Our Final Case Studies Diagnosis Review Questions Flashcards
What is Portal Hypertension caused by?
It is caused by damaged hepatocytes that impede the flow blood into the liver, thus causing an increase in PV pressure
What is the most common cause of Portal Hypertension in North America?
Cirrhosis
What is a common finding associated with Portal Hypertension and Cirrhosis?
Recanalized Umbilical Vein
What measurements are considered enlarged in regards to the portal vein ?
> 13 mm in diameter
What type of procedure is most commonly done to alleviate the pressure from Portal Hypertension?
TIPS- transjugular intrahepatic portosystemic shunt
What are some possible causes of hydronephrosis?
Causes can include: calculi, tumors, infection, previous obstruction, over-distended bladder and pregnancy.
With hydronephrosis, what other part of the urinary system can be dilated?
The ureters
If we see hydronephrosis , what other(s) should we look at further and why?
We should follow down the ureter to the bladder to check for any stones or obstruction.
What can be done to differentiate hydronephrosis from blood vessels?
Putting on color. The hydro will not light up whereas the vessels will.
If not resolved, what can hydronephrosis lead to?
It can lead to irreversible renal damage and loss of renal function
Is pyelonephritis more often seen in females or males?
females
What is the appearance of a kidney in typical cases of pyelonephritis?
They are typically normal and often not diagnosed with ultrasound.
What is pyelonephritis usually a result of?
Can be a result of a bladder infection
Is pyelonephritis always throughout the kidney or can it be localized?
It is often seen localized or patchy
Is hydronephrosis often seen in pyelonephritis?
No, hydronephrosis is not seen
What are two risk factors for PID?
Female gender, age younger than 35 years, sexual activity of two or more partners, and a use of an IUD.
What is a consequence of having recurrent infections of PID?
Chronic pelvic pain, peritonitis, ectopic pregnancy, maternal death from ectopic pregnancy, and infertility
Are patients with PID more at risk for infertility?
yes, after multiple recurrent episodes.
How do psuedocysts form?
Pancreatic enzymes escape from the gland and break down tissue to form a sterile abscess somewhere in the abdomen. Hagen pg. 322
What is the most common location for a pseudocyst
lesser sac (anterior to pancreas and posterior to stomach) Hagen PG. 322.
What lab values are important with diagnosing pseudocysts?
Amylase and lipase are increased, alkaline phosphatase will be increased with obstruction Hagen pg. 318
What is the most common complication of pseudocysts?
Spontaneous rupture Hagen pg. 323
What is the sonographic appearance of a pseudocyst?
Well-defined mass around pancreas, increased through transmission, round/oval, may have debris in bottom. Hagen pg. 318
What is the typical age of the patient with a Hepatoblastoma?
Young children: peak 1-2 yrs., more common in males, preemies and low birth weight infants Henningsen pg. 102
What lab values are important for diagnosing hepatoblastomas?
Increased alpha fetoprotein Henningsen pg. 102
What are the risk factors/predisposing conditions for developing hepatoblastomas?
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
What is the sonographic findings of a hepatoblastoma?
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
What is the prognosis for hepatoblastomas?
Dependent on the resectability of the mass, patients are usually in advanced stages when diagnosed. In these cases prognosis is poor. Henningsen pg. 102
What is the most common appearance of an hemangioma?
well defined, hyperechoic mass, that may be round, oval, or lobulated
The majority of hemangiomas cause severe pain?
False - Most often asymptomatic and found incidentally
Are hemangiomas more common in males or females
females
large hemangiomas are at risk for what 2 things?
hemorrhage and rupture
What are hemangiomas made up of?
cavernous, blood filled channels
Acute glomerulonephritis commonly leads to what?
chronic, which develops slowly and may not be detected until the kidneys are failing.
What lab values are important for acute renal failure?
Bun, creatinine, and WBC are all increased
Henningsen pg. 67
Are the kidneys enlarged or normal sized in acute renal failure?
Acute renal failure may manifest sonographically with normal-sized or enlarged kidneys.
