Pathology #3 Flashcards by lindsay crouse

While scanning the liver in patient with chronic cirrhosis, you notice a tubular vessel connecting to the LPV and exiting the liver coursing inferiorly. Flow within the vessel is very low velocity, continuous and moving in a caudal direction. Which of the following explains the ultrasound findings?

a dilated coronary vein is present which is a common complication of cirrhosis

the ductus venosus is dilated with antegrade flow which is a common complication of cirrhosis

a dilated umbilical vein is present which is a common complication of cirrhosis

a dilated SMV is present with flow reversal which is a common complication of cirrhosis

a dilated umbilical vein is present which is a common complication of cirrhosis

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While scanning the liver in a patient with chronic cirrhosis, you notice a tubular vessel connecting to the splenic vein just prior to its confluence with the SMV. Flow within the vessel is very low velocity, continuous and moving in a cephalic direction. Which of the following explains the ultrasound findings?

a dilated SMV is present with flow reversal which is a common complication or cirrhosis

a dilated coronary vein is present which is a common complication of cirrhosis

a dilated umbilical vein is present which is a common complication of cirrhosis

the ductus venosus is dilated with antegrade flow which is a common complication of cirrhosis

a dilated coronary vein is present which is a common complication of cirrhosis

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___ abscesses are most commonly found in countries outside the US. ___ abscesses are most commonly seen in immunosuppressed patients.

pyogenic, amebic
fungal, amebic
amebic, fungal
fungal, pyogenic

amebic, fungal

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Which of the following describes a non-infectious cause for hepatitis?

anabolic steroids
fungus
bacteria
virus

anabolic steroids

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What type of liver infection/abscess is commonly associated with immunocompromised patients?

schistosomiasis
amebic
pyogenic
candidiasis

candidiasis

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The diameter of the ___ will be relatively unaffected by hepatic congestion.

MPV
RHV
LHV
HA

**HA diameter is relatively unaffected but the resistance to flow can increase

HVs and PV will dilate

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What condition is associated with prominent portal walls?

hemangioma
fatty infiltration
acute viral hepatitis
cirrhosis

acute viral hepatitis

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Which of the following statements is true regarding the Doppler evaluation of the liver vasculature displayed?

the HA and PV are demonstrated with normal flow directions

the HA is hepatopetal and the PV is hepatofugal

the HA is hepatofugal and the PV is hepatopetal

the PV flow is normal but the HA demonstrates increased resistance

the HA is hepatopetal and the PV is hepatofugal

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The most common finding with congestive hepatomegaly is:

IVC dilatation
liver atrophy
AAA
PV aneurysm

IVC dilatation

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The hormone changes with pregnancy have been associated with the enlargement of what type of liver mass?

granuloma
hemangioma
schistosomiasis
hepatoma

hemangioma

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Which of the following statements is true regarding the displayed ultrasound image?

the PV is of normal diameter but appears to be filled with thrombus related to chronic PHTN

the PV is at the top normal diameter at 17mm. the PV is considered abnormally dilated at a diameter 18mm or greater

the PV is abnormally dilated at 17mm and is filled with mildly echogenic thrombus

the PV is dilated at 17mm but does not demonstrate color Doppler signals due to the perpendicular incidence with the probe

the PV is abnormally dilated at 17mm and is filled with mildly echogenic thrombus

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___ is the most common malignancy of the liver seen in a patient with AIDS. ___ is the most common infection of the liver seen in a patient with AIDS.

hepatocellular carcinoma, hepatitis
hepatoblastoma, candidiasis
metastasis, schistosomiasis
Kaposi sarcoma, pneumocystis carinii

Kaposi sarcoma, pneumocystis carinii

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Which of the following are contraindications for a liver transplant?

HCC and hepatitis
cholangiocarcinoma and current alcohol/drug abuse
autosomal recessive polycystic disease and biliary hamartomas
hep C and cirrhosis

cholangiocarcinoma and current alcohol/drug abuse

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You are scanning through the liver and note the caudate lobe is nearly the same size as the right lobe. The surface of the liver appears lobulated or nodular. Which of the following is the most likely diagnosis of these findings?

FNH
cirrhosis
hepatitis
HCC

cirrhosis

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Which of the following organs can be involved in this multi-organ syndrome and can also display the same abnormality seen here in the liver?

thyroid and thymus
peritoneum and mesentery
kidneys and ovaries
spleen and adrenal glands

kidneys and ovaries

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Alcoholic cirrhosis demonstrates a severe increase in ___, while viral hepatitis demonstrates a severe increase in ___.

