Final Flashcards
1
Q
what are adrenal glands?
A
cresent shaped hypoechoic structures surrounded by echogenic fat
2
Q
what are the regions of adrenal glands?
A
- medulla=inner portion
- cortex=outer portion
3
Q
what percent of the medulla comprises the gland?
A
10%
4
Q
what percent of the cortex comprises the gland?
A
90%
5
Q
where is the adrenal gland located in the body?
A
gerota’s fascia within the perinephric space
6
Q
where is the adrenal gland located to the kidney?
A
- anterior
- medial
- superior
7
Q
where is the right adrenal located?
A
posterolateral to the IVC
8
Q
where is the left adrenal located?
A
- lateral to aorta
- posteromedial to splenic artery and tail of the pancreas
9
Q
what is the vascular supply of the adrenal glands?
A
- superior suprarenal artery
- middle suprarenal artery
- inferior suprarenal artery
- Rt suprarenal vein
- left suprarenal vein
10
Q
where does the superior suprarenal artery arise from?
A
inferior phrenic artery
11
Q
where does the middle suprarenal artery arise from?
A
lateraal aspect of the aorta
12
Q
where does the inferior suprarenal artery arise from?
A
renal artery
13
Q
where does the right suprarenal vein drain?
A
IVC
14
Q
where does the left suprarenal vein drain?
A
left renal vein
15
Q
what are the adrenal functions?
A
- endocrine glands
- produce hormones
- medulla secretes epinephrine and norepinephrine
- corte secretes glutocorticoids, gonadal hormones, and mineral corticoids
16
Q
what are some indications for scanning the adrenal glands?
A
- abnormal lab values
- increase in abdoinal girth
- chronic liver disease
- congestive heart failure
- etc
17
Q
what are adrenal lab values?
A
- decreased hematocrit is suspicious for internal bleeding
- leukocytosis is suspicious for infection
- ACTH
- aldosterone
- potassium
- sodium
- glucocorticoids
18
Q
where is adrenocorticotrophic (ACTH) produced?
A
pituitary gland
19
Q
what is elevation of ACTH associated with?
A
- adrenal tumor
- cushing disease
- lung tumor
20
Q
where is aldosterone secreted?
A
cortex
21
Q
what is the funtion of aldosterone?
A
regulates sodium and water levels which affects blood volume and pressure
22
Q
what is elevation of aldosterone associated with?
A
hyperaldosteronism
23
Q
what is decrease in aldosterone associated with?
A
hypoaldosteronism
addison disease
24
Q
what is essential to normal function of every organ system?
A
potassium
25
what is the elevation of potassium associated with?
addison disease
26
what is the decrease of potassium associated with?
cushing disease
| hyperaldosteronism
27
what is the major component in determining blood volume?
sodium
28
what is the decrease in sodium associated with?
addison disease
29
Glutocorticoids
Regulation of the metabolism of glucose
30
Cortisol
It is released in response to stress and a low level of blood glucose
31
how is the left adrenal best visualized?
right lateral decubitus
32
how ia the right adrenal best visualized?
left lateral decubitus
33
what is the most commone adrenal tumor?
incidentalomas
| -adenomas
34
where may benign adrenal neoplasms be in?
- increases with age
- hypertensive people
- diabetics
- hyperthyroidism
- RCC
- hereditary colorectal adenomatosis
35
Adrenal myelipoma
A rare benign neoplasm composed of mature adipose tissue and a variable amount of hematopoietic elements
36
Nonhyperfunctioning adenomas
more common
| asymtomatic
37
Hyperfunctioning adenomas
Present clinically with symptoms related to excess hormone production
- cushing's syndrome
- conn's disease
38
Cushing’s syndrome
Excessive cortisol excretion
| Hyperplastic glands
39
Cushing’s syndrome characterized by?
```
Truncal obesity
Hirsutism
Amenorrhea
Hypertension
Weakness
```
40
Conn’s disease
excessive aldosterone excretion
41
Conn’s disease characterized by
Hypertension
Muscular weakness
Tetany(muscle spasms)
ECG abnormalities
42
Pheochromocytoma
Neuroendocrine tumor of the medulla
43
hyperfunctioning Pheochromocytoma
Secrete norepinephrine and epinephrine into blood
44
clinical manifestations hyperfunctioning Pheochromocytoma?
```
Hypertension
Severe headache
Palpitations
Tachycardia
Excessive perspiration
```
45
who is Pheochromocytoma most frequently seen in?
