Pathology Descriptions Flashcards
Dilated aorta >3cm
Fusiform or saccular
AAA
Asymptomatic until rupture
Abdo/back pain
Pulsatile abdominal mass
Hypotension
Syncope
↓Haematocrit
↓Haemoglobin
AAA
Saccular outpouching, localised and round/oval adjacent to artery
Hypoechoic/anechoic centre
Surrounding echogenic thrombus
Yin/Yang sign (Doppler)
Pseudoaneurysm
Localised pain/swelling
Palpable, pulsatile mass
Skin discolouration/warmth
↑WBC
↑CRP
↓Haematocrit/Haemoglobin
Pseudoaneurysm
Separates true/false lumen
Mobile, echogeni c line within aorta
May extend into branch arteries
Dissection aneurysm
Sudden, severe chest/back pain
Signs of ischaemia
Syncope/shock
↓Haematocrit
↑CRP
Dissection aneurysm
Aneurysmal dilation with thickened adventitia
Hypoechoic surrounding fibrosis of tissue around aorta
Sparing of posterior wall
Backache
Leg oedema
Inflammatory AAA
Pulsatile mass
Normal appearance of aorta
Large pelvic mass/mass elsewhere
PHx FIbroid uterus, para-aortic lymph nodes, retroperitoneal tumour
Pseudo-pulsatile abdominal mass
A congestive liver disease caused by wide array of conditions compromising HV outflow: thrombotic, non thrombotic
Budd-chiari syndrome
Reduced flow in hepatic veins, Echogenic thrombus in hepatic veins or IVC
Heterogenous/hypoechoic liver parenchyma
Anechoic fluid collection in abdomen
Dilated IVC
Budd-chiari syndrome
RUQ pain
Jaundice
Ascites
Hepatomegaly
Abnormal LFTs
IVC involvement = lower leg oedema
Budd-chiari syndrome
Dilated portal, spleen & mesenteric veins (PV >15mm)
Patent paraumbilical veins
Varices
Splenomegaly
Ascites (anechoic abdo fluid)
Atrophied live w/irregular surface
Portal venous hypertension
Causes of Pre-hepatic, post hepatic or hepatic portal venous hypertension
Congenital portal atresia, PV thrombosis, phlebitis of the PV, trauma of thrombosed portocaval shunt
Pre-hepatic
Causes of pre-hepatic, post-hepatic or hepatic portal venous hypertension?
Budd-Chiari syndrome, constrictive pericarditis, tricuspid valve incompetence
Post-hepatic
Causes of pre-hepatic, post-hepatic or hepatic portal venous hypertension
cirrhosis (alcoholic most frequent), chronic active hepatitis, parasitic diseases (schistosomiasis)
Hepatic
Marked ascites
Arterio-venous shunting
Haemorrhoids
Hypersplenism:
- Moderate anaemia, neutropaenia, thrombocytopaenia
Portal venous hypertension
Consequence of portal vein thrombosis
Ascites
Jaundice
Fatigue
WL/LOA
Abdo pain
Cavernous transformation of portal vein
Doppler: Hepatopetal, continus flow, low velocity
Extrahepatic PV not visualised
High level echoes in porta hepatis
Cavernous transformation of portal vein
Caused by biliary disease, alcohol abuse, trauma, ulcers
S&S:
Abdo pain
N,V,F
PHx gallstones, alcoholism
Jaundice, malabsorption
↑enzymes & leukocytes
↑serum amylase
↑urine amylase
↑serum lipase
Pancreatitis
Pancreas parencyhma:
Hyperechoic, homogenous, enlarged
Oedematous
Irregular borders
Peripancreatic fluid
Acute pancreatitis
Pancreas parenchyma:
Hyperechoic, heterogenous, atrophied
Irregular borders
Double duct sign - dilated pancreatic duct & dilated CBD
Calcifications in duct/ducts
Possible peripancreatic fluid
Chronic pancreatitis
PHx recurrent attacks of acute pancreatitis
PHx chronic alcoholism or Biliary disease
Pt may have:
Pseudocysts, ascites
Dilated CBD
Thrombosis of splenic vein, extending into portal vein
Chronic pancreatitis
A collection of fluid in the pancreas that arises from the loculation of inflammatory processes, necrosis, or haemorrhage
4-6 wks after onset of pancreatitis
Pancreatic pseudocyst
Well-defined cystic lesion adjacent to panc
Round/oval
Internal echoes may be seen due to debris
N,V,LOA
WL
Diarrhoea, fever
Tender abdo mass
Jaundice
Pancreatic pseudocyst
A cancer that develops in the lining or inner surface of the pancreas and usually has secretory properties
Pancreatic adenocarcinoma
Abdo/back pain
Onset of NIDDM/existing diabetes more difficult to control
LOA/WL/N/V
Diarrhoea/constipation
Jaundice, enlarged GB
Itchy skin
Pancreatic adenocarcinoma
Heterogenous, hypoechoic solid mass
May have cystic component
Double duct sign if mass in panc. head