Henningsen pg. 67
is acute glomerulonephritis more common in children, or adults?
children
List (2) common symptoms of acute glomerulonephritis?
foggy urine, history of recent fever, sore throat, joint pains, edema, nausea, oliguria, anemia, azotemia, HPTN
What are the classic sonographic signs of intussusception?
target sign, bulls eye in trans
may mimic pseudo kidney in sagittal
Intussusception most often occurs between what age range?
6 months and 2 years old
Absent blood flow in the bowel wall typically means what has happened to the bowel?
necrosis of the bowel
Intussusception is most commonly found at what location?
ileocolic junction (where the small and large intestines meet)
Patients with intussusception typically present with what (3) symptoms?
50% of patients present with
- intermittent abd pain
- red jelly like stools
- palpable sausage shaped mass
T/F - Serous tumors are the most common type of epithelial neoplasm?
True
Serous Cystadeoma most often occurring in women of what age range?
peri-postmenopausal women
Name the sonographic markers of serous cystadenocarcinoma
papillary projections
vascularity
thicker septations
solid areas
Serous Cystadenocarcinomas account for what percent of malignant ovarian neoplasms
50% of overall malignant ovarian neoplasms
Does malignancy cuase an incrased CA125 level 100% of the time?
no - cancer can be present without an increased CA 125
Serous Cystadenocarcinomas most often occurring in women of what age range?
40-50’s
What is Cholangitis?
Inflammation of the bile ducts
Where in the liver can liver abscesses form?
Intrahepatic, subhepatic and subphrenic areas of the liver
What causes Cholangitis?
ductal stricture, parasitic infection, bacterial infection, stones, or neoplasm
Are liver abscesses at risk for rupturing?
yes
What are the risk factors of Cholangitis?
Previous history of cholelithiasis, HIV, traveling outside the country, narrowing of the CBD, and sclerosing cholangitis
What are the clinical symptoms of Cirrhosis?
jaundice, nausea, weight loss, anorexia, ascitis
What are Patients with cirrhosis at risk of developing?
portal hypertension and HCC
what are the most common causes of cirrhosis
excessive alcohol consumption, hep B and hep C
Why does the cirrhotic liver appear “bright”?
due to the replacement of hepatocytes by fibrotic fatty tissue
(different from fatty infiltration)
What are the common sonographic findings with Cirrhoosis
a nodular, scalloped surface, hypertrophy of the caudate lobe, ascites, echogenic liver texture
Chronic = smaller in size
what is the difference between pyonephrosis and pyelonephrosis
Both are an inflammation/distention of the collection system, however pyonephrosis includes pus and pyelonephritis does not.
what are the clinical symptoms of pyonephrosis
fever, chills, UTI, elevated WBC
what causes pyonephrosis
UTI that was left untreated, calculus disease, any urinary obstruction that causes a hydronephrotic kidney to be filled with stagnant urine.
what are the sonographic features of pyonephrosis
Presence of hydro in conjunction with debris within the collecting system. Low level echoes are noted.
What can happen if pyonephrosis is left untreated
Patients may develop septic shock or may lead to irreversible kidney damage and loss of renal function ultimately requiring a nephrectomy.
what are endometrial polyps?
focal overgrowth of the endometrial glands and stroma
when are endometrial polyps most prevalent? (age range)
peri and postmenopausal women
what are the sonographic findings of an endometrial polyp
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.
Are endometrial polyps benign, or malignant
benign
what could the sonographer do to prove that this is a polyp?
turn on color to confirm a feeding vessel (stalk)
What lap works is elevated with acute pancreatitis?
amylase elevates first (normally within 24 hours)
lipase takes atleast 72 hours to elevate
What may happen to the IVC with acute pancreatitis
the IVC may become compressed
what should we look for with the pancreatic duct in acute pancreatitis
may become obstructed
are we looking for a more enlarged or smaller pancreas with acute pancreatitis
the pancreas becomes more enlarged and hypoechoic from inflammation due to the release of enzymes into the pancreatic tissue
how does the pancreas appear with chronic pancreatitis
normally appears smaller and more echogenic from the enzymes destroying the pancreatic tissue (necrotic)
What is the sonographic sign used to help identify biliary atresia
triangle cord sign
at what age does biliary atresia typically occur
usually diagnosed by 2 weeks after birth
what is the most common effect biliary atresia can have?
