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ABDOMEN > Superficial structures > Flashcards

Superficial structures Flashcards

1
Q

breast tissue aka

A

mammary gland

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2
Q

the mammary gland is a

A

modified sweat gland

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3
Q

3 tissue types in the breast

A

fatty, glandular, fibrous

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4
Q

3 zones of breast

A

subcutaneous/premammary
mammary/fibroglandular
retromammary

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5
Q

the premammary zone contains

A

subcutaneous fat, Cooper’s ligaments, mammry fascia,

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6
Q

no true breast lesions can occur in which zone

A

the premammary zone/ subcutaneous

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7
Q

what is mammary fascia

A

connective tissue enveloping mammary zone, continuous with Cooper’s ligaments,

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8
Q

function of mammary fascia

A

support and shape breast

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9
Q

mammary zone is made of

A

fibroglandular tissue (parenchyma)

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10
Q

mammary zone is in what area mainly

A

UOQ, areola

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11
Q

size of mammary zone depends on

A

functional state (cycle, age), inherited tissue pattern (genetics)

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12
Q

mammary zone contains

A

lobes -> lobules -> ducts, sinuses -> TDLU

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13
Q

number of lobes per breast

A

15-20

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14
Q

lobes are arranged

A

radially

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15
Q

lobes contain

A

ducts, stroma, acinus

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16
Q

acinus

A

milk-producing glands

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17
Q

number of lobules per lobe

A

20-40

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18
Q

lobules contain

A

individual milk producing glands

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19
Q

acini

A

individual milk producing glands

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20
Q

drain acini, lobules, lobes

A

ducts and sinuses

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21
Q

lactiferous ducts converge to form

A

lactiferous sinus

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22
Q

TDLU

A

terminal ductal-lobular unit

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23
Q

functional unit of breast

A

TDLU

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24
Q

TDLU consists of

A

lobule + extralobular terminal duct

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25
Q

undergoes monthly hormone-induced changes

A

TDLU

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26
Q

TDLU are in which layer

A

mammary zone, fibroglandular tissue

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27
Q

TDLU is surrounded by

A

connective tissue

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28
Q

size of TDLU

A

1-2 mm

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29
Q

site of most major breast pathology

A

TDLU

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30
Q

lobule + duct =

A

TDLU

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31
Q

tail of Spence

A

mammary tissue extending into axilla region

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32
Q

deepest layer

A

retromammary layer

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33
Q

retromammary layer contains

A

fat, blood, lymph

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34
Q

nipple

A

fibromuscular papilla, projecting from center of breast

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35
Q

normal variant of nipple

A

inverted nipple

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36
Q

multiple openings in nipple

A

lactiferous sinuses

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37
Q

pigmented area

A

areola

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38
Q

areola contains

A

many sebaceous glands

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39
Q

muscle posterior to retromammary layer

A

pectoralis major

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40
Q

covered by pectoralis major

A

pectoralis minor

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41
Q

breast vascular supply

A

lateral thoracic artery, internal mammary artery, intercostal arteries

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42
Q

blood vessel harvested for CABG

A

internal mammary artery

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43
Q

lymphatic drainage

A

axillary nodes, also pectoral, parasternal, subcutaneous nodes

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44
Q

breast cancer often cause what in LN

A

invasion

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45
Q

mammary glands are found in males, females or both

A

both

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46
Q

function of mammary glands

A

produce and secrete milk

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47
Q

mammary glands function is affected by

A

monthly hormonal changes, pregnancy, lactation

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48
Q

development of mammary glands starts

A

before menarche

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49
Q

age, stage of breast function affect

A

amount of parenchyma and stroma

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50
Q

estrogen effect

A

proliferates duct system

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51
