Pathology #3 Flashcards
While scanning the liver in patient with chronic cirrhosis, you notice a tubular vessel connecting to the LPV and exiting the liver coursing inferiorly. Flow within the vessel is very low velocity, continuous and moving in a caudal direction. Which of the following explains the ultrasound findings?
a dilated coronary vein is present which is a common complication of cirrhosis
the ductus venosus is dilated with antegrade flow which is a common complication of cirrhosis
a dilated umbilical vein is present which is a common complication of cirrhosis
a dilated SMV is present with flow reversal which is a common complication of cirrhosis
a dilated umbilical vein is present which is a common complication of cirrhosis
While scanning the liver in a patient with chronic cirrhosis, you notice a tubular vessel connecting to the splenic vein just prior to its confluence with the SMV. Flow within the vessel is very low velocity, continuous and moving in a cephalic direction. Which of the following explains the ultrasound findings?
a dilated SMV is present with flow reversal which is a common complication or cirrhosis
a dilated coronary vein is present which is a common complication of cirrhosis
a dilated umbilical vein is present which is a common complication of cirrhosis
the ductus venosus is dilated with antegrade flow which is a common complication of cirrhosis
a dilated coronary vein is present which is a common complication of cirrhosis
___ abscesses are most commonly found in countries outside the US. ___ abscesses are most commonly seen in immunosuppressed patients.
pyogenic, amebic
fungal, amebic
amebic, fungal
fungal, pyogenic
amebic, fungal
Which of the following describes a non-infectious cause for hepatitis?
anabolic steroids
fungus
bacteria
virus
anabolic steroids
What type of liver infection/abscess is commonly associated with immunocompromised patients?
schistosomiasis
amebic
pyogenic
candidiasis
candidiasis
The diameter of the ___ will be relatively unaffected by hepatic congestion.
MPV
RHV
LHV
HA
HA
**HA diameter is relatively unaffected but the resistance to flow can increase
HVs and PV will dilate
What condition is associated with prominent portal walls?
hemangioma
fatty infiltration
acute viral hepatitis
cirrhosis
acute viral hepatitis
Which of the following statements is true regarding the Doppler evaluation of the liver vasculature displayed?
the HA and PV are demonstrated with normal flow directions
the HA is hepatopetal and the PV is hepatofugal
the HA is hepatofugal and the PV is hepatopetal
the PV flow is normal but the HA demonstrates increased resistance
the HA is hepatopetal and the PV is hepatofugal
The most common finding with congestive hepatomegaly is:
IVC dilatation
liver atrophy
AAA
PV aneurysm
IVC dilatation
The hormone changes with pregnancy have been associated with the enlargement of what type of liver mass?
granuloma
hemangioma
schistosomiasis
hepatoma
hemangioma
Which of the following statements is true regarding the displayed ultrasound image?
the PV is of normal diameter but appears to be filled with thrombus related to chronic PHTN
the PV is at the top normal diameter at 17mm. the PV is considered abnormally dilated at a diameter 18mm or greater
the PV is abnormally dilated at 17mm and is filled with mildly echogenic thrombus
the PV is dilated at 17mm but does not demonstrate color Doppler signals due to the perpendicular incidence with the probe
the PV is abnormally dilated at 17mm and is filled with mildly echogenic thrombus
___ is the most common malignancy of the liver seen in a patient with AIDS. ___ is the most common infection of the liver seen in a patient with AIDS.
hepatocellular carcinoma, hepatitis
hepatoblastoma, candidiasis
metastasis, schistosomiasis
Kaposi sarcoma, pneumocystis carinii
Kaposi sarcoma, pneumocystis carinii
Which of the following are contraindications for a liver transplant?
HCC and hepatitis
cholangiocarcinoma and current alcohol/drug abuse
autosomal recessive polycystic disease and biliary hamartomas
hep C and cirrhosis
cholangiocarcinoma and current alcohol/drug abuse
You are scanning through the liver and note the caudate lobe is nearly the same size as the right lobe. The surface of the liver appears lobulated or nodular. Which of the following is the most likely diagnosis of these findings?
FNH
cirrhosis
hepatitis
HCC
cirrhosis
Which of the following organs can be involved in this multi-organ syndrome and can also display the same abnormality seen here in the liver?
thyroid and thymus
peritoneum and mesentery
kidneys and ovaries
spleen and adrenal glands
kidneys and ovaries
Alcoholic cirrhosis demonstrates a severe increase in ___, while viral hepatitis demonstrates a severe increase in ___.
AFP, ALP
AST, ALT
ALP, AFP
ALT, AST
AST, ALT
Which of the following correctly describes peliosis hepatis?
blood filled cavities of varied size form in the liver tissue
numerous AV fistulas form throughout the liver
infection of the cystic duct that transfers to the pancreas
numerous cysts form that connect to the extrahepatic portal vein
blood filled cavities of varied size form in the liver tissue
What liver abnormality results in low blood sugar levels?
hemangioma
FNH
glycogen storage disease
Wilson disease
glycogen storage disease
In patients with cirrhosis, what effect will deep inspiration have on the portal vein?
