Pediatric Registry Review Flashcards

Question 1

Q

Curved Array Transducers

Answer

A

Crystals arranged in the shape of an arc. Provide a wide field of view in the near field.

Question 2

Q

Linear Array Transducers

Answer

A

Crystals arranged in a line. Rectangular shaped image. Evaluation of Neonatal spine, infant abdomens, bowel wall, brain, MSK, abdominal and superifical parts.

Question 3

Q

Phased Array Transducers

Answer

A

Crystals arranged in a line. Image produced is pie shaped or vector shaped. Possess a small footprint making them advantageous for intercostal scanning, echocardiography or chest. Also, head imaged.

Question 4

Q

Narrow bandwidths emit __ frequencies.

Question 5

Q

Broad bandwidths emit __ frequencies.

Answer

A

Many; multi-hertz transducers have broad bandwidths, which allow the operator to change the frequency; harmonic imaging also results in broad bandwidths.

Question 6

Q

Frequency and Penetration are ___ proportional.

Answer

A

Inversely

Question 7

Q

Frequency and Spatial Resolution are __ proportional.

Question 8

Q

What is spatial resolution?

Answer

A

Capability of depicting structural detail (axial and lateral resolution)

Question 9

Q

Axial Resolution

Answer

A

display 2 closely spaced targets parallel to the sound beam as 2 distinct targets.

Dependent on the transducer’s spatial pulse length (SPL)

Spatial pulse length in ultrasound imaging describes the length of time that an ultrasound pulse occupies in space. Mathematically, it is the product of the number of cycles in a pulse and the wavelength. A shorter spatial pulse length results in higher axial resolution.

Question 10

Q

Lateral Resolution

Answer

A

ability of the transducer to display two targets perpendicular to the path of the sound beam as 2 distinct structures.

Improved with focusing and higher frequency transducers.

Question 11

Q

Propagation Speed of Soft Tissue

Question 12

Q

Propagation Speed of Water

Question 13

Q

Propagation Speed of Blood

Question 14

Q

Propagation Speed of Bone

Question 15

Q

Propagation speed is inversely proportional to:

Answer

A

density, elasticity and compressibility

Question 16

Q

Propagation speed is directly proportional to:

Answer

A

stiffness

Question 17

Q

Reflection

Answer

A

return of the sound beam back to the transducer; responsible for CREATING the image

Question 18

Q

Refraction

Answer

A

change of direction or bending of the sound wave as it passes from one tissue to another

only occurs if there is a change in velocity between 2 media and there is an oblique angle of incidence

Question 19

Q

Attenuation

Answer

A

weakening of the amplitude or intensity as it travels through a medium

Sources include absorption, reflection, scattering, refraction and interference

Question 20

Q

Dynamic range controls:

Answer

A

the number of gray shades represented in the display; the higher the dynamic range, the greater amounts of display and the lower the dynamic range, the less gray displayed (more contrasty)

Question 21

Q

Tissue Harmonic Imaging (THI)

Answer

A

improves the signal to noise ratio, reduces grating lobe artifacts, and improves lateral resolution.

Question 22

Q

What is the major benefit of Tissue Harmonic Imaging (THI)?

Answer

A

artifact reduction

Question 23

Q

B-Flow Imaging

Answer

A

displays the blood flow signal throughout an entire gray-scale image

can simultaneously visualize high and low velocities

detailed organ perfusion, such as renal or liver transplants, neonatal heads and superficial masses

Question 24

Q

Shear Wave Elastography

Answer

A

quantifies tissue stiffness

Question 25

Q

Strain Elastography

Answer

A

known as static or compression elastography; based on manual compression

Question 26

Q

Optimal spectral Doppler angle is ___ degrees.

Answer

A

zero degrees or parallel to vessel flow

zero is not always feasible; angles above 60 may result in errors of velocity calculations

Question 27

Q

Sample volume size or gate determines:

Answer

A

the number of blood cells sampled

Question 28

Q

Spectral analysis display demonstrates:

Answer

A

the direction and range of blood flow velocities in a structure of interest

Question 29

Q

Wall filter

Answer

A

sets the threshold or reject of low-level Doppler shift frequencies

Increasing the wall filter results in the ultrasound system being less sensitive to slow blood flow

Question 30

Q

Color Doppler displays:

Answer

A

mean or average Doppler velocities in a color format

Question 31

Q

Power Doppler displays:

Answer

A

total strength or amplitude of the Doppler signal within a specified region

represents the total number of RBCs in the region regardless of velocity

Question 32

Q

What is an artifact?

Answer

A

Any echo reflection anomaly in the image that does not correlate with actual tissue or structure

Question 33

Q

Posterior Acoustic Enhancement Artifact

Answer

A

A decrease in attenuation.

Mostly seen posterior to fluid filled structures such as cysts.

Question 34

Q

Focal Banding or Focal Enhacement Artifact

Answer

A

A region of echoes having increased or decreased strength, displayed across the width of an image

resolved by adjusting TGC’s

Question 35

Q

Shadowing Artifact

Answer

A

absence or reduction of echo signals distal or posterior to a strong reflecting structure

Indicative of calcium deposits, stones, gas, hard malignant masses, bone, etc.

Question 36

Q

Reverberation Artifact

Answer

A

occurs when the ultrasound beam is repeatedly reflected from an interface near the transducer

Seen as multiple equidistantly spaced linear reflections

Question 37

Q

Comet-Tail Artifact

Answer

A

Type of reverberation that occurs from two highly reflective interfaces and therefore echoes are closely spaced together

seen as multiple echogenic small bands (foreign bodies, surgical clips, needles, sutures, catheters, etc)

Question 38

Q

Ring Down Artifact

Answer

A

Type of reverberation that is thought to be a variation of comet-tail artifact; produced by small gas bubbles and appears as a single long, strong echo behind a reflector

Question 39

Q

Refraction Artifact

Answer

A

when the sound beam strikes adjacent interfaces of differing propagation speeds at an oblique angle; any other angle than 90 degree.

results in an incorrect location of structure

Question 40

Q

Grating Lobes Artifact

Answer

A

echoes placed laterally from true position

Question 41

Q

Section or Slice Thickness Artifact

Answer

A

Placement of echoes in the dependent portion of a fluid filled structure

Question 42

Q

Mirror Image Artifact

Answer

A

occurs in GS, CD and SD imaging.

near-total reflection occurs when an object is located directly in front of a highly reflective object. (diaphragm, pleura, bowel)

Question 43

Q

Aliasing Artifact

Answer

A

MOST COMMON artifact in Doppler Imaging

Occurs when the PRF is not high enough to sample the highest blood velocity

Question 44

Q

Color Bleeding/Blossoming Artifact

Answer

A

when color is seen beyond the area of interest

Question 45

Q

Color Noise Artifact

Answer

A

area of no flow are encoded with color

Question 46

Q

Flash Artifact

Answer

A

Wide region of a burst of color seen within a frame

Question 47

Q

Supine/Dorsal Decubitus

Answer

A

Pt lying face-up position on one’s back

Question 48

Q

Prone/Ventral Decubitus

Answer

A

Pt lying in face down position on one’s abdomen

Question 49

Q

Right Lateral Decubitus

Answer

A

lying on right side

Question 50

Q

Left Lateral Decubitus

Answer

A

lying on left side

Question 51

Q

Right Posterior Oblique

Answer

A

lying on right side at a 45 degree angle with left knee bent

Question 52

Q

Left Posterior Oblique

Answer

A

lying on left side at a 45 degree angle with right knee bent

Question 53

Q

Central Venous Line (CVL)

Answer

A

catheter is placed in a large vein in the neck, chest or leg that leads directly to the heart

Question 54

Q

Contact Precautions

Answer

A

Disease spreads through direct or indirect contact (open wound, draining of body fluids)

Gloves and Gown.

Question 55

Q

Droplet Precautions

Answer

A

Disease spread through acts such as talking, coughing and/or sneezing in which microorganisms travel no more than 3 feet from the pt

Face mask.

Question 56

Q

Airborne Precautions

Answer

A

Disease is spread through fine particles in the air (Tuberculosis)

Fit tested filtering face piece or a powered air-purifying respirator

Question 57

Q

Paracentesis

Answer

A

removal of peritoneal ascites

Question 58

Q

Thoracentesis

Answer

A

removal of pleural fluid

Question 59

Q

The liver, gallbladder and biliary system arise from the caudal end of the foregut during the __ week of gestation.

Question 60

Q

The liver reaches its full development by age __.

Answer

A

15

The right lobe grows faster than the left

Question 61

Q

The ductal system is complete by the __ week of gestation.

Question 62

Q

A connective tissue layer, known as ________, covers the surface of the liver and encapsulates all, but the smallest vessels in the liver.

Answer

A

Glisson’s Capsule

Question 63

Q

The right lobe of the liver is divided from the left lobe by:

Answer

A

the Main Lobar Fissure and Middle Hepatic Vein

Question 64

Q

Caudate Lobe is located ____ to the ligamentum venosum, ___ to the MPV and _____ to the IVC.

Answer

A

posterior to the ligamentum venosum
superior to the MPV
anterior medial to the IVC

Caudate lobe can be spared from disease due to a unique blood supply

Answer 57

A

inferior surface of liver
lies between the GB fossa and falciform ligament

anterior to porta hepatis

Answer 58

A

ligamentum venosum

Answer 59

A

Caudate Lobe
Left Lateral Superior
Left Lateral Inferior
4a. Left Medial Superior
4b. Left Medial Inferior
Right Anterior Inferior
Right Posterior Inferior
Right Posterior Superior
Right Anterior Superior

Answer 60

A

Coronary ligament

Answer 61

A

Falciform Ligament

Continuous with the ligamentum teres

Answer 62

A

Gastrohepatic Ligament

Answer 63

A

Hepatoduodenal Ligament

Answer 64

A

Left Triangular Ligament

Answer 65

A

Right Triangular Ligament

Answer 66

A

Ligamentum Teres or Round Ligament

Originates at the umbilicus and anastomoses with the umbilical portion of the left portal vein

Answer 67

A

more echogenic

Answer 68

A

Celiac Trunk of the Aorta

25-30%

Answer 69

A

Proper Hepatic Artery and Gastroduodenal artery (GDA)

Before branching, the hepatic artery is referred to as the common hepatic artery.

Answer 70

A

left and right hepatic arteries at the porta hepatis

Answer 71

A

anterior medial to MPV

medial to the CBD

Answer 72

A

splenic vein and the SMV

Answer 73

A

anterior and posterior branches

Answer 74

A

medial and lateral branches

LPV connects the umbilical vein remnant through the ligament of teres

Connects the IVC through the ligament venosum which is known as the obliterated ductus venosus

Answer 75

A

Reservoir for blood
Removes damaged RBCs and bacteria by phagocytosis
- Reticuloendothelial cells (Kupffer cells) responsible for clearing pathogens
Metabolizes lipids, proteins, and carbs into energy sources
Nutrient, mineral and vitamin storage
Formation and Excretion of Bile

Answer 76

A

evaluate liver function and liver injury

Answer 77

A

an increase in ALT values indicates damage to the liver usually from hepatitis, hepatocellular disease, or biliary tract obstruction.

Answer 78

A

Increases with hepatocellular disease as well as indicating skeletal and muscular damage

used for detecting liver damage due to hepatitis and cirrhosis

Answer 79

A

increase in ALP indicates liver or bone disease

Children and Adolescents often have an increase in ALP because their bones are still developing and growing.

MOST SPECIFIC INDICATOR OF BILIARY OBSTRUCTION

Paget’s disease, a condition causing excess bone growth and formation, will have an increase in ALP.

Answer 80

A

Increase in direct bilirubin is associated with decreased hepatic excretion, hepatitis, cholestasis and biliary obstruction

Answer 81

A

Increase associated with hemolytic anemia, hepatitis and cirrhosis

Answer 82

A

can be high in newborns due to physiologic jaundice but usually resolves itself in a few days.

