Abdomen PACS Final Flashcards
Column of Bertin
idents the renal medullary
do NOT distort the renal cortex
Dromedary Hump
more common on the left side
cortical border is intact and hump will contain normal appearing pyramid structures
Junctional Defect
a triangular echogenic area in the upper pole
Parenchymal Cyst (simple cyst)
50% of people over the age of 50 will have them
Polycystic Kidney Disease
Bilateral disease
50% of pts will have end stage renal disease by age 60
Acute Tubular Necrosis
Nephrocalcinosis
renal appearance is thinned cortex with enlarged, echogenic “globs” of meddullary tissue
Angiomyolipoma
benign
80% in women and 80% right kidney
hyperehoic mass found in renal cortex
Fetal Lobulation
cortical border is still intact and parenchymal thickness is uniform throughout kidney
Duplex Collecting System
on the trans image will appear to have no medullary
Extrarenal Pelvis
a portion of the collecting system that extends outside the renal sinus
Kidney Stone
most common renal problem
more common in men
present shadowing
Obstuctive Hydronephrosis
there are 3 grades
grade 1: splaying of the calyces
grade 2: fluid extends into the major and minor calyces with minimal thinning of the cortex
grade 3: massive dilation and renal pelvis with signifcant loss of renal cortex
Nonobstructive Hydronephrosis
dilation of renal sinus without blockage of the flow of urine to the bladder
ALWAYS check for bilateral urine jets wihen ANY dilation is noted
causes:
UTI, plevic masses, pregnancy, uterine fibroids and enlarge prostate
Chronic Medical Renal Disease
AKA: Chronic Renal Failure
bilateral process, results in small echogenic kidneys
cortical thickness = at least 1 cm
may have a hard time distinguishing from surrounding tissue
Renal Carcinoma
tumors are solid, parenchymal mass
often isoechoic or hypoechoic
disrupts the renal cortex
2x as common in men
after mass is found the IVC and renal veins should be imaged to determine if there is tumor extension
Medullary Sponge Kidney
enlarged echogenic medullary
asymptomatic and not found in young adulthood
Bladder Diverticulum
outpouching of the bladder wall
more common in older men
Bladder Tumors
95% are transitional cell carcinoma
appear as irregular, echogenic mass that projects into the lumen of the bladder wall or as wall thickening
Bladder Stones
echogenic foci along the bladder wall with shadowing
stones will move when you roll the patient, tumors will NOT move when the patient is rolled
Glomerulonephritis
necrosis of the glomerulus: a network of cappillaires which filters the blood into the renal tubule
cause: strepococcal bacteria
Pyelonephritis
an infection of the calyces and the renal pelvis
causes: UTIs, reflux obstruction and diabetes
has FOCAL echogenic area with the kidney
all forms of nephritis have similar appearance: Lupus/AIDS/Sickle Cell
Pelvic Kidney
most common location is found within the boney pelivs
Horseshoe Kidney
bilateral fusion of the lower poles
kidneys are closer to the spine
Thyroid: Graves Disease
most frequent cause of hyperthyroidism
women over 30
intense color doppler: thyroid storm or inferno
treatment: radioactive ablation with lifelong hormonal supplements
Thyroid: Hasimoto’s Thyroiditis
most common form of thyroiditis
yound middle aged women
enlarged, homogenous, hypoechoic thyroid texture
Thyroid Adenoma
variable size
homogenous
commonly have a peripheral halo
Multinodular Goiter
most common thyroid abnormality
NOT associated with hypo- hyper- thyroidism
Breast
Benign Lesions
Fibroadenoma: most common benign tumor
smooth rounded margins
grow horizontally within tissue planes
parallel to chest wall
round or oval shape
“wider than they are tall”
isoechic with breast tissue
are mobile and compressibile
DO NOT HAVE INCREASED BLOOD FLOW
Breast
Malignant Lesions
have finger like projectoins called spiculations
sharp angular borders
cause skin dimpling or nipple retraction
“Taller than wide”
hypoechoic
have posterior shadowing behind lesion
rigid and noncompressibile
HAS INCREASED BLOOD FLOW WITH A FEEDER VESSEL
Lymph Node
appearance changes from oval to round
echogenic hilum become more difficult to detect
Varicocele
they are caused by incompetent valves within the spermatic vein
more common on the left due to the LSV empting into the LRV
Hydrocele
a collection of serous fluid and is the most common cause of PAINLESS scrotal swelling
Microlithiasis
bilateral condition associated with high risk malignancy and infertility
smaller than 3mm
high incidence in men with a history of undescended testes
MUST have more than 5 microlithiasis on a single image
Testicular Carcinomas
95% of tumors are germ cell, most often seminoma
