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Case Studies > Our Final Case Studies Diagnosis Review Questions > Flashcards

Our Final Case Studies Diagnosis Review Questions Flashcards

1
Q

What is Portal Hypertension caused by?

A

It is caused by damaged hepatocytes that impede the flow blood into the liver, thus causing an increase in PV pressure

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2
Q

What is the most common cause of Portal Hypertension in North America?

A

Cirrhosis

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3
Q

What is a common finding associated with Portal Hypertension and Cirrhosis?

A

Recanalized Umbilical Vein

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4
Q

What measurements are considered enlarged in regards to the portal vein ?

A

> 13 mm in diameter

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5
Q

What type of procedure is most commonly done to alleviate the pressure from Portal Hypertension?

A

TIPS- transjugular intrahepatic portosystemic shunt

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6
Q

What are some possible causes of hydronephrosis?

A

Causes can include: calculi, tumors, infection, previous obstruction, over-distended bladder and pregnancy.

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7
Q

With hydronephrosis, what other part of the urinary system can be dilated?

A

The ureters

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8
Q

If we see hydronephrosis , what other(s) should we look at further and why?

A

We should follow down the ureter to the bladder to check for any stones or obstruction.

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9
Q

What can be done to differentiate hydronephrosis from blood vessels?

A

Putting on color. The hydro will not light up whereas the vessels will.

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10
Q

If not resolved, what can hydronephrosis lead to?

A

It can lead to irreversible renal damage and loss of renal function

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11
Q

Is pyelonephritis more often seen in females or males?

A

females

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12
Q

What is the appearance of a kidney in typical cases of pyelonephritis?

A

They are typically normal and often not diagnosed with ultrasound.

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13
Q

What is pyelonephritis usually a result of?

A

Can be a result of a bladder infection

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14
Q

Is pyelonephritis always throughout the kidney or can it be localized?

A

It is often seen localized or patchy

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15
Q

Is hydronephrosis often seen in pyelonephritis?

A

No, hydronephrosis is not seen

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16
Q

What are two risk factors for PID?

A

Female gender, age younger than 35 years, sexual activity of two or more partners, and a use of an IUD.

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17
Q

What is a consequence of having recurrent infections of PID?

A

Chronic pelvic pain, peritonitis, ectopic pregnancy, maternal death from ectopic pregnancy, and infertility

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18
Q

Are patients with PID more at risk for infertility?

A

yes, after multiple recurrent episodes.

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19
Q

How do psuedocysts form?

A

Pancreatic enzymes escape from the gland and break down tissue to form a sterile abscess somewhere in the abdomen. Hagen pg. 322

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20
Q

What is the most common location for a pseudocyst

A

lesser sac (anterior to pancreas and posterior to stomach) Hagen PG. 322.

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21
Q

What lab values are important with diagnosing pseudocysts?

A

Amylase and lipase are increased, alkaline phosphatase will be increased with obstruction Hagen pg. 318

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22
Q

What is the most common complication of pseudocysts?

A

Spontaneous rupture Hagen pg. 323

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23
Q

What is the sonographic appearance of a pseudocyst?

A

Well-defined mass around pancreas, increased through transmission, round/oval, may have debris in bottom. Hagen pg. 318

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24
Q

What is the typical age of the patient with a Hepatoblastoma?

A

Young children: peak 1-2 yrs., more common in males, preemies and low birth weight infants Henningsen pg. 102

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25
Q

What lab values are important for diagnosing hepatoblastomas?

A

Increased alpha fetoprotein Henningsen pg. 102

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26
Q

What are the risk factors/predisposing conditions for developing hepatoblastomas?

A

Beckwith-Wiedemann syndrome; hemihypertrophy; familial polyposis coli or familial adenomatous polyposis, which can present with its variant known as Gardner’s syndrome; fetal alcohol syndrome; and Wilms’ tumor Henningsen pg. 102

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27
Q

What is the sonographic findings of a hepatoblastoma?

A

Solid masses isoechoic to liver, spoke-wheel appearance (rare), calcifications, Additional intralesional necroses or tumor thrombi in the portal vein or hepatic veins may be seen. Henningsen pg. 102

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28
Q

What is the prognosis for hepatoblastomas?

A

Dependent on the resectability of the mass, patients are usually in advanced stages when diagnosed. In these cases prognosis is poor. Henningsen pg. 102

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29
Q

What is the most common appearance of an hemangioma?

A

well defined, hyperechoic mass, that may be round, oval, or lobulated

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30
Q

The majority of hemangiomas cause severe pain?

A

False - Most often asymptomatic and found incidentally

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31
Q

Are hemangiomas more common in males or females

A

females

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32
Q

large hemangiomas are at risk for what 2 things?

A

hemorrhage and rupture

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33
Q

What are hemangiomas made up of?

A

cavernous, blood filled channels

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34
Q

Acute glomerulonephritis commonly leads to what?

