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radiology > ultrasonography ch19 > Flashcards

ultrasonography ch19 Flashcards

1
Q

The creation of sonographic image (sonogram) depends on three major components:

A
  1. the production of high-frequency sound waves
  2. the reception of a reflected wave or echo
  3. conversion of that echo into actual image
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2
Q

The body surface that can be scanned can be

A

external (transabdominal)

internal (transvaginal, transösophageal, endovascular, transrectal)

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3
Q

A tissue that reflects more echoes is depicited ___ on the sonogram

A

brighter/whiter

hyperechoic

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4
Q

A tissue that transmits more echoes (resulting in less echoes reflected back to the transducer) is depicted __ on the image

A

darker
hypoechoic
sonloucent

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5
Q

A tissue that transmits all the echoes id sepicted as __ on sonogram

A

black

anechoic

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6
Q

Posterior acoustic shadowing

A

when a very dense structure, such as a gallstone or bone, reflects so many echoes that virtually no sound waves are transmitted, the tissue deeper to this structure is displayed as hypoechoic and this phenomenon is called posterior acoustic shadowing.

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7
Q

Posterior acoustic enhancement

A

when a structure transmits more echoes that the surrounding tissues, such as a cyst in the liver, the sound waves deeper to this structure (compared with surrounding structures) are depicted as hyperechoic and this phenomenon is called posterior acoustic enhancement

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8
Q

two common imaging planes used in ultrasonography

A

sagittal or longitudinal

transverse

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9
Q

small differences in acoustical impedance will result in:

A

greater sound transmission

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10
Q

greater differences in acoustical impedance will result in

A

greater sound reflection

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11
Q

Appearance of commonly encountered tissues on ultrasound: fluid

A

hypoechoic or anechoic (depending if the fluid is simple or complex (containging debris, pus, blood); may have posterior acoustic enhancement

example: cyst, abscess, gallbladder…

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12
Q

Appearance of commonly encountered tissues on ultrasound: calcium

A

hyperechoic, may have posterior acoustic shadowing

example: renal stones, bones, calc. in soft tissues

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13
Q

Appearance of commonly encountered tissues on ultrasound: air

A

hyperechoic foci; may cause posterior acoustic shadowing
examples: gas-forming infections (abscesses, fournier’s gangrene, endometritis),
intraperitoneal air, necrotizing enterocolitis

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14
Q

By convention, two common imaging planes are used:

A
  1. saggital or longitudinal plane (long axis)

2. transverse plane (perpendicular to long axis)

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15
Q

What influences resolution of images?

A

frequency of the soundwaves

higher frequency = higher resultion, more detail BUT shorter penetration

and vice versa

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16
Q

advantages of ultrasonography

A 
no ionizing radiation
no known long term side effects
real-time images
produces little or no patient discomfort
small, portable, inexpensive, ubiqutous
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17
Q

disadvantages of ultrasound

A

difficulty penetrating through bone
gas-filled structures reduce its utility
obese patients may be difficult to penetrate
dependent on the skill of the operator

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18
Q

list types of ultrasound

A 
A-mode
B-mode
M-mode
Doppler
Duplex ultrasonography
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19
Q

What is A-mode US

A

simplest type of US
spikes along a line represent the signal amplitude at a certain depth
used mainly in ophthalmology

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20
Q

what is B-mode US

A

mode most often used in diagnostic imaging; each echo is depicited as a dot and the sonogram is amde up of thousands of these dots; can depicit real-time motion

(basically US we use)

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21
Q

What is M-mode US

A

it is used to show moving tructures, such as blood flow or motion of the hear valves

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22
Q

what is doppler US

A

used to asses blood flow.

pulsed doppler devises emit short bursts of energy that allow for an accurate localization of the echo source

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23
Q

what is duplex ultrasonography

A

it is used in vascular studies;
it referst to the simultaneous use of both gray-scale (or color doppler) to visualize the structure of, and flow within, a vessel and spectral (waveform) doppler to quantgative flow

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24
Q

Doppler: the direction of flow is represented by colors red and blue.
____indicates flow towards and ____ indicates flow away from transducer.

