US PATHOLOGY - ABD REGISTRY
wolman disease
autosomal recessive disorder that causes excessive lipid storage in the liver, spleen and adrenal glands. most patients die in the first 6 mo of life > hepatosplenomegaly and massive adrenal gland enlargement
what is splenosis
autotransplantation of splenic tissue in the peritoneal cavity when the spleen ruptures either traumatically or spontaneously
what syndrome is hepatoblastomas associated with?
beckwith wiedemann syndrome (fetal syndrome)
what is pheochromocytoma? how will is displace the ipsilateral kidney?
benign tumor in adrenal gland will displace ipsilateral kidney inferiorly
hamartoma
benign tumorlike malformation
unilateral renal agenesis is associated with what anomaly in women? and in men?
bicornuate uterus; agenesis of the seminal vesicles in men
a duplicated collecting system will demonstrate what
circumferential cortex at the mid pole with upper and lower hilums
the hepatic vein in advances cirrhosis would show what kind of phasic pattern
cirrhosis causes compression of hepatic veins due to liver tissue fibrosis normal triphasic pattern become MONOPHASIC with minimal respiratory phasicity
case study: pt reports with RLQ pain, diarrhea, low grade fever. US shows: prominent lymph node and haustra
colitis
what is peribiliary fluid
collection of bile that forms around a perforated gb
malignancy ascites appearance
complex fluid collection with matted bowel loops
what causes schistosomiasis?
most common parasitic infection in humans caused by fluke parasite found in polluted waters and infested shellfish/snails portal vein carries ova to the liver narrowing and occlusion of smaller portal vessels causing portal HTN
how would acute hepatitis present
hepatomegaly with decreased echogenicity and scattered bright portal reflections within the parenchyma (starry night)
glycogen storage disease is associated with
hepatomegaly, increased echogenicity similar to fatty liver and hepatic adenoma formation
how does a yolk sac tumor present sonographically? what labs would be increased or decreased?
most common testicular tumor in pts under 2 yrs labs: elevated AFP sonographically: areas of hemorrhage and nercrosis - complex appearance
distal cholangiocarcinoma usually occurs
most commonly extrahepatic CBD near porta hepatis
describe transitional cell carcinoma
most commonly presents as diffuse bladder wall thickening with multiple masses within the wall
primary sclerosing cholangitis
most pts have inflammatory bowel disease or ulverative colitis causes chornic inflammation and fibrosis of the biliary ducts
MCKD (uni or bi?, caused by?)
multicystic kidney disease usually unilateral, if bilateral then fatal caused by insult during 14-18 weeks in fetal development
infectious vs non infectious causes for hepatitis
infectious: bacteria, fungus and virus non infectious: anabolic steroids (human made testosterone/androgens) (chronic use)
what is the key anatomic landmark in differentiating direct, indirect and spigelian hernias
inferior epigastric artery direct- herniated structures medial to the IEA indirect - lateral to the IEA spigelian - lateral to where the spigelian fascia is penetrated by the IEA
thyroiditis will display what sign
inferno sign - hypervascularity
what is bladder cystitis
inflammation of the bladder sonographically: bladder demonstrated thickened, irregular inferior wall w/ floating debris. represents urinary tract infection manifested as cystitis
what is epiploic appendagitis
inflammation of the thick fatty strands that attach to the serosal surface of the colon
schistosomiasis is an ??? cause of portal HTN. budd chiari syndrome is an ??? cause of portal HTN
intrahepatic PRESINUSOIDAL; intrahepatic POSTSINUSOIDAL
pseudomyxoma peritonei
intraperitoneal accumulation of a gelatinous ascites secondary to rupture of a mucinous tumor - most common cause is a rupture mucinous tumor of the appendix sonographically: mucinous secretions and tumor formation within lower abdomen causes bowel to be matted down against posterior abdominal wall
increased thyroid volume is associated with
iodine deficiency, acute hepatitis and chronic renal failure
most commonly found in the pancreatic body or tail and secretes hormones
islet cell tumors. two types: insulinomas and gastrinomas.
what are the 3 pancreatic endocrine tumors
islet cell tumors; insulinoma, gastrinoma, and glucagonoma
most common finding with congestive hepatomegaly is
ivc dilatation
??? is the most common malignncy of the liver seen in a pt with AIDS ?? is the most common infection of the liver seen in a pt with AIDS
kaposi sarcoma; pneumocystis carinii
most common type of cholangiocarcinoma
klatskin tumor
what would the labs be for pancreatitis ? what is a common complication?
