Liver Flashcards
which benign liver mass is typically isoechoic and contains a central scar?
hepatoblastoma
cavernous hemangioma
hamartoma
focal nodular hyperplasia
focal nodular hyperplasia (FNH)
the covering of the liver is referred to as:
Glisson capsule
Gerota fascia
Morison pouch
Hepatic fascia
Glisson capsule
the left lobe of the liver can be separated from the right lobe by the:
RHV
MHV
LHV
falciform ligament
MHV
the TIPS shunt is placed:
between the MHA and MPV
between a PV and HV
between the CHD and CBD
between a PV and HA
between a PV and HV
the right lobe of the liver is divided into segments by the:
MLF
MHV
RHV
LHV
RHV
the right intersegmental fissure contains the:
RHV
MHV
LPV
RPV
RHV
the MPV divided into:
middle, left and right branches
left and right branches
anterior and posterior branches
medial and lateral branches
left and right branches
the Lig Teres can be used to separate the:
medial and lateral segments of the LLL
medial and posterior segments of the RLL
anterior and medial segments of the LLL
anterior and posterior segments of the RLL
medial and lateral segments of the LLL
the MLF contains the:
RHV
MHV
MPV
RPV
MHV
all of the following are located within the porta hepatis EXCEPT:
MPV
CBD
HA
MHV
MHV
right-sided heart failure often leads to enlargement of the:
abdominal AO
IVC and hepatic veins
IVC and porta veins
portal veins and spleen
IVC and hepatic veins
Which is typically transmitted through contaminated water found in places such as Mexico, Central America, South America, Asia, India, and Africa?
amebic liver abscess
hydatid liver cyst
candidiasis
hepatoma
amebic liver abscess
the RPV divides into:
middle, left, and right branches
left and right branches
anterior and posterior branches
medial and lateral branches
anterior and posterior branches
diameter of the PV should not exceed:
4mm
8mm
10mm
13mm
13mm
the RLL can be divided into:
medial and lateral segments
medial and posterior segments
anterior and medial segments
anterior and posterior segments
anterior and posterior segments
which is true about the portal veins?
carry deoxygenated blood away from the liver
have brighter walls than the hepatic veins
should demonstrate hepatofugal flow
increase in diameter as the approach the diaphragm
have brighter walls than the hepatic veins
the LLL can be divided into:
medial and lateral segments
medial and posterior segments
anterior and medial segments
anterior and posterior segments
medial and lateral segments
normal flow within the hepatic artery should demonstrate a:
high resistance waveform pattern with a slow upstroke and gradual deceleration with diastole
low resistance waveform pattern with a quick upstroke and gradual deceleration with diastole
low resistance waveform pattern with a slow upstroke and gradual acceleration with diastole
high resistance waveform pattern with a quick upstroke and gradual deceleration with diastole
low resistance waveform pattern with a quick upstroke and gradual deceleration with diastole
Budd Chiari syndrome leads to a reduction in the size of the:
hepatic arteries
portal veins
hepatic veins
CBD
hepatic veins
a tonguelike extenstion of the RLL is termed:
papillary lobe
focal hepatomegaly
Riedel lobe
Morison lobe
Riedel lobe
the LPV divides into:
middle, left and right branches
left and right branches
anterior and posterior branches
medial and lateral branches
medial and lateral branches
the umbilical vein after birth becomes the:
falciform ligament
MLF
Lig Teres
Lig Venosum
Ligamentum Teres
normal flow within the hepatic veins is:
biphasic
irregular
high resistant
triphasic
triphasic
the inferior extension of the caudate lobe is:
papillary process
focal hepatomegaly
Riedel process
Morison lobe
papillary process
which is the most common reason for a liver transplant?
