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Flashcards in ultrasoundflash Deck (180):
1

Distinguishing characteristics between AMLs and hyperechoic RCCs?

AMLs tend to have acoustic shadowing. Hyperechoic RCCs may have cystic elements, calcifications, or hypoechoic halo.

2

Caudate lobe drains into what vein?

IVC via small veins separate from hepatic veins. Caudate veins function as collaterals in Budd-Chiari syndrome.

3

Distinguishing ultrasound features of peritoneal fluid collections versus simple ascites?

Fluid collections displace and distort adjacent structures. Ascites conforms to adjacent structures.

4

Causes of fatty liver infiltration?

Obesity. Alcohol abuse. TPN. Diabetes. Malnutrition. Steroid use. Hepatic toxins. Chemotherapy.

5

Usefull clue in located parathyroid adenomas and lymph nodes?

Parathyroid adenomas are medial to carotid arteries. Lymph nodes are usually lateral to carotids.

6

Baker's cyst, most characteristic diagnostic feature at Ultrasound?

Neck that extends between medial head of gastrocnemius and semimembranosus tendon.

7

Syndrome caused by hepatic hemangioma that sequesters platelets?

Kasaback-Merritt syndrome.

8

What markers are elevated in a pancreatic pseudocyst aspirate compared to a pancreatic cystic neoplasm aspirate?

Pseudocyst aspirate elevated amylase. Neoplastic aspirate elevated carcinoembryonic antigen.

9

Funiculocele, what is it?

Spermatic cord hydrocele.

10

Difference between a replaced and an accessory artery?

Replaced: Artery arises from an anomalous source (1 anomalous artery). Accessory: one of atleast two arteries arises from an anomalous source (2 arteries present, 1 artery anomalous).

11

Which gallstones can float?

Cholesterol stones can float in high specific gravity bile.

12

What patient's benefit from an carotid endarterectomy?

Symptomatic patients with stenosis >70%.

13

Best study to identify a splenule?

Sulfur colloid scan or heat-damaged tagged RBC scan.

14

Reversed flow in the internal mammary veins indicates?

Central venous obstruction

15

Solid renal neoplasms?

RCC. TCC. Renal medullary carcinoma. Renal sarcoma. Metastases. Lymphoma.

16

Sickle cell trait and solid renal neoplasm?

Renal medullary carcinoma.

17

When do hematomas and lymphoceles appear in renal transplant patients?

Hematoma: Immediately after transplant Lymphocele: 1 to 2 months posttransplant

18

Most common cause of calcified liver tumor?

Metastases.

19

Morton neuroma?

Benign mass of plantar digital nerves of the foot.

20

Which side is subclavian steal more common on?

Left.

21

What is normal portal vein velocity?

20 cm/s.

22

Pancreatic neoplasm almost exclusively seen in women?

Macrocystic neoplasm.

23

RCC stage when tumor invades renal vein or IVC?

At least IIIa

24

2 common liver locations for focal fatty infiltration?

Preportal. Anterior left lobe adjacent to ligamentum teres.

25

Resistive index (RI) formula?

RI = (S-D)/S

26

Parenchymal organ normal resistive index (RI)?

27

Midline prostate cysts?

Utricle cyst. Mullerian cyst.

28

What replaced artery can be seen coursing through the ligamentum venosum?

Replaced left hepatic artery.

29

Mucinous macrocystic pancreatic neoplasm, common locations?

Body and tail of pancreas.

30

Distinguish between classic and limited microlithiasis of testis?

Classic: > 5 microliths on 1 view. Limited: less than 5 on 1 view.

31

Multilocular cystic nephroma, population?

Young boys (3 months - 4 years). Adult women (>30 years old).

32

2 most common masses in the hand?

Ganglion cyst. Giant cell tumor.

33

Does a giant cell tumor move with the associated tendon?

No, it arrised from the tendon sheath not the tendon.

34

TCC, most common anatomy involved?

Bladder > renal pelvis > ureter.

35

Pheochromocytoma's 10% rule?

10% malignant. 10% extra-adrenal. 10% bilateral. 10% associated with MEN.