A

red towards (higher frequency) , blue away (lower frequency)

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25
Q

appereance of normal gallbladder on US

A

fluid-filled sonolucent (dark) lumen surrounded by echogenic wall (whitish wall)
4x10cm in size, wall normally no thicker than 3 mm

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26
Q

where will gallstone be impacted

A

in the neck of the gallbladder or cystic wall

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27
Q

how to differentiate biliary sludge from gallstones

A

sludge does not produce acoustic shadowing

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28
Q

how to recognize acute cholecystitis on US (3 points)

A
  • thickened gllbladder wall (>3mm)
  • pericholecystic fluid
  • positive sonographic Murphy sign
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29
Q

HIDA scans include radioactive traces which will show obustrction.
What does it mean when
a) the tracer does not appear in the gallbladder, and
b) when it does not appear in small intestine?

A

a) obustrction of cystic duct = no tracer in gallbladder

b) obustrction of the common bile duct = no tracer in small intestine

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30
Q

common bile duct (CBD) lies ___ to the portal vein and ___ to the hepatic artery in the porta hepatis

A

anterior to portal vein

lateral to hepatic artery

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31
Q

measurements of

a. CHD
b. CBD
c. pancreatic duct

A

a. 4 mm
b. 6 mm
c. 2 mm

32
Q

normal renal appereance on ultrasound

A

normal size 9-12 cm in length, 4-5cm width, 3-4 cm thiccc

renal sinus has fat so is brightly echogenic, calyces nor visibke, pyramids hypoechoic

33
Q

healthy kidney color compared to liver and spleen

A

renal parenchyma has uniformly low echogenicity (Dark), usually less than that of spleen and liver

kidneys are darker

34
Q

in patients who experience renal colic (pain) , US is used primarly to evaluate for the presence of ….

A

hydronephrosis (dilatation of the renal pelvis and calyces)

35
Q

what is the typical appereance of obstructive uropathy

A

dilated calyceal system

36
Q

what does ureter look like at the level of obstructing stone

A

it can be dilated

37
Q

if the kidney is sick, it will be darker or lighter than liver/spleen

A

lighter, ie.more echogenic

38
Q

what type of ultrasound will we use if we suspect testicular torsion

A

color doppler US, to see if there is scrotal blood flow

if torsed, then no blood flow

39
Q

normal abdominal aorta size

A

no more than 3cm

40
Q

moving blood within the lumen of the aorta will appear ____ ; thrombus in the wall will appear ____

A

moving blood: anechoic

thrombus: echogenic

41
Q

the position of the uterus in the body is described by its ___ and ___

A

version (angle between cervix and vag)

torsion (angle between uterine body and cervix)

42
Q

normal position of uterus

A

anteverted anteflexed

43
Q

shape and size of uterus

A

pear-shape
max dimensions: 8cm length, 5cm wide, 4cm AP dimension
normally collapsed state, has thin echogenic stripe or line between the apposing surfaces of the endometrium

44
Q

A molar pregnancy is suggested by uterine size which is disproportionaly ______ (large or small?) for the gestational age.

A

large

45
Q

amount of beta-HCG levels in molar pregnency

A

excess of 100 000 mIU/mL

46
Q

Beside large uterus and high beta HCG, what are other symptoms of molar pregnancy

A

vomiting, vaginal bleeding, toxemia

47
Q

How is ectopic pregnancy diagnosed?

A

Ectopic location is diagnosed by a combination of findings that includes absence of an identifiable intrauterine pregnancy, often with an extrauterine, extraovarian solid or cystic mass.

48
Q

if we have large amounts of free fluid (blood) inside ther abdominal cavity in a woman, that could indicate

A

ectopic pregnancy

49
Q

what can we use together with US to distinguish between intrauterine pregnancy, ectopic pregnancy, early abortion

A

beta hcg + ultrasound

50
Q

what are goals of first trimester ultrasound

A

to exclude ectopic pregnancy
to estimate the age of the pregnancy
to determine viability and the number of embryos

51
Q

what are goals of 2nd and 3rd trimester ultrasound

A

estimates of amniotic fluid volume
detection of fetal anomalies
determination of placental and fetal positioning
guidanace for invasive studies to determine the likelihood of fetabl viability in the event of premuature birth

52
Q

How do pelvic inflammatory diseases begin?