A

chronic, which develops slowly and may not be detected until the kidneys are failing.

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35
Q

What lab values are important for acute renal failure?

A

Bun, creatinine, and WBC are all increased

Henningsen pg. 67

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36
Q

Are the kidneys enlarged or normal sized in acute renal failure?

A

Acute renal failure may manifest sonographically with normal-sized or enlarged kidneys.

Henningsen pg. 67

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37
Q

is acute glomerulonephritis more common in children, or adults?

A

children

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38
Q

List (2) common symptoms of acute glomerulonephritis?

A

foggy urine, history of recent fever, sore throat, joint pains, edema, nausea, oliguria, anemia, azotemia, HPTN

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39
Q

What are the classic sonographic signs of intussusception?

A

target sign, bulls eye in trans

may mimic pseudo kidney in sagittal

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40
Q

Intussusception most often occurs between what age range?

A

6 months and 2 years old

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41
Q

Absent blood flow in the bowel wall typically means what has happened to the bowel?

A

necrosis of the bowel

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42
Q

Intussusception is most commonly found at what location?

A

ileocolic junction (where the small and large intestines meet)

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43
Q

Patients with intussusception typically present with what (3) symptoms?

A

50% of patients present with

  • intermittent abd pain
  • red jelly like stools
  • palpable sausage shaped mass
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44
Q

T/F - Serous tumors are the most common type of epithelial neoplasm?

A

True

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45
Q

Serous Cystadeoma most often occurring in women of what age range?

A

peri-postmenopausal women

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46
Q

Name the sonographic markers of serous cystadenocarcinoma

A

papillary projections
vascularity
thicker septations
solid areas

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47
Q

Serous Cystadenocarcinomas account for what percent of malignant ovarian neoplasms

A

50% of overall malignant ovarian neoplasms

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48
Q

Does malignancy cuase an incrased CA125 level 100% of the time?

A

no - cancer can be present without an increased CA 125

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49
Q

Serous Cystadenocarcinomas most often occurring in women of what age range?

A

40-50’s

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50
Q

What is Cholangitis?

A

Inflammation of the bile ducts

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51
Q

Where in the liver can liver abscesses form?

A

Intrahepatic, subhepatic and subphrenic areas of the liver

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52
Q

What causes Cholangitis?

A

ductal stricture, parasitic infection, bacterial infection, stones, or neoplasm

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53
Q

Are liver abscesses at risk for rupturing?

A

yes

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54
Q

What are the risk factors of Cholangitis?

A

Previous history of cholelithiasis, HIV, traveling outside the country, narrowing of the CBD, and sclerosing cholangitis

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55
Q

What are the clinical symptoms of Cirrhosis?

A

jaundice, nausea, weight loss, anorexia, ascitis

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56
Q

What are Patients with cirrhosis at risk of developing?

A

portal hypertension and HCC

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57
Q

what are the most common causes of cirrhosis

A

excessive alcohol consumption, hep B and hep C

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58
Q

Why does the cirrhotic liver appear “bright”?

A

due to the replacement of hepatocytes by fibrotic fatty tissue

(different from fatty infiltration)

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59
Q

What are the common sonographic findings with Cirrhoosis

A

a nodular, scalloped surface, hypertrophy of the caudate lobe, ascites, echogenic liver texture

Chronic = smaller in size

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60
Q

what is the difference between pyonephrosis and pyelonephrosis

A

Both are an inflammation/distention of the collection system, however pyonephrosis includes pus and pyelonephritis does not.

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61
Q

what are the clinical symptoms of pyonephrosis

A

fever, chills, UTI, elevated WBC

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62
Q

what causes pyonephrosis

A

UTI that was left untreated, calculus disease, any urinary obstruction that causes a hydronephrotic kidney to be filled with stagnant urine.

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63
Q

what are the sonographic features of pyonephrosis

A

Presence of hydro in conjunction with debris within the collecting system. Low level echoes are noted.

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64
Q

What can happen if pyonephrosis is left untreated

A

Patients may develop septic shock or may lead to irreversible kidney damage and loss of renal function ultimately requiring a nephrectomy.

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65
Q

what are endometrial polyps?

A

focal overgrowth of the endometrial glands and stroma

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66
Q

when are endometrial polyps most prevalent? (age range)

A

peri and postmenopausal women

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67
Q

what are the sonographic findings of an endometrial polyp

A

Found inside the endometrium.
Range from isoechoic-echogenic compared to the endometrial tissue and may appear as endometrial thickening.
It includes a vascular feeding stalk.

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68
Q

Are endometrial polyps benign, or malignant

A

benign

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69
Q

what could the sonographer do to prove that this is a polyp?

A

turn on color to confirm a feeding vessel (stalk)

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70
Q

What lap works is elevated with acute pancreatitis?