the PV diameter will increase by 50%
the PV will collapse at the deepest point of inspiration
there will be minimal change in the PV diameter
the PV diameter will double in size
there will be minimal change in the PV diameter
The findings on the image are most consistent with:
subcapsular hematoma of the liver
intraparenchymal hematoma of the liver
loculated pleural effusion
subcapsular hematoma of the spleen
subcapsular hematoma of the liver
The most common cause of spread of hepatitis in the US is:
blood transfusions
hereditary infection
IV drug users
liver transplants
IV drug users
A patient presents with splenomegaly and multiple, small, tortuous vessels are visualized in the porta hepatis area of the liver. These vessels most likely represent:
duplicated HA
cavernous transformation
dilated extrahepatic biliary system
portal aneurysm
cavernous transformation
___ should be suspected in an infant with a large hepatic hemangioma and unexplained thrombocytopenia.
Budd Chiari
cirrhosis
Kasabach-Merritt syndrome
fragile X syndrome
Kasabach-Merritt syndrome
**aka hemangioma thrombocytopenia syndrome
Steatosis refers to:
glycogen storage disease of the liver
chronic hepatitis infection
fatty liver disease
pneumocystis carinii
fatty liver disease
A RI over 0.8 in the common hepatic artery would be an expected finding in patients with:
cholangitis and steatosis
PHTN and transplant rejection
FNH and cirrhosis
Budd Chiari and a healthy liver transplant
PHTN and transplant rejection
___ is the most common cause for micronodular cirrhosis and ___ is the most common cause of macronodular cirrhosis.
analgesic consumption, alcohol consumption
alcohol consumption, chronic viral hepatitis
chronic viral hepatitis, alcohol consumption
alcohol consumption, analgesic consumption
alcohol consumption, chronic viral hepatitis
A liver mass with a hypoechoic rim should create a strong suspicion of:
a hepatic lipoma
PHTN
a liver adenoma
malignancy
malignancy
Which of the following is a potential collateral pathway formed in patients with cirrhosis?
blood moves from the gastric vein to the splenic vein
blood moves from the superior rectal vein to middle rectal vein
blood moves from the splenic vein to the coronary vein
blood moves from the emissary veins to the umbilical vein
blood moves from the superior rectal vein to middle rectal vein
Benign liver masses will usually demonstrate ultrasound contrast enhancement during the arterial and portal venous phases of imaging. Malignant masses will usually demonstrate:
no contrast enhancement
contrast enhancement during portal venous phase of imaging
contrast enhancement during the arterial and portal venous phases of imaging
contrast enhancement during the arterial phase of imaging
contrast enhancement during the arterial phase of imaging
A 65 year old male presents with a history of cirrhosis, RUQ pain, and recent weight loss over the last 6 months. Lab testing indicates abnormal LFTs and increased AFP. The image displayed is most suggestive of:
HCC
focal fatty sparing
TCC
metastasis
HCC
A 75 year old female presents with RUQ pain. She was diagnosed with cirrhosis 4 years ago. Lab values demonstrate increased levels of AFP, ALP, AST, and ALT. The US exam demonstrates a heterogenous liver texture that is decreased in size. The left lobe contains a new round hypoechoic mass with increased vascularity. These findings are most suggestive of:
hydatid cyst
metastatic lesion
FNH
HCC
HCC
Which of the following statements is true regarding the displayed image?
the patient’s liver is increased in echogenicity indicating acute viral hepatitis
bilirubin, AST and ALT levels will be elevated
the patient has a pleural effusion
the patient’s liver is decreased in echogenicity indicating cirrhosis
bilirubin, AST and ALT levels will be elevated
In a patient with cirrhosis, the __ lobe of the liver can enlarge to nearly half the size of the right lobe.
left
caudate
quadrate
none of the above, the entire liver shrinks in size
caudate
A patient presents with an isolated slight increase in liver function tests. You identify two hyperechoic, homogenous masses in the area of the porta hepatis. These findings are most consistent with:
focal fatty sparing
cavernous hemangioma formation
focal fatty infiltration
adenoma development
focal fatty infiltration
Liver elastography is used for:
staging of secondary malignancy
staging of primary malignancy
staging of steatosis
staging of fibrosis
staging of fibrosis
If this is a TRV view of the liver, where is the liver mass located?
lateral right
anterior right
caudate
lateral left
anterior right
A patient presents with a history of gastric carcinoma diagnosis. The image most likely demonstrates which of the following abnormalities?
HCC
metastatic lesions
GB carcinoma
PCLD
metastatic lesions
___ can lead to air within the portal venous system and ___ can lead to air within the biliary tree.
an ERCP, ulcerative colitis
diverticulitis, ulcerative colitis
ulcerative colitis, an ERCP
ulcerative colitis, appendicitis
ulcerative colitis, an ERCP
A cyst within a cyst (daughter cyst) is a classic sign of:
polycystic liver disease
hydatid cyst or fungal abscess
echinococcal cyst or pyogenic abscess
hydatid cyst or echinococcal cyst
hydatid cyst or echinococcal cyst
Which of the following is commonly associated with contaminated water and causes debris/occlusion within intrahepatic portal venous system?
schistosomiasis
pyogenic abscess
candidiasis
amebic abscess
schistosomiasis
A 45 year old male presents for an abdominal US due to suspected hepatomegaly. The exam demonstrates numerous cysts of all sizes throughout the liver parenchyma. Which of the following should be evaluated for the same abnormality?
pancreas
retroperitoneal lymph nodes
prostate
ovaries
pancreas
Which of the following correctly describes how to differentiate a liver hemangioma from focal fatty infiltration?
hemangiomas demonstrate internal vascularity, while focal fatty infiltration demonstrates peripheral vascularity
there are no distinguishing sonographic characteristics between liver hemangiomas and focal fatty infiltration
hemangiomas can compress or displace surrounding structures, fatty infiltration has no mass effect
hemangiomas are always identified in the right lobe, while focal fatty infiltrations always occurs at the porta hepatis
hemangiomas can compress or displace surrounding structures, fatty infiltration has no mass effect
Which of the following will cause an increase in values on liver function tests?
