Case study clinic term 2
21yo woman is referred for nonspecific neck discomfort. No neck masses are palpable. A mostly cystic thyroid nodule with a "spongiform" appearance is noted on the sonogram. Likely diagnosis?
Benign hyperplastic thyroid nodule
A slender postmenopausal woman is referred for neck sono to eval palpable, tender Rt neck nodule. She reports slight pain with palpation; no pain had been noted before the physical exam. Sono reveals 1.5 cm mostly cystic nodule with some solid debris. Uninterrupted, peripheral rim calcification is also noted. Likely diagnosis
Benign hyperplastic thyroid nodule
A 67yo patient w/increasing urinary frequency, increased leaking, and hesitation of the urine stream for more than 3.5 years. DRE and TRUS exam revealed enlarged prostate. Likely diagnosis
Benign prostate hyperplasia
A 73yo man in otherwise good health has experienced increasing episodes of the need to urinate duetting the night over the last year. DRE results described as: generous gland with no palpable nodules," and blood work revealed a high free/total PSA ratio. What is the likely cause to patients symptoms?
Benign prostatic hyperplasia
Incidental bilateral thyroid nodules noted on 75yo man getting carotid exam. Thyroid exam reveals Nodule in Rt lobe is mostly cystic but contains debris, nodule in the left lobe contains multiple microcystic spaces separated by thin septa. Finding suggest...
Bilateral benign thyroid nodules
A 42yo man presents to ER w/ ulceration on his toes and fingers. He has a known history of extremely heavy tobacco use. Lower ext Doppler all shows normal waveforms and color flow in com fem, profunda,superficial fem, and popliteal arteries. Doppler eval also shows a marked velocity decrease in post tibial artery, and flow could not be detected in the dorsal is pedis artery. What is most likely diagnosis?
Burger's disease
49yo woman HIV positive undergoes sono that shows small mass w/multiple, enlarged axillary nodes. Likely cause of lymph node abnormality.
Cancer/ HIV
Which of the following would be most worrisome? A. Hypoechoic oval mass with a hyperechoic center found in the breast of a 45yo woman B. Microcalcified mass seen on the breast of a 38yo woman C. Hard, mostly cystic mass seen 2 mo post op, posterior to mastectomy scar D. 4-cm, smooth, oval mass with cystic areas in the breast of a 55yo woman
D. 4-cm, smooth, oval mass with cystic areas in the breast of a 55yo woman
After a crushing injury (car accident), a 23yo woman complains of swelling and severe calf pain, specifically when the area is palpated or she moves her foot. Her pain has not been relieved by medicine and she stated she is losing sensation in her foot. Exam reveals: shiny skin and absent pedal pulse. Grey scale imaging does not reveal any intimate damage, however , spectral Doppler waveforms are high resistive in the popliteal artery and gradually diminish as samples are taken distally in the peroneal and post tibial arteries. Likely diagnosis?
Compartment syndrome
A 63 yo man presents to ER w/bilateral lower extremity edema and shortness of breath. Patient history is limited because of lack of medical records and he appears very confused. Sono findings for bilateral LEVD revealed fully compressible veins bilaterally, w/adequate color Doppler. Pulsed wave Doppler revealed halting proximal compressions with augmented distal compression bilaterally. Pulsed wave imaging also noted a lack of respiratory phasicity with very pulsatile veins bilaterally. What is the most likely diagnosis?
Congestive heart failure
An 18yo pregnant woman presents to ER w/bilateral lower extremity pain for past 2 days. Sono findings include fully compressible veins with adequate color Doppler signals. Proximal compression halts blood flow, where as the distal compression demonstrates adequate augmentation. Pulsed wave Doppler reveals monophasic waveforms down the entire lower extremities bilaterally. What is the most likely diagnosis?
IVC obstruction
The goal of PSA testing is to
Identify early stage prostate cancers
53yo woman is sent for a breast sono b/c of abnormality seen only on one view of her recent mammo. Sono shows area of distortion with thickened cooper's ligaments and lymphadenopathy but does not show a discrete mass. The findings are most consistent with...
Invasive Lobular Carcinoma
38yo pregnant woman presents w/rapid enlarging m, retroareolar, palpable mass. Sono shows, microlobulated mass w/internal blood flow. Findings consistent with
Invasive ductal carcinoma
64 yo woman presents with large irregular breast lesion with prominent vascularity. Likely diagnosis.
Invasive ductal carcinoma
65 yo man presents for mammogram and sono of a palpable retroareolar RNA's. Likely diagnosis?