Biliary Atresia can cause an increase in total bilirubin and unconjugated bilirubin

Answer 83

A

used as a tumor marker to detect hepatomas and hepatoblastomas

associated with chronic liver disease and chornic hep B or C

Answer 84

A

NPO for 4 hours

Answer 85

A

NPO for 5-6 hours

Answer 86

A

a tongue-like project of the right lobe that extends to the iliac crest

more common in females

Answer 87

A

left lobe may be located to the right of midline or may extend to the left lateral abdominal wall

Answer 88

A

disturbance in the usual location of the right and left distribution of the abdominal and thoracic organs

Associated with polysplenia, asplenia, cardiac defects, biliary atresia

Variable Sonographic findings:

liver located in midline
azygos or hemiazygous continuous of IVC
PV and IVC variations may be seen

Answer 89

A

Congenital disorder resulting in multifocal cystic dilation of the intrahepatic bile ducts as a result of congenital hepatic fibrosis

Associated with fibropolycystic liver disease and polycystic kidney disease

Clinical:

Intermittent RUQ pain
Jaundice
Fever

Sonographic:

Polycystic Liver Disease
Dilated Intrahepatic Ducts
Intraductal Calculi
Small PV branches with dilated bile ducts

Answer 90

A

Results in replacement of pancreatic tissue with fibrosis and fat; autosomal recessive disorder

Clinical:

Failure to thrive
abdominal pain
Jaundice

Sonographic:

Increased liver echogenicity
Micro or macro cysts on pancreas
Small GB and cholelithiasis

Answer 91

A

lipid storage disease; results in accumulation of lipids in brain, spleen, liver, lungs and bone marrow

Risk factors:

inherited
female
fatal

Clinical:

neurological symptoms
feeding and swallowing issues
elevated LFTs

Sonographic Findings:

Hepatosplenomegaly
Increased liver echogenicity
Enlarged nodes

Answer 92

A

lysosomal storage disease which results in increased glucosyleramide

Risks:

Jewish population
Autosomal recessive disorder

Clinical:

Hepatosplenomegaly
Abdominal pain
growth retardation

Sonographic:

Increased liver echogenicity
hepatosplenomegaly
nodular spleen

Answer 93

A

Chronic liver condition due to hepatic fat accumulation or steatosis

Associations:

Portal HTN
Cirrhosis
Hepatocellular Carcinoma

Sonographic Findings:

Hepatomegaly
Diffuse or focal areas of parenchymal echogenicity
The walls of the portal veins blend in due to the increasing parenchymal echogenicity

Answer 94

A

Fat accumulation plus inflammation, fibrosis and necrosis

Answer 95

A

Non-Alcoholic Fatty Liver Disease

Answer 96

A

Disorder characterized by fatty infiltration of the liver and encephalopathy

Typically occurs in young children following a previous viral infection : cold, flu, chicken box, use of aspirin

Answer 97

A

Excessive glycogen accumulates in the organs (Type 1 or Von Gierke’s disease occurs in the neonatal period)

Sonographic:

Increased liver echogenicity
Hepatomegaly
Associated liver cell adenomas

Answer 98

A

Glycogen Storage Disease

Answer 99

A

Disease in which liver tissue is replaced with fibrotic scar tissue

Risk Factors:

Biliary Atresia
Cystic Fibrosis
Chronic Hepatitis

Clinical:

Hepatomegaly
Jaundice
Increase in bilirubin and LFT’s
Ascites

Sonographic:

Decreased liver size
Nodular Surface
Heterogenous Parenchyma
Nodules
Portal HTN
Splenomegaly
Ascites

Answer 100

A

Collection of Pus

Answer 101

A

Abscesses

Answer 102

A

large network of vascular endothelium-lined spaces filled with RBCs

occurs in older children and adolescents

Sonographic:

Hyperechoic
Single or Multiple
Posterior Acoustic Enhacement
Color & Spectral show slow flow

Answer 103

A

benign mass composed of vascular spaces lined by several layers of endothelial cells

Typically diagnosed before 6 months of age

Clinical:

hemangiomas of the skin
abdominal distention
ongestive heart failure
Increased AFP

Sonographic:

well defined
hypoechoic nodule but can appear hyperechoic with cystic changes
single or multiple
Hepatic veins can be enlarged due to increased flow

Answer 104

A

Hemangioendothelioma

Answer 105

A

rare, benign tumor derived from periportal connective tissue or mesenchyme

Children less than 2

Sonographic Findings:

large lesions
complex
poorly circumscribed
swiss cheese appearance of liver
avascular

Answer 106

A

mass comprosed of abnormally arranged hepatocytes, Kupffer cells, bile duct elements and fibrous connective tissue

Clinical:

Hx of chemotherapy for neoplastic diseases
enlarged mass may cause pain
asymptomatic

Sonographic Findings:

Solitary
Well circumscribed
Isoechoic to liver
Central echogenic scar
Peripheral blood flow and blood flow within mass

Answer 107

A

Mass composed of abnormal hepatocytes

Clinical:

Von Gierke’s disease or Type 1 glycogen storage disease
asymptomatic
pain may occur if mass bleeds

Sonographic Findings:

Solitary
well defined
variable appearance
peripheral flow and blood flow within

Answer 108

A

Malignant neoplasm of the liver (infant to 5 years)

Clinical:

Associated with children with predisposing conditions
most common indication is painless abdominal mass with elevated AFP levels

Sonographic:

Hepatomegaly
well defined mass
heterogenous
high velocity, low resistant flow pattern

Answer 109

A

Hepatoblastoma

Answer 110

A

Stage 1: complete resection
Stage 2: resection with microscopic residual disease
Stage 3: resection with residual tumor, positive lymph nodes
Stage 4: metastic involvement

Answer 111

A

Primary malignancy of the liver

Clinical:

over 3 years old
preexisiting liver disease

Sonographic:

solid, hyperechoic mass
large
well defined or ill defined borders
tumor invasion or thrombus of Portal Vein

Answer 112

A

Malignant neoplasm of the lymphatic system

Liver, Renal and Testicular involvement typically from Non-Hodgkin’s Lymphoma

Lung/Thymus involvement typically Hodgkin’s Lymphoma

Clinical:

asymptomatic lymph node enlargement
abnormal pressure and congestion in the face, neck and chest
children over 5

Sonographic:

Focal mass
well-defined
variable appearance

Answer 113

A

Malignant disease involving the blood-forming tissues (bone marrow, lymph nodes and spleen)

Testicular involvement may occur at the same time of initial involvement or may occur after bone marrow remission

Clinical:

characterized by an abnormal increase in WBC
easy bruising or bleeding
non healing of minor wounds

Sonographic:
-Hypo or Hyperechoic lesions

Answer 114

A

Neuroblastoma

Wilm’s Tumor

Leukemia

Lymphoma

Answer 115

A

Portal venous pressure exceeding 5 mmHg or portal vein to hepatic vein gradient greater than 10 mmHg

Caused by a disruption of the flow through the portal system (PV thrombosis)

Sonographic:

Dilated MPV greater than 13mm
Recanalized ligamentum venosum and/or ligamentum teres
Hepatosplenomegaly

Treatment includes portosystemic shunts to reduce pressure within the portal system

Answer 116

A

intrahepatic etiologies, cirrhosis and liver disease

Answer 117

A

A total or partial obstruction of blood flow within the portal vein due to the formation of a thrombus

Cavernous Transformation occurs to bypass thrombotic site, hepatofugal flow happens because the collaterals can’t release the systems pressure

Clinical:

trauma
neonatal peritonitis
umbilical catheterization
sepsis

Answer 118

A

a collection of blood within or adjacent to liver usually from trauma

Commonly located in posterior segment of right lobe
Variable appearance based on age of hematoma

Answer 119

A

collection of bile in the liver or peritoneal cavity which is a late complication of hepatic trauma

Sonographic findings:

anechoic collection of fluid
thin walled
resolve spontaneously

Answer 120

A

Hartman’s Pouch

Answer 121

A

Length: 1.5-3 cm
Wall: less than 3 mm

Answer 122

A

Length: 3-7 cm
Wall: less than 3 mm

Answer 123

A

Cystic Duct

Answer 124

A

Duct of Luschka

Associated with bile leaks following surgical procedures

Answer 125

A

Common Bile Duct (CBD)

Answer 126

A

1-5 mm in diameter

Answer 127

A

Neonates: <1mm
Children up to 1: <2mm
1-10 years: <4mm
Adolescents/Yound Adults: <6mm

Answer 128

A

proximal small intestine

after eating, the acids are then transported to the distal ileum for absorption and maintenance

Answer 129

A

Junction fold - a fold at the GB neck

Answer 130

A

Phrygian Cap

Answer 131

A

complete absence of the GB with normal bile ducts

Answer 132

A

Congenital obstruction of biliary system that can affect intra or extrahepatic ducts

Clinical:

males
jaundice
acholic stools

Sonographic:

GB may or may not be affected (abnormal looking GB if affected)
“Triangle Cord Sign” : seen superior to PH which is a premature bile duct

Kasai Procedure and Liver Tx are treatments

Answer 133

A

Echogenic structure resembling a triangle that is found superior to porta hepatis.

Sign of biliary atresia

Answer 134

A

Cystic dilation of the biliary tree

Clinical:

Asian population
Female
Biliary Atresia

Sonographic:

Saccular dilation of the CBD or CHD
dilated cystic lesion that communicates with the bile ducts and is separate from the GB

Answer 135

A

Congenital disorder resulting in multifocal dilation of the intrahepatic ducts as a result of congenital hepatic fibrosis

Associated with polycystic liver and kidney disease

Answer 136

A

Adolescents

Answer 137

A

massive distention of the GB in the absence of inflammation

Greater than 3cm in length in children less than 1 and greater than 7 cm in length in older children

Answer 138

A

Conjugated hyperbilirubinemia occurring in neonates

Clinical:

jaundice
acholic stools
dark yellow urine

Sonographic:

Dilation of the biliary ducts
Gallstones
Sludge

Answer 139

A

Inflammation of the GB without gallstones

Clinical:

critcally ill patients
RUQ pain
Fever/Vomiting

Sonographic:

Edematous GB wall
GB wall measures >3mm
Pericholecystic Fluid
GB Distention

Answer 140

A

An acute inflammation of the GB usually from GB obstruction at the level of the cystic duct or GB neck

Clinical:

RUQ pain
Fever/Nausea/Vomiting

Sonographic:

GB wall thickening
Sludge
Pericholecystic Fluid
Hyperemia
Positive Sonographic Murphy’s Sign

Answer 141

A

Acute Calculus Cholecystitis

Answer 142

A

Prolonged inflammatory condition that is caused by intermittent blockage of the cystic duct

Sonographic Findings:

Contracted GB
Stones
Thick, hyperemic wall
Sludge

Answer 143

A

Inflammatory fibrosis of intra and extra hepatic ducts

Sonographic Findings:

Dilated bile ducts
Thickened bile duct walls
Choledocholithiasis
Cholelithiasis

Answer 144

A

Complete or partial obstruction of the bile ducts by biliary stones

large foci may cause intra or extra hepatic ductal dilatation

Answer 145

A

Extrahepatic biliary obstruction due to impacted cystic duct and associated extrinsic compression or inflammation of the cystic duct

Answer 146

A

Extrahepatic bile duct syndrome due to sludge

Echogenic debris within bile ducts

Answer 147

A

Rare malignant tumor made up of muscle tissue that arises from the porta hepatitis/trigone of bladder

usually found in children between 2-6 years and 14-18 years

Clinical:
-obstructive jaundice
-abdominal pain
-weight loss
elevated bilirubin, Alkaline phosphatase and WBC

Sonographic:

echogenic mass within bile ducts
may appear complex due to necrosis or hemorrhage
absence of posterior shadowing

Answer 148

A

non-epithelial tumor of the extrahepatic ducts

Clinical:

female
African American
Adolescents
jaundice
abdominal pain

Sonographic:

echogenic mass within the bile ducts
may appear complex due to necrosis or hemorrhage
absence of posterior shadowing

Answer 149

A

Retroperitoneal

Answer 150

A

right lateral to the SMV

Anterior to the IVC

caudal to the MPV

Answer 151

A

GDA: anterior lateral

CBD: posterior lateral

Answer 152

A

Duct of Wirsung

located within head and body of pancreas and merges with CBD

Answer 153

A

Duct of Santorini

Small branch of main pancreatic duct and located within head of panc

Answer 154

A

3 mm in the head

2 mm in the body

Answer 155

A

Pancreas

Exocrine: glands that secrete hormones through ducts
Endocrine: glands that secrete hormones without ducts

Answer 156

A

Lipase - fat
Trypsin - proteins
Amylase - carbohydrates

Answer 157

A

Cholecystokinin, gastrin and secretin

Answer 158

A

Islet cells of Langerhans

Answer 159

A

Alpha - glucagon
Beta - Insulin
Delta - Somatostatin

Answer 160

A

Pancreatic head encircles the duodenum

Clinical:

partial or complete duedenal atresia
males
asymptomatic
vomiting

Sonographic:
-circumferential band of tissue surrounding the duodenum

Answer 161

A

Complete or incomplete fusion of the pancreatic ducts

Complete: 2 seperate pancreatic duct systems
Incomplete: small branch between dorsal and ventral pancreatic ducts

Clinical:

pancreatitis
pancreatitis symptoms

Sonographic:

difficult to visualize
normal to enlarged pancreatic head

Answer 162

A

Pancreatic Divisum

Answer 163

A

Presence of pancreatic tissue outside of the pancreas (greater curvature of stomach, pylorus, duodenal bulb, prox jejunum, ileum, Meckel’s diverticulum)

Clinical:

severe epigastric pain
biliary disease
weight loss

Answer 164

A

Tumors arising from multiple organs

Pancreatic cysts are a common lesion of VHL (Type 1 is NOT associated with pheochromocytomas and Type 2 is associated with pheochromocytomas)

Sonographic:
-anechoic fluid filled pancreatic mass(es) with through transmission

Answer 165

A

congenital anomalies, exocrine pancreatic dysfunction, bone marrow failure, metaphyseal dysostosis and swarfism.

