Case Studies Final Review
What is the most common primary carcinoma of the pancreas?
Adenocarcinoma
What is the most common form of Pancreatic Cancer?
Adenocarcinoma More comm in men ages 60-80
What 2 Liver Pathologies are related to the use of oral contraceptives?
Adenoma FNH
The area indicated by the arrow was stationary upon change of position by the patient. What is a likely diagnosis? #6 on Image Review Doc
Adenomyomatosis, Cholesterolosis
A 40 year old woman with symptoms of heavy bleeding and painful periods presents to the ultrasound department. Her periods are regular, with her LMP being 1 week ago. She has a history of surgical removal of a right ovarian cyst 15 years ago. She has had 4 normal pregnancies and one miscarriage when she was 23 years old. No discrete masses were measured by the sonographer. Based on the following image what is her most likely diagnosis? #41 on Image Review Doc
Adenomyosis
A newborn with traumatic birth is coming for a suspected RUQ mass. Upon examination a swollen and bluish discolored scrotum is noted. Labs show the infant is anemic. The ultrasound showed a crescent shaped slightly hyperechoic right supra renal mass with no blood flow What is the most likely diagnosis? Select one: a. Wilm's tumor b. Adrenal hemorrhage c. Multicystic dysplastic kidney d. Neuroblastoma
Adrenal hemorrhage
What type of pt are you more likely to find fibroids?
African American
US Appearance: Emphysematous Cholecystitis
Air in GB wall may appear bright like a stone but no posterior shadow Ring Down artifact Comet Tail Artifact
What are common causes of Fatty Liver
Alcoholism obesity DM ** there is also non-alcoholic form called NASH**
US Appearance: Chronic Renal Failure
With progression = Small Echogenic Kidenys **Cortical Thinning** Initially = enlarged kidneys
US Appearance: Appendicitis
Blind-ended tubular structure Wall Thickness >2mm Diameter >6mm Non-compressable Bulls eye appearance may see Appendicolith with post shadowing Free fluid Increased vascularity
What is the most common cause of Hematoma of the Spleen
Blunt force trauma
Where is Panc Cystadenoma usually found?
Bod and Tail of Panc
Where are Islet Cell tumors of the Panc usually found?
Body and Tail of Panc
What types of patients are you more likely to see Papillary Necrosis?
Women pts with DM
Is fatty liver disease reversible?
YES
If this image was taken on a 33 year old woman and the endometrium measured 8 mm would you consider this normal? #39 on Image Review Doc
Yes, this is normal for her age
of what origin are most malignant testicular masses and which one is the most common?
germ cell origin, seminoma
what is the finding in the following images and name one cause of this:
hematocele- trauma
name 4 sono findings that may be seen with testicular torsion :
hypoechoic/heterogeneous no blood flow, hydrocele, enlarged epididymis
When is renal disease considered end stage?
if the kidney function is <10% at this point Dialysis is necessary then transplant if elligible
which side, right or left, are varicoceles more likely to develop?
left
US Appearance: Porcelain GB
Bright Echogenic wall with Shadowing May only affect a portion of the GB Wall Differential = WES sign
What is the most comm cause of Portal HTN?
CIRRHOSIS
Labs asso with Intussusception
Dehydration anemia Inc. WBCs
US AppearanceL Intussusception
Donut sign **Pseudokidney** Free Fluid Ascites
Risk Factors for Cholangiocarcinoma
Exposure to radionucleides, chemical carcinogens Some bili tract diseases (sclerosing cholangitis and choledochal cysts)
US Appearance: Acalculous Cholecystitis
Extremely thickened GB wall (>4-5 mm) Sludge Dilated GB PC Fluid + Murphys sign
What is the most common pelvic tumor?
FIBROIDS (leiomyoma, myoma) **leading cause of hysterectomy
Labs asso with Renal Fungal Infections
Hematuria Bacteriuria pyuria
S/Sx of RCC
Hematuria Palpable mass Flank Pain Weight Loss Fever HTN
Labs asso with Acute Glomerulonephritis
Hematuria Proteinuria **Decreased GFR** Increased BUN Increased Creatinine
US Appearance: Lymphoma
Hodgkins = may be heterogeneous liver parenchyma or focal hypoechoic masses Non-Hodgkins = more echogenic May also appear anechoic and be mistaken for liver cysts Hepatomegaly and Splenomegaly may also occur
US Appearance: Hamartoma of the Spleen
Homogeneous solid lesion can also be heterogeneous and complex with calcifications May be hypervascular May be slightly larger in females d/t hormones
What other pathology can Renal Parapelvic Cyst be confused for?
Hydro
US Appearance: Pyonephrosis
Hydro with debris (low level echoes) Not completely anechoic like reg Hydro
US Appearance: Angiomyolipoma (AML)
Hyperechoic May cause Shadowing Usually within the CORTEX
What is Pyloric Stenosis
Hypertrophy of the pyloric sphincter ==> constriction/obstruction of gastric outlet Milk is unable to pass from stomach into the duodenum to be digested
Ovarian torsion can present all of the following sonographic findings except: Select one: a. Fluid in the cul de sac b. Large ovary c. Mass on the ovary d. Hypervascularity
Hypervascularity
US Appearance: Islet Cell Tumors of the Panc
Hypoechoic Difficult to viz d/t small size
What is the most common vascular tumor of infancy within the first year of life?
Infantile hemangioendothelioma BENIGN More comm in girls Can lead to Congestive Heart Failure
US Appearance: Mesoblastic Nephroma
Lateral abd mass with polyhydramnios Large, solid, homogeneous mass - if hydrops present = poor prognosis
What is the most common location of a pancreatic pseudocyst?
Lesser sac
What is the clinical association between Hepatic Lipoma and other pathologies?
Lipoma can be asso with Renal Angiomyolipomas and TUBEROUS SCLEROSIS
US Appearance of Cholangiocarcinoma
Liver mass or mass arising from within the ducts Intrahep biliary dilation GB may appear collapsed
A patient presents with increase in direct bilirubin, ALT and Alkaline Phosphate. The sonogram shows multiple bulls eye lesions throughout the liver. The most likely diagnosis is:
Liver mets
S/Sx of Bladder Neoplasm (TCC)
Low back pain leg swelling suprapubic pain dysuria urinary frequency with little urine blood or clots in the urine
Where does RCC metastasize to?
Lymph nodes lungs bone Contralat Kidney Liver Adrenal Glands Brain
What are common causes of Appendicitis?
Lymphoid follicle hyperplasia Fecolith Foreign bodies Seeds Parasites
Your patient is a 67 year old male who has recently been diagnosed with a malignancy. The pathology is presenting itself within the spleen below. What is the most probable diagnosis? #4 on Image Review Doc
Lymphoma
What is the most common Malignant disease of the Spleen?
Lymphoma (Hodgkins & Non-Hodgkins) primary = more comm in elderly patients
For Bladder Neoplasm is it more comm for them to be benign or malignant?
MALIGNANT
US Appearance: Portal HTN
MPV > 13 mm may see hepatofugal flow in MPV
Which of the following pancreatic neoplasms occurs more frequently in the body, is more prominent in 50+ year old range, and is associated with a suspicion for malignant conversion?
Macrocystic cystadenoma
US Appearance: MCDK
Multiple noncommunicating cysts If Bilat - Empty Bladder
S/Sx of Cirrhosis
N anorexia weight loss jaundice
What is the most common cancer diagnosed in the first year of life?
NEUROBLASTOMA most occur in the adrenal medulla Cause is unknown
Is Cirrhosis reversible?
NO Causes: - Excessive ETOH - Viral Hep B and C
What are the Risk Factors for MCDK?
Mom's meds - seizure meds - ACE Inhibitors - ARBs Illegal Drugs Genetic Factors
What types of patients are you more likely to see Emphysematous Pyelonephritis?
More comm in Women DM
S/Sx of Angiomyolipomas
Most Asymptomatic If Larger: - palpable abd mass - hematuria - flank pain May hemorrhage
US Appearance: Pancreatic Adenocarcinoma
Most Commonly seen in Panc Head Irreg Hypoechoic mass If Isoechoic may appear as abnormal contour of panc Panc Duct dilation Displacement of vessels **Courvoiser's GB Dilated Intr/Extrahepatic ducts Biliary Sludge Lymphadenopathy Liver Mets May have anechoic portions
All of the following are characteristics of an endometriosis except: Select one: a. Can be located any where in the body b. Sonographic findings are low level echoes, thin wall, small echogenic foci and septations c. Symptoms are pelvic pain, AUB and dysmenorrhea d. Most common in women between 40 and 50
Most common in women between 40 and 50
The following image is taken from a pelvic ultrasound of a 65 year old woman with right adnexal pain. Blood flow was found in some areas. What is the most likely diagnosis? #42 on Image Review Doc
Mucinous cystadenocarcinoma
ongenital anomalies of the uterus result from the improper fusion of which of the following structures? Select one: a. Paramesonephric ducts b. Mullerian Ducts c. Gartner's ducts d. Mesonephric ducts
Mullerian Ducts
US Appearance: Amebic Abscess of the Liver
Multiple Hypoechoic lesions Round/Oval Irreg walls Fluid/debris level Posterior enhancement
US Appearance: ADPKD
Multiple cysts bilat
What does Chronic Cholecystitis result in?
Multiple episodes of Acute lead to fibrosis across the GB wall usu pts will not have acute tenderness
Which of the following conditions is most associated with urinary stasis?
Nephrolithiasis
A 29 year old male comes into the emergency room with 12 hours of extreme right flank pain. His pain started 6 days ago and has progressively worsened. His labs showed microscopic hematuria. Based on the ultrasound image what is the most likely diagnosis? How do you know this is the most likely diagnosis? What other function on the ultrasound machine could you use to prove this diagnosis? #30 on Image Review Doc
Nephrolithiasis, shadwoing, color to prove twinkle artifact
US Appearance: Portal V Thrombus
New = hyperech Old = hypoech **possible collaterals**
US Appearance: Cirrhosis
Nodular liver borders Hypertrophy of CAUDATE Atrophy of RT LOBE Hepatomegaly Ascites Portal-Splenic varicosities
What is the definitive sign for Positive Appendicitis
Non-Compressable Appendix
What are the 2 types of Islet Cell Tumors of the Panc?