Invasive ductal carcinoma
65yo man presents with palpable Rt upper outer quadrant breast mass. Sonographically, a solid mass with post shadowing is seen at 10:00 3 CMFN. Findings consistent with
Invasive ductal carcinoma
A 32 yo woman in first trimester of pregnancy presents for breast sono b/c of palpable lump. Sono reveals large, predominantly cystic mass with multiple mural nodules. Likely diagnosis?
Invasive ductal carcinoma
When performing a duplex carotid exam, a vessel is encountered demonstrating continuous low-velocity signal with irregular and varying shape. This most likely represents what vessel?
Jugular vein
12yo girl presents with breast asymmetry and a large palpable mass in her Rt breast. Likely diagnosis?
Juvenile fibroadenoma
which of the following is an acceptable termination point of the conus medullaris in a normal patient.
L1
55yo woman undergoes sono, revealing a retroareolar, Solis mass within dilated ducts. She has evidence of skin edema and complains of unilateral pink nipple discharge. What would be the likely diagnosis?
Papillary carcinoma
40yo woman has sono for palpable neck nodule that is nontender. High- resolution sono reveals a rounded hypoechoic lymph node that contains microcalifications and measures 1.0 cm in length and 1.0 cm in anteropisterior dimensions that correlates with the palpable lesion. A solid hypoechoic thyroid nodule on the same side of the neck is also noted. Likely diagnosis?
Papillary thyroid cancer
Transverse imaging of the prostate gland in a 70 yo man with history of urinary obstruction demonstrates an anechoic defect into the base of the prostate. This finding likely represents
Surgical defect from TURP
Which maneuver is performed to solicit subluxation
barlow maneuver
a 10 day old baby boy is seen for a hip sono b/c of a breech delivery. The mother states the initial clinical evaluation was normal. Sono reveals lt hip has 56% coverage. Rt hip has 60% coverage. What is appropriate treatment for this infant?
both hips WNL- No F/U
a 10yo boy is referred for scrotal sono b/c on clinical exam only one of his testicles was palpable within the scrotal sac. A homogenous ovoid mass is id'd w/in the lt inguinal canal. Surgical repair is recommended b/c this condition is associated with an increased risk for which of the following.
cancer
a baby boy is born at 32wks gestational age is diagnosed with hydranencephaly. Which cranial structure would be absent?
cerebrum
the sono 'bat-wing' sign is associated with which cranial anomaly?
chiari II malformation
a 30yo man with gynecomastia, elevated hCG, and no palpable scrotal mass presents for a sono. The most significant sono finding includes a 1.5 cm heterogeneous mass within the rt testicle. After orchiectomy, the prognosis remains poor because this type of cancer does not respond well to chemotherapy. The clinical and sonographic findings suggest which type of cancer?
choriocarcinoma
the key to the diagnosis of tethered cord is the sonographic visualization of the level of the
conus medullaris
which of the following views is taken at the lateral aspect of the infant with the transducer oriented parallel to the long axis of the body with the hip at a 90-degree angle?
coronal/flexion view
which views are combined with stress maneuvers for eval of hip stability?
coronal/flexion, transverse/flexion
a 4-day old infant is referred for sono of the spin for clinical suspicion of spinal dysraphism. The sono shows 2 seperate smaller spinal cords within the spinal cord. What sonographic appearance does this describe?
diastematomyelia
an incomplete or complete longitudinal split or cleft through the spinal cord is the definition of:
diastematomyelia
which term describes the type of hip abnormality in which the femoral head sits outside the confines of the acetabulum?
dislocation
Ina normal patient, the cauda equina nerve branches are the nerve fibers arising from the distal end of the spinal cord and sonographically appear
echogenic and oscillate with respirations
a 28yo man undergoes clinical evaluation for a palpable mass in the lt testicle. Sono reveals a solid, mostly hypoechoic mass including a shadowing calcification within the lt testicle. A small amount of fluid also surrounds the lt testicle. Findings are mostly suggestive of
embryonal cell carcinoma
which anatomic structure would aid in the differentiation of alobar holoprosencephaly from hydranencephaly.
falx
a normal variant that has no known clinical significance when it occurs alone is a:
filar cyst
A 57 yo man presents with general malaise and unintentional wt loss. Abdominal CT reveals retroperitoneal masses. He has no palpable scrotal abnormalities, but a sono reveals and irregular hypoechoic testicular lesion and microlithiasis. Likely diagnosis?
germ cell tumor
a premature infant born at 28 weeks gestational age is scanned to rule out intracranial hemorrhage. sono demonstrates echogenic material within normal-sized ventricles. This finding would be consistent with which pathology?
grade II hemorrhage
the risk factors for DDH include which of the following?
high birth wt, spina bifida, cold season
a baby boy is born prematurely at 32wks gestational age. Prenatal screening showed an abnormal quad screen, bot no amniocentesis was performed. A cranial sono is ordered. What is the most likely diagnosis based on figure?
