case studies Flashcards
a 55 year old man is seen for a routine physical examination. during the examination the physician feels a pulsatile mass at the level of the umbilicus. an ultrasound is ordered to ?
rule out AAA
A 72 year old woman is seen in an unconscious state in the emergency department. She is accompanied by her husband who states that she had a attack of severe abdominal pain and then passed out. Clinical evaluation reveals a hypotensive condition, and an abdominal ultrasound is ordered. the ultrasound reveals an aorta that measures 8 cm in diameter at the distal end and fluid in the peritoneal cavity. This would be consistent with?
aortic rupture
A 67 year old man with vague abdominal pain is seen by his physician. A kidney ureters bladder radiograph is ordered and is unremarkable except for calcifications noted along the aorta. An aortic ultrasound examination is ordered and reveals a distal aortic diameter of 4 cm. This would be consistant with?
abdominal aortic aneurysm
A 40 year old man with a history of Marfan syndrome is seen with intense chest pain in the emergency department. What is the diagnosis?
aortic dissection
fAll of the following are risk factor for abdominal aortic aneurysm except:
- advanced age
- atherosclerosis
- female gender
- hypertension
- smoking
female gender
a 72 year old man has an abdominal aortic aneurysm that measures 4 cm in diameter. This patient should be followed with what frequency to monitor for expansion of the aneurysm?
every 6 months
A 62 year old woman is seen inthe emeregency department with chest pain and fainting spell but is conscious and cognitive. Patient history includes a previously diagnosed abdominal aortic aneurysm. An ultrasound of the abdominal aorta and electrocardiography and echocardiography are ordered. The abdominal ultrasound reveals the aneurysm, which measures 4.8 cm. The sonographer also identifies a thin linear echo within the aorta and documents flow on both sides of this line with color doppler examinaiton. This would be consistent with ?
aortic dissection
A 58 year old woman with epigastric pain which eating is seen for an abdonimal ultrasound to rule out gallstones. The sonographer identifies normal appearing gallbladder, liver, pancreas and spleen. The sonographer also documents a dilation of the aorta, which measure 6 cm. at its greatest diameter. This could be consistant with?
aortic aneurysm
A 51 year old man undergoes an ultrasound of the RUQ. pertinent history includes multiple previous ultrasound examinations that document a small liver that is difficult to penetrate. Liver enzymes levels are elevated. The patien is very this, which a slightly protruding abdomen. The liver remains small and diffcult to penetrate, with poorly documented hepatic vasculature. No specific masses are noted. Free fluid is noted within the Morrisons pouch and right subphrenic space. The anterior border of the liver is noted to have a scalloped appearance. most likely?
cirrhosis
a 43 year old woman undergoes an ultrasound to rule out gallstones. She is moderately obese. The gallbladder contains a single stone, which produces a clean posterior shadow. The liver is hyperechoic, but hepatic vasculature is poorly seen. No distinct masses are noted. Based on her history and findings described, what could be the diagnosis?
fatty infiltration
a 21 year old man undergoes a RUQ ultrasound in the emergency room. AST and ALT levels are elevated. The liver appears normal in echo texture without masses noted. The right posterior lobe etends inferiorly beyond the lower pole of the right kidney. What is the most likely diagnosis?
acute hepatitis
A 52 year old man with long standing cirrhosis undergoes an abdominal ultrasound scan AST, ALT, and GGT levels are elevated. The liver is small and difficult to penetrate. Doppler examination reveals a hepatofugal blood flow in the main portal vein. What is the most likely diagnosis?
portal hypertension
a 41 year old woman iwth long standing cirrhosis undergoes an abdominal ultrasound scan. AST, ALT, and GGT levels are elevated. The liver is small and difficult to penetrate. A sonolucent area is noted between the left lateral and medial lobes and shows flow with color doppler. Based on the findings, what is the most likely diagnosis?
portal hypertension
A 62 year old man with long standing cirrhosis undergoes an abdominal ultrasound scan. AST, ALT, and GGT levels are elevated. The patient has long standing protal venous hypertension that has been managed with the placement of a TIPS catheter, ultrasound has been requested to assess the shunt for patency and size. The velocity within the TIPS catheter was documented at 150cm/s on the previous study od 6 months ago. Current flow is documented at 200cm/s. What is most likely on the basis of the provided information?
catheter stenosis
A 31 year old woman undergoes a RUQ ultrasound scan. She is obese and has RUQ pain. Liver enzyme levels are normal. The gallbladder is normal in appearance. The liver is noted to be hyperechoic, and hepatic vasculature is difficult to define. One hypoechoic area is noted anterior to the right portal vein near the porta hepatus. On the basis of these findings, what is the most likely diagnosis?