FNH
polycystic liver disease
adenoma
hepatitis
hepatitis
A liver ultrasound demonstrates a hyperechoic mass with smooth borders and posterior enhancement in the posterior right lobe. These findings are most suggestive of:
HCC
cavernous hemangioma
hepatic adenoma
focal fatty sparing
cavernous hemangioma
If a patient presents with a history of right breast cancer and you identify a solid liver mass with a hypoechoic halo, what is the most likely diagnosis of the finding?
hepatic metastasis
FNH
HCC
hepatic adenoma
hepatic metastasis
A 4 year old patient is referred for an abdominal ultrasound due to a palpable mass in the RUQ and jaundice. The image most likely represents which of the following findings?
hepatoblastoma
hepatoma
pheochromocytoma
nephroblastoma
hepatoblastoma
A 26 year old female presents for an abdominal ultrasound. Her clinical history includes current use of oral contraceptives and mild hyperglycemia. The image of the liver is most suggestive of:
normal liver echotexture, no masses/abnormalities identified
adenoma formation in the right lobe, posteriorly
focal fatty sparing in the left lobe, posteriorly
focal fatty sparing in the right lobe, posteriorly
adenoma formation in the right lobe, posteriorly
Placement of a Linton or Warren shunt is a method used to:
reroute blood flow around a large aortic aneurysm
streamline blood flow through a large aortic aneurysm
reduce PHTN
relieve significant hydronephrosis
reduce PHTN
Which of the following would cause an increase in serum AST levels with normal serum ALT levels?
CHF
hepatitis
metastasis
cirrhosis
CHF
Which lobe of the liver contains the mass?
lateral left lobe
anterior right lobe
medial left lobe
posterior right lobe
anterior right lobe
A 50 year old female presents with nausea, vomiting and increased levels of AFP in lab testing. Which of the following pathologies is demonstrated on the image displayed?
hepatoblastoma
klatskin tumor
krukenberg tumor
choledochal cysts
klatskin tumor
Which of the following is not an expected finding with fatty infiltration of the liver?
cystic degeneration
increased attenuation
degraded visualization of vessels
brighter parenchymal echoes
cystic degeneration
Which of the following is not an expected complication of a liver transplant?
abscess
biloma
urinoma
seroma
urinoma
The findings on the image are most suggestive of:
right heart failure
cirrhosis
Wilson disease
Budd Chiari disease
cirrhosis
The most common benign liver tumor is:
cavernous hemangioma
klatskin tumor
polycystic liver disease
hepatitis
cavernous hemangioma
Which waveform represents hepatic vein flow in a patient with advanced cirrhosis?
*** the color map displayed applies to all displayed Doppler tracings
B
A patient presents for a liver ultrasound. A 5cm mass is identified at the porta hepatis of the liver. How will this affect the IVC position in the abdomen?
IVC will be displaced posteriorly
IVC will be displaced anteriorly
IVC will be displaced inferiorly
a 6cm mass is not large enough to displace the IVC in most patients
IVC will be displaced posteriorly
Which of the following describes the sonographic appearance of hepatic candidiasis?
cystic mass with gravity dependent debris
mass formation is described as a wheel within a wheel pattern
complex cystic mass that typically forms near the porta hepatis
a large solid mass replaces the caudate lobe and displaces the IVC
mass formation is described as a wheel within a wheel pattern
Which of the following would indicate a normal Doppler evaluation of an intrahepatic shunt?
hepatofugal flow in the MPV
peak flow velocity of 35cm/s
peak flow velocity of 230cm/s
hepatofugal flow in the LPV
hepatofugal flow in the LPV
Liver transplant evaluation requires PW Doppler evaluation of all of the following, EXCEPT:
portal anastomosis
IVC anastomosis
hepatic arterial anastomosis
biliary anastomosis
biliary anastomosis - should be evaluated for obstruction of fluid collection using 2D ultrasound
What is the most common cause of a hepatic abscess in the US?
osteomyelitis and endocarditis
appendicitis and diverticulitis
cholangitis and cholecystitis
E. coli from digestive tract
cholangitis and cholecystitis
What is a potentially life threatening complication of PHTN?
ruptured gastroesophageal varices
ascites formation
aortic embolism
pulmonary embolism
ruptured gastroesophageal varices
Which of the following is a potential collateral pathway formed in patients with cirrhosis?
blood moves from the emissary veins into the umbilical vein
blood moves from the gastric vein into the splenic vein
blood moves from the splenic vein into the coronary vein
blood moves from the coronary and short gastric veins into the esophageal veins
blood moves from the coronary and short gastric veins into the esophageal veins
If a liver transplant patient has an interposition anastomosis, how does this affect your evaluation?
there will be two anastomosis sites in the IVC that must be evaluated
each hepatic vein is connected to the native IVC separately, so there will be three anastomosis sites in the IVC that must be evaluated
the HA anastomosis will not be able to visualized because it is located deep within the liver tissue
there will be two anastomosis sites in the MPV that must be evaluated
there will be two anastomosis sites in the IVC that must be evaluated
The Ultrasound Liver Imaging Reporting and Data System (US LI-RADS) is used to asses patients at risk for:
lymphoma
liver metastasis
cirrhosis
HCC
HCC
Which of the following describes the location of the mass within the liver?
