Module 3 : Vascular Diseases Flashcards
(124 cards)
1
Q
what are 5 conditions that can alter blood flow in and out of organs
A
- increase in vessel pressures
- thrombosis/tumor invasion
- atherosclerosis
- congenital abnormalities
- aneurysms
2
Q
what is the normal aortic waveform pattern prox and distal
A
- prox = moderate
- distal = high resistance
3
Q
renal artery normal wave form pattern
A
- low resistance
4
Q
sma normal wave form patter prandial and postprandial
A
- pre prandial = high resistance
- post prandial = low resistance
5
Q
normal portal venous flow
A
- hepatopedal
- monophasic flow with slight undulations
6
Q
hepatic veins and ivc normal flow
A
- phasic flow
- influence by the cardiac and respiratory cycles
- IVC often described as a saw tooth pattern
7
Q
normal ao prox measuremnt
A
2-2.5cm
8
Q
normal ao dist measurement
A
1.5cm
9
Q
at what measurement is the ao considered aneurysmal
A
3cm
10
Q
ivc size
A
5-29mm (usually less than 25mm)
11
Q
when is the IVC considered dilated
A
> 3.7cm
12
Q
what is the IVC size on initial inspiration
A
decreases in size
13
Q
what is the IVC size on suspended respiration
A
increases in size
14
Q
4 indications for arterial assessment
A
- pulsatile abdominal mass
- abdominal pain
- abdominal buit
- hemodynamic compromise of the lower limbs
15
Q
definiton of arteriosclerosis
A
hardening of arteries
16
Q
definition of atheroma
A
lipid deposits in arterial intima
17
Q
atherosclerosis definiton
A
- form of arteriosclerosis occurring in larger and medium arteries
18
Q
plaque definiton
A
platelets forming cap over fatty deposits
19
Q
characteristics of atheromatous disease (atherosclerosis)
A
- lipid deposits on intimal lining of any artery
- alteration of lining provokes fibrosis and calcification
20
Q
what 3 things is atherosclerosis associated with
A
- hypertension
- smoking
- diabetes
21
Q
does incidence of atherosclerosis incense or decrease with age
A
- increase
22
Q
does atherosclerosis effect females or males more
A
males
23
Q
sonographic appearance of atherosclerosis
A
- wall irregularities
- tortuous vesels
- calcifications
- narrowed vessel lumen
24
Q
do aneuysms effect only one artery
A
- no can affect any artery
25
6 types of aortic aneurysms
- abdominal aortic aneurysms
- splanchnic artery aneurysms (mesenteric)
- renal artery aneurysms
- iliac artery aneurysms
- mycotic aneurysms
- inflammatory aneurysms
26
what is an abdominal aortic aneurysm
- a weakening of the aortic wall that leads to a focal dilatation
27
what is a true aneurysms
- involves all 3 layers of the artery wall
28
what is ectasia
- slight widening of the aorta up to 3cm
29
where does AAA usually occur
- occur mainly below the level of the renal vessels (infrarenal)
30
5 causes of AAA
- atherosclerosis MOST COMMON
- syphilis
- systemic infection
- cystic medical necrosis
- other diseases (marfans)
31
4 increased risk factors for AAA
- men > 60
- hypertenison
- family history
- hypercholesteremia
32
6 signs and symptoms of AAA
- usually asymptomatic
- palpable mass
- incidental finding on X-ray
- lower back pain
- abdominal pain
- leg pain
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two types of AAA
- fusiform
| - saccular
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fusiform AAA
- uniform tubular dilation
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saccular AAA
- sac like protrusion towards one side connected to the aortal
- most often due to trauma or infection
36
sonographic appearance of a AAA
- dilation of the aorta 3cm or greater
- aorta projects anterior and left (ivc and spine)
- wall irregularities
- thrombus on anterior and lateral walls
-
37
what is thrombus
- clot attached to the vessel wall
| - poorly attached thrombus can result in the release of emboli
38
what three things cause thrombus
- slowing of the blood stream
- injury to vessel
- alterations to the blood constituents
