Chapter 18 Peritoneum, Noncardiac Chest, and Invasive Procedures

. The inferior portion of the peritoneum is formed by which of the following structures? a. pouch of Douglas

. a. The pouch of Douglas (retrouter-ine pouch) is located in the most posterior portion of the pelvis. The inferior portion of the parietal layer of the peritoneum forms it.

Which of the following terms is most likely used to describe the sonographic appearance of mesen-teric lymphomatous? b. sandwich sign

. b. The "sandwich sign" (anechoic mass with a hyperechoic center) is the most common term used to de-scribe the sonographic appearance of mesenteric lymphomatous.

20. A thin needle is used to obtain tissue samples in which of the following invasive procedures? a. thoracentesis b. paracentesis c. amniocentesis d. fine-needle aspiration

20. d. Fine-needle aspiration (FNA) uses a thin needle and gentle suc-tion to obtain tissue samples for pathological testing. .

Which of the following invasive procedures removes a small piece of tissue for microscopic analysis? a. biopsy

a. A biopsy removes a small piece of living tissue for microscopic analysis. Surgical incision of a tumor without removal of sur-rounding tissue describes a lumpec-tomy. Fine-needle aspiration uses a thin needle and suction to obtain tissue sampling for pathological testing.

Which of the following organs lie within the peritoneum? a. spleen

a. Organs contained within the peritoneum include the liver, spleen, stomach, gallbladder, uter-ine body, and portions of the small and large intestines. The pancreas, kidneys, and adrenal glands lie within the retroperitoneum.

. Peritoneal ascites is a common complication in which of the following conditions? a. malignancy

a. Peritoneal ascites is associated with malignancy, postsurgery, post-ovulation, chronic liver disease, cardiovascular disease, infection, and inflammation. Pneumonia is more likely to cause a pleural effu-sion rather than peritoneal ascites

Which of the following peritoneal spaces is located in this sonogram? a. lesser sac

a. The pancreas is identified in this transverse sonogram of the upper abdomen. The lesser sac separates the pancreas from the stomach

Which of the following structures encloses the inferior esophagus? c. lesser omentum

. c. The inferior end of the esopha-gus is enclosed by the lesser omen-tum. The lesser omentum extends from the portal fissure of the liver to the diaphragm.

15. The peritoneum is described as extending from the: a. posterior abdominal wall to the retroperitoneum b. diaphragm to the umbilicus c. diaphragm to the deep pelvic recesses d. posterior abdominal wall to the paraspina

5. c. The peritoneum extends from the diaphragm to the deep pelvic spaces and from the anterior ab-dominal wall to the retroperito-neum and paraspinal tissues.

Failure of the mesentery to fuse is a congenital anomaly associated with development of a(n): a. omental cyst

. a. Congenital failure of the mesen-tery to fuse is a congenital anomaly associated with development of an omental cyst. Mesentery cysts are related to the Wolffian or lymph ducts.

A patient is most commonly placed in which of the following positions during a thoracentesis procedure? b. sitting

. b. The patient is generally placed in a sitting position, bent slightly

A decrease in hematocrit is most consistent with which of the following conditions? c. hemorrhage

. c. A decrease in hematocrit is sus-picious for hemorrhage.

A middle-aged patient presents with a history of cirrhosis and abdominal bloating. Free fluid is identified in the right upper quadrant. Arrow c. coronary ligament

. c. Arrow A identifies a hyperechoic linear structure extending from the liver to the undersurface of the dia-phragm. This is most consistent with the coronary ligament. The right coronary ligament serves as a barrier between the right sub-phrenic space and the Morison pouch.

Which of the following peritoneal spaces is identi-fied by arrow C? c. subhepatic space

. c. Arrow C identifies a peritoneal space posterior to the liver and lat-eral to the gallbladder. This is most consistent with the subhepatic space.

. Which of the following peritoneal spaces is most likely identified by the arrow? c. Morison pouch

. c. The arrow identifies a space pos-terior to the right lobe of the liver and superior and lateral to the right kidney. This is most consistent with Morison pouch. Pouch of Douglas is located anterior to the rectum in the posterior pelvis

The lesser sac communicates with the subhepatic space through the foramen of: . Winslow

. d. The lesser sac communicates with the subhepatic space through the foramen of Winslow. Foramen of Monro is located between the third and lateral ventricles in the brain. Foramen ovale is located between the atrium of the heart. The common bile duct enters the descending portion of the duode-num through the ampulla of Vater.