partial agenesis of corpus callosum
a 1wk old baby girl is referred for a sono to rule out hip dysplasia b/c of a click felt on clinical exam. There is no other pertinent clinical history. Sono reveals rt hip normal, lt hip graf type II. what is diagnosis and treatment?
physiologic laxity and regular monitoring
a coronal image of the neonatal head demonstrates the lateral ventricles at the level of the third ventricle and foramen of Monro. The transducer should be angled in which direction to visualize the glomus of the choroid plexus?
posterior
a 58yo patient is noted to have swelling and discoloration in the groin after balloon angioplasty of com iliac artery. Gray-scale imaging demonstrates a cystic mass located adjacent to the com fem artery. Color and spectral doppler show turbulent flow within the mass and to-and-fro waveform i the neck connecting the mass to the artery. What is the most likely diagnosis?
pseudoaneurysm
a 6wk old infant infant with a history of a 'click' on clinical examination is seen for a hip sono. The alpha angle measures 60 degrees on the rt and 55 degrees on the lt. This would be consistent with which of the following?
rt hip type II, lt hip type III
a 30yo man undergoes sono exam for a painless mass in the rt hemiscrotum. Sono reveals multiple punctate huperechoic nonshadowing foci and a hypoechoic mass within the right testis. Likely diagnosis?
seminoma with microlithiasis
a 43yo man is seen with a mobile painless mass at the upper pole of his right testis. Sono reveals a 1.5cm, round anechoic lesion that demonstrates acoustic enhancement. No other abnormalities are apparent. This probably represents a
spermatocele
a 1 day old infant is referred for spinal sono after physical exam reveals a palpable subcutaneous sacral mass. The sono reveals a highly echogenic mass arising from the spinal canal. The conus medullaris is id'd at the level of L2. What is the most likely cause of this echogenic mass?
spinal lipoma
Which of the following defines grade III hemorrhage?
subependymal hemorrhage with extension into the ventricle with ventriculomegaly
a 15yo boy is seen in the ER after falling and straddling a bicycle cross-bar. He has pain and swelling of the scrotum. The sono demonstrates heterogeneity of the right testicle and hype vascularity on color doppler exam. An area of echogenic material is seen just outside the upper margin of the right testicle. What is the most likely diagnosis?
testicular rupture
A 1 yr old girl who was adopted from haiti was seen by the primary care physician for an abnormal gain and abnormal posturing of the lower extremities. On physical examination, the child was also found to have a skin tuft and nevi in the region of the sacrum. Based on the clinical symptoms and lack of medical attention from birth to age 1, what spinal dysraphism might the sonographer expect to find?
tethered cord
a pathologic fixation of the spinal cord in an abnormal caudal location is the definition of:
tethered cord
Following are the PSVs for a patient's carotid sonogram. What is the right ICA/CCA ratio?
1.82
When scanning to determine the presence of tethered cord, the vertebral level is determined by counting down from the____and confirmed by counting up from the______.
12th rib, L5-S1 junction
Sonographic findings of carotid sono reveals moderate heterogeneous plaque in the left CCA. Spectral Doppler revealed a PSV of 224 cm/s and EDV is 86 cm/s. What describes these sonographic findings?
50% to 79% stenosis
Which of the following is the percentage of stenosis of the RCCA on a transverse image with a true diameter of 10mm and a residual diameter of 2mm
80%
During a routine cardiac work-up, a 65yo man w/ hx Of smoking and HTN has experienced some intermittent loss of the uses of his lt arm. Sono findings include decreased color flow in the Rt ICA with a high-pitched Doppler signal measuring PSV of 600 cm/s and EDV of 140 cm/s. What do these findings suggest? What would be next step in treatment?
80-99% stenosis Tx: endarterectomy or angioplasty
During his annual physical exam, 79yo man is noted to have a palpable, nontender, slightly pulsatile mass in the right popliteal fossa. No defect is noted on lt side. Gray-scale imaging demonstrates a focal, dilated segment of the rt pop art that measures 3.1 cm in all dimensions. Visible echoes can also be seen within a portion of the lumen. Color Doppler shows normal flow in the non dilated segment and a yin-yang appearance in the dilated portion. Spectral Doppler is essentially normal. What is the likely diagnosis?
Popliteal aneurysm with mural thrombus
A man presents to his physician with a large, non painful mass in the posterior knee fossa. Doppler and gray-scale imaging reveal a patent popliteal artery w/ normal biphasic signal. Outer to outer wall diameters in prox, mid, and distal areas are .8cm, .9cm, and .7cm. There is a 3.0cm x 4.2 cm x 3.0 cm anechoic mass located medial to the popliteal artery. No color or spectral Doppler is demonstrated in the mass. What is the most likely diagnosis?