Nonfunctioning: - tendency to be malignant Functioning: - more often BENIGN - Most comm = Insulinomas (obesity and hypoglycemia) and Gastrinomas
US Appearance: Acute Renal Failure
Normal OR Enlarged Kidneys
Which of the following is true of serous cystadenocarcinoma? Select one: a. Occurs more frequently in women between the ages of 40 -50 b. Composed of germ layers, ectoderm, mesoderm, and endoderm c. Occurs in women who are peri menopausal and post menopausal d. Displays the sonographic feature called tip of the iceberg
Occurs more frequently in perimenopausal and postmenopausal
A malignant solid renal mass can be all of the following except: a. Adenocarcinoma of the kidney b. Oncocytoma c. Renal cell carcinoma d. Transitional cell carcinoma
Oncocytoma
A 55 year old white female presents to the ER with epigastric pain, a history of ETOH abuse and elevated amylase. What is the finding in the image below #18 on image Review Doc
Pancreatic pseudocyst
All you know about these two patients is that they have upper abdominal pain. What is the abnormality visualized? #20 on Image Review Doc
Pancreatic pseudocyst
Patient is a 72 year old male with history of gallstones without cholecystitis and non-alcoholic cirrhosis. Now complaining of abdominal pain that radiates to his mid-back. No mass or stones in the duct were found anywhere on his ultrasound. What is the most likely diagnosis causing these findings? #13 on Image Review Doc
Pancreatitis
Why can the Umb V Recanalize in a pt with PHTN?
The pressure created by PHTN ==> recanalization to alleviate this abnormal pressure
What is the relation between hormones and Hepatocellular Adenoma
They are fed by hormones, so women on oral contraceptives have an increased risk of developing Hep Adenoma - these may regress if stop taking Birth Ctrl Other Risk Factor = Type 1 Glycogen Storage Disease
What effect does Von Hippel-Lindau disease and Tuberous Sclerosis have on the kidneys?
They cause multiple cortical cysts and benign and malignant renal masses
US Appearance: Chronic Cholecystitis
Thickened GB Wall Cholelithiasis **WES Sign**
US Appearance ACUTE Cholecystitis
Thickened GB wall PC Fluid Sludge + Murphys sign Stones or not (ACALC) Enlarged GB
US Appearance: Gangrenous Cholecystitis
Thickened GB wall with edema Striations across GB wall PC fluid Cholelithiasis Echogenic non shadowing and non mobile material within GB
What is the most common Bladder cancer?
Transitional Cell Carcinoma Most comm in men 60-70 years
More than 90% of Malignant diseases that involve the bladder in the US are what type of cancer?
Transitional Cell Carcinoma may also be found in the kidney
What is usually the cause of a Hematoma of the liver
Trauma May also be the result of hemorrhagic neoplasm If r/t Pregnancy: - preeclampsia - hemolysis - elevated LFTs - Low Platelet Cound HELLP
What are some causes of Acute Tubular Necrosis?
Trauma Surgery HOTN D/T lack of blood supply to the kidneys Cause by the deposit of cellular debris within the renal collecting tubules ==> necrosis of Renal tubular epithelium
Which of the following disease processes might show bilateral angiomyolipomas and multiple small cysts? Select one: a. Recessive polycystic kidney disease b. Tuberous Sclerosis c. Von Hippel-Lindau Syndrome d. Acquired cystic disease
Tuberous Sclerosis
US Appearance: Wilm's Tumor
Typically unilat Large, spherical mass Solid Homogeneous Heterogeneous = most comm Areas of hemorrhage, necrosis or cysts Clalcs Well defined borders
What is the most common reason for pediatric hydronephrosis?
UPJ obstruction
What is the most common cause of Hydronephrosis in peds?
UPJ obstruction may also be caused by - UVJ obstruction - Posterior urethral valves and megaureter - urethral atresia - prune-belly synd - neoplasm
Labs asso with Renal Abscess
UTI Inc WBCs + Urine and Blood cultrues Heamturia Inc. BUN Inc. Creatinine Bateriuria Anemia Proteinuria Pyuria
US Appearance: Renal Cystic Malignancy
Uni/Multilocular May have solid nodules Irreg walls Calcs Highly vascular in septations and nodules Look at IVC, Lymph nodes, and contralat kidney for mets
Is MCDK usu unilat or bilat?
Unilat
US Appearance: Acute Pyelonephritis
Unilateral: - enlarged kidney - Dec. cortical echogenicity Prominent Renal sinus Prolonged Cases: - calyceal clubbing - cortical scarring May appear normal as well
What technique should you use to evaluate for Appendicitis
Use high freq transducer Use Graded compression
US Appearance GB Carcinoma
Usu seen @ Fundus Inhomogeneous Polypoid lesion >10mm (larger than norm polyp) Wall thickening Mass replacing GB Demonstrates Color Flow Signs of Mets; - Tumors in Liver - Ascites - Intraductal biliary dilation
US Appearance: Renal Abscess
Usu solitary disruption of corticomedullary junction Ill defined mass Thick walled hypoechoic Cystic mass Internal debris Gas w/ dirty shadow Septations
What is the postnatal presentation of Neuroblastoma?
mass asymptomatic critical illness or widely disseminated disease HTN Diarrhea Bone pain (mets) **Inc. Catecholamine Lvls**
S/Sx of Hydro
may be asymptomatic pain infection N/V dysuria chills uremia microscopic hematuria
US Appearance: Sludge
med-low level echoes Gravity dependent layered
what structure is an extension of the tunica albuginea and appears as an echogenic linear structure in the mid to posterior portion of the testicle?
mediastinum testis
what is the most likely dx from this image?
microlithiasis
Where does pain from pancreatitis radiate to?
mid back
Define Pyelectasis
mild hydro with dilated renal pelvis
When do Infantile Hemangioendotheliomas usually regress?
~ 12-18 months however complications can cause severe illness
What US finding is associated with Xanthogranulomatous Pyelonephritis?
Staghorn Calc
US Appearance Splenic Infarct
** Wedge shaped hypoechoic lesion **
Labs asso with Acute Tubular Necrosis
**Acute Dec. in GFR **Sudden Inc. in Creatinine and BUN
US Appearance: ARPKD
**Bilat Enlarged Kidneys **Loss of corticomedullary diff small/empty bladder Post-Natal: - enlarged kidneys that will dec. over time - Hepatomegaly - Inc. Liver echogenicity - Dilated intrahep ducts - Poorly viz Portal Venous syst
Labs asso with HCC
**Elevated Serum Alpha Fetoprotein (AFP) Abnormal LFTs
S/Sx of Emphysematous Pyelonephritis
**Extremely Sick fever flank pain **dehydration **electrolyte imbalance
S/Sx of Hepatitis
**Flu like Sx N/V fatigue
S/Sx of Acute Glomerulonephritis
**Foggy Urine** hx of recent fever soar throat joint pain periph edema N oliguria anemia azotemia HTN
What are the Risk Factors for Developing HCC?
**Hep B Hep c **Cirrhosis NASH Aflatoxin exposure
S/Sx of Chronic Pyelonephritis
**High Fever Malaise Progressive Renal Disfunction Anemia **Lethargy N/V Intense pain dysuria HTN
S/Sx of Renal Abscess
**Intense flank/abd pain palpable mass fever chills dysuria fatigue N/V weight loss **Recent UTI **Recent stone
What are the Risk Factors for developing Squamous Cell Carcinoma
**Persistent inflammation from long term catheters** Bladder Stones Infection Underdeveloped Countries: - infection from Schistosoma Haematobium
Clinical Presentation: Pyloric Stenosis
**Projectile Vomiting Jaundice **Olive shaped mass "Cervix Sign" on US
What are the Risk Factors for developing Renal Cell Carcinoma (RCC)?
**SMOKING** obesity HTN Chemical Exposure **Long Term Dialysis ** Von-Hippel disease More comm in men 60-70 years
Describe the characteristics of Acquired Cystic Kidney Disease
**Seen in Pts on long term Dialysis Results in Chronic Renal Failure Usu Asymptomatic
S/Sx of Acute Pyelonephritis
**Sudden onset back pain Fever Chills N dysuria **Freq urination
US Appearance: Biliary Atresia
**Triangle Cord Sign** - echogenic area sup to Portal V bifurcation Small/Absent GB in fasted state
US Appearance: Papillary Necrosis
**Usually Bilateral** **Clubbing of Calyces** **Echogenic Non-Shadowing Structure** Hydro Stones
What are examples of diffuse liver disease and what are the effects?
**diseases that affect the hepatocytes causing damage that decreases liver function** - Infections - Fatty Infiltration - Liver fibrosis
Labs asso with Papillary Necrosis
+ Urine culture proteinuria pyuria bacteriuria **Low Urine Specific Gravity**
What are the 2 types of Renal Abscesses?
1. Corticomedullary: - from ascending urinary tract infection d/t obstruction with sever parenchymal involvement 2. Cortical: - from the spread of bacteria from somewher else in the body via the vasc syst
What are the 2 most common locations for Kidney Stones?
1. Ureteropelvic Junction 2. Ureterovesical Junction
What is the standard of measurement for a varicocele ?
2mm
US Appearance: Acquired Cystic Kidney Disease
3 or more cysts in each kidney Dec. Renal size
What types of patients are you more likely to see Pyloric Stenosis
4-5x more likely in Males Higher occurrence in 1st born white males
What is the size of the normal Panc Duct?
<2mm
Which of the following describes adenomyomatosis of the gallbladder?
