Ultrasound Madness Flashcards

Question

Describe gallbladder sludge

Answer 1

consists of calcium bilirubinate granules and cholesterol crystals. -appears as nonshadowing reflectors localizing in the dependent portion>> forming a bile-sludge level - may fill the entire GB lumen - may form mass-like aggregates: sludge balls or tumefactive (no blood flow) sludge - Stones may coexist - can form echogenic bands >>confused with sloughed membranes -may produce Doppler twinkle artifact **In some cases the crystalline components of the sludge float in the nondependent portion of the GB lumen, producing multiple comet-tail artifacts **don’t confuse with stones -biliary crystals may cause pancreatitis and this can make the detection of sludge important in patients with pancreatitis of unknown origin

Answer 2

``` -Gallstones Wall thickening (≥3 mm) -Gallbladder enlargement >4 cm transverse >10 cm longitudinal Pericholecystic fluid -Impacted stone -Sonographic Murphy's sign ```

Answer 3

``` Pericholecystic fluid Sloughed mucosal membranes Wall disruption Wall ulceration Focal wall bulge ```

Answer 4

The fundus >> least vascularized portion of GB

Answer 5

manifests as bright reflections from a nondependent portion of the gallbladder wall The associated acoustic shadow is usually dirty and may demonstrate ring-down artifact

Answer 6

Mass centered on gallbladder fossa with associated stones Eccentric irregular wall thickening Bulky intraluminal polypoid mass Infiltration of adjacent liver or vessels Periportal and/or peripancreatic lymphadenopathy Bile duct obstruction -/+ detectable blood flow within mass

Answer 7

``` Common: Polyps (“ball on the wall”) Adenomyomatosis Gallbladder cancer Tumefactive sludge ``` Uncommon: Metastasis Chronic cholecystitis

Answer 8

``` Biliary: Cholecystitis Adenomyomstosis AIDS cholangiopathy Sclerosing cholangitis Cancer ``` ``` Non-Biliary: *more marked thickening Hepatits * Pancreatitis Heart failure Hypoproteinemia Cirrhosis Portal hypertension Lymphatic obstruction Mononucleosis ``` Most nonbiliary causes of gallbladder wall thickening produce concentric thickening that usually has a regular or irregular layered appearance with both hypoechoic and echogenic components.

Answer 9

associated with chronic gallbladder inflammation and 95% of the cases have gallstones USS: with extensive transmural calcification, it will appear as an echogenic arc with dense posterior shadowing

Answer 10

Thickened muscular layer Mucosal herniations:Rokitansky-Aschoff sinuses Comet tail artifact: cholesterol deposit in sinuses

Answer 11

Periportal fibrofatty tissue >> produce brighter echoes around portal V, adjacent hepatic arteries and bile ducts