HCC
Hep C
Hep B
hepatic metastasis
Hep C
clinical findings of fatty infiltration of the liver include:
elevated LFTs
fever
fatigue
weight loss
elevated LFTs
Sonographically, when the liver is difficult to penetrate and diffusely echogenic, this is a indicative of:
portal vein thrombosis
metastatic liver disease
primary liver carcinoma
fatty liver disease
fatty liver disease
the most common cause of cirrhosis is:
portal hypertension
hepatitis
alcoholism
cholangitis
alcoholism
clinical findings of hepatitis include all of the following EXCEPT:
jaundice
fever
chills
pericholescystic fluid
pericholescystic fluid
what form of hepatic abnormality are immunocompromised patients more prone to develop?
hepatic adenoma
amebic abscess
hydatid liver abscess
candidiasis
candidiasis
all of the following are sequela of cirrhosis EXCEPT:
portal vein thrombosis
hepatic artery contraction
portal hypertension
splenomegaly
hepatic artery contraction
normal flow towards the liver in the portal veins is termed:
hepatopetal
hepatofugal
hepatopetal
which mass would be most worrisome for malignancy?
echogenic mass
cystic mass with posterior enhancement
isoechoic mass with a central scar
hyperechoic mass with a hypoechoic halo
hyperechoic mass with a hypoechoic halo
which is the most common form of liver cancer?
HCC
adenocarcinoma
metastatic liver disease
hepatoblastoma
metastatic liver disease
which mass is closely associated with oral contraceptive use?
hepatic adenoma
hepatic hypernephroma
hepatic hamartoma
hepatic hemangioma
hepatic adenoma
which is considered the most common benign childhood hepatic mass?
hepatoblastoma
hepatoma
hematoma
hemangioendothelioma
hemangioendothelioma
all of the following are clinical findings of HCC EXCEPT:
reduction in AFP
unexplained weight loss
fever
cirrhosis
reduction in AFP
Beckwith-Weidemann is associated with an increased risk for developing:
hepatoblastoma
cirrhosis
portal hypertension
hepatitis
hepatoblastoma
which is associated with E. granulosus?
candidiasis
amebic liver abscess
hydatid liver cyst
HCC
hydatid liver cyst
You are scanning a patient with a known mass in the left medial segment of the liver. What anatomic landmark can you use to identify the left medial segment separate from the right anterior segment of the liver?
LPV
Lig Teres
Lig Venosum
MHV
LHV
MHV
what structure is located at the anterior border of the caudate lobe that will help you to identify this lobe of the liver?
LPV
fissure for the Lig Venosum
IVC
fissure for the Lig Teres
MLF
fissure for the Lig Venosum
You are asked to rule out the presence of a recanalized paraumbilical. Which anatomic structure is a useful landmark in location of this structure?
Lig Teres
Lig Venosum
coronary ligament
hepatodudenal ligament
Glisson’s ligament
Lig Teres
which vessel courses within the MLF?
MPV
LPV
MHV
proper HA
RHV
MHV
oxygenated blood is supplies to the liver via:
PV and HV
HV and HA
PV and HA
HA only
PV and HA
which forms the caudal border of the LPV?
Lig Venosum
hepatoduodenal ligament
MLF
coronary ligament
Lig Teres
Lig Teres
what differentiates the hepatic veins from the portal veins?
HVs converge toward the porta hepatis
HVs have brightly echogenic walls
PVs are largest near the dome of the liver
PVs are accompanied by branches of the biliary tree and HA
PVs normally exhibit a triphasic flow pattern
PVs are accompanied by branches of the biliary tree and HA
You have detected a mass anterior and to the left of the Lig Venosum. This mass is located in what lobe of the liver?
left lobe
caudate lobe
Riedel’s lobe
right lobe
quadrate lobe
left lobe
which course interlobar and intersegmental within the liver?
bile ducts
PVs
HAs
lymphatics
HVs
HVs
what lobe of the liver does the letter A represent?
left lobe
caudate lobe posterior right lobe
anterior right lobe
quadrate lobe
left lobe
what structure does the letter B represent?
Lig Teres
falciform ligament
hepatodudenal ligament
Lig Venosum
MLF
Lig venosum
what lobe does the letter C represent?
left lobe
caudate lobe
posterior right lobe
anterior right lobe
quadrate lobe
caudate lobe
identify the structure labeled A in this image of the liver
Lig Venosum
Lig Teres
hepatoduodenal ligament
coronary ligament
Glisson’s capsule
Lig Teres
identify the anatomy labeled A
MPV
right posterior portal vein branch
LPV
RHV
MHV
right posterior portal vein branch
vessel A is located in what lobe of the liver?