labs: increased serum levels of amylase and lipase common complication: pseudocyst (complicated cyst) in the left pararenal space
where does staghorn calculus occur?
largus calculus located in the renal pelvis area common finding with Xanthogranulomatous Pyelonephritis
vessels that are common source for a type 2 endoleak
leak at the branch vessels potential sources include: IMA, Internal iliacs, lumber arteries, and accessory renal arteries
parasitic cholangitis involves?
liver flukes or ascariasis >may see worms in the inflamed ducts as echogenic tortuous strands in the lumen
what is the most common liver malignancy
liver mets
liver mets vs hepatocellular carcinoma
liver mets is more likely if the pt has a hx of primary cx in body as well as a liver mass with halo hepatocellular carcinoma is more likely if the pt has a hx of chronic liver disease (i.e. hep c) and a liver mass with a halo
what is zenker diverticulum? it can by mistaken for
located at the back of the throat, protrudes posterior or midline - a thyroid mass
what causes mucocele
long standing obstruction of cystic duct (remainder of biliary system is normal and jaundice would not occur)
most common primary carcinomas to metastasize to thyroid
lung, breast, and renal cell cancers
most common secondary malignancy of the testicles
lymphoma
which type of pancreatic mass has a strong risk of malignant conversion
macrocystic type of serous cystadenoma of the pancreas
alpha fetoprotein levels will increase with
malignancy and pregnancy
bladder carcinoma will appear as
mass infiltration into the wall of the bladder loss of definition of the affected wall thrombus accumulation limited to internal lumen of bladder
what is a common complication of cystic fibrosis
meconium ileus mucous production of the pancreas causing blockage of the ileum
what is caroli disease assoc with?
medullary sponge kid and hepatic fibrosis (-defect of bile ducts that leads to numerous cysts in the biliary tree)
what is the second most common primary malignancy of the testicles
non seminomatous tumors
an epidermoid cyst will have what lab values? will appear sonographically as?
normal lab values will appear as a avascular mass with rings of alternating hyperechoic and hypoechoic tissue giving the mass an "onion" appearance
retroperitoneal lymph nodes: normal vs abnormal
normal: no posterior enhancement (composed of fatty tissue and lymphatic tissue that absorbs and scatters sound) abnormal: posterior enhancement due to increased fluid within inflamed tissues
where does rectus abdominus hematoma occur?
occurs below the arcuate line can extend to the Space of Retzius in the pelvis sonographically: anechoic or mildly hypoechoic to surrounding tissues
what is the most common parasitic infection in humans?
schistosomiasis
when do you see spontaneous splenic rupture
seen in pts with malaria, hep a, cytomegalovirus, mononucleosis and HIV
how to differentiate a thyroid adenoma from a parathyroid adenoma
thyroid adenomas are hypovascular vs parathyroid adenomas are hypervascular
what is a primary reason a retroperitoneal lymph node dissection (RLND) is performed?
to determine if systemic chemotherapy is needed >> removed for eval for signs of mets
ectopic thyroid tissue can migrate
to the chest
what zone does BPH usually affect
transitional zone
sonographic appearance of hepatoma
usually solitary, solid masses of varied echogenicity. can grow large
tumor invasion into bladder most commonly caused by ??? females vs males
uterine cancer vs prostate cancer
vascular vs. nonvascular gb wall thickening
vascular: caused by cholecystitis or hepatitis non vascular: caused by CHF, renal failure, and cirrhosis
what is the pampiniform plexus? what is a normal and abnormal measurement?
venous drainage system of the testicle and scrotum normally should appear as less than 2mm in diameter abnormally it will appear as more than 2mm, then it will be diagnosed as varicocele
how does adenomyomatosis appear sonographically?
wall thickness sinuses can fill with bile or cholesterol deposits and can collect sludge or stones. comet tail and twinkle artifacts are seen with deposits in the diverticula
what causes a wandering spleen? what increased risk does it have?