liver disease - most need transplant
what other effect might biliary atresia have on the liver
cause cirrhosis
what are 3 things that could be wrong with the biliary ducts causing biliary atresia
injured
blocked
missing ducts
what is the other name for endometrioma
chocolate cyst
what is the main cause of endometriomas & what are they an accumulation
accumulation of endometrial tissue in patients with endometriosis
what is the most common location for endometriomas to occur
ovary
can endometriomas be a reoccurring problem
Yes, this can reoccur, therefore surgery or hormone therapy is the recommended treatment for this pathology.
what age range is most effected and why
reproductive age - due to hormonal stimulation
What are the cystic areas in Ovarian Hyperstimulation Syndrome?
Luteinized follicles called theca lutein cysts
Henningsen pg 179
What is ovarian hyperstimulation syndrome caused by?
Excessive human chorionic gonadotropin levels Henningsen pg. 179
How is ovarian hyperstimulation syndrome resolved?
Discontinue stimulating medications Henningsen pg. 179
What conditions can develop from Ovarian Hyperstimulation syndrome?
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
Sonographic appearance of hepatocellular adenoma
Hepatocellular carcinomas can be both hyperechoic and hypoechoic depending on the amount of fat deposits throughout the tumor
What are some symptoms for acute renal failure?
Hypovolemia, hypertension, edema, oliguria, and hematuria.
Henningsen pg. 67
What lab values are important for acute renal failure?
Bun, creatinine, and WBC are all increased Henningsen pg. 67
Are the kidneys enlarged or normal sized in acute renal failure?
Acute renal failure may manifest sonographically with normal-sized or enlarged kidneys.
Henningsen pg. 67
why is hepatocellular adenoma more worrisome than FNH
This tumor is more worrisome than FNH because they are more likely to hemmmorage and/or turn into hepatocellular carcinoma.
what differentiates chronic cholecystitis from acute
chronic occurs from several boughts of acute cholecystitis
does pregnancy have an effect on hepatocellular adenoma
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
what is the recommended treatment of hepatocellular adnoma
Surgical removal is very common because of the relationship hepatocellular adenoma has with HCC
Sonographic appearance of hepatocellular adenoma
Hepatocellular carcinomas can be both hyperechoic and hypoechoic depending on the amount of fat deposits throughout the tumor
what else can we see on ultrasound with chronic cholecystitis
pericholecystic fluid, wes sign, thickend wall
symptoms of TCC
hematuria
will the GB be contracted or rull with cholecystitis
contracted
is cholelithiasis necessary for chronic cholecystitis
cholelithiasis is not necessary for diagnosis
what differentiates chronic cholecystitis from acute
chronic occurs from several boughts of acute cholecystitis
TCC can travel where
from bladder to the kidneys
will neuroblastomas have blood flow
yes
what does TCC look like ultrasound
slightly hyperechoic lesion in the bladder with vascularity
is TCC a common tumor in the urinary tract
most common urinary tract tumor
symptoms of TCC
hematuria
What are some causes of acute renal failure?
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
if a cyst is close to the ovary how can we differentiate between an ovarian cyst and a paraovarian cyst.
apply pressure to delineate the cyst
Does Tubo-Ovarian abscesses usually occur unilaterally or bilaterally?
bilaterally
Where do TOA’s appear in relation to the uterus?
Posterior cul-de-sac
How are TOAs treated?
antibiotics
What is the typical TOA appearance?
complex multiloculated mass with variable septations, irregular margins
Can this pathology involve the fallopian tube and if so what is this called?
yes it’s called tubo-ovarian complex
What is ADPKD also known as?
Adult Polycystic renal disease
ADPKD does not usually manifest until which decade of life?
4th-5th decade of life
Is ADPKD a unilateral or bilateral disease?
bilateral
what are some sonographic findings with panc cancer
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.
