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Veterinary Diagnostic Imaging > Module 1 - Ultrasonography I > Flashcards

Module 1 - Ultrasonography I Flashcards

Physics and principles of US; US liver, billiary system and spleen

1
Q

On Us, propagation speed error occurs because tissue density and propagation velocity have a direct or indirect correlation?

A

Indirect. For example, when sound travels through fatty tissues the reflector depth will be erroneously calculated as greater (or deeper) than it actually is, since fat has low density (less dense than water).

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2
Q

On US, does propagation velocity increase or decrease with tissue stiffness (elasticity)?

A

Propagation velocity is increased in stiff tissues.

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3
Q

What interfaces create a reverberation artefact?

A

Soft tissue–bone or soft tissue–gas.
Reverberation artefact is a strong reflection that occurs as a result of a combination of an abrupt change in sound velocity and the physical density of the media (defined as the acoustic impedance) at a soft tissue–bone or soft tissue–air interface.

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4
Q

What is the difference between a specular reflector and a diffuse/scatter reflector?

A

A specular reflector occurs when US waves hit a smooth, large surface, such as bone, and the sound wave is reflected back in a singular uniform direction (perpendicular to the beam).
Diffuse/scatter reflector occurs when US waves hit an irregular surface between two tissues, such as in soft tissue, and the reflections return to the transducer in a chaotic and disorganized way relative to the initial US beam.

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5
Q

Name the 4 basic interactions between ultrasounds and tissues.

A

1) Attenuation
2) Reflection
3) Refraction
Last too related to dispersion or Scattering or diffuse reflection, and Divergence/ Speckle reflection
4) Absorption

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6
Q

Establish a comparison of echogenicity between the kindey cortex, liver and spleen.

A

The kidney cortex is slightly hypoechogenic to the liver, which in turn is more hypoechogenic related to the spleen.

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7
Q

Name the Roentgen signs

A

“SSLMNO”
Size, Shape, Location, Margin, Number and Opacity.

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8
Q

Name the 4 useful US artifacts

A
  1. Acoustic shadowing
  2. Edge shadowing
  3. Distal enhancement
  4. Reverberation
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9
Q

What is the difference between clean shadowing and dirty shadowing?

A

Clean shadowing is encountered when absorption of the incident beam happens at a hyperattenuating interface, such as bone, calculi, or compact foreign material, that is larger than the ultrasound beam width. Dirty shadowing is present when the incident beam is mostly reflected, such as at a soft tissue–gas interface.

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10
Q

Name non useful US artifacts.

A

Side lobe (colon insede of the bladder)
Slice thickness (pseudosludge/pseudosediment)
Mirror artifact
Speed propagation error (kidney appears with irregular margins when under fat near the spleen).

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11
Q

How does the common bile duct (CBD) from a cat differ from a dog´s CBD?

A
  • Dogs:
  • Common bile duct enters close to but not merged with the pancreatic duct
  • Accessory pancreatic duct enters at minor duodenal papilla 2 cm aborally
  • Cats:
  • Common bile duct and pancreatic duct merges before opening at major duodenal papilla
  • Only 20% of cats have an accessory pancreatic duct at minor duodenal papilla
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12
Q

Name hyperechogenic diffuse changes in the liver.

A

Steroid hepathopathy
Other vacuolar hepatopathies
Chronic hepatitis
Lipidosis
Neoplasia (LSA, MCT, metastasis)

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13
Q

Name hypoechogenic diffuse changes in the liver.

A

Acute cholangiohepatitis
Acute hepatitis
Amyloidosis
Neoplasia (LSA, leukeamia, histiocytoma)
Passive venous congestion

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14
Q

Name mixed echogenicity diffuse changes in the liver.

A

Amyloidosis
Chronic hepatitis
Neoplasia (LSA, hepatocellular carcinoma, metastatic)
Nodular hyperplasia
Steroid hepatopathy
EMH
Necrosis
Cirrosis
Hepatocutaneous syndrome

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15
Q

Give 4 examples of hepatic disease that is associated with hepatomegaly.

A

Storage disease (lipisodis, DM, hyperadrenocorticism)
Infiltrative disease (massive hepatocellular carcinoma, round cell tumours)
Passive congestion

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16
Q

Give 4 examples of hepatic disease that causes asymetry of the liver.

A

Hepatic lobe torsion
Thrombosis
Cysts or Abscess
Primary neoplasia or mets

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17
Q

Give 3 differentials for microhepatia.

A

Hepatic fibrosis (end-stage liver failure, i.e cirrhosis)
Congenital abnormalities (PSS)
Hypovolemia

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18
Q

How is the triad of hepatopulmonary syndrome (HPS) characterized by?

A

Abnormally low arterial oxygenation (due to), intrapulmonary vascular dilatations (IPVDs) in the setting of liver disease leading to portal hypertension or caused by congenital portosystemic shunts.