Sonographic:
Hyperechoic pancreas with variable size

Answer 166

A

Sudden on set of inflammation to part or all of the pancreas

Clinical:

elevated amylase
elevated lipase
eleaved WBC
trauma
hereditary
viral infections

Sonographic:

diffusely enlarged pancreas
possible lymph nodes seen
fluid collections
abscess
pseudocysts

Answer 167

A

Relapsing pancreatitis resulting in pancreatic fibrosis and destruction of pancreatic cells

Clinical:

abdominal pain
jaundice

Sonographic:
-calcifications
heterogenous
-increased echogenicity

Answer 168

A

Fluid collection of pancreatic enzymes with a fibrous capsule

Clinical:

acute pancreatitis symptoms
abdominal pain
elevated amylase

Sonographic:

variable location
single or multiple
well defined walls with variable internal appearance

Answer 169

A

Malignant neoplasm of the acinar cells of the pancreas

Clinical:

occurs in the first decade
males
asian descent
beckwith-wiedemann syndrome
favorable outcome

Sonographic Findings:

large
well defined mass
variable appearance
vascularity within the mass

Answer 170

A

Aggressive malignant neoplasm arising from the ductal epithelium of acinar cells

Clinical:

Diabetes
Chronic Pancreatitis
Abdominal pain

Sonographic Findings:

poorly defined hypoechoic mass
biliary and pancreatic duct dilatation

Answer 171

A

Arise from the tissue of the Isles of Langerhans

Functional tumors: increased amounts of hormones
Nonfunctional tumors: may go undetected until they produce a palpable mass

Answer 172

A

Insulinoma (usually benign)
Gastrinoma (rare, malignant with mets to liver)
Nonfunctioning Tumors (malignant potential)

Answer 173

A

Insulinoma

Answer 174

A

Hematoma
Laceration
Fracture
Posttraumatic pancreatitis

Sonographic Findings:

pancreatic enlargement
edematous pancreas
fluid collections
linear areas representing fractures or lacerations

Answer 175

A

Pronephros
Mesonephros (functional embryonic kidney)
Metanephros (permanent kidney)

Answer 176

A

Pronephros regress at 4 weeks.

Mesonephros regress at 9 weeks.

Metanephros develop into the permanent kidneys.

Answer 177

A

By 15-20 weeks gestation

Answer 178

A

Neonates: 3.4-5 cm
5 years: 5-8 cm
10 years: 6-11 cm

Large kidneys are defined as 2 standard deviations above the mean.
Small kidneys are defined as 2 standard deviations below the mean.

Answer 179

A

Cortex is more echogenic than the liver and spleen.

Sinus is not echogenic due to the lack of fat.

Pyramids are hypoechoic and triangular in appearance.

Answer 180

A

Cortex is hypoechoic to liver and spleen.

Increased echogenicity of sinus.

Answer 181

A

anterior to the ureter
posterior to the renal vein

so from anterior to posterior:
Renal Vein
Renal Artery
Ureter

Answer 182

A

Main renal artery -> segmental -> interlobar -> arcuate -> interlobular -> afferent arterioles

Answer 183

A

Efferent arterioles -> interlobular veins -> arcuate veins -> interlobar veins -> segmental veins -> main renal vein

Answer 184

A

Serosa - outer layer
Muscle - middle layer
Mucosa - inner layer

Answer 185

A

Distended: 3 mm

Non-Distended: 5 mm

Answer 186

A

Renal dysfunction

Answer 187

A

BUN (blood urea nitrogen)

Answer 188

A

Chronic Renal Disease

Answer 189

A

Contour lobulation persisting after 5 years of life

Scalloped contour may appear similar to a cortical mass

Answer 190

A

A renal pelvis that is normally positioned within the kidney sinus appears to bulbously extend outward in the absence of urinary tract obstruction

Answer 191

A

An inward extension of the cortex between the renal pyramids extending into the sinus

Mimics the appearance of a renal mass and splays the calyces

Answer 192

A

A cortical bulge found on the lateral aspect of the left kidney

May be referred to as a pseudo tumor

Answer 193

A

Results when the kidney fails to migrate into the renal fossa

Pelvic Kidney which can be small and malrotated

Answer 194

A

Both kidneys located on the same side of the spine; left kidney is typically located on the right

Ectopic kidney lies inferior to the normally positioned kidney and the upper pole of the ectopic kidney is fused to the lower pole of the normal kidney.

Answer 195

A

congenital absence of the kidney with the presence of a normal adrenal gland

Associated with chromosomal abnormalities and genito anomalies

High blood pressure may be present

Answer 196

A

Absence of both kidneys

Associated with Potter’s syndrome, oligohydramnios in uteruo and pulmonary hypoplasia

Fatal

Answer 197

A

Fusion of the right and left kidneys which usually occurs at the lower poles

Answer 198

A

Horseshoe Kidney

Answer 199

A

A congenital small functioning Kidney

Unilateral - asymptomatic
Bilateral - hypertension, VUR

Answer 200

A

incomplete fusion of the upper pole moiety resulting in a complete or incomplete duplication of the renal collecting system

Answer 201

A

Duplex Collecting System

Answer 202

A

The urachus from the anterior bladder wall to the umbilicus remains open

Answer 203

A

Portion of the urachus at the umbilical end is open and the portion closest to the bladder is closed.

Answer 204

A

Urine is trapped in the middle portion of the urachus

Answer 205

A

Portion of the urachus at the umbilical end is closed and the portion closest to the bladder is open.

Answer 206

A

Enlarged bladder

Answer 207

A

Enlarged bladder and ureters

Answer 208

A

Enlarged bladder, ureters and renal pelvis
Dilated small bowel
Small colon

Answer 209

A

Failure of urine to drain from the kidney resulting in dilatation of the renal pelvis and calyces.

Grade 1: dilatation of the renal pelvis only
Grade 2: dilatation of the renal pelvis and some of the calices
Grade 3: dilatation of the renal pelvis and all of the calices
Grade 4: dilatation of the renal pelvis, all of the calices plus parenchymal thinning

Answer 210

A

Obstruction of urinary flow due to an instrinsic narrowing at the UPJ level

Arise from calculi, infections such as pyelonephritis and hemorrhage

Dilated renal pelvis and/or calyces with a collapsed proximal ureter

Answer 211

A

UPJ Obstruction (Ureteropelvic Junction)

Answer 212

A

obstruction of urinary flow at the insertion of the ureter into the bladder

neurogenic bladder in children with spinal anomalies and bladder outlet obstruction or PUV

Answer 213

A

Obstruction of urinary flow at the level of the posterior urethra valve in the urethra (results from an abnormal mucosal flap, fold or urethral tissue)

Sonographic:

Hydro
Dilated ureters
Thin, hyperechoic parenchyma
Loss of corticomedullary differentiation
trabeculated, thick walled bladder
keyhole bladder

Answer 214

A

PUV Obstruction

Answer 215

A

Congenital, non hereditary cystic renal disease

MCDK will eventually involute and the contralateral kidney will compensate for renal function.

If bilateral, the result is fetal demise.

Sonographic:

Multiple anechoic cysts of varying sizes throughout kidney
renal parenchyma not visualized
large kidney progressing to unidentifiable kidney with increasing age

Answer 216

A

Bilateral symmetric microcystic disease

Also known as infantile polycystic kidney disease

Sonographic:

enlarged, echogenic, normal shaped kidneys
microcysts in medulla and cortex
medullary pyramids appear hypoechoic in the early stage and become hyperechoic with a loss of corticomedullary differentiation later on

Answer 217

A

Uni or bilateral cystic disease

Also known as adult polycystic kidney disease (often associated with 4th decade of life)

Sonographic:

enlarged, lobulated kidneys
cysts of different sizes
renal parenchyma between the cysts is normal
normal tissue may become compressed due to cysts and later atrophy

Answer 218

A

Abnormal development of kidneys in the womb leading to abnormal kidneys

Associated with Prune Belly Syndrome and Eagle-Barrett Syndrome

Sonographic:

kidneys will appear large or small
abnormal renal parenchyma
may or may not have renal cysts
dilated renal collecting system or pelvis

Answer 219

A

Infection of the upper urinary tract

Sonographic:

normal to enlarged kidneys
areas of increased or decreased echogenicity
absence of perfusion
loss of corticomedullary differentiation

Answer 220

A

Calcium deposits in both kidneys

Seen in neonates with a metabolic disorder, which allows for the formation of calcium deposits later in life

Sonographic:

echogenic pyramids
shadowing may or may not be present

Answer 221

A

Benign renal tumor composed of blood vessels, smooth muscle cells and fat cells. It is usually associated with Tuberous Sclerosis.

Sonographic:

multiple hyperchoic masses in renal cortex
cysts may be seen
renal enlargement

Answer 222

A

Mass typically seen in the hilar region usually found in infants younger than 3 months.

Sonographic:

Solid well defined lesion
may appear cystic with changes due to hemorrhage or necrosis
distorted collecting system or parenchyma

chemo is used if lesion is not completely resected. Surgery often requires a complete nephrectomy.

Answer 223

A

Formed from persistent benign remnants of embryoic renal tissue beyond 36 weeks. Often stationary and slow growing but can develop into a Wilm’s Tumor.

Nephroblastomatosis describes multifocal or diffuse nephrogenic rests (found within intralobar and perilobar).

