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Vascular > Extracranial pathology > Flashcards

Extracranial pathology Flashcards

0
Q

Atherosclerotic disease: what do you need to evaluate?

A

location?

surface characteristics: smooth vs irregular??

echogenicty: homogeneous, heterogenous, calcification??

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1
Q

What is atherosclerosis?

A

thickening

hardening

loss of elasticity

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2
Q

WHat is plaque made of?

A

lipid complex carbohydrates

fibrous tissue

calcium

fibrin

it accumulates and causes the lumen to move

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3
Q

Where is the most common location for plaque?

A

typically in the bulb

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4
Q

What is a fatty streak of plaque?

A

thin layer of lipid material

homogeneous

low level echoes

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5
Q

what is fibrous plaque?

A

homogeneous

low to medium echoes

accumulation of lipid

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6
Q

what is a complicated lesion of plaque?

A

fibrous with collagen and debris

heterogeneous

bright echoes with shadow

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7
Q

what is an ulcerative lesion of plaque?

A

deterioration of the surface

may result in embolization

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8
Q

What causes a carotid artery stenosis?

A

accumulated plaque

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9
Q

Can a carotid have an aneurysm?

A

yes

walls should look like railroad tracks

rare but any artery can have an aneurysm

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10
Q

what is takayasu’s?

A

chronic inflammation that results in narrowing of arteries

arteritis - nonatherosclorotic

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11
Q

How do you determine the degree of stenosis?

A

elevated velocity through narrowed segment

color changes

post stenotic disturbances

turbulent blood flow

spectral broadening

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12
Q

How do you differentiate a stenosis from an occlusion?

A

rule out any trickle flow by using:

doppler

color doppler

power doppler

decrease color PRF

adjust sample volume

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13
Q

What are the secondary characteristics of an ICA occlusion?

A

echogenic material filling the lumen

lack of arterial pulsations

reveresed blood flow

loss of diastolic flow in the CCA

increase velocity in the ECA

increase velocity in the contralateral ICA

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14
Q

Where do you get the highest velocity?

A

at a stenosis

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15
Q

What is the stenosis criteria?

A

diameter PSV EDV

=. >=125cm/sec N/A

80-99% >=125cm/sec >= 140 cm/sec

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16
Q

What happens when there is a critical stenosis?

A

pressure and flow volume decrease cant get blood to brain

degree of abnormality depends on:

length of narrowing

diameter of narrowing

pressure

resistance

collateral

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17
Q

proximal to a stenosis flow is _______ and pulsatility _________

A

dampened

increases

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18
Q

At the stenosis _________velocities and spectral __________

A

increase

broadening

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19
Q

post stenotic flow ___________ and flow is _____________

A

reversed

disturbed

20
Q

What sound does a stenosis produce?

A

higher pitched sound

also have:

higher velocities

spectral broadening

distal to a stenosis: turbulence

dampened more rounded see slide 171 for picture

21
Q

how do you get rid of color alasing?

A

adjust the color scale

22
Q

what is the highest velocity obtained from an ICA stenosis is used to classify what?

A

the degree of narrowing

23
Q

What do the doppler signals obtained distal to the area of poststenotic flow disturbance look like?

A

may be normal or diminished

upstroke of the distal doppler spectral waveform may be slowed

24
Q

What is tardus parvus?

A

delay arrival of systolic peak with low velocity

see slide 174 for picture

25
Q

Is surgical intervention available for ICA occlusion?

A

no

26
Q

if you aren’t seeing good color, how might you improve the image?

A

change the PRF (scale) or the color gain

27
Q

What happens when you have an ICA occlusion on one side?

A

the other side changes velocity

28
Q

What is the sign name for trickle flow?

A

string sign (may need to use power doppler)

29
Q

What is the surgery called to remove a carotid stenosis?

A

thrombo endarterectomy

30
Q

If the ECA starts to look like the ICA what usually has disease?

A

the CCA is usually occluded

31
Q

if you have a high grade stenosis of ECA what happens to ICA

A

flow is elevated

32
Q

what causes turbulent flow?

A

stenosis

kinking

tortuosity

increase in vessel diameter

33
Q

what does the vertebral artery unite to form?

A

basilar artery

34
Q

how do you see the vertebral artery?

A

angle back toward the spine

35
Q

what kind of flow does a subclavian steal have?

A

monophasic flow damped

more often on the left side

reversed flow

36
Q

What questions must you answer for stenosis evaluation?

A

location of stenosis

extent of plaque patency of distal ICA

presence of tortuosity

characteristics of plaque

37
Q

What causes a dissection?

A

blunt and penetrating trauma

38
Q

what is Marfan’s syndrome?

A

connective tissue disorder

genetic

can cause aortic enlargement

39
Q

What is fibromuscular dysplasia (FMD)

A

non atherosclerotic

unknown etiology

affects the media of the arterial wall

mid segment of the ICA

bilateral in 65%

usually females

“string of pearls”

turbulent flow

absence of plaque

40
Q

What is a carotid body?

A

small mass of vascular tissue that adjoins the carotid sinuses

ovoid structure 1 mm in size

located in the adventitia

component of the nervous system

41
Q

what does the carotid body do?

A

assists in regulating heart rate, blood pressure, and respiration

chemoreceptor within the adventitial layer of the bifurcation

42
Q

what is a carotid body tumor?

A

rare

palpable neck mass

headache

hypervascular

between ICA and RCA

Blood supply via ECA branches

slow growing neoplasm/mass

43
Q

carotid body is ___________carotid body tumor is ___________

A

normal

abnormal

44
Q

What are some common features of a carotid aneurysm?

A

uncommon

pulsatile neck mass

bruit

weakness of the media

blood swirling

tortuous CCA

significant increase in vessel diameter

abnormal blood flow pattern

44
Q

What is the pathology of a dissection?

A

blunt and penetrating trauma

cervical injuries

neck flexion

associated with marfan’s syndrome

between the intima and medial layers creating a false lumen

45
Q

What is a carotid endarterectomy?

A

the assessment of the carotid endarterectomy site by duplex imaging for technical adequacy is an effective method to improve the results of the operation

transducer is placed in a sterile sleeve and imaging is performed on the exposed artery

after endarterectomy the intima is missing because of removal

46
Q

What is carotid artery stenting

A

technique that has been introduced as an alternative to carotid endarterectomy in selected patients

grayscale image of stent produces bright echoes

Vascular (6 decks)

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