weakened splenic ligaments: gastrosplenic and splenorenal ligaments increased risk for torsion
a mass that present with a bulls eye appearance within the liver tissue is most likely
mets
SMA is identified to the right of the SMV in apt with acute abd symptoms. what should you suspect
midgut malrotation
thyroglossal duct cyst location
midline neck superior to the thyroid gland
expected waveform from the hepatic waveform from the HV in pt with cirrhosis
monophasic, continuous antegrade flow
how does graves disease present symptomatically and sonographically? what labs would be increased or decreased?
most common cause of hyperthyroidism labs: increase t3 and t4 clinical symptoms: weight loss, night sweats, and exophthalmos (protruding eyeballs) sonographically: enlarged gland, diffuse decrease in echogenicity, coarse and heterogeneous texture and increased vascularity.
what is embryonal cell carcinoma? what are its lab values? how does it appear sonographically?
most common in men 25-35 years most aggressive malignancy with invasion of tunica albuginea in most patients labs: AFP and b-HCG are elevated sonographically: heterogeneous with solid and cystic portions and coarse calcifications. will have distorted organ contour
what is caroli disease? what does it cause? what is it assoc with?
congenital defect of bile ducts that leads to numerous cysts in the biliary tree. malformation causes bile stasis and impairs liver function associated with med sponge kid and hep fib
diffuse gb wall thickening with an irregular lumen contour and comet tail artifacts
adenomyomatosis
most common cause of small bowel obstruction in adults vs infants
adhesions; intussusception
cx assoc with cushing syndrome and hirsutism?
adrenal cortical cancer - causes elevated androgen levels complex sonographically
what is pneumobilia? how does it appear sonographically?
air in biliary tree air/tissue interface will cause reverberation or ring down artifact, as well as dirty shadowing posterior to the echogenic ducts
what happens after a transjugular intrahepatic shunt
air is retained within shunt after placement, limiting US eval for 3-5 days
what is the most common cause for multinodular cirrhosis and chronic pancreatitis
alcohol consumption
ADPKD (uni or bi?, caused by?)
autosomal polycystic kidney disease adult pkd is bilateral can reduce kidney function inherited genetic disorder
CHD obstruction would affect other biliary structures such as
contracted gb and dilater intrahepatic ducts
creeping fat is a sign of
crohns disease
patients with ? have a significantly increased risk of developing a seminoma
cryptorchidism
testicular seminomas are associated with
cryptorchidism, trisomy 21, klinefelter syndrome, and smoking
what is a choledochocele
cyst of intraduodenal portion of duct
how do embryonal cell tumors and testicular teratomas appear sonographically
cystic areas and coarse calcifications
a disorder that affects the pancreas by causing it to excrete a thick mucus like substance that inhibits the exocrine function is called
cystic fibrosis
sonographic appearance of a pancreas with chronic cystic fibrosis
decreased size and increased overall echogenicity
what sonographic appearance does oncocytomas and RCC have in common
demonstrate a central scar
adenoma of the thyroid sonographically appears
demonstrates halo sign (usually) thin, echolucent rim
the best way to image the patellar tendon with US
the patellar tendon connects the patella to the tibial tuberosity. imaging is performed from the anterior approach. when detached the pt is unable to extend their leg and patella is displaced superiorly
what is a tardus parvus waveform
"late and low" with late peaking and low velocity flow -will appear distal to significant stenosis where the flow will be dampened -refers to absence of early systolic peak and prolonged acceleration time
how would an abdominal wall hernia present
"mushroom cloud" of intestine through opening of peritoneum and muscular fascia valsalva maneuver will cause an increase in intra abdominal pressure, forcing bowel through the opening and peristalsis should occur upon release
congestive splenomegaly is an expected finding in patients with
(banti syndrome) is caused by excessive blood in the splenic tissues. commonly caused by portal HTN, CHF or splenic vein thrombosis.
adrenal cortical cancer causes? labs? clinical symptoms? contrast results? sonographical presentation? associated syndrome?
- causes neoplasm formation due to proliferation of cortical cells; very aggressive; can invade renal vein and ivc - larger than 6cm - elevated androgen levels - hirsutism - assoc with cushing syndrome - no contrast washout - sono: complex with hypoechoic solid components and cystic changes
what are 3 pleural effusion signs
- diaphragm sign: fluid above diaphragm and peripherally - displaced crus sign: fluid displaces crus away from spine - bare area sign: will extend behind liver at level of bare area
what are the different types of hernias and where do they occur
- femoral hernia - usually lies medial to the common femoral vein below the inguinal ligament - umbilical and spigelian hernias are abd hernias - direct inguinal hernias - occur superior to inguinal ligament and inferior and medial to inferior epigastric artery origin
what are the two difference liver tx anastomosis?