Sonographic:

hypoechoic nodules with diffuse nephroblastomatosis
renal enlargement with diffusely decreased echogenicity

Answer 224

A

Mesoblastic Nephroma (Fetal Renal Hamartoma)

Answer 225

A

Malignant tumor arising from mesodermal precursors of renal parenchyma and mesnephric remnants

Also referred to as nephroblastoma

Peaks at 3-4 years

Associated with Beckwith-Wiedemann Syndrome

Clinical:

painless RUQ fullness
asymptomatic
palpable mass

Sonographic Findings:

large, heterogenous solid well demarcated renal mass
displaces other tissues
renal vein or IVC thrombus

Answer 226

A

Wilm’s Tumor (Nephroblastoma)

Answer 227

A

Stage l: unilateral mass; intact renal capsule post surgery

Stage ll: unilateral mass that has grown into nearby tissue/blood vessels; regional tumor excision

Stage lll: unilateral tumor; mass not completely removed by surgery

Stage lV: unilateral tumor; mets to lung, liver bone and/or brain

Stage V: bilateral renal masses

Answer 228

A

Wilms engulfs the kidney, renal parenchyma in origin and displaces the vessels

Neuroblastoma is 90% calcific, displaces the kidney, adrenal in origin and encases the IVC and aorta

Answer 229

A

Malignant tumor of the renal parenchyma

Rare in first 2 decades of life (mean age is about 10 years in children)

More likely to metastasize to bone than Wilm’s

Associated with Von Hippel-Lindau Syndrome

Sonographic:

hypoechoic, isoechoic, or hyperechoic mass
homogeonous or heterogenous
tumor extension in the renal veins and IVC

Answer 230

A

malignant tumor arising from the medulla of the kidney

highly aggressive

found before 1 year of age

Sonographic:

large renal mass
heterogenous
poorly defined margins
calcifications
tumor extension into IVC and renal veins

Answer 231

A

Malignant tumor arising from the medulla of the kidney

highly aggressive

peaks between 1-4 years of age

Sonographic Findings:

heterogenous
poorly defined margins
cystic changes

Answer 232

A

Malignant epithelial tumor arisisng from the renal pelvis

Highly agressive
males
african american

Associated with Sickle Cell Trait

Sonographic Findings:

heterogenous mass
areas of hemorrhage or necrosis
fill renal pelvis
hypovascular
may invade surrounding structures

Answer 233

A

rare, non-thrombocytopenic small vessel vasculitis of autoimmune hypersensitivity

males
3-10 years

Sonographic Findings:

echogenic kidneys
intussusception
massive scrotal edema
bowel wall edema

Answer 234

A

Left adrenal hemorrage

Answer 235

A

accumulation of lymph fluid

result from renal transplant in which lymph fluid is leaked from severed lymphatic vessels or allograft

develops 2-8 weeks post surgery

Answer 236

A

collection of urine

associated with blunt trauma, transplant, postop complication and GI abnormality

Answer 237

A

Diliation and herniation of the ureter into the bladder

Intravesical: within the bladder
Extravesicial: portion at the level of the bladder or neck of urethra
Ectopic: insertion of ureter into the bladder

Answer 238

A

Herniation of the mucosa through the muscular wall

Arises from the base of the bladder or ureter orifice

Answer 239

A

nodular changes in bladder mucosa

Sonographic Findings:

irregular bladder mass
hyperechoic
broad base
may protrude into the bladder

Answer 240

A

Urethral Polyp

Answer 241

A

Transitional Cell Carcinoma

Answer 242

A

primary malignant epithelial tumor originating from the epithelial lining of the urinary tract

Sonographic Findings:

polypoid protusion into bladder lumen
focal irregular wall thickening

Answer 243

A

A term used to describe a dysfunctional urinary bladder as a results of an injury to the central or peripheral nerves that controls bladder regulation.

Spina bifida is a risk factor.

Sonographic Findings:

thick, irregular bladder wall with a small contracted or large bladder
echogenic bowel mucosa

Answer 244

A

anterior, medial and superior

Answer 245

A

3

Zona Glomerulosa
Zona Fasciculate
Zona Reticularis

Answer 246

A

secretes steroids:

produces aldosterone, glucocorticoids and stimulates production of testosterone and estrogen

Answer 247

A

regulates blood pressure and HR

secretes epinephrine and norepinephrine

Answer 248

A

10 to 20 times larger

Answer 249

A

Infant measures 1/3 of renal length

After one year its 1/13

Answer 250

A

absence of the adrenal gland or glands

If uni, associated with ipsilateral renal agenesis (and a decrease in size of remaining adrenal gland)
if bi, complete absence of cortisol, aldosterone and catecholamines

Answer 251

A

Failure in the development of the adrenal cortex (x-linked)

Answer 252

A

inherited disorder that results in low levels of cortisol and high levels of male hormones, causing development of male characteristics in females, and early puberty in both boys and girls

leads to ambiguous sexual development in newborn females

Sonographic Findings:

enlarged gland
abscence of central hyperechoic stripe
accessory adrenal glands

Answer 253

A

adrenal tissue in various locations in the body

Locations:
celiac plexus
testicles
pelvis near the ovaries and broad ligament
inguinal canal

Answer 254

A

A rare disorder of lipid and acid lipase which leads to an accumulation of cholesterol and triglycerides in organs

Adrenals are the organs most commonly affected

Sonographic Findings:

bilaterally enlarged glands
calcified with posterior shadowing

Answer 255

A

Benign epithelial tumor that may be function or non functioning

associated with cushings and conn’s diease

Sonographic Findings:
-small, round, hypoechoic mass

Answer 256

A

benign tumor arising from adrenal medulla

2nd-5th decade of life
higher prevalence on the right

Clinical:
headache
excessive sweating
tachycardia

Sonographic Findings:

focal solid mass
variable appearance
uni or bilateral

Answer 257

A

malignant tumor that arises from the sympathetic nervous system, mostly from adrenal gland but can arise anywhere along the chain

In children less than 1, mets are usually to the liver and skin with good prognosis

In older children, mets to the bone results in poor prognosis

Sonographic Findings:

heterogenous
internal vascularity
calcifications
displacement of kidney as well as encasing IVC and aorta

Answer 258

A

Neuroblastoma

Answer 259

A

Secondary to a traumatic delivery or stress

Sonographic Findings:

anechoic, avascular mass
early stage: solid with diffuise or inhomogenous echogenicity
late: mixed echogenicity with hypoechoic regions with later turn cyst like

Answer 260

A

up to 3 months: less than 6cm in length

3 months - 12 years: 6-12 cm in length

Answer 261

A

filter blood and produces immunity cells

Answer 262

A

remnants of the grooves separating the splenic lobulations in utero

2-3 cm indentation in the splenic parenchyma

Answer 263

A

genetic mutation in african americans resulting in altered shape and plasticity of RBCS

leads to increased viscosity, stasis, small vessel occlusion, infarction and necrosis

Sonographic Findings:

enlarged spleen in children (splenomegaly)
atrophy later in life

Answer 264

A

Parasitic infection cause by tapeworms

Most common cause of splenic cysts worldwide

Sonographic Findings:

solitary cyst with or without daughter cysts
echogenic septations
egg-shell calcification of borders

Answer 265

A

Hemangioma

Answer 266

A

Infarction

Answer 267

A

occlusion of segment of splenic arterial supply

Sonographic Findings:

wedge shaped lesion
variable echogenicity

Answer 268

A

Splenic vein thrombosis

Answer 269

A

Posttraumatic Splenic Cyst

*A psuedocyst lacks epithelial lining

Answer 270

A

12-14 weeks gestation

Answer 271

A

esophagus and stomach

Answer 272

A

stomach and duodenum

Answer 273

A

pancreatic head

Answer 274

A

midline and LUQ

Answer 275

A

midline and RLQ

Answer 276

A

6mm or less

Answer 277

A

Hyperechoic - mucosal layer
Hypoechoic - intramural layer
Hyperechoic - submucosa
Hypoechoic - muscularis propria
Hyperechoic - serosal layer

Answer 278

A

Small underdeveloped stomach

Sonographic Findings:
Small tubular stomach
Midline positioned stomach
dilated esophagus

Answer 279

A

Blind ending tube containing tissue layers found in the ileum

Most common congential diverticulum of the GI tract

Clinical:

less than 2 years
pain
small bowel obstruction
intussuception

Sonographic Findings:

Hypoechoic tubular or cystic mass (either ML or RLQ)
Hyperemia of the wall

Answer 280

A

Meckel’s Diverticulum

Answer 281

A

Meckel’s Diverticulum

Answer 282

A

newborn bowel obstruction of the distal ileum due to abnormally thick and impacted meconium

Sonographic Findings:

hyperechoic bowel
dilated loops of bowel
decreased peristalsis

Answer 283

A

The invagination of one portion of the bowel into another by peristalsis

Children 3 months - 3 years
Majority are ileocolic

Clinical:

intermittent abdominal pain
vomiting
bloody and mucous stools

Sonographic Findings:

doughnut or target sign in transverse
sandwich or pseudokidney in long

Treatment:

air reduction
barium enema
surgery

Answer 284

A

Complication of malrotated bowel resulting in proximal bowel obstruction or ischemia

SMA and SMV are compressed due to twisting of the bowel

Symptoms can mimic pyloric stenosis

Sonographic Findings:

whirlpool sign
dilated duedenum prox to obstruction
inverted SMA and SMV

Urgent surgical repair is required to prevent bowel ischemia

Answer 285

A

Gastric disorder of the pyloric opening resulting in enlargement and thickening of the pyloric muscle

Canal becomes hypertrophied resulting in a narrow lumen and obstructing gastric contents into duodenum

Affects male infants more than females

2 weeks-10 weeks

Clinical:

Failure to thrive
palpable olive RUQ
non bilious projectile vomiting

Answer 286

A

Muscle Thickness: greater than 3 mm
Channel Length: greater than 17 mm
Pyloric muscle length: greater than 20 mm
Transverse diameter: greater than 10 mm

Answer 287

A

Chronic inflammatory condition of the GI tract

Most common inflammatory disease of the small bowel
Children over 10 years

Clinical:

weight loss
fever
abdominal pain
diarrhea

Sonographic Findings:

target pattern
thickened bowel wall
non-compressible bowel loop
reduction or loss of peristalsis

Answer 288

A

Inflammation of the appendix

Cause by obstruction of the appendix lumen

Clinical:

periumbilical/flank pain
fever
localized pain the RLQ (McBurney sign)
Rebound tenderness

Sonographic Findings:

target appearance in trans
non-compressible
echogenic fat surrounding
periappendiceal fluid
appendicolith
greater than 6cm in diameter

Answer 289

A

Appendicitis

Answer 290

A

Gastric mass derived from partially digested or undigested material

Trichobezoar - hair or hair-like fibers
Phytobezoar - indigestible food fibers
Pharmacobezoar - medications

Clinical

intestinal blockage
ulcers
GI bleeding

Sonographic Findings:

complex mass
echogenic linear structures
with or without shadowing

Answer 291

A

tubular or spherical congenital malformation of GI tract

Clinical:

abdominal pain
bowel obstruction
palpable mass
GI bleeding

Sonographic Findings:

anechoic to hypoechoic mass
gut signature features may be apparant

Answer 292

A

Benign growths occuring on the lining of the GI tract (most common benign tumor of the small bowel in children)

Sonographic Findings:

intraluminal nodules
non-mobile

Answer 293

A

GI Polyps

Answer 294

A

A common but serious GI disease occurring in premature infants.

Ischemic disease of GI tract.

Clinical:

abdominal distention
bile-stained vomiting
signs of sepsis
bloody stools

Sonographic Findings:

bowel wall thickening
free fluid
portal venous gas

Answer 295

A

maintains body metabolism, growth and development

Controls basal metabolic rate (BMR)

Answer 296

A

2 sets or four parathyroid glands with a possible fifth known as supernumerary

Answer 297

A

congenital cyst of the neck

Sonographic Findings:

midline cystic mass
can be anechoic or irregular appearing (inflammed cyst)

Answer 298

A

Thyroglossal Duct Cyst

Answer 299

A

loss of thyroid function resulting in inadequate thyroid hormone production

Most common cause is dysgenesis

Clinical:

goiter
abnormal facial features
jaundice
poor weight gain
abnormal TSH (can be increased or decreased)
Decrease in T3 and T4

Sonographic:

normal echogenicity
varying size (small or large)

Answer 300

A

Congenital epithelial cyst

Most common non-inflammatory lateral neck mass in children

Sonographic Findings:

variable appearance
cyst like or hemorrhagic/infected

Answer 301

A

Cystic lymphatic malformation found posterior to the neck

Sonographic Findings:

thin walled
anechoic
may have striations

Answer 302

A

autoimmune thyroid disease in which antibodies attack the thyroid tissue

Most common type of thyroiditis and thyroid dysfunction in children
Most common cause of acquired hypothyroidism

Clinical:

painless enlargement of thyroid gland
Increased TSH
decreased T4
decreased to normal T3

Sonographic Findings:

varies with stage
early: enlargement, hypo to hetero, ill-defined nodules
late: small, hyperechoic, cervical adenopathy
normal to decreased blood flow

Answer 303

A

Increased thyroid activity of the thyroid gland resulting in excessive release of thyroid hormones

Most commonly associated with Grave’s Disease

Clinical:

weight loss
tremor
excessive sweating

Sonographic Findings:

varies with cause
gland enlargement
normal to hypo
hypervascularity (known as thyroid inferno)

Answer 304

A

Autoimmune disorder caused by an over production of thyroid hormones

most common cause of hyperthyroidism in children

Clinical:

irritability
heat intolerance
tachycardia

Sonographic Findings:

gland enlargement
lobulated
normal to hypo
hypervascularity (known as thyroid inferno)