AFP, ALP
AST, ALT
ALP, AFP
ALT, AST

AST, ALT

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Which of the following correctly describes peliosis hepatis?

blood filled cavities of varied size form in the liver tissue

numerous AV fistulas form throughout the liver

infection of the cystic duct that transfers to the pancreas

numerous cysts form that connect to the extrahepatic portal vein

blood filled cavities of varied size form in the liver tissue

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What liver abnormality results in low blood sugar levels?

hemangioma
FNH
glycogen storage disease
Wilson disease

glycogen storage disease

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In patients with cirrhosis, what effect will deep inspiration have on the portal vein?

the PV diameter will increase by 50%
the PV will collapse at the deepest point of inspiration
there will be minimal change in the PV diameter
the PV diameter will double in size

there will be minimal change in the PV diameter

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The findings on the image are most consistent with:

subcapsular hematoma of the liver
intraparenchymal hematoma of the liver
loculated pleural effusion
subcapsular hematoma of the spleen

subcapsular hematoma of the liver

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The most common cause of spread of hepatitis in the US is:

blood transfusions
hereditary infection
IV drug users
liver transplants

IV drug users

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A patient presents with splenomegaly and multiple, small, tortuous vessels are visualized in the porta hepatis area of the liver. These vessels most likely represent:

duplicated HA
cavernous transformation
dilated extrahepatic biliary system
portal aneurysm

cavernous transformation

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___ should be suspected in an infant with a large hepatic hemangioma and unexplained thrombocytopenia.

Budd Chiari
cirrhosis
Kasabach-Merritt syndrome
fragile X syndrome

Kasabach-Merritt syndrome

**aka hemangioma thrombocytopenia syndrome

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Steatosis refers to:

glycogen storage disease of the liver
chronic hepatitis infection
fatty liver disease
pneumocystis carinii

fatty liver disease

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A RI over 0.8 in the common hepatic artery would be an expected finding in patients with: cholangitis and steatosis PHTN and transplant rejection FNH and cirrhosis Budd Chiari and a healthy liver transplant

PHTN and transplant rejection

___ is the most common cause for micronodular cirrhosis and ___ is the most common cause of macronodular cirrhosis. analgesic consumption, alcohol consumption alcohol consumption, chronic viral hepatitis chronic viral hepatitis, alcohol consumption alcohol consumption, analgesic consumption

alcohol consumption, chronic viral hepatitis

A liver mass with a hypoechoic rim should create a strong suspicion of: a hepatic lipoma PHTN a liver adenoma malignancy

malignancy

Which of the following is a potential collateral pathway formed in patients with cirrhosis? blood moves from the gastric vein to the splenic vein blood moves from the superior rectal vein to middle rectal vein blood moves from the splenic vein to the coronary vein blood moves from the emissary veins to the umbilical vein

blood moves from the superior rectal vein to middle rectal vein

Benign liver masses will usually demonstrate ultrasound contrast enhancement during the arterial and portal venous phases of imaging. Malignant masses will usually demonstrate: no contrast enhancement contrast enhancement during portal venous phase of imaging contrast enhancement during the arterial and portal venous phases of imaging contrast enhancement during the arterial phase of imaging

contrast enhancement during the arterial phase of imaging

A 65 year old male presents with a history of cirrhosis, RUQ pain, and recent weight loss over the last 6 months. Lab testing indicates abnormal LFTs and increased AFP. The image displayed is most suggestive of: HCC focal fatty sparing TCC metastasis

HCC

A 75 year old female presents with RUQ pain. She was diagnosed with cirrhosis 4 years ago. Lab values demonstrate increased levels of AFP, ALP, AST, and ALT. The US exam demonstrates a heterogenous liver texture that is decreased in size. The left lobe contains a new round hypoechoic mass with increased vascularity. These findings are most suggestive of: hydatid cyst metastatic lesion FNH HCC

HCC

Which of the following statements is true regarding the displayed image? the patient's liver is increased in echogenicity indicating acute viral hepatitis bilirubin, AST and ALT levels will be elevated the patient has a pleural effusion the patient's liver is decreased in echogenicity indicating cirrhosis

bilirubin, AST and ALT levels will be elevated

In a patient with cirrhosis, the __ lobe of the liver can enlarge to nearly half the size of the right lobe. left caudate quadrate none of the above, the entire liver shrinks in size

caudate

A patient presents with an isolated slight increase in liver function tests. You identify two hyperechoic, homogenous masses in the area of the porta hepatis. These findings are most consistent with: focal fatty sparing cavernous hemangioma formation focal fatty infiltration adenoma development

focal fatty infiltration

Liver elastography is used for: staging of secondary malignancy staging of primary malignancy staging of steatosis staging of fibrosis

staging of fibrosis

If this is a TRV view of the liver, where is the liver mass located? lateral right anterior right caudate lateral left

anterior right

A patient presents with a history of gastric carcinoma diagnosis. The image most likely demonstrates which of the following abnormalities? HCC metastatic lesions GB carcinoma PCLD

metastatic lesions

___ can lead to air within the portal venous system and ___ can lead to air within the biliary tree. an ERCP, ulcerative colitis diverticulitis, ulcerative colitis ulcerative colitis, an ERCP ulcerative colitis, appendicitis

ulcerative colitis, an ERCP

A cyst within a cyst (daughter cyst) is a classic sign of: polycystic liver disease hydatid cyst or fungal abscess echinococcal cyst or pyogenic abscess hydatid cyst or echinococcal cyst

hydatid cyst or echinococcal cyst

Which of the following is commonly associated with contaminated water and causes debris/occlusion within intrahepatic portal venous system? schistosomiasis pyogenic abscess candidiasis amebic abscess

schistosomiasis

A 45 year old male presents for an abdominal US due to suspected hepatomegaly. The exam demonstrates numerous cysts of all sizes throughout the liver parenchyma. Which of the following should be evaluated for the same abnormality? pancreas retroperitoneal lymph nodes prostate ovaries

pancreas

Which of the following correctly describes how to differentiate a liver hemangioma from focal fatty infiltration? hemangiomas demonstrate internal vascularity, while focal fatty infiltration demonstrates peripheral vascularity there are no distinguishing sonographic characteristics between liver hemangiomas and focal fatty infiltration hemangiomas can compress or displace surrounding structures, fatty infiltration has no mass effect hemangiomas are always identified in the right lobe, while focal fatty infiltrations always occurs at the porta hepatis

hemangiomas can compress or displace surrounding structures, fatty infiltration has no mass effect

