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AB VASCULAR > Misc Conditions > Flashcards

Misc Conditions Flashcards

1
Q

What is the size range of the IVC?

A

Variable 1.5 - 2 cm (never exceed 2.5)

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2
Q

How many layers comprise the IVC?

A

Three

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3
Q

Is the IVC intra or retroperitoneal?

A

Retroperitoneal

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4
Q

Where is the IVC positioned?

A

Anterior to the spine, right lateral to the aorta

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5
Q

What are findings of thrombus in IVC?

A

IVC enlargement, absence of flow, material noted within lumen

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6
Q

Why is acute thrombus often overlooked?

A

It may be anechoic (acute thrombus is hypoechoic/chronic thrombus is hyperechoic)

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7
Q

What is an IVC filter used?

A

To trap emboli that could be traveling upstream

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8
Q

How is the IVC filter evaluated?

A

Proper placement and to assess for complications such as IVC perforation and to prevent PE

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9
Q

How does an umbrella filter appear?

A

Hyperechoic

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10
Q

How does a tumor thrombus (i.e. renal cell carcinoma) appear?

A

Aggressive mass invading the renal vein and IVC

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11
Q

How does the intrahepatic IVC appear with cardiac failure?

A

5.5 cm dilatation or more

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12
Q

What could be confused with thrombus in IVC?

A

Slow, sluggish blood flow

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13
Q

What is an anotomical variation of the IVC?

A

Double vena cava

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14
Q

What is portal vein thrombosis and where is it seen?

A

A developed clot within portal vein seen in HCC, portal hypertension, pancreatitis and pregnancy

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15
Q

What occurs with partial thrombosis?

A

There is flow within the vein

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16
Q

Besides Hep B / C and cirrhosis (including primary biliary), what are indications for a liver transplant?

A

Budd-chiari, acute liver failure, chronic active autoimmune hepatitis, primary sclerosing cholangitis, primary benign/malignant neoplasms

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17
Q

What conditions of liver are used for transplants?

A

Cadaveric allograft (including lobar transplant) and living related donor (also lobar)

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18
Q

What types of anastomoses are there in liver transplantation?

A

Suprahepatic, infrahepatic vena cava, hepatic artery and portal vein (as well as biliary anastomosis)

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19
Q

What must liver donors have done in addition to explantation?

A

Have a cholecystectomy

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20
Q

What is OLTX and LDLT(X)?

A

Orthotopic liver transplantation (cadaveric)

Living Donor Liver transplantation

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21
Q

What is the advantage of OLTX?

A

It doesn’t involve much anastomoses

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22
Q

Which portion of the liver is usually taken for grafting?

A

Right lobe

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23
Q

After you estimate liver and spleen size, what checklist must be done (pre-liver transplant)?

A

Patency of IVC, portal vein (length/dia of extrahepatic portion), anatomical variation of HA, collaterals portal to systemic, any hepatic mass or ascites quantity

24
Q

What does ultrasound show in a recipient’s liver parenchyma with cirrhosis changes?

A

Nodular contours, parenchymal inhomogeneity, right-lobe atrophy, and hypertrophy of lateral segment/caudate lobe

25
Q

What does cirrhosis cause?

A

Narrowing of the hepatic veins and loss of the normal phasic waveform, caudate lobe can enlarge and surround IVC

26
Q

How does blood flow show on a normal liver transplant?

A

Brisk systolic upstroke and continuous diastolic flow during spectral doppler evaluation

27
Q

What does spectral doppler show on a normal liver transplant?

A

Continuous, mildly undulating hepatopedal flow and hepatic veins show hepatofugal flow (RI range from 0.5-0.7)

28
Q

What is post-op evaluation of liver parenchyma?

A

Parenchymal echogenicity

29
Q

What is post-op evaluation of liver perihepatic spaces?

A

Ascites, hemorrhage and fluid collections

30
Q

What is post-op evaluation of liver biliary system?

A

Ductal dilation and intraluminal filling defects

31
Q

What is post-op evaluation of liver vasculature?