39
two associated findings with AAA
- iliac artery aneurysms
| - popliteal aneurysms
40
iliac artery aneurysms
- bilateral
- 2cm or greater
- usually asymptomatic
- older men
- can rupture
- causes hydronephrosis = compress ureters
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popliteal aneurysms
- 25% of cases
| - >1cm
42
protocol for measuring AAA
- place callipers outer to outer wall
| - measure perpendicular to the vessel
43
6 things you want to document with AAA
- length, width and AP dimension
- shape
- location in aorta
- does it involve renal or iliac arteries
- describe the wall thickening
- flow pattern
44
follow up treatment for 3-5cm aneurysm
- increasing in size 2-5mm/year
+ serial ultrasound exams
- increasing in size 10mm/year
+ surgery aortic graft
45
follow up and treatment for 5-6cm aneurysm
- surgery with good prognosis
| - at 6cm surgery is considered imperative
46
follow up and treatment for >7cm aneurysm
- 1 year survival rate 25%
- 75% risk of fatal rupture
- surgery = aortic graft
47
4 complications with AAA
- stenosis/occlusion MOST COMMON
- rupture
- dissection
- thrombosis
+ with distal emboli
48
characteristics of AAA rupture
- surgical emergency
- mortality rate >50%
- operative mortality rate >40-60%
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signs and symptoms of AAA rupture
- pain
- shock
- expanding abdominal mass
50
sonographic appearance of AAA rupture
- free fluid in abdomen
- complex fluid collection
- compression/displacement of surrounding structures
51
two types of AAA repair
- traditional graft
| - endovascular aortic stent
52
traditional graft
- surgical bypass graft
- open repair
- made by flexible synthetic material (teflon or Dacron)
53
endovascular stent
- less invasive
- stent inserted and ballooned out
- more popular and less invasive quicker recovery
54
sonographic appearance of end-vascular stent
- ribbed appearance
- straight distinct borders
- increased echoes
- post op = small layer of fluid normal
- graft older than 8 years may bee difficult to see
55
6 complications of surgical repair
- fluid collection
- hematomas seromas
- abscesses
- pseudoaneurysms
- stenosis
- endoleaks
56
splanchnic artery aneurysms
- celiac, SMA, IMA
| - rare but life threatening
57
order of arteries effected by splanchnic artery aneurysms
- splenic artery
- hepatic artery
- SMA
58
underlying causes of splanchnic artery aneurysms
- congenital
- atherosclerosis
- mycotic (fungal/bacterial)
- inflammatory
59
sonographic appearance of splanchnic artery aneurysms
- anechoic or complex area continuous with the vessel
- doppler signal
- can be mistaken for abscess/cyst/lymph node
60
renal artery aneurysms
- extra renal location
61
common underlying cause of renal artery aneurysms
- athersclerosis
| - polyarteritis
62
signs and symptoms of renal artery aneurysms
- palpable mass
- hypertension (kidneys controls blood pressure)
- hematuria
63
sonographic appearance of renal artery aneurysms
- anechoic mass connected to artery with doppler signal
64
mycotic aneurysms
- rare
- due to bacterial or fungal infection
- most are saccular with asymmetric wall thickening
- difficult to diagnose with ultrasound alone
65
inflammatory aneurysms
- uncommon
- dense fibrotic reaction around the aneurysm
- involves retroperitoneum
- high morbidity and mortality rate
- adherent to bowel, ureter, iliac veins and IVC
66
sonographic appearance of inflammatory aneurysms
- dilated aorta
- wall thick
- hypo echoic mantle around aorta
67
what is an aortic dissection
- tear of the intimal lignin got the aorta (and sometimes media)
- false lumen created as blood pulsates through the vascular wall layers
- begins at the thorax
- presents typically with chest pain
68
what are ao dissections related to
- hypertension
69
3 types of aortic dissections
- involving aortic arch and movie down the aorta
- marfans
+ ascending ao only