Which of the following will cause an increase in values on liver function tests? FNH polycystic liver disease adenoma hepatitis

hepatitis

A liver ultrasound demonstrates a hyperechoic mass with smooth borders and posterior enhancement in the posterior right lobe. These findings are most suggestive of: HCC cavernous hemangioma hepatic adenoma focal fatty sparing

cavernous hemangioma

If a patient presents with a history of right breast cancer and you identify a solid liver mass with a hypoechoic halo, what is the most likely diagnosis of the finding? hepatic metastasis FNH HCC hepatic adenoma

hepatic metastasis

A 4 year old patient is referred for an abdominal ultrasound due to a palpable mass in the RUQ and jaundice. The image most likely represents which of the following findings? hepatoblastoma hepatoma pheochromocytoma nephroblastoma

hepatoblastoma

A 26 year old female presents for an abdominal ultrasound. Her clinical history includes current use of oral contraceptives and mild hyperglycemia. The image of the liver is most suggestive of: normal liver echotexture, no masses/abnormalities identified adenoma formation in the right lobe, posteriorly focal fatty sparing in the left lobe, posteriorly focal fatty sparing in the right lobe, posteriorly

adenoma formation in the right lobe, posteriorly

Placement of a Linton or Warren shunt is a method used to: reroute blood flow around a large aortic aneurysm streamline blood flow through a large aortic aneurysm reduce PHTN relieve significant hydronephrosis

reduce PHTN

Which of the following would cause an increase in serum AST levels with normal serum ALT levels? CHF hepatitis metastasis cirrhosis

CHF

Which lobe of the liver contains the mass? lateral left lobe anterior right lobe medial left lobe posterior right lobe

anterior right lobe

A 50 year old female presents with nausea, vomiting and increased levels of AFP in lab testing. Which of the following pathologies is demonstrated on the image displayed? hepatoblastoma klatskin tumor krukenberg tumor choledochal cysts

klatskin tumor

Which of the following is not an expected finding with fatty infiltration of the liver? cystic degeneration increased attenuation degraded visualization of vessels brighter parenchymal echoes

cystic degeneration

Which of the following is not an expected complication of a liver transplant? abscess biloma urinoma seroma

urinoma

The findings on the image are most suggestive of: right heart failure cirrhosis Wilson disease Budd Chiari disease

cirrhosis

The most common benign liver tumor is: cavernous hemangioma klatskin tumor polycystic liver disease hepatitis

cavernous hemangioma

Which waveform represents hepatic vein flow in a patient with advanced cirrhosis? *** the color map displayed applies to all displayed Doppler tracings

A patient presents for a liver ultrasound. A 5cm mass is identified at the porta hepatis of the liver. How will this affect the IVC position in the abdomen? IVC will be displaced posteriorly IVC will be displaced anteriorly IVC will be displaced inferiorly a 6cm mass is not large enough to displace the IVC in most patients

IVC will be displaced posteriorly

Which of the following describes the sonographic appearance of hepatic candidiasis? cystic mass with gravity dependent debris mass formation is described as a wheel within a wheel pattern complex cystic mass that typically forms near the porta hepatis a large solid mass replaces the caudate lobe and displaces the IVC

mass formation is described as a wheel within a wheel pattern

Which of the following would indicate a normal Doppler evaluation of an intrahepatic shunt? hepatofugal flow in the MPV peak flow velocity of 35cm/s peak flow velocity of 230cm/s hepatofugal flow in the LPV

hepatofugal flow in the LPV

Liver transplant evaluation requires PW Doppler evaluation of all of the following, EXCEPT: portal anastomosis IVC anastomosis hepatic arterial anastomosis biliary anastomosis

biliary anastomosis - should be evaluated for obstruction of fluid collection using 2D ultrasound

What is the most common cause of a hepatic abscess in the US? osteomyelitis and endocarditis appendicitis and diverticulitis cholangitis and cholecystitis E. coli from digestive tract

cholangitis and cholecystitis

What is a potentially life threatening complication of PHTN? ruptured gastroesophageal varices ascites formation aortic embolism pulmonary embolism

ruptured gastroesophageal varices

Which of the following is a potential collateral pathway formed in patients with cirrhosis? blood moves from the emissary veins into the umbilical vein blood moves from the gastric vein into the splenic vein blood moves from the splenic vein into the coronary vein blood moves from the coronary and short gastric veins into the esophageal veins

blood moves from the coronary and short gastric veins into the esophageal veins

If a liver transplant patient has an interposition anastomosis, how does this affect your evaluation? there will be two anastomosis sites in the IVC that must be evaluated each hepatic vein is connected to the native IVC separately, so there will be three anastomosis sites in the IVC that must be evaluated the HA anastomosis will not be able to visualized because it is located deep within the liver tissue there will be two anastomosis sites in the MPV that must be evaluated

there will be two anastomosis sites in the IVC that must be evaluated

The Ultrasound Liver Imaging Reporting and Data System (US LI-RADS) is used to asses patients at risk for: lymphoma liver metastasis cirrhosis HCC

