Random 11 Flashcards

Question

Testicular cysts

Answer 1

* when an intratesticular lesion meet criteria for a simple cyst, it requires no further evaluation * 10% prevalence * more common in elderly men * often occur near the mediastinum * associated with tubular ectasia of the rete testes - both conditions may be caused by outflow obstruction of the seminal fluid

Answer 2

* aliasing is due to a basic principle of sampling theory = a periodic phenomenon must be sampled at twice its own frequency to be accurately reproduced * increase Doppler scale --\> decrease aliasing * decrease probe frequency --\> decrease aliasing * the frequency shift is proportional to the transmitted frequency * scan at a larger Doppler angle --\> decrease aliasing

Answer 3

* most frequently visualized in the epididymal body * causes of obstruction * vasectomy * trauma * infection

Answer 4

Indications for thyroid biopsy * nodules \> 1.5cm * solid and hypoechoic * irregular margins * thick halo * microcalcifications

Answer 5

Junctional parenchymal defect * 20% of patients * more common on the right * triangular-shaped defect along the anterior renal surface at the junction of upper and middle third * communicating with renal sinus fat

Answer 6

* homogeneous, hypoechoic, hypervascular mass - typical for a seminoma * DDx * seminoma * infarct * contusion * hematoma * focal orchitis * focal atrophy * sarcoid * primary tseticular tumors are the most common malignancy in young adults * most common - germ cell tumors * most common - seminoma

Answer 7

Kasabach-Merritt Syndrome Platelet sequestration and destruction by hemangiomas - extremely rare cause of thrombocytopenia

Answer 8

Hemangiomas will occasionally change in appearance over time. Typically, they will convert from hyperechoic to hypoechoic. Rarely, they will change echogenicity over a matter of minutes or even seconds. No other hepatic mass has been observed to have this behavior.

Answer 9

Baker’s cysts occur in the medial aspect of the posterior knee. The cyst arises from fluid accumulation in the bursa between the medial head of the gastrocnemius and the semimembranosus tendon.

Answer 10

Upper limit of normal for peripheral intrahepatic ducts is 2mm

Answer 11

* gallstone - echgoenic, mobile, shadowing * sludge ball - echogenic, mobile, non-shadowing * polyp - echogenic, non-mobile, non-shadowing

Answer 12

* spermatocele - more common * epididymal cyst - contains serous fluid

Answer 13

Alcohol causes precipitation of proteins that obstruct the ducts, and gallstones produce obstruction when they pass through the bile duct and lodge at the ampulla.

Answer 14

Varicoceles are dilated veins of the pampiniform plexus. They are almost always caused by incompetent valves within the internal spermatic vein. Normal peritesticular veins should be less than 2 or 3 mm in diameter. In my experience, they seldom exceed 2 mm. On color Doppler scanning, venous flow in varicoceles is generally too slow to be detected with the patient at rest. Sometimes, this slow flow is apparent on gray-scale imaging. With a Valsalva maneuver, there is augmented retrograde flow in the varicocele that is readily detectable on color Doppler imaging. This augmented flow usually lasts longer than 1 second.

Answer 15

Postcatheterization Pseudoaneurysm * The waveform exhibits pandiastolic flow reversal. The normal triphasic pattern has only a short period of flow reversal in early diastole. * "To-and-fro" waveform comes from the neck of a pseudoaneurysm and reflects flow into the aneurysm during systole and flow out of the aneurysm during diastole. * Color Doppler - "yin-yang" appearance * With grayscale imaging - often possible to see the collection expand during systole and contract during diastole. * DDx - hematoma, abscess, adenopathy, and hernia. * Rx - ultrasound-guided thrombin injection.

Answer 16

* Normally right hepatic artery runs anterior to the portal vein * If there is an artery runs b/t the PV and IVC, it is most likely to be an anomalous right hepatic artery arising from the SMA * Incidence of replaced or accessory right hepatic artery = 20%

Answer 17

Column of Bertin

Answer 18

Normal portal vein waveform * normal portal vein velocity - 15-30 cm/sec * Although the liver is very close to the heart, the hepatic parenchyma and its sinusoidal network effectively isolate the portal vein from the pressure fluctuations in the right heart. For this reason, the portal vein waveform is much less pulsatile than other centrally located veins. However, the normal portal vein waveform usually does have some gentle pulsatility related to the cardiac cycle. * A good rule of thumb is that minimum flow velocities should not drop all the way to the baseline and certainly not below baseline.

