Ultrasound Flashcards
(40 cards)
RFs for gallbladder carcinoma
Chronic cholecystitis (gallstones seen in most cases)
Underlying conditions: PSC, IBD (UC>Crohns)
Ethnicity (native americans)
FHx
Obesity, diabetes
Most common GB met
Melanoma
DDx. diffuse GB wall thickening
- Fluid overload: CHF, cirrhosis, hypoproteinemia (malnutrition), renal disease
- Inflammatory/infectious: Cholecystitis (acute and chronic), hepatitis, pancreatitis, etc.
- Infiltrative neoplastic disease: GB carcinoma, mets
- Post-prandial state
Risk factors for cholangiocarcinoma
- PSC (major risk factor in NA)
- RPC (asians)
- Choledocholithiasis
- Asian liver flukes
- Caroli disease/choledochal cysts
- Viral hepatitis
- Toxins
Most common US finding in viral hepatitis
Normal!!
Other findings: starry sky (echogenic portal triads), diffuse GB wall thickening
Ddx for hyperechoic mass in liver
- Hemangioma
- Hepatoma
- Mets (CC - 50%, RCC, breast, NETs, chorioCa)
- Fat containing HCC
US appearance of FNH versus adenoma
FNH - “stealth” lesion - difficult to detect, may have spoke-wheel configuration of vessels in central scar
Adenoma - can look like anything, hypo->hyperechoic (due to presence of fat), hypoechoic halo often seen
Ddx calcified liver mets
Colon Ca (esp mucinous subtype) Gastric adeno
Ddx cystic mets in liver
Ovarian Colorectal NET - classically have fluid fluid level Pancreatic adenoCa Melanoma
Which malignancy gives the pseudo-cirrhosis appearance of the liver
Treated breast Ca
Cause of increased and decreased hepatic vein pulsatility
Increased: Tricuspid regurgitation (accentuated A wave, reduced S wave), right-sided HF (accentuated A wave, normal S wave)
Decreased: Cirrhosis, Budd-Chiari (hepatic vein thrombosis), hepatic veno-occlusive disease (bone marrow transplant, chemo causing fibrosis of sinusoids)
Causes of pulsatile waveform in PV
Anything that causes transmitted pulsations
- TR, right sided HF
- AV shunt (cirrhosis), AV fistula (HHT)
Doppler findings in portal HTN
Low PV velocity (<16 cm/s)
Dilated main PV >14 mm
Hepatofugal flow
Portosystemic shunts
DDx: hypoechoic splenic lesions
Sarcoid Mets Lymphoma Abscess Infarct
US findings RVT post-transplant
Reversal of diastolic flow in RA (but can also be seen with allograft torsion, rejection, ATN)
Upper limit velocities in renal transplant
PSV 340-400 cm/sec at anastomosis
Other signs: delayed/blunted systolic upstroke downstream (tardus-parvus waveform), reduced RIs
List the values for grading carotid stenosis
Normal
<50%: visible plaque, but PSV<125 cm/s; ICA/CC PSV <2; end diastolic ICA<40 cm/s
50-69%: visible plaque, PSV125-230 cm/s; ICA/CC 2-4; end diastolic ICA 40-100 cm/s
>70% (but no near occlusion: PSV>230 cm/s; ICA/CC >4; end diastolic ICA >100 cm/s
Appearance in near occlusion of ICA in carotid stenosis?
- markedly narrow lumen on color and power Doppler
- slow and dampened (pseudovenous) flow velocity
- systolic spikes with absent or reversed diastolic flow (distal stenosis and occlusion can also have this appearance)
Doppler velocity cannot be relied upon to identify near-occlusion, especially with only partial collapse, where the peak systolic velocity may be misleadingly normal or elevated
Causes of renal artery stenosis
Atherosclerosis - most common FMD - second most common - younger, distal RA Vasculitis - PAN, takayasu NF1 - usually at the osmium Aorta - coarctation/dissection
Causes of elevated RIs in the kidney
Native kidney:
- medical renal disease
- obstruction
Transplant kidney:
- ATN
- Acute or chronic rejection
- Renal vein thrombosis
- Obstruction
- Drug toxicity
*Decreased RI seen in RAS (downstream from stenosis the velocities are decreased)
PSV for diagnosis of RAS
> 200 cm/s (or renal artery to aorta velocity ratio >3.5)
Key consideration for cystic node in neck on US
Papillary thyroid carcinoma versus SCC
Most common type of uterine malformation
Septate - also most likely to have miscarriage
Most common renal anomalies associated with MDA
Renal agenesis (most common)
Crossed fused renal ectopia
Duplex kidney