caudate lobe
medial segment left lobe
lateral segment left lobe
posterior segment right lobe
anterior segment right lobe
posterior segment right lobe
identify the anatomy labeled C
MPV
right posterior portal vein
LPV
RHV
MHV
LPV
the arrow labeled D is pointing to what lobe of the liver?
medial segment left lobe
lateral segment left lobe
posterior segment right lobe
anterior segment right lobe
caudate lobe
caudate lobe
You are performing an ultrasound exam of the liver on a small patient with a 5MHz curved linear array. Although you have increased the overall gain to its max setting, the posterior borders of the liver and diaphragm are not visualized. What should you do?
call the service representative to repair
decreased the transmit power
move the focal zone into the near field
rescan with a higher frequency
rescan with a lower frequency
rescan with a lower frequency
lower frequency = increase penetration
which correctly describes the probe placement and imaging plane you would use to demonstrate the three HVs and IVC in one view?
subcostal oblique approach with the probe angled superiorly and to the patient’s right
intercostal approach with the probe angled inferiorly to the patient’s left
intercostal approach with the probe oriented in a coronal plane
subcostal oblique approach with the probe angled inferiorly to the patient’s left
sag subcostal approach with the probe just to the right of midline
subcostal oblique approach with the probe angled superiorly and to the patient’s right
You are performing a follow up sonogram on a patient in which a 5mm cyst was previously identified at the anterior border of the LLL. Although you are using a 3.5MHz curved linear array probe, you do not see the cyst. Which would be most helpful in improving visibility of this cyst?
increase the overall gain
increase the dynamic range
increase the transmit power
rescan with a higher frequency
rescan with a lower frequency
rescan with a higher frequency
visibility of small cysts is limited by spatial resolution - to improve spatial resolution the best option is to increase frequency
You are imaging a patient with a high liver. Subcostal images do not clearly demonstrate the liver tissue. What should you do?
scan patient in deep inspiration
scan patient in expiration
place patient in trendelenberg position
have patient drink 32oz of water
scan patient in quiet respiration
scan patient in deep inspiration
A patient is referred for ultrasound evaluation of a questionable mass in the dome of the liver scan on a CT scan. Which method would improve visualization in this area of the liver?
subcostal scan with probe angled superior and patient in deep inspiration
intercostal scan with probe in the coronal plane and patient in expiration
subcostal scan with the patient performing valsalva
roll patient into right lateral decubitus and scan from the subcostal approach with patient in expiration
some of the liver cannot be seen with ultrasound
subcostal scan with probe angled superior and patient in deep inspiration
a patient is referred for a liver ultrasound with the clinical history of a raised serum AFP level, what should you look for?
FNH
fatty liver
HCC
hydatid disease
increased AFP levels are not associated with liver disease
HCC
elevation of both GGT and ALP:
suggest the source of elevated ALP is due to metastatic bone cancer
is a sensitive indicator of pancreatitis
indicate lab work is invalid and must be repeated
indicate the source of elevated ALP is the liver
is highly specific for HCC
indicate the source of elevated ALP is the liver
which lab test is NOT used in evaluation of liver function?
GGT
AST
direct bilirubin
indirect bilirubin
lipase
lipase
A patient is referred with RUQ tenderness and a history of oral contraceptive use. A solid, hypoechoic mass is identified in the RLL. Color doppler reveals hypervascularity of the mass. Which is most likely?
hydatid liver disease
hepatic lipoma
hepatic abscess
hepatic adenoma
HCC
hepatic adenoma
A liver ultrasound on a 49 year old obese male demonstrates diffuse increased echogenicity with focal hypoechoic area anterior to the PV. This most likely represents:
liver cirrhosis with HCC
hydatid disease
fatty metamorphosis with focal sparing
metastatic disease due to colon
normal life parenchyma with a simple cyst
fatty metamorphosis with focal sparing
A 52 year old male with known liver cirrhosis presents for an ultrasound. You will carefully evaluate the liver to rule out the presence of any focal mass because of which true statement?