36

Vascular pattern of FNH at ultrasound?

Spokewheel pattern.

37

Most definitive means of diagnosing FNH?

Sulfur colloid scanning.

38

Chronic calcific pancreatitis is caused by?

Alcoholic abuse, not gallstones.

39

Focal fatty sparing within the liver commonly occurs where?

Around the gallbladder. At portal bifurcation.

40

What is Page kidney?

Renal subcapsular hematoma causing hypertension.

41

Effect of renal vein thrombosis on resistive index (RI) of renal artery?

Normal to increased RI.

42

Horseshoe kidney predispositions?

Urinary obstruction. Stone formation. Rrenal trauma. Questionable increase risk of Wilm's tumor.

43

Upper limit of normal renal artery velocity?

180-200 cm/s.

44

Bile duct blood supply?

Hepatic artery. In liver transplant hepatic artery thrombosis bile ducts may form strictures due to ischemia.

45

Common factors that render pancreatic cancers nonresectable?

Lver metastases. Peripancreatic vessel invasion. Peritoneal spread.

46

Ultrasound signs of complete tendon rupture?

Blunt tendon tip (longitudinal view). Mass (transverse view). Refractive shadowing. Nonvisualization. Loss of fibrillar architecture. Fluid collection.

47

Sonographic signs of full-thickness rotator cuff tear?

Anechoic or hypoechoic defect. Focal superficial contour abnormality. Compressibility. Nonvisualization.

48

Characteristics of pseudoaneurysms on ultrasound?

Complex fluid collection. Single of multiple loculations. Visible pulsations on gray-scale imaging. Internal luminal flow on color Doppler. To and fro flow in the neck.

49

Characteristics of iatrogenic arteriovenous fistulas at ultrasound?

Usually located below femoral artery bifurcation. Perivascular tissue vibration. Low-resistance flow in supplying artery near fistula. High-velocity flow at site of communication. Turbulent and/or arterialized flow in draining vein near fistula.

50

Extremity artery waveform?

High-resistance flow. Typically triphasic waveform: Antegrade systole, retrograde early diastole, antegrade in mid diastole, absent flow in end diastole.

51

Extremity venous waveform?

Respiratory phasicity. Variable cardiac related pulsatility.

52

Factors that decrease chance of scrotal malignancy?

Extratesticular. Nonpalpable. Simple cystic appearance. No detectable vascularity.

53

Factors that increase chance of scrotal malignancy?

Intratesticular. Palpable. Solid or complex cyst. Detectable internal vascularity.

54

Germ cell tumor list?

Seminoma. Embryonal cell carcinoma. Teratoma. Choriocarcinoma. Yolk sac. Mixed germ cell.

55

Stromal testicular tumors?

Leydig cell tumor. Sertoli cell tumor.

56

Other non-germ cell and non-stromal testicular neoplasms?

Lymphyoma/leukemia. Metastases. Epidermoid cyst.

57

Testicular lesions mimicking tumors?

Focal orchitis. Focal atrophy/fibrosis. Infarcts. Abscess. Hematoma. Contusion. Sarcoid. Tuberculosis. Adrenal rest tissue.

58

Causes of enlarged hypoechoic testis?

Orchitis. Torsion. Lymphoma. Seminoma.

59

Of the four causes of enlarged hypoechoic testes, which have increased/decreased blood flow?

Increased flow: Orchitis. Lymphoma. Seminoma. Decreased (torsion).

60

Primary neoplasms of the bladder?

TCC. Adenocarcinoma. SCC. Pheochromocytoma.

61

Causes of bladder wall lesions from adjacent neoplasms?

Rectum. Prostate. Cervix. Uterus.

62

Causes of bladder wall lesions from inflammation from adjacent organs?

Diverticulitis. Crohn's disease. PID. Appendicitis.

63

Other bladder wall lesions?

Ureteroceles. Urachal cyst. Cystitis cystica. Endometriomas. Fistulas. Malakoplakia. Leukoplakia. Tuberculosis. Shistosomiasis.

64

Frequency of prostate cancer per anatomical zone?