- piggyback anastomosis: hepatic confluence of tx liver attached to native IVC; single anastomosis site - interposition anastomosis: donor IVC segment replaces a segment of the native IVC; two anastomosis sites
what are the 3 types of debakey classification
- type 1: involves ascending and descending aorta - type 2: involves ascending aorta; associated with Marfan syndrome; least common - type 3: involves the descending aorta; lowest mortality rate
what is liver elastography used for ? how is it performed? an increase indicates?
- used to stage degree of liver fibrosis - box must be at least 2cm from skin surface and 2cm from glisson capsule. pt performs neutral breath. record 10 measurements from the same area - increase indicated more severe fibrosis
what is emphysematous cholecystitis?
-common form of acute cholecystitis in elderly diabetic males -secondary infection of gallbladder wall with gas-forming bacteria and necrosis
what are some vascular complications with pancreatitis
-thrombosis of the splenic vein or pseudoaneurysm of the splenic artery - related to pancreatic enzymes causing vascular erosion of the vessels near the pancreas
Non-seminomatous germ cell tumors
-yolk sac -choriocarcinoma -embryonal carcinoma more aggressive than seminoma tumor second most common primary malignancy of the testicles >usually contain cystic areas and calcs to differentiate from seminomatous tumors
what are the number one and two causes of acute pancreatitis
1) biliary tract disease 2) alcohol abuse
a portal vein that is greater or equal to ? indicated portal HTN
13mm
massive splenomegaly is defined as a spleen that exceeds >
18cm in length
achilles tendon most commonly ruptures
4cm from the distal insertion point at the calcaneus
what labs will be affected with ductal obstruction
ALP, GGTP, and bilirubin level will be increased (AST is not affected)
what lab values will increase with cirrhosis
ALT, AST and alkaline phosphatase -if hepatocellular carcinoma develops with the cirrhosis, then AFP levels will rise
what is wilsons disease? what is it caused by? what symptoms will present? labs? sonographic appearance?
Autosomal recessive disorder of copper overload in which copper in the liver, brain and other tissues caused by: hepatic dysfunction, hepatitis, cirrhosis, and or liver failure symptoms: jaundice, hematemesis, portal htn, ascites, rusty ring around the iris of the eye. (kayser-fleischer rings) labs: increased AST, ALT, bilirubin, PT. decreased albumin sonographically: echogenic fatty liver, fibrotic periportal thickening, nodular cirrhotic changes
What is a Klatskin tumor?
Cholangiocarcinoma occuring at the confluence of the hepatic ducts
most sensitive enzyme indicator for alcoholism
GGTP
most common cause of spread of hepatitis in the US is
IV drug users sharing needles
most common cause for an abd mass in a newborn
MCKD
what are the two cystic congenital abnormalities in kidneys?
MCKD, and ADPKD
which of the following vessels will be abnormally dilated with significant portal HTN
MPV and left gastric vein (coronary vein); left gastric vein normally drains into the splenicvein near the portal confluence
biliary hamartomas are also known as
Meyenburg Complexes - multiple well defined hypoechoic solid nodules <1cm in diameter. associated with hepatic fibrosis, autosomal dominant polycystic disease and cholangiocarcinoma
most common extratesticular neoplasm
adenomatoid tumor
most common location for the pancreatic allograft
right iliac fossa
case study: pt has chronic cirrhosis, a tubular vessel connecting to teh left portal vein and exiting the liver coursing inferiorly with low velocity flow indicates that it is
a dilated, patent umbilical vein. this is a sign of significant portal HTN
papillary thyroid cx appears as
a hypoechoic mass with calcifications also associated with enlarged cervical lymph nodes but is highly curable
how would a fungal liver abscess present
a mass with internal septations similar to the spokes of a wheel
mirizzi syndrome
a stone in the cystic duct causes extrinsic compression of the CBD, very painful
most common cause of scrotal pain in postpubertal men
acute epididymitis
what is epididymo-orchitis and how does it present sonographically
acute infection assoc w/ RI <.5 in testes >uncomplicated: RI < .5 >complicated: will present diastolic flow reversal
what can cause intrinsic (infrarenal) renal failure
acute tubular necrosis, nephritic syndrome, interstitial nephritis, autoimmune diseases
what is the most common gi tract cx
adenocarcinoma
what is the most common malignant neoplasm found in the prostate
adenocarcinoma
what is milk of calcium bile
also known as limey bile in chronic cholecystitis sludge like material with a high concentration of calcium
cholangitis
an acute inflammation of the bile duct
priapism
an unwanted, persistent, painful erection that lasts more than 4 hours.