fatty infiltration & fat sparing
a 36 year old woman undergoes a RUQ ultrasound. AST and ALT levels are elevated. The liver appears hyperechoic in appearance. The portal veins appear prominent, with thick walls noted. The gallbladder shows a thick wall without internal inclusions. Based on the findings noted, what is the most likely diagnosis?
acute hepatitis
a 54 year old man with fatigue is seen in the ultrasound departement. Liver enzyme levels are slightly elevated. The liver is heterogenous in echo texture. What is the best diagnosis?
lymphoma
A patient is seen in the ultrasound department with a long standing history of cirrhosis and a recent surgical intervention of portal hypertension. Sonographically a tubular structure is noted within the right lobe of the liver that shows blood flow within it. Based on the history and the sonographic findings, what is the most likely diagnosis?
TIPS catheter
A 65 year old man with a history of chronic active hepatitis is seen with abdominal pain. Laboratory values reveal abnormal liver function test results and an elevated serum alpha-fetaprotein level. Ultrasound reveals a lobulated, hypoechoic mass in the posterior segment of the right lobe of the liver. Color doppler imaging shows a mosaic flow pattern within the mass. This is most suggestive of ?
hepatocellular carcinoma
a 32 year old woman with a history of RUQ pain with fatty foods is seen for ultrasound. The ultrasound reveals the presence of gallstones and in addition, a 3cm isoechoic mass in the liver. Power doppler investigation of the lesion show a “spoke wheel” pattern flow. What is the most likely diagnosis?
focal nodular hyperplasia
a 24 year old woman is seen for a renal ultrasound because of a recently diagnosed congenital uterine abomaly. The renal ultrasound is unremarkable . Incidentally noted is a 1.5cm echogenic mass in the right lobe of the liver. The most likely represents what?
hamangioma
a 38 year old woman with a history of von Gierke’s disease is seen for an abdominal ultrasound because of right upper quadrant pain. Two hyperechoic lesions are identified in the liver. Doppler reveals flow around the periphery of each of the lesions. This wuld be most consistent with ?
liver cell adenoma
a 45 year old man with a history of hepatitis is seen for ultrasound examination of the abdomen. The sonographer identifies a 6cm complex mass in the liver. This would be suspicious for what tumor?
hepatocellular carcinoma
a 70 year old woman is seen for malaise and wasting. The clinician orders abdominal ultrasound because of the patients history of colon cancer and elevated liver function tests. The sonographer notes multiple hyperechoic lesions withing hte liver and hepatomegaly. This is suggestive of ?
metastatic disease
a 32 year old obese women is seen for a right upper quadrant ultrasound to ruleout gallstones. The sonographers inquiry into the patients symptoms reveal a fatty food intolerance. Ultrasound examination of the abdomen reveals cholelithiases and a 1.5cm echogenic lesion in the liver. The most likely diagnosis for the liver lesion is?
hemangioma
A 59 year old woman with a history of ovarian cancer and increasing abdominal girth is seen for an abdominal ultrasound. The ultrasound reveals ascites and multiple hyopechoic lesion in the right and left lobes of the liver. This is consistent with?
metastasis
A 50 year old african immigrant with right upper quadrant pain and weight loss is seen for ultrasound. The patient states that he worked in the fields growing and harvesting a variety of grains for 30 years. Laboratory results reveal an elevated serum alpa fetoprotein level/ Ultrasound examination shows a 4cm heterogeneous lesion in the liver and a small amount of ascities.
This would suggest?
hepatocellular carcinoma
a 47 year old woman with a history of pancreatic carcinoma who is undergoing chemotherapy is seen. Previous ultrasound examination performed 3 months ago showed a normal appearing liver. The current ultrasound examination reveals two echogenic lesions in the right lobe of the liver. This would be most cosistent with ?
metastasis
Which of the following conditions make the pancreas difficult to image for sonography?