A proliferation of the mucosal layer, which extends into the muscle layer
S/Sx of Choledochal Cyst
Abd pain V Jaundice palpable mass may be present
Acute Cholecystitis VS Chronic Cholecystitis
ACUTE: - Cholelithiasis w/ obstruction - RUQ Pain - Fever - Inc WBCs Complications = Acalc, Emphysematous, Gangrenous, perforation CHRONIC: - Cholelithiasis - RUQ pain (not as severe) - Multiple episodes - Thickened GB Wall - ** WES Sign **
What is a common cause of Renal Artery Stenosis?
ATHEROSCLEROSIS RAS causes Renal Insufficiency and End Stage Renal Disease - HTN - Dec. Renal Function
What are some causes of Ureteropelvic Junction (UPJ) Obstruction
Abnorm development of muscle fibers of UPJ Fibrosis and narrowing of UPJ Compression of fetal vessels Arrest in normal develpment failure of recanalization of prox ureter
What is the most common Splenic congenital anomaly?
Accessory Spleen Usu singular Usu Found @ Hilum May become torsed and infarcted (rare)
US Appearance Liver Hematoma
Acute = Echogenic Later may appear cystic with septations
What are the most common causes of Hematuria?
Acute Infection Stones Tumor **In children = blunt or penetrating trauma** Gross Hematuria = visible in urine (asso with malignancy) Microscopic Hematuria = only seen in urinalysis
What is Acalculous Cholecystitis, and what types of patients usually develop this type of Cholecystitis
Acute Inflammation of the GB WITHOUT Stones (form of ACUTE Cholecystitis) seen in pts on TPN, post-op patients, trauma, and burn patients More Comm in males
What are the causes of Pancreatic Pseudocysts?
Acute Pancreatitis Chronic Pancreatitis Trauma
What is a common cause of Renal Transplant Failure?
Acute Tubular Necrosis
Acute Renal Failure VS Chronic Renal Failure
Acute: - sudden and severe Chronic: - slow and irreversible Renal Failure = Dec. Renal Function **Obstructive causes are treatable
What race are you more likely to see a Choledochal Cyst
Asians
What is an Amebic Abscess of the Liver and how does it get there?
Ameoba is ingested and spreads from the GI tract to the liver via Portal V Mortality rate is high if untreated More comm in Males not commonly seen in USA
S/sx of Hepatic Lipoma
Asymptomatic
S/Sx of Oncocytoma
Asymptomatic If large: - palpable mass - HTN - Hematuria - pain More Comm in Men
S/Sx of Panc Cystadenoma
Asymptomatic Epigastric pain weight loss palpable mass jaundice More comm in women
S/Sx of Hepatocellular Adenoma
Asymptomatic Palpable mass Pain with hemorrhage
S/Sx Amebic Abscess of the Liver
Asymptomatic RUQ Pain Hepatomegaly Fever Weight Loss DIARRHEA
S/sx of Adenomyomatosis
Asymptomatic or Similar to Gall Stones: - RUQ pain - N/V
US Appearance Liver Cysts
Anechoic Smooth walls Well defined round/oval posterior enhancement May be multiple or singular sizes vary Asymptomatic usually
US Appearance: Adenomyomatosis
Anechoic or Echogenic foci in GB wall Shadowing or Comet tail artifact post to foci May see thickened wall May be associated with stones
S/Sx of Adrenal Hemorrhage
Anemia Jaundice mass Swelling **Bluish discoloration of scrotum Acute Adrenal Crisis Shock
What is the most common atraumatic surgical abdominal disorder in children over 2 yrs
Appendicitis
What is the most common disease requiring emergency surgery in peds?
Appendicitis
Your patient is a 49 year old male. No previous medical history. Recent lab work shows an abnormality with his creatinine and BUN. He says he does have some vague right sided flank and back pain. Based on the images below what is the most likely diagnosis? #34 on Image Review Doc
Autosomal dominant polycystic kidney disease
What is Adenomyomatosis
BENIGN Hyperplasia of the GB mucosa that occurs in the muscular layer
What is Oncocytoma, and is it malignant or benign?
BENIGN Renal Neoplasm Difficult to distinguish from RCC
What is Adenoma of the GB?
BENIGN tumor within GB lumen may become malignant usually solitary If GB wall is thickened at the site of adenoma and if there are calcifications ==> ? malignancy
What is the most significant life-threatening hepatobiliary disorder in children?
BILIARY ATRESIA **Most common indication for liver transplant in peds pts**
US Appearance: TCC in Kidney and Bladder
BLADDER: - Bulky - Hypoechoic mass in bladder KIDNEY: - found in the sinus - Renal contour is norm BUT internal renal tissue is distorted
What are some predisposing conditions for Peds Hepatoblastoma?
Beckwith-Wiedemann Hemihypertrophy Familial polyposis coli or familial adenomatous polyposis Fetal Alcohol Synd Wilm's Tumor
What syndromes are associated with Wilm's Tumors
Beckwith-Wiedemann Isolated Hemihypertrophy WAGR synd Denys-Drash Synd
What is an Angiomyolipoma and what organ can they be found in?
Benign Neoplasm of the kidneys Consist of fat, muscle, and arterial vessels
Adenomyosis is: Select one: a. Benign penetration and growth of endometrial glands and stroma into the myometrium b. Endometrial stroma and glands located outside of the uterus c. Inflammation of the endometrium d. Malignant penetration and growth of endometrial glands and stroma into the myometrium
Benign penetration and growth of endometrial glands and stroma into the myometrium
What is the Prognosis for MCDK
Bilat: - poor prognosis Unilat with contralat anomaly: - poor Pts with unilat may experience HTN or Wilm's tumor
What are common causes of Acute Pancreatitis
Biliary disease Alcoholism
What is the usual cause of Acute Pyelonephritis?
Bladder infection that spreads to kidney
US Appearance: Mets in the Spleen
Bull's Eye Target appearance
What is the most common cause of Acute Cholecystitis?
Cystic duct obstruction from a stone More comm in females More severe in males
What is the most common BENIGN tumor of the liver?
Cavernous Hemangioma most comm in women
List common GB Diseases
Cholelithiasis (most comm) Porcelain GB Cholecystitis (Acute, Chronic, Emphysematous, and Gangrenous) Hyperplastic CholecystOsis (Adenomyomatosis, cholesterolosis and adenoma) GB Carcinoma Choledocholithiasis Cholangiocarcinoma
What is Cholesterolosis and what is another name for it?
Cholesterol deposits in GB wall AKA = Strawberry GB May be localized or diffuse associated with stones
Risk Factors for Pyogenic Abscess of the Liver
Cirrhosis Neoplasm Sickle Cell Anemia can also be seen following trauma and/or surgery
What is Cavernous Transformation?
Collaterals that form around the Portal V when Thrombosis is present **This is NOT Cavernous Hemangioma**
Renal Artery Stenosis is a common complication of what type of treatment?
Common Complication of Renal Transplant This is why we do a Renal Artery Study on all Transplant pts
elvic mass sonographic evaluation would include all of the following except: Select one: a. Comparison of contralateral ovary b. Evaluation for septations and their thickness c. Evaluation of overall internal echotexture d.Extensive search for mural nodules and blood flow within e. Evaluation for papillary projections
Comparison of contralateral ovary
US Appearance Hepatic Echinococcosis
Complex cystic lesion in the liver
What is Gangrenous Cholecystitis, and what can it lead to?
Complication of Acute Cholecystitis Extreme infection of GB May lead to Perforation and increased morbidity and mortality
What is Emphysematous Cholecystitis
Complication of Acute Cholecystitis Gas invasion of the GB wall and lumen May progress to Gangrenous or GB Rupture More Comm in Males Commonly seen in pts with DM and Peripheral Atherosclerotic Disease
What can sludge (Tumefactant sludge "ball") be confused with and how do you prove sludge vs other pathology
Confused with Stones or Polyps To differentiate between polyp and sludge ball = use Color Dopp Sludge = No Flow Polyp = Flow
Liver Cysts: Congenital VS Acquired
Congenital = comm seen in pts with ADPKD Acquired (not true cysts) = may result from trauma, parasitic or pyogenic abscess or necrotic neoplasm
What are other conditions that are related to UPJ obstruction
Contralat anomalies MCDK Renal duplication Agenesis
S/Sx of Intussusception
Crampy abd pain V Bloody Stools Lethargy fever diarrhea Abd Distention Irritability RUQ mass
What disease is asso with increased risk of Intussusception?
Cystic Fibrosis
US Appearance: Lymphangioma of the Spleen
Cystic Lesions May have septations and intralocular debris
What are some examples of Renal Cystic Malignancies?
Cystic Nephroma Cystic RCC
What is a Choledochal Cyst and what part of the biliary tree is most commonly affected?
Cystic dilation of the biliary tree CBD is most commonly affected
A 32 year old female comes for a pelvic ultrasound due to irregular periods and dull left adnexal pain for six months. Her LMP was 2.5 weeks ago. She has no history of surgery and 8 months ago she stopped taking birth control pills after 5 years of use. Based on this clinical and the following image what is the most likely diagnosis? #43 on Image Review Doc
Cystic teratoma
What is the Most Comm Cause of Chronic Renal Failure?
DM!!
Labs Asso with Hematoma of the Liver
Dec Hematocrit = bleed
Labs asso with Chronic Renal Failure
Dec. GFR Hyperkalemia (too much potassium) Inc. BUN Inc. Creatinine Anemia
What is Hyposplenia
Decreased function of the Spleen Cannot be Dx by US Spleen may appear smaller when asso with Sickle Cell, Celiac Disease, Autoimmune Disease, Hematologic Disorders or graft bone marrow transplants
S/Sx of Pancreatic Adenocarcinoma
Depend on location of mass weight loss N/V DM Intestinal malabsorption Palpable GB Jaundice **Most Comm = persistent aching pain in the mid-epigastrium or mid back
US Appearance: Acute Tubular Necrosis
Depends on Cause: - HOTN cause ==> normal appearance - Drugs, metal, and solvent exposure ==> enlarged echogenic kidneys - Severe cases ==> Bilat renal enlargement Enlarged Pyramids Inc. Cortical echogenicity with no medullary changes
Normal US Appearance of Endometrium
Depends on Stage in Menstrual Cycle and if pt is Peri/Post Menopausal Early Prolif = 4-8mm Late Prolif = 6-10mm Secretory = 7-14mm PostMeno (No HRT) = 1-4mm PostMeno (w/HRT) = up to 8mm
US Appearance: Adrenal Hemorrhage
Depends on age of bleed Upper pole of kidney
A 19 year old woman is referred for a pelvic ultrasound after her physician palpated a right adnexal mass. The sonographer could not identify a right ovary but noticed a discrete area with hyperechoic dots and lines, including a rounded echogenic area that produced shadowing. Bowel was ruled out due to the fact that the area did not peristalsis. What is the most likely diagnosis?