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19
Q

In cats, does polycystic kidney disease have a correlation to liver abnormalities?

A

Yes. In feline polycystic kidney disease (PKD), 68% of cats had concurrent ductal plate malformations, with congenital hepatic fibrosis and polycystic liver disease being most common.

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20
Q

What is the difference in terminology between liver nodules and liver masses?

A

Nodules are when the lesions are less than 3cm, and masses when they are >3cm.

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21
Q

In what breed of dogs there was a link between vacuolar hepathopathy and adrenal steroidogenesis and predisposition to hepatocellular carcinoma?

A

Scottish Terriers

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22
Q

What dog breeds may have cyst-like structures originating from the billiary tract?

A

Cairn terriers and West Highland white terriers (main two, but possible with others)

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23
Q

What is the most common billiary tumour in cats?

A

Biliary cystadenomas (which are the most common benign primary hepatic neoplasia in the cat). These are seen primarily in older cats and are benign hepatic tumors that have a characteristic cystic appearance.

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24
Q

What is the most commonly isolated bacteria from liver abscesses?

A

E. coli

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25
Q

Name 3 differential diagnosis for hepatic granuloma in cats.

A

Hepatic granulomas can be detected in cats, particularly in cases of fungal diseases, FIP or feline eosinophilic fibroplasia.

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26
Q

What is more common in dogs and cats in regards to liver neoplasia: primary or secondary?

A

Metastatic tumors in the liver from primary tumours of the pancreas, spleen and GI system are more common in the dog, whereas primary liver tumours are more common in cats.

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27
Q

What is the most common malignant primary tumour of the liver in the dog?

A

Hepatocellular carcinoma (often massive in classification). Cholangiocarcinoma is the second most common primary hepatic tumor in dogs.

28
Q

What is the most common malignant primary tumour of the liver in the cat?

A

Cholangiocarcinoma

29
Q

Are target or bullseye lesions pathognomonic of neoplastic malignancy?

A

Although not pathognomonic of malignancy nor neoplasia, when there are one or more target lesions in the liver or spleen, one study revealed they have a positive predictive value of 74% for malignancy, whereas finding these lesions in multiple organs had a positive predictive value of 81% for malignancy.

30
Q

Name 3 luminal billiary abnormalities.

A

Billiary sludge
Calculi (cholelithiasis), Mucocele

31
Q

Name 3 billiary wall abnormalities.

A

Cystic Mucinous hyperplasia
Polyp
Neoplasia

32
Q

Is billiary sludge normal?

A

There is no consensus if this is “normal” or not, but it can be seen in approximately 53% to 57% of healthy dogs ≥ 4 years of age.

33
Q

What are choleliths composed of?

A

In both dogs and cats, choleliths commonly contain mixtures of calcium (calcium carbonate, calcium bilirubinate), cholesterol, and bilirubin.

34
Q

How sensitive and specific is abdominal US for GB rupture?

A

Abdo US has a poor sensitivity (56.1%) but good specificity (91.7%) for the identification of gallbladder rupture.

35
Q

Name 4 differentials for GB wall double rim appearance (layered).

A

Acute cholangitis
Anaphylaxis
Pancreatitis
Hypoalbuminemia

36
Q

Is cystic mucinous hyperplasia of the GB correlated with GB mucocele?

A

It was histologically present at necropsy in 100% dogs with GB mucocoele in 4 studies.

37
Q

What is the most common feline hepatic inflammatory disease?

A

Cholangitis

38
Q

What is cholangitis/cholangiohepatitis?

A

This occurs when cholangitis extends beyond the limiting plate into the adjacent periportal region - it is then termed cholangitis/cholangiohepatitis.

39
Q

What sign has been called when there is intrahepatic bile ducts dilatation?

A

Shotgun sign (anaechoic tortuous tubular structures with hyperechoic walls).
This tends to happen 5-7 days after GB obstruction.

40
Q

Cholelithiasis is commonly associated with cholecystitis in cats. True or False?

A

True.

41
Q

It is possible to differentiate ultrasnonographically a plug of inspissated bile from a intraluminal billiary neoplasia.
True or false?

A

False.

42
Q

What are the two most commonly isolated bacteria in bile culture of dogs and cats?

A

E. coli and Enterococcus sp.

43
Q

What are the possible causes of GB wall oedema?

A

Causes of GB oedema can be extrinsic or intrinsic in nature – extrinsic: such as acute Budd Chiari syndrome, right sided heart failure, hypoalbuminaemia, portal hypertension, patients that received blood transfusion and anaphalaxis, and intrinsic due to inflammation.

44
Q

What type of cPSS are found in medium/large breed dogs versus small breed dogs?

A

Intrahepatic cPPS are more common in medium/large breed dogs whilst extrahepatic cPSS are more commonly seen in small breed dogs.