Popliteal cyst
83yo man with overall weakness, joint pain, and generally not feeling well for last 9mo. PSA was 23 ng/mL and prostate sono was ordered as well as nuclear med bone scan. Likely diagnosis
Prostate cancer
Radial arrangement of the sulci superior to the third ventricle is a sonographic finding associated with which anomaly?
ACC
a 78yo man with chief complaint of not being able to walk long distances without bilateral calf pain. Pain is also present when resting. LEV and ABI were both ordered. LEV shows fully collapsible vessels with wall to wall color with doppler. LEA shoes minimal plaque formation and no evidence of high-grade stenosis, although the average peak systolic velocity is 70cm/s. One section in the above knee popliteal artery demonstrates 112cm/s. The ABI is 1.1 on the right and 1.2 on the left. What is the most likely cause of patients leg pain?
ASO
A 62 yo man presents to ER with chest pain and sudden onset of shortness of breath. Findings of bilateral lower extremity Doppler reveal noncompressible veins from CFV to popliteal vein. Intraluminal echogenic matter is very difficult to visualize. Doppler signals are lacking as well. What is the most likely diagnosis?
Acute DVT
A patient describes loss of vision in the left eye as "someone pulling the shade down" what term describes this transient monocular blindness?
Amaurosis fugax
22yo man with extensive history of DVT with pulmonary embolism presents to his primary care physician to follow up a hospital stay because of DVT . What is the most likely treatment the physician will prescribe in an attempt to prevent future DVT?
Anticoagulants
A 23yo man arrived by ambulance to the ER from a motorcycle accident 4days ago. Portable lt LEVD revealed dilated proximal femoral vein with slow moving flow seen. Intraluminal hypoechoic matter was located in the left popliteal vein, extending down to the distal posterior tibial vein. Likely diagnosis?
Anticoagulants
After cardiac catheterization, a 72 yo woman complains of pain in her groin. On physical exam: bruit noted in area of arterial access. Spectral Doppler reveals high velocity and low resistance waveforms in the common fem artery proximal to the site of the catheterization and reduced flow distal to the site. Com fem is also noted to have increased pulsatile flow above the puncture site. A thrill can be palpated on the skin, and flash artifact is evident on color Doppler. Likely diagnosis?
Arteriovenous Fistula
Anatomically the prostate can be divided into 4 zones. These include al of the following except: A. Transition B. Medial C. Central D. Peripheral E. Anterior fibromuscular zone
B. medial
An 84yo woman presents for a bilateral LEVD for pain posterior to the Rt knee for 6mo. The patient has bilateral ankle edema; she denies any chest pain or shortness of breath. Each vein appears compressible, with no intraluminal echogenic matter seen. Color Doppler appears adequate. Pulsed wave Doppler reveals pulsatile veins bilaterally. A complex area was noted in the popliteal fossa that measures 5.4 cmx3.7cmx 4.0cm. What is most likely diagnosis?
Bakers' cyst with CHF
What is the first sign of subclavian artery stenosis?
Change in vertebral artery waveform
A 51yo man with ankle pin for the last 4 yrs presents for an outpatient LEVD. There is no apparent edema, stasis dermatitis, varicose veins. Sono findings include: fully compressible CFV, prox GSV, and femoral vein. Color Doppler reveals adequate blood flow with normal pulsed wave Doppler signals. Sonographer is trying to compress the popliteal vein but cannot. No intraluminal echogenic matter can be seen w/in the popliteal vein, and Doppler reveals normal signals. What should sonographer do next?
Change sonographic window
a head sono is ordered on a 4day old baby boy for premature delivery at 25wks gestation. The infant experienced episodes of apnea after delivery and was intubated but is otherwise stable. What sono finding is present in figure and what anomoly is associated with it?
Chiari II, malformation meningomyelocele
A young woman presents with a painless, diffusely enlarged thyroid gland on physical examination. Sono appearance confirms diffuse enlargement with a micronodular pattern and increased vasculrity. What is the likely condition
Chronic thyroiditis
45yo pt with PSA value of 1.5 ng/mL underwent TRUS exam. Pt unaware of any prostate or urinary symptoms. Sono image finding conclude what?
Ejaculatory duct cyst
A 42yo man presents to the ER for Rt lower extremity pain and edema. Patient history includes: heavy smoker, alcohol abuse, and diabetes. Noncompliant in tx of diabetes due to homelessness. Rt LEVD revealed intraluminal echoes in the proximal fem vein with lack of color flow, which were difficult to ID, and a non compressible trifurcation that is small and hyperechoic. Prox compressions reveal that blood flow could not be halted. On locating difficult to ID intraluminal echoes in prox femur, distal compressions were ceased. Likely diagnosis?