A patient presents with a history of elevated liver function tests and shortness of breath. An anechoic fluid collection is identified in which of the following regions? a. pleural space

a. A fluid collection is identified anterior to the diaphragm consis-tent with a pleural effusion. Sub-phrenic ascites would be located posterior to the diaphragm.

Which of the following terms best describes an intraperitoneal collection of anechoic-free fluid? a. ascites

a. An abnormal collection of free fluid in the peritoneal cavity de-scribes abdominal ascites. Seroma, hematoma, and lymphocele are re-stricted fluid collections.

Which of the following structures has the potential to seal off infections within the peritoneal cavity? a. greater omentum

a. The greater omentum has the potential to seal off infections or hernias within the peritoneal cavity. The greater omentum spreads like an apron covering most of the ab-dominopelvic cavity

. A delicate serous membrane composed of a visceral and a parietal layer best describes a. pleura

a. The pleura is a fine, delicate, serous membrane composed of visceral and parietal layers.

The prevesical space is located in which of the following regions? a. pelvis

a. The prevesical space is located in the pelvis, lying anterior to the uri-nary bladder and posterior to the symphysis pubis. It is also known as the retropubic space.

Which of the following invasive procedures is documented in this sonogram? b. core-needle biopsy

b. A large core needle is identified consistent with a core needle bi-opsy. A slender needle is used in fine-needle aspiration procedures.

Which of the following acoustic windows is gen-erally used in noncardiac imaging of the chest? b. intercostal

b. An intercostal (between the ribs) approach is typically used in non-cardiac imaging of the chest. Intra-costal pertains to the inner surface of the rib. Subcostal and supraster-nal are used in cardiac imaging.

A 28-year-old woman presents to the ultrasound department complaining of left lower quadrant pain. An anechoic area is identified in which of the following regions? b. pouch of Douglas

b. Free fluid is identified posterior to the uterus and anterior to the rectum consistent with the pouch of Douglas posterior cul de sac, or retrouterine pouch. .

Omental cysts generally develop adjacent to which of the following structures? b. pancreas and stomach

b. Omental cysts are small cystic structures developing adjacent to the stomach or lesser sac (pancreas).

. On ultrasound, visualization of a biopsy needle is obtained in a plane: b. parallel with the needle path

b. On ultrasound, visualization of the biopsy needle is obtained in a plane parallel with the needle path.

Which of the following patient positions is utilized for a paracentesis procedure? b. supine

b. Patients are typically placed in the supine position for a paracentesisprocedure. Renal biopsies are gener-ally performed with the patient in a prone position. .

Which of the following structures is located within the right coronary ligament? b. bare area

b. The bare area (lacking perito-neum) is a triangular space located between the two layers of the right coronary ligament.

The subphrenic space is divided into right and left sides by the: b. falciform ligament

b. The falciform ligament divides the subphrenic space into right and left sides. The crura of the dia-phragm extend from the diaphragm to the vertebral column.

Which of the following structures is located within the peritoneal cavity? b. liver

b. The liver is located in the perito-neal cavity. The pancreas, kidneys, and great vessels are located within the retroperitoneum.

Which of the following structures lines the abdomi-nal cavity? b. peritoneum

b. The peritoneum is an extensive serous membrane lining the ab-dominal cavity. The lesser and greater omentum are part of the peritoneum. The mesentery is a double layer of peritoneum sus-pending the intestines from the posterior abdominal wall.

Which of the following peritoneal spaces is located anterior to the uterus and posterior to the urinary bladder? b. vesicouterine

b. The vesicouterine pouch or ante-rior cul de sac is located anterior to the uterus and posterior to the uri-nary bladder. The retropubic and prevesical spaces are located ante-rior to the urinary bladder and pos-terior to the symphysis pubis.

Chylous ascites is most commonly associated with which of the following abnormalities? c. abdominal neoplasm

c. A collection of chyle and emulsi-fied fats in the peritoneal cavity (chylons ascites) is most commonly associated with an abdominal neo-plasm. Cirrhosis, acute cholecysti-tis, and congestive heart failure demonstrate benign ascites.

. Which of the following fluid collections is typically located medial to a renal transplant? c. lymphocele

c. A lymphocele is an accumulation of lymphatic fluid more commonly occurring following a renal trans-plant. Lymphoceles are usually lo-cated medial to a renal transplant.