A

amylase elevates first (normally within 24 hours)

lipase takes atleast 72 hours to elevate

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71
Q

What may happen to the IVC with acute pancreatitis

A

the IVC may become compressed

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72
Q

what should we look for with the pancreatic duct in acute pancreatitis

A

may become obstructed

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73
Q

are we looking for a more enlarged or smaller pancreas with acute pancreatitis

A

the pancreas becomes more enlarged and hypoechoic from inflammation due to the release of enzymes into the pancreatic tissue

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74
Q

how does the pancreas appear with chronic pancreatitis

A

normally appears smaller and more echogenic from the enzymes destroying the pancreatic tissue (necrotic)

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75
Q

What is the sonographic sign used to help identify biliary atresia

A

triangle cord sign

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76
Q

at what age does biliary atresia typically occur

A

usually diagnosed by 2 weeks after birth

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77
Q

what is the most common effect biliary atresia can have?

A

liver disease - most need transplant

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78
Q

what other effect might biliary atresia have on the liver

A

cause cirrhosis

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79
Q

what are 3 things that could be wrong with the biliary ducts causing biliary atresia

A

injured
blocked
missing ducts

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80
Q

what is the other name for endometrioma

A

chocolate cyst

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81
Q

what is the main cause of endometriomas & what are they an accumulation

A

accumulation of endometrial tissue in patients with endometriosis

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82
Q

what is the most common location for endometriomas to occur

A

ovary

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83
Q

can endometriomas be a reoccurring problem

A

Yes, this can reoccur, therefore surgery or hormone therapy is the recommended treatment for this pathology.

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84
Q

what age range is most effected and why

A

reproductive age - due to hormonal stimulation

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85
Q

What are the cystic areas in Ovarian Hyperstimulation Syndrome?

A

Luteinized follicles called theca lutein cysts

Henningsen pg 179

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86
Q

What is ovarian hyperstimulation syndrome caused by?

A

Excessive human chorionic gonadotropin levels Henningsen pg. 179

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87
Q

How is ovarian hyperstimulation syndrome resolved?

A

Discontinue stimulating medications Henningsen pg. 179

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88
Q

What conditions can develop from Ovarian Hyperstimulation syndrome?

A

Ascites and pleural effusions may develop and lead to hypovolemia, hypotension, and impaired renal function. Patients may become critically ill and need care in an intensive care unit. Henningsen pg. 179 Severe pelvic pain, ovaries can measure over 10 cm, ascites, pleural effusion

Hagen pg. 1009

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89
Q

Sonographic appearance of hepatocellular adenoma

A

Hepatocellular carcinomas can be both hyperechoic and hypoechoic depending on the amount of fat deposits throughout the tumor

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90
Q

What are some symptoms for acute renal failure?

A

Hypovolemia, hypertension, edema, oliguria, and hematuria.

Henningsen pg. 67

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91
Q

What lab values are important for acute renal failure?

A

Bun, creatinine, and WBC are all increased Henningsen pg. 67

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92
Q

Are the kidneys enlarged or normal sized in acute renal failure?

A

Acute renal failure may manifest sonographically with normal-sized or enlarged kidneys.
Henningsen pg. 67

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93
Q

why is hepatocellular adenoma more worrisome than FNH

A

This tumor is more worrisome than FNH because they are more likely to hemmmorage and/or turn into hepatocellular carcinoma.

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94
Q

what differentiates chronic cholecystitis from acute

A

chronic occurs from several boughts of acute cholecystitis

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95
Q

does pregnancy have an effect on hepatocellular adenoma

A

Since patients taking oral contraception has been known to effect this disease, being pregnant has actually been known to increase the size of the tumor

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96
Q

what is the recommended treatment of hepatocellular adnoma

A

Surgical removal is very common because of the relationship hepatocellular adenoma has with HCC

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97
Q

Sonographic appearance of hepatocellular adenoma

A

Hepatocellular carcinomas can be both hyperechoic and hypoechoic depending on the amount of fat deposits throughout the tumor

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98
Q

what else can we see on ultrasound with chronic cholecystitis

A

pericholecystic fluid, wes sign, thickend wall

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99
Q

symptoms of TCC

A

hematuria

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100
Q

will the GB be contracted or rull with cholecystitis

A

contracted

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101
Q

is cholelithiasis necessary for chronic cholecystitis

A

cholelithiasis is not necessary for diagnosis

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102
Q

what differentiates chronic cholecystitis from acute

A

chronic occurs from several boughts of acute cholecystitis

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103
Q

TCC can travel where

A

from bladder to the kidneys

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104
Q

will neuroblastomas have blood flow

A

yes

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105
Q

what does TCC look like ultrasound

A

slightly hyperechoic lesion in the bladder with vascularity

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106
Q

is TCC a common tumor in the urinary tract

A

most common urinary tract tumor

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107
Q

symptoms of TCC

A

hematuria

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108
Q

What are some causes of acute renal failure?

