Abdomen PACS Final

Question 1

Column of Bertin

idents the renal medullary

do NOT distort the renal cortex

Answer 1

Question 2

Dromedary Hump

more common on the left side

cortical border is intact and hump will contain normal appearing pyramid structures

Answer 2

Question 3

Junctional Defect

a triangular echogenic area in the upper pole

Answer 3

Question 4

Parenchymal Cyst (simple cyst)

50% of people over the age of 50 will have them

Answer 4

Question 5

Polycystic Kidney Disease

Bilateral disease

50% of pts will have end stage renal disease by age 60

Answer 5

Question 6

Acute Tubular Necrosis

Nephrocalcinosis

renal appearance is thinned cortex with enlarged, echogenic “globs” of meddullary tissue

Answer 6

Question 7

Angiomyolipoma

benign

80% in women and 80% right kidney

hyperehoic mass found in renal cortex

Answer 7

Question 8

Fetal Lobulation

cortical border is still intact and parenchymal thickness is uniform throughout kidney

Answer 8

Question 9

Duplex Collecting System

on the trans image will appear to have no medullary

Answer 9

Question 10

Extrarenal Pelvis

a portion of the collecting system that extends outside the renal sinus

Answer 10

Question 11

Kidney Stone

most common renal problem

more common in men

present shadowing

Answer 11

Question 12

Obstuctive Hydronephrosis

there are 3 grades

grade 1: splaying of the calyces

grade 2: fluid extends into the major and minor calyces with minimal thinning of the cortex

grade 3: massive dilation and renal pelvis with signifcant loss of renal cortex

Answer 12

Question 13

Nonobstructive Hydronephrosis

dilation of renal sinus without blockage of the flow of urine to the bladder

ALWAYS check for bilateral urine jets wihen ANY dilation is noted

causes:

UTI, plevic masses, pregnancy, uterine fibroids and enlarge prostate

Answer 13

Question 14

Chronic Medical Renal Disease

AKA: Chronic Renal Failure

bilateral process, results in small echogenic kidneys

cortical thickness = at least 1 cm

may have a hard time distinguishing from surrounding tissue

Answer 14

Question 15

Renal Carcinoma

tumors are solid, parenchymal mass

often isoechoic or hypoechoic

disrupts the renal cortex

2x as common in men

after mass is found the IVC and renal veins should be imaged to determine if there is tumor extension

Answer 15

Question 16

Medullary Sponge Kidney

enlarged echogenic medullary

asymptomatic and not found in young adulthood

Answer 16

Question 17

Bladder Diverticulum

outpouching of the bladder wall

more common in older men

Answer 17

Question 18

Bladder Tumors

95% are transitional cell carcinoma

appear as irregular, echogenic mass that projects into the lumen of the bladder wall or as wall thickening

Answer 18

Question 19

Bladder Stones

echogenic foci along the bladder wall with shadowing

stones will move when you roll the patient, tumors will NOT move when the patient is rolled

Answer 19

Question 20

Glomerulonephritis

necrosis of the glomerulus: a network of cappillaires which filters the blood into the renal tubule

cause: strepococcal bacteria

Answer 20

Question 21

Pyelonephritis

an infection of the calyces and the renal pelvis

causes: UTIs, reflux obstruction and diabetes

has FOCAL echogenic area with the kidney

all forms of nephritis have similar appearance: Lupus/AIDS/Sickle Cell

Answer 21

Question 22

Pelvic Kidney

most common location is found within the boney pelivs

Answer 22

Question 23

Horseshoe Kidney

bilateral fusion of the lower poles

kidneys are closer to the spine

Answer 23

Question 24

Thyroid: Graves Disease

most frequent cause of hyperthyroidism

women over 30

intense color doppler: thyroid storm or inferno

treatment: radioactive ablation with lifelong hormonal supplements

Answer 24

Question 25

Thyroid: Hasimoto's Thyroiditis most common form of thyroiditis yound middle aged women enlarged, homogenous, hypoechoic thyroid texture

Answer 25

Question 26

Thyroid Adenoma variable size homogenous commonly have a peripheral halo

Answer 26

Question 27

Multinodular Goiter most common thyroid abnormality NOT associated with hypo- hyper- thyroidism

Answer 27

Question 28

**Breast** **Benign Lesions** **Fibroadenoma: most common benign tumor** smooth rounded margins grow horizontally within tissue planes parallel to chest wall round or oval shape "wider than they are tall" isoechic with breast tissue are mobile and compressibile DO NOT HAVE INCREASED BLOOD FLOW

Answer 28

Question 29

**Breast** **Malignant Lesions** have finger like projectoins called spiculations sharp angular borders cause skin dimpling or nipple retraction "Taller than wide" hypoechoic have posterior shadowing behind lesion rigid and noncompressibile HAS INCREASED BLOOD FLOW WITH A FEEDER VESSEL

Answer 29

Question 30

Lymph Node appearance changes from oval to round echogenic hilum become more difficult to detect

Answer 30

Question 31

Varicocele they are caused by incompetent valves within the spermatic vein more common on the left due to the LSV empting into the LRV

Answer 31

Question 32

Hydrocele a collection of serous fluid and is the most common cause of PAINLESS scrotal swelling

Answer 32

Question 33

Microlithiasis bilateral condition associated with high risk malignancy and infertility smaller than 3mm high incidence in men with a history of undescended testes MUST have more than 5 microlithiasis on a single image

Answer 33

Question 34

Testicular Carcinomas 95% of tumors are germ cell, most often seminoma occurs most frequently between ages 20-35 patients present painless, palpable mass oftern hypoechoic, homogenous with SMOOTH borders