DVT- deep vein thrombosis, and Venous reflux
a cranial sono is performed b/c of an abnormal prenatal scan. Routine coronal and sagittal views are performed through the anterior fontanelle. Additional scanning through the mastoid fontanelle reveals hypoplasia of the cerebellar vermis and communication between the 4th ventricle and posterior fossa. These findings would be consistent with which anomaly?
Dandy-walker variant
Most common reason for elevated PSA is
Enlarged prostate gland (BPH)
after experiencing a ruptured Achilles' tendon injury, a 34yo man complains of severe leg pain and swelling. Spectral doppler of the veins reveals normal phasicity and complete compressibility from the thigh to just below the knee. Due to extreme pain the sonographer is unable to compress calf or document augmented flow within the veins by color Doppler and notes that arterial signals seem weak. Arterial spectral tracing confirm diminished flow and shows flow disappears completely in distal calf. A large hematoma between the gastrocnemius and the soleus is noted. What is most likely diagnosis?
Entrapment syndrome
A 40 yo woman presents to ER with uncontrolled HTN and abnormal lab values. Bilateral carotid bruit is noted on cervical auscultation. Renal angiogram results reveal multiple bulbous, luminal irregularities in the renal arteries bilaterally. What is the most likely cause of this patients carotid bruit?
Fibromuscular dysplasia
A 68yo man. Seeks treatment for Rt leg pain during exercise. He has difficulty walking short distances without calf cramping. Gray-scale imaging demonstrates heavily shadowing plaque throughout the Rt superficial femoral artery. Color Doppler demonstrates flow with luminal irregularities throughout the entire femoral artery except in the mid portion where no flow is seen. Spectral Doppler confirms this finding, demonstrating monophasic flow with a good upstroke in the proximal femoral artery, no flow in the mid to distal femoral artery, and tardus parvus flow in the proximal popliteal artery. What is the most likely diagnosis?
Focal occlusion of the native femoral artery in the setting of ASO
a 32yo man undergoes eval for infertility and is ordered for sono exam. Sono shows a collection of vessels measuring 2.0-2.5mm in the left hemiscrotum. What doppler findings within this collection of vessels would suggest a primary vericocele?
Further Dilation and increased blood flow during valsalva maneuver
A 16uo girl presents w/breast mass that has been palpable for 6mo. Sonographically, a 7cm, smooth, oval, gently Lou later mass is seen. Findings consistent with
Giant fibroadenoma
A 35yo man presents with symptoms consistent with hyperthyroidism. Neck sono reveals diffusely hypoechoic with a lobulated contour. No discrete modules are seen. Color D. Shows a dramatic increase in flow throughout the gland. Likely cause for findings
Graves' disease
A 31yo woman is referred for sono after bilateral neck fullness is noted during a routine physical exam. Sono appearance of thyroid gland is diffuse, hypoechoic enlargement of both lobes and the isthmus and "coarse" parenchyma. The sono features of the mass along with patients gender and age are suspicious for
Hashimoto's thyroiditis
How can the ICA Doppler flow be best described?
High flow and low resistance signal
Sonographically prostate cancers are often visualized as focal, hypoechoic nodules most often found:
In the peripheral zone
Benign enlargement of the prostate gland occurs almost exclusively
In the transition zone
Which of the following is not considered a mass of the breast tissue? Oil cyst Inclusion cyst Lipoma Hematoma Galactocele
Inclusion cyst
A 10yo girl presents with a very tender, high- midline neck mass. Her parents report feeling a small lump in this location since she was a baby, but it has enlarged and is now painful. The sono reveals an oval, 1.0 cm x1.5 cm cystic mass with a thin wall and some internal debris. It is located approximately 3cm superior to the thyroid isthmus. What is most likely cause I'd cystic mass?
Infected thyroglossal duct cyst
Commonly seen in men older than 50, symptoms of BPH include
Leaking or dribbling of urine Weak or hesitant urine stream Increased urinary frequency Nocturia Answer: all of the above
A 50yo woman palpates a compressible minke mass in her lt breast . Somographically, the mass, although palpable, is indistinguishable from the surrounding breast tissue. Likely diagnosis?
Lipoma
failure of the sulci and gyri to develop in a term infant is associated with which cranial anomaly?
Lissencephaly
a 6wk old baby girl is seen for a sono to rule out hip dysplasia. The alpha angle for the lt hip is 64% and the alpha angle for the rt hip is 58%. What are graf classifications for these hips.