what is the most lethal type of thyroid malignancy
anaplastic thyroid, very aggressive
how does AML present sonographically
angiomyolipoma sonographically: hyperechoic to the renal cortex and isoechoic to renal sinus
the diaphragm crura is located ? to the AO?
anterior
a pseudocyst most commonly forms in which retroperitoneal spaces
anterior pararenal space (where the panc is located)
a right adrenal mass would displace the ivc ...?
anteriorly the right adrenal gland is posterior to the ivc. tumor formation could dipslace the ivc anteriorly
where does retroperitoneal fibrosis occur
at the level of aortic bifurcation (usually). ureters pass through this space to reach the bladder. if both ureters are impinged, bilateral hydro will occur
what causes postrenal failure
bilateral renal obstruction
testicular lymphoma presents as
bilateral swelling and pain bilateral solid masses in parenchyma
hutch diverticula are identified in the
bladder - congenital outpouchings of the bladder wall near the ureteral orifice
potential collateral pathway formed in pts with cirrhosis
blood moves from superior rectal vein to middle rectal vein
a vascular condition of the lier seen in women who take oral contraceptives is
budd chiari syndrome
what is angiosarcoma? where? sonographic appearance?
cancer that forms in the lining of blood vessels an lymph vessels primary malignant neoplasm of spleen > splenomegaly with heterogeneous echotexture, complex mass and solid components and increased vascularity
what causes a corticomedullary renal abscess
caused by ascending bacteria in the urinary tract
parathyroid gland adenomas cause?
causes serum hypercalcemia and potential renal stone formation bc intestines have decreased calcium excretion. High PTH levels means low calcitonin which means high calcium levels. constant filtration of excess calcium in kidneys can lead to stone formation
CCK - cholecystokinin
causes the gb to contract and expel bile
primary sclerosing cholangitis is the most common risk factor of
cholangiocarcinoma
because there is a risk of cholangiocarcinoma with all cases of ????, surgical resection is recommended
choledochal cysts
most common cause of cholangitis
choledocholithiasis
decreased thyroid volume is associated with
chronic hepatitis, thyroxine treatment and radioactive iodine treatment
what causes azygous veins
chronic moderate CHF can cause dilated IVC and then dilated azygous and hemiazygous veins these veins connect the upper abd IVC to SVC in the chest so that the blood can reach the right atrium sonographically: visualize collaterals connecting IVC to SVC
splenic vein thrombosis is a common finding in pts with
chronic pancreatitis
what is a pyloric stenosis
diagnosed when muscle wall thickness exceeds 4mm with the stomach demonstrated medially
acute renal vein thrombosis would cuase
diastolic flow reversal in the renal arteries
sonographic appearance of epididymal torsion
difference in blood flow indicated partial or complete torsion in the segment >pain, hydrocele, normal head of CF but not body or tail >> focal torsion of body and tail
schistosomiasis and chronic cystitis are commonly associated with
diffuse bladder wall calcification
what is prostatis
diffuse process affecting entire gland, increased size and vascularity
how does cystitis appear sonographically
diffuse thickening of the bladder wall
primary gb carcinoma most commonly presents as
diffusely thickened gb with stones
chronic cirrhosis, tubular vessel connecting to the splenic vein just prior to its confluence with the SMV
dilated coronary vein
what is caput medusa
dilated, tortuous vessels around the umbilicus caused by portal HTN
asplenia causes
double right sidedness. involves absent spleen, right sided aorta, left sided ivc, midline liver and gb, horseshoe kidneys and congenital heart defects
what is the most common congenital anomaly of the urinary system
duplicated collecting system
echinococcal infection
early infection: simple cyst with debris later: daughter cysts "honeycomb" formation >>walls may be thick or calcified in chronic infection - possible calcified mass most commonly affects RIGHT LOBE
study: pt n&v, ruq pain, fever, increased wbc. gb is enlarged and filled with echogenic material that does not shadow or demonstrate fluid levels. these findings are most consistent with:
empyema of the gb (pus in the gb)
what are the most common causes of splenic abscess
endocarditis, septicemia, and trauma
most common cause of pneumobilia
endoscopic retrograde cholangiopancreatography (ERCP)
what is varicocele, which side is more common?
