Flashcards in ultrasoundflash Deck (180):
Distinguishing characteristics between AMLs and hyperechoic RCCs?
AMLs tend to have acoustic shadowing. Hyperechoic RCCs may have cystic elements, calcifications, or hypoechoic halo.
Caudate lobe drains into what vein?
IVC via small veins separate from hepatic veins. Caudate veins function as collaterals in Budd-Chiari syndrome.
Distinguishing ultrasound features of peritoneal fluid collections versus simple ascites?
Fluid collections displace and distort adjacent structures. Ascites conforms to adjacent structures.
Causes of fatty liver infiltration?
Obesity. Alcohol abuse. TPN. Diabetes. Malnutrition. Steroid use. Hepatic toxins. Chemotherapy.
Usefull clue in located parathyroid adenomas and lymph nodes?
Parathyroid adenomas are medial to carotid arteries. Lymph nodes are usually lateral to carotids.
Baker's cyst, most characteristic diagnostic feature at Ultrasound?
Neck that extends between medial head of gastrocnemius and semimembranosus tendon.
Syndrome caused by hepatic hemangioma that sequesters platelets?
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.
Funiculocele, what is it?
Spermatic cord hydrocele.
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).
Which gallstones can float?
Cholesterol stones can float in high specific gravity bile.
What patient's benefit from an carotid endarterectomy?
Symptomatic patients with stenosis >70%.
Best study to identify a splenule?
Sulfur colloid scan or heat-damaged tagged RBC scan.
Reversed flow in the internal mammary veins indicates?
Central venous obstruction
Solid renal neoplasms?
RCC. TCC. Renal medullary carcinoma. Renal sarcoma. Metastases. Lymphoma.
Sickle cell trait and solid renal neoplasm?
Renal medullary carcinoma.
When do hematomas and lymphoceles appear in renal transplant patients?
Hematoma: Immediately after transplant Lymphocele: 1 to 2 months posttransplant
Most common cause of calcified liver tumor?
Benign mass of plantar digital nerves of the foot.
Which side is subclavian steal more common on?
What is normal portal vein velocity?
Pancreatic neoplasm almost exclusively seen in women?
RCC stage when tumor invades renal vein or IVC?
At least IIIa
2 common liver locations for focal fatty infiltration?
Preportal. Anterior left lobe adjacent to ligamentum teres.
Resistive index (RI) formula?
RI = (S-D)/S
Parenchymal organ normal resistive index (RI)?
Midline prostate cysts?
Utricle cyst. Mullerian cyst.
What replaced artery can be seen coursing through the ligamentum venosum?
Replaced left hepatic artery.
Mucinous macrocystic pancreatic neoplasm, common locations?
Body and tail of pancreas.
Distinguish between classic and limited microlithiasis of testis?
Classic: > 5 microliths on 1 view. Limited: less than 5 on 1 view.
Multilocular cystic nephroma, population?
Young boys (3 months - 4 years). Adult women (>30 years old).
2 most common masses in the hand?
Ganglion cyst. Giant cell tumor.
Does a giant cell tumor move with the associated tendon?
No, it arrised from the tendon sheath not the tendon.
TCC, most common anatomy involved?
Bladder > renal pelvis > ureter.
Pheochromocytoma's 10% rule?
10% malignant. 10% extra-adrenal. 10% bilateral. 10% associated with MEN.
Vascular pattern of FNH at ultrasound?
Most definitive means of diagnosing FNH?
Sulfur colloid scanning.
Chronic calcific pancreatitis is caused by?
Alcoholic abuse, not gallstones.
Focal fatty sparing within the liver commonly occurs where?
Around the gallbladder. At portal bifurcation.
What is Page kidney?
Renal subcapsular hematoma causing hypertension.
Effect of renal vein thrombosis on resistive index (RI) of renal artery?
Normal to increased RI.
Horseshoe kidney predispositions?
Urinary obstruction. Stone formation. Rrenal trauma. Questionable increase risk of Wilm's tumor.
Upper limit of normal renal artery velocity?
Bile duct blood supply?
Hepatic artery. In liver transplant hepatic artery thrombosis bile ducts may form strictures due to ischemia.
Common factors that render pancreatic cancers nonresectable?
Lver metastases. Peripancreatic vessel invasion. Peritoneal spread.
Ultrasound signs of complete tendon rupture?
Blunt tendon tip (longitudinal view). Mass (transverse view). Refractive shadowing. Nonvisualization. Loss of fibrillar architecture. Fluid collection.
Sonographic signs of full-thickness rotator cuff tear?
Anechoic or hypoechoic defect. Focal superficial contour abnormality. Compressibility. Nonvisualization.
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.
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.
Extremity artery waveform?