HCC

Which of the following describes the location of the mass within the liver? lateral left lobe anterior right lobe medial left lobe posterior right lobe

medial left lobe **TRV view of the liver, the mass is anterior and between the left and middle hepatic vein

Which of the following findings indicates a failed transjugular intrahepatic shunt? continuous flow pattern within the shunt diminished flow in the right and left portal branches spleen length <12cm in average patient hepatofugal flow in the MPV

hepatofugal flow in the MPV

What fetal syndrome is most commonly associated with hepatoblastoma? trisomy Beckwith-Wiedemann syndrome Budd Chiari down syndrome

Beckwith-Wiedemann syndrome

What is caput medusa? formation of splenorenal varices failure of a TIPS shunt tortuous vessels around the umbilicus caused by PHTN formation of gastroesophageal varices

tortuous vessels around the umbilicus caused by PHTN

Which of the following is a contraindication to placement of a TIPS shunt? HCC cirrhosis portal thrombosis HA aneurysm

portal thrombosis ** thrombus could then travel from the PV to the IVC and into the lungs causing pulmonary embolism

While performing ultrasound on the liver, a TRV view reveals a hyperechoic triangular structure in the inferior left lobe. The hyperechoic structure demonstrates an anechoic center that fills with color when Doppler is applied. Which of the following best describes the finding identified on the image? recanalized coronary vein recanalized umbilical vein metastaisis FNH

recanalized umbilical vein

What liver complication is associated with cholangitis, diverticulitis, and osteomyelitis? steatosis fungal abscess pyogenic abscess metastasis

pyogenic abscess

A portal vein diameter that is greater than or equal to ___ indicates PHTN. 8mm 10mm 13mm 15mm

13mm

Which of the following is most likely to demonstrate a simple cyst with gravity dependent debris in the right lobe of the liver? early schistosomiasis infection chronic FNH early echinococcal infection chronic hydatid infection

early echinococcal infection

Which of the following Doppler characteristics of the hepatic arteries will be seen in a normal liver transplant? increased RI sharp systolic upstroke prolonged acceleration time diastolic flow reversal

sharp systolic upstroke

A patient presents with a history of RUQ pain. He currently uses anabolic steroids. The exam demonstrates multiple irregular anechoic areas throughout the liver parenchyma. No internal flow is documented in these areas on color Doppler evaluation. These findings are most suggestive of: peliosis hepatis metastatic disease from colon primary HCC Budd Chiari

peliosis hepatis

A 28 year old male presents with jaundice, increased AST and ALT, decreased albumin and elevated serum copper levels. The liver appears diffusely echogenic with periportal thickening. These findings are most suggestive of: alcoholic cirrhosis chronic hepatitis glycogen storage disease Wilson disease

Wilson disease

A patient presents with new onset of jaundice 2 weeks after a liver transplant. This clinical finding is most suggestive of what complication? HA stenosis biliary stricture HV stenosis PV stenosis

biliary stricture

Which of the following Doppler parameters is most commonly used when evaluating the common hepatic artery in a patient with a liver transplant? S/D ratio PI PSV RI

RI ** RI >0.8 implies PHTN, hepatic congestion, transplant rejection, or chronic hepatocellular disease

What is the most common primary cancer to metastasize to the liver? ovary GI tract melanoma lung

1. GI tract 2. pancreas 3. breast 4. lung 5. ovary

Which of the following statements is true regarding the sonographic appearance of fatty infiltration? as fatty infiltration increases in the liver, the HV branches become increasingly visible as fatty infiltration increases in the liver, all walls of all liver vascularity become increasingly echogenic as fatty infiltration increases in the liver, the PV branches become more difficult to visualize as fatty infiltration increases in the liver, the walls of the PV branches become increasingly echogenic

as fatty infiltration increases in the liver, the PV branches become more difficult to visualize

Diastolic flow reversal in the right and left hepatic arteries of a newly placed liver allograft indicates: significant stenosis of the common hepatic artery PHTN normal post-surgical findings possible rejection

possible rejection

A ___ abscess is caused by bacteria and most commonly forms within the right lobe of the liver. A ___ abscess is caused by a parasite and usually forms in the right dome of the liver causing elevation of the diaphragm. fungal, pyogenic parasitic, fungal amebic, pyogenic pyogenic, amebic

pyogenic, amebic

Which of the following liver tumors is usually treated by surgical resection due to risk of hemorrhage and malignant transformation? hemangioma adenoma pyogenic abscess lipoma

adenoma

___ is the most common malignant liver mass found in children. mets from brain hepatoblastoma hepatoma mets from nephroblastoma

hepatoblastoma

Reduced glycogen storage in the liver usually causes the liver parenchyma to have a sonographic appearance similar to: polycystic disease acute viral hepatitis cirrhosis steatosis

acute viral hepatitis

If discovered in early stages, which of the following effects on the liver can be reversed? cirrhosis fatty infiltration hepatoma metastasis

fatty infiltration

A contrast enhanced ultrasound examination is performed on a patient with suspected HCC. What are the expected findings if the exam is positive? hypoechoic lesions during the arterial phase and hyperechoic lesions during the portal venous phase hyperechoic lesions during the arterial phase and hypoechoic lesions during the portal venous phase hypoechoic lesions that demonstrate absence of contrast uptake throughout the arterial and venous phases of circulation hyperechoic lesions that demonstrate sustained levels of contrast uptake throughout the arterial and venous phases of circulation

hyperechoic lesions during the arterial phase and hypoechoic lesions during the portal venous phase