Dermoid
What is Polysplenia
Development of multi small splenic nodules Asso with Lt Sided lung and cardiac defects US Appearance = small spleens in LUQ
What type of treatment is required for Chronic Renal Failure?
Dialysis Transplant
US Appearance: Renal Fungal Infection
Diffuse through Renal Parenchyma Medium lvl echogen Nonshadowing Mobile Fungal Ball: - echogenic - nonshadowing - soft tiss mass
US Appearance: Lymphoma of the Spleen
Diffuse, nodular spleen Hypoechoic lesions Diffuse inhomogeneity
US Appearance: Emphysematous Pyelonephritis
Dirty Shadows Enlarged kidney Hypoechoic Inflamed appearance
All of the following are sonographic features of adenomyosis except: Select one: a.Disruption of the borders of the endometrium b. Diffusely large uterus c. Discrete lesions seen in the uterus d. Myometrial cysts
Discrete lesions seen in the uterus
A simple cyst may exhibit all of the following except: Select one: a. Posterior enhancement b. Anechoic interior c. Distal acoustic shadow d. Thin walls
Distal acoustic shadow
What type of treatment is necessary for Chronic Glomerulonephritis?
Dyalisis Renal transplant Chronic Glom is irreversible and progressive glomerular fibrosis ==> Dec. GFR and Retention of uremic toxins ==> Chronic Renal Failure, End Stage Renal Disease, and Death
Labs asso with Emphysematous Pyelonephritis
E. coli **hyperglycemia **acidosis
US Appearance of Gall Stones
Echogenic foci Mobile With Posterior Shadowing "WES sign"
US Appearance: Nephrolithiasis
Echogenic foci Posterior Shadowing "Twinkle Sign" Hydronephrosis Dilated ureter **Absent/Weak ureteral Jet**
US Appearance Choledocholithiasis
Echogenic foci with shadowing in the bile duct
What can happen if Intussusception is left untreated?
Edema gangrene perforation peritonitis vascular compromise
Labs asso with Infantile Hemangioendothelioma
Elevated AFP
What is the Lab associated with HCC?
Elevated AFP!!
Labs asso with Hepatitis
Elevated AST and ALT
Labs associated with Cholangiocarcinoma
Elevated Bilirubin Abnormal LFTs + CEA (carcinoembryonic antigen)
Labs asso with Pyogenic Abscess of the Liver
Elevated LFTs Elevated WBCs
What are the causes of Splenic Infarct
Embolic event Hematologic Disorder Vasc or Panc disease Congenital abnormalities or neoplasm
How is Emphysematous Pyelonephritis treated
Emergency nephrectomy
Which of the following is least likely to be true of dermoid tumors? Select one: a. Most common benign germ cell tumor in females b. May cast an acoustic shadow c. Also called benign cystic teratoma d. Encountered in more women over 40
Encountered in more women over 40
This 29 year old patient presents with a history of chronic pelvic pain especially during menses, back pain and dyspareunia. What is the most likely diagnosis? #44 on Image Review Doc
Endometrioma
US Appearance: Hydronephrosis
Enlarged Kidney may see stone obstructing Pelvocalyceal fullness Chronic Hydro-atrophy of renal parenchyma "Bear-Claw Effect" Cortical Thinning Dec. Renal Blood Flow Inc. Resistive Index Absent ureteral Jet
Labs Asso with RCC
Erythropoietin blood level RBCs WBCs Bacteria Creatinine BUN
S/sx Cholangitis
Fever Abd Pain Jaundice Abnormal Alkaline Phos and Bilirubin leveles
S/Sx of Pyonephrosis
Fever Chills UTI Obstruction Hydro Flank pain
S/Sx of Papillary Necrosis
Fever Flank pain Abd pain HTN dysuria hematuria
S/Sx of Pyogenic Abscess of the Liver
Fever Jaundice RUQ Pain N/V Anorexia Fatigue Can be lethal if abscess ruptures so immediate diagnosis and treatment is important
What should not be included in an Endometrial measurment
Fluid in the endo Hypoechoic rim
What is the second most common BENIGN tumor of the liver?
Focal Nodular Hyperplasia FNH most comm in women of child bearing age b/c FNH is fed by hormones typically asymptomatic
A 31 year old woman presents to the ultrasound department with mild right adnexal pain x 2 months. Periods are regular with LMP being 5 days ago. She has had 3 normal pregnancies with one c section. Her mother has a history of ovarian cancer at the age of 76. The finding in the following image has no internal blood flow and measures 3.2 cm. What is the most likely diagnosis of the choices given below? #45 on Image Review Doc
Follicular cyst
What are Fungal bezoars
Fungal balls (similar to sludge ball in GB) Mobile and can ==> Hydro Differentials: - blood clots - non-shadowing stones - TCC - slough papillae
US Appearance: Choledochal Cyst
Fusiform Dilation of the CBD Intrahepatic duct dilation Multiple cyst in the area of the Porta Hepatis Easily mistaken for normal GB
What is Emphysematous Pyelonephritis and what are some causes?
Gas formation within Renal Parenchyma Causes: - Vascular Disease - Elevated Glucose lvls - Necrotizing Infection
S/sx of Gangrenous Cholecystitis
Generalized pain since it is a systemic infection instead of + Murphys sign
80% of pts with Cirrhosis will develop what type of cancer?
HCC
What is the most common benign tumor of the Spleen
HEMANGIOMA!! may be asso with Klippel-Trenaunay-Weber Syndrome usu isolated and insignificant Larger lesions are at risk for rupture/hemorrhage
What is the most common PRIMARY Liver tumor in young children?
HEPATOBLASTOMA Usu presents @ 1-2 years More Comm in males
What is the most common PRIMARY MALIGNANT tumor of the liver
HEPATOCELLULAR CARCINOMA (HCC) more comm in males often Dx in late stages
S/Sx of Acute Tubular Necrosis
HTN oliguria edema HOTN **Intermittent Flank pain** N/V hematuria Infection Sepsis **Dec. Consciousness** Muscle necrosis
What are the most common forms of Hepatitis?
Hep A **Hep B - health care workers at a higher risk of getting this type **Hep C
Why are Hepatocellular Adenomas more worrisome than FNH?
Hep Adenomas have an increased risk of hemorrhage and possibility to transform into HCC
Describe the characterization of Autosomal Dominant Polycystic Kidney Disease (ADPKD)
Hereditary Leads to Ren Failure **Presents in 3-4th decade of life May see cysts in liver, panc, and spleen Causes Dec. Renal Function and HTN
US Appearance: Angiosarcoma of the Spleen
Heterogeneous, complex mass Inhomogeneity Multi hypoechoic masses Complex lesions
What are Risk Factors for developing Panc Adenocarcinoma?
High fat diet smoking **Chronic Pancreatitis Primary Sclerosing Cholangitis hereditary pancreatitis fam hx DM
What is a Hamartoma?
Splenoma/Splenoadenoma BENIGN vascular proliferation tumor usu asymptomatic
Why is early detection important for Pyonephrosis
If delayed - abscess formation - **Septic Shock** - Kidney damage - Loss of Renal Function - death
Labs asso with Amebic Abscess of the Liver
Inc WBCs
Labs Asso with Kidney Stones
Inc WBCs Bacteria in urine and/or bloodstream
Labs asso with Acute Pancreatitis
Inc WBCs Inc Amylase (first) Inc Lipase (second)
Labs asso with Acute Pyelonephritis
Inc. WBCs Pyuria Bacteriuria
Labs asso with Pyonephrosisi
Inc. WBCs pyuria bateriuria
Labs associated with Gall Stones
Increased Lipase Increased Amylase Increased LFTs Increased AST and ALT
Labs associated with Cholecystitis
Increased Panc enzymes (ACUTE, CHRONIC, and ACALC) Abnormal LFTs in all forms
US Appearance: Fatty Liver Disease
Increased echogenicity of the liver Poorly viz vascular structures **Focal Fatty Sparing (usu found ant to GB, near portal v, and Lt lobe close to diaphragm)**
What are some causes of Chronic Renal Failure?
Infection DM HTN Congenital/Hereditary Disorders Toxic Nephropathy Obstructive Nephropathy
What is Hepatic Echinococcosis
Infection caused by a tapeworm usu seen in Sheep herding areas
What is Cholangitis and what are the different types?
Inflammation of the Bile ducts Types: - Oriental Cholangitis - Sclerosing Cholangitis = asso with ulcerative colitis - AIDS Cholangitis - Acute Obstructive Suppurative Cholangitis
What is Cholecystitis and what are the different types?
Inflammation of the GB Acute = Sudden onset Acalculous = no stones Emphysematous = gas forming bacteria in GB wall Gangrenous = extreme infctn Chronic = recurrent episodes of Cholecystitis
What is Pyelonephritis and what is the cause?
Inflammation of the renal collecting syst and parenchyma Usu caused by retrograde migration of bacteria up the ureter and into the kidney Acute and Chronic
Describe the Charateristics of Autosomal Recessive Polycystic Kidney Disease (ARPKD)
Inherited disorder Cystic dilation of the renal collecting ducts in conjunction with hepatic abnormalities that may include cysts, fibrosis, and PHTN Most cases are Dx in prenatal period
What types of fibroids are most common?
Intramural
What is the most common form of Biliary atresia?