A

An acute kidney injury may have different causes depending on the stage of the disease.
Prerenal: hypoperfusion of the kidney
Renal: parenchymal diseases, such as acute glomerulonephritis, renal vein thrombosis, acute tubular necrosis
Postrenal: obstruction

Henningsen pg. 67

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109
Q

if a cyst is close to the ovary how can we differentiate between an ovarian cyst and a paraovarian cyst.

A

apply pressure to delineate the cyst

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110
Q

Does Tubo-Ovarian abscesses usually occur unilaterally or bilaterally?

A

bilaterally

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111
Q

Where do TOA’s appear in relation to the uterus?

A

Posterior cul-de-sac

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112
Q

How are TOAs treated?

A

antibiotics

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113
Q

What is the typical TOA appearance?

A

complex multiloculated mass with variable septations, irregular margins

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114
Q

Can this pathology involve the fallopian tube and if so what is this called?

A

yes it’s called tubo-ovarian complex

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115
Q

What is ADPKD also known as?

A

Adult Polycystic renal disease

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116
Q

ADPKD does not usually manifest until which decade of life?

A

4th-5th decade of life

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117
Q

Is ADPKD a unilateral or bilateral disease?

A

bilateral

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118
Q

what are some sonographic findings with panc cancer

A

irregular hypoechoic mass in panc. Isoechoic masses may be seen as enlargement or irregular contour of pancreas, ductal dilation, liver mets, lymphadenopathy and biliary issues may be apparent as well.

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119
Q

Is ADPKD considered a progressive disease?

A

yes

120
Q

what age range is affected by neuroblastoma

A

1st year of life

121
Q

what is the cause of neuroblastoma

A

unkown

122
Q

where are neuroblastomas located

A

adrenal gland

123
Q

sonographic findings for wilms

A

palpable mass, appearance is variable, large spherical mass with mainly intrarenal location, may be solid and homogeneous but is usually heterogeneous with areas of hemorrhage, necrosis and cysts

124
Q

will neuroblastomas have blood flow

A

yes

125
Q

where do paraovarian cysts originate

A

broad ligament

126
Q

what are the symptoms of paraovarian cysts

A

asymptomatic

127
Q

what age range is at risk for paraovarian cysts

A

menstruating women

128
Q

what are hemorrhagic cyst caused by

A

Caused by hemorrhage in a follicular or corpus luteum cyst.

129
Q

if a cyst is close to the ovary how can we differentiate between an ovarian cyst and a paraovarian cyst.

A

apply pressure to delineate the cyst

130
Q

How do liver abscess occur?

A

Complications of biliary tract disease, surgery or trauma

131
Q

What are the different types of liver abscess?

A

Pyogenic abscess, hepatic candidiasis, chronic granulomatous disease, amebic abscess and echinococcal disease

132
Q

Where in the liver can they form?

A

Intrahepatic, subhepatic and subphrenic areas of the liver

133
Q

What characteristics are we looking for in a liver abscess?

A

Solitary or multiple lesions within the liver or abnormal fluid collections in Morison’s pouch or in the subphrenic space (between the liver and diaphragm)

134
Q

Are they at risk for rupturing?

A

yes

135
Q

Seminoma is the most common type of?

A

Germ cell tumor

136
Q

what are some causes of choledochal cyst

A

panc juices refluxing into the duct, it can be congenital, or it may be associated with stones, pancreatitis, or cirrhosis

137
Q

Testicular tumors are generally divided into what two types?

A

Germ cell and non-germ cell tumors

138
Q

Approximately ______% of all testicular tumors are of the germ cell type and highly malignant

A

95%

139
Q

Is testicular cancer curable?

A

yes with surgery

140
Q

name the 4 most common sonographic findings for acute cholecystitis

A

Common sonographic findings:

Usually includes cholelithiasis, thickened wall, pericholecystic fluid, Murphys sign and enlarged GB

141
Q

what are the sonographic findings of PCOS

A

string of pearls effect
multiple follicles around the periphery
may be normal or enlarged

142
Q

does acute cholecystitis pt normally have a fever

A

yes can present with fever

143
Q

does acute cholecystitis occur more often in women or men

A

women

144
Q

what is the most common type of panc carcinoma

A

adenocarcinoma

145
Q

is panc cancer more common in women or men

A

men

146
Q

do islet cell tumors grow quickly

A

They are slow-growing, and multiple tumors may be found once diagnosed.

147
Q

what are some risk factors of panc cancer

A

high-fat diet, smoking, chronic pancreatitis, primary sclerosing cholangitis, family hx of pancreatic cancer, and DM

148
Q

what are some sonographic findings with panc cancer

A

irregular hypoechoic mass in panc. Isoechoic masses may be seen as enlargement or irregular contour of pancreas, ductal dilation, liver mets, lymphadenopathy and biliary issues may be apparent as well.