Peripheral zone 75%. Transitional zone 20%. Central zone 5%

65

Percentage of prostate cancers that are hypoechoic?

Hypoechoic 70%. Hyperechoic/mixed 30%.

66

Sonographic characteristics of seminoma?

Homogeneous and hypoechoic.

67

Most common scrotal mass?

Spermatocele.

68

Causes of hydroceles?

Idiopathic (most common). Tumors. Torsion. Inflammatory disorders. Trauma.

69

Varicocele percentage on the left?

Left-sided 85%. Right-sided 15%.

70

Scrotal mass with peripheral calcification and/or onion peel appearance?

Epidermoid cyst.

71

Testicular microlithiasis and germ cell tumor relevance?

Isolated microlithiasis increases risk of germ cell cancer. Annual physical exam recommended.

72

Besides absent blood flow, other signs of testicular torsion?

Enlarged hypoechoic testis. Torsion knot. Reactive hydrocele. Scrotal wall thickening.

73

Distinguishing characteristic of blood clot from bladder cancer on ultrasound?

Blood clot is mobile.

74

After injection of vasoactive substance, normal penile Doppler should have a deep cavernosal velocity that exceeds?

35 m/s

75

Plaque formation in the tunica albuginea of the corpora cavernosa?

Peyronie's disease.

76

Sonographic signs of acute pancreatitis?

Decreased or heterogeneous pancreatic echogenicity. Pancreatic enlargement. Peripancreatic fluid collection. Perivascular fluid collection. Periduodenal fluid collection. Perirenal fluid collection.

77

Complications of Pancreatitis?

Pseudocyst formation. Bile duct obstruction. Pancreatic abscess. Venous thrombosis. Pseudoaneurysm.

78

Causes of solid hypoechoic pancreatic masses?

Carcinoma. Focal Pancreatitis. Lymphoma. Metastases. Islet cell tumors. Thrombosed aneurysm.

79

Pancreatic cystic lesions?

Pseudocyst. Macrocystic (mucinous) tumor. Microcystic (serous) tumor. Intraductal papillary mucinous tumor. Solid and papillary epithelial neoplasm. Autosomal dominant polycystic kidney disease. von Hippel-Lindau disease. Cystic fibrosis. Aneurysm/pseudoaneurysm.

80

Normal pancreatic duct should mearsure?

Less than or equal to 3 mm, but can enlarge with age.

81

Sonographic signs of chronic pancreatitis?

Pancreatic calcification. Ductal dilation. Ductal irregularity. Parenchymal atrophy.

82

Pancreatic and islet cell tumors are generally hypoechoic. T/F?

TRUE

83

Pancreatic neoplasm that contains serous fluid, consists of multiple small cystic elements, and is benign?

Microcystic adenoma.

84

Pancreatic neoplasm that contains mucinous fluid, large cystic elelements, thick septations, solid elements, and can be malignant or benign?

Macrocystic tumors.

85

Solid spleen lesions?

Hemangiomas. Hamartomas. Lymphomas. Metastases. Infarcts. Abscesses. Sarcoidosis. Granulomas. Extramedullary hematopoiesis.

86

Causes of splenomegaly?

Heart failure. Portal hypertension. Leukemia. Lymphoma. Hepatitis. Mononucleosis. Generalized infections. Hemolytic anemias. Glycogen storage disease. Malaria. Myelofibrosis.

87

Lymphoma and leukemia sonographic appearance in the spleen?

Focal. Multifocal. Diffuse. Almost always hypoechoic.

88

Multiple small calcifications within the spleen?

Granulomatous disease. Histoplasmosis. Tuberculosis.

89

The age of pregnancy definition?

1st day of LMP/

90

When is the earliest, on TV US, that gestational sac, yolk sac, and embryo can be seen?

Gestational sac 5 wks. Yolk sac 5.5 wks. Embryo 6 wks.

91

What structure, if seen, can confirm a IUP even before the embryo is identified?

Yolk sac.

92

What is better at estimating gestational age than LMP?

1st trimester CRL (crown rump length). 2nd trimester biparietal diameter (+/- 1 wk) LMP (+/- 2 wks)

93

Normal gestational sac characteristics on US?