Involves the extrahepatic portion of biliary tree (including the GB)
US Appearance: Bladder Neoplasm
Irreg shape Hypervascular Thickened Bladder Walls Echogenicity is variable
Isolated Angiomyolipomas VS Angiomyolipomas associated with Tuberous Sclerosis
Isolated AML: - 80% - more comm in women 40-60 years - usually in the Rt Kidney AML asso with Tuberous Sclerosis: - typically larger - bilaterall - multiple
S/Sx of Biliary Atresia
Jaundice Acholic stools (pale, clay colored) Dark urine Enlarged girth d/t hepatomegaly
S/Sx of Mets to the liver
Jaundice pain weight loss anorexia hepatomegaly
What is the treatment for Biliary Atresia?
Kasai procedure - delays/decreases the need for liver transplant If untreated, prognosis is poor
What is Nephrolitiasis and what are the causes?
Kidney Stones!! Causes: - fam hx - dry/hot climate - high concentration of stone constituents in the blood (Ca/K) - changes in urine pH - presence of bacteria in urine More Comm in MEN
All of the following would be important when scanning a possible case of pyosalpinx except: Select one: a. Knowing if the patient has a positive beta HcG b. Differentiating tube from surrounding structure c. Using color Doppler to show increased flow in the pelvic structures due to infection d. Proving the difference between bowel and tube through peristalsis
Knowing if the patient has a positive beta HcG
S/Sx Splenic Infarct
LUQ pain
S/Sx of Lymphangioma of the Spleen
LUQ pain N ABDOMINAL DISTENTION
S/Sx Angiosarcoma of the Spleen
LUQ pain malaise fever weight loss
S/Sx of Accessory Spleen
LUQ pain if torsed
US Appearance: Squamous Cell Carcinoma in the Kidney
Large, bulky mass in the renal pelvis
US Appearance: Acute Glomerulonephritis
May appear norm Irreg cortical echo pattern Inc. cortical echogenicity Renal Pyramids well viz Bilat Renal Enlargement
US Appearance: ACUTE Pancreatitis
May appear normal in early stages Enlarged panc duct Inc Panc size **Dec Echogenicity** Irregular borders
Why should you investigate the contralat kidney if you find MCDK?
May have anomaly in contralat kidney - most likely UPJ obstruction
What is the cause of Papillary Necrosis?
Medullary vasculature being compressed with inflammation Papillary Necrosis causes Hydro
What types of patients are you more likely to see Acute Glomerulonephritis?
Men Children
What is the most common Renal Tumor identified in the neonatal period>
Mesoblastic Nephroma It is also the most frequent BENIGN renal tumor in childhood
What is the most common MALIGNANT tumor of the Liver
Metastasis Liver is the 2nd most common site of mets Common Primary sites: - GB - colon - stomach - lung - breast - pancreas
How do you treat an Amebic Abscess of the Liver?
Metronidazole Can be drained and contents tested
What are the 2 types of Cystadenoma of the Panc
Microcystic Serous - <2cm - Always benign Macrocystic Mucinous - >2cm - Suspect malignancy
S/Sx and Labs asso with Renal Hematoma
Mild-Intense pain Dec. Hematocrit
Define Pevivaliectasis
Moderate hydro with dilation of renal pelvis and calyces
If there is Mets to the Spleen, what are the common locations that it spreads from?
Ovarian Prostate Lung Breast
S/Sx of TCC
PAINLESS Hematuria Pain Hydro if in the collecting system More common in men
All of the following are structural reasons for AUB except: Select one: a. Polycystic ovarian disease b. Fibroids c. Retained products of conception d. Endometrial hyperplasia
PCOS
What is Hyperplastic CholecystOsis
POLYPS increased risk in females Characterized by hyperconcentration, Hyperexcitability, and Hyperexcretion
What is Angioscarcoma of the Spleen
PRIMARY and very aggressive usu arises in Spleen or Liver More comm in older pts Risk of Splenic Rupture Mets to Bone, bone Marrow, lymphatic syst, liver, and/or lungs
S/Sx of GB perforation
Pain Inc WBCs Fever Mortality rate is significant
S/Sx of Kidney Stones
Pain (pain level depends on loc of obstruction) N/V fever chills painful urination
S/Sx Cholangiocarcinoma
Painless Jaundice Pruritis Abdomen pain anorexia malaise weight loss
S/Sx of HCC
Palpable mass hepatomegaly fever cirrhosis N/V Weight loss and appetite disorder
Clinical presentation of Wilm's Tumor
Palpaple abd mass Pain Gross hematuria Compression of surrounding tissues Vasc Invasion (Ren V/IVC) Ascites CHF Hepatomegaly Varicosities
S/Sx of Appendicitis
Periumbilical pain N/V RLQ pain Fever McBurney's sign **Rebound Tenderness** Elevated WBCs
What type of infection commonly causes Acute Glomerulonephritis
Pharyngitis not from kidney infection
The following image was taken from a 32 year old with 14 months of irregular bleeding. The patient is not on any type of hormonal birth control birth and has no other symptoms. Based on the image and clinical scenario what is the most likely diagnosis? #40 on Image Review Doc
Polyp
US Appearance: Cholesterolosis "Strawberry GB"
Polyps in wall non shadowing non mobile comet tail
What is the prognosis for Peds Hepatoblastoma?
Poor d/t late dx
If a pt is diagnosed with cirrhosis, what other pathology are these patients at risk of developing?
Portal HTN HCC cirrhosis eventually ==> liver failure
If a pt has PHTN what is likely to occur because of blood pooling?
Portal Vein Thrombus If pt has thrombus it may ==> Formation of collaterals
What types of patients are you more likely to see Pediatric Hepatoblastoma?
Premature infants Low birth weight babies Males 1-2 years old
What are some causes of Adrenal Hemorrhage in healthy infants?
Preterm Delivery Prolonged labor Breech delivery Large birth weight Infection Trauma from birth anoxia
What is Biliary Atresia?
Progressive disease that is the result of narrowing of the bile ducts Intra or Extrahepatic May involve GB **the cause is unknown**
S/Sx of Infantile Hemangioendothelioma
Pt will present with hepatomegaly (may also have CHF and cutaneous hemangioma)
What types of patients are you more likely to see Renal Fungal Infection?
Pts w/ DM Pts w/ AIDS
What type of patients are you more likely to see Chronic Pyelonephritis?
Pts with Urinary Tract Obstruction, Stones, Dysplasia, or Vesicoureteral Reflux Recurrent or Persistent inflammation If left untreated ==> renal failure and need dialysis or transplant
What problems can occur in a fetus with ARPKD?
Pulmonary Hyperplasia d/t oligohydramnios
What is a Pyogenic Abscess
Pus/Bacteria filled abscess Usu caused by biliary tract disease may be asso with the spread of infection thru the Hep Art or Portal V
What is Pyonephrosis and what is the cause?
Pus/Infected urine within the collecting syst Usu occurs from long standing ureteral obstruction
A 26 year old woman presents to her family physician with a one month history of intermittent pelvic pain, intermittent fevers, and an unusual vaginal discharge. She has no pregnancies and no pelvic surgeries. She has an IUD and her periods have been regular but she is unsure of her last period. Based on this information and the following image what is the most likely diagnosis? #46 on Image Review Doc
Pyosalpinx
Labs asso with Chronic Pyelonephritis
Pyuria Proteinuria Bacteriuria Inc. Creatinine Inc. BUN
What is Lymphangioma and what type of patients is it most commonly seen?
RARE Most common in CHILDREN May result in bleeding, coagulopathy, hypersplenism, or PHTN
What is Cholangiocarcinoma, and what is the most common location?
RARE MALIGNANT can occur anywhere in the bili tract BUT most comm is the perihilar region (Klatskin's tumor)
What is GB Carcinoma
RARE but most comm cancer of the biliary tract Most comm in females and elderly pts Dx is usu late = poor prognosis
What side are you most likely to see Adrenal Hemorrhage?
RT Bilat hemorrhage is more comm in Males
Failure to treat appendicitis within 36 hrs leads to an increased risk of what complication?
RUPTURE rupture can ==> Sepsis
S/Sx of Hematoma of the Liver
RUQ pain HOTN Hepatomegaly
S/Sx of Choledocholithiasis
RUQ pain Jaundice Inc Bilirubin
S/Sx of Gall Stones
RUQ pain especially after meals Epigastric pain N/V Pain radiating to the shoulder -- May be asymptomatic as well
Describe Hepatic Cyst Adenoma
Rare Cystic structure within larger lesions Usu large enough to palpate
Describe the characteristics of Medullary Cystic Disease
Rare Inherited Tubular atrophy ==> cyst development
What is Asplenia
Rare congenital anomaly where spleen is absent asso with Visceral Heterotaxy, Situs Ambiguus complexes or Cardiopulm abnormalities
What are the causes of a Renal Hematoma?
Renal Bx Trauma RCC AML Renal Infarction Arteriovenous malformation hemorrhagic cyst abscess lithotripsy idiopathic
What anomaly is commonly asso with UVJ Obstruction?
Renal Duplication anomaly
What are problems that can occur in an infant with ARPKD?
Renal Failure Hepatic Dysfunction Large Bilat Flank masses
What vessels can RCC invade into?
Renal Vein/IVC
What could happen in an infant with bilat MCDK or unilat MCDK with contralat anomaly in utero?
Respiratory distress d/t lack of Amniotic fluid
What are complications of untreated appendicitis
Rupture Perforation
S/Sx and Labs asso with Acute Renal Failure?
