Abdominal Vasculature Flashcards by lindsay crouse

in the SAG plane, you recognize a circular, anechoic vascular structure posterior to the IVC. Which of the following would this structure be most likely?

abdominal AO
LRV
RRA
SMA

RRA

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a disorder of the connective tissue characterized by tall stature and aortic and mitral balance insufficiency is:

wilms syndrome
meckel-gruber syndrome
marfan syndrome
kleinman syndrome

marfan syndrome

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the inner wall layer of a vessel, closest to the passing blood is the:

tunica media
tunica intima
tunica rugae
tunica adventitia

tunica intima

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what vessel can be often noted coursing between the SMA and abdominal AO in the TRV scan plane?

LRV
LRA
RRV
RRA

LRV

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the first main visceral branch of the abdominal AO is the:

SMA
celiac artery
renal arteries
hepatic arteries

celiac artery

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an aneurysm associated with infection is termed:

recanalized
saccular
fusiform
mycotic

mycotic

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which is NOT true about the abdominal AO?

the abdominal AO bifurcates into the common iliac arteries

the prox AO is situated more anterior than the distal AO

the AO has a thicker tunica media than the IVC

the third major branches of the abdominal AO are the renal arteries

the prox AO is NOT situated more anterior than the distal AO

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all of the following are branches of the celiac axis EXCEPT:

right gastric artery
hepatic artery
splenic artery
left gastric artery

right gastric artery

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the outer wall layer of a vessel is the:

tunica media
tunics intima
tunica rugae
tunica adventitia

tunica adventitia

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what should the postprandial flow pattern be within the SMA?

high resistance
low resistance

low resistance

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the second main branch of the abdominal AO is the:

SMA
celiac artery
renal arteries
hepatic artery

SMA

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which vessel shows a different flow pattern after eating?

celiac artery
splenic artery
renal artery
SMA

SMA

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what flow pattern would the postprandial SMA yield in a small bowel ischemia?

high resistance
low resistance

high resistance

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an AAA is present when the diameter of the abdominal AO exceeds:

10 mm
2.5 mm
3 cm
2 mm

3 cm

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occlusion of the hepatic veins describes:

marfan syndrome
klinefelter syndrome
morrison syndrome
budd-chiari syndrome

budd-chiari syndrome

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the most common shape of an AAA is:

saccular
bulbous
true
fusiform

fusiform

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what branch and its tributaries of the abdominal AO appear as a “seagull” in the TRV plane?

SMA
hepatic artery
celiac artery
common iliac artery

celiac artery

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which vascular structure may be confused for the main pancreatic duct?

hepatic artery
left gastric artery
SMA
splenic artery

splenic artery

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the IVC terminates at the:

common iliac veins
right atrium
left atrium
left ventricle

right atrium

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A patient presents with unexplained abdominal pain for a vascular assessment of the SMA. sonographically, you note that the patient’s SMA yields a persistent high-resistive flow pattern. This is indicative of:

crohn disease
intussusception
bowel obstruction
small bowel ischemia

small bowel ischemia

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the MPV is created by the union of the:

splenic vein and SMV
SMV and IMV
splenic vein and IMV
splenic vein and gastroduodenal vein

splenic vein and SMV

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the veins seen attaching to the IVC just below the diaphragm are the:

renal veins
SMV
hepatic veins
celiac axis

hepatic veins

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the AO originates at the:

left atrium
right atrium
left ventricle
right ventricle

left ventricle

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which is not a section of the IVC?

postrenal
pancreatic
prerenal
hepatic

pancreatic

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the hepatic artery should demonstrate: high resistance flow low resistance flow

low resistance flow

clinical findings of an AAA include all of the following EXCEPT: LE pain back pain abdominal bruit elevated hematocrit

elevated hematocrit

An outpatient with a history of back pain and HTN presents to the ultrasound department for an abdominal aortic sonogram. Sonographically, you visualize a 6 cm infrarenal aortic aneurysm with an echogenic linear structure noted gently swaying in the aortic lumen. What is the most likely diagnosis? aortic rupture chronic aortic aneurysm aortic dissection pseudoaneurysm

aortic dissection

the left gonadal vein drains directly into the: IVC SMV LRV left iliac vein

LRV

which would most likely yield a high-resistance flow pattern? celiac artery common iliac artery splenic artery RRA

common iliac artery

what vessel may attach to the splenic vein before reaching the portal confluence? LRV IMV RRV celiac vein