patients with liver cirrhosis are at increased risk for HCC
patients with liver cirrhosis tend to develop multiple cysts in their liver and pancreas
metastasic disease occurs commonly with cirrhosis
the presence of regenerative nodules rules out cirrhosis
all of the above are correct
patients with liver cirrhosis are at an increased risk for HCC
you are scanning a patient with suspected liver cirrhosis, all of the following are sonographic features of cirrhosis EXCEPT:
surface nodularity
shrunken caudate lobe
altered echo texture
ascites
regenerative nodules
shrunken caudate lobe
in cirrhosis, the caudate lobe is most commonly enlarged compared to the RLL due to sparing
an ultrasound evaluation of liver cirrhosis should include a search for which associated complication?
biliary dilatation
mesentery ischemia
splenic infarction
Kaposi’s sarcoma
portal hypertension
portal hypertension
Ultrasound findings of an abdominal study on a 51 year old female include enlargement of the HVs and IVC in an otherwise normal appearing liver. These findings are most consistent with:
Budd Chiari syndrome
right-sided heart failure
liver cirrhosis
portal hypertension
sarcoidosis
right sided heart failure
focal fatty liver is most commonly found in which location?
medial to the ascending branch of the LPV
posterior to the RHV
lateral, inferior tip of the right lobe
adjacent to the fissure for the Lig venosum
anterior to the PV at the porta hepatis
anterior to the PV at the porta hepatis
You have performed an ultrasound on a patient with an enlarged caudate lobe, shrunken right lobe, and splenomegaly. The HVs could not be identified. No other abnormalities were discovered. What should you do?
scan the pelvis to rule out pelvic mass
have the patient perform valsalva and re-examine the HVs
evaluate the HVs and IVC with color doppler to confirm patency
have the patient return in a week for a repeat study
nothing
evaluate the HVs and IVC with color doppler to confirm patency
A patient is referred to rule out hepatomegaly, all of the following are useful indicators EXCEPT:
rounding of the inferior border of the liver
longitudinal measurement of the right lobe exceeding 15.5cm
extension of the right lobe inferior to the lower pole of the right kidney
increased diameter of the MPV greater than 1cm
increased AP measurement of the right lobe
increased diameter of the MPV greater than 1cm
You have identified a single homogenous hyperechoic lesion measuring 2.4 cm in the posterior aspect of the RLL. What is the most common etiology of a mass fitting this description?
cyst
hepatic adenoma
cavernous hemangioma
HCC
focal fatty sparing
cavernous hemangioma
A patient is referred for a sonogram of the liver to rule out metastatic disease. Which describes the sonographic appearance of liver metastasis?
single hypoechoic mass
multiple hyperechoic masses
masses of mixed echogenicity
cystic masses
all of the above
all of the above
which is NOT a feature of hepatic cysts?
thin wall
posterior acoustic enhancement
anechoic
increased attenuation
increased through transmission
increased attenuation
attenuation through a cyst is decreased
A single large, well defined mass with smooth walls and homogenous low level echoes is seen within the anterior RLL in a 48 year old female. No doppler signals could be obtained within the mass. Which of the following conditions is the most likely etiology of this mass?
Kaposi’s sarcoma
focal nodular hyperplasia
hemorrhagic cyst
PV aneurysm
HCC
hemorrhagic cyst
You are scanning a patient with a history of fever, abnormal LFTs, and RUQ tenderness. The liver is enlarged with decreased echogenicity, GB wall thickness, and thick echogenic bands are noted surrounding the PVs. Which of the following conditions is most likely?
fatty liver
cirrhosis
Budd-Chiari
hepatitis
normal liver
hepatitis
bright bands = “periportal cuffing”
You are evaluating a suspicious lesion and look for gas bubbles to confirm the presence of liver abscess in a patient with fever and increased WBC count. What is the sonographic appearance of the gas bubbles?
brightly echogenic echoes with clean distal acoustic shadow
brightly echogenic foci associated with echogenic ring down artifact
hypoechoic area within the mass associated with increased through transmission
anechoic foci with distal acoustic enhancement
hyperechoic foci with distal acoustic enhancement
brightly echogenic foci associated with echogenic ringdown artifact
which is associated with infestation by a parasite and is most prevalent in sheep and cattle raising countries?