Lt-type 1 rt-type 2
An elderly man with painless, palpable thyroid nodule is referred for thyroid sono. Precious imaging studies have reported a thyroid nodule with calcification. A 2nd sono is done and reveals 2x3 cm solid, hypoechoic nodule with a hypoechoic halo and disruption of peripheral, egg shell calcification. These findings make this nodule suspicious for
Malignant nodule
A 34 yo woman is who is 4hrs postpartum complains of sudden onset of lt lower extremity pain. Hx shows lt lower extremity pain for last 7yrs. Lt LEVD reveals fully compressible veins and no intraluminal echogenic matter w/an adequate color Doppler signal. On pulsed wave Doppler, prox compressions fully halt blood flow, and distal compression demonstrates a good augment. However, Doppler reveals dampened waveform down the entire lt lower extremity. What is the most likely diagnosis?
May-Thurner syndrome
A young man is referred for sono eval of lateral neck mass that is nontender. Sono reveals a solitary thyroid nodule and multiple rounded masses that follow the carotid jugular areas. Both the intrathyroidal and extrathyroidal masses contain microcalcifications. This should represent
Metastatic thyroid cancer
A 63yo man in apparent good health is seeking a second opinion for a thyroid nodule that was diagnosed elsewhere. He was told that the nodule contained "psammoma bodies" this findings refers to
Microcalcifications in a nodule
A 66yo woman complains of pain in her legs during exercise, worse in lt calf but is bilateral. ABI is ordered. Biphasic waveforms noted throughout Rt leg and lt com fem, lt leg is monophasic in popliteal, posterior tibial, and dorsal is pedis arteries. Before the exercise portion of the test, ABI values: 1.0 Rt and 0.76 Lt. After exercise, lt foot pallor is noted, and the ABI values are 0.80 on the right and 0.35 on the left. Most likely cause of leg pain?
Mild disease in the right leg and severe arterial occlusive disease in the left leg
A 39yo man presents for bilateral LEVD for leg pain that has persisted for the past month. Patient history includes diabetes mellitus, HTN, and hyperlipidemia. This patient is noncompliant and does not take medications, including insulin, as directed. Sono shows fully compressible veins bilaterally w/adequate color Doppler. Pulsed wave Doppler revealed halting prox compressions with an augmented distal compression bilaterally. What is the likely diagnosis?
Neuropathy from the diabetes
Routine annual F/U exam of a popliteal artery stent reveals an echo-free lumen by grayscale. Color Doppler shows aliasing within the stent, and spectral Doppler confirms the mildly elevated velocities. Flow distal to the stent becomes triphasic and demonstrates normal velocities. What is the most likely diagnosis?
Normal Findings in a stent
A 61yo man with a biopsy- proven papillary thyroid cancer is also noted to have several oval, flat, elongated masses in the area between the jugular vein and carotid artery. Hyperechogenicity is noted in the hilar regions of these "masses" What is the most likely diagnosis
Normal cervical lymph nodes
A 69yo man presents to ER with a 1 day history of a cold, purple lt foot. He has a history of a lt common femoral artery- popliteal bypass graft. No detectable color or spectral Doppler flow is noted. The native popliteal artery distal to the graft has a monophasic spectral Doppler waveform. What is the most likely diagnosis?
Occlusion if the arterial bypass graft with refilling of the popliteal artery versus a large reversed branch(acting as a collateral)
30yo woman w/hx of breast reduction sent for sono for palpable masses along surgical scar. Sono reveals 3 round, smooth, anechoic masses. Findings are most consistent with which of the following?
Oil cysts
A 23yo woman w/ a morbid undead in body habitus complains of lt lower extremity pain with swelling and edema. During the exam she becomes short of breath with hem Optus is. Sono findings include dilated femoral vein with walls that do not coapt on extrinsic transducer pressure. The lumen of the vessel demonstrates echogenic matter that is difficult to visualize. Doppler signals are absent. Likely diagnosis?
PCD
a premature infant born at 26wks gestational undergoes scanning at 4wks of age for routine f/u to prematurity. Sono reveals symmetric regions of increased echogenicity in the watershed area. This would be consistent with which?
