Abdo- retroperitoneum

Question 1

Where is the retroperitoneal space?

Answer 1

• area between posterior portion of the parietal peritonuem and the posterior abdominal wall muscles
• extends from diaphragm to the pelvis

Question 2

retroperitoneal space lateral boundaries?

Answer 2

• boundaries extend to the extraperitoneal fat planes within the trandversalis fascia

Question 3

the retroperitoneal space medially?

Answer 3

encloses the great vessels

Question 4

retroperitoneal space 3 categories?

Answer 4

1. anterior pararenal space
2. perirenal space
3. posterior pararenal space

Question 5

borders of the retroperitoneum?

• superior
• inferior
• anterior
• posterior
• lateral

Answer 5

superior: diaphragm
inferior: pelvic rim
anterior: posterior parietal peritoneum
posterior: posterior abdominal wall muscle and spine
lateral: transversalis fascia and peritoneal portions of the mesentery

Question 6

what is the anterior pararenal space?

Answer 6

the fat area between the posterior peritoneum and gerota’s fascia

Question 7

what does the anterior pararenal space include? (5)

Answer 7

• pancreas
• descending portion of the duodenum
• ascending and descending colon
• superior mesenteric vessels
• inferior portion of the common bile duct

Question 8

where is the perirenal space?

Answer 8

space separated from the pararenal space by gerota’s fascia

Question 9

perirenal space includes?

Answer 9

• kidneys and adrenal glands
• perinephric fat
• ureters
• renal vessels
• aorta and IVC
• lymph nodes

Question 10

posterior pararenal space is located where?

Answer 10

space between gerota’s fascia and the posterior abdominal wall muscles

Question 11

posterior pararenal space includes?

Answer 11

• iliopsoas
• the posterior abdominal wall
• contains fat and nerves

Question 12

SADPUCKER?

Answer 12

S= suprarenal (adrenal) glands 
A= aorta/ IVC 
D= duodenum 
P= pancreas
U= ureters 
C= colon 
K= kidneys 
E= esophagus 
R= rectum

Question 13

spaces in the retroperitoneum should be evaluated for? (4)

Answer 13

• lymphadenopathy
• neoplasms
• fluid collections
• ascites

Question 14

division of abdominal lymph nodes (2)?

Answer 14

• parietal

- visceral

Question 15

lymph nodes functions?

Answer 15

• filter the lymph of debris and organisms

- form lymphocytes and antibodies to fight infection

Question 16

where are parietal nodes located?

Answer 16

• loacted in retroperitoneum

- surround aorta

Question 17

what is parietal nodes subdivided into? (7)

Answer 17

• common iliac
• epigastric
• external iliac
• iliac circumfrence
• internal iliac
• lumbar
• sacral nodes

Question 18

what drains into the paraaortic nodes?

Answer 18

kidney, adrenal gland, ovarian/testicular nodes

Question 19

where are visceral nodes located?

Answer 19

• within peritoneum
• course along the vessels supplying the major organs
• generally located at the hilum of the organ

Question 20

Normal or abnormal lymph node?

Answer 20

normal

Question 21

normal or abnormal lymph node?

Answer 21

abnormal

Question 22

sono appearance of normal lymph nodes?

Answer 22

• hypoechoic cortex
• hyperechoic fatty center
• smooth margins
• oval shape
• internal vascular blood flow especially at the hilum
• usually measures <1cm

Question 23

sono appearance of abnormal lymph nodes?

Answer 23

• enlarged hypoechoic mass >1cm
• loss of hyperechoic fatty center
• displacement of adjacent structures

Question 24

lymph nodes- infection?

Answer 24

smooth wall margins and oval shape typically caused by infection

Question 25

abnormal lymph nodes malignant characteristics?

Answer 25

- irregular margins | - round shape

Question 26

paraaortic lymph nodes sonographically?

Answer 26

- rounded - focal - echo-poor lesions - >1cm - echo-poor masses - often displace kidney laterally

Question 27

Answer 27

paraaortic lymph node

Question 28

what might a sonographer detect in paraaortic lymph nodes?

Answer 28

- mantle of nodes in paraspinal location - floating or anteriorly displaced aorta - mesenteric sandwich sign

Question 29

what is the mesenteric sandwich sign?

Answer 29

- anterior and posterior node masses surrounding mesenteric vessels

Question 30

splenomegly should be evaluated in patients with what?

Answer 30

lyphadenopathy

Question 31

As gentle pressure is applied with the transducer in an effort to displace the bowel, the lymph nodes remain constant in shape T or F?

Answer 31

true

Question 32

3 node regions?

Answer 32

periaortic pericaval intraaortocaval

Question 33

lymph nodes associated pathology (3)?

Answer 33

- lymphoma - renal carcinoma - metastatic disease

Question 34

non- vascular retroperitoneal pathology? (5)

Answer 34

- lymphadenopathy - mesenteric adenitis - metastatic disease - benign masses - retroperitoneal fibrosis

Question 35

what is the most common primary retroperitoneal tumor?

Answer 35

lymphoma

Question 36

Sonographic evaluation for abdominal lymphoma is performed to determine the presence or absence of?

Answer 36

- lymphadenopathy

Question 37

lymphoma- main areas to be evaluated?

Answer 37

- hepatic and splenic hilum - celiac and SMA - paraaortic and renal hilum

Question 38

Answer 38

lymphadenopathy

Question 39

lymphoma accuracy of u/s?

Answer 39

- detection 90% when lymph nodes are >2cm in diameter

Question 40

sono appearance of lymphoma?

Answer 40

ranges: - round - hypoechoic masses - anechoic masses with posterior enhancement

Question 41

Answer 41

Lymphoma

Question 42

most common primary malignancies that spread into the retroperitoneum are from the? (3)

Answer 42

- breast - lung - testies

Question 43

what usually indicates seeding or invasion of the peritoneal surface?

Answer 43

- ascites | - retroperitoneal tumor

Question 44

Benign retroperitoneal masses?

Answer 44

Fibromas Schwannomas Neurofibromas Lipomas Fluid collections: Hematoma Urinoma , lymphocele Abscess, pseudocyst

Question 45

Retroperitoneal Fibrosis(Ormond’s Disease) is characterized by?

Answer 45

- an idiopathic condition characterized by thick sheets of fibrous tissue in the retroperitoneal cavity

Question 46

fibrosis may encase and obstruct what?

Answer 46

- ureters and vena cava with resultant hydronephrosis

Question 47

what is retroperitoneal fibrosis (Ormond's disease) associated with? (4)

Answer 47

- infiltrating neoplasms - acute immune diseases (crohn disease) - ulcerative colitis - sclerosing cholangitis

Question 48

Retroperitoneal Fibrosis(Ormond’s Disease) clinically?

Answer 48

- abdominal pain - hypertension - oilgoanuria

Question 49

Retroperitoneal Fibrosis(Ormond’s Disease) on ultrasound?

Answer 49

- abnormal hypoechoic tissue surrounding the anterolateral aspect of the aorta and/or the IVC