149
Q

80% of wilms tumors are diagnosed before what age

A

before 5 yrs

150
Q

what is the average age for wilms tumor

A

mean age 3.5

151
Q

name some syndromes associated with wilms

A

Beckwith-Wiedemann syndrome, isolated hemihypertrophy, WAGR syndome, and Denys-Drash syndrome

152
Q

is wilms usually unilateral or bilateral

A

usually unilateral but may be bilateral

153
Q

sonographic findings for wilms

A

palpable mass, appearance is variable, large spherical mass with mainly intrarenal location, may be solid and homogeneous but is usually heterogeneous with areas of hemorrhage, necrosis and cysts

154
Q

symptoms of adenomyomatosis

A

may be asymptomatic or have symptoms similar to GB stones

155
Q

What are clinical findings for FNH?

A

It is usually asymptomatic and discovered incidentally, as a solitary lesion in the right lobe.

156
Q

What are some sonographic characteristics for FNH?

A

Because FNH is comprised of liver cells, it is often isoechoic to the liver parenchyma; a change in the contour of the liver or displacement of vascular structures is often a clue to its existence; color Doppler is useful in identification of the prominent vascularity of the central stellate scar.

157
Q

Is it most often seen in women or men; is there a reason that plays a role in the developing of FNH?

A

It is most often seen in women of childbearing age and female hormones are believed to play a role in the development of FNH.

158
Q

What is a distinguishing feature of FNH?

A

FNH has a central stellate scar. Some times it looks like a “spokewheel”vascularity patern.

159
Q

name the common sonographic pattern associated with hemorrhagic cyst

A

“fishnet” or retracting clot patterns, internal echoes with a fluid level. Some may be mostly solid but color Doppler demonstrates no BF. May have vascular rim around periphery of cyst

160
Q

when is ARPKD typically diagnosed

A

neonatal period

161
Q

is ARPKD unilateral or bilateral

A

bilateral

162
Q

are are the sonographic findings in ARPKD

A

bilateral enlarged kidneys with a loss of corticomedullary differentiation

163
Q

what are hemorrhagic cyst caused by

A

Caused by hemorrhage in a follicular or corpus luteum cyst.

164
Q

What is Chronic Renal Failure?

A

CRF is the gradual decrease in renal function over time.

165
Q

What is the most common cause of Chronic Renal Failure?

A

The most common cause of CRF is diabetes mellitus. It is considered the leading cause of end stage renal disease.

166
Q

What are some of the other causes of chronic renal failure?

A

Other causes include, but are not limited to, glomerulonephritis, chronic pyelonephritis, metabolic disorders, chronic UTI, and TB.

167
Q

what are some complications that can occur if left untreated

A

gangrene and rupture

168
Q

Sonographic features of Chronic Renal Failure?

A

Sonographically, the kidneys will appear small, echogenic, and may contain cysts, loss of normal corticomedullary differentiation.

169
Q

True or False: Are leiomyomas the most common benign gynecologic tumors and leading cause of hysterectomy?

A

True. Leiomyomas/Fibroids are the most common benign gynecologic tumors and leading cause of hysterectomy and gynecologic surgery.

170
Q

What are types of leiomyomas?

A

There are three types of leiomyomas: intramural (within the myometrium); subserosal (grows outward and distort the uterus); submucosal (adjacent to the endometrium-main cause of AUB).

171
Q

Who are at a greater risk for development of fibroids?

A

African American women, obese, nonsmokers, and perimenopausal women.

172
Q

larger RCC lesions tend to have what kind of echogenicity

A

Larger lesions are usually more heterogeneous and are more often hypoechoic

173
Q

Medical treatment of fibroids?

A

The medical treatment for fibroids is hormone therapy; surgical treatment (hysterectomy or myomectomy); and uterine artery embolization (used inhibit blood supply to the mass).

174
Q

What age range is mucinous cystadenocarcinoma more common? (Compare it with benign form)

A

Older women are at higher risk with the mucinous cystadenocarcinoma, while younger women are more likely to present with benign form.

175
Q

What are some clinical findings for mucinous cystadenoma

A

Clinical findings of mucinous cystadenocarcinoma include weight loss, pelvic pressure and swelling, GI symptoms, abdominal pain, and elevated CA 125.

176
Q

What are sonographic characteristics of mucinous cystadenocarcinoma? (compare with mucinous cystadenoma)

A

Sonographically it is similar to mucinous cystadenoma but with more prominent papillary projections and thicker septations, with echogenic material within the cystic components of the mass, and may have complex ascites.

177
Q

T/F Unilateral MCDK usually manifests with an empty bladder

A

False

178
Q

What is a condition associated with mucinous cystadenocarcinoma?

A

Mucinous cystadenocarcinoma is associated with pseudomyxoma peritonei.

179
Q

2 most common causes of chronic pancreatitis

A

Biliary disease and alcoholism.