Correct positioning within uterus. Double decidual sac DDS. Continuous hyperechoic rim > 2mm. Spherical or ovoid shape. Growth of > 1.2 mm/day.

94

2 hyperechoic lines surrounding a hypoechoic closed endometrial canal?

DDS, Double decidual sign

95

How does seeing a DDS help in 1st trimester US?

Its absence is more suggestive of miscarriage or ectopic pregnancy. Does not exclude IUP.

96

At what CRL is heart activity expected?

5 mm.

97

By 5 wks the embryonic heart rate should be?

> 120.

98

After 3 wks the embryonic heart rate should be?

120 - 180

99

At what Beta-hCG level should an intra-uterine gestation sack be seen on TV US?

2000 IU/L

100

In early pregnancy the Beta-hCG level should double how often?

Every 2 days.

101

Differential diagnosis of positive pregnancy test?

IUP. Miscarriage. Ectopic pregnancy.

102

Risk factors for ectopic pregnancy?

Abnormal fallopian tubes. Previous ectopic pregnancy. IUD. Fertility medication. In-vitro fertilization.

103

Beta-hCG level in an ectopic pregnancy patients increases slower or faster than an IUP?

Slower.

104

Where can an ectopic pregnancy occur within the uterus?

Cornua. Cervix.

105

Define an heterotopic pregnancy?

Concomitant intrauterine and extrauterine pregnancy.

106

What is a pseudogestational sac?

Collection of fluid or decidual cast within endometrial canal or thickened endometrium in an ectopic pregnancy.

107

With a positive pregnancy test, give 5 findings that have positive predictive value for ectopic pregnancy?

Gestation sac in ectopic position Adnexal mass with yolk sac or embryo. Tubal ring appearing as an empty gestation sac. Complex or solid adnexal mass. Moderate amount of intraperitoneal fluid.

108

Common causes of bowel wall thickening?

Inflammation. Infection. Neoplasm. Ischemia. Edema. Hemorrhage.

109

Sonographic signs of appendicitis?

Diameter greater than 6 mm. Lack of compressibility. Inflamed, echogenic periappendiceal fat. Hyperemia. Appendicolith. Adjacent fluid collection.

110

Causes of peritoneal masses?

Metastases. Tuberculosis. Mesothelioma. Pseudomyxoma peritonei. Omental infarct.

111

Causes of abdominal wall masses?

Metastases. Lipoma. Hernia. Hematoma. Abscess. Seroma. Desmoid. Endometriosis. Sarcoma. Lymphoma.

112

Features of Abdominal Aortic Aneurysms?

95% infrarenal. Majority are fusiform. Mural thrombus common with large aneurysm. Surgery considered when >5 cm. AP diameter measured on sagittal images. Transverse diameter measured on coronal images.

113

Common causes of adrenal masses?

Adenoma. Metastases. Pheochromocytomas. Primary carcinoma. Lymphoma. Myelolipoma. Hemorrhage.

114

Pseudokidney sign?

Extensive mesenteric adenopathy.

115

Distinguishing feature of tumor thrombus from blood clot?

Tumor thrombus has internal vascularity.

116

Ultrasound is not good at characterizing most adrenal masses, except for?

Myelolipomas.

117

Benign characteristics of thyroid nodules?

Cystic elements. Hyper or isoechoic. Eggshell calcification. Inspissated colloid.

118

Malignant characteristics of thyroid nodules?

Entirely solid. Hypoechoic. Microcalcifications. Associated cervical adenopathy.

119

Characteristics of parathyroid adenomas on ultrasound?

Solid. Hypoechoic. Oval shape. Hypervascular. Posterior to thyroid. Medial to carotid.

120

Locations of ectopic parathyroid adenomas?

Low neck. Mediastinum. Retrotracheal/retroesophageal. Carotid sheath. Intrathryoidal.

121

Characteristics of Neoplastic Neck Lymph Nodes?

Obliteration of echogenic hilum. Long-axis to short-axis ration less than 1.5. Cystic changes. Microcalcifications.

122

Differences between ICA and ECA?