Is ADPKD considered a progressive disease?
yes
what age range is affected by neuroblastoma
1st year of life
what is the cause of neuroblastoma
unkown
where are neuroblastomas located
adrenal gland
sonographic findings for wilms
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
will neuroblastomas have blood flow
yes
where do paraovarian cysts originate
broad ligament
what are the symptoms of paraovarian cysts
asymptomatic
what age range is at risk for paraovarian cysts
menstruating women
what are hemorrhagic cyst caused by
Caused by hemorrhage in a follicular or corpus luteum cyst.
if a cyst is close to the ovary how can we differentiate between an ovarian cyst and a paraovarian cyst.
apply pressure to delineate the cyst
How do liver abscess occur?
Complications of biliary tract disease, surgery or trauma
What are the different types of liver abscess?
Pyogenic abscess, hepatic candidiasis, chronic granulomatous disease, amebic abscess and echinococcal disease
Where in the liver can they form?
Intrahepatic, subhepatic and subphrenic areas of the liver
What characteristics are we looking for in a liver abscess?
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)
Are they at risk for rupturing?
yes
Seminoma is the most common type of?
Germ cell tumor
what are some causes of choledochal cyst
panc juices refluxing into the duct, it can be congenital, or it may be associated with stones, pancreatitis, or cirrhosis
Testicular tumors are generally divided into what two types?
Germ cell and non-germ cell tumors
Approximately ______% of all testicular tumors are of the germ cell type and highly malignant
95%
Is testicular cancer curable?
yes with surgery
name the 4 most common sonographic findings for acute cholecystitis
Common sonographic findings:
Usually includes cholelithiasis, thickened wall, pericholecystic fluid, Murphys sign and enlarged GB
what are the sonographic findings of PCOS
string of pearls effect
multiple follicles around the periphery
may be normal or enlarged
does acute cholecystitis pt normally have a fever
yes can present with fever
does acute cholecystitis occur more often in women or men
women
what is the most common type of panc carcinoma
adenocarcinoma
is panc cancer more common in women or men
men
do islet cell tumors grow quickly
They are slow-growing, and multiple tumors may be found once diagnosed.
what are some risk factors of panc cancer
high-fat diet, smoking, chronic pancreatitis, primary sclerosing cholangitis, family hx of pancreatic cancer, and DM
what are some sonographic findings with panc cancer
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.
80% of wilms tumors are diagnosed before what age
before 5 yrs
what is the average age for wilms tumor
mean age 3.5
name some syndromes associated with wilms
Beckwith-Wiedemann syndrome, isolated hemihypertrophy, WAGR syndome, and Denys-Drash syndrome
is wilms usually unilateral or bilateral
usually unilateral but may be bilateral
sonographic findings for wilms
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
symptoms of adenomyomatosis
may be asymptomatic or have symptoms similar to GB stones
What are clinical findings for FNH?
It is usually asymptomatic and discovered incidentally, as a solitary lesion in the right lobe.
What are some sonographic characteristics for FNH?
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.
Is it most often seen in women or men; is there a reason that plays a role in the developing of FNH?
It is most often seen in women of childbearing age and female hormones are believed to play a role in the development of FNH.
What is a distinguishing feature of FNH?
FNH has a central stellate scar. Some times it looks like a “spokewheel”vascularity patern.
name the common sonographic pattern associated with hemorrhagic cyst
“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
when is ARPKD typically diagnosed
neonatal period
is ARPKD unilateral or bilateral
bilateral
are are the sonographic findings in ARPKD
bilateral enlarged kidneys with a loss of corticomedullary differentiation
what are hemorrhagic cyst caused by
Caused by hemorrhage in a follicular or corpus luteum cyst.
What is Chronic Renal Failure?
CRF is the gradual decrease in renal function over time.
What is the most common cause of Chronic Renal Failure?
The most common cause of CRF is diabetes mellitus. It is considered the leading cause of end stage renal disease.
What are some of the other causes of chronic renal failure?
Other causes include, but are not limited to, glomerulonephritis, chronic pyelonephritis, metabolic disorders, chronic UTI, and TB.
what are some complications that can occur if left untreated
gangrene and rupture
Sonographic features of Chronic Renal Failure?
Sonographically, the kidneys will appear small, echogenic, and may contain cysts, loss of normal corticomedullary differentiation.
True or False: Are leiomyomas the most common benign gynecologic tumors and leading cause of hysterectomy?
True. Leiomyomas/Fibroids are the most common benign gynecologic tumors and leading cause of hysterectomy and gynecologic surgery.