180
Q

what are the common sonographic findings of chronic pancreatitis

A

Pancreas appears small and hyperechoic due to scarring and fibrosis, diffuse calcifications with a coarse echo texture.

181
Q

what are some other associated findings with chronic pancreatitis

A

Pseudo cyst formation, stones within the pancreatic duct or other biliary ducts, cholelithiasis, portal splenic thrombus.

182
Q

what is the most common type of choledochal cyst

A

fusifrom dilation

183
Q

what age is choledochal cyst commonly diagnosed

A

first 6 months of life

184
Q

what are the 3 most common reasons for persistent jaundice in a neonate

A

choledochal cyst, biliary atresia and hepatitis

185
Q

what are some differentials that could be confused with choledochal cyst

A

duplicated GB, hepatic cyst, fluid in duodenum, or adenoma

186
Q

what are some causes of choledochal cyst

A

panc juices refluxing into the duct, it can be congenital, or it may be associated with stones, pancreatitis, or cirrhosis

187
Q

is PCOS hormone related

A

yes
high androgen levels
may be resistant to the effect of insulin

188
Q

what are some complications of PCOS

A

infertility, early pregnancy loss, hirsutism, acne, and amenorrhea

189
Q

how is PCOS diagnosed

A

clinical presentation & hormone levels

cannot be made with ultrasound alone

190
Q

are there any risk factors for PCOS

A

80% are obese and at risk for diabetes

191
Q

what are the sonographic findings of PCOS

A

string of pearls effect
multiple follicles around the periphery
may be normal or enlarged

192
Q

what is the most common islet cell tumor

A

insulinoma

193
Q

what are non-functioning and functioning islet cell tumors

A

30% of islet cell tumors are nonfunctioning and tend to be malignant; functioning are more often benign.

194
Q

what are the sonographic features of the different islet cell tumors

A

Non-functioning are usually small, hypoechoic, and generally found in the body and tail of the pancreas. Insulinomas are small, hyper-vascular, may have calcifications. Gastrinomas are mostly in the pancreas body but may be outside of the pancreas.

195
Q

what are some risk factors of insulinomas (islet cell tumors)

A

Patients may be obese and have hypoglycemic episodes.

196
Q

do islet cell tumors grow quickly

A

They are slow-growing, and multiple tumors may be found once diagnosed.

197
Q

what are the sonographic features of an angiomyolypoma

A

hyperechoic

198
Q

are angiomyolypomas benign or malignant

A

benign

199
Q

do angiomyolypoma’s cause pain

A

most often asymptomatic and found incidentally

200
Q

what can we use to help diagnose angiomyolypomas

A

color Doppler

201
Q

Sonographic features of adenomyomatosis

A

echogenic streaking originating from the wall of the GB

202
Q

name the artifact seen with adenomyomatosis

A

comet tail or ring down

203
Q

what causes adenomyomatosis

A

hyperplasia of the GB mucus layer invading the wall of GB

204
Q

symptoms of adenomyomatosis

A

may be asymptomatic or have symptoms similar to GB stones

205
Q

What are some risk factors of HCC?

A

Male, Hepatitis B, Hepatitis C, Cirrhosis, nonalcoholic steatohepatitis, aflatoxin exposure

206
Q

T/F: HCC is the most common primary malignant neoplasm of the liver?

A

True- Most common primary malignant neoplasm of the liver

207
Q

What are some signs/symptoms of HCC?

A

Signs/Symptoms: Fever, palpable mass, hepatomegaly, cirrhosis, abnormal LFTs, elevated AFP

208
Q

Sonographically, what is the appearance of smaller hepatocellular carcinomas?

A

hypoechoic

209
Q

Sonographically, how do larger hepatocellular carcinomas appear?

A

hyperechoic and heterogenous

210
Q

what are the sonographic features of ovarian torsion

A

enlarged, heterogeneous ovary

211
Q

how/why is the time frame relevant for ovarian torsion

A

acute process

212
Q

how long do we have to correct ovarian torsion

A

pt should be in surgery within first 6 hours for best possible outcome

213
Q

why is Doppler an important in diagnosis of ovarian torsion

A

aids in seeing if there is any absent blood flow in the ovary

214
Q

what are the risk factors of ARPKD

A

inherited disorder

215
Q

when is ARPKD typically diagnosed

A

neonatal period

216
Q

is ARPKD unilateral or bilateral

A

bilateral

217
Q

are are the sonographic findings in ARPKD

A

bilateral enlarged kidneys with a loss of corticomedullary differentiation

218
Q

what artifact is most often seen with emphysematous cholecystitis

A

comet tail - caused by gas forming bacteria in wall

219
Q

emphysematous cholecystitis is a complication of what disease

A

acute cholecystitis

220
Q

is emphysematous cholecystitis commonoly found

A

no - rare

221
Q

what clinical condition puts patients at the highest risk for emphysematous cholecystitis

A

diabetes

222
Q

what are some complications that can occur if left untreated

A

gangrene and rupture

223
Q

what is a definite risk factor for RCC

A

smoking

224
Q

what abnormal lab values can be found with RCC

A

elevated creatinine, BUN, erythropoietin blood level, red blood cells, white blood cell count, bacteria in urine

225
Q

peak incidence of RCC occurs at what age

A

60-70

226
Q

smaller RCC lesions tend to have what kind of echogenicity

A

Smaller lesions are more likely to be hyperechoic (and may be confused with an angiomyolipoma)

227
Q

larger RCC lesions tend to have what kind of echogenicity

A

Larger lesions are usually more heterogeneous and are more often hypoechoic

228
Q

Is oncocytomas a benign or malignant finding?