Q

progesterone effect

A

stimulates development of lobular cells

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52
Q

prolactin effect

A

stimulates milk production

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53
Q

oxytocin

A

causes milk ejection from lactating breast

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54
Q

pre-pubescent breast

A

rudimentary ducts, tissue dev under nipple, little fat tissue

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55
Q

young adult breast

A

mostly dense fibroglandular tissue, minimal fat

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56
Q

adult breast tissue

A

equal fibroglandular and fat

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57
Q

pregnant/lactating breast

A

glandular tissue, prominent ducts

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58
Q

older/multiparous breast

A

increased subcutaneous/retromammary fat, +/- isolated fat areas

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59
Q

menopause breast

A

parenchyma mainly under nipple and outer quadrant

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60
Q

post-menopausal breast

A

lobules and ducts atrophy, fatty replacement, Cooper’s ligaments easily id’d

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61
Q

sono appearance of nipple

A

homogeneous, mid level echoes, post shadowing

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62
Q

subcutaneous fat lobules do not extend

A

post to nipple

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63
Q

sono appearance of subcutaneous fat lobules

A

hypoechoic, echogenic strands

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64
Q

parenchyma appears ___ compared to fat

A

echogenic

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65
Q

sono appearance of parenchyma

A

hypoechoic ducts tracking towards nipple, interspersed with hypo areas of fat

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66
Q

sono appearance of lactiferous ductules

A

hypoechoic tubes, track towards nipple, increasing in size, up to 8 mm, radial pattern

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67
Q

sono appearance of Cooper’s ligaments

A

curved echogenic striations, surround fat lobules

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68
Q

sono appearance of retromammary layer

A

hypoechoic, ant to pec major

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69
Q

sono appearance of muscles

A

striated, med - low level echoes, immediately post to breast

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70
Q

normal LN

A

< 1 cm, oval, hypoechoic, echogenic hilum, minimal flow

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71
Q

birads

A

system of lesion classification, categorizing according to degree of suspicion

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72
Q

birads 1

A

sonographically normal

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73
Q

birads 2

A

benign finding

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74
Q

birads 3

A

probably benign

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75
Q

birads 4a

A

low suspicion, requires biopsy

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76
Q

birads 4b

A

intermediate suspicion

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77
Q

birads 4c

A

moderate suspicion

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78
Q

birads 5

A

highly suggestive of malignancy (> 95%)

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79
Q

birads 6

A

known cancer

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80
Q

pseudo mass can be due to

A

retroareolar ducts, costal cartilage, prominent tissue, acoustic shadow at nipple, surgical scar

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81
Q

breast cyst is a ___ abnormality

A

benign

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82
Q

cause of breast cyst

A

obstruction in terminal portion of duct

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83
Q

cyst is more/less mobile than fibroadenoma>

A

less

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84
Q

are breast cysts palpable?

A

yes

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85
Q

sono features of breast cyst

A

strong back wall, round/oval, post enhancement, anechoic

86
Q

origin of sebaceous cyst

A

skin, in premammary zone

87
Q

sono features of complex cyst

A

low level internal echoes, septations, post enhancement

88
Q

cyst formation in post-meno women is linked to

A

HRT

89
Q

foam cyst

A

cyst filled with low level echoes -> PAM, protein, fat

90
Q

PAM

A

papillary apocrine metaplasia: altered acini cells, clustered overgrowth of tissue

91
Q

acorn cyst

A

cyst displaying non-dependent echogenic layer -> overgrowth of cells, won’t move, benign overgrowth

92
Q

most common benign tumour in women of child bearing years

A

fibroadenoma

93
Q

benign tumour stimulated by estrogen

A

fibroadenoma

94
Q

benign tumour formed in adolescence

A

fibroadenoma

95
Q

what causes a fibroadenoma to increase in size

A

pregancy, HRT

96
Q

fibroadenomas are

A

painless, palpable, mobile

97
Q

sono features of fibroadenoma

A

lobulated contour, elliptical, well defined, thin echogenic capsule, hypoechoic, homogeneous, wider than tall, solid, no change with comp

98
Q

fibroadenoma compressible?

A

no

99
Q

fibroadenoma can be mistaken for

A

fat lobule

100
Q

giant fibroadenoma

A

cystosarcoma phylloides

101
Q

prominent feature of cystosarcoma phylloides

A

very fast growing

102
Q

cystosarcoma phylloides occurs in which age group

A

40-50 yrs

103
Q

cystosarcoma phylloides is uni/bilateral

A

unilateral

104
Q

sono features of cystosarcoma phylloides

A

low level internal echoes, hypoechoic, irregular edges, borders defined, lobulated