IMV

what vessel travels directly anterior to the LRA? LRV hepatic artery RRV SMV

LRV

what abnormality would the failure of an EVAR to isolate an aneurysm from circulation most likely result in? endoleak aortic dissection pulmonary embolism DVT

endoleak

A patient presents to the sonography department with a history of marfan syndrome. The sonographic evaluation reveals a linear echo within the aortic lumen that extends from the celiac axis to the iliac arteries. Color doppler reveals flow throughout the AO on both sides of the linear echo. The patient has has no surgeries and there is no AAA. What does the linear echo most likely represent? calcific thrombus intimal flap EVAR aortic filter

intimal flap

which vessel would be the shortest in length? RRV RRA LRV LRA

RRV

which would have a pulsatile, triphasic blood flow pattern? renal veins hepatic veins gonadal veins common iliac veins

hepatic veins

the diameter of the IVC should never exceed: 1.5 cm 2.5 cm 3.5 cm 8 mm

2.5 cm

which statement about the IVC is NOT true: the diameter of the IVC is variable respiration can affect the size it is located to the left of the AO it is considered retroperitoneal

the IVC is NOT located to the left of the AO

which statement about the abdominal AO is NOT true: most aneurysms located within the abdominal AO are false aneurysms the abdominal AO is located just left of the midline the most common location of an AAA is infrarenal the abdominal AO is considered to be retroperitoneal

most aneurysms located within the abdominal AO are NOT false aneurysms

which three structures compose the portal triad? HA, PV, and bile duct HV, HA, and bile duct HV, HA, and PV LPV, LHA, and Lig Teres porta hepatis, MPV, and CBD

HA, PV, and bile duct

what vessel is anterior to the uncinate process and posterior to the neck of the pancreas? SMA IMA confluence of portal and splenic vein IMV common HA

confluence of portal and splenic vein

what is the relationship of the LRV to the AO and SMA? posterior to both anterior to both parallel and to the left of both anterior to AO, posterior to SMA superior to AO, inferior to SMA

anterior to AO, posterior to SMA

which shows the correct plane for measuring the diameter of this aortic aneurysm? A B C D both B and C are correct

B SAG plane, perpendicular to the long axis of the vessel at its widest point

You are performing a doppler study of the hepatic venous system and cannot obtain a color doppler signal from the MPV. What should you do? increase the color dynamic range increase the system high pass filter decrease the system PRF increase the doppler angle of incidence decrease color gain

decrease the system PRF more "listening" time increases sensitivity to slow flow

which is NOT a direct branch of the abdominal AO? celiac trunk SMA external iliac artery IMA renal artery

external iliac artery

A 57 year old woman has been referred for an abdominal ultrasound with a history of an abdominal bruit. What pathology are you searching for? cholecystitis para-aortic lymphadenopathy retroperitoneal fibrosis varices vascular compromise involving the AO or its branches

vascular compromise involving the AO or its branches (stenosis or aneurysm)

you are performing a doppler study on a patient with median arcuate ligament syndrome. what vessel are you studying? IMA renal artery PV SMV celiac trunk

celiac trunk median arcuate ligament of the diaphragm lies anterior to the abdominal AO just proximal to the origin of the celiac trunk

a 54 year old man has been referred for an abdominal doppler ultrasound with a history of uncontrollable high BP. what pathology are you searching for? vascular compromise of the superior mesenteric, inferior mesenteric, and celiac trunk hepatofugal PV flow RA stenosis splenic varices aortic aneurysm

RA stenosis uncontrollable HTN is an indication of doppler evaluation of the RAs

while performing a doppler evaluation of the abdominal vessels, you detect a stenosis in the RRA. which is NOT a sign of stenosis with spectral analysis? spectral broadening distal to the stenosis increased PSV at the stenosis increased PDV proximal to the stenosis increased pulsatility proximal to the stenosis dampening of the waveform distal to the stenosis

increased PDV proxminal to the stenosis proximal to the stenosis, the flow is typically dampened with decreased diastolic