lateral left lobe
anterior right lobe
medial left lobe
posterior right lobe
medial left lobe
**TRV view of the liver, the mass is anterior and between the left and middle hepatic vein
Which of the following findings indicates a failed transjugular intrahepatic shunt?
continuous flow pattern within the shunt
diminished flow in the right and left portal branches
spleen length <12cm in average patient
hepatofugal flow in the MPV
hepatofugal flow in the MPV
What fetal syndrome is most commonly associated with hepatoblastoma?
trisomy
Beckwith-Wiedemann syndrome
Budd Chiari
down syndrome
Beckwith-Wiedemann syndrome
What is caput medusa?
formation of splenorenal varices
failure of a TIPS shunt
tortuous vessels around the umbilicus caused by PHTN
formation of gastroesophageal varices
tortuous vessels around the umbilicus caused by PHTN
Which of the following is a contraindication to placement of a TIPS shunt?
HCC
cirrhosis
portal thrombosis
HA aneurysm
portal thrombosis
** thrombus could then travel from the PV to the IVC and into the lungs causing pulmonary embolism
While performing ultrasound on the liver, a TRV view reveals a hyperechoic triangular structure in the inferior left lobe. The hyperechoic structure demonstrates an anechoic center that fills with color when Doppler is applied. Which of the following best describes the finding identified on the image?
recanalized coronary vein
recanalized umbilical vein
metastaisis
FNH
recanalized umbilical vein
What liver complication is associated with cholangitis, diverticulitis, and osteomyelitis?
steatosis
fungal abscess
pyogenic abscess
metastasis
pyogenic abscess
A portal vein diameter that is greater than or equal to ___ indicates PHTN.
8mm
10mm
13mm
15mm
13mm
Which of the following is most likely to demonstrate a simple cyst with gravity dependent debris in the right lobe of the liver?
early schistosomiasis infection
chronic FNH
early echinococcal infection
chronic hydatid infection
early echinococcal infection
Which of the following Doppler characteristics of the hepatic arteries will be seen in a normal liver transplant?
increased RI
sharp systolic upstroke
prolonged acceleration time
diastolic flow reversal
sharp systolic upstroke
A patient presents with a history of RUQ pain. He currently uses anabolic steroids. The exam demonstrates multiple irregular anechoic areas throughout the liver parenchyma. No internal flow is documented in these areas on color Doppler evaluation. These findings are most suggestive of:
peliosis hepatis
metastatic disease from colon primary
HCC
Budd Chiari
peliosis hepatis
A 28 year old male presents with jaundice, increased AST and ALT, decreased albumin and elevated serum copper levels. The liver appears diffusely echogenic with periportal thickening. These findings are most suggestive of:
alcoholic cirrhosis
chronic hepatitis
glycogen storage disease
Wilson disease
Wilson disease
A patient presents with new onset of jaundice 2 weeks after a liver transplant. This clinical finding is most suggestive of what complication?
HA stenosis
biliary stricture
HV stenosis
PV stenosis
biliary stricture
Which of the following Doppler parameters is most commonly used when evaluating the common hepatic artery in a patient with a liver transplant?
S/D ratio
PI
PSV
RI
RI
** RI >0.8 implies PHTN, hepatic congestion, transplant rejection, or chronic hepatocellular disease
What is the most common primary cancer to metastasize to the liver?
ovary
GI tract
melanoma
lung
- GI tract
- pancreas
- breast
- lung
- ovary
Which of the following statements is true regarding the sonographic appearance of fatty infiltration?
as fatty infiltration increases in the liver, the HV branches become increasingly visible
as fatty infiltration increases in the liver, all walls of all liver vascularity become increasingly echogenic
as fatty infiltration increases in the liver, the PV branches become more difficult to visualize
as fatty infiltration increases in the liver, the walls of the PV branches become increasingly echogenic
as fatty infiltration increases in the liver, the PV branches become more difficult to visualize
Diastolic flow reversal in the right and left hepatic arteries of a newly placed liver allograft indicates:
significant stenosis of the common hepatic artery
PHTN
normal post-surgical findings
possible rejection
possible rejection
A ___ abscess is caused by bacteria and most commonly forms within the right lobe of the liver. A ___ abscess is caused by a parasite and usually forms in the right dome of the liver causing elevation of the diaphragm.
fungal, pyogenic
parasitic, fungal
amebic, pyogenic
pyogenic, amebic
pyogenic, amebic
Which of the following liver tumors is usually treated by surgical resection due to risk of hemorrhage and malignant transformation?
hemangioma
adenoma
pyogenic abscess
lipoma
adenoma
___ is the most common malignant liver mass found in children.
mets from brain
hepatoblastoma
hepatoma
mets from nephroblastoma
hepatoblastoma
Reduced glycogen storage in the liver usually causes the liver parenchyma to have a sonographic appearance similar to:
polycystic disease
acute viral hepatitis
cirrhosis
steatosis
acute viral hepatitis
If discovered in early stages, which of the following effects on the liver can be reversed?
cirrhosis
fatty infiltration
hepatoma
metastasis
fatty infiltration
A contrast enhanced ultrasound examination is performed on a patient with suspected HCC. What are the expected findings if the exam is positive?