- dissection of descending ao after origin of left subclavian
+ MOSR COMMON
70
sonographic appearance of ao dissection
- thin, linear, echogenicity within the arterial lumen
+ flap moves with cardiac cycle
- doppler
+ demonstrates blood flow on both sides of the flap
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what is a psuedoaneurysms
- blood escapes through a tear in the vessel wall and Is contained by surrounding tissues
72
causes of pseudo aneurysms
- failed graft
- post angiogram
- trauma
73
sonographic appearance of pseudoaneurysms
- round/oval appearnce
- blood circulates through in systole
- pulsatile jet entry
- variable waveform
- always identify neck of mass
74
treatment of pseudoanerysm
- ultrasound guided compression
- ultrasound guided thrombin injection
+ cause blood to clot off
- monitored with color doppler imaging
75
what is an arteriovenous AV fistula
- abnormal communication between and artery and vein
- blood moves from high to low pressure
- most secondary to trauma, can be complication to aortic aneurysm
76
clinical presentation of AV fistula
- lower back and abdominal pain
- hemodynamics altered
- swelling of lower trunk and extremities
- dilated veins
77
sonographic appearance of AV fistula
- dilated IVC
- pulsatile IVC
- irregular waveform high velocites
- reduced distal arterial flow
78
vascular stenosis
- can occur in varying degree
| - caused by atherosclerotic plaque
79
common 2D and doppler findings of vascular stenosis
- narrowed lumen
- post stenotic dilation
- increased velocities at stenosis
- downstream changes
80
renal artery stenosis
- associated with incontrollable hypertension
- decreased glomerular filtration rate
- causes ischemic renal damage
- commonly at the origin from the aorta within the first 2cm
81
4 things to look for when assessing the IVC
- changes with respiration
- compressibility
- echo free lumen
- patency
82
what is a dilated IVC
- caliber increases below the point of obstruction
83
what is a dilated IVC associated with
- right ventricular failure
84
4 signs and symptoms of dilated IVC
- abdominal pain
- ascites
- hepatomegaly
- lower extremity edema
85
characteristics of ivc tumors
- primary metastatic or extension
| - present with leg edema, ascites and abdominal pain
86
primary IVC tumors
- uncommon
- leiomyoma/leiomyosarcoma
+ tumor of smooth muscle
87
metastatic ivc tumors
- most commonly RCC
88
sonographic appearance of ivc tumors
- intraluminal ehcogenic foci
- can be isoechoic or heterogeneous
- caliber of ivc increased
- loss of respiratory changes
89
characteristics of IVC thrombus
- life threatening
- MOST COMMON ABNORMALITY OF IVC
- spreads from other veins
90
sonographic appearance of IVC thrombosis
- intraluminal filling defect expanding the vessel
- echogenicity of the thrombus depends on its age
- respiratory changes decreased or absent
- color doppler is useful will show no flow in the region of the thrombus
- IVC filters used for treatment
91
signs and symptoms of IVC thrombus
- leg edema
- lower back pain
- GI complaints
- enlarged liver
- ascites
92
renal vein thrombosis characteristics
- serious complication in a dehydrated state or septic infant
- in adults occur as result of shock, renal tumor, renal transplants or trauma
- associated with diabetes and high blood pressure
93
3 signs an symptoms of renal vein thrombosis
- flank pain/mass
- hematuria
- proteinuria
94
sonographic appearance of renal vein thrombosis
- enlarged kidney hypo echoic
- dilated renal vein
- filing defects of variable echogenicty
- decreased or absent venous signal
95
congenital abnormalities of the IVC
- most occur at or below level of the renals
96
what are the most common congenital abnormalities of IVC
- duplication and transposition
97
when does azygous/hemiazygous abnormality occur
- when hepatic segment of the IVC fails to develop
98
three types of congenital IVC abnormality