occurs most frequently between ages 20-35
patients present painless, palpable mass
oftern hypoechoic, homogenous with SMOOTH borders
Epididymitis
common cause if from a spread of a UTI or STD
most common cause of ACUTE scrotal pain in ADULTS
patient has increasing pain over a few days
increased doppler within testis
Torsion
occurs from Bell Clapper deformity
EARLY: affected testis is swollen and midly heterongenous
LATE: affected testis become swollen and hypoechoic, the VENOUS flow will be affected first causing occluded veins, tissue necrosis will develop following venous flow restriction
When scanning torsed testicles, ALWAYS compare both sides with the same parameters to show a difference in blood flow
parameters used: gain, scale, wall filter and color box
Cavernous Hemangioma
usually asymptomatic and discovered incidentally
hyperechoic and typically have posterior enhancement, usually in the right lobe of liver and near the dome
Focal Nodular Hyperplasia
second most common benign mass
in women under 40 and asymptomatic
occur mostly in right lobe of liver, hyper- to isoechoic, many have central scar
Fatty Liver/Fatty Sparing
acquired diffuse disorder, resulting in an accumulation of triglycerides with the hepatocytes
not always uniform and present as patchy
LIVER ECHOGENICITY COMPARED TO RIGHT KIDNEY IS IMPORTANT IN MAKING DIAGNOSIS OF FATTY LIVER
Riedels Lobe-Congenital Variant
anterior projection over the liver, extending near the iliac crest
It is NOT merely an elongated inferior, posterior segment extending over the right kideny
Metastic Disease
most common cancerous mass of the liver
mostly from primary GI (including GB and pancreas), breast and lung
hyperechoic, hypoechoic, bull’s eye sign
Ascites
accumulation of serous fluid in the peritoneal cavity
echo free fluid regions indented and shaped by the surrounding organs
first fills the pouch of douglas before it ascends to the paracolic gutters
small bowel loops sink and float with the fluid
Liver Cyst
occur in 5% of people over the age of 50
same songraphic characteristics of renal simple cysts
often seen in patients with polycystic kidney disease (ADPKD)
Pancreatic Adenocarcinoma
most common occurring in the head region
usually cause obstruction of CBD
symptoms include: abdominal and back pain, painless jaundice and weight loss
irregualr, hypoechoic lesion, dilated pancreatic duct, liver and para-arotic nodes
Pancreatitis (Acute)
inflammation of the pancreas
organ appears hypoechoic and edematous with irregular borders
pancreatic duct may be enlarged
Chronic: appears hyperechoic with echogenic foci randomly dispersed throughout the gland
Pseudocysts
accumulation of pancreatic fluid and necrotic debris confined by the retropertoneum
common causes: acute pancreatitis, chronic pancreatitis, pancreatic trauma, pancreatic ductal obstruction and pancreatic neoplasms
in children the most common cause for pseudocysts is abdominal trauma
Splenic Calcifications (granulomatous infection)
granulomas are focal lesions resulting from previous infections
bright echogenic lesions with or without shadowing
two of the most common causes: tuberculosis and histoplasmosis
Accessory Spleen
common congential anomaly
typically round and isoechoic with the spleen
can be found by the hilum
GB Polyps
smooth and on a stalk, do NOT shadow and do NOT move when the patient is rolled
most common tumor of the GB
Adenomyomatosis
hyperplastic wall changes- more echogenic than polyps, do NOT move and have ring down or “comet tail artifact”
Gallstones
echogenic foci
can be multiple or single
have shadowing
they DO move when the patient is rolled
WES (wall echo shadowing)
GB packed with stones
no visible bile within the GB lumen
Porcelain GB
the whole wall of the GB is incrusted with calcium
has a similar pattern of distinct posterior shadowing in the area of the GB
GB Sludge
mildly echogenic bile
can float, move as a ball, contain high echogenic tiny foci, can be seen along gallstones
ACUTE Cholecystitis
positive murphy’s sign
thickened wall with sonolucent area between the 2 walls
CHRONIC Cholecystitis
transient RUQ pain with NO positive murphy’s sign
more common than acute
results from multiple episodes of acute and fibrosis developing in the wall
Dilated Common Bile Duct (Extrahepatic)
occurs before intraheptic
blockage of the distal CBD from a stone or a pancreatic head tumor results in enlarged common duct and eventual dilated intrahepatic ducts
blcokage at the porta-hepatis will demonstrate a normal CBD
characterized by the appearance of “too many tubes” or “double barrel” sign
IT IS THE JOB OF THE SONOGRAPHER TO FIND THE SOURCE AND LOCATION OF THE DUCTAL OBSTRUCTION