40-60 years
46
is Pheochromocytoma curable?
rare but curable cause of hypertension
47
Pheochromocytoma sonographically
- 5-6cm in diameter-easily seen
- More often in right gland
- Well marginated
- May be calcified
- Heterogenous or homogenously solid
- May have areas of necrosis or hemorrhage
48
how do you diagnose rare benign adrenal tumors?
diagnosis must be made histologically
49
is Primary Adrenocortical cancer benign or malignant?
highly malignant
50
what does Primary Adrenocortical cancer show in hyperfunctioning?
Clinical manifestations of excess hormone production in hyperfunctioning tumors are apparent
51
what does Primary Adrenocortical cancer invade?
adrenal vein
IVC
lymphatics
52
when does Primary Adrenocortical cancer recur?
after surgical excision
53
what is the sonographic appearance of hyperfunctioning malignant meoplasms?
- smaller when discovered
| - homogenous echo pattern
54
what is the sonographic appearance of nonhyperfunctioning malignant neoplasms?
- Heterogenous
- Central areas of necrosis and hemorrhage
- Calcifications
- Well defined lobulated border
55
adrenal gland is the ___ most frequent site of metastatic disease
4th
| after lung, liver, and bone
56
where is the most common primary tumors to spread to adrenal gland?
```
Lung
Breast
Melanoma
Kidney
Thyroid
Colon
```
57
what can we not sonogrpahically differentiate between?
adenomas
carcinoma
pheochromocytoma metastases
58
smaller lesions are more likely to be ______
benign
59
when are larger lesions more likely to be malignant?
- hemorrhage
- necrosis
- calcification
60
what is useful to ruleout venous tumor extension?
duplex and colour doppler
61
what do tumors look like sonographically?
solid
| typically heterogenous
62
why may a tumor have inhomogeneity?
necrosis
| hemorrhage
63
what do MRI and CT help distinguish?
difference between adenoma and metastases
64
adrenal masses over 6cm
suspicous for malignancy
| typically resected
65
adrenal masses 4-6cm
close imaging followup
| or surgical resection
66
adrenal masses less than 4cm
managment is based on additional imaging findings
67
what is another name for addisons disease?
Primary hypoadrenalism
68
Addison’s disease
| primary
- Autoimmune disease
- Antibodies attack the adrenal cortex
- Failure of the adrenal gland ensues
- Deficiency of cortisol –potentially fatal
- ACTH deficiency
69
Secondary hypoadrenalism
Disease of pituitary gland
| Leads to adrenal failure
70
tuberculosis-acutely
bilateral diffuse enlargment
| -inhomogenous
71
tuberculosis-chronically
more atropic and calcified
72
Histoplasmosis
Caused by breathing in spores of a fungus,found in bird and bat droppings
73
what is the 2 most common causes of adrenal calcifications in the adult?
- tuberculosis (acute or chronic)
| - histoplasmosis
74
Up to ____ of patients who sustain blunt abdominal trauma are discovered to have hematomas in the ______region
25%, adrenal
75
who can adrenal hemorrhage occur in?
patients on anticoagulant medication and can lead to hypocortisolism (addison disease)
76
adrenal abscess sonographic appearance
- usually hypoechoic or has complex echo structure
- rarely anechoic
- wall is irregular
- distal acoustic enhancment may be present
- air within the structure
77
adrenal cysts
rare, benign lesions
78
who do we see adrenal cysts in?
- more frequently in 3rd-5th decades
| - more in females
79
adrenal cysts symptoms
-asymtomatic
-may cause symptoms with growth
(can compress adjacent structures)
80
Hemochromatosis
- Increased iron absorption
- Leads to mild adrenocortical insufficiency
- Glands are typically small
81
Wolman’s disease
- Rare autosomal recessive
- Lipid storage disease
- Infants die within 6 months of life
82
what are the borders of the retroperitoneum?
- superior-diaphragm
- inferior-pelvic rim
- anterior-posterior parietal peritoneum
- posterior-posterior abdominal wall muscles and spine
- lateral border-transversalis fascia and peritoneal portions of the mesentery
83
Anterior Pararenal Space
Fat area between the posterior peritoneum and Gerota’s fascia
84
what does the anterior pararenal space include?
- pancreas
- descending portion of the duodenum
- ascending and descending colon
- superior mesenteric vessels
- inferior portion of the common bile duct
85
Posterior Pararenal Space
Space between Gerota’s fascia and the posterior abdominal wall muscles
86
what does the posterior pararenal space include?
- iliopsoas and quadratus lumborum muscles
- the posterior abdominal wall
- contains fat and nerves.
87
Perirenal Space
Space separated from the pararenal space by Gerota’s fasci
88
what does the perirenal space include?
- kidneys and adrenal glands
- perinephric fat
- ureters
- renal vessels
- aorta and inferior vena cava
- lymph nodes
89
Spaces in the retroperitoneum should be evaluated for what?
lymphadenopathy
neoplasms
fluid collections
ascites
90
functions of the lymph nodes?