enlarged veins of the spermatic cord linked to infertility more common on left due to gonadal vascularity: left renal vein courses b/w sma and ao which increases risk of extrinsic compression causing decreased drainage of left gonad can be caused by nutcracker syndrome
best plane to see a dilated umbilical vein
sagittal and to the left of midline
phlegmon formation is associated with
focal pancreatitis
klatskin tumor
form of cholangiocarcinoma located at the liver hilum
portal HTN results in ??
formation of varices due to cavernous transformation which can results in rupture and cause significant hemorrhage from varices.(life threatening complication)
how does adenomyomatosis present sonographically
gallbladder sonographically: diffuse or segmental thickening of gb wall with formation of diverticula within wall - irregular lumen contour and comet tail artifacts occur from cholesterol deposits in Rokitansky - Aschoff sinuses
what is the most common primary cancer to met to the liver
gallbladder, then colon, then stomach, then pancreas
GGTP increase with ALP vs. ALT
gamma-glutamyl transpeptidase - moderate increased of GGTP is seen with liver damage due to alc, drugs, and chemo - a marked increase is seen with liver disease and post hepatic biliary obstruction ; increased GGTP and ALP: biliary obstruction ; increased GGTP and ALT: hepatocellular disease
what is GGTP
gamma-glutamyl transpeptidase - normally found in liver cells and biliary epithelium this enzyme is most sensitive indicator for alcoholism
what is cystic fibrosis
genetic disorder that affects the pancreas by causing it to excrete a thick mucus that inhibits the exocrine func
how to differentiate ganglion cyst from giant cell tumor of the hand
giant cell tumors are soft tissues masses and will not have posterior enhancement; wont move with adj tendon ganglion cysts are simple cysts with enhancement and do move with adj tendon
most common cause of hyperthyroidism
graves disease
what is kasaback-merritt syndrome
happens in infants with large hemangiomas what is it? sequestrian and destruction of plts w/in the large cavernous hemangiomas which causes significant thrombocytopenia results in : reduced plt count, visible cutaneous blue or reddish-brown lesions on extremities, and also hepatomegaly or jaundice sonographically: liver and spleen should be evaluated for hemangioma formation, possible hepatomegaly
how does anaplastic cx usually present
hard, fixed mass with rapid growth and invades surrounding neck structures
another term for Kasaback-Merritt Syndrome
hemangioma thrombocytopenia syndrome
primary indication for a liver tx in an adult vs child
hep c; biliary atresia
what is hepatization
hepatization of the gb reders to a gb filled with sludge that is isoechoic to the liver. makes gb hard to identify
how does transrectal prostatitis present sonographically
heterogeneous peripheral gland w/ a hypoechoic halo at the periurethral area hypervascularity abscess can form later on
echinococcal cysts are also called
hydatid cysts
what are common findings in horseshoe kidneys
hydronephrosis, calculi and pyelocaliectasisn (dilation of pelvis and calyces) are common
How does peyronie's disease present?
hyperechoic areas along the outer margins of the corpus cavernosa - scar tissue and fibrous plaque involving the tunica albuginea
what can cause prerenal failure
hypotension, volume depletion, heart failure, acute occlusion of the renal artery
biliary atresia
if jaundice persists more than 14 days after birth, the lack of opening in biliary tree will cause persistence of jaundice after birth
adrenal hemorrhage (labs, causes, and sono)
in newborns, caused by traumatic birthing in adults, results from trauma and hematologic disorders i.e. thrombocytopenia presents as jaundice and anemia labs: decreased hematocrit indicating internal bleeding sonographically: mass with varied echogenicity
HIV cholangitis
in pts with advanced HIV infection
lab values for yolk sac tumors (testicular tumor)
increased AFP (not b-HCG)
lab values for choriocarcinoma (testicular tumor)
increased b-HCG (not AFP)
lab values for embryonal cell carcinoma (testicular tumor)
increased b-HCG and increased AFP
splenic infarction
increased risk compared to other organs bs intraspenic arteries do not have communicating arteries which eliminates possibility of collateral formation when infarction occurs
what is endocarditis
infection of the lining of the heart and valves infection can spread through the arterial system to the spleen
another name for wilms tumor
nephroblastoma
what is wilms tumor
nephroblastoma most common renal tumor in children mass formation can lead to hematuria
sponge kidney is often associated with what finding
nephrocalcinosis: the formation of multiple calcifications/stones within medullary pyramids
3 characteristics of courvoisier syndrome or sign
painless jaundice, distended gb and an obstruction at the ampulla of vater
when a pancreas has enteric drainage, what should you image?