A. its deep location in the mid abdomen
B. proximity of the stomach and duodenum
C. proximity of the transverse colon
D. indistinct borders from absence of a true capsule
its deep location in the mid abdomen
A 69 year old man with alcholism is seen with leukocytosis and elevated amylase level and a rising lipase level. The entire pancreas appears enlarged and hypoechoic with ill defined borders. The most likely diagnosis is?
acute diffuse pancreatitis
A 52 year old woman is seen in the emergency department with epigastric discomfort and chest pressure. Electrocardiogram results are normal, and a nitroglycerin tablet does not relieve the pain. The laboratory values show an elevated white blood cell count, mildly elevated amylase level, and markedly elevated lipase level. The abdominal sonographic examination reveals a small hyperechoic pancreas with dilated pancreatic duct. This is most likely?
chronic pancreatitis
a 45 year old woman is seen by her physician with mild epigastric pain, weightloss, and a large palpable abdominal mass. The sonographic examinatin reveals a 9cm multilobulated, cystic mass occupying the mid epigastrium. The cysts measure larger than 2cm, with internal papillary projections and calcifications. CT scan results confirm the mass orginates form the pancreatic body. The most likely diagnosis is?
macrocystic cystadenocarcinoma
a 56 year old woman is seen in sonographic department for a renal examination. While scanning the left kidney, the sonographer notices a multicystic mass in the tail of the pancreas. The patient is asymptomatic for pancreatic disease. CT scan follow up confirms a multicystic lesion, with cysts that measure less than 2 cm. The most likely diagnosis is?
microcystic cystadenoma
a 39 year old morbidly obese woman undergoes surgery for gastric stapling and an abdominal exploratory procedure. She had hormonal imbalances. During surgery, the surgeon notices an irregularity on the anterior surface of the pancreas. intraoperative sonography reveals two small hypoechoic lesion that measure approximately 1 cm. The most likely diagnosis is?
islet cell tumor
visualization of which of the folowing structures is most improved with oral contrast during pancratic sonography
A. head of pancreas
B. tail of pancreas
C. peripancreatic tissue
D. pancreatic duct
E. uncinate process of the pancreas
B. tail of pancreas
a 40 year old woman is seen for a renal ultrasound. microscopic hematuria was found during her routine annual physical examination. A solid mass is identified int he renal cortex. The mass is more echogenic than the renal sinus, and the collecting system is not dilated. what is the most likely diagnosis?
AML
A 25 year old patient with right flank pain, nausea, and vomiting is seen for a renal ultrasound. The ultrasound reveals large echogenic foci with posterior acoustic shadowing in the kidney. The calyces appear to be dilated. What is the most likely diagnosis?
Calculi
A 2 year old boy with a history of weight loss, vomiting and hypertension and with dark pink urine is seen for an abdominal ultrasound. The sonographer identifies a large homogeneous echogenic mass distoring the kidney. What is the most likely diagnosis?
nephroblastoma
A teenage boy is tackled roughly during a football game. After the game he has abdominal pain. The pain becomes intense and the next day he is seen at the emergency department. The laboratory values are abnormal, the hematocrit level is low, and microscopic hematuria is found. A renal ultrasound is ordered. The ultrasound of the left kidney is normal. The right kidney appears normal, but a sonolucent rign is seen surrounding the kidney. This is most consistent with?
perinephric hematoma
A patient undergoing long term dialysis with hypertension and flank pain is seen for a renal ultrasound. The ultrasound reveals a normal let kidney and a large complex lower pole mass of the right kidney. Low level echoes are identified in the right renal vein. The most likely diagnosis is ?
RCC
a 32 year old patient with severe left flank pain and hematuria is seen for a renal ultrasound. The ultrasound reveals a dilated ureter, and no urteral jet is seen on the left side. The right kidney appears normal, and the left renal collecting system is dilated. This is most consistent with?
ureteral stone
A middle aged patient with microscopic hematuria and no pain is seen for a renal ultrasound. The ultrasound reveals a small solid left renal mass that causes the renal cortex to bulge. No vascular flow is seen with color doppler. This is most suggestive of?
adenoma
A patient with a history of tuberous sclerosis, recent onset of hematuria, and pain is seen for a renal ultrasound. The ultrasound reveals bilateral well dringed echogenic renal cortex masses with increased posterior acoustic enhancement. This finding is most consisten with?
AML
a 42 year old man who was recently told that he has hematuria is seen for an abdominal ultrasound. The ultrasound is unremarkable except for a 3 cm well defined mass with a central scar in the left kidney. What is the most likely diagnosis?
oncocytoma
a 10 year old boy is seen for a scrotal ultrasound. on the clinical examination, no testicles were palpated within the scrotal sac. A homogenous ovid mass is identified within the left inguinal canal. This mass probably represents?
cryptorchidism
a 52 year old man is seen with pain and enlargement of the scrotum. An ultrasound evaluation is ordered by the attending physician and reveals a small hydrocele on the left with a swollen heterogeneous appearing left testicle and left epididymis. Increased blood flow is also identified on color doppler. This is suggestive of?
