IVC Abnormalties Flashcards Preview

*Ultrasound* > IVC Abnormalties > Flashcards

Flashcards in IVC Abnormalties Deck (118):
1

With deep INSPIRATION, venous return _____ (increases/decreases) and the IVC _____ (increases/decreases).

decreases
decreases

2

With deep EXPIRATION, venous return _____ (improves/decreases) and the IVC _____ (increases/decreases).

improves
increases

3

When performing the Valsalva maneuver, venous return is _____ and flow temporarily _____ in the IVC causing it to bulge.

blocked
reverses

4

Because IVC examinations need to be done in a consistant manner, it is usually best accomplished when the patient _____ inspiration.

suspends

5

When the normal blood flow in the IVC is obstructed, the normal response of the vessel is to _____ (increase/decrease) in caliber _____ (above/below) the point of obstruction. Respiratory changes are _____ (increased/decreased) below the obstructed segment.

increase
below
decreased or absent

6

The most common cause of IVC obstruction is

right-sided heart failure

7

Other causes for IVC obstruction are (5)

1) enlarged liver
2) para-aortic lymph node enlargement
3) retroperitoneal masses or tumors
4) pancreatic tumors
5) a congenital IVC valve may obstruct the lumen of the IVC

8

Symptoms of IVC obstruction may include (4)

1) abdominal pain
2) ascites
3) tender hepatomegaly
4) lower extremity edema (often in most severe forms of IVC obstruction)

9

In right-sided heart failure, the distal IVC and hepatic veins (HVs) become congested, resulting in a(n) _____ (increase/decrease) in diameter. Respiratory changes are markedly _____(increased/decreased).

increase
decreased or absent

10

"Respiratory changes" refers to the IVC _____ or _____ with breathing patterns.

compressing
dilating

11

Sonographic signs and physical signs of CHF are (3)

1) Dilation of the IVC and HVs
2) Hepatomegaly
3) Ascites

12

An indication that there is possible CHF and an US is needed is often

abnormal LFTs

13

If large enough, a solid, complex, or echo-poor tumor in the retroperitoneum or pancreas may obstruct the IVC, causing lower trunk and leg _____.

edema

14

Overall enlargement of the liver would cause the IVC to _____ (constrict/dilate) as it presses on the vessel.

dilate

15

The most encountered intraluminal anomaly of the IVC is _____, which usually spreads from another vein in the pelvis, lower limb, liver, or kidney.

thrombus (clot)

16

Typically, the more echogenic a thrombus is, the _____ (younger - acute/older - chronic) it is.

older - chronic

17

T or F? A doppler of a thrombus produces no signal.

True

18

Where is the most likely site of origin for a thrombus in the IVC?

kidneys

19

The normal response of a vein below the point of obstruction will be _____ (dilation/constriction), but above the obstruction the vein should remain normal diameter.

dilation

20

What is the metal device called that is made of either stainless steel or nitinol and placed in the IVC to trap clots that are 5mm or larger?

IVC filter

21

T or F? Most IVC filters in the US are placed temporarily rather than permanantly.

False - they are usually permanant

22

When an IVC filter fracture occurs, it means a fragment migrates to

adjacent tissues

23

If an IVC fracture occurs without symptoms (asymptomatic), is treatment necessary?

no

24

Tumors of the IVC may be _____, _____, or _____.

primary
metastatic
an extension from primary

25

A primary tumor of the IVC is one that

started in the IVC

26

A metastatic tumor of the IVC is one that

started in another organ and invaded the IVC

27

An extension from a primary tumor of the IVC is one that

a large tumor that grows from another adjacent organ

28

A leiomyoma is a _____ (benign/malignant) tumor of the smooth muscle.

benign

29

A leiomyasarcoma is a _____ (benign/malignant) tumor of the smooth muscle.

malignant

30

Primary tumors of the IVC are not very common, and have a vascular incidence of only ____%.

2%

31

Primary tumors, if any, tend to develop in _____ (men/women) and have a median age of detection at _____ years old.

women
61

32

With leiomyosarcomas, metastasis to the liver and lung has been reported in _____-_____% of cases. A _____% recurrence rate is also reported, and prognosis is _____ (good/poor).