Answer 305

A

Inflammation of the thyroid resulting in diffuse enlargement (usually from bacterial or viral infection)

Clinical:

fever
painful, enlarged thyroid

Sonographic Findings:

enlarged thyroid
lobulated
single or multiple masses, some abscess
hypervascularity

Answer 306

A

Benign lesions from over-proliferation of thyroid follicular cells

most frequent benign neoplasm of the thyroid

Sonographic Findings:

single or multiple
well defined
round or oval
varying echogenicity
hypoechoic halo
vascular rim

Answer 307

A

Enlarged thyroid containing multiple nodules

Clinical:

adolescent girls near puberty
previous radiation therapy

Sonographic Findings:

enlarged, heterogenous gland
variable echogenicity
nodules
blood flow normal to increased

Answer 308

A

malignant disease of the thyroid that arises from the thyroid tissue

accounts for 70-90% of thyroid cancers in children
(uncommon before age 15)

Clinical:

normal thyroid function
palpable neck mass
cervical adenopathy

Sonographic Findings:

solid lesion
thick, irregular, or absent peripheral halo
variable appearance
calcifications
irregular margins
abnormal lymph nodes

Answer 309

A

Malignant disease of the thyroid originating from follicular cells

Clinical:

normal thyroid function
palpable neck mass
female

Sonographic Findings:

solid lesion
thick, irregular, or absent peripheral halo
variable appearance
calcifications
irregular margins
abnormal lymph nodes

Answer 310

A

malignant disease of the thyroid arising from parafollicular cells and secretes calcitonin

Clinical:

female
strong family history
elevated serum calcitonin
palpable neck mass
cervical lymphadenopathy

Sonographic Findings:

solid lesion
thick, irregular, or absent peripheral halo
variable appearance
calcifications
irregular margins
abnormal lymph nodes

Answer 311

A

malignant thyroid tumor that develop as a second primary tumor

higher mortality rate than primary tumors

Clinical:

15-19 years old
palpable nodule
cervical adenopathy
possible pain or loss of voice

Sonographic Findings:

small
solid lesion
thick, irregular, or absent peripheral halo
variable appearance
calcifications
irregular margins
abnormal lymph nodes

Answer 312

A

Diffuse enlargement with develops as a result of excess parathyroid hormone production.

Secondary hyperparathyroidism is a result of hypercalcemia

Sonographic Findings:

enlarged parathyroid glands
located separately from thyroid by thin echogenic line
may appear as multiple homogenous low-level solid nodules

Answer 313

A

Benign proliferation of fibrous tissue infiltrating the sternocleidomastoid muscle

Clinical:

neonates and young infants
found clinically as a palpable, non-tender mass in infants with torticollis

Sonographic Findings:

focal hyperechoic mass within the body of SCM muscle
diffuse enlargement of SCM
heterogenous muscle echotexture
enlargement noted with comparison to contralateral side

Answer 314

A

Infection of the lymph nodes in the neck

Common in pediatric population (usually caused by viral or bacterial infection)

Clinical:

enlarged cervical nodes
neck pain

Sonographic Findings:

oval
well-defined mass
hypoechoic
echogenic hilum

Answer 315

A

Left: 2
Right: 3

Answer 316

A

Mass of non-functioning lung tissue separate from the normal tracheobronchial tree

two types: extralobar and intralobar

extralobar: congenital (associated with maternal hydrops and polyhydramnios)
intralobar: acquired (associated with pneumonia, bronchial obstruction)

Sonographic Findings:

solid echogenic mass
cystic changes may be seen
mass is commonly triangular in shape
color doppler shows an anomalous blood vessel connected to the aorta

Answer 317

A

Multicystic mass within the lung

also referred to as CPAM

Type 1: cysts greater than 2 cm
Type 2: multiple small cysts
Type 3: microcysts

Sonographic Findings:

usually unilateral
displacement of mediastinal structures may occur
echogenicity varies with type (refer to above)

Answer 318

A

herniation of abdominal viscera into the fetal chest as a result of a defect in the diaphragm

may contain stomach, intestines, liver and/or spleen

usually occurs on the left

2 types:
Bochdalek: defect in posterolateral (most common)
Morgagni’s: defect anterior

Sonographic Findings:

absence of or incomplete visualization of diaphragm
displaced heart
stomach may appear as a cystic mass in chest
hypoechoic or cystic structures respresenting bowel in chest
liver may herniate if a right sided defect is present

Answer 319

A

failure of the fetal lung bud to develop into primitive lung tissue

variable locations

Sonographic Findings:

well-defined
round mass
varying echogenicity depending on content
peripheral flow

Answer 320

A

thymic tissue positioned abnormally anywhere along the path of descent

Clinical:

palpable, non tender, soft tissue mass
bulging mass like projection from suprasternal region

Sonographic Findings:

well defined
homogenous, hypoechoic mass
located in lower cervical area, anterior to trachea and inferior to thyroid

Answer 321

A

Abnormal collection of air or gas in the pleural space (collapsed lung)

Associated with trauma or known lung disease

Sonographic Findings:
-absence of normal sliding lung

Answer 322

A

abnormal collection of fluid in the pleural space

Clinical:

respiratory distress
SOB
cough
abnormal x-ray

Sonographic Findings:
-anechoic fluid located in dependent lung portion

Answer 323

A

Solidification of lung tissue due to an accumulation of solid and liquid material in the air space that is normally filled with air

affects lung ability to expand

Most common cause is pneumonia

Sonographic Findings:

homogenous mass seen floating in pleural effusion
air bubbles in bronchi during respiration
absence of sinusoid sign (M-Mode)

Answer 324

A

mass composed of hair, fat, bone, cartilage, muscle, GI tissue, thyroid tissue

Immature: solid, malignant
Mature: cystic, benign

Sonographic Findings:

variable size and appearance
compress or displace surrounding structures
avascular to hypovascular

Answer 325

A

Rare tumor derived from pulmonary tissue or the pleura

Type 1: cystic
Type 2 and 3: solid

Most common primary lung neoplasm in children

Sonographic Findings:

variable appearance
distort surrounding structures

Answer 326

A

Pleuropulmonary Blastoma

Answer 327

A

absence of diaphragmatic motion

unilateral or bilateral

Birth trauma, spinal cord injuries, neuropathic disease

Sonographic Findings:

echogenic diaphragm
absence or paradoxial motion of one side of the diaphragm motion during imaging

Answer 328

A

Abnormal inverted position of the diaphragm

Sonographic Findings:

inverted appearance
abnormal movement
presence of thoracic mass or fluid collection

Answer 329

A

mesonephric

Answer 330

A

neonate: 1.5 cm in length
children up to 6: 2 cm in length
postpubertal: 3-5 cm in length

volume of less than 5mL prior to age 12

Answer 331

A

increases

Answer 332

A

WBC increase with INFECTION

Testosterone increases with MALIGNANCY

Hematocrit is abnormal in cases of TRAUMA

AFP increases with NON-SEMINOMA GERM CELL TUMOR

HCG increases with SEMINOMA AND NON-SEMINOMA TUMOR

Answer 333

A

Occurs when the testicles or teste has not descended into the proper location within the scrotal sac

80% are found in the inguinal canal

Smaller measurements than normal

Answer 334

A

Infection of the epididymitis

Most commonly caused by a UTI in children

Clinical:

pain increases over a period of 1 or 2 days due to the infection
fever
dysuria
swollen testicle
increased WBC

Sonographic Findings:

enlarged head
scrotal wall thickening
decreased echogenicity
increased flow to affect area(s)

Answer 335

A

Epididymitis

Answer 336

A

Inflammation of the testes

Secondary to epididymitis

Sonographic Findings:
Focal:
-hypoechoic areas within teste
-often mistaken for tumor
Diffuse:
-hypoechoic, hypervascular, reactive hydrocele in acute phase
-atrophied teste and thick scrotal wall in chronic phase

Answer 337

A

Hydrocele: abnormal accumulation of fluid

Hematocele: blood in scrotal sac; direct trauma to scrotum or pelvic region

Pyocele: pus in scrotal sac; trauma or ruptured abscess

Answer 338

A

Testicular Abscess

Answer 339

A

benign and malignant forms

benign: prepubertal
malignant: older patients

ClinicaL:

painless, palpable mass
increased HCG, AFP and LDH

Sonographic Findings:

mixed echogenicity mass
cystic mass

Answer 340

A

non-germ cell, stromal tumor

benign and malignant forms

testosterone producing tumors

peak occurrence in the first 2 years of life

Sonographic Findings:

small, well defined, hypoechoic mass
large, heterogenous mass with cystic spaces

Answer 341

A

non-germ cell, stromal tumor

some tumors are estrogen producing

typically seen in the first year of life

Sonographic Findings:

small, well defined, hypoechoic mass
large, heterogenous mass with cystic spaces

Answer 342

A

germ cell tumor comprised of a mixture of germ cell and sex-cord-stromal elements

Associated with dysgenetic gonads, turners syndrome and secondary sex organs

Sonographic Findings:

solid mass
hypoechoic
cystic areas may be visible

Answer 343

A

Malignant germ cell tumor made up of seminomatous elements

present in adolescents

Clinical:

gradual enlarging mass
normal AFP
increased HCG, PLAP, and testosterone

Sonographic Findings:

hypoechoic mass
echogenic band within mass
hydrocele
hypervascularity

Answer 344

A

malignant germ cell tumor

mets to lung, liver and brain

Sonographic Findings:

hypoechoic mass
ill defined borders
invades tunica albuginea

Answer 345

A

malignant germ cell tumor

primarily in children less than 2

Sonographic Findings:

variable echogenicity
echogenic foci or cystic areas may be present

Answer 346

A

Yolk Sac Tumor or Endodermal Sinus Tumor

Answer 347

A

Intravaginal torsion: more common in puberty, occurs within tunica vaginals
Extravaginal: in utero or neonatal period; occurs proximal to tunica vaginals
Partial: 360 degree or less

Acute: before 24 hours of onset of pain
Chronic: 24-48 hours post onset of pain, may not be painful anymore

Answer 348

A

torsion of testicular appendix

peak incidence 7-14 years of ago

Answer 349

A

2-8 months

Answer 350

A

Made up of the pelvic girdle

Ilium: broad portion of the hip bone
Ischium: lower posterior portion
Pubis: lower anterior portion

Convergence of the bones creates the concave hip socket

Answer 351

A

acetabulum

Answer 352

A

procedure utilized to determine if the hip could become dislocated.

Hip is flexed with the thigh abducted.
Pressure is applied to the knee by pushing it posteriorly.

Answer 353

A

procedure used to determine if the dislocated femoral head can be repositioned back into the acetabulum

Hip is flexed with thigh abducted
Thigh pulled anteriorly.
A “click” may be heard when it moves back in

Answer 354

A

used for infants 3 months and older
the child is placed in a supine position with the hips and knees bent and feet flat

examiner looks for any unevenness between the knees - if one knee is lower than the other, there may be a hip dislocated on the lower side

Answer 355

A

Neutral: neutral position with leg at a 15-20 degree flexion angle

Flexion: hip flexed at 90 degree angle
referred to as "ball on a spoon"
ball - femoral head
acetabulum - scoop of spoon
Iliac line - handle of spoon

Answer 356

A

Neutral: leg at 15-20 degrees
referred to as a “U”
U is made up of metaphysis and ischium

Flexion: hip at 90 degrees
referred to as the flower view
Femoral head - "bloom"
Ischium and pubis - "leaves"
triradiate cartilage -- "stem"

Answer 357

A

most commonly as a measurement of acetabular concavity

angle greater than 60 is normal
angle between 50-59 represents immature hip
angle less than 50 indicates pathological condition

Answer 358

A

indicates acetabular cartilaginous roof coverage

normal is less than 55 degrees

Answer 359

A

percentage of femoral head covered by the acetabulum

coverage of 58% or greater is normal

Answer 360

A

most common form of dislocation is superiolaterally

Answer 361

A

femoral head is in contact with part of the acetabulum or is displaced but partly covered

soft tissue identified between the femoral head and acetabulum

Answer 362

A

femoral head has no contact with the acetabulum

thickened abnormal labrum may be present
irregular acetabular roof

Answer 363

A

increased amount of synovial fluid within the hip joint

greater than 2mm difference between hips
greater than 3 for up to 4 years
greater than 5 for 4-8 years
greater than 7 for 8+

Answer 364

A

Infection in the bone that can be caused by infections traveling through the bloodstream or by spreading from nearby tissue.