Epididymoorchitis
A 22 year old man is awakened with a sudden onset of scrotal pain. on examination in the emergency room, a scrotal ultrasound is ordered. The sonogram reveals slight enlargement of the right testicle and a small hydrocele. On color doppler examination, no blood flow can be shown. What do these finding suggest?
testicular torsion
a 43 year old male is seen with a grossly enlarged scrotum. Sonographic examination reveals bilateral large hydorceles. In addition, a hypoechoic area inthe head of the epididymis is identified. This hypoechoic are probably represents?
Spermatiocele
A 35 year old man is seen for sonographic examination fo the scrotum for palpable mass in the right hemiscrotum. The sonogram reveals multiple punctuate foci and large are of decreased echogenicity in the right testis. These finding are suggestive of?
a 40 year old man undergoes evaluation for infertility. His physician orderas an ultrasound for further evaluation. During the ultrasound exam, an area of dilated vessels is identified in the left scrotum. Some of these vessels measure 1.5mm to 2.0 mm. These vessels are suggestive of?
variocele
A 26 year old male construction worker is seen in the emergency department after falling onto a metal pip from a ladder. He currently has pain and swelling of the scrotum. An ultrasound is ordered. During the sonogram, increased echogenicity of the right testicle is noted. In addition, hypervascularity of the righ testicle is noted on color doppler examination. An area of echogenic material is seen in the upper margin of the right testicle. These findings represent?
testicular rupture
a 28 year old undergoes clinical evaluation for a palpable mass in the left testicle. An ultrasound exam is ordered for further evaluation. The soogram reveals a solid hypoechoic mass within the left testicle. A small amount of fluid also surrounds the left testicle. These findings are suggestive of?
seminoma
a patient is seen for neck ultrasound 2 years after surgery for papillary thyroid cancer. The sonogram reveals bilateral multiple masses, presumable lymph nodes, along the carotid-jugular areas.Of note is one mass that is hypoechoic and rounded in shape. The shape and location fo this mass make it most suggestive of?
thyroid adenoma
renal cyst in LUQ medial to splenic hilum
accessory spleen
LUQ pain, weakness, left side bruising, decreased hematocrit, subcapsular fluid in spleen, fluid in morrison pouch
splenic trauma
round anechoic lesion in spleen with 2 cm w/ posterior enhancement
cyst
large palpable mass protruding from neck (thyroid)
adenoma
complex appearing multi mass in thryoid
complex cyst
Right flank pain, naseua, vomiting, lg. chogenic foci with posterior enhancement in kidney, calyces dilated
renal stones/ calculi
hematuria, solid right renal upper pole mass, enlarged kidney
renal cell carcinoma; should evaluate IVC and renal veins
hypotension, decreased heematocrit, 8.5 cm at aorta
AAA with rupture
hypertension & flap
aortic dissection
calfication on aorta; distal aorta 4cm
AAA
RUQ pain, history of chronic pain, cyst in bile duct
choleductyl cyst
immobile hyperechic mass attached to GB wall
polyp
hepatic calculi, RUQ pain, history of cholecystecomy
dilated ducts; evaluate the liver and pancreas
pyloric stenosis measurements
muscle thickness greater than 3.5mm; channel length greater than 17mm; muscle length greater than 20mm
AML
angiomyolipoma of the kidney
strawberry appearance
cholesterolosis
RUQ pain, GB wall thickness, 1.8mm CBD with stones
cholelithiasis with dilated CBD
OPC, hard liver,
focal nodular hyperplasia
moderately obese, peptic discomfort, hyperechoic liver
fatty liver
alcohol abuse, diffusely inhomogenous liver, RUQ pain, elevated liver enzymes
hepatocellular carcinoma
increased abdominal girth, anorexia, AST & ALT levels elevated, vague discomfort, liver hyperechoic, free fluid in abdomen, borders of liver shows nodular irregularity
Cirrhoisis “Egg on legs”
weightloss, epigastric pain and nausea, palpable mass RUQ, jaundice, enlarged GB with gallstones, CBD measure 1.3 mm, pancreas ill defined, hypoechoic lesion
adenocarcinoma(cancer in head of pancreas)
enlarged thyroid
goiter
a 7 week old male infant is seen with projectile vomiting for 3 days. He is dehydrated and on physical examination, has an olive shaped mass in the upper right quadrant. What is the most likely diagnosis?