A

benign

229
Q

Is oncocytoma more common in males or females?

A

male

230
Q

What is the most typical sign/symptom of an Oncocytoma

A

asymptomatic

231
Q

What are other possible signs/symptoms if the the oncocytoma is larger?

A

If mass is large, can cause- Flank/abdominal pain, hypertension, hematuria, and/or pain

232
Q

What will an oncocytoma look like on ultrasound?

A

Well-defined, homogeneous, hypo or isoechoic,

hyperechoic central scar, central radiating vessels/spook-wheel pattern of vessels (more on CT/MRI)

233
Q

What layer(s) of the uterus does adenomyosis involve?

A

Glands and stroma from the basal layer of the Endometrium penetrates into and distorts the Myometrium

234
Q

How is adenomyosis usually diagnosed?

A

70% diagnosed through Hysterectomy

235
Q

What are some symptoms of Adenomyosis?

A

dysmenorrhea and AUB

236
Q

is adenomyosis a focal or diffuse condition?

A

Diffuse (more common) & Focal

237
Q

Sonographically, how will adenomyosis appear?

A

Diffuse- ill-defined myometrium, heterogeneous and enlarged uterus,
hyperplasia and hypertrophy of the myometrium, hypoechoic striations, heterogeneous myometrium with cysts, thickened posterior uterine wall, diffuse vascularity, globular uterine configuration

Focal- focal adenomyomas

238
Q

How does Uterus Didelphys occur?

A

The mullerian ducts fail to fuse

239
Q

What can Uterus Didelphys be associated with

A

unilateral hematocolpos

240
Q

T/F: Uterus Didelphys is a common uterine anomaly

A

False

241
Q

Signs and symptoms of Uterus Didelphys.

A

Signs/Symptoms- progressive pelvic pain after menses, dysmenorrhea, unilateral pelvic mass

242
Q

What does Uterine Didelphys appear like on US?

A

Sonographically- 2 separate endometriums, deep fundal notch separated widely with a full complement of myometrium,

-2 uterus, 2 cervix, 2 vaginas

243
Q

is MCDK unilateral or bilateral

A

unilateral

Bilateral is less common but has a poorer prognosis

244
Q

MCDK is most often associated with what renal anomaly

A

UPJ obstruction

245
Q

are kidneys with MCDK functional

A

no

246
Q

what are MCDK patients at higher risk for

A

HPTN, and Wilms tumor

247
Q

T/F Unilateral MCDK usually manifests with an empty bladder

A

False

248
Q

How does Bicornuate Uterus occur?

A

Only a partial fusion of the mullerian ducts occur

249
Q

Does bicornuate uterus cause infertility?

A

True-fertility problems can occur if one cornua doesn’t communicate and is rudimentary

250
Q

T/F There is only 1 vagina in bicornuate uterus.

A

True-1 vagina

251
Q

T/F There is only 1 cervix in bicornuate uterus

A

False- Can have 1 OR 2 cervix

252
Q

How will bicornuate uterus look like on ultrasound?

A

1 vagina, 1 or 2 cervix, deep fundal notch, 2 endometriums widely separated

253
Q

Peritoneal inclusion cysts can be found in women with a history of?

A

PID, endometriosis, trauma, abd/pelvic surgery

254
Q

where does the fluid come from that forms a peritoneal cyst and how does it get trapped?

A

It is released by the ovary

Adhesions form due to an inflammatory process and the fluid becomes trapped by these adhesions

255
Q

are peritoneal inclusion cyst usually simple or multiloculated

A

Multiloculated (adjacent to or surrounding the ovary)

The ovary may in the center of the septations or located peripherally

256
Q

what do echoes in a peritoneal inclusion cyst indicate

A

hemorrhage or protein is present

257
Q

what re some treatment methods for peritoneal inclusion cysts

A

fluid aspiration or oral contriceptives

258
Q

A fatty liver can sometimes be hard to fully visualize clearly. What is a helpful tool or method for clearly visualizing a fatty liver?

A

Using a lower frequency transducer or using Harmonic imaging

259
Q

What are the most common causes of a fatty liver?

A

The most common causes are alcoholism, obesity, and diabetes.

260
Q

Can a fatty liver impair liver function?

