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*Ultrasound* > IVC Abnormalties > Flashcards

IVC Abnormalties Flashcards

1
Q

With deep INSPIRATION, venous return _____ (increases/decreases) and the IVC _____ (increases/decreases).

A

decreases

decreases

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2
Q

With deep EXPIRATION, venous return _____ (improves/decreases) and the IVC _____ (increases/decreases).

A

improves

increases

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3
Q

When performing the Valsalva maneuver, venous return is _____ and flow temporarily _____ in the IVC causing it to bulge.

A

blocked

reverses

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4
Q

Because IVC examinations need to be done in a consistant manner, it is usually best accomplished when the patient _____ inspiration.

A

suspends

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5
Q

When the normal blood flow in the IVC is obstructed, the normal response of the vessel is to _____ (increase/decrease) in caliber _____ (above/below) the point of obstruction. Respiratory changes are _____ (increased/decreased) below the obstructed segment.

A

increase
below
decreased or absent

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6
Q

The most common cause of IVC obstruction is

A

right-sided heart failure

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7
Q

Other causes for IVC obstruction are (5)

A

1) enlarged liver
2) para-aortic lymph node enlargement
3) retroperitoneal masses or tumors
4) pancreatic tumors
5) a congenital IVC valve may obstruct the lumen of the IVC

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8
Q

Symptoms of IVC obstruction may include (4)

A

1) abdominal pain
2) ascites
3) tender hepatomegaly
4) lower extremity edema (often in most severe forms of IVC obstruction)

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9
Q

In right-sided heart failure, the distal IVC and hepatic veins (HVs) become congested, resulting in a(n) _____ (increase/decrease) in diameter. Respiratory changes are markedly _____(increased/decreased).

A

increase

decreased or absent

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10
Q

“Respiratory changes” refers to the IVC _____ or _____ with breathing patterns.

A

compressing

dilating

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11
Q

Sonographic signs and physical signs of CHF are (3)

A

1) Dilation of the IVC and HVs
2) Hepatomegaly
3) Ascites

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12
Q

An indication that there is possible CHF and an US is needed is often

A

abnormal LFTs

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13
Q

If large enough, a solid, complex, or echo-poor tumor in the retroperitoneum or pancreas may obstruct the IVC, causing lower trunk and leg _____.

A

edema

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14
Q

Overall enlargement of the liver would cause the IVC to _____ (constrict/dilate) as it presses on the vessel.

A

dilate

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15
Q

The most encountered intraluminal anomaly of the IVC is _____, which usually spreads from another vein in the pelvis, lower limb, liver, or kidney.

A

thrombus (clot)

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16
Q

Typically, the more echogenic a thrombus is, the _____ (younger - acute/older - chronic) it is.

A

older - chronic

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17
Q

T or F? A doppler of a thrombus produces no signal.

A

True

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18
Q

Where is the most likely site of origin for a thrombus in the IVC?

A

kidneys

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19
Q

The normal response of a vein below the point of obstruction will be _____ (dilation/constriction), but above the obstruction the vein should remain normal diameter.

A

dilation

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20
Q

What is the metal device called that is made of either stainless steel or nitinol and placed in the IVC to trap clots that are 5mm or larger?

A

IVC filter

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21
Q

T or F? Most IVC filters in the US are placed temporarily rather than permanantly.

A

False - they are usually permanant

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22
Q

When an IVC filter fracture occurs, it means a fragment migrates to

A

adjacent tissues

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23
Q

If an IVC fracture occurs without symptoms (asymptomatic), is treatment necessary?

A

no

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24
Q

Tumors of the IVC may be _____, _____, or _____.

A

primary
metastatic
an extension from primary

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25
Q

A primary tumor of the IVC is one that

A

started in the IVC

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26
Q

A metastatic tumor of the IVC is one that

A

started in another organ and invaded the IVC

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27
Q

An extension from a primary tumor of the IVC is one that

A

a large tumor that grows from another adjacent organ

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28
Q

A leiomyoma is a _____ (benign/malignant) tumor of the smooth muscle.

A

benign

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29
Q

A leiomyasarcoma is a _____ (benign/malignant) tumor of the smooth muscle.

A

malignant

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30
Q

Primary tumors of the IVC are not very common, and have a vascular incidence of only ____%.

A

2%

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31
Q

Primary tumors, if any, tend to develop in _____ (men/women) and have a median age of detection at _____ years old.