hypoechoic lesions during the arterial phase and hyperechoic lesions during the portal venous phase
hyperechoic lesions during the arterial phase and hypoechoic lesions during the portal venous phase
hypoechoic lesions that demonstrate absence of contrast uptake throughout the arterial and venous phases of circulation
hyperechoic lesions that demonstrate sustained levels of contrast uptake throughout the arterial and venous phases of circulation
hyperechoic lesions during the arterial phase and hypoechoic lesions during the portal venous phase
A patient presents for an abdominal ultrasound with a history of increased LFTs and obesity. The referring doctor would like to rule out hepatomegaly. Which of the following findings will indicate hepatomegaly is present?
when the right lobe is rounded inferiorly and extends past the upper pole of the right kidney
when the right lobe is rounded inferiorly and extends below the lower pole of the right kidney
hepatomegaly causes rounding of the superior liver segments
the liver is considered enlarged when the AP measurement exceeds 15.5cm
when the right lobe is rounded inferiorly and extends below the lower pole of the right kidney
Which of the following sonographic characteristics is associated with Budd Chiari syndrome?
dilated IVC
portal system aneurysm
agenesis of the HA
atrophied HVs
atrophied HVs
___ lobe of the liver does not normally atrophy with chronic Budd Chiari
caudate
right anterior
right posterior
left medial
caudate
Which of the following correctly describes how to determine if a peripheral mass is intrahepatic or extrahepatic?
evaluate the biliary tree for the presence of dilatation which is only seen with an extrahepatic mass
assess the liver capsule and look for indentations that indicate extrahepatic origin or outward bulging that indicates intrahepatic origin
assess the location of the mass in relation to the stomach
use PW Doppler to obtain the RI of the lesion and compare it to the RI of the normal liver tissue
assess the liver capsule and look for indentations that indicate extrahepatic origin or outward bulging that indicates intrahepatic origin
Which of the following describes the sonographic appearance of FNH?
single or multiple hypoechoic, rounded masses with mild posterior shadowing within the liver parenchyma
a single hyperechoic mass most commonly found adjacent to the porta hepatis
a single mass <5cm with a central scar and prominent central and radial vascularity
diffuse echogenic nodules or foci scattered throughout the liver parenchyma
a single mass <5cm with a central scar and prominent central and radial vascularity
Compensatory enlargement of the caudate lobe occurs with which of the following?
Wilson disease and glycogen storage disease
cirrhosis and acute hepatitis
fatty infiltration and glycogen storage disease
cirrhosis and Budd Chiari
cirrhosis and Budd Chiari
A 43 year old female with a history of Hep C presents with jaundice, increased abdominal girth and pain. The most probable US finding in the liver will be:
metastasis from GI tract
cirrhosis and ascites
schistosomiasis and splenic atrophy
fatty filtration
cirrhosis and ascites
Contrast enhanced ultrasound is used to determine the outcome of tumor ablation in the liver. If the procedure was a success, what are the expected findings on the image?
consistent contrast uptake occurs during the arterial and venous phase
contrast uptake occurs during the venous phase
contrast uptake occurs during the arterial phase
no contrast enters the lesion during the cardiac cycle
no contrast enters the lesion during the cardiac cycle
A patient presents for a liver ultrasound due to a history of cirrhosis. The prior US report indicates the presence of a dilated umbilical vein. What is the proper probe position and location needed to demonstrate the umbilical vein as seen in the image?
TRV, subcostal angulation
SAG, intercostal
SAG, just to the right of midline
SAG, just to the left of midline
SAG, just to the left of midline
Which liver disorder leads to the sonographic appearance of hepatomegaly with decreased echogenicity and scattered bright portal reflections within the parenchyma?
acute viral hepatitis
hydatid disease
chronic viral hepatitis
cirrhosis
acute viral hepatitis
High-intensity transient signals (HITS) are seen on the Doppler evaluation of a patient with:
portal venous gas
hyperfunctioning adenoma
significant aortic stenosis
critical RA stenosis
portal venous gas
Which liver mass demonstrates characteristics most consistent with a klatskin tumor?
What usually causes an echinococcal cyst in the liver?
hepatitis
ingestion of raw oysters
hemangioma
ingestion of raw pork
ingestion of raw pork
The US exam of a patient’s liver demonstrates a patent umbilical vein. The most common cause for this recanalization is:
PHTN
hepatitis
ascites
abscess
PHTN
A 10 year old presents for an abdominal ultrasound with a palpable RUQ mass. He has no history of liver disease and AFP levels are normal. You identify a 9cm mass in the right lobe that demonstrates punctuate calcifications and a central scar. These findings are most suggestive of:
hepatoblastoma
fibrolamellar carcinoma
hepatoma
metastasis
fibrolamellar carcinoma
** subtype of HCC found in adolescents and young adults
What is the yellow arrow pointing to?
