Abdominal Vasculature Flashcards
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
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
the inner wall layer of a vessel, closest to the passing blood is the:
tunica media
tunica intima
tunica rugae
tunica adventitia
tunica intima
what vessel can be often noted coursing between the SMA and abdominal AO in the TRV scan plane?
LRV
LRA
RRV
RRA
LRV
the first main visceral branch of the abdominal AO is the:
SMA
celiac artery
renal arteries
hepatic arteries
celiac artery
an aneurysm associated with infection is termed:
recanalized
saccular
fusiform
mycotic
mycotic
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
all of the following are branches of the celiac axis EXCEPT:
right gastric artery
hepatic artery
splenic artery
left gastric artery
right gastric artery
the outer wall layer of a vessel is the:
tunica media
tunics intima
tunica rugae
tunica adventitia
tunica adventitia
what should the postprandial flow pattern be within the SMA?
high resistance
low resistance
low resistance
the second main branch of the abdominal AO is the:
SMA
celiac artery
renal arteries
hepatic artery
SMA
which vessel shows a different flow pattern after eating?
celiac artery
splenic artery
renal artery
SMA
SMA
what flow pattern would the postprandial SMA yield in a small bowel ischemia?
high resistance
low resistance
high resistance
an AAA is present when the diameter of the abdominal AO exceeds:
10 mm
2.5 mm
3 cm
2 mm
3 cm
occlusion of the hepatic veins describes:
marfan syndrome
klinefelter syndrome
morrison syndrome
budd-chiari syndrome
budd-chiari syndrome
the most common shape of an AAA is:
saccular
bulbous
true
fusiform
fusiform
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
which vascular structure may be confused for the main pancreatic duct?
hepatic artery
left gastric artery
SMA
splenic artery
splenic artery
the IVC terminates at the:
common iliac veins
right atrium
left atrium
left ventricle
right atrium
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
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
the veins seen attaching to the IVC just below the diaphragm are the:
renal veins
SMV
hepatic veins
celiac axis
hepatic veins
the AO originates at the:
left atrium
right atrium
left ventricle
right ventricle
left ventricle
which is not a section of the IVC?
postrenal
pancreatic
prerenal
hepatic
pancreatic
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
PV
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
