walls may be thick or calcified in chronic infection - possible calcified mass most commonly affects RIGHT LOBE

study: pt n&v, ruq pain, fever, increased wbc. gb is enlarged and filled with echogenic material that does not shadow or demonstrate fluid levels. these findings are most consistent with:

empyema of the gb (pus in the gb)

what are the most common causes of splenic abscess

endocarditis, septicemia, and trauma

most common cause of pneumobilia

endoscopic retrograde cholangiopancreatography (ERCP)

what is varicocele, which side is more common?

enlarged veins of the spermatic cord linked to infertility more common on left due to gonadal vascularity: left renal vein courses b/w sma and ao which increases risk of extrinsic compression causing decreased drainage of left gonad can be caused by nutcracker syndrome

best plane to see a dilated umbilical vein

sagittal and to the left of midline

phlegmon formation is associated with

focal pancreatitis

klatskin tumor

form of cholangiocarcinoma located at the liver hilum

portal HTN results in ??

formation of varices due to cavernous transformation which can results in rupture and cause significant hemorrhage from varices.(life threatening complication)

how does adenomyomatosis present sonographically

gallbladder sonographically: diffuse or segmental thickening of gb wall with formation of diverticula within wall - irregular lumen contour and comet tail artifacts occur from cholesterol deposits in Rokitansky - Aschoff sinuses

what is the most common primary cancer to met to the liver

gallbladder, then colon, then stomach, then pancreas

GGTP increase with ALP vs. ALT

gamma-glutamyl transpeptidase - moderate increased of GGTP is seen with liver damage due to alc, drugs, and chemo - a marked increase is seen with liver disease and post hepatic biliary obstruction ; increased GGTP and ALP: biliary obstruction ; increased GGTP and ALT: hepatocellular disease

what is GGTP

gamma-glutamyl transpeptidase - normally found in liver cells and biliary epithelium this enzyme is most sensitive indicator for alcoholism

what is cystic fibrosis

genetic disorder that affects the pancreas by causing it to excrete a thick mucus that inhibits the exocrine func

how to differentiate ganglion cyst from giant cell tumor of the hand

giant cell tumors are soft tissues masses and will not have posterior enhancement; wont move with adj tendon ganglion cysts are simple cysts with enhancement and do move with adj tendon

most common cause of hyperthyroidism

graves disease

what is kasaback-merritt syndrome

happens in infants with large hemangiomas what is it? sequestrian and destruction of plts w/in the large cavernous hemangiomas which causes significant thrombocytopenia results in : reduced plt count, visible cutaneous blue or reddish-brown lesions on extremities, and also hepatomegaly or jaundice sonographically: liver and spleen should be evaluated for hemangioma formation, possible hepatomegaly

how does anaplastic cx usually present

hard, fixed mass with rapid growth and invades surrounding neck structures

another term for Kasaback-Merritt Syndrome

hemangioma thrombocytopenia syndrome

primary indication for a liver tx in an adult vs child

hep c; biliary atresia

what is hepatization

hepatization of the gb reders to a gb filled with sludge that is isoechoic to the liver. makes gb hard to identify

how does transrectal prostatitis present sonographically

heterogeneous peripheral gland w/ a hypoechoic halo at the periurethral area hypervascularity abscess can form later on

echinococcal cysts are also called

hydatid cysts

what are common findings in horseshoe kidneys

hydronephrosis, calculi and pyelocaliectasisn (dilation of pelvis and calyces) are common

How does peyronie's disease present?

hyperechoic areas along the outer margins of the corpus cavernosa - scar tissue and fibrous plaque involving the tunica albuginea

what can cause prerenal failure

hypotension, volume depletion, heart failure, acute occlusion of the renal artery

biliary atresia

if jaundice persists more than 14 days after birth, the lack of opening in biliary tree will cause persistence of jaundice after birth

adrenal hemorrhage (labs, causes, and sono)

in newborns, caused by traumatic birthing in adults, results from trauma and hematologic disorders i.e. thrombocytopenia presents as jaundice and anemia labs: decreased hematocrit indicating internal bleeding sonographically: mass with varied echogenicity