Answer 34

Question 35

Epididymitis common cause if from a spread of a UTI or STD most common cause of ACUTE scrotal pain in ADULTS patient has increasing pain over a few days increased doppler within testis

Answer 35

Question 36

Torsion occurs from Bell Clapper deformity EARLY: affected testis is swollen and midly heterongenous LATE: affected testis become swollen and hypoechoic, the VENOUS flow will be affected first causing occluded veins, tissue necrosis will develop following venous flow restriction When scanning torsed testicles, ALWAYS compare both sides with the same parameters to show a difference in blood flow parameters used: gain, scale, wall filter and color box

Answer 36

Question 37

Cavernous Hemangioma usually asymptomatic and discovered incidentally hyperechoic and typically have posterior enhancement, usually in the right lobe of liver and near the dome

Answer 37

Question 38

Focal Nodular Hyperplasia second most common benign mass in women under 40 and asymptomatic occur mostly in right lobe of liver, hyper- to isoechoic, many have central scar

Answer 38

Question 39

Fatty Liver/Fatty Sparing acquired diffuse disorder, resulting in an accumulation of triglycerides with the hepatocytes not always uniform and present as patchy LIVER ECHOGENICITY COMPARED TO RIGHT KIDNEY IS IMPORTANT IN MAKING DIAGNOSIS OF FATTY LIVER

Answer 39

Question 40

Riedels Lobe-Congenital Variant anterior projection over the liver, extending near the iliac crest It is NOT merely an elongated inferior, posterior segment extending over the right kideny

Answer 40

Question 41

Metastic Disease most common cancerous mass of the liver mostly from primary GI (including GB and pancreas), breast and lung hyperechoic, hypoechoic, bull's eye sign

Answer 41

Question 42

Ascites accumulation of serous fluid in the peritoneal cavity echo free fluid regions indented and shaped by the surrounding organs first fills the pouch of douglas before it ascends to the paracolic gutters small bowel loops sink and float with the fluid

Answer 42

Question 43

Liver Cyst **occur in 5% of people over the age of 50** same songraphic characteristics of renal simple cysts often seen in patients with polycystic kidney disease (ADPKD)

Answer 43

Question 44

Pancreatic Adenocarcinoma most common occurring in the head region usually cause obstruction of CBD symptoms include: abdominal and back pain, painless jaundice and weight loss irregualr, hypoechoic lesion, dilated pancreatic duct, liver and para-arotic nodes

Answer 44

Question 45

Pancreatitis (Acute) inflammation of the pancreas organ appears hypoechoic and edematous with irregular borders pancreatic duct may be enlarged Chronic: appears hyperechoic with echogenic foci randomly dispersed throughout the gland

Answer 45

Question 46

Pseudocysts accumulation of pancreatic fluid and necrotic debris confined by the retropertoneum common causes: acute pancreatitis, chronic pancreatitis, pancreatic trauma, pancreatic ductal obstruction and pancreatic neoplasms in children the most common cause for pseudocysts is abdominal trauma

Answer 46

Question 47

Splenic Calcifications (granulomatous infection) granulomas are focal lesions resulting from previous infections bright echogenic lesions with or without shadowing two of the most common causes: tuberculosis and histoplasmosis

Answer 47

Question 48

Accessory Spleen common congential anomaly typically round and isoechoic with the spleen can be found by the hilum

Answer 48

Question 49

GB Polyps smooth and on a stalk, do NOT shadow and do NOT move when the patient is rolled most common tumor of the GB

Answer 49

Question 50

Adenomyomatosis hyperplastic wall changes- more echogenic than polyps, do NOT move and have ring down or "comet tail artifact"

Answer 50

Question 51

Gallstones echogenic foci can be multiple or single have shadowing they DO move when the patient is rolled

Answer 51

Question 52

WES (wall echo shadowing) GB packed with stones no visible bile within the GB lumen

Answer 52

Question 53

Porcelain GB the whole wall of the GB is incrusted with calcium has a similar pattern of distinct posterior shadowing in the area of the GB

Answer 53

Question 54

GB Sludge mildly echogenic bile can float, move as a ball, contain high echogenic tiny foci, can be seen along gallstones

Answer 54

Question 55

ACUTE Cholecystitis positive murphy's sign thickened wall with sonolucent area between the 2 walls

Answer 55

Question 56

CHRONIC Cholecystitis transient RUQ pain with NO positive murphy's sign more common than acute results from multiple episodes of acute and fibrosis developing in the wall

Answer 56

Question 57

Dilated Common Bile Duct (Extrahepatic) occurs before intraheptic blockage of the **distal CBD** from a stone or a pancreatic head tumor results in enlarged common duct and eventual dilated intrahepatic ducts blcokage at the porta-hepatis will demonstrate a normal CBD characterized by the appearance of "too many tubes" or "double barrel" sign IT IS THE JOB OF THE SONOGRAPHER TO FIND THE SOURCE AND LOCATION OF THE DUCTAL OBSTRUCTION

Answer 57

Question 58

Dissecting Aneursyms blood filled channel within the walls of the aorta occurs primarily in thoracic aorta marfrans-stretching disroder of all arterial vessels

Question 59

Saccular Aneursyms Large 5-10 cm connected to aorta by mouth or channel usually filled with thrombus or clot

Question 60

Fusiform Aneursyms most common general widening of aorta distal atherosclerosis/smoking/family history

Question 61

Pseudo Aneursyms pulsatile hematoma results from interventional procedures punctured artery fails to seal off US can be used to seal off the leak with compression