A patient presents for an abdominal ultrasound with a history of increased LFTs and obesity. The referring doctor would like to rule out hepatomegaly. Which of the following findings will indicate hepatomegaly is present? when the right lobe is rounded inferiorly and extends past the upper pole of the right kidney when the right lobe is rounded inferiorly and extends below the lower pole of the right kidney hepatomegaly causes rounding of the superior liver segments the liver is considered enlarged when the AP measurement exceeds 15.5cm

when the right lobe is rounded inferiorly and extends below the lower pole of the right kidney

Which of the following sonographic characteristics is associated with Budd Chiari syndrome? dilated IVC portal system aneurysm agenesis of the HA atrophied HVs

atrophied HVs

___ lobe of the liver does not normally atrophy with chronic Budd Chiari caudate right anterior right posterior left medial

caudate

Which of the following correctly describes how to determine if a peripheral mass is intrahepatic or extrahepatic? evaluate the biliary tree for the presence of dilatation which is only seen with an extrahepatic mass assess the liver capsule and look for indentations that indicate extrahepatic origin or outward bulging that indicates intrahepatic origin assess the location of the mass in relation to the stomach use PW Doppler to obtain the RI of the lesion and compare it to the RI of the normal liver tissue

assess the liver capsule and look for indentations that indicate extrahepatic origin or outward bulging that indicates intrahepatic origin

Which of the following describes the sonographic appearance of FNH? single or multiple hypoechoic, rounded masses with mild posterior shadowing within the liver parenchyma a single hyperechoic mass most commonly found adjacent to the porta hepatis a single mass <5cm with a central scar and prominent central and radial vascularity diffuse echogenic nodules or foci scattered throughout the liver parenchyma

a single mass <5cm with a central scar and prominent central and radial vascularity

Compensatory enlargement of the caudate lobe occurs with which of the following? Wilson disease and glycogen storage disease cirrhosis and acute hepatitis fatty infiltration and glycogen storage disease cirrhosis and Budd Chiari

cirrhosis and Budd Chiari

A 43 year old female with a history of Hep C presents with jaundice, increased abdominal girth and pain. The most probable US finding in the liver will be: metastasis from GI tract cirrhosis and ascites schistosomiasis and splenic atrophy fatty filtration

cirrhosis and ascites

Contrast enhanced ultrasound is used to determine the outcome of tumor ablation in the liver. If the procedure was a success, what are the expected findings on the image? consistent contrast uptake occurs during the arterial and venous phase contrast uptake occurs during the venous phase contrast uptake occurs during the arterial phase no contrast enters the lesion during the cardiac cycle

no contrast enters the lesion during the cardiac cycle

A patient presents for a liver ultrasound due to a history of cirrhosis. The prior US report indicates the presence of a dilated umbilical vein. What is the proper probe position and location needed to demonstrate the umbilical vein as seen in the image? TRV, subcostal angulation SAG, intercostal SAG, just to the right of midline SAG, just to the left of midline

SAG, just to the left of midline

Which liver disorder leads to the sonographic appearance of hepatomegaly with decreased echogenicity and scattered bright portal reflections within the parenchyma? acute viral hepatitis hydatid disease chronic viral hepatitis cirrhosis

acute viral hepatitis

High-intensity transient signals (HITS) are seen on the Doppler evaluation of a patient with: portal venous gas hyperfunctioning adenoma significant aortic stenosis critical RA stenosis

portal venous gas

Which liver mass demonstrates characteristics most consistent with a klatskin tumor?

What usually causes an echinococcal cyst in the liver? hepatitis ingestion of raw oysters hemangioma ingestion of raw pork

ingestion of raw pork

The US exam of a patient's liver demonstrates a patent umbilical vein. The most common cause for this recanalization is: PHTN hepatitis ascites abscess

PHTN

A 10 year old presents for an abdominal ultrasound with a palpable RUQ mass. He has no history of liver disease and AFP levels are normal. You identify a 9cm mass in the right lobe that demonstrates punctuate calcifications and a central scar. These findings are most suggestive of: hepatoblastoma fibrolamellar carcinoma hepatoma metastasis

fibrolamellar carcinoma ** subtype of HCC found in adolescents and young adults

What is the yellow arrow pointing to? IVC tumor extension mass in the CBD retroperitoneal lymphadenopathy thrombus in the PV

thrombus in the PV

About 50% of all primary tumors that metastasize to the liver are drained through the: AO HV IVC PV