HIV cholangitis

in pts with advanced HIV infection

lab values for yolk sac tumors (testicular tumor)

increased AFP (not b-HCG)

lab values for choriocarcinoma (testicular tumor)

increased b-HCG (not AFP)

lab values for embryonal cell carcinoma (testicular tumor)

increased b-HCG and increased AFP

splenic infarction

increased risk compared to other organs bs intraspenic arteries do not have communicating arteries which eliminates possibility of collateral formation when infarction occurs

what is endocarditis

infection of the lining of the heart and valves infection can spread through the arterial system to the spleen

another name for wilms tumor

nephroblastoma

what is wilms tumor

nephroblastoma most common renal tumor in children mass formation can lead to hematuria

sponge kidney is often associated with what finding

nephrocalcinosis: the formation of multiple calcifications/stones within medullary pyramids

3 characteristics of courvoisier syndrome or sign

painless jaundice, distended gb and an obstruction at the ampulla of vater

when a pancreas has enteric drainage, what should you image?

pancreas has two drainage routes: bowel (enteric) and bladder when a tx has enteric drainage you should image the bowel for obstruction with enteric exocrine drainage and image the bladder with bladder drainage

whipple procedure

pancreaticoduodenectomy removes the head of the pancreas and portion of the duodenum, gb and bile duct most commonly performed operation to treat panc cx

are papillary carcinoma or anaplastic carcinoma more common in thyroid cancers

papillary carcinoma

what is the most common type of thyroid cx

papillary thyroid cx

most suggestive complications of ormond disease

pedal edema and scrotal swelling

how does UPJ obstruction present sonographically

pelvis and calyces are dilated, but ureter is normal

schistosomiasis vs amebic abscess

polluted water with fluke parasites; protozoan parasites in contaminated water

chronic cholecystitis is related to an increased risk of?

porcelain GB and carcinoma.

what is a contraindiction to placement of a TIPS shunt and why

portal thrombosis bc thrombus could then travel from the portal vein to the IVC and into the lungs causing PE

diastolic flow reversal in the right and left HA of a newly placed liver allograft indicates

possible rejection

difference between prerenal, intrinsic, and postrenal acute renal failure

prerenal - diminished renal blood flow intrinsic - damage to renal parenchyma postrenal - caused by urinary tract obstruction

acute occlusion of the main renal artery can cause ? acute renal failure

prerenal failure other causes: hypotension, volume depletion, heart failure

if testicular cx presents unilaterally then most likely it is? bilaterally?

primary if unilateral secondary if bilateral

PSA

prostate-specific antigen signifies carcinoma or PSA if lesser elevation > 10ng/mL

matted bowel is suggestive of?

pseudomyxoma peritonei

what usually causes an echinococcal cyst in the liver

raw pork can carry parasites.

what does kasaback merritt syndrome result in

reduced plt count, visible cutaneous blue or reddish-brown lesions on extremities, and also hepatomegaly or jaundice liver and spleen may also have hemangiomas

what is a scrotal pearl

refers to extratesticular calcification with posterior shadowing

what is the appendix testes

remnant of mullerian duct located between epididymal head and testis

what is a renal carbuncle? what causes it? how does it appear?

renal abscess that forms in the parenchyma caused by hematogenous spread of staphylococcus aureus sonographically: dirty shadowing and ring down artifact if gas is produced by bacteria in the abscess

what is oncocytoma? how does it present?

renal tumor that occur later in life and are usually benign has a central scar

how would RI appear in a liver tx rejection

results in high resistance within hepatic artery and liver tissues

ormond disase also known as ? what is it?

retroperitoneal fibrosis refers to overgrowth of fibrous tissue around atherosclerotic aorta - complications: ivc compression, pedal edema, gonadal vein compression adn ureteral obstruction >> hypoechoic, soft tissue mass with smooth borders

what is the most commonly occurring germ cell tumor of the testicle

seminoma

what is gangrenous cholecystitis? what can it be a complication of? how does it appear sonographically?

severe form of acute cholecystitis complication of untreated cholecystitis > diffusely thickened gb wall with hypervascularity and intraluminal membranes >>perfusion detected in thickened walls which indicated areas of necrosis (gangrene) >>>abscess formation also possible

how do TB and sarcoidosis appear within the spleen

similar findings multiple hypoechoic nodules in the spleen during active disease afterwards the nodules become echogenic foci that can demonstrate posterior shadowing

difference between hemobilia and sludge

similar us eval hemobilia is related to percutaneous biliary procedures, liver bx, or trauma

sonographic appearance of focal nodular hyperplasia

single mass <5cm with a central scar and prominent central and radial vascularity forms due to a benign overgrowth of normal liver cells that are arranged in an abnormal function

