Chapter 13- Abdominal Vasculature

25. Development of an arteriovenous fistula may be caused by:

A. Neoplasm (Development of an arteriovenous fistula may be congenital or caused by trauma, surgery, inflammation, or neoplasm.)

34. An asymptomatic patient presents with a history of an abdominal aortic aneurysm. The findings in his sonogram are most suspicious for which of the following conditions?

D. Aneurysm with chronic thrombus (The anechoic area represents the lumen of the aorta, and the complex area represents chronic changes in intraluminal thrombus. Chronic thrombus within an aneurysm may demonstrate a complex appearance mimicking a dissection or rupture.)

9. The celiac axis branches into what arteries?

D. Common hepatic, left gastric, and splenic artery (The celiac axis branches into the common hepatic, left gastric, and splenic arteries.)

40. Which if the following vessels lies between the duodenum and the anterior portion of the pancreatic head?

D. Gastroduodenal artery (The gastroduodenal artery lies between the superior portion of the duodenum and the anterior aspect of the pancreatic head.)

42. Which of the following arteries supplies the left transverse colon, the descending colon, and the sigmoid?

D. Inferior mesenteric artery (The IMA supplied the left transverse colon, descending colon, upper rectum, and sigmoid.)

4. The left renal vein receives tributaries from which of the following veins?

D. Left suprarenal and left gonadal veins (The left renal vein receives the left suprarenal vein superiorly and the left gonadal vein inferiorly.)

14. Which of the following vein courses in an oblique plane between the right and left lobes of the liver?

D. Middle hepatic vein (Hepatic veins course between the segments of the liver toward the IVC. The middle hepatic vein divides the liver into right and left segments.)?

31. A 65 year old local farmer presents with a history of leukocytosis and an enlarging, pulsatile, abdominal mass. The anterior, posterior, and lateral borders of the distal aorta are outlined by the calibers. On the basis of the clinical history, the sonogram is most likely demonstrating which if the following pathologies?

D. Mycotic abdominal aortic aneurysm (The clinical history includes: leukocytosis and an enlarged pulsatile abdominal mass. The distal aorta measures 5 cm in height and 6 cm in width. Complex intraluminal echoes are also identified. The sonographic findings are most suspicious for a mycotic abdominal aortic aneurysm.)

17. The arrow is demonstrating which of the following vascular structures?

D. Right renal artery (A cross sectional image of a vascular structure is identified posterior to the IVC. This most likely represents the right renal artery.)

35. Arrow A is most likely identifying which of the following vascular structures?

D. Right renal vein (Vessel A is located in the upper abdomen and courses in a transverse plane, posterior to the liver toward the right renal hilum. Arrow A is most likely the right renal vein

33. Which of the following vascular structures is identified in arrow B?

D. SMA (Arrow B identifies a vascular structure located posterior to the body of the pancreas and is surrounded by a thick hyperechoic rim. These findings are most consistent with the sma.)

49. A dilatation of an artery when compared with a more proximal segment describes which if the following abnormalities?

D. Saccular artery (An ectatic aneurysm is a dilatation of an artery when compared with a more proximal segment. In cases of abdominal aortic aneurysms, the ectatic dilatation does not exceed 3.0 cm in diameter.

6. What statement most accurately describes the left renal vein?

D. The left renal vein may appear dilated because of compression from the mesentery (Normal compression from the mesentery may cause dilatation of the left renal vein. Renal veins demonstrate a spontaneous phasic flow pattern.)

50. Which of the following controls will decrease artifactual echoes only within the abdominal aorta?

D. Time gain compensation (Decreasing the time gain compensation at he level of the abdominal aorta will decrease the artifactual echoes only within the abdominal aorta.

10. The presence of a palpable "thrill" within an artery is suspicious for:

D. arteriovenous fistula (A palpable vibration within an artery is highly suspicious for an arteriovenous fistula.)

7. What structure is located anterior to the IVC?

Head of the pancreas (The psoas muscles, right adrenal gland, and diaphragmatic crura are located posterior to the IVC.)

47. Normal diameter of the splenic vein should not exceed:

B. 1.0 cm (The normal diameter of the splenic vein should not exceed 1.0 cm)

44. The risk of rupture in an abdominal aortic aneurysm measuring 6.0 cm in diameter is approximately:

B. 15% within 5 years (15% of abdominal aortic aneurysms measuring 6.0 cm in diameter will rupture within 5 years.)

41. The IVC generally measures less than:

B. 2.5 cm (The diameter of the IVC generally measures less than 2.5 cm and is considered enlarged after the diameter exceeds 3.7 cm)

30. Hypovolemic shock is a clinical finding in patients with a history of:

B. A ruptured aortic aneurysm (Hypovolemic shock is a clinical finding in patients with a history of ruptured aortic aneurysm. Marfan syndrome is associated with a aorta dissection.)

2. A fusiform aneurysm is best described as:

B. A uniform dilatation of the arterial walls (A fusiform aneurysm is characterized by a uniform dilatation of the arterial walls.)

12. The gonadal arteries arise from the:

B. Abdominal aorta (The gonadal arteries arise from the anterior aspect of the abdominal aorta inferior to the renal arteries and superior to the lumbar arteries.)

19. Which viscera branch of the abdominal aorta is identified by arrow A?

B. Celiac axis (Arrow A identifies a proximal anterior branch of the aorta. The celiac axis is the first visceral branch of the abdominal aorta. The inferior phrenic artery is the first parietal branch of the abdominal aorta.)