105
Q

fatty benign tumour

A

lipoma

106
Q

lipomas occur in

A

middle aged or post meno women

107
Q

sono features of lipomas

A

hypoechoic,- depending on surrounding tissue, defined margins, thin capsule

108
Q

hemorrhage or liquefaction of fatty area

A

fat necrosis

109
Q

fat necrosis is due to

A

trauma, surgery, inflammation

110
Q

fat necrosis forms a

A

dense scar, or lipid cyst, may calcify, skin retraction, nipple inversion

111
Q

sono features of fat necrosis

A

irregular, hypoechoic, complex mass, may shadow

112
Q

benign solid mass in lining of ducts

A

papilloma

113
Q

symptoms of papilloma

A

bloody discharge, tender breast

114
Q

papillomas are found usually

A

near nipple

115
Q

sono features of papilloma

A

solid lesion in a cyst, or dilated duct, ductal ectasia near mass

116
Q

exaggerated cyclic changes in breast tissue

A

fibrocystic changes

117
Q

fibrocystic changes

A

cells in breast ducts proliferate and retain water

118
Q

fibrocystic changes usually occur

A

in UOQ

119
Q

fibrocystic changes tissue processes

A

apocrine metaplasia, fibrosis, sclerosing adenosis

120
Q

fibrocystic changes can be seen as

A

lumpy, swollen, painful breasts, nodular, nipple discharge, mammo changes mimicking cancer

121
Q

fibrocystic changes on U/S

A

multiple cysts, echogenic fibrous tissue, small nodules ( < 1 cm) in parenchyma

122
Q

fibrocystic changes treatment

A

eliminate caffeine, hormone therapy, vitamin E

123
Q

obstruction of a lactiferous duct in pregnant or lactating woman

A

galactocele

124
Q

location of galactocele

A

retro-areolar

125
Q

galactoceles can lead to

A

mastitis

126
Q

mastitis

A

inflammation of breast

127
Q

sono features of galactocele

A

well-defined cystic mass, less post enhancement than regular cyst, internal debris; lipid-fluid layers

128
Q

tubular hypoechoic structure converging towards nipple

A

ductal ectasia

129
Q

size of ductal ectasia

A

> 8 mm

130
Q

ductal ectasia occurs in

A

lactating pts, > 50 yrs

131
Q

ductal ectasia can lead to

A

mastitis

132
Q

breast inflammation

A

mastitis

133
Q

mastitis can be __ or ___

A

focal; diffuse

134
Q

mastitis usually occurs in

A

lactating patients

135
Q

mastitis is caused by

A

obstruction of duct by milk, bacteria enters through nipple, trauma, radiation, diabetes, immune compromised

136
Q

mastitis can lead to

A

abcess formation

137
Q

S/S of mastitis

A

hot, red, tender (very painful), fever, palpable mass, nipple discharge

138
Q

U/S features of mastitis

A

irregular fluid collection with debris, edema, loss of tissue definition, complex collection, shaggy wall, septations, post enhancement

139
Q

low risk nipple discharge

A

bilateral, multiple orifices, milky/greenish, fibrocystic changes or duct ectasia

140
Q

high risk nipple discharge

A

unilateral, spontaneous, clear, bloody, serous

141
Q

malignancy location categories

A

ductal, lobular

142
Q

non-invasive

A

in situ

143
Q

invasive

A

infiltrating

144
Q

sonographic characteristics of malignancy

A

taller > wide; angled, irregular borders, spiculated, heterogeneous, post shadowing, thick echogenic rim, hypo halo, ductal extension, branch pattern, microlobulations, microcalcs

145
Q

secondary findings of malignancy

A

skin changes: skin thickening, flattening, retraction, inverted nipple, LN invasion, dilated ducts, surrounding tissue highly echogenic, thickened Cooper’s ligaments

146
Q

15 % of all breast cancers

A

non-invasive (in situ) carcinoma

147
Q

most common non-invasive carcinoma

A

ductal carcinoma in situ

148
Q

ductal carcinoma in situ usually occurs in

A

post-menopausal women

149
Q

features of ductal carcinoma in situ

A

nipple discharge, microcalcs, +/- palpable lump

150
Q

25 % of all breast cancers

A

lobular carcinoma in situ

151
Q

lobular carcinoma in situ occurs in

A

reproductive years

152
Q

not considered a true cancer

A

lobular carcinoma in situ

153
Q

characteristics of intracystic papillary carcinoma in situ

A

rare, middle aged, well-defined, mobile, palpable - cyst is palpated, with cancer growing inside

154
Q

most common invasive ca

A

infiltrating ductal carcinoma

155
Q

infiltrating ductal carcinoma accounts for ___% of all ca

A

65%

156
Q

characteristics of infiltrating ductal carcinoma

A

hard, stationary, painless, palpable mass, microcalcs, spiculations, taller > wide, hyperechoic rim, shadowing