High-resistance flow. Typically triphasic waveform: Antegrade systole, retrograde early diastole, antegrade in mid diastole, absent flow in end diastole.
Extremity venous waveform?
Respiratory phasicity. Variable cardiac related pulsatility.
Factors that decrease chance of scrotal malignancy?
Extratesticular. Nonpalpable. Simple cystic appearance. No detectable vascularity.
Factors that increase chance of scrotal malignancy?
Intratesticular. Palpable. Solid or complex cyst. Detectable internal vascularity.
Germ cell tumor list?
Seminoma. Embryonal cell carcinoma. Teratoma. Choriocarcinoma. Yolk sac. Mixed germ cell.
Stromal testicular tumors?
Leydig cell tumor. Sertoli cell tumor.
Other non-germ cell and non-stromal testicular neoplasms?
Lymphyoma/leukemia. Metastases. Epidermoid cyst.
Testicular lesions mimicking tumors?
Focal orchitis. Focal atrophy/fibrosis. Infarcts. Abscess. Hematoma. Contusion. Sarcoid. Tuberculosis. Adrenal rest tissue.
Causes of enlarged hypoechoic testis?
Orchitis. Torsion. Lymphoma. Seminoma.
Of the four causes of enlarged hypoechoic testes, which have increased/decreased blood flow?
Increased flow: Orchitis. Lymphoma. Seminoma. Decreased (torsion).
Primary neoplasms of the bladder?
TCC. Adenocarcinoma. SCC. Pheochromocytoma.
Causes of bladder wall lesions from adjacent neoplasms?
Rectum. Prostate. Cervix. Uterus.
Causes of bladder wall lesions from inflammation from adjacent organs?
Diverticulitis. Crohn's disease. PID. Appendicitis.
Other bladder wall lesions?
Ureteroceles. Urachal cyst. Cystitis cystica. Endometriomas. Fistulas. Malakoplakia. Leukoplakia. Tuberculosis. Shistosomiasis.
Frequency of prostate cancer per anatomical zone?
Peripheral zone 75%. Transitional zone 20%. Central zone 5%
Percentage of prostate cancers that are hypoechoic?
Hypoechoic 70%. Hyperechoic/mixed 30%.
Sonographic characteristics of seminoma?
Homogeneous and hypoechoic.
Most common scrotal mass?
Causes of hydroceles?
Idiopathic (most common). Tumors. Torsion. Inflammatory disorders. Trauma.
Varicocele percentage on the left?
Left-sided 85%. Right-sided 15%.
Scrotal mass with peripheral calcification and/or onion peel appearance?
Testicular microlithiasis and germ cell tumor relevance?
Isolated microlithiasis increases risk of germ cell cancer. Annual physical exam recommended.
Besides absent blood flow, other signs of testicular torsion?
Enlarged hypoechoic testis. Torsion knot. Reactive hydrocele. Scrotal wall thickening.
Distinguishing characteristic of blood clot from bladder cancer on ultrasound?
Blood clot is mobile.
After injection of vasoactive substance, normal penile Doppler should have a deep cavernosal velocity that exceeds?
Plaque formation in the tunica albuginea of the corpora cavernosa?
Sonographic signs of acute pancreatitis?
Decreased or heterogeneous pancreatic echogenicity. Pancreatic enlargement. Peripancreatic fluid collection. Perivascular fluid collection. Periduodenal fluid collection. Perirenal fluid collection.
Complications of Pancreatitis?
Pseudocyst formation. Bile duct obstruction. Pancreatic abscess. Venous thrombosis. Pseudoaneurysm.
Causes of solid hypoechoic pancreatic masses?
Carcinoma. Focal Pancreatitis. Lymphoma. Metastases. Islet cell tumors. Thrombosed aneurysm.
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.
Normal pancreatic duct should mearsure?
Less than or equal to 3 mm, but can enlarge with age.
Sonographic signs of chronic pancreatitis?
Pancreatic calcification. Ductal dilation. Ductal irregularity. Parenchymal atrophy.
Pancreatic and islet cell tumors are generally hypoechoic. T/F?
Pancreatic neoplasm that contains serous fluid, consists of multiple small cystic elements, and is benign?
Pancreatic neoplasm that contains mucinous fluid, large cystic elelements, thick septations, solid elements, and can be malignant or benign?
Solid spleen lesions?
Hemangiomas. Hamartomas. Lymphomas. Metastases. Infarcts. Abscesses. Sarcoidosis. Granulomas. Extramedullary hematopoiesis.
Causes of splenomegaly?
Heart failure. Portal hypertension. Leukemia. Lymphoma. Hepatitis. Mononucleosis. Generalized infections. Hemolytic anemias. Glycogen storage disease. Malaria. Myelofibrosis.
