U/S

Question 1

Aorta enters diaphragm at what level

Answer 1

T12

Question 2

Aorta bifurcates into common iliacs at what level

Answer 2

L4 or 1 to 2 cm below umbilicus

Question 3

What is upper limit of normal for AA

Answer 3

3cm (actually its 2cm or 1.5X proximal uninvolved segment)

Question 4

What three branches of aorta are routinely imaged in U/S?

Answer 4

celiac, superior mesenteric, renal aa

Question 5

The celiac trunk has what two main branches visible on U/S?

Answer 5

splenic (to L) and hepatic (to R)

Question 6

Once you identify the celiac and SMA, what is easiest way to see renal?

Answer 6

Fan up and down

Question 7

What veins draining into IVC are routinely visualized on U/S?

Answer 7

renal and hepatic; portal, splenic, SMA

Question 8

Describe view for seeing portal vein

Answer 8

sagital plane over liver, portal vein will be intrahepatic superior to IVC (which is longtiduinal); portal vein looks axial

Question 9

How do you distinguish portal from hepatic veins?

Answer 9

PORTAL veins have thick echogenic walls

Question 10

What vascular structure is just anterior to the SMA?

Answer 10

splenic VEIN

Question 11

Classic liver ultrasound signature

Answer 11

ground glass

Question 12

4 lobes of liver

Answer 12

R, L, quadrate, and caudate

Question 13

Normal GB dimensions

Answer 13

2-3 X 7-8 cm

Question 14

Normal GB wall thickness:

Answer 14

<3.5mm

Question 15

Three parts of GB

Answer 15

neck, body, fundus

Question 16

What common non-pathologic cause makes the GB bigger?

Answer 16

poor oral intake

Question 17

What position improves scanning of the biliary system?

Answer 17

left lateral decub

Question 18

Once the GB is located in a transverse view, what is the best way to obtain axial view?

Answer 18

rotate transducer counter-clockwise

Question 19

What is the position of the bile duct relative to the portal vein?

Answer 19

CBD is parallel and superficial to portal vein

Question 20

What CBD internal diameter usually indicates pathology?

Answer 20

1cm

Question 21

What makes up the portal triad?

Answer 21

CBD, hepatic artery, portal vein

Question 22

If cystic duct is seen, can probably assume what?

Answer 22

it’s abnormal

Question 23

What can be used to help distinguish CBD from veins?

Answer 23

doppler

Question 24

Which is better for detecting injury of spleen, CT or U/S?

Answer 24

CT

Question 25

What vessels can be used to help locate the pancreas?

Answer 25

splenic artery and vein course along superior aspect

Question 26

AAA criteria

Answer 26

>3cm (30mm) or >1.5X larger than proximal uninvolved segment

Question 27

AAA location

Answer 27

90% infrarenal; supra renal 40%; 1 in 3 involve both supra and infrarenal

Question 28

Most common AAA shape

Answer 28

fusiform; sac usually projects anteriorly and to the left with thrombus on the left anterior wall

Question 29

How do you measure AAA?

Answer 29

OUTSIDE to OUTSIDE (do NOT only measure internal lumen b/c thrombus may be occluding)

Question 30

Why not measure AAA in sagital plane?

Answer 30

May not be measuring along midline-may be gettign tangential cut

Question 31

When AAA is observed, where else should one look?

Answer 31

At Morison's pouch to see if leaking blood

Question 32

What does CT add in the evaluation of AAA that is better than U/S?

Answer 32

detection of retroperitoneal bleeding; also better for judging proximal and distal extent of aneurysm

Question 33

What to do if see aneurysm?

Answer 33

If 4cm, outpt surgical consult | >5cm ED surgical consult

Question 34

DeBakey Classification system

Answer 34

1: both=surgica 2: ascending only=surgical 3. descending only=medical

Question 35

Stanford dissection classfication

Answer 35

A. involve ascending +/- descending=surgical | B. descending=medical

Question 36

What do you look for on U/S of dissection?

Answer 36

intimal flap

Question 37

Which type of gallstone is most common?

Answer 37

mixed (other main types are pure cholesterol and pigmented)

Question 38

Three processes of gallstone formation

Answer 38

abnormal bile composition, bile stasis, infection

Question 39

gallstone criteria on U/S

Answer 39

acoustic shadowing, gravitational dependence, echogenic

Question 40

What is wall-echo sign?

Answer 40

"WES" GB full of stones, examiner only seems rim of bladder and superficial surface of stones; may look similar tobowel gas; huge shadow behind

Question 41

What are U/S findings of cholecystitis?

Answer 41

GB wall thickening, pericholecystic fluid, U/S murphy's sign; cholelithiasis

Question 42

Where do you measure GB wall?

Answer 42

at interface of the liver with the anterior wall of the GB (avoids distorting effects posterior acoustic enhancement, etc)

Question 43

How does diameter of CBD change with age?

Answer 43

increases; gains about 1mm/decade

Question 44

What causes false-positive wall thickening?

Answer 44

normal GB contraction; any condition that causes generalized edema (ie ascites, anasarca) can cause GB wall thickening

Question 45

How do polyps differ from stones

Answer 45

Not gravity dependent and usually don't have shadows; need to consider cancer

Question 46

What size renal stone can be seen on U/S?

Answer 46

usually >1cm

Question 47

Can you usually see ureteral stones?

Answer 47

no

Question 48

If you think you see uerter (unlikely) what can help?

Answer 48

color doppler

Question 49

What can help you tell that a cystic structure does indeed have fluid in it?

Answer 49

posterior acoustic enhancement

Question 50

When might you want doppler to look at kidney?

Answer 50

transplanted kidney

Question 51

How sensitive is U/S for spleen?

Answer 51

very very poor; get a CT