Hemothorax is best described as an accumulation of: c. fluid and blood in the pleural cavity

c. An accumulation of blood and fluid in the pleural cavity describes a hemothorax.

An anechoic fluid collection is identified by arrow B . This is most consistent with which of the following conditions? c. subphrenic ascites

c. Arrow B identifies an anechoic area posterior to the diaphragm and anterolateral to the liver. This is most consistent with free fluid (as-cites) in the right subphrenic space. Blood typically demonstrates inter-nal echoes.

A patient presents with a history of hepatitis C. Ascites is identified in which of the following peritoneal spaces? c. paracolic gutter

c. Ascites is identified adjacent to hyperechoic bowel in the right paracolic gutter. The retrovesicle pouch is located posterior to the urinary bladder and anterior to the rectum. Space of Retzius is located anterior to the urinary bladder and posterior to the symphysis pubis

Hemoperitoneum may be associated with which of the following conditions? c. necrotic neoplasm

c. Blood in the peritoneal cavity (hemoperitoneum) can be associ-ated with trauma, rupture of an abdominal blood vessel, postsurgi-cal complication, ectopic preg-nancy, fistulas, and necrotic neo-plasms.

An accumulation of fluid and pus in the peritoneal cavity describes: c. exudative ascites

c. Exudative ascites is defined as an accumulation of fluid, pus, or serous fluid in the peritoneal cavity. Transudative ascites contains small protein cells. Chylous ascites con-tains chyle and emulsified fats

Which of the following peritoneal spaces serves as a conduit between the upper abdominal cavity and pelvis? c. paracolic gutters

c. The paracolic gutters are located in the lateral portions of the ab-dominopelvic cavity and serve as conduits between the upper abdo-men and the deep pelvis.

Which of the following peritoneal spaces is located lateral to the intestines? c. paracolic gutter

c. The paracolic gutters are located lateral to the intestines. The retro-vesical pouch is located posterior to the urinary bladder and anterior to the rectum.

Which of the following functions is considered the responsibility of the peritoneum? c. secretion of serous fluid to reduce organ friction

c. The peritoneum secretes serous fluid to reduce friction between or-gans. It also enfolds and suspends peritoneal organs. The coronary ligament serves as a barrier be-tween the subphrenic and subhe-patic spaces.

A patient arrives by ambulance to the emergency department following a motor vehicle accident. On ultrasound, a large hypoechoic fluid collection is identified in the left subphrenic space. On the basis of the clinical history, this fluid collection most likely represents: d. hemoperitoneum

d. An intraabdominal fluid collec-tion (subphrenic) following a recent trauma most likely represents blood within the peritoneal cavity (hemoperitoneum).

Which of the following is a predisposing condition associated with the development of a pleural effusion? d. congestive heart failure

d. Infectious or inflammatory condi-tions of the lungs and cardiovascular disease are predisposing factors for developing a pleural effusion.

Which of the following invasive procedures accomplishes withdrawal of fluid from the abdominal cavity? d. paracentesis

d. Paracentesis is an invasive pro-cedure where fluid is withdrawn from the abdominal cavity for diag-nostic or therapeutic purposes. Bi-opsies remove a small portion of living tissue.

An apron of peritoneum covering the small intestines describes the: d. greater omentum

d. The greater omentum is a double fold of peritoneum that spreads like an apron over the transverse colon and small intestines. The mesentery suspends the intestines from the posterior abdominal wall. The perineum supports and surrounds the distal portions of the urogenital and gastrointestinal tracts of the body

The lesser omentum is also known as the: d. gastrohepatic omentum

d. The lesser omentum extends from the lower end of the esopha-gus to the liver and is also known as the gastrohepatic omentum. The lesser sac is also known as the omental bursa.

The lungs are separated into hemispheres by which of the following structures? d. pleural membrane

d. The lungs are separated into right and left hemispheres by the pleural membrane. The heart is located between the inferior borders of the lungs. The pleural cavity is a space within the thorax that con-tains the lungs. The sternum is the middle portion of the anterior thorax.

Free fluid most commonly accumulates in which of the following peritoneal spaces? d. subhepatic space

d. The subhepatic space is the most common site for ascites to collect, followed by the Morison pouch.

When localizing a fluid collection for a paracente-sis procedure, the sonographer must: d. remain perpendicular to the floor

d. When localizing a fluid collec-tion for a paracentesis procedure, the sonographer must align the transducer perpendicular to the ta- ble or floor. Care should be taken to use minimal transducer pressure for accurate depth measurement