You are performing an ultrasound exam on a patient with a history of chronic pancreatitis and abdominal bruit. What vascular abnormality is associated with this history? AAA RA stenosis IMA occlusion retroaortic RV pseudoaneurysm of the hepatic or splenic artery

pseudoaneurysm of the hepatic or splenic artery

the IVC empties blood into which of the following? abdominal AO right atrium left atrium right ventricle left ventricle

right atrium

which does NOT drain directly into the IVC? renal vein right hepatic vein common iliac vein splenic vein middle hepatic vein

splenic vein splenic vein joins the SMV to form the portal vein, does not empty into IVC

You are imaging the common hepatic artery and detect its division into two branches. What are these two branches? proper hepatic artery and right gastric artery right gastric artery and gastroduodenal artery left gastric artery and proper hepatic artery proper hepatic artery and gastroduodenal artery gastroduodenal artery and left gastric artery

proper hepatic artery and gastroduodenal artery

in "replaced" hepatic artery, the right hepatic artery originates from what artery? celiac trunk SMA abdominal AO IMA left hepatic artery

SMA

which describes the anatomic course of the gastroduodenal artery? caudal course, anterior to the pancreatic head caudal course, posterior to the pancreatic head cranial course, anterior to the duodenum and medial to the pancreatic neck cranial course, posterior to the pancreatic head lateral course, cephalic to the pancreatic head

caudal course, anterior to the pancreatic head

which artery supplies the small intestines, right colon, and most of the transverse colon? celiac trunk splenic artery superior mesenteric inferior mesenteric left gastric

superior mesenteric

what are the symptoms of chronic mesenteric ischemia? weight gain, abdominal gas, bloating postprandial abdominal pain and weight loss flank pain radiating toward the hip RUQ pain radiating to the left shoulder HTN, weight gain, abdominal pain

postprandial abdominal pain and weight loss

what vessels will you study in a patient with chronic mesenteric ischemia? portal, superior mesenteric, and splenic veins AO, renal, and common iliac arteries main renal and intrarenal vessels distal AO, common iliac, external iliac, and common femoral arteries celiac trunk, superior mesenteric, and inferior mesenteric arteries

celiac trunk, superior mesenteric, and inferior mesenteric arteries

A 38 year old female has been referred for a doppler study of the liver with a history of ETOH abuse and cirrhosis. What vascular condition is associated with this history? mesenteric ischemia PHTN HA fibromuscular dysplasia splenic artery pseudoaneurysm budd-chiari syndrome

PHTN

which describes the waveform you will see in the PV in a normal study? bidirectional triphasic mildly undulating highly pulsatile continuous

mildly undulating

which is the biggest risk factor for rupture of an AAA? aneurysm location aneurysm size patient age flow velocity through the aneurysm presence of laminar thrombus

aneurysm size

you cannot obtain a clear image of the AO in a midline SAG view due to overlying bowel gas. what should you do? have the patient return after fasting overnight have the patient perform a valsalva maneuver while scanning the same area roll the patient into either decubitus position and image the AO from a coronal plane scan the patient in a reverse trendelenberg position scan the AO from a probe position

roll the patient into either decubitus position and image the AO from a coronal plane

You have detected an AAA. Considering this finding, you should tailor your exam to include which of the following? evaluation of the common iliac arteries measurement of TRV and AP diameter assessment of intraluminal thrombus location of aneurysm in relation to renal arteries all of the above

all of the above

You are scanning a patient with marfan's syndrome. Ultrasound findings reveal a linear band throughout the length of the abdominal aorta that is mobile in relation to the cardiac cycle. What pathology is most likely present? aortic pseudoaneurysm aortic dissection micotic aortic aneurysm inflammatory aortic aneurysm fibromuscular dysplasia of the AO

aortic dissection

what is the most significant clinical consequence of PHTN? respiratory compromise ascites variceal hemorrhage liver ischemia vascular thrombosis

variceal hemorrhage hemorrhage from esophageal varies is a life threatening condition associated with PHTN