Answer 12

``` 13-17cm at midclavicular line Echogenecity: >/= right kidney =/< pancreas < spleen Homogenous Smooth ```

Answer 13

extension of the right lobe BELOW the lower pole of the kidney (in the absence of a Riedel's lobe), - rounding of the inferior tip of the liver - extension of the left lobe into the left upper quadrant above the spleen.

Answer 14

Classic 3: - anechoic lumen - increased through transmission - well defined back wall *may have partial septation or puckering Complex: * often due to hemorrhage - internal echoes - thick wall - numerous thick septations - solid component - calcification *doppler to rule out vascular lesion

Answer 15

Common -Cysts Uncommon - Abscess - Hematoma - Cystic metastases - Biloma - Echinococcus ``` Rare Aneurysm/pseudoaneurysm Arterioportal fistula Portal hepatic vein fistula Biliary cystadenoma (carcinoma) ```

Answer 16

Most common benign liver neoplasm Women > Men - a homogeneous, hyperechoic mass that is usually less than 3 cm in size. - sharp/smooth margins - round/slightly lobulated * some> hyperechoic periphery with isoechoic center “reverse-target” *blood flow is generally too slow to be detected with Doppler techniques. >>

Answer 17

Common -Hemangioma Uncommon - Metastases - Fatty infiltration (focal or diffuse) **steatosis may obscure hemangioma OR make it appear hypoechoic - Hepatocellular cancer Rare - Adenoma - Focal nodular hyperplasia -Lipoma

Answer 18

- isoechoic or nearly isoechoic to liver (cellular makeup similar to liver>> hepatocytes, Kuppfer cells, biliary structures - spoke-wheel pattern of internal vascularity is better displayed on color or power Doppler than on CT or MRI.

Answer 19

Women taking brith control pills (incidence related to dose and duration of use) Men taking anabolic steroids *multiple >>hepatic adenomatosis Simple >> homogenous, often hypoechoic Prone to bleed (surgical lesion)>> Internal hemorrhage or necrosis usually produces a heterogeneous appearance and/or complex cystic components - Intratumoral fat >> hyperechoic appearance. - calcification in 10% - Free intraperitoneal w intraperitoneal rupture

Answer 20

Rare/benign -consists of abundant fibrocollagenous tissue containing disorganized bile ducts - typically <5mm - usually solid, nonshadowing, homogeneous, and either hyperechoic or less commonly hypoechoic - may produce comet-tail artifacts ** multiplicity and size of these lesions should suggest the diagnosis

Answer 21

an echogenic or isoechoic center with a hypoechoic halo * Thin halos >> dilated peritumoral sinusoids or compressed liver parenchyma, * Thick halos>> proliferating tumor DDX: Common METASTASES! *usually multiple Hepatocellular cancer ``` Uncommon Lymphoma Focal nodular hyperplasia Pyogenic abscess Fungal microabscess Adenoma ``` **mets can have a variety of appearances

Answer 22

-5th most common malignancy worlwide Features are variable: solitary, multifocal, diffuse and infiltrating (eg hepatic vasculature) One typical pattern>> large dominanting lesion with scattered small satellite lesions

Answer 23

Any solid mass detected in an initial sonogram in a patient with cirrhosis should be considered malignant until proven otherwise! *even if features suggest hemangioma

Answer 24

- appear as complex fluid collections with mixed echogenicity, thick walled cystic lesions or as cysts with fluid-fluid levels - may mimic solid hepatic mass - presence of through transmission >> clue to liquefied nature of mass. - gas>> highly reflective regions with shadowing and ring down artefacts - may calcify DDX: hematoma, hemorrhagic cysts, necrotic or hemorrhagic tumor **fungal abscess: typically not larger than 1cm, target sign

Answer 25

occurs most often in immunocompromised state >> AIDS or post transplantation * a very homogenous tumor, typically hypo echoic * may appear as a target lesion

Answer 26

- marked discrepancy between hyper echoic liver and less echogenic kidney - liver more hyper echoic than pancreas (normally pancreas is more echogenic) - finer echotexture of liver parenchyma (increased concentrations of tiny reflectors (fatty infiltrates)) -can be patchy/geographic **spared parenchyma usually in front of right portal vein or portal bifurcation or around gallbladder >> appears hypo echoic **focal fatty sparing

Answer 27

Caused by cellular death and resulting fibrosis and regeneration Commonly: alcohol abuse >> micro nodular change (<1cm) Next common: hepatitis >> macro nodular (1-5cm) Nodularity seen on parenchymal surfaces and interfaces Coarsening of parenchyma

Answer 28

- ascites - splenomegaly - sluggish portal flow - portosystemic collaterals (recanalaized umbilical vein *usually straight, coronary vein seen immediately posterior to splenic artery) - enlergrd hepatic arteries - hepatofugal (reversed) portal flow