40-50%
36%
poor

33

A mass _____ (has/doesn't have) color flow, a clot _____ (has/doesn't have) color flow.

has
doesn't have

34

The most common incidence of metastasis/extension of tumors in the IVC is

renal carcinoma

35

If there is a primary tumor in the IVC (which is rare), it is most likely a _____ or a _____.

leiomyoma
leiomyosarcoma

36

Tumors within the IVC tend to appear as _____ (echogenic/hypoechoic) foci.

echogenic

37

Large primary tumors of the IVC may be _____ (homogeneous/heterogeneous), with areas of necrosis.

heterogeneous

38

When an IVC mass is identified, it is important to attempt to identify (3)

1) the presence of a primary tumor
2) does it involve the HVs or right atrium (extent of cranial involvement)?
3) possible tumor involvement or invasion of the wall of the vessel

39

Doppler and color flow in the IVC is usually steady. When the IVC is partially obstructed, the blood velocity at the narrowed segment _____ (increases/decreases).

increases

40

When blood flow in the IVC is obstructed, the normal response of the vessel is to _____ (increase/decrease) in caliber _____ (above/below) the point of obstruction.

increase
below

41

In right-sided heart failure, the distal IVC and HVs become _____, resulting in a(n) _____ (increase/decrease) in diameter.

congested
increase

42

Malignant invasion or tumor extension of the IVC may occur from (6)

1) renal carcinoma
2) secreting/non-secreting adrenal tumors
3) retroperitoneal sarcomas
4) hepatocellular carcinoma
5) teratomas
6) lymphomas

43

What is the most common physical sign of an IVC tumor invasion?

leg edema

44

The most common reasons that renal veins enlarge are (3)

1) increased flow due to splenorenal/gastrorenal shunt or AV malformation in kidney
2) portal HTN or thrombosis
3) tumor involvement from renal cell carcinoma

45

T or F? Tumor involvement of the renal veins (RVs) usually produces no specific symptoms that would lead to suspicion of tumor extenstion.

True

46

T or F? Symptoms of the presence of an enlarged renal vein (RV) are generally associated with the initial disease process, not because of the actual venous enlargement.

True

47

An enlarged renal vein is one that exceeds

1.5 cm

48

Another sonographic finding that suggests increased flow into the renal vein is abrupt IVC dilation at the level of the _____ _____ _____.

renal insertion point

49

If enlargment of the RVs IS NOT bilateral or symmetric, this would indicate that the disease process _____ (does/does not) involve(s) the IVC at the level above the insertion of the RVs.

does not

50

If enlargement of the RVs IS bilateral or symmetric, this would indicate that the disease process _____ (does/does not) involve(s) the IVC at the level above the insertion of the RVs.

does

51

T or F? In portal HTN, several collateral pathways are apt to develop as the pressure in the portal system increases. These collateral pathways connect to _____ veins, and these are known as _____ veins.

True
systemic
varicose

52

In portal HTN, blood flow is diverted to the collaterals, which may in turn affect the LRV how and why?

The collaterals may fistulize to the LRV in order to alleviate pressure.

53

In portal venous HTN, is the LRV, RRV, or both typically involved? Why?

LRV
Because collaterals that form loop around and reconnect to the LRV

54

If portal venous HTN occurs, the doppler flow will show blood _____ (entering/leaving) the liver because

leaving
because the blood is being blocked from the liver and is forced to flow backwards

55

In tumor invasion or an AV fistula, is the LRV, RRV, or both typically involved (as compared to PV HTN vessel involvement).

LRV or RRV

56

It has been determined that the prevalence of RV involved in renal cell carcinoma is approximately _____ to _____%.

21% - 55%

57

When renal cell carcinoma invasion occurs, obstruction to the RV result in _____ (constriction/dilation).

dilation

58

What is the normal PV caliber?