IVC tumor extension
mass in the CBD
retroperitoneal lymphadenopathy
thrombus in the PV
thrombus in the PV
About 50% of all primary tumors that metastasize to the liver are drained through the:
AO
HV
IVC
PV
PV
Which of the following liver abnormalities is commonly associated with the recanalization of the vessel within the structure indicated by the purple arrows?
acute hepatitis
cirrhosis
fatty infiltration
hydatid disease
cirrhosis
A mass that presents with a bull’s eye appearance within the liver tissue is most likely ___.
fatty sparing
lymphoma
FNH
metastasis
metastasis
Which of the following statements is true regarding the image displayed?
the liver is demonstrated in the TRV plane at the level of the caudate lobe and has a normal echotexture
there is a mass identified in the lateral left lobe of the liver adjacent to the IVC
there is a mass identified in the medial left lobe of the liver adjacent to the IVC
the liver is demonstrated in the TRV plane at the levels of the caudate lobe and has a normal echotexture. there is an enlarged lymph node seen anterior to the AO and adjacent to the IVC
there is a mass identified in the medial left lobe of the liver adjacent to the IVC
Which type of liver abscess is caused by a parasite?
pyogenic
fungal
amebic
viral
amebic
A patient presents for a follow up ultrasound due to Budd Chiari. Which of the following is an expected finding on the exam?
thrombosis of the HVs with hepatic congestion
adrenal adenoma and/or kidney adenoma
pancreatic head mass and dilated intrahepatic ducts
prostatitis and neurogenic bladder
thrombosis of the HVs with hepatic congestion
Which of the following is true regarding a liver hemangioma?
fluid and debris levels are commonly present
a hemangioma is composed of an abnormal concentration of smooth muscle and Kupffer cells within the liver
Color Doppler is not usually helpful in evaluating this highly vascular mass
most hemangiomas demonstrate some level of posterior shadowing
Color Doppler is not usually helpful in evaluating this highly vascular mass
When reviewing a prior US exam for an upcoming follow up exam for the same patient, you come across an image labeled “sandwich sign.” What are they referring to?
extrinsic compression of the IVC by a pancreatic tumor
the layering of the stomach wall at the head of the pancreas
lymphadenopathy surrounding the PV
the head of the pancreas is abnormally compressed between the liver and great vessels
lymphadenopathy surrounding the PV
A vascular condition of the liver seen in women who take oral contraceptives is:
hereditary telangiectasia
liver adenoma
Budd Chiari
portal aneurysm
Budd Chiari
Hypoalbuminemia associated with cirrhosis leads to:
GB and bowel wall thickening
liver capsule contraction and surface irregularities
hepatomegaly
nodule formation
GB and bowel wall thickening
Which metabolic infiltrative disorder is associated with hepatic adenoma formation?
amyloidosis
Von Gierke disease
Wilson disease
hemochromatosis
Von Gierke disease
A patient is referred for an abdominal ultrasound after a CT demonstrated a possible mass near the fundus of the GB. The ultrasound demonstrates mild hepatomegaly with a mild diffuse increase in echogenicity. The area in question appears hypoechoic to the surrounding tissues. These findings are most consistent with:
hepatic adenoma
focal fatty sparing
diffuse fatty infiltration
cystic artery thrombosis
focal fatty sparing
A patient is referred for a RUQ scan due to the possibility of a fungal infection of the liver. They have a 4 year history of treatment for AIDS. The liver demonstrates diffuse presentation of multiple calcifications of different sizes, with and without shadowing. These findings are most consistent with:
steatosis
liver
pneumocystis carinii
hydatid sand from echinococcal infection
pneumocystis carinii
A patient presents with abdominal pain for 3 months following a missionary trip to India. Lab values demonstrate normal LFTs. The US exam demonstrates a 3cm cyst with septations in the right lobe of liver. These findings are most consistent with:
candidiasis
hydatid disease
histoplasmosis infection
schistosomiasis
hydatid disease
Schistosomiasis is an ___ cause of PHTN. Budd Chiari syndrome is an ___ cause of PHTN.
extrahepatic presinusoidal, intrahepatic postsinusoidal
intrahepatic presinusoidal, extrahepatic presinusoidal
intrahepatic presinusoidal, extrahepatic postinusoidal
intrahepatic presinusoidal, intrahepatic postsinusoidal
intrahepatic presinusoidal, intrahepatic postsinusoidal
Which of the following describes the appearance of the liver in a patient in the later stages of cirrhosis caused by viral hepatitis?
diffuse coarse liver echotexture with no nodule formation
multiple nodules usually 1-5cm in size
significant hepatomegaly with diffuse decrease in hepatic echotexture
multiple nodules usually <1cm in size
multiple nodules usually 1-5cm in size
Which liver pathology is most commonly associated with the GB pathology demonstrated on the image?
FNH
hepatitis
hepatoma
fatty infiltration
hepatitis
Which of the following vessels will be abnormally dilated with significant PHTN?
MPV only
HVs only
MPV and left gastric vein
HVs, MPV, and left gastric vein
MPV and left gastric vein
If a liver transplant patient has a piggyback anastomosis, how does this affect your evaluation?
there will be two anastomosis sites in the MPV that must be evaluated
the HA anastomosis will not be able to be visualized because it is located deep within the liver tissue
there will be a single anastomosis site in the IVC that must be evaluated
each HV is connected to the native IVC separately, so there will be three anastomosis sites in the IVC that must be evaluated
there will be a single anastomosis site in the IVC that must be evaluated
**piggyback - hepatic confluence of the transplant liver attached to native IVC (single anastomosis site)
interposition - donor IVC segment replaces a segment of the native IVC (two anastomosis sites)
A patient is scheduled for abdominal ultrasound every 6 months due to their history of cirrhosis. Which of the following is true?