Answer 29

Uncommon due to dual arterial and portal blood supply Even in setting of total portal vein thrombosis Usually occur only in advanced underlying vascular disease of liver

Answer 30

Small, individual, bright, intraluminal reflectors that move with the portal blood flow are seen on gray scale ** may be confused with pneumobilia, gas-containing abscesses, or calcifications on sonography and is more easily recognized on CT

Answer 31

Dilated intrahepatic ducts can be distinguished from portal veins by: - their tortuosity - wall irregularity, - presence of increased through transmission - a stellate configuration centrally - lack of Doppler signal - if ducts more than 40% of the diameter of adjacent portal vein, - peripheral ducts more than 2 mm in diameter * Confusion >> in setting of portal hypertension when hepatic arterial flow increases to compensate for decreased portal venous flow

Answer 32

multifocal saccular dilatation of the intrahepatic bile ducts with sparing of the extrahepatic ducts -Central dot sign Commonly associated with: - hepatic fibrosis >> which leads to portal HTN and variceal bleeding - cystic kidney disease

Answer 33

an uncommon phenomenon that results in extrinsic compression of an extrahepatic biliary duct from one or more calculi within the cystic duct or gallbladder USS detection: in the setting of dilated ducts if an extrinsic mass effect from a shadowing stone is seen at the level of obstruction

Answer 34

well-defined cyst with a 'neck' at its deepest extent, extending into the space between the semimembranosus tendon and the medial head of the gastrocnemius - at posteromedial knee - looks like a "speech bubble" -may be simple appearing or contain internal echoes, internal septations, thick irregular walls, nodular synovial proliferation, and loose bodies

Answer 35

Gravid uterus reveals an echogenic, heterogeneous mass with multifocal small cystic spaces (hydropic villi) filling the endometrial canal *Theca Lutein cysts -an associated finding in 15-30% of COMPLETE moles >> a result of hyperstimulation of the ovaries from excessive circulating serum hCG. >>the ovaries demonstrate frank enlargement with essential replacement by multiple, large cysts

Answer 36

An epithelial cell cancer Accounts for approx 80% of all thyroid Ca !! Most prevalent in young females USS: hypoechoic with microcalcifications (“snowstorm apperance”)and hypervascularity

Answer 37

Renal vein thrombosis ``` USS: Enalrged kidney Visible thrombus Absence of flow Reversal of diastolic flow within the main renal artery and the intrarenal arteries. ```

Answer 38

Determination of chorionicity and amnionicity the “twin peak” or “lambda” sign: -Best seen at approximately 10 to 14 weeks’ gestational age - extremely specific sign of dichorionicity, regardless of the stage at which it is detected - a triangular appearance of the chorion insinuating between the layers of the intertwin membrane

Answer 39

- calcifications within the layers of tunica vaginalis >>echogenic foci with posterior acoustic shadowing - Benign - hx of previous trauma/inflammation - NO association to testicular cancer unlike testicular microlithiasis

Answer 40

In pregnant women: Abdominal wall defects (Omphalocele, gastrochisis) Neural tube defects (spina bifida, anencephaly) False positives: - multiple gestations - gestational diabetes ``` Non pregnant individuals: -LIVER Hepatocellular cancer Metastatic liver cancer Liver cirrhosis Hepatitis ``` - Germ cell tumors - Yolk sac tumor -Ataxia telangiectasia **LOW maternal AFP: Down Syndrome

Answer 41

- Hyperparathyroidism (40%) - Medullary Sponge Kidney (20%) - Distal Type 1nRenal Tubular Acidosis (20%) - Drugs (steroids, furosemide) - Sarcoidosis * Initially may appear as hyperechoic rings around the pyramids >> progress to markedly hyperechoic renal pyramids, which may produce distal acoustic shadowing

Answer 42

AKA hepatic venous outflow obstruction (HVOO), -caused by partial or complete obstruction of one or more hepatic veins or the IVC Features: - hepatomegaly - splenomegaly - heterogenous echo texture of liver - no detectable flow or reversed flow on color Doppler, - ascites - hypertrophied caudate lobe **causes -IDIOPATHIC (1/3 cases) -hypercoaguable states (pregnancy, meds) -venous thrombosis sec. to >>dehydration, sepsis >>tumor -inflammation >> autoimmune -trauma

Answer 43

a chronic anovulation syndrome associated with androgen excess Rotterdam criteria, 2 out of 3 for diagnosis: - oligo/anovulation - hyperandrogenism - polycystic ovaries USS: enlarged ovaries with volume >10 cc and >12 follicles per ovary measuring <10 mm in diameter ``` ** Other clinical findings: -hirsutism -obesity -infertility, acne, alopecia or; -biochemically show increased androgen levels ```

Ultrasound Madness Flashcards

(69 cards)