Lymphoma and leukemia sonographic appearance in the spleen?
Focal. Multifocal. Diffuse. Almost always hypoechoic.
Multiple small calcifications within the spleen?
Granulomatous disease. Histoplasmosis. Tuberculosis.
The age of pregnancy definition?
1st day of LMP/
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.
What structure, if seen, can confirm a IUP even before the embryo is identified?
What is better at estimating gestational age than LMP?
1st trimester CRL (crown rump length). 2nd trimester biparietal diameter (+/- 1 wk) LMP (+/- 2 wks)
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.
2 hyperechoic lines surrounding a hypoechoic closed endometrial canal?
DDS, Double decidual sign
How does seeing a DDS help in 1st trimester US?
Its absence is more suggestive of miscarriage or ectopic pregnancy. Does not exclude IUP.
At what CRL is heart activity expected?
By 5 wks the embryonic heart rate should be?
After 3 wks the embryonic heart rate should be?
120 - 180
At what Beta-hCG level should an intra-uterine gestation sack be seen on TV US?
In early pregnancy the Beta-hCG level should double how often?
Every 2 days.
Differential diagnosis of positive pregnancy test?
IUP. Miscarriage. Ectopic pregnancy.
Risk factors for ectopic pregnancy?
Abnormal fallopian tubes. Previous ectopic pregnancy. IUD. Fertility medication. In-vitro fertilization.
Beta-hCG level in an ectopic pregnancy patients increases slower or faster than an IUP?
Where can an ectopic pregnancy occur within the uterus?
Define an heterotopic pregnancy?
Concomitant intrauterine and extrauterine pregnancy.
What is a pseudogestational sac?
Collection of fluid or decidual cast within endometrial canal or thickened endometrium in an ectopic pregnancy.
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.
Common causes of bowel wall thickening?
Inflammation. Infection. Neoplasm. Ischemia. Edema. Hemorrhage.
Sonographic signs of appendicitis?
Diameter greater than 6 mm. Lack of compressibility. Inflamed, echogenic periappendiceal fat. Hyperemia. Appendicolith. Adjacent fluid collection.
Causes of peritoneal masses?
Metastases. Tuberculosis. Mesothelioma. Pseudomyxoma peritonei. Omental infarct.
Causes of abdominal wall masses?
Metastases. Lipoma. Hernia. Hematoma. Abscess. Seroma. Desmoid. Endometriosis. Sarcoma. Lymphoma.
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.
Common causes of adrenal masses?
Adenoma. Metastases. Pheochromocytomas. Primary carcinoma. Lymphoma. Myelolipoma. Hemorrhage.
Extensive mesenteric adenopathy.
Distinguishing feature of tumor thrombus from blood clot?
Tumor thrombus has internal vascularity.
Ultrasound is not good at characterizing most adrenal masses, except for?
Benign characteristics of thyroid nodules?
Cystic elements. Hyper or isoechoic. Eggshell calcification. Inspissated colloid.
Malignant characteristics of thyroid nodules?
Entirely solid. Hypoechoic. Microcalcifications. Associated cervical adenopathy.
Characteristics of parathyroid adenomas on ultrasound?
Solid. Hypoechoic. Oval shape. Hypervascular. Posterior to thyroid. Medial to carotid.
Locations of ectopic parathyroid adenomas?
Low neck. Mediastinum. Retrotracheal/retroesophageal. Carotid sheath. Intrathryoidal.
Characteristics of Neoplastic Neck Lymph Nodes?
Obliteration of echogenic hilum. Long-axis to short-axis ration less than 1.5. Cystic changes. Microcalcifications.
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.
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.
Midline complex lesions that are usually intimately associated with the hyoid bone?
Thyroglossal duct cyst.
Most common cause of hyperparathyroidism?
Carotid artery flow velocities and ratios start to increase at what stenotic level?
Sonographic characteristics of unstable carotid artery plaques?
Heterogenous plaques with focal hypoechoic regions.
Causes of polyhydramnios?
Idiopathic. Maternal (diabetes). Fetal (Anomalies, Hydrops).
Findings in anencephaly
Absence of normal calvarium and brain above orbits. Residual dysmorphic brain may be seen, called angiomatous stroma.
Moderate to marked polyhydramnios is often associated with what fetal anomalies?
CNS. GI. Fetal hydrops.
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.
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.
Regardless of hydrocephaly severity there is always a?
Thin cortical mantle. Hydrancephaly may mimic this but instead is destroyed brain.
Midline developmental anomaly, three forms (alobar, semilobar, lobar).
Relatively common anterior cephalocele
Ethmoidal sinus region.
Banana shaped cerebellum?
Neural tube defect with downward displacement of cerebellum.
Enlarged cisterna magna with splaying of cerebellar hemispheres and a vermian defect?