A

women

61

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32
Q

With leiomyosarcomas, metastasis to the liver and lung has been reported in _____-_____% of cases. A _____% recurrence rate is also reported, and prognosis is _____ (good/poor).

A

40-50%
36%
poor

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33
Q

A mass _____ (has/doesn’t have) color flow, a clot _____ (has/doesn’t have) color flow.

A

has

doesn’t have

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34
Q

The most common incidence of metastasis/extension of tumors in the IVC is

A

renal carcinoma

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35
Q

If there is a primary tumor in the IVC (which is rare), it is most likely a _____ or a _____.

A

leiomyoma

leiomyosarcoma

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36
Q

Tumors within the IVC tend to appear as _____ (echogenic/hypoechoic) foci.

A

echogenic

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37
Q

Large primary tumors of the IVC may be _____ (homogeneous/heterogeneous), with areas of necrosis.

A

heterogeneous

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38
Q

When an IVC mass is identified, it is important to attempt to identify (3)

A

1) the presence of a primary tumor
2) does it involve the HVs or right atrium (extent of cranial involvement)?
3) possible tumor involvement or invasion of the wall of the vessel

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39
Q

Doppler and color flow in the IVC is usually steady. When the IVC is partially obstructed, the blood velocity at the narrowed segment _____ (increases/decreases).

A

increases

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40
Q

When blood flow in the IVC is obstructed, the normal response of the vessel is to _____ (increase/decrease) in caliber _____ (above/below) the point of obstruction.

A

increase

below

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41
Q

In right-sided heart failure, the distal IVC and HVs become _____, resulting in a(n) _____ (increase/decrease) in diameter.

A

congested

increase

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42
Q

Malignant invasion or tumor extension of the IVC may occur from (6)

A

1) renal carcinoma
2) secreting/non-secreting adrenal tumors
3) retroperitoneal sarcomas
4) hepatocellular carcinoma
5) teratomas
6) lymphomas

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43
Q

What is the most common physical sign of an IVC tumor invasion?

A

leg edema

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44
Q

The most common reasons that renal veins enlarge are (3)

A

1) increased flow due to splenorenal/gastrorenal shunt or AV malformation in kidney
2) portal HTN or thrombosis
3) tumor involvement from renal cell carcinoma

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45
Q

T or F? Tumor involvement of the renal veins (RVs) usually produces no specific symptoms that would lead to suspicion of tumor extenstion.

A

True

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46
Q

T or F? Symptoms of the presence of an enlarged renal vein (RV) are generally associated with the initial disease process, not because of the actual venous enlargement.

A

True

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47
Q

An enlarged renal vein is one that exceeds

A

1.5 cm

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48
Q

Another sonographic finding that suggests increased flow into the renal vein is abrupt IVC dilation at the level of the _____ _____ _____.

A

renal insertion point

49
Q

If enlargment of the RVs IS NOT bilateral or symmetric, this would indicate that the disease process _____ (does/does not) involve(s) the IVC at the level above the insertion of the RVs.

A

does not

50
Q

If enlargement of the RVs IS bilateral or symmetric, this would indicate that the disease process _____ (does/does not) involve(s) the IVC at the level above the insertion of the RVs.

A

does

51
Q

T or F? In portal HTN, several collateral pathways are apt to develop as the pressure in the portal system increases. These collateral pathways connect to _____ veins, and these are known as _____ veins.

A

True
systemic
varicose

52
Q

In portal HTN, blood flow is diverted to the collaterals, which may in turn affect the LRV how and why?

A

The collaterals may fistulize to the LRV in order to alleviate pressure.

53
Q

In portal venous HTN, is the LRV, RRV, or both typically involved? Why?

A

LRV

Because collaterals that form loop around and reconnect to the LRV

54
Q

If portal venous HTN occurs, the doppler flow will show blood _____ (entering/leaving) the liver because

A

leaving

because the blood is being blocked from the liver and is forced to flow backwards

55
Q

In tumor invasion or an AV fistula, is the LRV, RRV, or both typically involved (as compared to PV HTN vessel involvement).

A

LRV or RRV

56
Q

It has been determined that the prevalence of RV involved in renal cell carcinoma is approximately _____ to _____%.

A

21% - 55%

57
Q

When renal cell carcinoma invasion occurs, obstruction to the RV result in _____ (constriction/dilation).

A

dilation

58
Q

What is the normal PV caliber?