pancreas has two drainage routes: bowel (enteric) and bladder when a tx has enteric drainage you should image the bowel for obstruction with enteric exocrine drainage and image the bladder with bladder drainage
whipple procedure
pancreaticoduodenectomy removes the head of the pancreas and portion of the duodenum, gb and bile duct most commonly performed operation to treat panc cx
are papillary carcinoma or anaplastic carcinoma more common in thyroid cancers
papillary carcinoma
what is the most common type of thyroid cx
papillary thyroid cx
most suggestive complications of ormond disease
pedal edema and scrotal swelling
how does UPJ obstruction present sonographically
pelvis and calyces are dilated, but ureter is normal
schistosomiasis vs amebic abscess
polluted water with fluke parasites; protozoan parasites in contaminated water
chronic cholecystitis is related to an increased risk of?
porcelain GB and carcinoma.
what is a contraindiction to placement of a TIPS shunt and why
portal thrombosis bc thrombus could then travel from the portal vein to the IVC and into the lungs causing PE
diastolic flow reversal in the right and left HA of a newly placed liver allograft indicates
possible rejection
difference between prerenal, intrinsic, and postrenal acute renal failure
prerenal - diminished renal blood flow intrinsic - damage to renal parenchyma postrenal - caused by urinary tract obstruction
acute occlusion of the main renal artery can cause ? acute renal failure
prerenal failure other causes: hypotension, volume depletion, heart failure
if testicular cx presents unilaterally then most likely it is? bilaterally?
primary if unilateral secondary if bilateral
PSA
prostate-specific antigen signifies carcinoma or PSA if lesser elevation > 10ng/mL
matted bowel is suggestive of?
pseudomyxoma peritonei
what usually causes an echinococcal cyst in the liver
raw pork can carry parasites.
what does kasaback merritt syndrome result in
reduced plt count, visible cutaneous blue or reddish-brown lesions on extremities, and also hepatomegaly or jaundice liver and spleen may also have hemangiomas
what is a scrotal pearl
refers to extratesticular calcification with posterior shadowing
what is the appendix testes
remnant of mullerian duct located between epididymal head and testis
what is a renal carbuncle? what causes it? how does it appear?
renal abscess that forms in the parenchyma caused by hematogenous spread of staphylococcus aureus sonographically: dirty shadowing and ring down artifact if gas is produced by bacteria in the abscess
what is oncocytoma? how does it present?
renal tumor that occur later in life and are usually benign has a central scar
how would RI appear in a liver tx rejection
results in high resistance within hepatic artery and liver tissues
ormond disase also known as ? what is it?
retroperitoneal fibrosis refers to overgrowth of fibrous tissue around atherosclerotic aorta - complications: ivc compression, pedal edema, gonadal vein compression adn ureteral obstruction >> hypoechoic, soft tissue mass with smooth borders
what is the most commonly occurring germ cell tumor of the testicle
seminoma
what is gangrenous cholecystitis? what can it be a complication of? how does it appear sonographically?
severe form of acute cholecystitis complication of untreated cholecystitis > diffusely thickened gb wall with hypervascularity and intraluminal membranes >>perfusion detected in thickened walls which indicated areas of necrosis (gangrene) >>>abscess formation also possible
how do TB and sarcoidosis appear within the spleen
similar findings multiple hypoechoic nodules in the spleen during active disease afterwards the nodules become echogenic foci that can demonstrate posterior shadowing
difference between hemobilia and sludge
similar us eval hemobilia is related to percutaneous biliary procedures, liver bx, or trauma
sonographic appearance of focal nodular hyperplasia
single mass <5cm with a central scar and prominent central and radial vascularity forms due to a benign overgrowth of normal liver cells that are arranged in an abnormal function
what are psammoma bodies
small round calcifications
phlegmon
solid inflammatory mass that tends to infiltrate surrounding structures aka focal pancreatitis
how does renal infection present symptomatically and sonographically
sonographically: dilated calyces with thickened walls and debris, consistent with infection symptoms: increased WBC and fever
what is a common complication of a vasectomy
sperm granuloma
?? artery aneurysms are commonly assocaited with pancreatit and peptic ulcer disease while ??? artery aneurysms are usually caused by cystic medial necrosis
splenic artery; superior mesenteric artery
what is fibrolamellar carcinoma? what are its lab values? how does it appear sonographically?