What are types of leiomyomas?
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).
Who are at a greater risk for development of fibroids?
African American women, obese, nonsmokers, and perimenopausal women.
larger RCC lesions tend to have what kind of echogenicity
Larger lesions are usually more heterogeneous and are more often hypoechoic
Medical treatment of fibroids?
The medical treatment for fibroids is hormone therapy; surgical treatment (hysterectomy or myomectomy); and uterine artery embolization (used inhibit blood supply to the mass).
What age range is mucinous cystadenocarcinoma more common? (Compare it with benign form)
Older women are at higher risk with the mucinous cystadenocarcinoma, while younger women are more likely to present with benign form.
What are some clinical findings for mucinous cystadenoma
Clinical findings of mucinous cystadenocarcinoma include weight loss, pelvic pressure and swelling, GI symptoms, abdominal pain, and elevated CA 125.
What are sonographic characteristics of mucinous cystadenocarcinoma? (compare with mucinous cystadenoma)
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.
T/F Unilateral MCDK usually manifests with an empty bladder
False
What is a condition associated with mucinous cystadenocarcinoma?
Mucinous cystadenocarcinoma is associated with pseudomyxoma peritonei.
2 most common causes of chronic pancreatitis
Biliary disease and alcoholism.
what are the common sonographic findings of chronic pancreatitis
Pancreas appears small and hyperechoic due to scarring and fibrosis, diffuse calcifications with a coarse echo texture.
what are some other associated findings with chronic pancreatitis
Pseudo cyst formation, stones within the pancreatic duct or other biliary ducts, cholelithiasis, portal splenic thrombus.
what is the most common type of choledochal cyst
fusifrom dilation
what age is choledochal cyst commonly diagnosed
first 6 months of life
what are the 3 most common reasons for persistent jaundice in a neonate
choledochal cyst, biliary atresia and hepatitis
what are some differentials that could be confused with choledochal cyst
duplicated GB, hepatic cyst, fluid in duodenum, or adenoma
what are some causes of choledochal cyst
panc juices refluxing into the duct, it can be congenital, or it may be associated with stones, pancreatitis, or cirrhosis
is PCOS hormone related
yes
high androgen levels
may be resistant to the effect of insulin
what are some complications of PCOS
infertility, early pregnancy loss, hirsutism, acne, and amenorrhea
how is PCOS diagnosed
clinical presentation & hormone levels
cannot be made with ultrasound alone
are there any risk factors for PCOS
80% are obese and at risk for diabetes
what are the sonographic findings of PCOS
string of pearls effect
multiple follicles around the periphery
may be normal or enlarged
what is the most common islet cell tumor
insulinoma
what are non-functioning and functioning islet cell tumors
30% of islet cell tumors are nonfunctioning and tend to be malignant; functioning are more often benign.
what are the sonographic features of the different islet cell tumors
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.
what are some risk factors of insulinomas (islet cell tumors)
Patients may be obese and have hypoglycemic episodes.
do islet cell tumors grow quickly
They are slow-growing, and multiple tumors may be found once diagnosed.
what are the sonographic features of an angiomyolypoma
hyperechoic
are angiomyolypomas benign or malignant
benign
do angiomyolypoma’s cause pain
most often asymptomatic and found incidentally
what can we use to help diagnose angiomyolypomas
color Doppler
Sonographic features of adenomyomatosis
echogenic streaking originating from the wall of the GB
name the artifact seen with adenomyomatosis
comet tail or ring down
what causes adenomyomatosis
hyperplasia of the GB mucus layer invading the wall of GB
symptoms of adenomyomatosis
may be asymptomatic or have symptoms similar to GB stones
What are some risk factors of HCC?
Male, Hepatitis B, Hepatitis C, Cirrhosis, nonalcoholic steatohepatitis, aflatoxin exposure
T/F: HCC is the most common primary malignant neoplasm of the liver?
True- Most common primary malignant neoplasm of the liver
What are some signs/symptoms of HCC?