S/Sx: - Hypovolemia - HTN - Edema - oliguria - hematuria Labs: - Inc. WBCs - Inc. Creatinine - Inc. BUN
S/Sx and Labs asso with Renal Failure
S/Sx: - flank pain - N/V - anemia - headaches - polyuria - oliguria - anuria Labs: - pyuria - hematuria - WBCs in urine - bacteria in urine - **Elevated BUN** - **Elevated Creatinine**
S/Sx and Labs asso with Peds Hepatoblastoma
S/Sx: - palpable mass - fever - pain - anorexia - weight loss Labs: - Elevated AFP
S/Sx of Splenic Hematoma
Severe LUQ pain dec Hematocrit Syncope HOTN Splenosis may occur (piece of spleen detaches and attaches to new area) US Appearance varies depending on age
US Appearance: Pyelonephritis
Should not see any renal pelvic or ureteral dilation - if Hydro seen, consider pyonephrosis Isolated increases in medullary echogenicity Renal enlargement
Define Severe Hydro
Significant pelvicaliectasis and thinning renal parenchyma **Bear Claw**
US Appearance: Renal Artery Stenosis
Significantly smaller kidney on affected side Abnormal Wave forms: - High Systolic peak velocities - little to no Diastolic component @ stenosis - ** Tardus Parvus distal to stenosis** Typical loc of stenosis = Junction of RA and AO
What is a Renal Parapelvic cyst and where is it found?
Simple cyst loc in the Renal sinus Does not communicate with renal collecting syst
US Appearance: Panc Cystadenoma
Single or Lobulated anechoic mass with enhancement Internal Septations and echoes Thick walls Papillary projections Calcs Overall solid appearance
US Appearance: Hepatitis
Slightly enlarged liver Splenomegaly Thickened GB walls Thickened Portal V walls **hard to differentiate between fatty liver and hepatitis** need liver bx to determine between Hepatitis and Fatty Liver
US Appearance: CHRONIC Glomerulonephritis
Small Smooth Echogenic Kidneys Beginning Stages: - Inc. Cortical echogenicity - but not medullary echotexture Later: - increase echogenicity of both cortex and medulla
US Appearance: Chronic Pyelonephritis
Small Shrunken, misshaped kidney Stones Unilat/Bilat **Dilated Blunt Calyx Cortical scarring/atrophy Inc. Echogenicity of kidney **Islands of norm tissue Irreg Renal outline **Cortical Thinning
How is Acute Pyelonephritis characterized?
Small abscesses within the renal Medulla More Comm in women
Which of the following properly describes the typical appearance of islet cell tumors?
Small and hypoechoic
US Appearance: RCC
Small lesions can be confused with angiomyolipoma May contain calcs Echogenicity is variable **Use Color Dopp to eval Renal Vein and IVC for invasion
US Appearance: Medullary Cystic Disease
Small-Norm sized kidneys Cysts are loc in the medulla
US Appearance: CHRONIC Pancreatitis
Smaller than norm **Hyperechoic** Calcifications Stones Stones in Panc duct Portal-Splenic thrombosis
US Appearance: Peds Hepatoblastoma
Solid masses Isoech to liver Spoke-wheel appearance May have Calcs Intralesional necrosis May have tumor thrombi in the portal V and Hep V
What is Splenomegaly and what are the causes?
Spleen > 12 cm Causes: - PHTN - infection - hematologic disorders - immunologic disorders - trauma - neoplasm - vascular anomalies - STORAGE DISEASE
What are some examples of Collateral pathways that form d/t Portal V thrombus?
Splenic V into the Lt Renal V Recanalized Umb V (seen around ligament of teres) Lt gastric V to the esophagus (high risk of hemorrhage)
Risk Factors for GB Carcinoma
Stones Chronic Cholecystitis PORCELAIN GB Exposure to carcinogens some blood groups
Risk Factors for GB Perforation
Stones Infection DM Trauma Malignancy Drugs Angitis Atherosclerosis Usually occurs in the fundus of the GB
What are some causes of Hydronephrosis?
Stones Tumor infection Previous obstruction overdistended bladder anatomic/congenital abnormalities pregnancy
What is Choledocholithiasis?
Stones within the bile ducts that have migrated from the GB into the CBD **Always investigate the CBD thoroughly when stones are seen in the GB**
What is the sonographic sign for Polycystic Ovarian Syndrome? Select one: a. Small atrophic ovaries b. Dilated tube with echogenic debris c. Tip of the iceberg d. String of pearls
String of pearls
What types of fibroids are most common to cause Abnormal Uterine bleeding?
Submucosal and Large Intramural
S/Sx of ACUTE Cholecystitis
Sudden RUQ pain + Murphys sign Fever Increased WBCs
How is Portal V Thrombosis Treated?
TIPS Procedure - catheter placed via IJ into the Rt Atrium then into a Hep V into the Portal V
Where are most Panc Pseudocysts found?
Tail of the Panc or Lesser Sac of Omentum
US Appearance: Mets to the liver
Variable Most likely multiple Target or Bull's Eye appearance
US Appearance: Neuroblastoma
Variable Small = homogeneous and hyperech Large = heterogeneous and complex May see Calcs
US Appearance: Hepatocellular Carcinoma
Variable solitary or multiple Small lesions = hypo Large lesions = hyper/heterogeneous Possible Hypoechoic halo may be diffuse throughout liver **May invade the Portal Vs and Hepatic Vs
US Appearance: Hemorrhagic Renal Cyst
Variable based on age of hemorrhage Possible posterior enhancement Use Color Dopp to differentiate from mass if clot is present
US Appearance: Renal Hemangioma
Variable echogenicity Usually seen @ Pelvocalyceal Junction or Inner Medulla
US Appearance: Hepatocellular Adenoma
Varied Hypo-Hyperechoic (if contains fat) Anechoic-hyperechoic (if hemorrhage) Peripheral Vascularity
US Appearance: Hepatic Lipoma
Very echogenic (similar to hemangioma) BUT will have posterior shadowing/prop speed artifact (unlike hemangioma)
US Appearance: GB Perforation
Viz of "hole sign" Cholelithiasis GB Wall thickening Intraluminal debris Intraluminal ascites PC abscess Gall stones floating in ascites around liver
What is the most common Renal tumor in Children?
WILM'S TUMOR More than 80% are Dx before 5years
What is Ectopic Spleen and Why does it occur
Wandering Spleen = spleen is not in normal location Occurs d/t laxity of the ligaments that hold the spleen May lead to torsion
S/Sx GB Carcinoma
Weight Loss anorexia pain jaundice N/V hepatomegaly
US Appearance: Pancreatic Pseudocyst
Well Defined Anechoic Posterior Enhancement May appear complex with inflammation, hemorrhage, and necrosis
US Appearance: Infantile Hemangioendothelioma
Well circumscribed Hypo/Hyperechoic Vasc Flow Calcs may be present
US Appearance: Oncocytoma of the Kidney
Well defined Homogeneous may see central radiating vessels on Color Dopp Spoke-wheel pattern seen on CT/MRI but not usu viz on US
The 5 F's of Cholelithiasis
forty fat fertile female flatulent
What types of patients will you most likely see a Renal Hemangioma?
Young Adults
Labs asso with Mets to the liver
abnormal LFTs
What is Acute Renal Injury/Failure and what are the causes
abrupt dec. in renal function causing retention of nitrogenous waste Causes: - Acute Glomerolonephritis - Ren V Thrombosis - Acute Tubular Necrosis - Obstruction
US Appearance: Hepatic cysts
anechoic smooth borders posterior enhancement
A 25 year old is referred for a pelvic ultrasound due to multiple miscarriages. The ultrasound shows a subtle fundal indentation on the uterus with a slightly concave uterine cavity. These findings would be consistent with what uterine abnormality? Select one: a.Septate uterus b.Bicornuate uterus c. Uterine Didelphys d. Arcuate uterus
arcuate uterus
Labs asso with Pyelonephritis
bacteriuria Inc. WBCs Pyuria
between what two layers of the scrotal sac can a hydrocele form?
between the parietal and visceral layers of the tunica vaginalis.
Which uterine abnormality consists of a duplicated uterus with or without duplication of the cervix? Select one: a. Bicornuate uterus b. Arcuate uterus c. Uterus didelphys d. Septate uterus
bicornuate uterus
Causes of GB Sludge
bile stasis, long periods of fasting, hyperalimentation therapy, GB obstruction
US Appearance: Cholangitis
biliary duct dilation Biliary duct strictures Thickening of duct walls
What is Porcelain GB
calcium incrustation of the GB wall Associated with Gall stones Increased risk of GB cancer Most Comm in Elderly females
S/Sx Porcelain GB
commonly asymptomatic May present with Chronic cholecystitis sx
all of these are sono findings of epididymitis except: enlarged decreased blood flow heterogeneous hydrocele
decreased blood flow ( it will be hyperemic)
name three sono findings of orchitis:
enlarged, increased blood flow, hypoechoic/heterogeneous,
If an appendix is visualized with ultrasound it is considered enlarged and abnormal. True or False?
false
Risk Factors for Gall Stones
family hx sedentary lifestyle no ETOH use Inflamm Bowel Disease Heart disease Diet induced weight loss Pregnancy TPN DM White/Hispanic
S/Sx of Pyelonephritis
fever chills N/V dysuria
S/Sx of ADPKD
flank pain hematuria
A 25 year old woman has a pelvic ultrasound for LLQ pain and has a negative pregnancy test. The ultrasound shows a 2.0 cm essentially circular cystic area adjacent to the ovary? Which of the following statements is the most accurate with concern to the findings? Select one: a. Most likely a corpus luteum b. Most likely a paraovarian cyst c. Most likely an ectopic pregnancy beside the ovary d. Most likely a teratoma and will need follow up
most likely paraovarian cyst
Which ovarian mass is more likely to have low level echoes internally? Select one: a. Corpus luteum b. Mucinous cystadenoma c. Benign cystic teratoma d. Serous cystadenoma
mucinous cystadenoma
What is the supposed cause of Multicystic Dysplastic Kidney (MCDK) disease
obstruction in utero or cessation of embryologic development into the metanephros
What are some causes of Renal Failure?
obstruction of urine flow decreased renal blood flow renal parenchymal disease
What is the most likely dx from the image below in a patient with scrotal pain and previous dx of epididymitis?