ICA: Larger. Posterolateral location. No branches. Low resistance wavefore. Negative temporal tap. ECA: Smaller. Anteriomedial location. Branches. High resistance waveform. Positive temoral tap.

123

ICA peak systolic velocities and associated stenoses?

Normal less than 125cm/s. 50-69% stenosis 125-230 cm/s. >70% stenosis >230 cm/s. Near occlusion variable. Complete occlusion no flow.

124

Midline complex lesions that are usually intimately associated with the hyoid bone?

Thyroglossal duct cyst.

125

Most common cause of hyperparathyroidism?

Parathyroid adenoma.

126

Carotid artery flow velocities and ratios start to increase at what stenotic level?

>50% stenosis.

127

Sonographic characteristics of unstable carotid artery plaques?

Heterogenous plaques with focal hypoechoic regions.

128

Causes of polyhydramnios?

Idiopathic. Maternal (diabetes). Fetal (Anomalies, Hydrops).

129

Findings in anencephaly

Absence of normal calvarium and brain above orbits. Residual dysmorphic brain may be seen, called angiomatous stroma.

130

Moderate to marked polyhydramnios is often associated with what fetal anomalies?

CNS. GI. Fetal hydrops.

131

Fetal head measurements (BPD and HC) are accurate for gestational age until when?

Within 1.2 weeks up to 24 weeks. Accuracy decreases in third trimester.

132

Fetal lateral ventrical evaluation and measurement?

Measured at atria. Less than or equal to 10 mm. Choroid plexus occupying 60%. Small or dangling choroid plexus may indicate ventriculomegaly.

133

Regardless of hydrocephaly severity there is always a?

Thin cortical mantle. Hydrancephaly may mimic this but instead is destroyed brain.

134

Holoprosencephaly

Midline developmental anomaly, three forms (alobar, semilobar, lobar).

135

Relatively common anterior cephalocele

Ethmoidal sinus region.

136

Banana shaped cerebellum?

Neural tube defect with downward displacement of cerebellum.

137

Enlarged cisterna magna with splaying of cerebellar hemispheres and a vermian defect?

Dandy-Walker abnormality.

138

A nuchal fold measurement above _____ is a marker for trisomy 21?

6 mm.

139

Choroid plexus cyst possibilities?

Normal or other chromosomal abnormalities such as trisomy 18.

140

Secondary abnormalities of the skull that occur with spinal defects?

Lemon sign (least specific). Banana sign. Hydrocephalus.

141

Large aorta in fetal ultrasound?

Tetralogy of Fallot. Truncus arteriosus.

142

Small aorta in fetal ultrasound?

Coarctation. Hypoplastic left heart.

143

Small pulmonary artery in fetal ultrasound?

Hypoplastic right heart. Ebstein's anomaly with pulmonary hypoplasia.

144

Fetal hydrops generalities

Immune and nonimmune causes. Excessive fetal body water. Fluid in serous cavities, skin thickening, placental enlargement, polyhydramnios.

145

Fetal pericardial effusions are normal if isolated and measure less than ____?

2 mm in thickness.

146

Fetal cystic thoracic masses

Bochdalek congenital diaphragmatic hernias. Type I and II cystic adenomatoid malformations. Bronchogenic cysts. Duplication cysts. Pulmonary sequestration.

147

Fetal solid thoracic masses

Morgagni and some Bochdalek congenital diaphragmatic hernias. type III CAMs. Bronchopulmonary sequestration.

148

Most common fetal intrathoracic, extracardiac abnormality

CDH, Left-sided posterolateral hernia (Bochdalek).

149

Enlarged hyperechoic fetal lungs, a finding for this rare entity

Laryngeal atresia.

150

Most common cause of enlarged fetal liver?

Hydrops and infections.

151

Most common cause of small fetal liver?

Growth restriction

152

Fetal pseudoascites?

Hypoechoic band in upper abdomen

153

Umbilical vein varix implications?

Normal outcome or fetal hydrops. Structural abnormalities. Aneuploidy. Intrauterine demise.

154

Fetal meconium ileus?