Answer 19

1. inner hyperechoic layer - interface reflection b/t luminal contents and superficial mucosa 2. inner hypoechoic layer - deep mucosa and muscularis mucosa 3. middle hyperechoic layer - submucosa 4. outer hypoechoic layer - muscularis propria 5. out hyperechoic layer - serosa/adventitia

Answer 20

* A transverse temporal bone fracture extends at a right angle to the long axis of the petrous pyramid. It tends to course through the internal auditory canal and cochlea predisposing the patient to facial and auditory nerve damage that may result in facial palsy and sensorineural hearing loss. The ossicular chain is typically not affected. * A longitudinal fracture is the most common type (80%) of temporal bone fractures. The fracture line runs parallel to the long axis of the petrous pyramid. It tends to course through the tympanic membrane and middle ear cavity predisposing the patient to ossicular chain disruption and conductive hearing loss.

Answer 21

The incus is the least stable ossicle because of its weak attachments to the malleus and stapes with the incudostapedial joint being the most common site of traumatic separation (82%). The malleus is anchored by the tensor tympani muscle and its tendon while the stapes is fastened by the stapedius muscle and its tendon, making dislocations of the malleus and stapes a rare occurrence. Fractures of the stapes crura are also uncommon.

Answer 22

"This can also be re-assessed at the time of follow up US."

Answer 23

* porcelain gallbladder - clean shadow * emphysematous cholecystitis - dirty shadow * as well as ring down artifact * only gas can give you ring down artifact! (maybe metal also) * can be differentiated with AXR or CT

Answer 24

When the calcification is diffuse and thick, the superficial wall of the gallbladder is seen as a bright, curvilinear reflector with an associated shadow. Because of extensive attenuation of the sound pulse, the back wall is not visible when the calcification is thick. If the calcification is thin, enough sound may penetrate the superficial wall in order to image part of or even the entire back wall. Such is the case in this patient. The ability to see the back wall is important because that excludes a gallbladder full of stones from the differential diagnosis.

Answer 25

* gallbladder polyp * gallbladder cancer * tumerfactive sludge * pus * blood clots can use Doppler flow to distinguish

Answer 26

* \<5mm - ignore * 5-10mm - follow up * \>10mm - cholecystectomy

Answer 27

* usually pedunculated * most common gallbladder polyp * enlarged papillary fronds filled with lipid-laden macrophages - a form of gallbladder cholesterolosis * "ball on the wall" sign * does *_not_* appear to be associated with an increased incidence of cholesterol stones

Answer 28

* air in the lung base and air in the trachea acts as an acoustic mirror

Answer 29

* PSV \> 125cm/s * can be confounded by other factors * high baseline PSV may be due to contralateral ICA or CCA occlusion * low baseline PSV may be due to aortic stenosis or a second more proximal stenosis * ICA/CCA \> 2

Answer 30

* Hyperacute - anechoic * Acute - hyperechoic * Subacute - complex cystic, partially liquefied

Answer 31

Pancreatic tail is positioned below the splenic vein, as the splenic vein exits the splenic hilum. Pancreatic tail is usually immediately anterior to the upper pole of the left kidney.

Answer 32

* metastases * lymphoma * sarcoidosis * abscesses * infarcts

Answer 33

This abnormality is caused by stenosis of the subclavian artery prior to the origin of the vertebral artery.

Answer 34

Morton's neuroma * arise from plantar branch of the digital nerves * most often located in the 2nd and 3rd webspaces of the foot at the level of the metatarsal heads * more common in women * due to perineural fibrosis, likely related to repetitive trauma * pain and paresthesias with walking and marked tenderness to direct palpation * hypoechoic masses

Answer 35

* metastases\* (most common) - colorectal carcinoma most common primary, ovarian, gastric, RCC * infectious/inflammatory - granulomatous disease (TB, histo), echinococcus, healed pyogenic or amebic abscess * primary liver neoplasm - fibrolamellar HCC with calcification in the central scar

Answer 36

Chronic calcific pancreatitis is a complication of prolonged alcohol abuse. It is believed that alcohol predisposes to the precipitation of proteins in the side branches of the pancreatic duct. These proteins attract calcium carbonate and form stones that obstruct the peripheral side branches, resulting in an inflammatory response that causes parenchymal damage and, ultimately, periductal fibrosis. Side branch strictures and ectasia result from the scarring and from the intraductal concretions. With more advanced disease, the main pancreatic duct becomes involved, with alternating strictures and dilatation.