patients with cirrhosis should have their liver vasculature evaluated regularly due to an increased risk of tumor invasion from metastasis
patients with cirrhosis do not need to be evaluated regularly once the diagnosis has been made because the treatment options are limited
cirrhosis commonly leads to ascites which may require intermittent thoracentesis treatments
patients with cirrhosis should have their vasculature evaluated regularly due to an increased risk of portal thrombosis
patients with cirrhosis should have their vasculature evaluated regularly due to an increased risk of portal thrombosis
___ usually presents as multiple target lesions in the liver
klatskin tumor
metastasis
fungal abscess
hydatid disease
metastasis
What abnormality causes focal developmental lesions of the liver and is associated with congenital hepatic fibrosis, autosomal dominant polycystic disease and cholangiocarcinoma?
biliary hamartomas
Wilson disease
schistosomiasis
candidiasis
biliary hamartomas
The most frequently involved organ in metastatic disease is the:
pancreas
spleen
liver
GI tract
liver
All of the following statements correctly describe infantile hemangioendothelioma, EXCEPT:
usually spontaneously regresses before age 2 years
can lead to cardiac failure if associated with an AV malformation within the tumor
most common benign vascular tumor of the liver in infants and toddles
highly aggressive liver malignancy seen early in life
highly aggressive liver malignancy seen early in life
A TIPS shunt is placed into the liver circulation to alleviate PHTN. What two vessels are usually connected?
RPV and LPV
HA and PV
RPV and RHV
RHV and LHV
RPV and RHV
A patient presents with a history of AIDS and recent pneumocystis carinii infection. What charges to the liver do you expect to see on the ultrasound exam?
diffuse increase in liver tissue echogenicity with ascites
formation of multiple abscesses within the liver tissue
gas-producing abscess near the porta hepatis
diffuse echogenic foci throughout the liver tissue
diffuse echogenic foci throughout the liver tissue
___ is the most common liver malignancy, while ___ is the most common primary liver malignancy
HCC, metastasis
HCC, Kaposi sarcoma
metastasis, HCC
HCC, fibrolamellar carcinoma
metastasis, HCC
A 40 year old female patient presents with increasing RUQ pain over the last month, beginning upon returning from a trip to Indonesia. The findings on her exam are most consistent with:
echinococcal cyst
schistosomiasis cyst
lymphatic cyst
fungal abscess
echinococcal cyst
A patient presents with a history of Hep C and you identify a solid liver mass with a hypoechoic halo. This finding is most consistent with:
HCC
FNH
hepatic adenoma
hepatic metastasis
HCC
Which of the following is true regarding a liver hemangioma?
Color Doppler is a valuable tool in evaluating this highly vascular mass
fluid and debris levels are commonly present in a hemangioma
most hemangiomas demonstrate some level of posterior shadowing
a hemangioma is comprised of an abnormal concentration of vascular tissues within the liver
a hemangioma is comprised of an abnormal concentration of vascular tissues within the liver
A patient is scanned for symptoms of mild epigastric pain. A nearly isoechoic liver mass is identified in the caudate lobe. A liver biopsy demonstrates normal liver cell structure but abnormal cellular arrangement. What type of mass was identified on the US image?
FNH
hepatoma
hemangioma
adenoma
FNH
**usually isoechoic to mildly hypoechoic to the liver tissue
A patient presens with increasing RUQ pain and vomiting after a recent liver biopsy. An irregular mass with internal debris and an overall heterogenous appearance is noted in the right lobe. The mass also demonstrates several echogenic foci with ringdown artifact. These findings are most suggestive of:
hematoma
abscess
lymphocele
pseudoaneurysm
abscess
How can a hepatic adenoma be differentiated from FNH on contrast enhanced ultrasound?
FNH lesions usually demonstrate centripetal enhancement while adenomas demonstrate centrifugal enhancement
FNH lesions demonstrate significant contrast uptake while adenomas demonstrate no contrast uptake
FNH lesions demonstrate no contrast uptake while adenoms demonstrate significant contrast uptake
FNH lesions usually demonstrate centrifugal enhancement while adenomas demonstrate centripetal enhancement
FNH lesions usually demonstrate centrifugal enhancement while adenomas demonstrate centripetal enhancement
Portalization of the HVs is a common finding in which of the following?
mild to moderate steatosis
severe tricuspid valve regurgitation
hemolytic anemia
advanced cirrhosis
advanced cirrhosis
The primary finding that differentiates liver mass formation from steatosis is:
steatosis will cause wall thickening of the portal system while mass formation invades the wall
steatosis causes an irregular liver surface contour while mass formation does not effect the surface contour of the liver
steatosis will demonstrate normal vessel course through affected areas while mass formation displaces vasculature
steatosis will cause dilated HVs while mass formation will cause narrowed HVs
steatosis will demonstrate normal vessel course through affected areas while mass formation displaces vasculature
Liver hemangiomas are a common benign neoplasm that will usually appear on an US of a normal liver as:
cystic mass within the liver
well defined, hyperechoic liver mass
complex liver mass with irregular borders
solid hypoechoic mass with posterior shadowing
well defined, hyperechoic liver mass
Which type of liver abscess presents as a mass with internal septations similar to the spokes of a wheel?
fungal
viral
amebic
pyogenic
fungal
Periportal cuffing is a sign of:
acute viral hepatitis
Caroli disease
intrahepatic biliary tree obstruction
extrahepatic biliary tree obstruction
acute viral hepatitis
Fulminant hepatitis is most commonly caused by:
acetaminophen abuse
alcohol abuse
viral infection
fungal infection
acetaminophen abuse
Which of the following describes the expected waveform from the HV in a patient with cirrhosis?