Which of the following liver abnormalities is commonly associated with the recanalization of the vessel within the structure indicated by the purple arrows? acute hepatitis cirrhosis fatty infiltration hydatid disease

cirrhosis

A mass that presents with a bull's eye appearance within the liver tissue is most likely ___. fatty sparing lymphoma FNH metastasis

metastasis

Which of the following statements is true regarding the image displayed? the liver is demonstrated in the TRV plane at the level of the caudate lobe and has a normal echotexture there is a mass identified in the lateral left lobe of the liver adjacent to the IVC there is a mass identified in the medial left lobe of the liver adjacent to the IVC the liver is demonstrated in the TRV plane at the levels of the caudate lobe and has a normal echotexture. there is an enlarged lymph node seen anterior to the AO and adjacent to the IVC

there is a mass identified in the medial left lobe of the liver adjacent to the IVC

Which type of liver abscess is caused by a parasite? pyogenic fungal amebic viral

amebic

A patient presents for a follow up ultrasound due to Budd Chiari. Which of the following is an expected finding on the exam? thrombosis of the HVs with hepatic congestion adrenal adenoma and/or kidney adenoma pancreatic head mass and dilated intrahepatic ducts prostatitis and neurogenic bladder

thrombosis of the HVs with hepatic congestion

Which of the following is true regarding a liver hemangioma? fluid and debris levels are commonly present a hemangioma is composed of an abnormal concentration of smooth muscle and Kupffer cells within the liver Color Doppler is not usually helpful in evaluating this highly vascular mass most hemangiomas demonstrate some level of posterior shadowing

Color Doppler is not usually helpful in evaluating this highly vascular mass

When reviewing a prior US exam for an upcoming follow up exam for the same patient, you come across an image labeled "sandwich sign." What are they referring to? extrinsic compression of the IVC by a pancreatic tumor the layering of the stomach wall at the head of the pancreas lymphadenopathy surrounding the PV the head of the pancreas is abnormally compressed between the liver and great vessels

lymphadenopathy surrounding the PV

A vascular condition of the liver seen in women who take oral contraceptives is: hereditary telangiectasia liver adenoma Budd Chiari portal aneurysm

Budd Chiari

Hypoalbuminemia associated with cirrhosis leads to: GB and bowel wall thickening liver capsule contraction and surface irregularities hepatomegaly nodule formation

GB and bowel wall thickening

Which metabolic infiltrative disorder is associated with hepatic adenoma formation? amyloidosis Von Gierke disease Wilson disease hemochromatosis

Von Gierke disease

A patient is referred for an abdominal ultrasound after a CT demonstrated a possible mass near the fundus of the GB. The ultrasound demonstrates mild hepatomegaly with a mild diffuse increase in echogenicity. The area in question appears hypoechoic to the surrounding tissues. These findings are most consistent with: hepatic adenoma focal fatty sparing diffuse fatty infiltration cystic artery thrombosis

focal fatty sparing

A patient is referred for a RUQ scan due to the possibility of a fungal infection of the liver. They have a 4 year history of treatment for AIDS. The liver demonstrates diffuse presentation of multiple calcifications of different sizes, with and without shadowing. These findings are most consistent with: steatosis liver pneumocystis carinii hydatid sand from echinococcal infection

pneumocystis carinii

A patient presents with abdominal pain for 3 months following a missionary trip to India. Lab values demonstrate normal LFTs. The US exam demonstrates a 3cm cyst with septations in the right lobe of liver. These findings are most consistent with: candidiasis hydatid disease histoplasmosis infection schistosomiasis

hydatid disease

Schistosomiasis is an ___ cause of PHTN. Budd Chiari syndrome is an ___ cause of PHTN. extrahepatic presinusoidal, intrahepatic postsinusoidal intrahepatic presinusoidal, extrahepatic presinusoidal intrahepatic presinusoidal, extrahepatic postinusoidal intrahepatic presinusoidal, intrahepatic postsinusoidal

intrahepatic presinusoidal, intrahepatic postsinusoidal

Which of the following describes the appearance of the liver in a patient in the later stages of cirrhosis caused by viral hepatitis? diffuse coarse liver echotexture with no nodule formation multiple nodules usually 1-5cm in size significant hepatomegaly with diffuse decrease in hepatic echotexture multiple nodules usually <1cm in size

multiple nodules usually 1-5cm in size

Which liver pathology is most commonly associated with the GB pathology demonstrated on the image? FNH hepatitis hepatoma fatty infiltration

hepatitis

Which of the following vessels will be abnormally dilated with significant PHTN? MPV only HVs only MPV and left gastric vein HVs, MPV, and left gastric vein

MPV and left gastric vein

If a liver transplant patient has a piggyback anastomosis, how does this affect your evaluation? there will be two anastomosis sites in the MPV that must be evaluated the HA anastomosis will not be able to be visualized because it is located deep within the liver tissue there will be a single anastomosis site in the IVC that must be evaluated each HV is connected to the native IVC separately, so there will be three anastomosis sites in the IVC that must be evaluated

there will be a single anastomosis site in the IVC that must be evaluated **piggyback - hepatic confluence of the transplant liver attached to native IVC (single anastomosis site) interposition - donor IVC segment replaces a segment of the native IVC (two anastomosis sites)