A

Hepatic A/V’s, portal vein, IVC patency, arterial/venous waveforms and RI’s, anastomoses (focal color aliasing/elevated velocities)

32
Q

What are 2 complications in LDLT?

A

Acute rejection and vascular complications

33
Q

What is the range of LDLT acute liver rejection and how does it compare cadaveric?

A

17% - 40% and is lower (unknown)

34
Q

What are U/S findings of coarsed, heterogeneous parenchyma found in the first stages of liver transplant?

A

Recurrent cirrhosis, ischemia and necrosis

35
Q

What are U/S findings of focal lesion in the first stages of liver transplant?

A

Neoplasm, infarct, abscess, and ductal abnormality

36
Q

What are U/S findings of elevated resistive indices in the first stages of liver transplant?

A

Extrinsic compression, parenchymal disease, and venous outflow obstruction

37
Q

What are U/S findings of decreased resistive indices in the first stages of liver transplant?

A

Hepatic artery stenosis, advanced aortoiliac atherosclerosis, median arcuate ligament compression

38
Q

What are U/S findings of hepatic venous phasicity loss in the first stages of liver transplant?

A

Advanced parenchymal disease, rejection, and caval anastomotic stenosis

39
Q

What are vascular complications of LDLT and what percentage does it make up?

A

Thrombosis, stenosis of the hepatic artery/veins, portal veins, and pseudoaneurysms making up 9% of liver transplants (most common)

40
Q

Which group of people are more likely to have vascular problems in LDLT?

A

Pediatric (small size of vessels)

41
Q

What is the most common vascular complication of liver transplantation?

A

Hepatic artery thrombosis

42
Q

What are complications in LDLT?

A

Acute rejection, vascular complications and biliary complications

43
Q

What is the most common vascular complication of liver transplantation?

A

Hepatic artery thrombosis (requiring revascularisation/retransplantation)

44
Q

What are U/S findings of hepatic artery inflow compromise?

A

Intrahepatic tardus parvus (slow upstroke/low-res flow

45
Q

What are findings of significant stenosis?

A

A focal high velocity jet in the hepatic artery in excess of 200 cm/s or greater than 3X the velocity in prestenotic HA

46
Q

What does spectral show with hepatic artery stenosis?

A

A delayed systolic upstroke and rounding of the systolic peak consistent w/tardus-parvus due to anastomotic stenosis in the HA

47
Q

What will show with HA pseudoaneurysm post biopsy?

A

Color flow will show a marginated, round lesion with internal flow consistent with a pseudoaneurysm

48
Q

When do portal vein abnormalities occur in LDLT?

A

1% to 3% and are uncommon

49
Q

What is a portal vein LDLT abnormality and how does is appear?

A

Acute portal vein thrombus which appears moderately hypoechoic or isoechoic w/absence of Doppler signal (diffuse low velocity/focal elevated velocities @ anastomosis are signs of portal vein stenosis)

50
Q

How can color flow appear in the portal vein following the liver transplant?

A

Swirling due to helical flow and can indicate the vessels kinking or significant vessels size mismatch

51
Q

What percentage of liver transplants have biliary complications?

A

24% with a significant cause of post-transplant morbidity and mortality

52
Q

What type of liver transplant are more common with biliary complications?

A

LDLT including bile leaks, strictures, calculi or sludge, dysfunction of the sphincter of Oddi

53
Q

What kinds of collections can occur after LDLT?

A

Perihepatic fluid collections and abscesses

54
Q

How do intra-hepatic conditions appear on U/S?

A

Cystic/solid masses without internal vascularity (may represent seromas, hematomas or infarction)

55
Q

What indicates a hematoma?

A

Complex lesions w/mass effect on surrounding structures (U/S detects collections and can guide drainage)

56
Q

What type of post-transplant malignancies can occur?

A

4% - 5% develop malignant tumors with increased incidence of lymphoma (mostly non-Hodgkin’s) and recurrent HCC

AB VASCULAR (5 decks)

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