DDx

Question 1

DDx?

Answer 1

1. Multicystic dysplastic kidney: multiple, large, non-communicating cysts which distort/replace the renal parenchyma.
2. Acquired renal disease: multiple cysts of varying sizes, in a pt who has undergone renal dialysis; intervening parenchyma will be echogenic.
3. ADPKD: pts will have cysts in the liver & pancreas.
4. Hydro: these “cysts” will communicate w/the renal pelvis; use real-time cine Ix to differentiate.

Question 2

DDx?

Answer 2

DDx pneumobilia:

1. Sphincterotomy: correlate w/Hx of obstructing stones & removal; air may pass from the duodenum retrograde into the biliary tree.
2. Acute cholangitis: correlate w/Sx of Charcot triad (fever, jaundice, RUQ pain); progression may lead to pneumobilia. Emergent Tx is necessary to decompress the biliary tree.
3. Emphysematous chole: air in the GB wall may enter the biliary tree.
4. Biliary-enteric fistula: correlate w/Hx of surgery or GS ileus.

Question 3

DDx?

Answer 3

DDx: enlarged ovary w/mass w/o flow:

1. Torsion: younger, pain, reduced/no flow.
2. Neoplasm: benign or malignant.
3. TOA: pain, fever, discharge, hyperemic.

Question 4

DDx?

Answer 4

DDx: enlarged ovary w/multiple peripheral follicles:

1. Torsion: pain, decreased/no flow.
2. PCOS: enlarged ovaries w/peripheral follicles; correlate w/clinical Sx of androgen excess, e.g., hirsutism, amenorrhea, irregular menses, obesity.
3. Ovarian hyperstim: ovaries usually massively enlarged (>20cc); correlate w/Hx of fertility meds; look for ascites, pleural effusion.

Question 5

DDx?

Answer 5

DDx: hyperechoic liver mass:

1. Hemangioma: sharply demarcated, often solitary, more common in women.
2. Focal fat: more geographic.
3. HCC: in at risk pts, has a variety of appearances, but vascular.
4. Adenoma: variety of appearances; more common in women; can be hyperechoic b/c fat-containing.
5. FNH: rare; rarely they can be hyperechoic.

Question 6

DDx?

Answer 6

DDx: complex extratesticular fluid collection:

1. Hematocele: tunica vaginalis; trauma or iatrogenic.
2. Pyocele: Hx will differentiate: fever, acute pain Hx of infection or ascending cystitis; scrotum may be red/swollen.
3. Huge varicocele: valsalva will change it.
4. Huge spermatocele: in epididymis.

Question 7

DDx?

Answer 7

DDx “starry sky” appearance of the liver:

1. Acute hepatitis: most common cause; hepatomegaly; RFs.
2. Hepatic congestion: look for pulsatility in the HVs & PVs; Budd-Chiari; right heart enlargement; will also show hepatomegaly.
3. Infiltrating neoplasm:
4. Biliary or PV gas: will move.
5. Toxic shock syndrome: correlate w/fever, rash, hypotension, vomiting, diarrhea.

Question 8

DDx?

Answer 8

DDx: targetoid liver lesions:

1. Mets: most commonly breast, lung, GI.
2. HCC: invade PV; correlate w/RFs.
3. Lymphoma: lymphadenopathy, splenomegaly; often prefers periportal areas b/c of high content of lymphatic tissue.
4. Abscesses: fever, leukocytosis.

Question 9

DDx?

Answer 9

DDx portal vein occlusion:

1. Tumour thrombus: HCC (most commonly), GB ca, pancreatic ca, gastric ca, mets.
2. Hepatic cirrhosis w/PHTN: sluggish PV flow which leads to thrombus; look for other signs, e.g., cavernous transformation, cirrhosis, recanalized umbilical vein.
3. Infection/inflammation: sepsis, cholangitis, hepatitis, pancreatitis.
4. Inheritable states: factor V Leiden, protein C/S deficiency.

Question 10

DDx?

Answer 10

DDx, multiple splenic hypoechoic foci:

1. Candidiasis/aspergillus/cryptococcus: immune compromised.
2. Granulomatous disease: histoplasmosis if immunocompetent, TB or PJP if not; calcify over time.
3. Diffuse lymphoma:
4. Sarcoid:
5. Mets: rare; seen only in advanced disease w/widespread involvement; 50% melanoma.

Question 11

DDx?

Answer 11

DDx hyperechoic foci in the GB wall:

1. Porcelain GB: obtain CT or XR to confirm; look for GB mass, liver lesions or LAN.
2. Emphysematous cholecystitis: dirty shadowing.
3. Adenomyomatosis: look for comet tail artifact.
4. Wall echo shadow sign: of GB packed w/gallstones.

Question 12

DDx?

Answer 12

DDx, fetal sacral mass:

1. Sacrococcygeal teratoma: most common;
2. Myelomeningocele: usually lumbosacral; abnormal spinal cord; assoc w/Chiari II.
3. Rhabdomyosarcoma: usually w/o calcs, fat or cysts.

Question 13

DDx?

Answer 13

DDx, GB wall thickening:

1. Edema: 2dry to congestive heart failure, renal failure, advanced liver disease, lymphatic obstruction 2dry to portal LAN or mass; thickened, striated appearance suggests this.
2. Acute chole.
3. 2dry inflammation: pancreatitis, hepatitis, pyelo.
4. GB carcinoma: especially if asymmetric thickening.
5. Diffuse adenomyomatosis:

Question 14

DDx?

Answer 14

DDx fetal hyperechoic thoracic mass:

1. CPAM: most common thoracic mass; connects w/the airway & w/pulmonary circulation.
2. Sequestration: LLL; does not connect w/the airway; Doppler will show systemic arterial feeder (Ao commonly).
3. Congenital lobar emphysema: most commonly LUL; pulmonary arterial feeder.
4. CDH: most commonly bottom left (90%). May contain stomach/bowel.

Question 15

DDx?

Answer 15

DDx, hyperechoic intracardiac focus:

1. Echogenic intracardiac focus: sommonin high risk pts may be assoc w/T21.
2. Rhabdomyoma:
3. Fibroma:

Question 16

DDx?

Answer 16

DDx, halo sign:

1. Angioinvasive aspergillosis.
2. Hemorrhagic mets.
3. Wegeners.

Question 17

DDx?

Answer 17

DDx cavitary pulmonary mass/thick-walled cavities: (see word doc)

Question 18

DDx?

Answer 18

Arthritis mutilans (opera-glass hands) DDx:

• Psoriatic arthritis: classic
• RA
• Juvenile chronic arthritis
• Leprosy / neuropathic arthritis
• Reactive