Answer 37

Up to one-third of patients with chronic pancreatitis have a focal inflammatory mass in the pancreas. These masses are usually located in the pancreatic head and may cause dilatation of the common bile duct and the pancreatic duct. Therefore, they can be difficult to distinguish from pancreatic carcinoma. The presence of calcifications strongly supports the diagnosis of chronic pancreatitis. When calcifications are absent and especially when the mass is hypoechoic, ERCP and biopsy should be considered to further evaluate for possible.

Answer 38

Tenosynovitis An effusion with thickening and increased vascularity of the tendon sheath around the tendon.

Answer 39

Papillary thyroid cancer Psammoma bodies (microcalcifications)

Answer 40

* Cysts of the tunica albuginea are entities distinct from intratesticular cysts. * Typically, they are very firm on physical examination and often are first recognized by the patient. * Since they arise from the tunica albuginea, they are always located at the periphery of the testis. * Although they occur in a range of sizes, they are most often less than 5 mm in diameter.

Answer 41

* if there is a prior history of lymphoma * or if there is history of another primary tumor likely metastasizing to the kidneys

Answer 42

Sickle cell disease

Answer 43

Hydatid cyst can have macroscopic fat in them maybe due to communication with biliary ducts

Answer 44

ILIAC side!!! anteroinferior side of SI joints and Iliac side!

Answer 45

Splenic vein thrombosis

Answer 46

* AComm - 30% * ICA at the PComm origin - 25% * MCA bifurcation - 20% * ICA bifurcation - 7.5% * Vertebrobasilar - 10%

Answer 47

Age \< 20 years should not exceed 1.8 cm in maximum transverse (short axis) thickness. If exceed this measurements? Thymic hyperplasia.

Answer 48

The umbilical vein travels inferior to the liver along the deep aspect of the abdominal wall toward the umbilicus. It eventually connects to the inferior epigastric veins, which then drain into the femoral– iliac system. In some cases, the umbilical vein turns superiorly to communicate with the superior epigastric veins and the internal mammary veins. The umbilical vein normally exits the liver and travels along the anterior abdominal wall toward the umbilicus. As it leaves the liver, it ramifies into paraumbilical veins.

Answer 49

Parathyroid adenomas are almost always medial to the carotid artery. A nodule seen lateral to the carotid is much more likely to be a lymph node. The incidence of ectopic parathyroid nodules is approximately 10%.

Answer 50

\> 50% stenosis - \> 125cm/s \> 70% stenosis - \> 230cm/s

Answer 51

DDx for hepatic target lesions Hyperechoic centrally with hypoechoic peripheral rim DDx * metastases * HCC * lymphoma * abscess The hypoechoic rim represents viable tumor. In fact, when performing percutaneous biopsy of these lesions, the highest yield is from the hypoechoic rim.

Answer 52

Causes of ring down artifact * gas bubbles - msot common * metal (cholecystectomy clips) If a complex fluid collection gives ring down artifact - abscess containg gas locules If echogenic gallbladder wall gives shadowing and ring down - emphysematous cholecystitis If ring down in the gallbladder fossa following cholecystectomy - surgical clips

Answer 53

WES - thin hypoechoic wall superficially

Answer 54

Hepatic abscesses can appear as solid lesions on US Look for target lesion appearance and relative posterior acoustic enhancement

Answer 55

Normal hepatic vein waveform ## Footnote During right atrial contraction there is a short period during which the blood flow in the hepatic vein actually reverses and heads back into the liver. This is seen as the short phase of flow above the baseline. As the right atrium relaxes (corresponding to ventricular systole), blood flow rapidly exits the liver and enters the atrium, producing flow below the baseline. As the atrium starts to fill up, the flow out of the liver slows, and the waveform starts to approach the baseline. Then the tricuspid valve opens (at the beginning of ventricular diastole), and the right atrium starts to decompress into the right ventricle. This leads to another period of rapid outflow from the liver into the right atrium, resulting in a second pulse of flow below the baseline. Finally, the right atrium starts to contract again, and the process repeats itself. The end result is a triphasic pattern with one retrograde pulse above the baseline (during atrial contraction) and two antegrade pulses below the baseline. The first antegrade pulse is usually the largest and occurs during ventricular systole. The second antegrade pulse is usually smaller and occurs during ventricular diastole.