PVL
A 19yo man w/no significant medical history is seen with a palpable nodule in the region of the right inferior lobe of the thyroid. On sono exam, corresponding nodule is found to be slightly less echogenic than the surrounding thyroid parenchyma. There is a wide , irregular halo surrounding the nodule and fine punctuate internal calcification throughout the nodule. What is the most likely diagnosis
Papillary thyroid cancer
A 75yo woman is referred with elevated serum calcium level. Neck sono reveals an oblong hypoechoic mass adjacent to the posterior aspect of the lower third of the left thyroid lobe. Likely diagnosis
Parathyroid adenoma
A postmenopausal pt with hypercalcemia and hypophosphatasia is referred for sono of the neck. An oval shaped, hypoechoic mass is seen posterior to the mid-lower right lobe of the thyroid. The clinical findings of hypercalcemia and hypophosphatasia along with the shape and location are most suggestive of
Parathyroid adenoma
a 16yo boy is seen in er for severe scrotal pain that he awoke from. Sono exam reveals an enlarged, slightly hypoechoic lt testicle compared with the rt. Initial color doppler of the lt testis is shown in fig. Color doppler at the end of exam shows normal profusion as compared to color doppler at beginning of exam. What is likely diagnosis
Partial Torsion
An 81yo man comes to ER with blue Rt toe. His history is positive for long term tobacco use. On clinical examination, the patient has Rt ABI of 0.40 and a left ABI of 0.70. On lower extremity Doppler imaging, the common femoral artery through the popliteal artery are patent, however, severe irregular plaque is noted. The peroneal artery is occluded at its origin, but the posterior tibial and anterior tubal arteries are patent; modest plaque buildup is noted. What is the most likely diagnosis?
Peripheral arterial disease and arterial thromboemboli causing acute ischemia
A 32yo woman presents to the ER w/excruciating Rt lower extremity pain for the PZT 3 hours. Patient history includes a morbid increase in body habitus, sedentary lifestyle, and mild to moderate Rt lower extremity pain for the past week that has gotten worse in the past 3 hours. The clinician notes a bluish tinge to the massively enlarged leg. Her toes and foot are becoming increasingly white. What is the most likely diagnosis?
Phlegmasia alba dolens
The PSA density result in an asymptomatic 65yo African American man is 0.2, DRE reveals a nodule. Likely diagnosis?
Prostate cancer
A 32yo man with constant deep throbbing pain behind his scrotum, and elevated temp for a few days alongside intermittent fever and chills. Labs show elevated PSA and WBC. Sono showed diffuse increase in color flow Doppler in the prostate gland and an irregular, cystic structure at the junction of a seminal vesicle and prostate. Diagnosis?
Prostatitis, abcess
A 61yo man presents to the ER for severe leg pain and generalized erythema, or redness. Silvery, scarlet skin that is severely flaking is noted bilaterally from the lower abdomen to the toes. Patient history revealed that he is currently undergoing chemotherapy treatments. LEVD. Appeared negative for any echogenic matter . What is the most likely diagnosis?
Psoriasis
A man stumbles into the ER showing signs of dysarthria and problems with gait and stance. The front desk personnel assumes the man is severely intoxicated and do not assist him right away. Why is this a possible detrimental mistake?
Pt is presenting with stroke symptoms and the sooner he is treated the less likelihood of fatality
A young woman in the upper Midwest presents with painful ties that turn white, blue, and finally red during cold, winter weather, this occurs in a few of her fingers as well. She admits this also happens sometimes in the summer when in an air conditioned building. An arterial lower vascular lab study came back with normal pressures. Her digital pressure indices all are less than 0.79, her digital temps are about 21 degrees C, and her fingers are noticeably discolored. After hearing her fingers, her pressures and temps improve and are bright red. What is the most likely diagnosis?
Raynaud's disease
A 67yo man developed acute blindness in the lt eye while at work. When he arrived at the hospital he claimed to have gotten lost. He appeared uncoordinated and confused and had trouble expressing himself. A carotid sono reveals lt vertebral occlusion. 3 days later pt symptoms completely resolved. What do these findings suggest?
Reversible ischemic neurologic deficit
A neurologic deficit that lasts longer that 24 hours but completely resolved is a :
Reversible ischemic neurologic deficit
A patient presents with lt arm paralysis; which artery is the most likely cause
Right ICA
50yo woman w/augmented breasts complains of newly occurring asymmetry of breast size, Rt smaller than lt. Sono shows: Rt has long echogenic lines w/in the internal portion of the implant. Shadowing resembling bowel gas is also seen along external periphery of implant. Findings consistent with..
Rt breast "stepladder" and "snowstorm" signs
A 67yo man is taken to the hospital via ambulance. His symptoms include confusion, loss of memory, aphasia, and left sided hemiparesis. His history includes hypertension, hypercholesterolemia, and smoking. A carotid sono revealed echogenic material with the right internal carotid lumen. No flow was seen with spectral Doppler. What do these findings indicate?
Rt internal carotid occlusion
A routine 6mo follow up exam of a femoropoliteal bypass vein graft reveals a new, moderately echogenic region protruding into the lumen near the proximal anastamosis. Color Doppler shows aliasing and flow disturbance, where as spectral tracings demonstrate very high velocities and marked spectral broadening. What is the most likely diagnosis?