A

as transient endometritis and then they ascend to infection of the tubes and ovaries

53
Q

how to recognize pelvic inflammatory disease on ultrasound

A
  • ovaries are enlarged and they have multiple cysts and we see periovarian inflammation
  • fallopian tubes are fluid-filled and dilated (pyosalpnix)
  • there may be fusion of the dilated fallopian tube and ovary (tubo-ovarian complex)
  • a multiloculated mass with septations (tubo-ovarian abscess) may be present
  • CT can be used for cases of complicated PID or for patients whose history may not suggest the diagnosis
54
Q

How do malignant ovarian cysts look like on US?

A
  • they have thick and irregular walls
  • thick and irregular septations
  • internal vascular flow
  • solid papillary projections in the tumors
55
Q

what lesions are called “chocolate cysts”

A

endometriomas, part of the disease endometriosis

they are filled with brownish-red blood

56
Q

nonfunctional cysts of ovary include ___ and ____

A

dermoid cysts and endometriomas

57
Q

what are dermoid cysts

A

they are mature teratomas and are most commonly found in women of reproductive age and are bilateral in up to 25% of cases

58
Q

what cysts can serve as a lead point for ovarian torsion

A

dermoid cysts (nonfunctional)

59
Q

symptoms of Stein-Leventhal syndrome

A

: numerous ovarian follicles (>25/ovary), oligomenorrhea, hirsutism, obesity

60
Q

how do functional cysts look like on US

A

they are well-defined, thin-walled, anechoic (black) structures with homogenous internal fluid echogencitiy

61
Q

do functional cysts require follow up

A

no

62
Q

functional cysts include ___ and ____

A

follicular cysts and corpus luteal cysts

63
Q

size of ovaries in premenopausal women

A

2x3x4cm (5-15mL)

64
Q

what is sonohysterography

A

procedure in which saline is instilled in the endometrial cavity while transvaginal US images are obtained. Saline distends the normally collapsed endometrial cavity and seperates endometrial walls to allow the delineation of endometrial polyps, submucosal myomas, and adhesions

65
Q

how to recognize uterine leiomyomas on US

A

they are heterogenously hypoechoic, solid masses

fibroids may undergo degeneration and calcify and could result in acoustical shadowing

66
Q

location of fibroids is important to aid in treatment. it can be ____, ____, and ____.

A

submucosal (bleeding and infertility), myometrial (most common) and subserosal

67
Q

what is adenomyosis

A

ectopic endometrial tissue within myometrium

68
Q

patients position when preforim US for inguinal hernia

A

supine

69
Q

what does patient need to do during US exam of inguinal hernia

A

preform Valsava maneuver to increase intraabdominal pressure

70
Q

what is normal diemater of appendix

A

less than 6mm and will compress when pressure is applied with transducer

71
Q

how to recognize appendicitis on US

A

diameter of 6mm or more,
noncompressable
tender when paplated with probe
fecalith can be present

72
Q

how to recognize tendinopathy on US

A

tendon appears thickened or there is fluid around tendon

73
Q

how to recognize tendon tear on US

A

tendon tear appears ad fluid in the tendon or discontinuity of the tendon fibers

74
Q

what foreign body can be appreciated on US

A

wood splinters which are sometimes not visible on x-rays can be echogenic (white) on US . other foreign bodies too like metal, glass, plastic

75
Q

contrast-enhances US involves the use of a _____

A

microbubble contrast agent

76
Q

what is contrast-enhanced US used for

A

to demonstrate vascular flow and soft-tissue prefusion

77
Q

is microbbuble contrast agent safe?

A

yes, there is no nephrotoxicity or risk of nephrogenic system fibrosis with it

radiology (8 decks)

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