what are psammoma bodies

small round calcifications

phlegmon

solid inflammatory mass that tends to infiltrate surrounding structures aka focal pancreatitis

how does renal infection present symptomatically and sonographically

sonographically: dilated calyces with thickened walls and debris, consistent with infection symptoms: increased WBC and fever

what is a common complication of a vasectomy

sperm granuloma

?? artery aneurysms are commonly assocaited with pancreatit and peptic ulcer disease while ??? artery aneurysms are usually caused by cystic medial necrosis

splenic artery; superior mesenteric artery

what is fibrolamellar carcinoma? what are its lab values? how does it appear sonographically?

subtype of HCC that is found in adolescents and young adults with no coexisting liver disease AFP are normal sonographically: punctate calcifications and central echogenic scar helps differentiate it from hepatoma

what is used to treat hypothyroidism

synthroid, levothyroxine, iodine or iron supplements

what are some sonographic signs that indicated thyroid malignancy

taller than wide mass, absent halo sign, microcalcifications, and intranodular flow.

what is peyronie disease, how does it present sonographically and symptomatically

testicular causes scar tissue and fibrous plaque formation that usually involve tunica albuginea causes restriction and curvature of affected size of penis and can be painful sonographically: hyperechoic areas along the outer margins of the corpus cavernosa

where and how do non seminomatous germ cell tumors present

testicular demonstrate cystic degeneration and internal necrosis with heterogeneous texture.

what testicular cancers occur bilaterally

testicular lymphoma, leukemia, and metasis

labs with leydig cell tumor

testicular tumor causes an endocrine imbalance with elevated b-HCG levels causing gynecomastia

leydig cell tumors of the testicle will demonstrate high serum levels of ?? which can lead to ??

testosterone; precocious puberty

what to do if diaphragmatic paralysis is suspected

the diaphragmatic thickness should be measures at the zone of apposition during inspiration and expiration <thickening should occur during inspiration (minimal or absent thickening indicated paralysis) >M mode can be used to document abnormal absent motion and thickening

what is nutcracker syndrome

the engorgement of the L renal vein due to compression b/t the SMA & AO

pleural effusion: transudative fluid vs exudative fluid

transudative fluid: free fluid that is pushed out of capillary beds due to high pressure. > low protein and lactate dehydrogenase > related to: CHF, liver and kidney disease exudative fluid: free fluid leaks outside the capillary cells due to inflammation. >>high protein and lactate dehydrogenase >>related to: malignancy, lupus, pneumonia and tuberculosis

two most common infections that cause granuloma formation in the spleen

tuberculosis and histoplasmosis

what is tubular ectasia

tubular ectasia of the rete testis is dilated testicular mediastinal tubules benign condition resulting from partial or complete obliteration of efferent ducts

according to the debakey classification system, what type of aortic dissection is most commonly associated with Marfan syndrome

type 2 - involves ascending aorta and associated with marfan syndrome

most primary testicular cancers are uni or bi?

uni

a pt with a seminoma of the left testicle will usually be treated by ???? while a pt with a non seminomatous tumor of the left testicle will usually be treated by ??

unilateral orchiectomy and chemotherapy; unilateral orchiectomy (non sem are not responsive to therapies)

what two bladder abnormalities are most commonly assocaited with a duplicated collecting system?

ureterocele of the distal insertion site of the upper pole ureter. vesicoureteral reflux is common in the lower pole ureter

where do AAA usually occur

usually lie below the level of the renal artery origins (infrarenal)

AML

usually originates in the adrenal cortex and is composed of fat and bony elements associated with cushing syndrome, conn syndrome, and adrenal hyperplasia

adenocarcinoma and focal pancreatitis usually affect what portion of the pancreas

usually pancreatic head

what is the sandwich sign

when multiple lymph nodes are surrounding a vessel image will show enlarged nodes surrounding portal vein or other vessel

what is the most commonly performed operation to the treat panc cx

whipple procedure aka pancreaticoduodenectomy also done for chronic pancreatitis or benign tumors

what is the most common renal tumor in children

wilms tumor/nephroblastoma

massive adrenal gland enlargement, hepatomegaly and splenomegaly are common findings in what autosomal recessive disorder

wolman disease ; excessive lipid storage in liver, spleen, and adrenal glands

most common testicular tumor in pts under 2 yrs?

yolk sac tumor