157
Q

most common location of infiltrating ductal carcinoma

A

UOQ

158
Q

10-15 % of all breast ca

A

infiltrating lobular carcinoma

159
Q

most frequently missed ca

A

infiltrating lobular carcinoma

160
Q

infiltrating lobular carcinoma has increased risk of

A

occurence in contralateral breast

161
Q

infiltrating lobular carcinoma is often associated with

A

nipple retraction

162
Q

infiltrating ductal carcinoma is more common on the ___ side

A

left

163
Q

infiltrating lobular carcinoma is found in which zone

A

pre-mammry zone

164
Q

fastest growing ca

A

medullary carcinoma

165
Q

looks like fibroadenoma or phylloides

A

medullary carcinoma

166
Q

phylloides tumour is

A

benign

167
Q

fastest growing breast CA

A

medullary carcinoma

168
Q

difficult to distinguish from fibroadenoma

A

medullary carcinoma

169
Q

rare, older women, slow growth

A

mucinous carcinoma

170
Q

this type of breast CA needs biopsy to determine what type

A

mucinous carcinoma

171
Q

breast ca typically affecting post-meno women

A

papillary carcinoma

172
Q

associated with intraductal papilloma

A

papillary carcinoma

173
Q

commonly has bloody nipple discharge

A

papillary carcinoma

174
Q

typically located in central breast area

A

papillary carcinoma

175
Q

favourable prognosis

A

papillary carcinoma

176
Q

intraductal papilloma can turn into

A

papillary carcinoma

177
Q

all solid breast lesion should be considered

A

malignant

178
Q

augmented breast

A

breast implant

179
Q

2 types of breast implants

A

silicone, saline

180
Q

reconstructive breast augmentation

A

post- mastectomy

181
Q

problem with ALL silicone implants

A

leakage

182
Q

cosmetic implants are place ___ to pec major

A

anterior

183
Q

reconstructive implants are place ___ to pec major, _____ to pec minor

A

posterior; anterior

184
Q

problems with implants

A

leakage, rupture, contraction

185
Q

implant contracture is associated with

A

immune and connective disorders

186
Q

U/S appearance of implant

A

anechoic, anterior reverberation, anterior capsule formed by body, radial folds- anterior

187
Q

silicone leak occurs

A

outside envelope

188
Q

“step-ladder” sign

A

intra-capsular rupture

189
Q

“snowstorm” sign

A

extra-capsular rupture

190
Q

tear in sell of implant, silicone between shell and fibrous capsule

A

intra-capsular rupture

191
Q

numerous linear echogenic structures

A

intra-capsular rupture

192
Q

low level homogenoeous echoes beyond ant third of implant

A

intra-capsular rupture

193
Q

tear in fibrous capsule

A

extra-capsular rupture

194
Q

extravasion of silicone into breast parenchyma or LN

A

extra-capsular rupture

195
Q

implant rupture

A

change in breast shape or consistency, chronic burning

196
Q

occurs in ALL silicone implants

A

silicone bleeds

197
Q

microscopic leakage thorugh an intact implant, contained in fibrous capsule

A

silicone bleeds

198
Q

snowstorm appearance in LN

A

silicone bleeds

199
Q

contracture can occur in

A

all implant types

200
Q

normal body response to implant

A

fibrous capsule

201
Q

fibrous capsule is normally

A

larger than implant, flexible

202
Q

fibrous capsule in contracture

A

contracts, constricts, hard, disfiguring

203
Q

lower risk of contracture in

A

posteriorly placed implants

204
Q

palpable lump in saline implants

A

fill valve, directly posterior to nipple

205
Q

male breast enlargement

A

gynecomastia

206
Q

abnormal growth of retroareolar glandular tissue and increase in subcutaneous fat

A

gynecomastia

207
Q

most common breast abn in men

A

gynecomastia

208
Q

gynecomastia is linked to

A

estrogen and androgen use, HTN drugs, depression meds, estrogenic neoplasms

209
Q

S/S of gynecomastia

A

enlarged breast, palpable mass at nipple, firm, pain, tenderness

210
Q

U/S features of gynecomastia

A

triangular area of hypoechoic glandular tissue under nipple, ducts seen tracking to nipple, increased fat, can be unilateral

ABDOMEN (4 decks)

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