- filter the lymph and debris and organisms
| - form lymphocytes and antibodies to fight infection
91
parietal nodes
- retroperitoneum
- surround aorta
- are subdivided into groups
- kidney, adrenal gland, ovarian/testicular nodes drain into the paraaortic nodes
92
what do the parietal nodes subdivide into?
- common illiac
- epigastric
- external illiac
- iliac circumflex
- internal illiac
- lumbar and sacral nodes
93
visceral nodes
- peritoneum
- course along the vessels supplying the major organs
- located at the hilum of the organ
94
what is a normal sonogrpahic appearance of a lymph node?
- hypoechoic cortex
- hyperechoic fatty center
- smooth margins
- oval shape
- internal vascular blood flow especially at hilum
- usually measures less than 1 cm
95
what is a abnormal sonographic appearance of a lymph node?
- enlarged hypoechoic mass over 1 cm in size
- loss of lyperechoic fatty center
- displacement of adjacent structures
96
what is the sonographic appearance of a infected lymph node?
smooth wall margins and oval shaoe caused by infection
97
what is the sonogrpahic appearance of a malignant lymph node?
- irregular margins
| - round shape
98
gastrohepatic node region
region of the gastrohepatic ligament
99
what is the associated pathology for gastrohepatic node region?
- stomach, esophageal, and pancreatic carcinoma
- lymphoma
- metastaic disease
100
mesenteric node region
along the mesentery
101
what is the associated pathology for mesenteric node region?
- inflammatory bowel
| - small bowel carcinoma
102
Pancreaticoduodenal node region
- anterior to the IVC
| - between the duodenum and head of pancreas
103
what is the associated pathology for Pancreaticoduodenal node region?
- colon and stomach carcinoma
| - carcinoma of the pancreatic head
104
perisplenic node region
splenic hilum
105
what is the associated pathology for perisplenic node regions?
- leukemia
- non-hodgkin's lymphoma
- small bowel and colon carcinoma
- metastatic disease
106
porta hepatis node region
anterior and posterior to portal vein
107
associated patholgy for porta hepatis node region?
- gallbladder, biliary, liver, stomach, pancreatic carcinoma
- lymphoma
- metastatic disease
108
retrocrural node region
inferior posterior mediastinum
109
associated pathology for retrocrural node regions?
- lung carcinoma
| - lymphoma
110
retroperitoneal node regions
- periaortic
- pericaval
- intraaortocaval
111
associated pathology for retroperitoneal node regions
- lymphoma
- renal carcinoma
- metastatic disease
112
Superior mesenteric and celiac arteries node region
periaortic
113
associated pathology for Superior mesenteric and celiac arteries node region?
intraabdominal neoplasms
114
Pelvic node regions
along the iliac vessels
115
associated pathology for pelvic node regions
carcinoma of the pelvis
116
why do we evaluate the retroperitoneum?
- lymphadenopathy
- neoplasms
- fluid collections
- ascities
117
what are some non-vascular retroperitoneal pathology?
```
Lymphadenopathy
Mesenteric Adenitis
Metastatic Disease
Benign Masses
Retroperitoneal Fibrosis
```
118
what is the most common solid retroperitoneal mass?
lymphadenopathy
119
lymphadenopathy
- enlarged lymph nodes
- infection or lymphoma
- most commonly hypoechoic
- if rounded with loss of echogenic central fat
120
Mesenteric adenitis
-Inflammation of mesenteric lymph nodes
-Bacterial infection
-If it occurs in RLQ-pain
mimics appendicitis
-Linear probe is useful
121
what is the most common malignant retroperitoneal tumor?
primary malignancies
122
Metastatic disease
- Frequently spreads to lymph nodes
| - Appear as solid retroperitoneal masses
123
Primary malignancies
lymphoma
124
Other primaries include
- Sarcomas
| - High rate of recurrence after surgical excision
125
Benign retroperitoneal masses
-Fibromas
-Schwannomas
-Neurofibromas
-Lipomas
-Fluid collections
CT or MRI needed to define benignity
126
fluid collections
```
Hematoma
Urinoma
lymphocele
Abscess
pseudocyst
```
127
Retroperitoneal fibrosis
- Associated with inflammatory AAA-5%
- Patients more prone to back ache
- Chronic periaortis
- Mass(rind of tissue) encases the aorta and common iliac arteries
- May involve ureters
- Regresses after repair of AAA
128
what is the most common complication of Retroperitoneal fibrosis?
ureteral obstruction and hydronephrosis
129
how often to bilary structures occur?
5-23%
130
Biliary strictures
- Present with painless obstructive jaundice
| - Abnormalities in liver function tests
131
most common cause of biliary obstruction post transplant
Anastomotic stricture