subtype of HCC that is found in adolescents and young adults with no coexisting liver disease AFP are normal sonographically: punctate calcifications and central echogenic scar helps differentiate it from hepatoma
what is used to treat hypothyroidism
synthroid, levothyroxine, iodine or iron supplements
what are some sonographic signs that indicated thyroid malignancy
taller than wide mass, absent halo sign, microcalcifications, and intranodular flow.
what is peyronie disease, how does it present sonographically and symptomatically
testicular causes scar tissue and fibrous plaque formation that usually involve tunica albuginea causes restriction and curvature of affected size of penis and can be painful sonographically: hyperechoic areas along the outer margins of the corpus cavernosa
where and how do non seminomatous germ cell tumors present
testicular demonstrate cystic degeneration and internal necrosis with heterogeneous texture.
what testicular cancers occur bilaterally
testicular lymphoma, leukemia, and metasis
labs with leydig cell tumor
testicular tumor causes an endocrine imbalance with elevated b-HCG levels causing gynecomastia
leydig cell tumors of the testicle will demonstrate high serum levels of ?? which can lead to ??
testosterone; precocious puberty
what to do if diaphragmatic paralysis is suspected
the diaphragmatic thickness should be measures at the zone of apposition during inspiration and expiration <thickening should occur during inspiration (minimal or absent thickening indicated paralysis) >M mode can be used to document abnormal absent motion and thickening
what is nutcracker syndrome
the engorgement of the L renal vein due to compression b/t the SMA & AO
pleural effusion: transudative fluid vs exudative fluid
transudative fluid: free fluid that is pushed out of capillary beds due to high pressure. > low protein and lactate dehydrogenase > related to: CHF, liver and kidney disease exudative fluid: free fluid leaks outside the capillary cells due to inflammation. >>high protein and lactate dehydrogenase >>related to: malignancy, lupus, pneumonia and tuberculosis
two most common infections that cause granuloma formation in the spleen
tuberculosis and histoplasmosis
what is tubular ectasia
tubular ectasia of the rete testis is dilated testicular mediastinal tubules benign condition resulting from partial or complete obliteration of efferent ducts
according to the debakey classification system, what type of aortic dissection is most commonly associated with Marfan syndrome
type 2 - involves ascending aorta and associated with marfan syndrome
most primary testicular cancers are uni or bi?
uni
a pt with a seminoma of the left testicle will usually be treated by ???? while a pt with a non seminomatous tumor of the left testicle will usually be treated by ??
unilateral orchiectomy and chemotherapy; unilateral orchiectomy (non sem are not responsive to therapies)
what two bladder abnormalities are most commonly assocaited with a duplicated collecting system?
ureterocele of the distal insertion site of the upper pole ureter. vesicoureteral reflux is common in the lower pole ureter
where do AAA usually occur
usually lie below the level of the renal artery origins (infrarenal)
AML
usually originates in the adrenal cortex and is composed of fat and bony elements associated with cushing syndrome, conn syndrome, and adrenal hyperplasia
adenocarcinoma and focal pancreatitis usually affect what portion of the pancreas
usually pancreatic head
what is the sandwich sign
when multiple lymph nodes are surrounding a vessel image will show enlarged nodes surrounding portal vein or other vessel
what is the most commonly performed operation to the treat panc cx
whipple procedure aka pancreaticoduodenectomy also done for chronic pancreatitis or benign tumors
what is the most common renal tumor in children
wilms tumor/nephroblastoma
massive adrenal gland enlargement, hepatomegaly and splenomegaly are common findings in what autosomal recessive disorder
wolman disease ; excessive lipid storage in liver, spleen, and adrenal glands
most common testicular tumor in pts under 2 yrs?
yolk sac tumor