Pancreatic adenocarcinoma
Forms in cells that make gastrin
↑gastrin & stomach acid
Forms in head of panc, sometimes small intestines
Most are malignant
Recurrent stomach ulcers
Abdo/back pain
Reflux
Diarrhoea
Gastrinoma
Forms in cells that make insulin
Slow growing, rarely spreads
Forms in head, body or tail of panc
Usually benign
Insulinoma
Hypoglycaemia w/signs:
blurred vision, headache, lightheaded
Tired, weak, shaky, nervous
Irritable, sweaty, confused
Hungry, fast HR
Insulinoma
Panc duct anomaly:
Primary duct
Extends the entire of the gland
Duct of Wirsung
Panc duct anomaly:
Secondary duct
Drains upper anterior head
Duct of Santorini
PHx obesity & aging
PHX pancreatitis, ETOH++, liver disease
Dyslipidaemia & hyperglycamia = non-alcoholic version of this
Fatty pancreas
Diffuse hyperechoic pancreas parenchyma
Can be enlarged
More attenuating
Fatty pancreas
Acute RUQ pain
Fever
Leukocytosis
↑serum bilirubin
↑ALP
Thickened GB wall (<3mm)
Distended GB lumen (<4cm)
Echogenic calculi
+ve Murphy’s sign
Increased vasc in GB wall
Pericholecystic fluid collection
Impacted stone in GB neck, Hartmann’s puch, cystic duct
Acute cholecystitis
or without ↑serum, ALP & calculi:
Acute acalculous cholecystitis
PHx repeated acute cholecystitis
RUQ pain
Thickened GB wall
GB scarring
Atrophied
Lack/minimal pericholecystic fluid
Chronic cholecystitis
Air in wall/lumen of GB, tissue adjacent or in biliary ducts
WES sign if air within GB
Emphysematous cholecystitis
Thickened GB wall, de-lamination
↓vascularity
Irregular GB mucosal layer outline
Gas within GB
Possible absence of calculi
Large pericholecystic collection
Gangrenous cholecystitis
When bile flow ceases or reduces significantly, caused by some of the following:
Acute hepatitis
Alcoholic liver disease
Cirrhosis (Hep B, C)
Pancreatic adenocarcinoma
Pancreatitis
Cholestasis
Jaundice
Dark urine
Light-coloured stools
Itching
Abdo pain/LOA/V/F
Not specifically visible on U/S
Cholestasis
PHx gallstones & inflammation of GB
S&S: same as most GB pathology
Thickened wall
Irregular shape/margins
Hypoechoic, heterogenous
Invasion of adjacent structures
GB adenocarcinoma
> 40 yrs old (most pts)
Formation of Rokitansky-Aschoff sinuses
Comet tail artefact
Adenomyomatosis
Calculi within bile duct
Primary: within bile ducts
Secondary: moved into biliary tree from GB
Choledocholithiasis
Inflammation of bile ducts/biliary tree
Most commonly frm calculi, can be from stricture or malignancy
Segmental narrowing & dilation of bile duct
Thickened biliary duct wall
Cholangitis
Bile duct cancer
PHx choledochal cyst, chronic liver disease
Abdo pain
Jaundice
WL/F
Itching
Cholangiocarcinoma
Dilation of intra & extrahepatic bile ducts
Hypoechoic, heterogenous
Bile duct wall thickening/mass
Cholangiocarcinoma
Caused by round worm
Come through sphincter of Oddi into biliary tree
Echogenic worm like structures in GB
Ascariasis
Fatty liver disease associated with dyslipidaemia
Non-Alcoholic steatosis
Fatty liver disease that can lead to hepatomegaly, hepatitis, cirrhosis
Alcohol-related steatosis
Mild: Minimal diffuse increase in hepatic echogenicity
Moderate: increased echogenicity, slightly impaired visualisation, slightly grainy
Severe: Significant increase in echogenicity of liver, decreased penetration, very grainy
Steatosis
Fatigue, N/V/F
Abdo pain
Dark urine
Joint pain
Liver texture may appear normal
PV more prominent than usual
Slightly hypoechoic liver parenchyma
Attenuation
Hepatospelnomegaly
GB wall thickened
Acute Hepatitis
May be asymptomatic
Coarse/echogenic due to fibrosis
PV walls less discrete
Liver not enlarged
Soft shadowing due to fibrosis
Changes to liver contour
Chronic hepatitis
Permanent scarring of the liver where normal liver tissue is replaced by scar tissue
Cirrhosis
Hepatomegaly, jaundice, ascites
N/WL/F
Anorexia
Dark urine
Fatigue
Varicosities
Micronodular, macronodular or mixed
Irregular liver contour
enlarged caudate lobe
splenomegaly
Cirrhosis
Inner layer of connective tissue layer over the liver and surrounding the portal triad within the liver
Can be cause of pain with hepatomegaly
Glisson’s capsule