45
Q

What values of PV/Ao ratio rule out or include extrahepatic congenital portal communication as a diagnosis?

A

PV/Ao ratio ≤0.65 is considered to be compatible with an extrahepatic CPC (although the ratio is also reduced in primary portal hypoplasia), whereas a ratio ≥0.8 rules it out.

46
Q

Older dogs and cats are more likely to have multiple acquired extrahepatic shunts secondary to chronic liver disease. True or false?

A

True.
Portal hypertension can lead to the opening of preexisting embryonic vessels that connect the portal and the systemic circulation.

47
Q

How are the causes of portal hypertension classified?

A

Pre-hepatic, hepatic and port-hepatic causes.

48
Q

What is hepatic portal hypoplasia?

A

Hepatic portal hypoplasia occurs when portal blood is shunted through the liver, bypassing the sinusoids and draining directly into the central veins of the liver, whilst a macroscopic shunt cannot be identified; portal hypertension will develop in some affected patients leading to multiple acquired extrahepatic shunts. Hepatic microvascular dysplasia is another term for this disease.

49
Q

Mention diseases that may predispose to portal vein thrombosis.

A

Portal vein thrombosis: described in cases of HAC, hepatic neoplasms, PLE and autoimmune pathologies.

50
Q

Name abnormalities that can present with splenomegaly but with normal splenic echogenicity on US.

A

Secondary effect of sedation
Chronic anemia
IMHA
Diffuse malignant infiltration (round cell tumours - LSA, MCT, histiocytic)
Pyogranulomatous splenitis associated with FIP

51
Q

Name causes of splenomegaly with hypoechogenicity.

A

Neoplasia: malignant infiltration, round cell tumours (LSA, MCT, histiocytic sarcoma), leukemia, plasmocytic neoplasia (MM)
Passive venous congestion
Acute systemic inflammation
Acute splenitis

Lacy pattern:
Splenic torsion
Widespread thrombosis

52
Q

Describe the ultrasonographic appearance characteristic of splenic torsion.

A

Starry sky (lacy)
And perivascular triangle sign (fat)

53
Q

Name differentials for splenomegaly with mixed echogenicity.

A

RCTs: MCT (diffusely mottled), LSA (Swiss cheese)
Myeloproliferative disease
Splenitis
Arterial thrombosis
Diffuse nodular hyperplasia

54
Q

Name differentials for splenomegaly and hyperechogenic appearance of the spleen.

A

Lymphosarcoma (dogs), MCT (sometimes in dogs, rarely hyper in cats)
Chronic myeloproliferative diseases
Chronic inflammatory processes
Granulomatous disease

55
Q

Splenic torsion is more common in large or small breed dogs?

A

Large breed.
Great Danes and German shepherds appear predisposed.

56
Q

Name differentials for splenic vein thrombosis

A

Splenic vein thrombosis
causes include: splenic torsion, generalized vascular or clotting disorders, neoplasia [lymphoma (++)], hyperadrenocorticism, mast cell disease

57
Q

What are characteristic ultrasound features of splenic hemangiosarcoma?

A

Hemangiosarcoma of the spleen may present with focal mixed echogenicity/heterogenous, with septations and anaechoic cavities.

58
Q

List differentials for honeycomb pattern of the spleen on US.

A

Lymphoma
IMHA
EMH

59
Q

List differentials for target lesions in the spleen on US.

A

Metastatic disease
EMH
Nodular hyperplasia

60
Q

List differential diagnosis for focal infart of the spleen.

A

Differential diagnosis for this lesion include nodular hyperplasia, abscess, haematoma and neoplasia.

61
Q

Describe the echogenic evolution of a splenic hematoma.

A

First 24h: iso/hyperechoic.
post 48-96h: hypo/anaechoic
After 96h: hyperehoic

62
Q

What are the two most common neoplasms of the spleen in the cat?

A
  1. MCT
    (accounts for 15% of all splenic pathology in cats; disseminating to the liver, in 90%)
  2. Lymphoma
63
Q

What is the most common neoplasm of the spleen in the dog?

A

HSA is the most common splenic tumor in dogs and accounts for 24%-50% dogs with splenic masses.

64
Q

Where does a splenic hemangiosarcoma tend to metastasize to?

A

Lungs (++), kidneys, liver and right atrium.
Splenic HSA is highly metastatic: > 50% metastatic rate.

65
Q

How does metastatic carcinoma of the spleen appear on US in cats?

A

Anechoic to hypoechoic solitary, well-defined, nodules (whilst in dogs it´s more frequently target lesions).

66
Q

What is the US appearance of a spleen in a case of multiple myeloma?

A

Multiple myeloma is a systemic disease in which multiple, small hyperechoic nodules can be seen in dogs, but the spleen may appear normal in cats.

Veterinary Diagnostic Imaging (2 decks)

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