You are performing an abdominal doppler study and suspect the presence of median arcuate ligament syndrome.To rule out this condition, which of the following should be done? obtain baseline doppler values, give patient a fatty meal, and rescan 10, 20, and 30 min following the meal obtain doppler readings during both inspiration and expiration and in both the supine and upright positions obtain doppler readings at an angle of 45 degrees and then repeat at an angle of 60 and 90 degrees obtain baseline doppler readings and have the patient return in approximately two weeks for a comparison study obtain doppler readings from the prox, mid, and distal aspect of the artery

obtain doppler readings during both inspiration and expiration and in both the supine and upright positions

which describes cavernous transformation of the PV? retrograde PV flow PV thrombosis tumor invasion of the PV network of vessels replacing obliterated PV PV aneurysm

network of vessels replacing obliterated PV

You are performing an ultrasound study on a patient with an aortoiliac graft and suspect the presence of a pseudoaneurysm at the graft site. What is the typical waveform in the neck of a pseudoaneurysm? continuous low velocity, monophasic tardus parvus high velocity, bidirectional high velocity, low resistance

high velocity, bidirectional

which visceral artery is most commonly involved with aneurysmal formation? hepatic artery splenic artery SMA IMA gastroduodenal artery

splenic artery

which vessel normally follows a retroaortic course? LRV RRV SMV IMA none of the above

none of the above

which courses posterior to the IVC? right hepatic artery LRV RRA LRA none of the above

RRA

what is the relationship of the splenic vein to the pancreas? posterior and superior posterior and inferior anterior and superior anterior and inferior

posterior and inferior

which vessels course intersegmental in the liver? PVs HVs HAs both PVs and HVs both PVs and HAs

HVs

A patient has been referred for a doppler study to rule out the presence of RA stenosis. A thorough knowledge of the renal vasculature is required to perform this study. Which of the following is NOT true regarding the renal vasculature? multiple RAs are rare, occurring in fewer than 5% of individuals RAs lie posterior to the RVs RAs branch off the AO immediately below the SMA RRV is shorter than the LRV RVs drain into the IVC

multiple RAs are NOT rare occur in approximately 30% of individuals

within the liver, the IVC lies along the posterior surface of what lobe? left lobe caudate lobe anterior segment right lobe posterior segment right lobe quadrate lobe

caudate lobe

what vessel is this waveform from? SMV PV renal vein hepatic vein splenic vein

hepatic vein

You are performing an ultrasound on a patient with a recent aortoiliac graft and detect this waveform adjacent to the graft site near a pulsating hematoma. This waveform was most likely obtained from which of the following? graft stenosis graft occlusion neck of pseudoaneurysm normal graft graft aneurysm

neck of pseudoaneurysm the waveform obtained from the neck of a pseudoaneurysm typically displays a high-velocity, bidirectional, or "to-and-fro" signal. due to the changes in pressure between the native vessel and aneurysm with the cardiac cycle during systole the pressure is lowest in the pseudoaneurysm and flow courses in that direction. during diastole the pressure is lowest in the native vessel and blood flows back into it.

what is the vessel labeled A? abdominal AO IVC RRV LRV SMV

IVC

what vessel is labeled C? RRV LRV RRA LRA SMA

RRA

what is the vessel labeled E? right internal iliac artery left external iliac artery right common iliac vein left internal iliac vein right common iliac artery

right common iliac artery

this image was obtained in what plane? TRV SAG coronal oblique none of the above

coronal

which vessel were you most likely sampling? HV HA IVC PV AO

what vessel lies immediately posterior to the pancreatic head? abdominal AO IVC SMV splenic vein PV

IVC

which describes the fusiform aneurysmal shape? bulbous enlargement with a sharp junction between the normal and abnormal segment dilation with a gradual transition between the normal and abnormal segment figure eight appearance to the aneurysm intimal flap within the aneurysm sharp, sudden sac-like protuberance

dilation with a gradual transition between the normal and abnormal segment

which defines an aortic aneurysm? when the length of the dilated segment exceeds 3 cm a dilation of the AO exceeding 3 cm in any dimension a focal dilation of any segment exceeding 4 mm when the AO becomes tortuous and dilated with an AP diameter greater than 4 can when the diameter of the AO is greater than 2.5 cm

a dilation of the AO exceeding 3 cm in any dimension