Signs/Symptoms: Fever, palpable mass, hepatomegaly, cirrhosis, abnormal LFTs, elevated AFP
Sonographically, what is the appearance of smaller hepatocellular carcinomas?
hypoechoic
Sonographically, how do larger hepatocellular carcinomas appear?
hyperechoic and heterogenous
what are the sonographic features of ovarian torsion
enlarged, heterogeneous ovary
how/why is the time frame relevant for ovarian torsion
acute process
how long do we have to correct ovarian torsion
pt should be in surgery within first 6 hours for best possible outcome
why is Doppler an important in diagnosis of ovarian torsion
aids in seeing if there is any absent blood flow in the ovary
what are the risk factors of ARPKD
inherited disorder
when is ARPKD typically diagnosed
neonatal period
is ARPKD unilateral or bilateral
bilateral
are are the sonographic findings in ARPKD
bilateral enlarged kidneys with a loss of corticomedullary differentiation
what artifact is most often seen with emphysematous cholecystitis
comet tail - caused by gas forming bacteria in wall
emphysematous cholecystitis is a complication of what disease
acute cholecystitis
is emphysematous cholecystitis commonoly found
no - rare
what clinical condition puts patients at the highest risk for emphysematous cholecystitis
diabetes
what are some complications that can occur if left untreated
gangrene and rupture
what is a definite risk factor for RCC
smoking
what abnormal lab values can be found with RCC
elevated creatinine, BUN, erythropoietin blood level, red blood cells, white blood cell count, bacteria in urine
peak incidence of RCC occurs at what age
60-70
smaller RCC lesions tend to have what kind of echogenicity
Smaller lesions are more likely to be hyperechoic (and may be confused with an angiomyolipoma)
larger RCC lesions tend to have what kind of echogenicity
Larger lesions are usually more heterogeneous and are more often hypoechoic
Is oncocytomas a benign or malignant finding?
benign
Is oncocytoma more common in males or females?
male
What is the most typical sign/symptom of an Oncocytoma
asymptomatic
What are other possible signs/symptoms if the the oncocytoma is larger?
If mass is large, can cause- Flank/abdominal pain, hypertension, hematuria, and/or pain
What will an oncocytoma look like on ultrasound?
Well-defined, homogeneous, hypo or isoechoic,
hyperechoic central scar, central radiating vessels/spook-wheel pattern of vessels (more on CT/MRI)
What layer(s) of the uterus does adenomyosis involve?
Glands and stroma from the basal layer of the Endometrium penetrates into and distorts the Myometrium
How is adenomyosis usually diagnosed?
70% diagnosed through Hysterectomy
What are some symptoms of Adenomyosis?
dysmenorrhea and AUB
is adenomyosis a focal or diffuse condition?
Diffuse (more common) & Focal
Sonographically, how will adenomyosis appear?
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
How does Uterus Didelphys occur?
The mullerian ducts fail to fuse
What can Uterus Didelphys be associated with
unilateral hematocolpos
T/F: Uterus Didelphys is a common uterine anomaly
False
Signs and symptoms of Uterus Didelphys.
Signs/Symptoms- progressive pelvic pain after menses, dysmenorrhea, unilateral pelvic mass
What does Uterine Didelphys appear like on US?
Sonographically- 2 separate endometriums, deep fundal notch separated widely with a full complement of myometrium,
-2 uterus, 2 cervix, 2 vaginas
is MCDK unilateral or bilateral
unilateral
Bilateral is less common but has a poorer prognosis
MCDK is most often associated with what renal anomaly
UPJ obstruction
are kidneys with MCDK functional
no
what are MCDK patients at higher risk for
HPTN, and Wilms tumor
T/F Unilateral MCDK usually manifests with an empty bladder
False
How does Bicornuate Uterus occur?
Only a partial fusion of the mullerian ducts occur
Does bicornuate uterus cause infertility?
True-fertility problems can occur if one cornua doesn’t communicate and is rudimentary
T/F There is only 1 vagina in bicornuate uterus.
True-1 vagina
T/F There is only 1 cervix in bicornuate uterus
False- Can have 1 OR 2 cervix
How will bicornuate uterus look like on ultrasound?
1 vagina, 1 or 2 cervix, deep fundal notch, 2 endometriums widely separated
Peritoneal inclusion cysts can be found in women with a history of?