Sonographic Findings:

fluid collection adjacent to bony structures
varying echogenicity
joint effusion

Answer 365

A

Ventral - anterior aspect of abdominal wall

Umbilical - umbilicus

Spigelian - through spigelian fascia or layer of tissue that separates the rectus muscles and the later obliques.

Inguinal - groin

Answer 366

A

Hernia that is not reducible

treatment not always needed

Answer 367

A

incarcerated bowel loops that have become mechanically obstructred

treatment needed

Answer 368

A

incarcerated contents with compromised vascularity

depending on content may need to have emergency surgical repair

Answer 369

A

Umbilical

Answer 370

A

Inguinal

More common on the right if unilateral

Indirect inguinal hernia: involves internal inguinal ring
Direct inguinal hernia: does not involve inguinal ring; common in athletes

Answer 371

A

Less than 10 mm or 1.0 cm

Answer 372

A

loss of fatty hilum
low to medium level echo pattern
loss of normal shape
lobular contour
disruption of vascularity

Answer 373

A

enlargement of lymph nodes cause by inflammatory processes, primary tumor or metastatic spread of cancer

Floating aorta sign: obliteration of echogenic aorta wall

Silhouette sign: elevate celiac axis and SMA anteriorly

Sandwich Sign: visible nodes at the hilum of kidneys, liver and spleen

Answer 374

A

round or oval
eccentric cortical widening
narrow or absent echogenic hilum
displaced or distorted intranodal vessels

Answer 375

A

two Mullerian ducts or paramesonephric ducts

Answer 376

A

Serosa - thin outer layer
Myometrium - middle layer (bulk of uterus)
Endometrium - innermost layer

Answer 377

A

Prepubertal: uniform homogenous texture, low to moderate echogenicity

Postpubertal: outer layer hypoechoic and may have anechoic spaces representing arcuate vessels; middle layer more echogenic; inner layer hypoechoic layer surrounding endometrium

Answer 378

A

Superficial layer or Zonus Functionalis

Deep or Basal layer

Answer 379

A

Zonus Functionalis

Answer 380

A

May not be noticeable.

In newborns, may be a thin echogenic line due to utero hormonal stimulation

Answer 381

A

Thin, echogenic line during menses (2-3 mm)

Thin, echogenic line during proliferative phase (4-8 mm)

Three-line sign during mid to late proliferative phase

Thick, echogenic line during secretory phase (8-14 mm)

Answer 382

A

Neonate: 2-4.5 cm (cervix is longer than uterine body)

Infancy to young Adolescent: 3-4 cm

Puberty: 5-8 cm (uterine growth begins at approximately 7-8 years of age)

Answer 383

A

positioned to the right of midline

Answer 384

A

positioned to the left of midline

Answer 385

A

fundus and body is flexed posteriorly relative to the cervix

Answer 386

A

fundus and body is flex anteriorly relative to the cervix

common with a non-distended bladder

Answer 387

A

fundus, body and cervix are positioned posteriorly relative to the vagina

common with a non-distended bladder

this position is associated with poor visualization of the endometrium and uterus

Answer 388

A

fundus, body and cervix are positioned anteriorly relative to the vagina

cervix and vagina form at 90 degree angle

Answer 389

A

Premenarche: 2.5 cm in length

Menstruating: 2.5 - 5 cm in length

Answer 390

A

extend from the lateral aspect of the uterus

attaches to the uterus, fallopian tubes and ovaries

Answer 391

A

twits the uterine fundus in a forward position

Answer 392

A

inferior border of the broad ligaments

supports uterus and cervix

Answer 393

A

extends from cervix to sacrum

supports the uterus and holds the uterus in place

Answer 394

A

anterior to the uterus

lies posterior to the bladder

Answer 395

A

posterior to the uterus

anterior to the rectum

common area of fluid collection due to secondary conditions

Answer 396

A

posterior to the pubic symphysis and anterior to the urinary bladder

presence of pathology tends to displace the bladder posteriorly

Answer 397

A

A dual blood supply supports each ovary

Ovarian gonadal arteries off of Aorta
Ovarian branch of the uterine artery

Answer 398

A

Hypothalamus, anterior pituitary and ovaries

Answer 399

A

Gonadotropin-releasing hormone

Answer 400

A

Follicle stimulating hormone (FSH)

Answer 401

A

Luteinizing hormone (LH)

Answer 402

A

Estrogen and progesterone

Answer 403

A

Progesterone

Answer 404

A

Menstruation phase: days 1-5
Proliferative phase: days 6-14
Secretory phase: days 15-28

Answer 405

A

Primordial follicles become primary follicles.
Primary follicles become secondary follicles.
Secondary follicles become Graafian follicles.

Answer 406

A

Follicular phase: days 1-13
Ovulation: day 14
Luteal phase: days 15-28

Answer 407

A

physical appearance of the external genitalia cannot be clearly identified as male or female.

Answer 408

A

appearance of physical characteristics and hormones associated with puberty prior to age 8

Answer 409

A

appearance of physical characteristics and hormones associated with puberty prior to age 8 caused by adrenal or ovarian dysfunction.

associated with congenital adrenal hyperplasia, adenoma or carcinoma of adrenal gland, ovarian dysgerminoma, choriocarcinoma and follicular retention cysts

sonographically, uterus and ovaries will still look prepubertal

Answer 410

A

absence of the vagina

neonate or adolescent at the time of menarche

Sonographic Findings:
-fluid collections within vaginal or uterine cavity

Answer 411

A

persistence of the vaginal hymen or transverse septum

Associated with Mater-Rokitansky-Kuster-Hauser syndrome

Sonographic Findings:
-fluid collections within vaginal or uterine cavity

Answer 412

A

absence of the uterus

Associated with Mater-Rokitansky-Kuster-Hauser syndrome

Sonographic Findings:

uterus and cervix not identified
vagina absent or small
ovaries are seen

Answer 413

A

one uterine horn and one fallopian tube develop

Sonographic Findings:

difficult to differentiate from a normal uterus
uterus appears small and laterally positioned
loss of pear shaped uterus

Answer 414

A

two uterine horns
two cervices
two vaginas

Answer 415

A

septum is formed between the symmetrical horns which may extend from the external os or the internal os

Uterus Duplex Bicollis:

two uterine hornes
two cervices
one vagina

Uterus Bicornis Unicollis:

two uterine horns
one cervix
one vagina

Answer 416

A

Mild indentation of the endometrium in the uterine fundus

indentation of less than 1cm

Answer 417

A

two endometrial cavities visualized

uterine fundus flay or mildly indented on transverse view

Answer 418

A

vaginal cyst

Answer 419

A

Cervical cyst

Answer 420

A

inflammatory condition affecting all or some of the following: cervix, uterus, fallopian tubes, ovaries and peritoneal surfaces

usually results from a microorganisms ascent from the vagina and cervix to the endometrium and into the fallopian tubes

associated with STDS, most commonly gonorrhea and chlamydia

4 classifications: endometritis, salpingitis, tubo-ovarian abscess and peritonitis

Answer 421

A

Infection of the endometrium

Sonographic Findings:

normal
thickened endo
fluid or air within
increased vascularity

Answer 422

A

Infection of the fallopian tubes

hydrosalpinx: fluid filled fallopian tube
pyosalpinx: “beads on a string”

Sonographic Findings:

distended
serpiginous
thickened wals
fluid filled

Answer 423

A

purulent material from fallopian tube travels to ovary causing ovary and tube to be adhered which results in an abscess

Sonographic Findings:

large complex adnexal mass with irregular borders
irregular margins
fluid fluid level
difficult to identify ovaries within mass
may be uni or bilateral

Answer 424

A

infectious spread to peritoneum

Sonographic Findings:

free or loculated fluid in peritoneum cavities
echogenic debris or septations
bowel walls appear thick

Answer 425

A

fluid filled vaginal cavity

Answer 426

A

fluid filled endometrium

Answer 427

A

fluid filled endometrium and vaginal cavity

Answer 428

A

blood filled endometrium

Answer 429

A

blood filled endometrium and vaginal cavity

Answer 430

A

infectious fluid trapped in endometrium

Answer 431

A

benign tumor made up of smooth muscle cells and fibrous tissue that can undergo cystic degeneration

Sonographic Findings:

various appearance
variable number
focal discrete mass
diffuse irregular appearance of the uterus
thin vessels with low velocity doppler
no flow in masses undergo degeneration

Answer 432

A

Intramural: within myometrium
Submucosal: protrudes within endmetrium
Subserosal: projects from peritoneal surface
Pedunculated or exophytic: seperate pelvic mass attached by a stalk to the peritoneal surface of the uterus

Answer 433

A

Fibroid

*uncommon in females less than 20 years of age

Answer 434

A

Rhabdomyosarcoma

presents within the first few years of life
usually arises from anterior wall of vagina

Answer 435

A

malignant tumor most commonly found in the vagina in pediatric patients

very aggressive in young children
family history of endometrium cancer

Answer 436

A

functional ovarian cysts resulting from excessive stimulation of the fetal ovary from placental and maternal hormones

torsion if large

Answer 437

A

complex endocrine disorder associated with anovulatin and oligomenorrhea

Answer 438

A

benign tumor containing serous fluid
-more frequent than mucinous cystadenoma

Sonographic Findings:

large, unilateral ovarian cystic mass (4-20cm)
thin walled

Answer 439

A

benign tumor containing mucoid substance

Sonographic Findings:

large unilateral mass
multiloculated
septations
papillary projections

Answer 440

A

Most common germ cell tumor location after infancy is the ovary.

Immature: solid, malignant
Mature: cystic, benign

Sonographic Findings:
-Tip of the Iceberg

Answer 441

A

sex-cord stromal tumor typically occuring in children birth to 10 years of age

benign or malignant

Sonographic Findings:

unilateral
cystic with septations when large
solid when small

Answer 442

A

Dysgerminoma

Answer 443

A

malignant germ cell tumor that resembles yolk sac, allantois and extraembryonic mesenchyme

second most common malignant ovarian germ cell tumor

highly aggressive
females under 20

Sonographic Findings:
-large slid mass

Answer 444

A

sex cord stromal tumor that produces androgen

benign or malignant

associated with DICER1 gene

Clinical:

pain
virilization
menstrual irregularity
increased testosterone or other androgen

Sonographic Findings:

range in size from 5-15 cm
unilateral
solid hypoechoic mass
may appear as cystic or complex

Answer 445

A

partial or complete rotation of the ovarian pedicle typically caused by an ovarian mass

Answer 446

A

enlargement of the ovaries due to stromal edema

Clinical:

intermittent ovarian torsion
pain
pelvic distention

Sonographic Findings:

enlarged ovary
complex solid or multicystic mass
venous and lymphatic occlusion without arterial occlusion

Answer 447

A

complex fluid filled mass in the peritoneal cavity

referred to as a pseudocyst

under normal conditions, the peritoneum absorbs fluid but causes of abnormal absorption include surgery, trauma, inflammation or endometriosis

Answer 448

A

cystic mass filled with blood representing a localized form of endometriosis

Diffuse: most common form of endmetriosis
Localized: usually on ovaries

Sonographic Findings:

variable size
well-defined
unilocular or multilocular mass

Answer 449

A

ventricular system and spinal cord

Answer 450

A

spinal cord

Answer 451

A

largest component of the brain

comprised of the telencephalon and the diencephalon

Answer 452

A

connects the spinal cord and forebrain

Answer 453

A

joins with the spinal cord

comprised of metencephalon and myelencephalon

Answer 454

A

5-6 weeks

neural tube is formed and closed.
abnormal closure results in abnormalities

Answer 455

A

7-12 weeks

prosencephalon, mesencephalon and rhombencelphalon form from the neural tube

Answer 456

A

Frontal (1)
Parietal (2)
Temporal (2)
Occipital (1)
Ethmoid - between orbits
Sphenoid - base of skull