13mm

59

Multiple worm-like serpiginous vessels in the region of the PV that result from longstanding thrombus and subsequent collateral vessel formation of a network of vessels that replace the obliterated PV is called

cavernomatous transformation

60

What is the acute or chronic hepatocellular disease that blocks the flow of blood through the liver, causing it to back up into the hepatic portal circulation and causes the blood pressure in the hepatic circulation to increase?

portal HTN

61

What helps to relieve high pressure in the portal system?

the formation of callateral vessels or varicose veins

62

Where do collateral vessels usually form (3)?

esophagus
stomach
rectum

63

What is the most clinical consequence of portal HTN?

variceal hemorrhage

64

What kind of blood flow is observed in patients with portal HTN?

hepatofugal or retrograde

65

Because of the variations in caliber of the IVC during respiration, it is imperative that examinations are done in a consistent manner. This is usually best accomplished by examining while the patient ______ inspiration.

suspends

66

The average measurment of an IVC is ______. Above ______ is considered abnormal.

2 cm - 3.7 cm
3.7 cm

67

Abnormal connection between the arterial and venous vessels is called

AV malformation

68

What causes blood to be routed directly from the artery into the vein in order to increase blood flow through the veins (AV malformation/fistula)?

high pressure in the arterial system

69

The natural response for a vein under increased blood flow is to ______ (constrict/dilate).

dilate

70

AV fistulas may occur for a number of reasons, including (5)

1) blunt or penetrating trauma
2) biopsy complications
3) tumor involvement
4) nephrectomy (kidney removal)
5) idiopathic causes

71

If a tumor is found in the RVs, the _____ should be checked to identify if there is an extension beyond the RVs.

IVC

72

In a tumor-free vessel, _____ may mimic a tumor or possibly a thrombus.

reverberation artifact

73

Some metastatic tumors may appear _____ (type of echogenicity) with the surrounding blood, making them difficult to identify.

isogenic

74

The LRV may appear enlarged at the point that it crosses over the AO, before entering the IVC; this is normal unless

the entire length of the RV is enlarged

75

T or F? Although extremely rare, IVC duplication may be misintrepreted as LRV enlargement. To avoid this confusion, it is wise to

True
follow the vessel in question to its origin

76

RV thrombosis may occur in these disorders (6)

1) nephrotic syndrome
2) renal tumors
3) renal transplants
4) trauma
5) infant dehydration
6) compression of RV secondary to tumor

77

Signs and symptoms of acute RV thrombosis (Renal Vein Clot) may include (4)

loin or flank pain
hematuria

leg swelling
proteinuria

78

With RV thrombosis, the RV is dilated at the point _____ (proximal/distal) to the occulsion.

proximal

79

With RV thrombosis, renal size generally _____ (increases/decreases) in the acute phase and a loss of normal renal structure may be identified. Doppler flow _____ (increases/decreases).

increases
decreases

80

Thrombus generally appears as a(n) _____ (echogenicity) focus, especially in longstanding cases.

echogenic

81

In acute phases of thrombus, it may not appear _____ (echogenicity) but may appear _____ (echogenicity) to the surrounding blood.

echogenic
isoechoic

82

T or F? Venous aneurysms are very rare.

True

83

Some possible causes of venous aneurysms are (3)

1) weakening of vessel wall by pancreatitis
2) portal HTN
3) embryonic malformations (congenital anomalies)

84

T or F? There are often symptoms associated with small aneurysms of the PVS.

False

85

Portal venous aneurysms can be recognized as _____ (echogenicity) areas in the porta hepatis. There may or may not be thrombus and also a communication with the PV can be seen.

anechoic

86

The PV drains blood from the (6)

small intestines
large intestines
stomach
spleen
pancreas
GB

87

The SMV and SV unite behind the neck of the pancreas to form the

PV

88

The portal trunk divides into 2 lobar veins. The right branch drains the _____ and the left branch receives the _____ and _____ veins that enlarge to form umbilical varices in portal HTN.

cystic vein
umbilical
paraumbilical

89

The coronary vein, which runs along the _____ curvature of the stomach, receives _____, which also enlarge in portal HTN.