A

13mm

59
Q

Multiple worm-like serpiginous vessels in the region of the PV that result from longstanding thrombus and subsequent collateral vessel formation of a network of vessels that replace the obliterated PV is called

A

cavernomatous transformation

60
Q

What is the acute or chronic hepatocellular disease that blocks the flow of blood through the liver, causing it to back up into the hepatic portal circulation and causes the blood pressure in the hepatic circulation to increase?

A

portal HTN

61
Q

What helps to relieve high pressure in the portal system?

A

the formation of callateral vessels or varicose veins

62
Q

Where do collateral vessels usually form (3)?

A

esophagus
stomach
rectum

63
Q

What is the most clinical consequence of portal HTN?

A

variceal hemorrhage

64
Q

What kind of blood flow is observed in patients with portal HTN?

A

hepatofugal or retrograde

65
Q

Because of the variations in caliber of the IVC during respiration, it is imperative that examinations are done in a consistent manner. This is usually best accomplished by examining while the patient ______ inspiration.

A

suspends

66
Q

The average measurment of an IVC is ______. Above ______ is considered abnormal.

A

2 cm - 3.7 cm

3.7 cm

67
Q

Abnormal connection between the arterial and venous vessels is called

A

AV malformation

68
Q

What causes blood to be routed directly from the artery into the vein in order to increase blood flow through the veins (AV malformation/fistula)?

A

high pressure in the arterial system

69
Q

The natural response for a vein under increased blood flow is to ______ (constrict/dilate).

A

dilate

70
Q

AV fistulas may occur for a number of reasons, including (5)

A

1) blunt or penetrating trauma
2) biopsy complications
3) tumor involvement
4) nephrectomy (kidney removal)
5) idiopathic causes

71
Q

If a tumor is found in the RVs, the _____ should be checked to identify if there is an extension beyond the RVs.

A

IVC

72
Q

In a tumor-free vessel, _____ may mimic a tumor or possibly a thrombus.

A

reverberation artifact

73
Q

Some metastatic tumors may appear _____ (type of echogenicity) with the surrounding blood, making them difficult to identify.

A

isogenic

74
Q

The LRV may appear enlarged at the point that it crosses over the AO, before entering the IVC; this is normal unless

A

the entire length of the RV is enlarged

75
Q

T or F? Although extremely rare, IVC duplication may be misintrepreted as LRV enlargement. To avoid this confusion, it is wise to

A

True

follow the vessel in question to its origin

76
Q

RV thrombosis may occur in these disorders (6)

A

1) nephrotic syndrome
2) renal tumors
3) renal transplants
4) trauma
5) infant dehydration
6) compression of RV secondary to tumor

77
Q

Signs and symptoms of acute RV thrombosis (Renal Vein Clot) may include (4)

A

loin or flank pain
hematuria

leg swelling
proteinuria

78
Q

With RV thrombosis, the RV is dilated at the point _____ (proximal/distal) to the occulsion.

A

proximal

79
Q

With RV thrombosis, renal size generally _____ (increases/decreases) in the acute phase and a loss of normal renal structure may be identified. Doppler flow _____ (increases/decreases).

A

increases

decreases

80
Q

Thrombus generally appears as a(n) _____ (echogenicity) focus, especially in longstanding cases.

A

echogenic

81
Q

In acute phases of thrombus, it may not appear _____ (echogenicity) but may appear _____ (echogenicity) to the surrounding blood.

A

echogenic

isoechoic

82
Q

T or F? Venous aneurysms are very rare.

A

True

83
Q

Some possible causes of venous aneurysms are (3)

A

1) weakening of vessel wall by pancreatitis
2) portal HTN
3) embryonic malformations (congenital anomalies)

84
Q

T or F? There are often symptoms associated with small aneurysms of the PVS.

A

False

85
Q

Portal venous aneurysms can be recognized as _____ (echogenicity) areas in the porta hepatis. There may or may not be thrombus and also a communication with the PV can be seen.

A

anechoic

86
Q

The PV drains blood from the (6)

A 
small intestines
large intestines
stomach
spleen 
pancreas
GB
87
Q

The SMV and SV unite behind the neck of the pancreas to form the

A

PV

88
Q

The portal trunk divides into 2 lobar veins. The right branch drains the _____ and the left branch receives the _____ and _____ veins that enlarge to form umbilical varices in portal HTN.

A

cystic vein
umbilical
paraumbilical

89
Q

The coronary vein, which runs along the _____ curvature of the stomach, receives _____, which also enlarge in portal HTN.