pyloric stenosis
a 6 month old chubby female infant is seen with lethargy, fever and diarrhea. A small amount of blood is found in the stool. What is the most likely diagnosis?
intussusception
a 31 year old woman is seen with right lower quadrant pain, fever and elevated WBC count. what is the most likely diagnosis?
appendictitis
a 50 year old man with a history of stomach ulcers is seen with weight loss and projectile vomiting. What is the most likely diagnosis?
pyloric stenosis
a 5 year old boy is seen with periumbilical pain, nausea, and fever. Both of his parents had surgical appendectomies as childre. What is the most likely diagnosis?
appendicitis
a 10 year old girl with cystic fibrosis is seen with abdominal pain, vomiting, and lethargy. A sausage shaped mass is palpated in the RUQ. What is the most likely diagnosis?
intussusception
A 3 week old male infant with an absent mandibular frenulum is seen with projectile vomiting. What is the most likely diagnosis?
pyloric stenosis
A pregnant 23 year old patient is seen with RLQ pain and vomiting. The WBC count is elevated. What is the most likely diagnosis?
appendicitis
a 63 year old man with a history of diverticulitis is seen with abdominal pain and bloody stools. He is lethargic with fever and diarrhea. What is the most likely diagnosis?
intussusception
A 45 year old woman with a history of fibrosis and stomach ulcers is seen with vomiting, weight loss, and electrolye imbalance. What is the most likely diagnsis?
pyloric stenosis
a 62 year old man with a history of right flank pain is seen for a renal ultrasound. Sonographic examination of the right kidney reveals a 3 cm round, anechoic lesion that is thin walled and has acoustic enhancement . This is most consistant with?
simple cyst
an asymptomatic 26 year old woman is seen with a family history of ADPKD. Because of the high cost of DNA testing a screening renal ultrasound is ordered to rule out renal cystic disease. The sonographer identifies two simple cyststic lesion in the right kidney and two simple cystic lesions in the left kidney. This is consistant with?
autosomonal dominant kidney disease
A 55 year old man is seen with flank pain. Clinical evaluation reveals that hs is febrile and that there are white blood cells in his urine. A renal ultrasound is ordered. Sonographic evaluation of the kidneys reveals a normal right kidney with 1 cm simple cyst. The left kidney contains a 2.7 cm thick walled cyst. Most consistant with?
right renal simple cyst, left renal infected cyst
a 42 year old woman is seen for a routine physical that reveals an elevated blood pressure. Thye patient had a first degree relative who also had hypertenhsion and died of a “kidney problem” A renal ultrasound is ordered and shows four cysts in the right kidney and five cysts in the left kidney. In addition the kidneys are slightly increased in size.
autosomonal dominant polycystic kidney disease
a 45 year old man with a history of left flank pain is seen for a renal ultrasound. The ultrasound reveals a normal right kidney measureing 11.5cm. The left kidney measures 12 cm and contains a round anechoic lesion that has a thin well defined wall located at the superior aspect. No enhancement is identified.
atypical cyst
a 56 year old woman with a history of a UTI is seen for a renal ultrasound. The ultrasound reveals mild hydronephrosis in the right kidney and 2 cm cystic lesion within the renal hilum. This wouod bge consistent with?
hydronephrosis associated with parapelvic cyst
a 65 year old man with diabetes and subsquent renal disease who has been on dialysis for 9 years is seen for a renal ultrasound. The ultrasound reveals kidneys that are decreased in size bilaterally with five small cysts on the left kidney and three small cyst on the right kidney. This would be consistant with?
acquired cystic kidney disease
A 35 year old man witha history of intermitent epigastric pain with meals is seen for a RUQ ultrasound to rule out gallstones. The gallbladder, liver and pancreas are unremarkable. The right kidney is normal in size, and the pyramids are highly echogenic. Examination of the left kidney reveals a similar appearance. This would be consistent with?
nephrocalcinosis
a 72 year old man with intermittent flank pain is seen for a physical. Laboratory test results reveal abnormal renal function tests. A renal ultrasound is ordered and reveals bilateral enlarged kidneys with multiple cysts to numerous to count. This would be consistent with ?
ADPKD
a 55 year old man with epigastric pain is seen for abdominal ultrasound. The liver, kidney, gallbladder and pancreas are unremarkable. The spleen is within normal limits and homogeneous. The splenic hilum contains a round 1.5 cm lesion that is hnomogenou. Doppler examination shows a vessel connecting the spleen to the lesion. What could this be?
accessory spleen