A patient is scheduled for abdominal ultrasound every 6 months due to their history of cirrhosis. Which of the following is true? patients with cirrhosis should have their liver vasculature evaluated regularly due to an increased risk of tumor invasion from metastasis patients with cirrhosis do not need to be evaluated regularly once the diagnosis has been made because the treatment options are limited cirrhosis commonly leads to ascites which may require intermittent thoracentesis treatments patients with cirrhosis should have their vasculature evaluated regularly due to an increased risk of portal thrombosis

patients with cirrhosis should have their vasculature evaluated regularly due to an increased risk of portal thrombosis

___ usually presents as multiple target lesions in the liver klatskin tumor metastasis fungal abscess hydatid disease

metastasis

What abnormality causes focal developmental lesions of the liver and is associated with congenital hepatic fibrosis, autosomal dominant polycystic disease and cholangiocarcinoma? biliary hamartomas Wilson disease schistosomiasis candidiasis

biliary hamartomas

The most frequently involved organ in metastatic disease is the: pancreas spleen liver GI tract

liver

All of the following statements correctly describe infantile hemangioendothelioma, EXCEPT: usually spontaneously regresses before age 2 years can lead to cardiac failure if associated with an AV malformation within the tumor most common benign vascular tumor of the liver in infants and toddles highly aggressive liver malignancy seen early in life

highly aggressive liver malignancy seen early in life

A TIPS shunt is placed into the liver circulation to alleviate PHTN. What two vessels are usually connected? RPV and LPV HA and PV RPV and RHV RHV and LHV

RPV and RHV

A patient presents with a history of AIDS and recent pneumocystis carinii infection. What charges to the liver do you expect to see on the ultrasound exam? diffuse increase in liver tissue echogenicity with ascites formation of multiple abscesses within the liver tissue gas-producing abscess near the porta hepatis diffuse echogenic foci throughout the liver tissue

diffuse echogenic foci throughout the liver tissue

___ is the most common liver malignancy, while ___ is the most common primary liver malignancy HCC, metastasis HCC, Kaposi sarcoma metastasis, HCC HCC, fibrolamellar carcinoma

metastasis, HCC

A 40 year old female patient presents with increasing RUQ pain over the last month, beginning upon returning from a trip to Indonesia. The findings on her exam are most consistent with: echinococcal cyst schistosomiasis cyst lymphatic cyst fungal abscess

echinococcal cyst

A patient presents with a history of Hep C and you identify a solid liver mass with a hypoechoic halo. This finding is most consistent with: HCC FNH hepatic adenoma hepatic metastasis

HCC

Which of the following is true regarding a liver hemangioma? Color Doppler is a valuable tool in evaluating this highly vascular mass fluid and debris levels are commonly present in a hemangioma most hemangiomas demonstrate some level of posterior shadowing a hemangioma is comprised of an abnormal concentration of vascular tissues within the liver

a hemangioma is comprised of an abnormal concentration of vascular tissues within the liver

A patient is scanned for symptoms of mild epigastric pain. A nearly isoechoic liver mass is identified in the caudate lobe. A liver biopsy demonstrates normal liver cell structure but abnormal cellular arrangement. What type of mass was identified on the US image? FNH hepatoma hemangioma adenoma

FNH **usually isoechoic to mildly hypoechoic to the liver tissue

A patient presens with increasing RUQ pain and vomiting after a recent liver biopsy. An irregular mass with internal debris and an overall heterogenous appearance is noted in the right lobe. The mass also demonstrates several echogenic foci with ringdown artifact. These findings are most suggestive of: hematoma abscess lymphocele pseudoaneurysm

abscess

How can a hepatic adenoma be differentiated from FNH on contrast enhanced ultrasound? FNH lesions usually demonstrate centripetal enhancement while adenomas demonstrate centrifugal enhancement FNH lesions demonstrate significant contrast uptake while adenomas demonstrate no contrast uptake FNH lesions demonstrate no contrast uptake while adenoms demonstrate significant contrast uptake FNH lesions usually demonstrate centrifugal enhancement while adenomas demonstrate centripetal enhancement

FNH lesions usually demonstrate centrifugal enhancement while adenomas demonstrate centripetal enhancement

Portalization of the HVs is a common finding in which of the following? mild to moderate steatosis severe tricuspid valve regurgitation hemolytic anemia advanced cirrhosis

advanced cirrhosis

The primary finding that differentiates liver mass formation from steatosis is: steatosis will cause wall thickening of the portal system while mass formation invades the wall steatosis causes an irregular liver surface contour while mass formation does not effect the surface contour of the liver steatosis will demonstrate normal vessel course through affected areas while mass formation displaces vasculature steatosis will cause dilated HVs while mass formation will cause narrowed HVs

steatosis will demonstrate normal vessel course through affected areas while mass formation displaces vasculature