- transposition
- duplication
- azygous continuation
99
what is hepatic congestion
- passive edema of liver secondary to vascular congestion
- related to heart failure
- blood flow to the right side of heart is impaired
100
sonographic appearance of acute hepatic congestion
- enlarged liver
- IVC dilated/ no respiratory changes
- hepatic veins = highly pulsatile, flow reversal
- portal vein flow = pulsatile
101
sonographic appearance of chronic hepatic congestion
- shrunken liver
- hepatic veins distended
- LFT may be altered
102
what is portal hypertension
- due to increase portal venous pressure
| - 2 types based on whether hepatic vein pressure are normal or elevated
103
2 types of portal hypertension
- presinusoidal
+ normal hepatic vein pressure
- intraheptaic
+ abnormal hepatic vein pressure
104
2 types of presinusoidal hypertension
- extrahepatic
| - intrahepatic
105
extra hepatic presinusoidal hypertension
- PV and SV thrombosis
- results in ascites, splenomegaly, varices
- possible causes
+ malignancy, infection, inflammation, trauma, splenectomy, hypercoaguable states
106
intrahepatic presinusoidal hypertension
- caused by diseases affecting the portal zones
+ schistosomiasis (panc infection)
+ primary biliary cirrhosis
107
intrahepatic portal hypertension
- most common in western world = cirrhosis
- normal liver parenchyma is replaced which leads to increased resistance to PV flow and obstruction of HV outflow
- results in ascites, splenomegaly, collaterals
108
sonographic appearance of both types of portal hypertension
```
- dilated PV in the early stages
+ upper limit of normal 13mm
- collateral flow
- patent umbilical vein/coronary vein
- ascites
- splenomegaly
- monophasic >> biphasic>> hepatofugal
```
109
5 most common collateral routes
```
- gastroesophageal
+ fatal hemorrhage
- paraumbilical
+ leads to caput medusa
- splenorenal/gastrorenal
- intestinal
- hemorrhoidal
```
110
what is portal vein thrombosis
- clot in portal venous system
| - can result in cavernous transformation
111
causes of portal vein thrombosis
- malignancy
- infection/inflammation
- trauma
- splenectomy
112
why is color doppler important for portal vein thrombosis
- useful in distinguishing benign and malignant thrombi
| - acute thrombus may be relatively anechoic
113
what is cavernous transformation
- formation of venous channels around a thrombodes vein portal vein
114
what is Budd chairi syndrome
- rare
| - obstruction of hepatic veins with possible IVC occlusion
115
causes of Budd chiari syndrome
- coagulation/congenital abnormalites
- trauma
- ORAL CONTRACEPTIVES
- tumor invasion
116
sonographic appearance of Budd chiari
- stage dependant
- enlarged liver (acute)
- poor visualization of hepatic veins
- thrombus in IVC
- caudate lobe enlarged/hypoechoic
- HV flow absent or reversed
117
signs and symptoms of Budd Chiari
- RUQ
- hepatomegaly
- occasionally splenomegaly
118
treatment of portal hypertension
- portosystemic shunts
119
portisystemic shunts characteristic
- shunts venous blood flow from congested venous system to a systemic vein
- decompress PV system
- can be placed surgically or percutaneously
- TIPS
120
TIPS shunt
- trans jugular intrahepatic portosystemic shunt
- stent inserted percutaneously via jugular vein
- inserted HV to PV
- blood flows from PV system into hepatic venous system
121
what is an infarction
- sudden interruption of blood supply that may lead to encores
122
splenic infarct
- common cause of focal splenic lesions
- caused by occlusion of the splenic artery
- sudden onset of LUQ pain
- underlying causes = sickle cell anemia
123
sonographic appearance of splenic infarct
- hypo echoic wedge shaped round area
| - echogenicity changes over time (becomes hyperechoic)
124
renal infarct
- can be segmental or diffuse
- appearance is time dependant
+ early = hypo
+ late = hyper
- renal function often remains normal