Budd-Chiari
hydatid disease
candidiasis
Hep A
Kaposi’s sarcoma
hydatid disease
You are scanning the liver and notice irregularity of the surface. A nodular liver surface is associated with:
cirrhosis
acute hepatitis
fatty liver
polycystic liver disease
hepatomegaly
cirrhosis
which is NOT true regarding fatty liver?
it is irreversible
it may be caused by obesity
it may be diffuse or focal
it may show a rapid change in appearance
it commonly causes increased attenuation of the sound beam through liver
fatty liver is a reversible disorder
You are scanning through the liver and notice luminal narrowing of the HVs. Color and spectral doppler reveal high velocities through the strictures. These findings are most commonly associated with:
diffuse fatty liver
acute hepatitis
cirrhosis
focal fatty infiltration
glycogen storage disease
cirrhosis
which is most commonly associated with invasion of the PV?
HCC
cavernous hemangioma
liver metastasis
hepatic adenoma
focal nodular hyperplasia
HCC
You have been asked to perform a liver sonogram on a patient with AIDS. Which is most commonly associated with this history?
HCC
Kaposi’s sarcoma
Budd-Chiari syndrome
hemangiosarcoma
hepatic adenoma
Kaposi’s sarcoma
You are scanning a 53 year old female with a history of recent weight loss and vague abdominal pain. The liver is markedly heterogenous and contains numerous calcified lesions. This most likely represents metastasis disease from which primary?
Non-Hodgkin lymphoma
cystadenocarcinoma of the ovary
lung
adenocarcinoma of the colon
breast
adenocarcinoma of the colon
During ultrasound evaluation of the liver, a bulls-eye or target lesion is identified in the anterior right lobe. The most likely etiology of this mass is:
liver abscess
hepatic adenoma
FNH
HCC
liver metastasis from lung cancer
liver metastasis from lung cancer
You are performing an ultrasound exam on a young female and notice a well defined solitary mass with a central scar measuring 4 cm in diameter. Color doppler reveals prominent blood vessels coursing within the scar. This most likely represents:
liver abscess
hepatic adenoma
FNH
HCC
liver metastasis from lung cancer
FNH
You are performing a liver sonogram on a young female with RUQ pain, sudden onset ascites, and hepatomegaly. You have obtained TRV and SAG images of the liver, CBD, and GB according to your protocol. What else should you do?
nothing
expand the study to include kidneys to rule out associated hydronephrosis
use color and special doppler to determine patency of the portal and hepatic venous systems
give the patient a fatty meal and then measure the PV diameter at 1,2,5, and 10mins
call the referring physician to get an order to perform a pelvic study to see if the patient’s pain is referred from an ovarian mass
use color and special doppler to determine patency of the portal and hepatic venous systems
which is NOT true regarding cavernous hemangiomas?
small, well defined, hyperechoic
consist of a vascular network
more common in women
usually asymptomatic
show prominent, high velocity color doppler signals
they DO NOT show prominent, high velocity color doppler signals
A patient is referred for ultrasound with a history of liver transplantation. You identify an extrahepatic fluid collection. What is the likely etiology of this finding?
biloma
hematoma
loculated ascites
abscess
any of the above
any of the above
what significant complication following liver transplantation is NOT detectable with ultrasound?
rejection
malignant disease
HA thrombosis
PV thrombosis
pseudoaneurysm
rejection
liver biopsies are frequently performed to rule out rejection
You are scanning a patient with a history of liver transplantation. You should search for all of the following complications EXCEPT:
biliary sludge
acute cholecystitis
PV thrombosis
HA thrombosis
liver malignancy
acute cholecsytitis
the donor GB is excised during the transplant surgery
You have been asked to provide ultrasound imaging during liver surgery. What transducer would be best suited for this purpose?
3.5MHz curved linear
10MHz linear
2.25MHz phased
7MHz linear
12MHx curved linear
7MHz linear
During intraoperative scanning, the sterile transducer is placed directly on the exposed liver. For this reason, a transducer with higher than usual frequency can be used to image the liver nonsurgically. Typically, a 5-7 MHz linear array is used.