Answer 56

* Thallium - taken up by cells via the Na/K ATPase pump (85% first pass extraction fraction) and is cleared predominantly by the kidneys * Sestamibi - lipophilic cationic agent, taken up by cells via passive diffusion (concentrated in the mitochondria) and cleared via the hepatobiliary route. Hence, in addition to the normal biodistribution of the radiotracer, there is also visualization of liver, gallbladder, and bowel

Answer 57

The left hepatic artery occasionally arises from the left gastric artery. In such cases, it enters the liver through the fissure for the ligamentum venosum.

Answer 58

How to reduce Doppler aliasing * increase Doppler angle (to closer to 90 degrees) * increase Doppler scale * increase pulse repetition frequency * decrease transmitted frequency

Answer 59

Right portal vein A common portal systemic collateral in patients with portal hypertension is the recanalized umbilical vein, which is supplied by the left portal vein. A common finding in these patients is reversed right portal flow that crosses the portal bifurcation and contributes to antegrade left portal flow and ultimately to flow into the umbilical vein. Thus, flow reversal is more common in the right portal vein.

Answer 60

Confirm vascularity with *_spectural Doppler_*

Answer 61

Islet cell tumors are more likely to contain calcifications

Answer 62

RI = (PSV-EDV)/PSV PI = (PSV-EDV)/mean velocity

Answer 63

* calcifications within the seminiferous tubules * usually bilateral * controversial re: whether predisposes to cancer - can recommend annual US followup * classification * classic: \> 5 microliths/view * limited: \< 5 microliths

Answer 64

* a benign renal neoplasm. * consists of multiple cystic spaces that do not communicate with each other or with the renal collecting system. The cysts are epithelium lined and separated by fibrous septations. The lesion is usually well encapsulated. * demographics: * young boys (typically 3 months to 4 years of age) * adult women (older than age 30 years) * surgical resection due to overlapping appearance with cystic RCC

Answer 65

Spectral broadening * can be a sign of disordered or turbulent blood flow * but can be typical of small parenchymal vessels * This difference is at least partially related to the relative size of the vessel and the size of the sample volume. In a small vessel, the slow flow at the edge of the vessel wall and the faster flow in the center of the lumen are being sampled simultaneously. In a larger vessel, only the faster flow in the center is being sampled. In addition to large sample volumes, high Doppler gain and high power outputs can also produce spectral broadening in normal vessels.

Answer 66

With current harmonic imaging technology, only the second harmonic, which is twice the fundamental frequency, is used. In this case, the image was created by transmitting at 1.6 MHz and analyzing the 3.2-MHz harmonic signal after the 1.6-MHz echoes were filtered out. Because the harmonic signal is a higher frequency, axial resolution improves with harmonic imaging. Additionally, the harmonics allow for better focusing, which also improves lateral resolution.

Answer 67

* in the proper clincial setting, it indicates a proximal arterial stenosis *

Answer 68

* 10-30% malignant * C-KIT positive * may have cystic necrosis, hemorrhage, calcifications * the tumors grow in an exophytic fashion and this can make if difficult to determine where the lesion arises. This growth pattern is particularly true of large lesions. Therefore, it is important to include GIST in the differential diagnosis of large intra-abdominal masses that do not arise from a defined solid organ.

Answer 69

* Palpable intratesticular masses are usually malignant * Palpable extratesticular masses are usually benign * Most common benign intratesticular neoplasm - stromal tumor (such as Leydig cell tumors) * Most common palpable extratesticular lesion - spermatocele * Most common extratesticular scrotal neoplasm - adenomatoid tumor

Answer 70

* benign * most common location - epididymis * homogeneous and small; may be hypo-, iso-, or hyper-echoic to the testis * DDx * inflammatory mass * post-inflammatory scar * sperm granuloma

Answer 71

Bladder diverticulum * more common in older male (BPH) * complicatiosn - stasis, stone, infection, cancer * further imaging - often associated with bladder outlet obstruction, therefore post void residual is indicated

Answer 72

* solid, homogeneous * features: a thin, uniform, hypoechoic halo surrounding the tumor

Answer 73

FNH * a collection of vessels arranged in a spokewheel configuration. * Central calcification suggests the diagnosis of fibrolamellar hepatocellular carcinoma and would prompt a more aggressive approach. * NM study - sulfur colloid scan - Due to the concentration of Kupffer cells, approximately 60% of FNHs are either more intense or isointense to adjacent liver.

Answer 74

Peyronie's disease Peyronie’s disease is fibrosis of the tunica albuginea of the corpora cavernosa.