3. The first visceral branch of the abdominal aorta is the:

B. Celiac axis (The celiac axis is the first visceral branch of the abdominal aorta. The celiac artery courses approximately 1 to 3 cm before trifurcating into the splenic, left gastric, and common hepatic arteries.)

28. Berry shaped aneurysms primarily affect which artery?

B. Cerebral ( berry aneurysms are small saccular aneurysms primarily affecting the cerebral arteries.)

27. Direct extension of thrombus into the IVC is most likely caused by thrombus originating in the:

B. Femoral vein (Direct extension of thrombus into the IVC most commonly originates from the lower extremity, but may also originate from the iliac, renal, hepatic, or right gonadal veins.)

18. The anechoic structure lying anterior to the IVC and posterior to the liver most likely represents the:

B. Gallbladder (An anechoic structure is identified adjacent to the main lobar fissure in the region of gallbladder fossa.)

36. The anechoic area identified by arrow B its most consistent with which of the following vascular structures?

B. IVC (Vessel B courses in a sagittal plane directly posterior to the liver. This is most consistent with the IVC.)

1. A true aortic aneurysm is defined as a dilatation of the abdominal aorta:

B. Measuring 3.0 cm or greater (An ectatic aneurysm describes an arterial dilatation that measures larger than a more proximal segment but less than 3.0 cm in diameter.)

39. Which of the following vascular structures courses posterior to the IVC?

B. Right renal artery (The right renal artery is a common sonographic landmark coursing posterior to the IVC.)

13. What arteries give rise to the gastroepiploic artery?

B. Splenic artery (The gastroepiploic artery is a branch of the splenic artery.)

16. A patient presents with a history of pulmonary embolism. A sagittal image of the IVC demonstrates an intraluminal mass. On the basis of the clinical history, the mass is most suspicious for a:

B. Thrombus (Based on a history of pulmonary embolism, the echogenic mass is most suspicious for a thrombus. The majority of pulmonary embolisms propagate from the lower extremities though the IVC to the lungs.)

11. The contour of a mycotic aneurysm is most commonly described as:

B. saccular shaped (Saccular shapes aneurysms are most often caused by an infection or trauma. A mycotic aneurysm generally demonstrates a focal outpouching of one arterial wall.)

15. The normal diameter of the main portal vein should not exceed:

C. 1.3 cm (The diameter of the mpv should not exceed 1.3 cm in diameter in adults older than 20 years, 1.0 cm in diameter between 10 and 20 years of age, and 0.85 cm in younger than 10 years. )

38. The common iliac artery is considered enlarged after the diameter exceeds:

C. 2.0 cm (The common iliac artery is considered enlarged after the diameter exceeds 2.0 cm in diameter.)

29. Duplication of the main renal arteries is demonstrated in approximately:

C. 33% of the population (No explanation)

8. The abdominal aorta usually bifurcates into the right and left common iliac arteries at the level of the:

C. 4th lumbar vertebra (The abdominal aorta bifurcates into the right and left common iliac arteries at the level of the fourth lumbar; aka umbilicus.)

21. What condition most commonly coexists with a popliteal aneursym?

C. Abdominal aortic aneurysm (Approximately 25% of patients with a popliteal aneurysm demonstrate a coexisting abdominal aortic aneurysm.)

43. Patients with Marfan syndrome have a predisposing risk factor for developing an:

C. Abdominal aortic aneurysm (Marfan Syndrome is a musculoskeletal condition thats affects the elastic fibers in the media of the aorta, increasing the risk for developing an aneurysm.)

22. Development of an abdominal aorta aneurysm is most commonly caused by:

C. Arteriosclerosis (Pathological thickening, hardening, and loss of wall elasticity allow the weakened arterial walls to stretch)

24. The IVC is considered enlarged after diameter exceeds

D. 3.7 cm (The IVC usually measures less than 2.5 cm and is considered enlarged after the diameter exceeds 3.7 cm)

45. The amount of blood supplied to the liver from the portal venous system is approximately:

D. 70% (Approximately 70% of blood supplied to the liver is from the portal venous system, whereas the hepatic artery supplies 30%.)

26. An infiltrating neoplasm within the IVC most commonly originates from which structure?

C. Kidney (Neoplasms from the kidney extend into the renal vein and may infiltrate the IVC.)

5. The main portal vein bifurcates at the hepatic hilum into the:

C. Left and right portal veins (No reason/ explanation.)

46. Which of the following vessels course anterior to the abdominal aorta and posterior to the superior mesenteric artery?

C. Left renal vein (The left renal vein courses anterior to the aorta and left renal artery and posterior to the sma. The splenic vein courses anterior to the sma.)

32. Which of the following vascular structures is identified by arrow A?

C. Left renal vein (The vascular structure identified by arrow A courses in transverse plane, anterior to the sma, and posterior to the body of the pancreas. This is most consistent with the splenic vein.)

23. Which aneurysm is associated with a recent history of bacterial infection?

C. Mycotic (A mycotic aneurysm is usually caused by a recent bacterial infection.)

37. Dilatation of an artery caused by damage to one or more layers of the arterial wall describes a:

C. Pseudoaneurysm (Trauma and aneurysm rupture are the most common etiologies.)

20. Which of the following branches of the abdominal aorta is identified by arrow B?

C. SMA (An anechoic tubular structure is branching from the anterior aspect of the abdominal aorta. Arrow B identifies the sma, a common sonographic landmark. The renal arteries arise from the lateral aspect of the abdominal aorta.)

48. Which if the following vascular structures is most commonly mistaken as a dilated pancreatic duct?

C. Splenic artery (The splenic artery is a tortuous branch of the celiac axis and is most commonly mistaken as a dilated pancreatic duct.)