Liver hemangiomas are a common benign neoplasm that will usually appear on an US of a normal liver as: cystic mass within the liver well defined, hyperechoic liver mass complex liver mass with irregular borders solid hypoechoic mass with posterior shadowing

well defined, hyperechoic liver mass

Which type of liver abscess presents as a mass with internal septations similar to the spokes of a wheel? fungal viral amebic pyogenic

fungal

Periportal cuffing is a sign of: acute viral hepatitis Caroli disease intrahepatic biliary tree obstruction extrahepatic biliary tree obstruction

acute viral hepatitis

Fulminant hepatitis is most commonly caused by: acetaminophen abuse alcohol abuse viral infection fungal infection

acetaminophen abuse

Which of the following describes the expected waveform from the HV in a patient with cirrhosis? triphasic, highly pulsatile antegrade flow monophasic, continuous retrograde flow monophasic, continuous antegrade flow triphasic antegrade flow without cardiac pulsatility

monophasic, continuous antegrade flow

Which of the following describes the Doppler appearance of liver transplant rejection? mottled appearance of the liver parenchyma with ascites low resistance flow in the PV high resistance flow in the HA nodular formations within the liver parenchyma

high resistance flow in the HA

In what lobe of the liver is the mass located? right caudate the mass is within the IVC not the liver left

caudate

What is the most common liver malignancy identified on ultrasound? hepatoma metastatic tumor klatskin tumor adenoma

metastatic tumor

A 6 month old female is referred for an abdominal ultrasound due to suspected Kasabach-Merritt syndrome. What are you looking for on the exam? liver or spleen hemangioma formation pancreatic divisum ascites, pleural effusion and abscess formation in the abdominal wall absence of the biliary tree

liver or spleen hemangioma formation

Which of the following is true regarding a transjugular intrahepatic shunt? air is retained within the shunt after placement which limits the US evaluation for the first 3-5 days the shunt is advanced into the liver through a puncture of the groin and common iliac vein a harvested branch of the HV is normally used as the shunt the shunt connects the dilated umbilical vein to the IVC

air is retained within the shunt after placement which limits the US evaluation for the first 3-5 days

Shear wave elastography can be used to assess the liver. Which of the following correctly describes the results of an abnormal exam? higher values indicate liver fibrosis red color superimposed over liver parenchyma indicates liver fibrosis lower values indicate liver fibrosis blue color superimposed over liver parenchyma indicates liver fibrosis

higher values indicate liver fibrosis <5kPA = normal 13-17kPA = highly suggestive of advanced chronic liver disease >17kPA = highly suggestive of clinically significant PHTN

A patient presents for a liver ultrasound due to a history of cirrhosis. While scanning in the subcostal SAG plane, just to the left of midline, you obtain the images displayed below. Which of the following best describes the findings? splenic varices patent umbilical vein dilated MPV esophageal varices

patent umbilical vein

The most common parasitic infection in humans is: pneumocystis carinii hepatitis schistosomiasis hydatid disease

schistosomiasis

If tardus parvus waveforms are identified in the intrahepatic artery waveforms of a transplant, this finding is ___. If biphasic waveforms are identified in the right and left hepatic arteries, the finding is ___. suspicious for HA stenosis, normal normal, suspicious for HA stenosis suspicious for organ rejection, suspicious for HA stenosis suspicious for HA stenosis, suspicious for organ rejection

suspicious for HA stenosis, suspicious for organ rejection

Cirrhosis causes reduced serum albumin levels. What complication does this cause? increased ammonia production ascites and peripheral edema jaundice recanalization of the umbilical vein

ascites and peripheral edema

Triglyceride accumulation in the liver leads to ___, while copper accumulation in the liver leads to ___. steatosis, hemochromatosis amyloidosis, hemochromatosis amyloidosis, steatosis steatosis, Wilson disease

steatosis, Wilson disease

Longitudinal images are presented of the anterior abdomen just superior to the umbilicus. What is the most common cause of the abnormality seen? PHTN polycythemia vera malignant HTN steatosis

PHTN

A patient presents with lower extremity edema and increased abdominal girth 2 weeks after a liver transplant. These findings are most suggestive of what complications? HV stenosis cholangitis HA stenosis biliary stricture

HV stenosis

Which of the following is the most common cause for intrahepatic cholestasis? hepatitis pancreatic head mass stone in the distal CBD fatty infiltration of the liver

hepatitis

HA hypertrophy is a common finding with: celiac axis stenosis splenic vein thrombosis cirrhosis cholecystitis

cirrhosis

Which of the following describes the most common sonographic appearance of hepatoma? solid mass that may be more or less echogenic than the liver parenchyma usually causes multiple diffuse solid mass formation most commonly demonstrates diffuse coarse liver texture in the affected lobe echogenic mass with a central scar

solid mass that may be more or less echogenic than the liver parenchyma

Which of the following correctly describes how contrast enhanced ultrasound can be used to differentiate benign and malignant masses? significant contrast uptake occurs in malignant nodules, while no contrast uptake is seen in benign nodules significant contrast uptake occurs in benign nodules, while no contrast uptake is seen in malignant nodules benign nodules usually demonstrate hypervascular enhancement while malignant tumors usually demonstrate hypovascular enhancement benign nodules usually demonstrate isovascular enhancement while malignant tumors usually demonstrate hypervascular enhancement

benign nodules usually demonstrate isovascular enhancement while malignant tumors usually demonstrate hypervascular enhancement

Portal thrombosis may lead to an accumulation of fluid in the abdomen called: pleural effusion pericardial effusion ascites retroperitoneal effusion

ascites

The most definitive sonographic sign of cirrhosis is: hepatoma formation associated hepatomegaly PHTN decreased liver size with coarse texture and nodule formation

decreased liver size with coarse texture and nodule formation

Pathology #3 Flashcards

(163 cards)