A

lesser

distal esophageal veins

90
Q

A potential complication of portal vein thrombus is

A

bowel ischemia and perforation

91
Q

Portal venous thrombosis goes through several stages and appearance varies with each stage. In stage 1, the thrombus is _____ (echogenicity) in the vessel lumen.

A

echogenic

92
Q

In stage 2 of portal venous thrombosis, the _____ and _____ are seen.

A

thrombus

small collaterals

93
Q

In stage 3 of portal venous thrombosis, the ______ is/are seen and the ______ is not seen/identifiable (which is called ______).

A

large collaterals
PV
cavernomatous transformation of the PV

94
Q

Direct signs of PV thrombosis are (6)

as in, what is seen visually to suggest PV thrombosis

A

1) visualization of clot in lumen
2) clot appears echogenic
3) if acute, clot may be difficult to see
4) local buldge of the vein at clot level
5) total occlusion: no venous or doppler signals
6) partial occlusion: normal doppler but decreased flow in vein

95
Q

The most common cause of portal HTN in the western world is

A

cirrhosis

96
Q

Clinical signs and symptoms of portal HTN are (5)

A

1) ascites
2) gastrointestinal bleeding
3) poor renal function
4) impaired coagulation
5) recannalization

97
Q

Under extreme pressure, the round ligament (AKA ligamentum teres) may reopen to allow the passage of blood. This is called

A

recannalization

98
Q

Recannalization is most common in patients with ______ and ______.

A

cirrhosis

portal HTN

99
Q

T or F? A dilated coronary vein detected along with identification of esophageal varices is a good indicator of portal HTN. (80%-90%).

A

True

100
Q

A very useful landmark for the location of recannalized veins (especially the paraumbilical vein) is the _____ vein along with esophageal varices, because it increases in size in 80-90% of cases. 20% of patients also have a patent _____ vein.

A

coronary vein

umbilical vein

101
Q

The most significant clinical consequence of portal HTN is

A

variceal hemorrhage

102
Q

The term to describe the appearance of distended and engorgeed umbilical veins, which are seen radiating from the umbilicus across the abdomen to join systemic veins is

A

Caput Medusae

103
Q

_____ is a sign of severe portal HTN with portal systemic shunting through the umbilical veins.

A

Caput Medusae

104
Q

Portal HTN flow is _____. Which is odd because flow should be _____.

A

hepatofulgal

hepatopedal

105
Q

T or F? In portal HTN there is isolated LPV involvement. But with tumor invasion or AV fistulas, the LRV and/or RRV may be involved.

A

True

106
Q

IVC thrombus is sonographically diagnosed/described as

A

An intraluminal filling defect that usually expands the diameter of the vessel.

107
Q

The differential diagnosis of vascular tumor masses tends to be large because

A

because the similarity in echographic appearance.

108
Q

What are the main indicators of portal HTN? (2)

A

esophageal varices

dilated coronary vein

109
Q

A collateral network may involve (5)

A 
coronary vein*****
gastroesophageal vein
umbilical vein
pancreatic duodenal vein
gastrorenal and splenorenal veins
110
Q

This vein is identified by locating the splenic vein in a midline sagittal view and moving the probe to the right. It is recognized as a small vessel coursing cephalad from the splenic vein near the portal splenic confluence.

A

coronary vein

111
Q

What does the presence of caput medusae indicate?

A

posthepatic or intrahepatic portal HTN

112
Q

How is caput medusae formed?

A

by the recannalization of the umbilical vein which connects with the left hepatic branch of the PV

113
Q

When shouldn’t caput medusae be observed and why?

A

with isolated extrahepatic PV obstruction because the obstruction would be below the origin of the umbilical vein

114
Q

Explain recannalization.

A

Under extreme pressure, the round ligament (ligamentum teres) reopens to allow the passage of blood. This is common in patients with cirrhosis and portal HTN. Patients with cirrhosis experience rapid growth of scar tissue in and around the liver, often functionally obstructing nearby vessels.

115
Q

What is the sonographic appearance of PV thrombosis?

A

goes through about 3 stages

1) echogenic thrombus in lumen
2) thrombus and small collaterals visible
3) large collaterals and no identifiable PV (cavernomatous transformation)

116
Q

Leiomyosarcomas are known to mestastitize to the ______ and ______.

A

liver

lungs

117
Q

What is a rare tumor of the IVC and where does it originate?

A

chromaffin

outside the adrenal gland

118
Q

This tumor extends into the IVC and right atrium

A

wilms tumor

*Ultrasound* (14 decks)

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