orchitis
A 26 year female patient has extreme RLQ pain. On ultrasound a large ovary with almost no blood flow is seen with fluid in the cul de sac. The most likely diagnosis is: Select one: a. Dermoid b. Ovarian torsion c. Tuboovarian abscess d. Endometroid tumor
ovarian torsion
S/Sx Hydronephrosis Peds
palpable mass oliguria anuria
An adnexal mass is palpated in a 34 year old female with symptoms of pelvic pressure. A pelvic ultrasound shows a 4 cm solid adnexal mass with a normal appearing ovary adjacent to it. What is the most likely diagnosis? Select one: a. Intramural fibroid b. Submucosal fibroid c. Ovarian Cancer d. Pedunculated fibroid
pedunculated fibroid
Abnormal accumulation of intraperitoneal fluid that becomes trapped in adhesions in a patient with a history of previous surgery is most likely to cause what to form? Select one: a. Dermoid cyst b. Follicular cyst c. Ovarian torsion d. Peritoneal inclusion cyst
peritoneal inclusion cyst
What is the cause of Ureterovesical Junction (UVJ) Obstruction?
results from abnorm insertion of the ureter into the bladder wall
What can Acute Glomerulonephritis lead to
results in inability to properly filter blood to make urine leads to scarring, poor kidney function, and ultimately Renal Failure
what is the finding in the image besides the small hydrocele? what previous medical hist can cause this?
scrotal pearl hist of torsion.
your patient is a 29 yo male with intermittent scrotal swelling. Now with right sided pain during times of swelling. No known injury to scrotum. From the image, what is the most likely dx?
seminoma
Which uterine abnormality will present with two separate endometriums and often has no effect on the contour of the uterus? Select one: a. Septate uterus b. Bicornuate uterus c. Uterus didelphys d. Arcuate uterus
septate uterus
What is a Staghorn Calculus
stone in the renal pelvis that extends into the infundibulum and calyces
S/Sx of Acute Pancreatitis
sudden onset epigastric pain N/V Fever
what type of cyst is typically seen in the head of the epididymis?
the book/powerpoint says spermatocele
Which of the following is not a true characteristic of serous cystadenoma? Select one: a. Usually are large with thin walls b. Thick septations c.Most common benign ovarian neoplasm d. Interior of mass is mostly anechoic
thick septations
your pt is a 12 yo with pain and swelling in the right testicle for three hours. based on the image, what is the most likely dx? describe two findings to support this dx:
torsion, no blood flow and a hydrocele on right.
What is the most common loc to find TCC?
trigone of the bladder along lateral/posterior wall of bladder
S/Sx Hepatic Cysts
usu asymptomatic may cause pain if rupture or hemorrhage
US Appearance GB Adenoma
usu homogeneous (can be hetero) usu solitary Blood flow on Color Dopp
US Appearance: FNH
usu solitary isoechoic to liver Stellate scar (will show flow on Color Dopp) **look out for change in liver contour or disruption of vessels**
S/Sx of Cavernous Hemangioma
usually asymptomatic may cause pain if rupture
what patient technique is necessary to formally dx a varicocele?
valsalva
US Appearance: Cavernous Hemangioma
well defined HYPERECHOIC possible posterior enhancement may develop calcs over time
What is the most common gallbladder disease?
Cholelithiasis
What is the standard of measurement for the portal vein to assess whether it is large? In what disease process and/or evaluation is it important to accurately measure velocities in the portal system? #11 on Image Review Doc
13 mm portal vein, cirrhosis
What is the measurement criteria for the length of the pylorus? Select one: a.14 - 17 mm b. 14 - 17 cm c. 3 - 4 cm d. 3 - 4 mm
14-17mm
The normal size of the pancreatic duct is less than
2 mm
Which of the following would be normal wall measurement for the appendix? Select one: a. 2 mm b. 5 mm c. 3 mm d.4 mm
2mm
What is the upper limits of normal measurement for the diameter of the appendix? Select one: a. 4 mm b. 5 mm c. 6 mm d. 7 mm
6mm
The following image is from a RUQ performed on a 24 year old female who has a recent surgery and has been in the Surgical Intensive Care Unit for 7 days. Not seen in the images below, but pericholecystic fluid was found What is the most likely differential diagnosis and why? #7 on Image Review Doc
Acalculus cholecystitis
Identify the lab value which is specific for a malignant hepatoma of the liver.
Alpha fetoprotein
A 47 year old female comes to the ultrasound department for a RUQ. She has had recent acid reflux and epigastric pain. She says she has been under a lot of stress lately. Her labs are normal and the sonographer finds a normal gallbladder and liver. What is the finding on the right kidney? #32 on Image Review Doc
Angiomyolipoma
A renal ultrasound shows a well defined echogenic mass in the renal cortex . This is most characteristic of what?
Angiomyolipoma
A seven year old girls presents to the ultrasound department from the emergency room. She is experiencing lower abdominal pain and a fever. What abnormality is seen below? What other sonographic feature is seen in the image below? What two complications could this indicate? #37 on Image Review Doc
Appendicitis, free fulid with debris - possible abscess, perforated/ruptured appendix
A 50 year old female with a long history of alcoholism presents with increased abdominal girth. A sonogram of the abdomen is performed and the most probable finding is:
Ascites with a small echogenic liver
Your patient is a 48 year old male with flank pain and hematuria. He has never had an ultrasound or any imaging of his kidneys. What is the most likely diagnosis based on the images below? What will be the outcome of this disease process? (The first image is the right kidney measuring 16.5 cm, the second image if the left kidney measuring 17.6 cm) #28 on Image Review Doc
Autosomal dominant polycystic kidney disease, renal failure
Which pathology could present sonographically with a triangular cord sign and what is the normal location? Select one: a. Pyloric stenosis, posterior to portal vein b. Pyloric stenosis, anterior to portal vein c. Biliary atresia, posterior to portal vein d. Intussusception, anterior to portal vein e. Biliary atresia, anterior to portal vein
Biliary atresia, anterior to portal vein
A 10 day old infant was brought to the ER with persistent yellowing of the skin and parents state the belly appears to be growing. The baby has refused to eat and has had regular stools and urine over the past 24 hours. From the following image what is the most likely diagnosis? What sonographic finding in the image helps you to determine this? If this disease process is not found early what could be the outcome for this child? (give me two possibilities) #36 on Image Review Doc
Biliary atresia, triangular chord sign, transplant or death
One could expect to image all of the following in a case of end stage liver disease except: a. Small atrophied liver b. Biliary dilatation c. Ascites d. Echogenic nodular liver e. Portal hypertension
Biliary dilatation
All of the following are clinical symptoms of pyloric stenosis except: Select one: a. Projectile vomitting b. Dehydration c. Bloody stools d. Olive shape palpable mass e. Weight loss
Bloody stools
A patient with biopsy-proven cirrhosis is referred for sonographic evaluation of the liver. Which lobe of the liver should the sonographer expect to demonstrate hypertrophy?
Caudate
What is the most common benign liver neoplasm?
Cavernous Hemangioma
Assuming color has been optimized, what is the finding in the following image? #15 on Image Review Doc
Cavernous transformation
What term is used to describe collaterals that form in the area of the porta hepatis when thrombus is present in the portal system?
Cavernous transformation
The patient is a 63 year old with abdominal pain, painless jaundice, no N/V. What is the most likely diagnosis based on the following images and why? #9 on Image Review Doc
Cholangiocarcinoma, Klatskins tumor
A 6 month old boy of Asian ethnicity is sent for abdominal ultrasound with a clinical indication of pain, vomiting, and a palpable RUQ mass. The sonographer notices the boy appears to be jaundice and the mom confirms he has looked like that since the week after birth. Based on the following image what is a probable diagnosis? #35 on Image Review Doc
Choledochal cyst
What predominately pediatric abnormality can be confused with a normal appearing gallbladder?
Choledochal cyst
Which abnormality is a form of hyperplastic cholecystosis? a. Cholelithiasis b. Cholesterlosis c. Gangrenous cholecystitis d. Cholangitis
Cholesterolosis
All of the following are true of fatty infiltration of the liver except: a. Focal sparing can be seen anywhere in the liver b. NASH can cause fatty infiltration c.Chronic cirrhosis patients typically have severe fatty infiltration d. Sound waves have a hard time penetrating tissue affected by fatty infiltration
Chronic cirrhosis patients typically have severe fatty infiltration
A renal ultrasound is performed on a 30 year old patient with right flank pain, elevated BUN and creatinine. The findings in the following image are consistent with all of the following except: a. Stone in the ureter b. Chronic renal failure c. Bladder mass d. Posterior urethra valve e. Enlarged prostate #26 on Image Review Doc
Chronic renal failure
Your patient is a 65 year old male. Recently lab work has shown that his BUN and creatinine are elevated. He has noticed oligouria in the last month. Based on the image below what would be the most likely diagnosis and what would be one of the most important questions you should ask your patient? The other kidney had a similar sonographic appearance. a. Nephrocalcinosis, do you have a history of renal stones or gallstones b. Renal artery stenosis, do you have hypertension c. Acute renal failure, are you a diabetic d. Pyelonephritis, have you had an infection or fever recently e. Chronic renal failure, are you on dialysis f. Chronic renal failure, are you a diabetic #33 on Image Review Doc
Chronic renal failure, are you a diabetic
Chronic active hepatitis C is a progressive destructive liver disease that eventually leads to:
Cirrhosis
The following image is most consistent with which abnormality? #14 on Image Review Doc
Cirrhosis with portal vein thrombosis
A technique that uses microbubbles of gas to enhance the echogenicity of blood flow and improve the assessment of vascularity of lesions is known as:
Contrast enhanced ultrasound
All of the following are causes of acute renal failure except: Select one: a. Diabetes b. Renal vein thrombosis c. Infection d. Obstruction
Diabetes
What is the most common cause of chronic renal failure?
Diabetes Mellitus
Patient is a 52 year old male with RUQ pain and fever times 4 days. His WBC count is elevated. He has a history of diabetes. What is the most likely diagnosis based on the following image? #8 on Image Review Doc
Emphysematous cholecystitis
All of the following are clinical signs of appendicitis except: Select one: a. Fever b. Lethargy c. Loss of appetitie d. Projectile vomitting
projectile vomitting
An 82 year old woman presents with RUQ pain, jaundice, N/V, and weight loss. An abdominal ultrasound reveals cholelithiasis. Other findings on the ultrasound were an irregular focal thickening of the gallbladder wall and polypoid lesion in the fundus that demonstrates vascularity. What is the most probably diagnosis?