PID, endometriosis, trauma, abd/pelvic surgery
where does the fluid come from that forms a peritoneal cyst and how does it get trapped?
It is released by the ovary
Adhesions form due to an inflammatory process and the fluid becomes trapped by these adhesions
are peritoneal inclusion cyst usually simple or multiloculated
Multiloculated (adjacent to or surrounding the ovary)
The ovary may in the center of the septations or located peripherally
what do echoes in a peritoneal inclusion cyst indicate
hemorrhage or protein is present
what re some treatment methods for peritoneal inclusion cysts
fluid aspiration or oral contriceptives
A fatty liver can sometimes be hard to fully visualize clearly. What is a helpful tool or method for clearly visualizing a fatty liver?
Using a lower frequency transducer or using Harmonic imaging
What are the most common causes of a fatty liver?
The most common causes are alcoholism, obesity, and diabetes.
Can a fatty liver impair liver function?
Yes, it can impair liver function, especially when associated with NASH
What occurs in renal papillary necrosis?
Sloughed papillae (d/t necrosis) obstructs the calyces/medulla/ureters
What is commonly caused by renal papillary necrosis?
hydronephrosis
Is renal papillary necrosis typically a bilateral or unilateral process?
bilateral
Is renal papillary necrosis concerning condition and if so, what can it lead to?
yes, can lead to renal failure or death
What are the main things that we are evaluating for sonographically with papillary necrosis?
Evaluate for obstruction, calculi, & hydronephrosis
What effect does Tamoxifen have on endometrial tissue?
It stimulates cell growth and proliferation in the endometrial tissue
What changes will we visualize sonographically with endometrial hyperplasia?
Endometrial thickening and/or cystic changes within the endometrium
Other than Tamoxifen, what are some other risk factors for endometrial hyperplasia?
Patients taking estrogen-only hormone replacement medications or women with chronic anovulation
How can we make a definite diagnosis on a case of endometrial hyperplasia?
biopsy
What is a differential for endometrial hyperplasia
endometrial carcinoma
What characteristic differentiates septate uterus from a bicornuate uterus?
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.
What complications can arise from having a septate uterus?
infertility
Is a septate uterus “treatable”? If so, how?
Yes, the septum can be removed via hysteroscopy to increase the chances of conception
What is the difference between a septate and arcuate uterus?
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.
Can an arcuate uterus cause infertility?
there is no clear answer whether it does or not.
Is cholangiocarcinoma benign or malignant disease?
malignant
What is another name for cholangiocarcinoma?
Klatskin Tumor
Where cholangiocarcinoma most commonly occurs?
in the perihilar region
What is the most common presentation of cholangiocarcinoma(hint:symptom)?
painless jaundice
What can sonographic evaluations of cholangiocarcinoma reveal?
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.
Where do most stones originate?
kidney
Is Nephrolithiasis more common in male or female?
male
If the stone is located in the bladder where pain will radiate to ?
lower back pain radiating down to pelvic
What are the two most common sites of obstruction of nephrolithiasis? (location)
Ureteropelvic juntion(junction between the ureter and the renal pelvis of the kidney) and ureterovesical junction(where the ureter meets the bladder)
Stone that pass into the ureter may cause ?
hydronephrosis
Is pyloric stenosis most commonly occurs in female or male patients?
male
Describe the normal pylorus appearance and where it is located.
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.”
What are the clinical presentations of pyloric stenosis?
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.
What are the most common accepted measurmnets for diagnosing pyloric stenosis?
AP muscle wall thickness of 3.0 mm or more with a pylorus length of 17 mm or more.
What are the importance when we scan pylorus?
Absence peristalsis and lack of movement of fluid through the pylorus with a thickened AP muscle wall and increased pylorus channel length indicate stenosis.
Are dermoids malignant or benign?
benign
What are the other names for Dermoids?
cystic teratoma, dermoids, dermoid cysts
What are the 3 germ layers and what is the most common component?
(dermoids)
Ectoderm, mesoderm, and endoderm. Ectoderm being the most common component.
Unique sonographic feature of dermoids can be described as ______?
tip of iceberg
What cystic teratomas are prone to?
prone to torsion and rupture.