Answer 457

A

extends from anterior to posterior fontanelle

Answer 458

A

lies perpendicular to sagittal suture

located between frontal and parietal bones

Answer 459

A

extends from posterior aspect of sagittal suture

located between occipital and parietal bones

Answer 460

A

lies between parietal and temporal bones

Answer 461

A

typically between 9 months - 15 months of age

can remain open until 2

Answer 462

A

begins to close around 6 months of age but may remain open until 2 years

Answer 463

A

closes around 6 months of age

used to evaluate circle of willis

Answer 464

A

Pia Mater: interal layer
Arachnoid: middle layer
Dura Mater: outer layer

Answer 465

A

Subdural Space: separates arachnoid layer from dura mater

Subarachnoid Space: separates arachnoid layer from pia mater
-contains CSF and vessels

Answer 466

A

fold of dura mater protruding into cranial cavity (tent-shaped fold over the posterior fossa)

separates the occipital lobes of the cerebrum from the cerebellum

used as a reference point to describe location of a lesion
infratentorial or supratentorial

Answer 467

A

By the epithelial cells of the choroid plexus

Answer 468

A

Choroid Plexus in lateral ventricles
Foramen of Monro
3rd ventricle
Cerebral Aqueduct/Aqueduct of Sylvius
4th ventricle
Foramen of Magendie and Luschka
Cisterna Magna and Subarachoid Space

Answer 469

A

Body and Trigone or Atrium

Choroid plexus also located in 3rd and 4th ventricles

Answer 470

A

Trigone

largest part referred to as glomus

used as the landmark for measuring lateral ventricles

Answer 471

A

lateral ventricles and 4th ventricle

Answer 472

A

the two hemispheres of thalami and inferior to cavum septum pellucidum

Answer 473

A

anterior to the cerebellum

posterior to the pons and medulla oblongata

Answer 474

A

Cerebrum

consists of gray and white matter

Answer 475

A

separates cerebrum into right and left hemispheres

located in the midline

Answer 476

A

separates temporal lobe from the anterior and parietal lobes

contains MCA

Answer 477

A

separates occipital lobe from parietal lobe and temporal lobe

Answer 478

A

separates occipital lobe of the cerebrum from the cerebellum

Answer 479

A

separates frontal lobe from the parietal lobe

Answer 480

A

parallel to corpus callosum

Answer 481

A

located between frontal and parietal lbes

Answer 482

A

extends from the posterior aspect of the corpus callosum to the temporal lobe

Answer 483

A

located above corpus callosum

Answer 484

A

located on inferior surface

Answer 485

A

outermost layer of the cerebellum

outer layer of gray matter and an inner layer of white matter

Answer 486

A

Thick band of myelin-coated nerve fibers connecting the cerebral hemispheres

forms most of the roof of the lateral ventricles

parallel to cavum setum pellucidum in sag lane

Answer 487

A

midline cystic structure not connected to the ventricular system or subarachnoid space.

Regresses during the gestation period.

Usually complete obliteration in most infants by 2 months of age

Answer 488

A

Caudate Nucleus

Mass of gray matter located adjacent to the lateral ventricles

Answer 489

A

Paired ovoid structures connected by a band of tissue known as massa intermedia

Answer 490

A

Highly vascular rudimentary embryonic structure that develops deep to the ependyma. Regresses during gestational period

Landmark area known as caudothalamic groove represents the germinal matrix between head of the caudate nucleus and the thalamus. It is considered a favorable region for the development of subependymal hemorrhages in the neonate.

Answer 491

A

Connects the cerebral hemispheres with the spinal cord and consists of the midbrain, pons and medulla oblongata

Answer 492

A

Composed of two hemispheres. The vermis is located between the two hemispheres.

Located in the posterior cranial fossa, it is separated from the cerebrum by tentorium cerebelli.

Answer 493

A

CCA
ICA
ECA
Circle of Willis (MCA, ACA, PCA)
Vertebral Artery
Basilar Artery

Answer 494

A

the venous sinuses of the dura mater and into the IJV.

Intracranial veins do not contain valves

Answer 495

A

A dural sinus drains venous blood and reabsorbs CSF.

The superior sagittal sinus is located in the midline at the falx cerebri, receives blood from superior cerebral veins and is continuous with the transverse sinus

Answer 496

A

Vascular beds between the end branches of major arteries.

Vulnerable to decreased perfusion pressure resulting in infarction.

Largest watershed area is the white matter located lateral and posterior to the lateral ventricles

Answer 497

A

Refraction, reverberation and grating lobe artifacts

Answer 498

A

Mild: 8-10 mm
Moderate: 11-14 mm
Marked: >14 mm

Answer 499

A

Echogenic

Sylvian fissure is Y shaped and separates the frontal lobe from the temporal lobe

Answer 500

A

Hypoechoic

Answer 501

A

Echogenic

They may not be noted until 26 weeks gestation. Central sulcus of Rolando separates the frontal lobe from the parietal lobe.

Answer 502

A

linear areas of increased echogenicity (less echogenic than choroid)

seen posterior to the occipital horns of the lateral ventricles and anterior to the frontal horns

Answer 503

A

Anterior fontanelle

Answer 504

A

infratentorial contents and identification of hemorrhage in the occipital horn of the lateral ventricles

Answer 505

A

circle of Willis, ventricles and posterior fossa

Answer 506

A

anterior horn of the lateral ventricles and the frontal lobe of the cerebrum

Answer 507

A

posterior fossa and upper spinal cord

Answer 508

A

hydrocephalus and intraventricular hemorrhage

Answer 509

A

partial or complete absence of the commisure connecting the cerebral hemispheres

Associated with:
Trisomy 8, 13 or 18
Porencephaly
Isolated Finding

Sonographic Findings:

Absence of corpus callosum
Absence of CSP
Sulci radiate outward and resemble a sunburst sign
widely separated lateral ventricles

Answer 510

A

caudal displacement of cerebellar hemispheres without displacement of fourth ventricle or medulla.

commonly found in children

Answer 511

A

Elongation and caudal displacement of the brainstem and cerebellum through the foramen magnum into the cervical spinal canal

Most common type

Highly associated with an open spinal defect

Anterior and inferior pointing of frontal horns of the lateral ventricles resulting in a bat-wing appearance

Answer 512

A

protrusion of the medulla, 4th ventricle, and entire cerebellum through an encephalomeningocele

rare

high mortality rate

Sonographic Findings:

hydrocephalus
gyral anomalies
dysgenesis of corpus callosum

Answer 513

A

Severe hypoplasia of the cerebellum without displacement

rate

most severe form with high infant mortality

Sonographic Findings:

severe hypoplasia of the cerebellum hemispheres without displacement
hypoplasia of pons
small posterior fossa

Answer 514

A

Severe Anomaly

Cerebellum vermis is absent or hypoplastic

Associations:

agenesis of CC
encephalocele
microcephaly
Trisomy 13, 18, 21

Sonographic Findings:

large anechoic posterior fossa cyst
splayed cerebellum hemispheres
elevated tentorium
enlarged lateral ventricles
enlarged 3rd ventricle
4th ventricle communicating with cisterna magna

Answer 515

A

Less severe and occurs more than DW malformation

Cerebellum vermis is hypoplastic

Sonographic Findings:

normal cerebellum size and placement
normal or slight enlargement of posterior fossa
dilatation of aqueduct of sylvius
enlarged 3rd and 4th ventricle
communication seen between 4th ventricle and cerebellum vermis

Answer 516

A

Enlargement of the cisterna magna in the presence of normal cerebellum, cerebellum vermis and intracranial ventricle system.

Freely communicates with the 4th ventricle
Represents a normal variant

Sonographic Findings:

enlarged anechoic cisterna magna
normal size ventricles
normal cerebellum vermis

Answer 517

A

posterior fossa cyst lesion resulting from ballooning of the posterior membranous area into the cisterna magna

rare

Answer 518

A

absence of cavum septum pellucidum with optic nerve hypoplasia

Sonographic Findings:

agenesis of CSP
fused frontal horns

Answer 519

A

midline malformation characterized by absence of the interhemispheric fissure, falx cerebri, and third ventricle. Single ventricle replaces bilateral lateral ventricles and fused thalami

Most severe form of holoprosencephaly

Clinical:

cebocephaly
cyclopia, anopthalmia or microphthalmia
cleft lip
low set ears

Answer 520

A

midline malformation characterized by cerebral hemispheres that are partially separated posteriorly and a single anterior ventricular cavity

Answer 521

A

Subtle derangement with the separation of the cerebral hemispheres except at the level of the cingulate gyri and anterior horns of the lateral ventricles

least severe form

Sonographic Findings:

absence of CSP
absent or hypoplastic cerebellar vermis
dilated lateral ventricles
fused squared shaped anterior horns
third ventricle present

Answer 522

A

herniation of meninges through a defect in bony cranium

Answer 523

A

herniation of meninges and brain tissue through a defect in the bony cranium

Answer 524

A

Occipital region

Answer 525

A

enlargement of the lateral ventricles

normal intraventricular pressure
normal head size

Answer 526

A

enlargement of the ventricles

Increased intraventricular pressure
Increased head size

may be communicating or non communicating

communicating/non-obstructive: results from lack of circulation and absorption of CSF

non-communicating/obstructive: occurs when the flow of CSF is obstructed along one or more of the paths of within the ventricular system (aqueduct of sylvius stenosis is the most common cause of ventricular enlargement)

Answer 527

A

abnormal enlargement of one of the cerebral hemispheres with the other being normal

rare

enlarged ventricle in the affected hemisphere

Answer 528

A

neuron clusters in abnormal locations

rare

X-linked dominant
Associated with Lissencephaly

Sonographic Findings:

abnormal wall indentations of the lateral ventricle
normal or enlarged lateral ventricles

Answer 529

A

Smooth brain due to abnormally developed sulci and gyri

Type 1/Classical: 4 layers of the cortex instead of 6
Type 2/Cobblestone: migration interrupted at the surface resulting in over migration and clustering of the neurons

Sonographic Findings:

absence of normal echogenic sulci pattern
abnormal appearance or absence of sylvian fissure including lack of MCA pulsations
enlargement of lateral ventricles

Answer 530

A

Enlarged occipital frontal head circumference greater than 2 standard deviations above the mean

enlargement not due to tumors or enlarged intracranial ventricles

Sonographic Findings:

normal appearance of intracranial structures
enlarged anechoic lateral ventricles
irregular wall indentations of the lateral ventricles
enlarged gyri

Answer 531

A

Small occipital frontal head circumference greater than 2 standard deviations below the mean

can be congenital or occur in infancy

Associated with prenatal exposure to Zika Virus and Fetal Alcohol Syndrome

Sonographic Findings:

normal appearance of intracranial structures
calcifications
partial or complete agenesis of the corpus callosum
irregular wall indentations of the lateral ventricles
absence or enlarged gyri

Answer 532

A

Clefts in the gray matter of the cerebral hemispheres which extend to the lateral ventricle

Type 1: no communication between lateral ventricles and subarachnoid space
Type 2: communication between lateral ventricles and subarachnoid space

Associated with vascular occlusion during brain development

Sonographic Findings:

anechoic fluid filled clefts extending from the brain surface to the lateral ventricle
unilateral or bilateral
commonly located in the area of the Sylvian fissure

Answer 533

A

brain injury due to a disruption in cerebral blood flow and oxygen

hypoxic - reduction of oxygen
ischemic - reduction of blood flow

Maternal causes: chronic cardiac disease, lung disease, placental insufficiency, cocaine use, birth trauma, RH incompatibility
Neonatal causes: immature vasculature, absence of autoregulation in the white matter, alloimmune thrombocytopenia
Causes in older children: drowning, asphyxiation

Clinical:

low five minute Apgar scores
abnormal neurological exam

Sonographic Findings:

diffuse echogenic brain tissue
poorly defined sulci
snowstorm speckling in the parenchyma
loss of anatomical landmarks
ventriculomegaly
pulse wave shows elevation of RI and reversal of diastolic flow in the intracranial arteries

Answer 534

A

infarction and necrosis of periventricular white matter

common hypoxic ischemic event in premature infants

Phases:
Acute - initial event
Chronic - occurs 2-3 weeks after onset
Atrophic - occurs 3-4 months after onset

Associated with immature vasculature in periventricular watershed, absence of autoregulation, infections, low birth weight infants

Sonographic Findings:

bilateral involvement
Acute Phase: no evidence of abnormalities, increased tissue echogencity surrounding ventricles
Chronic Phase: echogenic areas replaced with anechoic cystic areas, septations may be seen in cystic areas
Atrophic Phase: widening of interhemisphere fissure, enlarged subarachnoid spaces, widened cerebral sulci, ventriculomegaly