Gallbladder carcinoma
Choose the sonographic description that best suits hydronephrosis. a. Fluid filled pararenal space b. Echogenic renal cortex c. Distortion of the renal shape d. Multiple cystic space masses throughout the kidney e. Fluid filled pelvocaliceal collecting system
Fluid filled pelvocaliceal collecting system
This type of liver lesion is characterized by often being isoechoic to the liver, prompted by female hormones, and displaces normal liver vasculature.
Focal Nodular Hyperplasia
All of the following increase the risk of hepatocellular carcinoma except: a. Hepatits C b. Cirrhosis c. Hepatitis B d. Gallbladder Cancer
Gallbladder Cancer
Patient is a 78 year old female with abdominal pain, N/V, weight loss times one month and increased bilirubin. The findings on the gallbladder scan were not mobile with change in patient position. What is the most likely diagnosis? #1 on Image Review Doc
GB carcinoma
A 39 year old woman presents to the emergency department with severe right upper quadrant pain. Sonography shows that the gallbladder is normal, but a 3.8 cm heterogeneous mass is noted in the anterior segment of the right lobe of the liver. The patient reveals that she has been taking oral contraceptives since she was 22 years old. What is the most likely diagnosis?
Hemorrhagic Adenoma
A one year boy who was delivered prematurely due to fetal alcohol syndrome presents for abdominal ultrasound. He has hepatomegaly and an elevated AFP. The sonographer finds a 9 cm hepatic mass with calcifications with invasion into the portal system. What is the most likely diagnosis? Select one: a. Infantile Hemangioendothelioma b. Neuroblastoma c. Wilm's Tumor d. Hepatoblastoma
Hepatoblastoma
In a patient with a history of 15 years of Hepatitis B what would be the most likely diagnosis from the image below? #17 on Image Review Doc
Hepatocellular carcinoma
Patient is a 62 year old male with history of cholecystectomy. Patient has no other pertinent medical history or symptoms, but on regular lab work an elevated AFP was found. The finding in the first image was found to have internal flow on a color Doppler image. What is the most likely diagnosis and what are the findings in the second image? #16 on Image Review Doc
Hepatocellular carcinoma and left portal vein thrombosis.
All of the following are associated with late stage cirrhosis except a. Collateral vessel development b. Hepatomegaly c. Jaundice d.Splenomegaly e. Ascites
Hepatomegaly
A 51 year old male complaining of RUQ pain presents to the ultrasound department with a history of gallstones. Based on the the image below what is the most likely diagnosis? #27 on Image Review Doc
Hydronephrosis
What is the most common location of an intussusception? Select one: a. Ileocolic region b. Inferior and to right of stomach c. RLQ d. LUQ
Ileocolic region
Fatty infilatraion of the liver can be assessed sonographically by visualizing:
Increased liver echogenicty
All of the following are risk factors for renal cell carcinoma except: a. Infection b. Chemical exposure c. Smoking d. Hypertension e. Long term dialysis
Infection
A 4 year old boy present to the ultrasound department from the emergency with intermittent extreme upper abdominal pain. He has had nausea and vomiting and the ER physician thinks he is palpating a mass in the mid right abdomen. Based on the image below what is the most likely diagnosis? What other sonographic findings must be evaluated for to help the physician decided how the boy will be treated? Name at least two. (These two should not include measuring the abnormality) #38 on Image Review Doc
Intussusception, vascularity, free fluid, fluid filled loops of bowel
All of the following can be sonographic findings of intussusception except: Select one: a. Lack of fluid moving through the bowel b. Free fluid c. Hypoechoic and hyperechoic outer rings d. Bulls eye target sign
Lack of fluid moving through the bowel
What is most likely abnormal liver finding is seen in the following image? #19 on Image Review Doc
Metastatic liver disease
A 35 year old male with a history of DM comes in for a RUQ ultrasound. He has slightly elevated AST and ALT and intermittent, vague abdominal pain. What does the following image show about his liver? #21 on Image Review Doc
Most likely cavernous hemangioma
Which of the following accurately describes rebound pain? Select one: a. Pain experienced upon the release of compression b. Pain experienced the the compression of one finger c. Pain experienced during a graded compression technique d. Pain experienced upon compression
Pain experienced upon the release of compression
Your patient is a 43 year old Hispanic female with DM and HTN for 5 years. She has a recent history of epigastric pain. The findings in the gallbladder were mobile and the gallbladder wall measured 3.8 mm with no color flow found in the gallbladder lumen or wall. Referring to the following image what one other sonographic finding, except sludge, is important for you to rule out for diagnosing this patient? #5 on Image Review Doc
Pericholecystic fluid
Describe the sonographic findings in this image. #3 on Image Review Doc
Pericholecystic fluid and echogenic foci with shadowing.
Diffuse wall thickening of the gallbladder can be significant in all of the following except: a. Ascites b. Hepatitis c. Acute cholecystitis d.Portal hypertension
Portal hypertension
A 36 year old female is referred from her primary physician for a renal ultrasound. The clinical indications given by the physician are flank pain and increased creatinine and WBC. Patient describes her pain to be on the right and in the past 24 hours has developed nausea and vomiting. Would your probably diagnosis be pyonephrosis or pyelonephritis? #24 on Image Review Doc
Pyelonephritis
In a patient with fever, chills nausea, dysuria and vomiting and labs that show leukocytosis, bacteria and pyuria who presents with the following image on ultrasound, what would be the most likely diagnosis? #29 on Image Review Doc
Pyelonephritis
A common cause of acute pyelonephritis is..
Pyogenic bacteria
A staghorn calculus refers to a large stone located within:
Renal Pelvis
Which of the following structures could be mistaken for a dilated ureter? a.Adrenal cyst b. Hypertrophied column of Bertin c. Renal vein d. Junctional parenchymal defect
Renal Vein
When performing a renal ultrasound you find echogenic bilateral kidneys that measure approximately 6 cm each. You should consider all of the following differential diagnosis except: Select one: a. Chronic glomerulonephritis b. Renal vein thrombosis c. Chronic renal failure d. Chronic pyelonephritis
Renal Vein Thrombosis
A 62 year old white male presents to the ultrasound department for a renal ultrasound. He has a history of smoking, HTN, and obesity. On labs performed during a routine physical exam microscopic hematuria was seen and his creatinine was slightly elevated. Based on the following images what could be a probably diagnosis? What specifically is the second image showing? #25 on Image Review Doc
Renal cell carcinoma, invasion into the IVC
All of the following may be indicated by the image below except: a. Jaundice b. Reversed flow in the portal confluence c. Intrahepatic ductal dilatation d. Enlarged gallbladder #12 on Image Review Doc
Reversed flow in the portal confluence
Clinical sign and symptoms in acute pancreatitis include all of the following except: a. Nausea and vomiting b. Severe abdominal pain radiating to the back c. Severe abdominal pain radiating to the shoulder d. Elevated amylase
Severe abdominal pain radiating to the shoulder
Without any clinical history what would be the most likely diagnosis based on the appearance of the pathology below? #10 on Image Review Doc
Splenic Infarct
A two year old boy presents with hematuria and a palpable right flank mass. The ultrasound showed a solid renal mass, What is the most likely diagnosis?
Wilm's tumor
What is the sonographic finding that can distinguish acute from chronic cholecystitis? a. pericholecystic fluid b. Cholelithiasis c. WES sign d. Wall thickening
WES sign for chronic (In class it was pericholecystic fluid for acute)
The causes of a large gallbladder include all of the following except a. Obstruction b. Adenomyomatosis c. Gallbladder Carcinoma d. Common duct obstruction
adenomyomatosis
Patient is a 23 year old African American female coming in through the emergency department with RUQ pain and N/V. Her labs show an elevation in bilirubin. She has a CT of her abdomen three years ago that was negative. No history of diabetes, cancer, surgeries or major illnesses. What is the most likely diagnosis? #2 on Image Review Doc
choledocholithiasis
All of the following are sonographic characteristics of chronic renal failure except: Select one: a. Thin renal parenchyma b. Small kidneys c. Increased cortical echogenicity d. Decreased cortical echogenicity
decreased cortical echogenicity
What abnormality is visualized in this image? What is the official name of the most likely diagnosis causing this dilatation and where is this finding most frequently located? #22 on Image Review Doc
dilated pancreatic duct and dilated common bile duct, pancreatic adenocarcinoma, head of the pancreas
All of the following are sonographic findings of acute calculous cholecystitis except: a. Gallbladder wall thickening b.Ductal dilatation c. Pericholecystic fluid d. Cholelithiasis
ductal dilatation
Adenomyomatosis is often referred to as a strawberry gallbladder. True of False?
false
Cholangiocarcinoma is always seen originating from intrahepatic ducts? True or False?
false
Chronic cholecystitis does not raise the risk of gallbladder carcinoma? True or False
false
Which landmark is essential to the location of the appendix and typically sits posterior to the appendix? Select one: a. Bladder b. Right kidney c. Umbilicus d. Iliac vessels
iliac vessels
If your patient has fatty infiltration and your image is dark in the far field what should be your first choice of optimization?
lower your scale FIRST (then adjust tgc, but the scale was the right answer on the test)
A 35 year old woman comes for a renal ultrasound due to microscopic hematuria. She has had no pain and no history of any kidney problems. Based on the image below which of the following diagnoses would be most likely? #31 on Image Review Doc
parapelvic renal cyst
Identify the lab test used to assess renal function.
serum creatinine
A 75 year old American male comes to the ultrasound department for a renal ultrasound. He has experienced gross hematuria for one month and has had recent trouble with voiding. He has smoked for 45 years and has HTN. Based on the images below what would be the most likely diagnosis? #23 on Image Review Doc
transitional cell carcinoma
What is the most common etiology for hydronephrosis ?
urinary tract obstruction
