Lesson 1C (Part 2)

Question 1

Where do you commonly see bull eyes or target patterns?

Answer 1

With lung cancer

Question 2

What is the sonographic appearance of a bull eyes or target pattern?

Answer 2

Hypoechoic peripheral halo

- hyperechoic centre

Question 3

What are calcified metastases marked by? (2)

Answer 3

1. Echogenicity

2. Distal acoustic shadowing

Question 4

What is shadowing in the liver caused by? (4)

Answer 4

1. Calcifications
   - clean shadow
2. Air
   - dirty shadow
3. Stones
4. Fat containing lesions

Question 5

What are the most common causes of a calcified liver tumour?

Answer 5

Metastases

Question 6

What are 3 examples of cystic mets?

Answer 6

1. Necrosis
   - sarcomas
2. Cystadenocarcinoma of ovary & pancreas
3. Mucinous carcinoma of colon

Question 7

What is the sonographic appearance of cystic metastases? (5)

Answer 7

1. Mural nodules
2. Thick walls
3. Fluid-fluid levels
4. Internal septations
5. Extensive necrosis

Question 8

Where are infiltrative mets seen?

Answer 8

1. Breast
2. Lung
3. Malignant melanoma

Question 9

What is the sonographic appearance of infiltrative metastatic disease? (2)

Answer 9

1. Diffuse disorganization of parenchyma
   - may be confused with cirrhosis or fatty liver
2. Chemotherapy may make liver fatty

Question 10

Kaposi sarcomas

Answer 10

Arise from connective tissue but can spread to liver

- rare

Question 11

CEUS

Answer 11

Contrast enhancement ultrasound

Question 12

What is the major role for contrast enhancement ultrasound? (2)

Answer 12

1. Diagnosis

2. Detection of mets

Question 13

What does CEUS involve?

Answer 13

The use of microbubble contrast agents and specialized imaging techniques
- tiny bubbles in an injectable gas

Question 14

What are benefits to CEUS? (6)

Answer 14

1. Shows sensitive blood flow and tissue perfusion
2. Are not nephrotoxic
3. No ionizing radiation
4. Similar results as CT and MRI
5. Determines vascularity in metastases
6. Biopsy establishes the primary tissue site

Question 15

What is a normal variant for hepatomegaly?

Answer 15

Reidels lobe

Question 16

What are 9 causes of hepatomegaly?

Answer 16

1. Liver Trauma ***
   - alcohol abuse
2. Passive liver congestion
3. Fatty liver
4. Viral infections
   - Hepatitis A, B and C
5. Mononucleosis
6. Hemochromatosis
7. Primary liver cancer
8. Leukemia
9. Lymphoma

Question 17

Hepatomegaly

Answer 17

Enlargement of the liver

- can feel the liver edge below the rib cage

Question 18

What is the normal range of the right lobe?

Answer 18

13-17cm

Question 19

Where is Reidels lobe more common?

Answer 19

In women

Question 20

Reidels lobe

Answer 20

Tongue shaped process of the liver

- gets mistaken for an enlarged liver

Question 21

What are symptoms of hepatomegaly? (4)

Answer 21

1. Abdominal pain
2. Swelling
3. Feeling of fullness
4. Jaundice

Question 22

What are diagnostic tests that can be taken for hepatomegaly? (5)

Answer 22

1. Ultrasound
2. X-ray
3. CT scan
4. Liver function blood tests
5. Biopsy

Question 23

What can hepatic trauma cause?

Answer 23

Enlargement

Question 24

What is the sonographic appearance of fresh hemorrhage?

Answer 24

Echogenic

- after 1 week its hypoechoic

Question 25

What is passive liver congestion caused by?

Answer 25

Stasis of the blood within the liver parenchyma

Question 26

What are some negative side effects of passive liver congestion? (2)

Answer 26

1. Hepatic venous drainage is compromised | 2. Common complication of congestive heart failure

Question 27

Why does the liver get enlarged with passive liver congestion?

Answer 27

Sinusoids dilate to accommodate back flow of the blood

Question 28

Portal venous gas

Answer 28

Accumulation of gas in the peripheral portal venous system

Question 29

What is portal venous gas caused by?

Answer 29

1. Ischemic, necrotic, ulcerated bowel 2. Colorectal carcinoma 3. Inflammatory bowel disease 4. Perforated peptic ulcer - GI issues