A

Yes, it can impair liver function, especially when associated with NASH

261
Q

What occurs in renal papillary necrosis?

A

Sloughed papillae (d/t necrosis) obstructs the calyces/medulla/ureters

262
Q

What is commonly caused by renal papillary necrosis?

A

hydronephrosis

263
Q

Is renal papillary necrosis typically a bilateral or unilateral process?

A

bilateral

264
Q

Is renal papillary necrosis concerning condition and if so, what can it lead to?

A

yes, can lead to renal failure or death

265
Q

What are the main things that we are evaluating for sonographically with papillary necrosis?

A

Evaluate for obstruction, calculi, & hydronephrosis

266
Q

What effect does Tamoxifen have on endometrial tissue?

A

It stimulates cell growth and proliferation in the endometrial tissue

267
Q

What changes will we visualize sonographically with endometrial hyperplasia?

A

Endometrial thickening and/or cystic changes within the endometrium

268
Q

Other than Tamoxifen, what are some other risk factors for endometrial hyperplasia?

A

Patients taking estrogen-only hormone replacement medications or women with chronic anovulation

269
Q

How can we make a definite diagnosis on a case of endometrial hyperplasia?

A

biopsy

270
Q

What is a differential for endometrial hyperplasia

A

endometrial carcinoma

271
Q

What characteristic differentiates septate uterus from a bicornuate uterus?

A

In transverse, the endometrial echoes appear widely separated with a bicornuate uterus and closely separated by a thin septum with a septate uterus. In the sagittal view of a septate uterus, the fundal contour is typically normal without any indentation. It is deeply indented in a bicornuate uterus.

272
Q

What complications can arise from having a septate uterus?

A

infertility

273
Q

Is a septate uterus “treatable”? If so, how?

A

Yes, the septum can be removed via hysteroscopy to increase the chances of conception

274
Q

What is the difference between a septate and arcuate uterus?

A

An arcuate uterus is considered a normal variant, because the endometrium is almost always normal. The uterus does tend to have a subtle fundal indentation and slightly concave uterine cavity. A septate uterus tends to have a normal uterine contour with two endometrial echoes.

275
Q

Can an arcuate uterus cause infertility?

A

there is no clear answer whether it does or not.

276
Q

Is cholangiocarcinoma benign or malignant disease?

A

malignant

277
Q

What is another name for cholangiocarcinoma?

A

Klatskin Tumor

278
Q

Where cholangiocarcinoma most commonly occurs?

A

in the perihilar region

279
Q

What is the most common presentation of cholangiocarcinoma(hint:symptom)?

A

painless jaundice

280
Q

What can sonographic evaluations of cholangiocarcinoma reveal?

A

May reveal a liver mass or a mass arising from within the ducts. Intrahepatic biliary tract dilation may also be identified in the absence of extrahepatic dilation.

281
Q

Where do most stones originate?

A

kidney

282
Q

Is Nephrolithiasis more common in male or female?

A

male

283
Q

If the stone is located in the bladder where pain will radiate to ?

A

lower back pain radiating down to pelvic

284
Q

What are the two most common sites of obstruction of nephrolithiasis? (location)

A

Ureteropelvic juntion(junction between the ureter and the renal pelvis of the kidney) and ureterovesical junction(where the ureter meets the bladder)

285
Q

Stone that pass into the ureter may cause ?

A

hydronephrosis

286
Q

Is pyloric stenosis most commonly occurs in female or male patients?

A

male

287
Q

Describe the normal pylorus appearance and where it is located.

A

The pylorus is a tubular structure located on the right side of the stomach. It is the sphincter that connects the stomach with the duodenum of the small intestine. A stenotic pyloric channel appearance of the cervix “cervix sign.”

288
Q

What are the clinical presentations of pyloric stenosis?

A

Projectile vomiting, vomiting can result in dehydration and metabolic alkalosis. Jaundice may also occur. Hypertrophic pylorus can usually be palpated after a feeding and described as an olive- shaped mass.

289
Q

What are the most common accepted measurmnets for diagnosing pyloric stenosis?

A

AP muscle wall thickness of 3.0 mm or more with a pylorus length of 17 mm or more.

290
Q

What are the importance when we scan pylorus?

A

Absence peristalsis and lack of movement of fluid through the pylorus with a thickened AP muscle wall and increased pylorus channel length indicate stenosis.

291
Q

Are dermoids malignant or benign?

A

benign

292
Q

What are the other names for Dermoids?

A

cystic teratoma, dermoids, dermoid cysts

293
Q

What are the 3 germ layers and what is the most common component?

(dermoids)

A

Ectoderm, mesoderm, and endoderm. Ectoderm being the most common component.

294
Q

Unique sonographic feature of dermoids can be described as ______?

A

tip of iceberg

295
Q

What cystic teratomas are prone to?

A

prone to torsion and rupture.

Case Studies (14 decks)

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