Present in the liver
Benign
Anechoic fluid
Well-circumscribed
Thin-walled
Simple liver cysts
Genetic disease
Most often associated with autosomal dominant polycystic kidney disease
Multiple cysts throughout liver
Polycystic liver disease
Symptoms:
Abdo pain
Post-prandial epigastric pain/discomfort
Sono app:
Often multiloculated
Well-defined
Anechoic
Septations
DDx:
Simple cysts
Cystadenocarcinoma
Focal nodular hyperplasia
Cystadenoma
Sympt:
Maybe asymptomatic
Jaundice
WL/P/
Distension
Ascites
Dyspnoea
Sono app:
Multiloculated
Intracystic solid areas
Septations
Grows from biliary epithelium
DDx:
cystadenoma
pseudocyst
Focal nodular hyperplasia
Hepatic cysts
Cystadenocarcinoma
Symp:
RUQ pain
Chest pain
F/chills/night sweats
N/V/LOA
WL
Sono app:
Poorly demarcated
Variable appearance/echogenicity
Gas may be present
Hepatic abscess
Most prevalent tumour of the liver
Benign
Most often asymptomatic
Larger may cause pain/discomfort
Sono app:
well-circumscribed, echogenic solid lesions
Mostly no vascularity
Haemangioma
Benign
Often asymptomatic
Arises from pre-existing arteriovenous malformation in liver
Sono app:
Well-circumscribed
Isoechoic/hypoechoic
Solid lesion
Hypervascular
Focal nodular hyperplasia
Rare, presents in adult females
Mainly found in kidneys, can present in liver
Blood, muscle, fat
Sono app:
Mostly hyperechoic & homogenous
Can be heterogenous
Angiomyolipoma (AML)
Well-circumscribed
Echogenic solid lesion
Posterior enhancement
Consists of fat & blood
Lipoma
PHx:
Sarcoidosis
Tuberculosis
Neoplastic disease
Primary biliary cholangitis or drug induced
Sono app:
Highly echogenic solid focus
Posterior shadowing
Irregularly shaped if larger
Granuloma
PHx chronic liver disease
Symp:
RUQ pain, lump
LOA/WL
N/F/V
Jaundice
Sono app:
Densely echogenic
Diffuse
Mixture of densely echogenic or diffuse
Can be solitary, multiple nodules or diffuse infiltrative masses
Hepatocellular carcinoma (HCC)
Childhood tumour up to 5 yrs
Most begin in right lobe of liver
Symp:
RUQ pain, lump
LOA/WL
N/F/V
Jaundice
Sono app:
Hyperechoic, hetero
Calcifications
Vascular
Solid
Hepatoblastoma
Symp:
Weakness/poor health
LOA/WL
Fever
Fatigue/bloating/itching
Leg oedema
Jaundice
Sono app:
Hypoechoic, hetero
Variable echogenicity
Target lesions
Multiple
Liver Metastases
Most common metastases from colon or rectal cancer
Less commonly from breast, oesophageal, stomach, panc, lung, kidney, skin
Liver metastasis
Symp:
Often non-specific
Haematuria
Flank pain
Palpable mass
Sono app:
Mostly isoechoic but can be hyperechoic
Renal cell carcinoma
Rare type of kidney cancer, most common bladder/lower UT cancer
Symp:
Back pain
Haematuria
Frequency
Sono app:
Solid lesion
Hypoechoic
Originate within renal pelvis or calyx
Transitional Cell Carcinoma (TCC)
Most common childhood cancer
Affects 3-4 yrs old, less common after 5
Symp:
Constipation
abdo pain/swelling
N/V/F/LOA
Sono app:
Large solitary, solid mass
Echogenic
May contain cystic areas/multiloculated
Can be present in utero
Wilm’s Tumour (nephroblastoma)
Most common metastasises from carcinomas (lung, colorectal, ENT, breast, soft tissue, thyroid)
Symp:
Flank pain, haematuria
WL
Renal metastases
Vesicoureteric reflux due to blockage of urine flow down ureter
Hydronephrosis
Sono app:
Dilated ureter/s
Depending on grade:
2. Full pelvis, major calyces dilated
- Uniformly dilated minor calyces, parenchyma spared
- Parenchyma compromise
Hydronephrosis
Symp:
Severe pain
Sono app:
Very echogenic calculi within bladder
Posterior shadowing
Urolithiasis
Increased calcium levels in the kidney
Caused by hypercalcaemia due to hyperparathyroidism, medications, sarcoidosis
Nephrocalcinosis
Sono app:
Calcification in medullary pyramids
Posterior shadowing depending on calcifications
Nephrocalcinosis
Urine backs up into kidney causing swelling
Sono app:
Unilateral or bilateral
Hydronephrosis
Changes to renal arterial Haemodynamics
Thinned parenchyma (long term)
Obstructive nephropathy
Type of blood cancer: bone marrow over-produces RBCs
Enlarged spleen
Hepatomegaly, ascites, DVT
Splenic infarctions & thromboses common
Polycythaemia vera
