case studies Flashcards
a 55 year old man is seen for a routine physical examination. during the examination the physician feels a pulsatile mass at the level of the umbilicus. an ultrasound is ordered to ?
rule out AAA
A 72 year old woman is seen in an unconscious state in the emergency department. She is accompanied by her husband who states that she had a attack of severe abdominal pain and then passed out. Clinical evaluation reveals a hypotensive condition, and an abdominal ultrasound is ordered. the ultrasound reveals an aorta that measures 8 cm in diameter at the distal end and fluid in the peritoneal cavity. This would be consistent with?
aortic rupture
A 67 year old man with vague abdominal pain is seen by his physician. A kidney ureters bladder radiograph is ordered and is unremarkable except for calcifications noted along the aorta. An aortic ultrasound examination is ordered and reveals a distal aortic diameter of 4 cm. This would be consistant with?
abdominal aortic aneurysm
A 40 year old man with a history of Marfan syndrome is seen with intense chest pain in the emergency department. What is the diagnosis?
aortic dissection
fAll of the following are risk factor for abdominal aortic aneurysm except:
- advanced age
- atherosclerosis
- female gender
- hypertension
- smoking
female gender
a 72 year old man has an abdominal aortic aneurysm that measures 4 cm in diameter. This patient should be followed with what frequency to monitor for expansion of the aneurysm?
every 6 months
A 62 year old woman is seen inthe emeregency department with chest pain and fainting spell but is conscious and cognitive. Patient history includes a previously diagnosed abdominal aortic aneurysm. An ultrasound of the abdominal aorta and electrocardiography and echocardiography are ordered. The abdominal ultrasound reveals the aneurysm, which measures 4.8 cm. The sonographer also identifies a thin linear echo within the aorta and documents flow on both sides of this line with color doppler examinaiton. This would be consistent with ?
aortic dissection
A 58 year old woman with epigastric pain which eating is seen for an abdonimal ultrasound to rule out gallstones. The sonographer identifies normal appearing gallbladder, liver, pancreas and spleen. The sonographer also documents a dilation of the aorta, which measure 6 cm. at its greatest diameter. This could be consistant with?
aortic aneurysm
A 51 year old man undergoes an ultrasound of the RUQ. pertinent history includes multiple previous ultrasound examinations that document a small liver that is difficult to penetrate. Liver enzymes levels are elevated. The patien is very this, which a slightly protruding abdomen. The liver remains small and diffcult to penetrate, with poorly documented hepatic vasculature. No specific masses are noted. Free fluid is noted within the Morrisons pouch and right subphrenic space. The anterior border of the liver is noted to have a scalloped appearance. most likely?
cirrhosis
a 43 year old woman undergoes an ultrasound to rule out gallstones. She is moderately obese. The gallbladder contains a single stone, which produces a clean posterior shadow. The liver is hyperechoic, but hepatic vasculature is poorly seen. No distinct masses are noted. Based on her history and findings described, what could be the diagnosis?
fatty infiltration
a 21 year old man undergoes a RUQ ultrasound in the emergency room. AST and ALT levels are elevated. The liver appears normal in echo texture without masses noted. The right posterior lobe etends inferiorly beyond the lower pole of the right kidney. What is the most likely diagnosis?
acute hepatitis
A 52 year old man with long standing cirrhosis undergoes an abdominal ultrasound scan AST, ALT, and GGT levels are elevated. The liver is small and difficult to penetrate. Doppler examination reveals a hepatofugal blood flow in the main portal vein. What is the most likely diagnosis?
portal hypertension
a 41 year old woman iwth long standing cirrhosis undergoes an abdominal ultrasound scan. AST, ALT, and GGT levels are elevated. The liver is small and difficult to penetrate. A sonolucent area is noted between the left lateral and medial lobes and shows flow with color doppler. Based on the findings, what is the most likely diagnosis?
portal hypertension
A 62 year old man with long standing cirrhosis undergoes an abdominal ultrasound scan. AST, ALT, and GGT levels are elevated. The patient has long standing protal venous hypertension that has been managed with the placement of a TIPS catheter, ultrasound has been requested to assess the shunt for patency and size. The velocity within the TIPS catheter was documented at 150cm/s on the previous study od 6 months ago. Current flow is documented at 200cm/s. What is most likely on the basis of the provided information?
catheter stenosis
A 31 year old woman undergoes a RUQ ultrasound scan. She is obese and has RUQ pain. Liver enzyme levels are normal. The gallbladder is normal in appearance. The liver is noted to be hyperechoic, and hepatic vasculature is difficult to define. One hypoechoic area is noted anterior to the right portal vein near the porta hepatus. On the basis of these findings, what is the most likely diagnosis?
fatty infiltration & fat sparing
a 36 year old woman undergoes a RUQ ultrasound. AST and ALT levels are elevated. The liver appears hyperechoic in appearance. The portal veins appear prominent, with thick walls noted. The gallbladder shows a thick wall without internal inclusions. Based on the findings noted, what is the most likely diagnosis?
acute hepatitis
a 54 year old man with fatigue is seen in the ultrasound departement. Liver enzyme levels are slightly elevated. The liver is heterogenous in echo texture. What is the best diagnosis?
lymphoma
A patient is seen in the ultrasound department with a long standing history of cirrhosis and a recent surgical intervention of portal hypertension. Sonographically a tubular structure is noted within the right lobe of the liver that shows blood flow within it. Based on the history and the sonographic findings, what is the most likely diagnosis?