You are scanning through the RLL and notice that although you have maximized the far field TGC, the parenchyma in the far field and diaphragm are not clearly visualized. What should you do?
decrease the transmission power
increase the compression curve
decrease the transmit frequency
decrease the overall gain
increase the dynamic range
decrease transmit frequency
hepatofugal flow in the PV is a sign of:
normalcy
HA thrombosis
PHTN
acute cholecystitis
HCC
PHTN
A patient is referred for abdominal ultrasound with a high fever and RUQ pain. You document the presence of a large, rounded, homogeneous mass with low-level internal echoes and poorly defined borders. The mass is located in the RLL, adjacent to the capsule, and shows increased through transmission. This most likely represents:
hemorrhagic cyst
abscess
hematoma
choledochal cyst
loculated ascites
abscess
You are scanning a patient with known liver cirrhosis and notice a focal mass within the posterior right lobe. What lab test would be most helpful in determining if this mass is HCC?
serum AFP
ALP
serum bilirubin
serum creatine
lactate dehydrogenase (LD)
serum AFP
You have been asked to perform an ultrasound to rule out the presence of Budd-Chiari syndrome. You will tailor your exam to include:
volume measurement of spleen
doppler analysis of HVs
both supine and upright views of porta hepatis
oblique view of the RLL to include right hemidiaphragm
careful search for periaortic lymphadenopathy
dopple analysis of HVs
the majority of the blood supply to the liver is provided from the:
HVs
PV
HA
SMV
gastroduodenal artery
PV
following liver transplantation, which of the following anatomical locations has an anastomotic connection that should be evaluated with ultrasound?
IVC
PV
HA
bile duct
all of the above
all of the above
You are scanning a patient with liver cirrhosis and suspected PHTN. In this study, assessment of the size of which of the following is most important?
spleen
CBD
abdominal AO
RHV
IVC
spleen
the spleen is enlarged in nearly all cases of PHTN
What is the best sonographic window to view a recanalized paraumbilical vein?
intercostal oblique view through the right lobe
subcostal oblique view through the right lobe
saggital subcostal view through the left lobe at the level of the Lig Teres
saggital subcostal view through the right lobe at the level of the MLF
saggital subcostal view to the left of midline
saggital subcostal view through the left lobe at the level of the Lig Teres
You are evaluating a patient with PHTN. Enlargement of which of the following structures is diagnostic of this condition?
coronary vein
HV
renal vein
CBD
Lig Teres
coronary vein
coronary or left gastric vein normally empties flow from the esophageal veins into the splenic vein. It can become dilated with portal hypertension. Flow direction may become reversed forming dangerous esophageal varices.
regenerating nodules are a feature associated with:
hepatitis
HCC
hydatid disease
cirrhosis
polycystic liver disease
cirrhosis
You are performing an ultrasound exam on a patient with a history of alcoholic liver cirrhosis. You have documented the presence of splenomegaly and dilated veins at the splenic hilum. Considering the patient’s history and findings, what else should you do?
search for signs of acute cholecystitis
carefully scan the spleen for the presence of infarcts
search for the presence of portosystemic collaterals
check the pelvis for a left side mass
rule out the presence of an AAA
search for the presence of portosystemic collaterals
what is the best view for ultrasound demonstration of the coronary vein?
TRV scan under the RLL
oblique subcostal scan under the RLL with the probe oriented toward the patient’s head
SAG view of the splenic vein near the midline
SAG view through the splenic hilum
TRV view along the long axis of the LRV
SAG view of the splenic vein near the midline
You are performing a follow up study on a patient with a history of cavernous transformation. Where should you look to evaluate this condition?
splenic hilum
pancreatic head
porta hepatis
renal hilum
LLL
porta hepatis
You are scanning a patient with an enlarged caudate lobe and shrunken right lobe. What diffuse liver process should you suspect?
cirrhosis
acute hepatitis
fatty infiltration
candidiasis
HCC
cirrhosis
You are scanning an obese patient to rule out fatty liver. Which of the following describes a common sonographic appearance of this condition?
increased through transmission throughout the hypoechoic liver
increased echogenicity of the liver compared to normal
focal hypoechoic masses throughout both lobes of the liver surrounded by normal liver echotexture
shrunken liver with surface nodularity
enlarged, hypoechoic right lobe compared to a small and shrunken left lobe
increased echogenicity of the liver compared to normal
A patient presents with acute RUQ pain and decreasing hematocrit. What is the possible diagnosis?
simple cyst
abscess
hemorrhagic cyst
parasitic cyst
hemorrhagic cyst