A nuchal fold measurement above _____ is a marker for trisomy 21?
Choroid plexus cyst possibilities?
Normal or other chromosomal abnormalities such as trisomy 18.
Secondary abnormalities of the skull that occur with spinal defects?
Lemon sign (least specific). Banana sign. Hydrocephalus.
Large aorta in fetal ultrasound?
Tetralogy of Fallot. Truncus arteriosus.
Small aorta in fetal ultrasound?
Coarctation. Hypoplastic left heart.
Small pulmonary artery in fetal ultrasound?
Hypoplastic right heart. Ebstein's anomaly with pulmonary hypoplasia.
Fetal hydrops generalities
Immune and nonimmune causes. Excessive fetal body water. Fluid in serous cavities, skin thickening, placental enlargement, polyhydramnios.
Fetal pericardial effusions are normal if isolated and measure less than ____?
2 mm in thickness.
Fetal cystic thoracic masses
Bochdalek congenital diaphragmatic hernias. Type I and II cystic adenomatoid malformations. Bronchogenic cysts. Duplication cysts. Pulmonary sequestration.
Fetal solid thoracic masses
Morgagni and some Bochdalek congenital diaphragmatic hernias. type III CAMs. Bronchopulmonary sequestration.
Most common fetal intrathoracic, extracardiac abnormality
CDH, Left-sided posterolateral hernia (Bochdalek).
Enlarged hyperechoic fetal lungs, a finding for this rare entity
Most common cause of enlarged fetal liver?
Hydrops and infections.
Most common cause of small fetal liver?
Hypoechoic band in upper abdomen
Umbilical vein varix implications?
Normal outcome or fetal hydrops. Structural abnormalities. Aneuploidy. Intrauterine demise.
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.
Fetal meconium peritonitis findings
Intraperitoneal calcifications. Meconium pseudocysts. Bowel dilation. Ascites. Polydyramnios.
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.
Most common fetal anterior wall defects
Omphalocele. Gastroschisis. Elevated alpha-fetoprotein.
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.
Paraumbilical, usually right lower quadrant. No covering membrane. Protruding bowel floats freely in amniotic fluid. No associated anomalies or abnormal karyotype.
Fetal cystic abdominal masses
Mesenteric cyst. Duplication cyst. Urachal cysts. Ovarian (female).
Common third trimester cause of oligohydramnios
Spontaneous rupture of membranes.
Common second trimester causes of oligohydramnios
Bilateral renal abnormalit. Urinary bladder obstruction (posterior urethral valves).
Keyhole fetal bladder configuration
Dilated bladder and proximal urethra due to posterior urethral valves.
Enlarged hyperechoic fetal kidneys with oligohydramnios?
Infantile polycystic kidney disease (ARPKD).
Bilateral fetal renal abnormalities?
Urethral obstruction (posterior urethral valves). Renal agenesis. Infantile polycystic kidney disease. Bilateral UPJ obstruction.
Distinguishes dilated fetal ureter from bowel and blood vessel?
Doppler distinguishes from blood vessel. Real time imaging distinguishes bowel (peristalsis).
Fetal renal dysplasia findings
Increased renal cortex echogenicity (greater than liver). Subcortical cysts
Common fetal unilateral renal anomalies?
Multicystic dysplastic kidney. Reflux. UPJ obstruction.
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.
Four major fetal skeletal anomalies, which account for 2/3 or all dysplasias?
Heterozygous achondroplasia. Osteogenesis imperfecta. Achondrogenesis. Thanatophoric dysplasia
Heterozygous achondroplasia fetal US findings?
Femur length falls below 10th percentile before 28 weeks' gestation.
Osteogenesis imperfecta fetal US findings?
Skeletal deformities (fractures and abnormal bowing) or demineralization.
Achondrogenesis fetal US major finding?
Severe shortening of limbs (micromelic pattern). Varying degrees of demineralization and chest narrowing.
Thanatophoric dysplasia fetal US findings?
Normal bone brightness. Severe limb shortening and chest narrowing. Pronounced polyhydramnios.
Amniotic band syndrome at fetal US?
Skeletal deformities are asymmetric and atypical in appearance compared to skeletal dysplasias.
Subchorionic versus retroplacental hemorrhages, prognosis?
Uncomplicated subchorionic hemorrhages are usually benign. Retroplacental hemorrhages can cause considerable fetal and, infrequently, maternal problems.
Placenta previa classification?
Low-lying (near). Marginal (touching). Complete (covering cervical os).
Presence of fetal (not placental) blood vessels that cross the internal cervical os (marginal or velamentous cord insertions or with succenturiate lobes).
Cervical incompetence US findings?
Shortening of endocervical length to less than 2.5 cm, with or without cervical funneling.