lesser
distal esophageal veins

90

A potential complication of portal vein thrombus is

bowel ischemia and perforation

91

Portal venous thrombosis goes through several stages and appearance varies with each stage. In stage 1, the thrombus is _____ (echogenicity) in the vessel lumen.

echogenic

92

In stage 2 of portal venous thrombosis, the _____ and _____ are seen.

thrombus
small collaterals

93

In stage 3 of portal venous thrombosis, the ______ is/are seen and the ______ is not seen/identifiable (which is called ______).

large collaterals
PV
cavernomatous transformation of the PV

94

Direct signs of PV thrombosis are (6)

(as in, what is seen visually to suggest PV thrombosis)

1) visualization of clot in lumen
2) clot appears echogenic
3) if acute, clot may be difficult to see
4) local buldge of the vein at clot level
5) total occlusion: no venous or doppler signals
6) partial occlusion: normal doppler but decreased flow in vein

95

The most common cause of portal HTN in the western world is

cirrhosis

96

Clinical signs and symptoms of portal HTN are (5)

1) ascites
2) gastrointestinal bleeding
3) poor renal function
4) impaired coagulation
5) recannalization

97

Under extreme pressure, the round ligament (AKA ligamentum teres) may reopen to allow the passage of blood. This is called

recannalization

98

Recannalization is most common in patients with ______ and ______.

cirrhosis
portal HTN

99

T or F? A dilated coronary vein detected along with identification of esophageal varices is a good indicator of portal HTN. (80%-90%).

True

100

A very useful landmark for the location of recannalized veins (especially the paraumbilical vein) is the _____ vein along with esophageal varices, because it increases in size in 80-90% of cases. 20% of patients also have a patent _____ vein.

coronary vein
umbilical vein

101

The most significant clinical consequence of portal HTN is

variceal hemorrhage

102

The term to describe the appearance of distended and engorgeed umbilical veins, which are seen radiating from the umbilicus across the abdomen to join systemic veins is

Caput Medusae

103

_____ is a sign of severe portal HTN with portal systemic shunting through the umbilical veins.

Caput Medusae

104

Portal HTN flow is _____. Which is odd because flow should be _____.

hepatofulgal
hepatopedal

105

T or F? In portal HTN there is isolated LPV involvement. But with tumor invasion or AV fistulas, the LRV and/or RRV may be involved.

True

106

IVC thrombus is sonographically diagnosed/described as

An intraluminal filling defect that usually expands the diameter of the vessel.

107

The differential diagnosis of vascular tumor masses tends to be large because

because the similarity in echographic appearance.

108

What are the main indicators of portal HTN? (2)

esophageal varices
dilated coronary vein

109

A collateral network may involve (5)

coronary vein*****
gastroesophageal vein
umbilical vein
pancreatic duodenal vein
gastrorenal and splenorenal veins

110

This vein is identified by locating the splenic vein in a midline sagittal view and moving the probe to the right. It is recognized as a small vessel coursing cephalad from the splenic vein near the portal splenic confluence.

coronary vein

111

What does the presence of caput medusae indicate?

posthepatic or intrahepatic portal HTN

112

How is caput medusae formed?

by the recannalization of the umbilical vein which connects with the left hepatic branch of the PV

113

When shouldn't caput medusae be observed and why?

with isolated extrahepatic PV obstruction because the obstruction would be below the origin of the umbilical vein

114

Explain recannalization.

Under extreme pressure, the round ligament (ligamentum teres) reopens to allow the passage of blood. This is common in patients with cirrhosis and portal HTN. Patients with cirrhosis experience rapid growth of scar tissue in and around the liver, often functionally obstructing nearby vessels.

115

What is the sonographic appearance of PV thrombosis?

goes through about 3 stages
1) echogenic thrombus in lumen
2) thrombus and small collaterals visible
3) large collaterals and no identifiable PV (cavernomatous transformation)

116

Leiomyosarcomas are known to mestastitize to the ______ and ______.

liver
lungs

117

What is a rare tumor of the IVC and where does it originate?

chromaffin
outside the adrenal gland

118

This tumor extends into the IVC and right atrium

wilms tumor