Answer 535

A

vascular insult which results in cystic lesions forming in areas of tissue necrosis

may be referred to as porencephalic cyst

Sonographic Findings:

anechoic cystic masses
single or multiple
no mass effect on other structures

Answer 536

A

Destruction of cerebral hemispheres with replacement by CSF

Associated with occlusion of vessels involved in anterior circulation such as ICA

Clinical:

enlarged head circumference
irritability

Sonographic Findings:

anechoic fluid filled cranial cavity
echogenic interhemispheric fissure
normal appearing thalami, cerebellum and brainstem

Answer 537

A

cystic lesion containing CSF located between the layers of the arachnoid membrane

Cysts do not communicate with ventricles or CSF in surrounding surrounding subarachnoid space.
Primary cysts are congenital
Secondary cysts are caused from infection, injury or hemorrhage

Supratentorial is the most common location

Clinical:

asymptomatic
headaches
nausea and vomiting
dizziness

Sonographic Findings:

anechoic
thin smooth walls
round
increased posterior enhancement
internal debris may be seen with infection or hemorrhage

Answer 538

A

A type of glioma originating from star-shaped astrocytes

Most common type of glioma tumor in children
Most common spinal cord tumor in children

Associated with Tuberous Sclerosis

Sonographic Findings:

focal or diffuse
variable echogenicity and size (isoechoic when located within spinal cord)

Answer 539

A

lesion derived from the overgrowth of fat cells

Associated with epilepsy

May present with seizures

Sonographic Findings:

echogenic
may contain calcifications
variable locations (most occur near midline)
single or multiple

Answer 540

A

Benign epithelial tumor made up of choroid plexus cells that produce CSF

Associated with Von Hippel-Lindau syndrome

Sonographic Findings:

solid mass
echogenic
enlarged ventricles may be seen
vascular

Answer 541

A

multi-stem disease associated with the development of benign tumors in numerous parts of the body

CNS is frequently affected

Sonographic Findings:

multiple
echogenic
found in parenchyma and periventricular regions

Answer 542

A

most common type of IVH in infants

usually occurs in the first 3 days of life
less common in the full term newborn

Associated: infants born before 32 weeks, infants weighing less than 1500 grams, coagulation disorders, unknown etiology

Clinical:

hypoxia
HTN
apnea
lethargy
decreased muscle tone
low hematocrit

Answer 543

A

results from the rupture of very fine network of blood vessels located in the germinal matrix (caudothalamic groove most common location)

Seen in up to 70% of premature infants on assisted ventilation

Sonographic Findings:

echogenic area in caudothalamic groove
resolution of blood clots results in echogenicity changes resulting in a cystic lesion (subependymal cyst)

Answer 544

A

extension of the subependymal hemorrhage into the lateral ventricle without ventricular dilatation

Sonographic Findings:

abnormal echogenicity within the lateral ventricle
echogenic layering within the occipital horn
completely fill ventricles
thickened appearance of choroid plexus (color doppler can differentiate the vascular choroid from the avascular blood clot)
anechoic central areas with resolution

Answer 545

A

germinal matrix IVH with dilatation of ventricles

dilatation is caused by interference of CSF flow - blood clot is blocking the aqueduct of sylvius or the 3rd or 4th ventricle

Sonographic Findings:

abnormal echogenicity within the lateral ventricle
enlarged ventricles
resolution results in anechoic central areas and eventual decreased size of ventricles

Answer 546

A

germinal matrix IVH with hemorrhage in the cerebral cortex typically in the periventricular region of the frontal and parietal lobes

Sonographic Findings:

variable
echogenic debris within ventricle that extends beyond the walls of the ventricle
complex cystic mass connected to the ventricle

Answer 547

A

presence of cerebellum or posterior fossa hemorrhage

in preterm neonates: germinal matrix bleeding near the 4th ventricle
in term: associated with traumatic delivery or coagulopathy

Sonographic Findings:

variable
loss of definition of cerebellum and 4th ventricle
echogenic areas within cerebellum
cystic areas with regression
enlargement of intracranial ventricles

Answer 548

A

blood in the subarachnoid space

more commonly seen in full term neonates than preterm

Sonographic Findings:

thick echogenic interhemispheric and sylvian fissures
thick echogenic subarachnoid space
enlarged ventricles

Answer 549

A

blood in the subdural or epidural space

Associated with birth trauma and coagulopathy

Sonographic Findings:

Infratentorial: fluid collection between the tentorium and cerebellum; hydrocephalus
Supratentorial: widened interhemispheric fissure, fluid collection in the interhemispheric fissure, mass effect

Answer 550

A

Intracerebral AVM which results in a dilated vein of Galen

referred to as Galenic venous malformation

Sonographic Findings:

midline, anechoic cystic mass
located between lateral ventricles, posterior to the foramen of monroe and superior to the third ventricle

Answer 551

A

Toxoplasmosis: infection resulting from the parasite toxoplasma gondii

Other Agents: syphilis, HIV, Varicella-Zoser

Rubella: contagious viral disease

Cytomegalovirus: most common congenital viral infection

Herpes: common viral infection

Sonographic Findings:

calcifications
hydrocephalus
subependymal cysts
increased echogenicity
enlarged ventricles
anechoic cystic areas
cerebral edema

Answer 552

A

inflammation of the protective membrane, meninges, of the brain

most cases occur in children less than 2

Clinical:

fever
seizures
irritability
apnea
bulging fontanelle
N/V
headache
lethargy

Sonographic Findings:

normal appearing brain or increased echogenicity
widened and echogenic sulci
extra-axial fluid
focal or diffuse
enlarged ventricles

Answer 553

A

inflammation of the brain parenchyma either from an infection or immune system reaction

Frequently involves the meninges resulting in meningoencephalitis

Sonographic Findings:

focal, diffuse or patchy parenchymal echoes
increased echogenicity of gyri
decreased appearance of vascular pulsations

Answer 554

A

inflammation of the ependymal lining of the intracranial ventricles

complication of meningitis, abscess rupture or VP shunt infection

Sonographic Findings:

slit like ventricles in acute phase
enlarged ventricles
hyperechoic, thick, irregular walls
irregular, hyperechoic choroid plexus

Answer 555

A

focal or diffuse cystic lesions n the area of the damaged brain tissue

end result of meningoencephalitis or hypoxic-ischemic events

Answer 556

A

presence of excess fluid in the gray and white matter in response to a brain insult

associated with full term infants who have experience a hypoxic-ischemic event

Clinical:

bulging anterior fontanelle
splaying of cranial sutures
enlarged head circumference

Sonographic Findings:

Initial phase: slit like ventricles, diffuse echogenic brain, poorly defined sulci, snowstorm speckling, loss of anatomical landmarks
Mid phase: generalized brain atrophy, porencephaly or encephalomalacia
Following Severe Infarction: brain volume loss, compensatory enlargement of ventricles, enlargement of extra axial spaces

Answer 557

A

7 cervical 
12 thoracic
5 lumbar
5 fused
4 coccygeal

Answer 558

A

Conus Medullaris

Answer 559

A

Filum Terminale

echogenic cord like structure. Pulsations from the cauda equina can be seen around the filum terminale,

Answer 560

A

Cauda Equina

echogenic nerve roots

Answer 561

A

Enlargement of the subarachnoid space between the conus medullaris and the inferior end of the subarachnoid space and dura matter

located at the lower portion of the spinal dural sac from the first lumbar to the second sacral vertebra

Answer 562

A

T12 - L1 or L2

Answer 563

A

Lumbar Cistern

Answer 564

A

ovoid cystic structure located inferior to the tip of the conus medullaris within the filum terminate.

No clinical significance and is a common finding.

Answer 565

A

slight widening or oval cystics areas of the central canal of the spinal cord.

Located within conus medullaris.

Regresses and typically not visible after the first few months of life.

Answer 566

A

spectrum of structure defects involving the lower spine, sacrum and coccyx

Type 1: severe, high lying cord and an abrupt wedge-shaped terminus of the cord

Type 2: less severe, low lying tethered conus medullaris

Type 1 is more common

There is an increased frequency in diabetic mothers

Sonographic Findings:

absence of bony structures in the lower spine, sacrum and or coccyx
rounded or blunted end of conus medullaris
tethered cord

Answer 567

A

partial or complete cleft of the spinal cord resulting in two hemicords

most commonly occurs in the thoracolumbar region

Sonographic Findings:

two spinal cords are seen on transverse view (Resembles a figure eight, cords appear hypoechoic)
presence of a spur may appear hypoechoic or echogenic

Answer 568

A

abnormal caudal fixation of the spinal cord below L3

Associated with VACTERL and anal or urogenital malformations

Cutaneous markers:

hair tuft
sinus tract
skin tag
dimple
pigmented nevi

Sonographic Findings:

abnormal caudal position
conus medullaris often eccentrically located
diminished cord motion
short thick filum terminale

Answer 569

A

A long, thing epithelium lined sinus extending from the dorsal skin surface to the spinal cord, cauda equine or arachnoid

most common location is the lumbar sacral region

Clinical:

small midline back dimple
discharge from dimple
other cutaneous markers

Sonographic Findings:

echogenicity varies depending on location
elongated structure
extends superiorly from the skin surface into the subcutaneous tissues or into the area of the spinal cord

Answer 570

A

Dilatation of the central canal of the spinal cord and the presence of cysts in or lateral to the spinal cord

Syringomelia - fluid filled cyst that forms within the spinal cord
Hydromela - dilatation of the central canal of the spinal cord

Associated with myelomeningocele and Chiari malformation

Sonographic Findings:

anechoic dilatation of the central canal
cysts in or lateral to the central canal

Answer 571

A

Lipomyeloceles or Lipomyelomeningocele

appears as an echogenic mass within the spinal cord

Answer 572

A

Variable appearing neoplasm seen that can be externally, internally, or both internally and externally.

Occurs more in females.
Most often presents as a skin covered mass.

Answer 573

A

Common intramedullary spinal tumor in children

Clinical:

pain
weakness
sensory change

Sonographic Findings:

well defined
echogenic
smooth walls
can occur anywhere along the spinal cord

Answer 574

A

Refers to a group of disorders in which the posterior bony elements of the spine do not close properly

usually an isolated finding with spina bifida

Answer 575

A

contents of the canal protude through a bony defect in the spine and outside of the body into a CSF filled space.

Non skin covered, open neural tube defect

Typically found in the lumbar sacral region

Associated with myelocele, meningocele and myelomeningocele

Answer 576

A

bony defect of the spine associated with cutaneous markers such as an abnormal hair tuft, collection of fat or dimple.

typically does not involve spinal nerves. Referred to as hidden spina bifida.

Associated with lipomyelomeningocele, thickened filum terminale, diastematomyelia

Answer 577

A

Myelomeningocele: protruding sac of CSF containing the spinal cord and meninges

Myelocele: protrusion of the spinal cord

most common congenital spine malformations
occurs most frequently in the lumbosacral spine
Protruding sac may rupture

Sonographic Findings:

tethered cord
cranial abnormalities
splayed echogenic vertebral bodies
anechoic fluid filled mass with internal echogenicities which could represent the spinal cord and nerves

Answer 578

A

Types of spina bifida occulta

Both are contained by intact skin and contain a fatty mass

Lipomyelocele: fatty mass extending through soft tissues, dura, and vertebral elements where it is contiguous with a low lying spinal cord

Lipomyelomeningocele: fatty mass extending through soft tissue vertebral elements, and dura where it attaches to the spinal cord

Sonographic Findings:

vertebral bony abnormality
echogenic mass continuous with the back and extending through the defect and inserting into or adjacent to the cord
dilated subarachnoid space

Answer 579

A

Sonographic Findings:

presence of echogenic debris
increased echogenicity of normal structures
irregular borders of normal structures
abscess formation

Risk factors: invasive procedure, open defect, dorsal sinus tract or bacterial/viral infections

Answer 580

A

Sonographic Findings:

cord disruption
variable echogenicity in the area of hemorrhage
debris in subarachnoid space
displaced of the cord due to epidural or subdural hemorrhage

Associated with non-traumatic and traumatic birth including use of forceps and breech delivery

Brainscape's Knowledge GenomeTM

Pediatric Registry Review Flashcards

Brainscape's Knowledge Genome^TM