Impaction of thick meconium within terminal ileum. Proximal bowel dilation may not occur until 3rd trimester. Causes: Mechanical intestinal obstruction. Cystic fibrosis.

155

Fetal meconium peritonitis findings

Intraperitoneal calcifications. Meconium pseudocysts. Bowel dilation. Ascites. Polydyramnios.

156

Hyperechoic fetal bowel

If equal to or greater than bone brightness it may be abnormal. Associations: Cystic fibrosis. Chromosomal abnormalities. Growth restriction. Swallowed blood. Perinatal death.

157

Most common fetal anterior wall defects

Omphalocele. Gastroschisis. Elevated alpha-fetoprotein.

158

Fetal omphaloceles

Defects of mid abdomen. Covered by thin amnioperitoneal membrane. Large type contains liver, usually stomach and bowel. Small type contains only bowel located at the base of umbilical cord. Associations: Structural abnormalities and chromosomal abnormalities.

159

Fetal gastroschisis

Paraumbilical, usually right lower quadrant. No covering membrane. Protruding bowel floats freely in amniotic fluid. No associated anomalies or abnormal karyotype.

160

Fetal cystic abdominal masses

Mesenteric cyst. Duplication cyst. Urachal cysts. Ovarian (female).

161

Common third trimester cause of oligohydramnios

Spontaneous rupture of membranes.

162

Common second trimester causes of oligohydramnios

Bilateral renal abnormalit. Urinary bladder obstruction (posterior urethral valves).

163

Keyhole fetal bladder configuration

Dilated bladder and proximal urethra due to posterior urethral valves.

164

Enlarged hyperechoic fetal kidneys with oligohydramnios?

Infantile polycystic kidney disease (ARPKD).

165

Bilateral fetal renal abnormalities?

Urethral obstruction (posterior urethral valves). Renal agenesis. Infantile polycystic kidney disease. Bilateral UPJ obstruction.

166

Distinguishes dilated fetal ureter from bowel and blood vessel?

Doppler distinguishes from blood vessel. Real time imaging distinguishes bowel (peristalsis).

167

Fetal renal dysplasia findings

Increased renal cortex echogenicity (greater than liver). Subcortical cysts

168

Common fetal unilateral renal anomalies?

Multicystic dysplastic kidney. Reflux. UPJ obstruction.

169

If obstruction is identified in upper but not lower pole of kidney, what should be considered?

Duplicated kidney with ectopic uretrerocele from upper pole moiety.

170

Four major fetal skeletal anomalies, which account for 2/3 or all dysplasias?

Heterozygous achondroplasia. Osteogenesis imperfecta. Achondrogenesis. Thanatophoric dysplasia

171

Heterozygous achondroplasia fetal US findings?

Femur length falls below 10th percentile before 28 weeks' gestation.

172

Osteogenesis imperfecta fetal US findings?

Skeletal deformities (fractures and abnormal bowing) or demineralization.

173

Achondrogenesis fetal US major finding?

Severe shortening of limbs (micromelic pattern). Varying degrees of demineralization and chest narrowing.

174

Thanatophoric dysplasia fetal US findings?

Normal bone brightness. Severe limb shortening and chest narrowing. Pronounced polyhydramnios.

175

Amniotic band syndrome at fetal US?

Skeletal deformities are asymmetric and atypical in appearance compared to skeletal dysplasias.

176

Subchorionic versus retroplacental hemorrhages, prognosis?

Uncomplicated subchorionic hemorrhages are usually benign. Retroplacental hemorrhages can cause considerable fetal and, infrequently, maternal problems.

177

Placenta previa classification?

Low-lying (near). Marginal (touching). Complete (covering cervical os).

178

Vasa previa?

Presence of fetal (not placental) blood vessels that cross the internal cervical os (marginal or velamentous cord insertions or with succenturiate lobes).

179

Cervical incompetence US findings?

Shortening of endocervical length to less than 2.5 cm, with or without cervical funneling.

180

Complete (classic) hydatidiform mole features?

Noninvasive (85%). Locally invasive (13%). Metastatic (choriocarcinoma 2%). Enlarged uterus filled with hyperechoic tissue (multiple cysts). No fetus present.