TIPS catheter
A 65 year old man with a history of chronic active hepatitis is seen with abdominal pain. Laboratory values reveal abnormal liver function test results and an elevated serum alpha-fetaprotein level. Ultrasound reveals a lobulated, hypoechoic mass in the posterior segment of the right lobe of the liver. Color doppler imaging shows a mosaic flow pattern within the mass. This is most suggestive of ?
hepatocellular carcinoma
a 32 year old woman with a history of RUQ pain with fatty foods is seen for ultrasound. The ultrasound reveals the presence of gallstones and in addition, a 3cm isoechoic mass in the liver. Power doppler investigation of the lesion show a “spoke wheel” pattern flow. What is the most likely diagnosis?
focal nodular hyperplasia
a 24 year old woman is seen for a renal ultrasound because of a recently diagnosed congenital uterine abomaly. The renal ultrasound is unremarkable . Incidentally noted is a 1.5cm echogenic mass in the right lobe of the liver. The most likely represents what?
hamangioma
a 38 year old woman with a history of von Gierke’s disease is seen for an abdominal ultrasound because of right upper quadrant pain. Two hyperechoic lesions are identified in the liver. Doppler reveals flow around the periphery of each of the lesions. This wuld be most consistent with ?
liver cell adenoma
a 45 year old man with a history of hepatitis is seen for ultrasound examination of the abdomen. The sonographer identifies a 6cm complex mass in the liver. This would be suspicious for what tumor?
hepatocellular carcinoma
a 70 year old woman is seen for malaise and wasting. The clinician orders abdominal ultrasound because of the patients history of colon cancer and elevated liver function tests. The sonographer notes multiple hyperechoic lesions withing hte liver and hepatomegaly. This is suggestive of ?
metastatic disease
a 32 year old obese women is seen for a right upper quadrant ultrasound to ruleout gallstones. The sonographers inquiry into the patients symptoms reveal a fatty food intolerance. Ultrasound examination of the abdomen reveals cholelithiases and a 1.5cm echogenic lesion in the liver. The most likely diagnosis for the liver lesion is?
hemangioma
A 59 year old woman with a history of ovarian cancer and increasing abdominal girth is seen for an abdominal ultrasound. The ultrasound reveals ascites and multiple hyopechoic lesion in the right and left lobes of the liver. This is consistent with?
metastasis
A 50 year old african immigrant with right upper quadrant pain and weight loss is seen for ultrasound. The patient states that he worked in the fields growing and harvesting a variety of grains for 30 years. Laboratory results reveal an elevated serum alpa fetoprotein level/ Ultrasound examination shows a 4cm heterogeneous lesion in the liver and a small amount of ascities.
This would suggest?
hepatocellular carcinoma
a 47 year old woman with a history of pancreatic carcinoma who is undergoing chemotherapy is seen. Previous ultrasound examination performed 3 months ago showed a normal appearing liver. The current ultrasound examination reveals two echogenic lesions in the right lobe of the liver. This would be most cosistent with ?
metastasis
Which of the following conditions make the pancreas difficult to image for sonography?
A. its deep location in the mid abdomen
B. proximity of the stomach and duodenum
C. proximity of the transverse colon
D. indistinct borders from absence of a true capsule
its deep location in the mid abdomen
A 69 year old man with alcholism is seen with leukocytosis and elevated amylase level and a rising lipase level. The entire pancreas appears enlarged and hypoechoic with ill defined borders. The most likely diagnosis is?
acute diffuse pancreatitis
A 52 year old woman is seen in the emergency department with epigastric discomfort and chest pressure. Electrocardiogram results are normal, and a nitroglycerin tablet does not relieve the pain. The laboratory values show an elevated white blood cell count, mildly elevated amylase level, and markedly elevated lipase level. The abdominal sonographic examination reveals a small hyperechoic pancreas with dilated pancreatic duct. This is most likely?
chronic pancreatitis
a 45 year old woman is seen by her physician with mild epigastric pain, weightloss, and a large palpable abdominal mass. The sonographic examinatin reveals a 9cm multilobulated, cystic mass occupying the mid epigastrium. The cysts measure larger than 2cm, with internal papillary projections and calcifications. CT scan results confirm the mass orginates form the pancreatic body. The most likely diagnosis is?
macrocystic cystadenocarcinoma
a 56 year old woman is seen in sonographic department for a renal examination. While scanning the left kidney, the sonographer notices a multicystic mass in the tail of the pancreas. The patient is asymptomatic for pancreatic disease. CT scan follow up confirms a multicystic lesion, with cysts that measure less than 2 cm. The most likely diagnosis is?
microcystic cystadenoma
a 39 year old morbidly obese woman undergoes surgery for gastric stapling and an abdominal exploratory procedure. She had hormonal imbalances. During surgery, the surgeon notices an irregularity on the anterior surface of the pancreas. intraoperative sonography reveals two small hypoechoic lesion that measure approximately 1 cm. The most likely diagnosis is?
islet cell tumor
visualization of which of the folowing structures is most improved with oral contrast during pancratic sonography
A. head of pancreas
B. tail of pancreas
C. peripancreatic tissue
D. pancreatic duct
E. uncinate process of the pancreas
B. tail of pancreas
a 40 year old woman is seen for a renal ultrasound. microscopic hematuria was found during her routine annual physical examination. A solid mass is identified int he renal cortex. The mass is more echogenic than the renal sinus, and the collecting system is not dilated. what is the most likely diagnosis?
AML
A 25 year old patient with right flank pain, nausea, and vomiting is seen for a renal ultrasound. The ultrasound reveals large echogenic foci with posterior acoustic shadowing in the kidney. The calyces appear to be dilated. What is the most likely diagnosis?
Calculi
A 2 year old boy with a history of weight loss, vomiting and hypertension and with dark pink urine is seen for an abdominal ultrasound. The sonographer identifies a large homogeneous echogenic mass distoring the kidney. What is the most likely diagnosis?
nephroblastoma