Stenosis secondary to intimal hyperplasia
A 52yo woman with a painful lt leg is seen by her physician. Physical exam reveals a red swollen leg with "tough cords" running just below the skin surface. B-mode exam shows silted, superficial vessels ( w/in 1st fascial plane) filled with low-level echoes. Deep veins of upper and lower leg are compressible and show normal flow w/out evidence of internal thrombus. What is the most likely diagnosis?
Superficial thrombophlebitis
A non complaint 58yo woman with depression and hypertension presents to the emergency dept with aphasia, lt hemiplagia, and possible lt hemianopia. The patient communicates that her symptoms started early in the morning. While waiting for further testing that day, neurologic deficits resolve. What is the most likely diagnosis?
TIA- transient ischemic attack
A 25 yo man has a sudden onset of scrotal pain during a soccer game. During examination in the ER, the right hemiscrotum is still painful. Sono reveals slight enlargement of right testicle, and on color doppler examination, no blood flow can be found in the right testicle. Likely diagnosis?
Testicular torsion
In which of the following views does the normal hip display a 'U' shape?
Transverse/flexion
Which of the following would meet the criteria of the minimum standard examination?
Transverse/flexion view with stress maneuvers, coronal/neutral view
Which of the following is a sonographic feature of advanced prostate cancer?
Tumor extension to the peripristatic lymph nodes
Symptoms of prostatitis include all of the following except: A. Fever and chills B. Perineal region pain C. Microhematuria D. Urethral discharge E. Urinary urgency or frequency
Urinary urgency or frequency
A 54yo man presents to ER w/a large weepy ulcer on his rt lower extremity. The clinician notices stasis dermatitis with putting edema in the rt gaiter zone. The patient denies any chest pain or shortness of breath. Sono findings include fully compressible veins, demonstrating adequate color Doppler flow. Proximal compression cannot halt blood flow, but distal compression yields augmentation. What is the most likely diagnosis?
Venous insufficiency
a 72yo man is seen in ER with swelling and pain in the rt hemiscrotum of 2 days duration. His scrotum is red and warm to touch. son reveals fig 28-28. Likely diagnosis?
acute epididymo-orchitis
as and infant grows, a tethered cord causes increasing tension leading to:
ambulation problems
a newborn was noted to have hemangioma in the area of the sacrum. At 5 days of age, he underwent a sono to RO spinal dysraphism. The sono revealed abnormal widening of the central nervous canal by CSF. Likely diagnosis?
hydromyelia
the bony acetabulum consists of which of the following?
ilium, ischium, pubis
a sono is performed on a premature infant born at 26 weeks gestational age. Delivery was complicated by severe birth asphyxia. Previous sonos have documented grade I hemorrage. What is the new diagnosis?
infarction and global hypoxic ischemic encephalopathy
suspected abnormal growth or development of the spinal cord and adjacent structures is known as
occult spinal dysraphism
all of the following are indications for neonatal spine sono except: a. lipoma b. osteosarcoma c. sacral dimple d. sacral skin defect
osteosarcoma
a 52 yo man is diagnosed with epididymo-orchitis after sono eval. His clinical signs and symptoms most likely include which of the following?
painful enlargement of the scrotum
A family practice resident examines a newborn in the first week of life. Lt hip feels unstable and sono is ordered . Eval reveals a graf type II hip with alpha angle of 56 degrees. What is the appropriate treatment for this infant.
this is typical of physiologic laxity and F/U exam in 4-6 weeks for re-evaluation
an infant is seen with positive Allis sign on the rt side. Clinical exam is limited due to fussiness. Sono is ordered to RO hip dysplasia. Sono IDs lt hip sitting deep in the acetabulum, and rt dislocate, but reduces with stress maneuvers. What are treatment options for this infant.
treat with Pavlik Harness
a 61yo man is seen with intermittent pain and swelling of the rt scrotum, radiating to the rt inguinal canal. Sono is ordered b/c a scrotal hernia is suspected. Which of the following sono findings is suggestive of scrotal hernia?
tubular structures that demonstrate peristalsis within the scrotum
a 40 yo man is seen after being involved in an explosion accident. Sono is ordered b/c of contusion on the rt hemiscrotum and shows that the capsule of testis is irregular. Likely diagnosis?
tunica rupture
which Graf classification describes an immature hip with an alpha angel of 50-60 degrees?
type II
a 39yo man is seen with rt-sided painless scrotal swelling. sono reveals appearance shown in fig 28-29-(dilatated blood vessels). What is the likely diagnosis and where else should sonographer investigate?
varicocele, RUQ