Abnormal Abdominal Vasculature Part 2 Flashcards
Aortic Rupture
Significant complication of _______
Operative mortality rate between _____-_____%
Untreated ruptured AAA about _____%
Risk of AAA rupture within 5 years:
>___cm = 76%
AAA 40 60 100 7.0 6.0 5.0 surgery kidneys hematoma
Diagnosing Aneurysm
Normal diameter of aorta = up to ____cm
Aneurysm diameter = >____cm
Can range from ____ - ____ cm
Generally an aneurysm increase in diameter at the rate of about ____ mm/yr
Measurements taken from ______ wall to _____ wall for the size of the true vessel
Measure true and patent lumen
True = entire \_\_\_\_\_\_\_ Patent = area of \_\_\_\_\_ with flow
Measuring an Aneurysm
Longitudinal - largest
Entire length of _______
AP (optional if measured on _______)
Transverse - largest
______
AP (optional if measure on _______)
3 3 3 20 2 outer outer vessel vessel aneurysm transverse width sag
Sono Images
Evaluate entire _______
Determine extension to or above the _______ arteries and extension to CIA’s
Measure _______
Presence / absence of _______ thrombus
Use color flow to exclude _______
Attempt to determine patency of _______ arteries and _______
Document kidneys - rule out _______
NOTE
The tendency for aortic aneurysms to occur infrarenally is of great importance because the surgeon may conveniently maintain perfusion of the kidneys during surgical repair by cross clamping the aorta below the RAs
Repair cephalic to the RAs may involve reimplantation of the RAs or mesenteric vessels
aorta renal aneurysm mural dissection renal SMA hydro
Problem and Solution in Ao Imaging
_______ obscuring Aorta - Firm continuous transducer pressure (about 2 mine.); scan coronally through left flank with patient in right lateral decub position
Apparent _______ of AO = Rotate transducer to scan obliquely following tortuous Ao
_______, ? ______ = Vary gain setting to ensure no reverberation artifact or dropout of true mural thrombus; color flow to identify patent lumen
gas
occlusion
aneurysm
thrombus
3 Graft Types
_______ tube
_______-_______ Femoral Artery
_______
Surgical mortality for repair for AAA before rupture is about ____%
Most surgeons do not consider operating on an aneurysm that is less then ____-____cm
straight arto-iliac aortobifem 4 4-5
Graft Sonographically
_______ walls
Possible ribbing
Measuring is the same as with an _______ …. measure native lumen and area of flow within the graft
bright
aneurysm
Pseudoaneurysm
Do not have a wall but are surrounded by _______
Result from a tear in the vessel _______ that allows blood to escape into the surrounding tissues
Most common causes:
_______
Arterial _______
Sonographically:
May present as a _______ in the region of an artery where there was trauma
Mass contains variable amount of _______ material (blood clot) with pulsations / swirling / YING YANG Sign
Real-time imaging allows visualization of _______ or the _______ of blood through the mass
Color Doppler Turbulent flow (swirling) with the site of communication termed the \_\_\_\_\_\_\_
Doppler
Advantageous in making the diagnosis of pseudo vs. _______
_______ Doppler analysis reveals a to-and-fro pattern
clot wall trauma catherizations mass echogenic pulsations swirling neck hematoma spectral
Aorta - Vein (AV) Fistula
Abnormal connection or passageway between an _______ and a _______
It may be congenital, surgically created for hemodialysis treatments, or acquired due to pathologic process, such as _______ or erosion of an arterial aneurysm
May be _______
artery
vein
trauma
palpable
Pathology of IVC
Mural Lesions
Include adherent _______ and _______
Most common 1 is leiomyosarcoma of the IVC _______ (older females)
Mets from direct spread of HCC, RCC, breast and lymphoma
May exert _______ effect
Mat spread to _______ and/or _______
thrombus tumor wall mass RVs HVs
Intravascular Thrombosis
_______ most commonly encountered intraluminal anomaly of IVC; usually spread from another vein
SONO:
Intraluminal filling defect usually expanding diameter of _______
Echogenicity of thrombud depends on _______; chronic thrombus may calcify
If hypo- or _______ color doppler will demonstrate a filling defect
thrombosis
IVC
age
isoechoic
Intravascular Thrombus and IVC Filters
Variety of IVC filter to prevent thrombi from traveling to the _______ and causing a PE (pulmonary embolism)
SONO:
Tips of filter can be seen on images in transverse esp as _______ echogenic structures mimicking “foci”
lungs
bright
Dilatation and Compression
Cardiac failure and fluid overload _______ diameter of IVC and HVs; exaggerate normal doppler flow pattern
_______ of the IVC can result from thrombosis secondary to hypercoagulable disorders, extrinsic compression by tumors, infective phlebitis, inflammation, trauma, surgery, or in many number of cases, idiopathic
In longstanding cases, it results in swelling of extremities, pain, venous ulceration and impaired liver and renal functions. The course of the disease can be rapidly fatal, or at times it may be confused with other causes of cirrhosis and portal hypertension
increase
obstruction
Transportation of the IVC
_______ Inversus: Mirror reversal in location of vessels and organs
_______ syndrome: IVC is anterior to the aorta (other anomalies are also present)
_______ Transposition: Retrohepatic IVC is in normal position, but the IVC lies to the left of the aorta below the level of the renal veins
situs
asplenia
partial
Azygos Continuation of the IVC
Congenital absence of normal _______
_______ veins are dilated and seen posterior to the diaphragmatic crus, lateral to the vertebrae
Associated with _______ syndrome
IVC
azygous
polysplenia