triphasic, highly pulsatile antegrade flow
monophasic, continuous retrograde flow
monophasic, continuous antegrade flow
triphasic antegrade flow without cardiac pulsatility
monophasic, continuous antegrade flow
Which of the following describes the Doppler appearance of liver transplant rejection?
mottled appearance of the liver parenchyma with ascites
low resistance flow in the PV
high resistance flow in the HA
nodular formations within the liver parenchyma
high resistance flow in the HA
In what lobe of the liver is the mass located?
right
caudate
the mass is within the IVC not the liver
left
caudate
What is the most common liver malignancy identified on ultrasound?
hepatoma
metastatic tumor
klatskin tumor
adenoma
metastatic tumor
A 6 month old female is referred for an abdominal ultrasound due to suspected Kasabach-Merritt syndrome. What are you looking for on the exam?
liver or spleen hemangioma formation
pancreatic divisum
ascites, pleural effusion and abscess formation in the abdominal wall
absence of the biliary tree
liver or spleen hemangioma formation
Which of the following is true regarding a transjugular intrahepatic shunt?
air is retained within the shunt after placement which limits the US evaluation for the first 3-5 days
the shunt is advanced into the liver through a puncture of the groin and common iliac vein
a harvested branch of the HV is normally used as the shunt
the shunt connects the dilated umbilical vein to the IVC
air is retained within the shunt after placement which limits the US evaluation for the first 3-5 days
Shear wave elastography can be used to assess the liver. Which of the following correctly describes the results of an abnormal exam?
higher values indicate liver fibrosis
red color superimposed over liver parenchyma indicates liver fibrosis
lower values indicate liver fibrosis
blue color superimposed over liver parenchyma indicates liver fibrosis
higher values indicate liver fibrosis
<5kPA = normal
13-17kPA = highly suggestive of advanced chronic liver disease
>17kPA = highly suggestive of clinically significant PHTN
A patient presents for a liver ultrasound due to a history of cirrhosis. While scanning in the subcostal SAG plane, just to the left of midline, you obtain the images displayed below. Which of the following best describes the findings?
splenic varices
patent umbilical vein
dilated MPV
esophageal varices
patent umbilical vein
The most common parasitic infection in humans is:
pneumocystis carinii
hepatitis
schistosomiasis
hydatid disease
schistosomiasis
If tardus parvus waveforms are identified in the intrahepatic artery waveforms of a transplant, this finding is ___. If biphasic waveforms are identified in the right and left hepatic arteries, the finding is ___.
suspicious for HA stenosis, normal
normal, suspicious for HA stenosis
suspicious for organ rejection, suspicious for HA stenosis
suspicious for HA stenosis, suspicious for organ rejection
suspicious for HA stenosis, suspicious for organ rejection
Cirrhosis causes reduced serum albumin levels. What complication does this cause?
increased ammonia production
ascites and peripheral edema
jaundice
recanalization of the umbilical vein
ascites and peripheral edema
Triglyceride accumulation in the liver leads to ___, while copper accumulation in the liver leads to ___.
steatosis, hemochromatosis
amyloidosis, hemochromatosis
amyloidosis, steatosis
steatosis, Wilson disease
steatosis, Wilson disease
Longitudinal images are presented of the anterior abdomen just superior to the umbilicus. What is the most common cause of the abnormality seen?
PHTN
polycythemia vera
malignant HTN
steatosis
PHTN
A patient presents with lower extremity edema and increased abdominal girth 2 weeks after a liver transplant. These findings are most suggestive of what complications?
HV stenosis
cholangitis
HA stenosis
biliary stricture
HV stenosis
Which of the following is the most common cause for intrahepatic cholestasis?
hepatitis
pancreatic head mass
stone in the distal CBD
fatty infiltration of the liver
hepatitis
HA hypertrophy is a common finding with:
celiac axis stenosis
splenic vein thrombosis
cirrhosis
cholecystitis
cirrhosis
Which of the following describes the most common sonographic appearance of hepatoma?
solid mass that may be more or less echogenic than the liver parenchyma
usually causes multiple diffuse solid mass formation
most commonly demonstrates diffuse coarse liver texture in the affected lobe
echogenic mass with a central scar
solid mass that may be more or less echogenic than the liver parenchyma
Which of the following correctly describes how contrast enhanced ultrasound can be used to differentiate benign and malignant masses?
significant contrast uptake occurs in malignant nodules, while no contrast uptake is seen in benign nodules
significant contrast uptake occurs in benign nodules, while no contrast uptake is seen in malignant nodules
benign nodules usually demonstrate hypervascular enhancement while malignant tumors usually demonstrate hypovascular enhancement
benign nodules usually demonstrate isovascular enhancement while malignant tumors usually demonstrate hypervascular enhancement
benign nodules usually demonstrate isovascular enhancement while malignant tumors usually demonstrate hypervascular enhancement
Portal thrombosis may lead to an accumulation of fluid in the abdomen called:
pleural effusion
pericardial effusion
ascites
retroperitoneal effusion
ascites
The most definitive sonographic sign of cirrhosis is:
hepatoma formation
associated hepatomegaly
PHTN
decreased liver size with coarse texture and nodule formation
decreased liver size with coarse texture and nodule formation
