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Body Imaging > Ultrasound > Flashcards

Ultrasound Flashcards

1
Q

RFs for gallbladder carcinoma

A

Chronic cholecystitis (gallstones seen in most cases)
Underlying conditions: PSC, IBD (UC>Crohns)
Ethnicity (native americans)
FHx
Obesity, diabetes

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2
Q

Most common GB met

A

Melanoma

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3
Q

DDx. diffuse GB wall thickening

A
  • Fluid overload: CHF, cirrhosis, hypoproteinemia (malnutrition), renal disease
  • Inflammatory/infectious: Cholecystitis (acute and chronic), hepatitis, pancreatitis, etc.
  • Infiltrative neoplastic disease: GB carcinoma, mets
  • Post-prandial state
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4
Q

Risk factors for cholangiocarcinoma

A
  • PSC (major risk factor in NA)
  • RPC (asians)
  • Choledocholithiasis
  • Asian liver flukes
  • Caroli disease/choledochal cysts
  • Viral hepatitis
  • Toxins
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5
Q

Most common US finding in viral hepatitis

A

Normal!!

Other findings: starry sky (echogenic portal triads), diffuse GB wall thickening

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6
Q

Ddx for hyperechoic mass in liver

A
  1. Hemangioma
  2. Hepatoma
  3. Mets (CC - 50%, RCC, breast, NETs, chorioCa)
  4. Fat containing HCC
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7
Q

US appearance of FNH versus adenoma

A

FNH - “stealth” lesion - difficult to detect, may have spoke-wheel configuration of vessels in central scar

Adenoma - can look like anything, hypo->hyperechoic (due to presence of fat), hypoechoic halo often seen

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8
Q

Ddx calcified liver mets

A 
Colon Ca (esp mucinous subtype)
Gastric adeno
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9
Q

Ddx cystic mets in liver

A 
Ovarian 
Colorectal 
NET - classically have fluid fluid level
Pancreatic adenoCa
Melanoma
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10
Q

Which malignancy gives the pseudo-cirrhosis appearance of the liver

A

Treated breast Ca

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11
Q

Cause of increased and decreased hepatic vein pulsatility

A

Increased: Tricuspid regurgitation (accentuated A wave, reduced S wave), right-sided HF (accentuated A wave, normal S wave)

Decreased: Cirrhosis, Budd-Chiari (hepatic vein thrombosis), hepatic veno-occlusive disease (bone marrow transplant, chemo causing fibrosis of sinusoids)

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12
Q

Causes of pulsatile waveform in PV

A

Anything that causes transmitted pulsations

  • TR, right sided HF
  • AV shunt (cirrhosis), AV fistula (HHT)
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13
Q

Doppler findings in portal HTN

A

Low PV velocity (<16 cm/s)
Dilated main PV >14 mm
Hepatofugal flow
Portosystemic shunts

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14
Q

DDx: hypoechoic splenic lesions

A 
Sarcoid
Mets
Lymphoma
Abscess 
Infarct
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15
Q

US findings RVT post-transplant

A

Reversal of diastolic flow in RA (but can also be seen with allograft torsion, rejection, ATN)

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16
Q

Upper limit velocities in renal transplant

A

PSV 340-400 cm/sec at anastomosis

Other signs: delayed/blunted systolic upstroke downstream (tardus-parvus waveform), reduced RIs

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17
Q

List the values for grading carotid stenosis

A

Normal
<50%: visible plaque, but PSV<125 cm/s; ICA/CC PSV <2; end diastolic ICA<40 cm/s
50-69%: visible plaque, PSV125-230 cm/s; ICA/CC 2-4; end diastolic ICA 40-100 cm/s
>70% (but no near occlusion: PSV>230 cm/s; ICA/CC >4; end diastolic ICA >100 cm/s

18
Q

Appearance in near occlusion of ICA in carotid stenosis?

A
  • markedly narrow lumen on color and power Doppler
  • slow and dampened (pseudovenous) flow velocity
  • systolic spikes with absent or reversed diastolic flow (distal stenosis and occlusion can also have this appearance)

Doppler velocity cannot be relied upon to identify near-occlusion, especially with only partial collapse, where the peak systolic velocity may be misleadingly normal or elevated

19
Q

Causes of renal artery stenosis

A 
Atherosclerosis - most common
FMD - second most common - younger, distal RA
Vasculitis - PAN, takayasu
NF1 - usually at the osmium 
Aorta - coarctation/dissection
20
Q

Causes of elevated RIs in the kidney

A

Native kidney:

  • medical renal disease
  • obstruction

Transplant kidney:

  • ATN
  • Acute or chronic rejection
  • Renal vein thrombosis
  • Obstruction
  • Drug toxicity

*Decreased RI seen in RAS (downstream from stenosis the velocities are decreased)

21
Q

PSV for diagnosis of RAS

A

> 200 cm/s (or renal artery to aorta velocity ratio >3.5)

22
Q

Key consideration for cystic node in neck on US

A

Papillary thyroid carcinoma versus SCC

23
Q

Most common type of uterine malformation

A

Septate - also most likely to have miscarriage

24
Q

Most common renal anomalies associated with MDA

A

Renal agenesis (most common)
Crossed fused renal ectopia
Duplex kidney

25
Q

List the subtypes of Mullerian duct abnormalities

A

Uterine agenesis/hypoplasia
Unicornuate (+/- horn)
Didelphys (separate uterus/cervix) - 75% vaginal septum
Bicornuate (partial - 1 cervix, complete - 2 cervix)
Septate (partial or complete) - convex fundus
Arcuate (small inpouching at fundus)
DES (T-shaped) - associated with clear cell vaginal ca

26
Q

US cut-off for endometrial thickness

A

Pre-menopausal: up to 16 mm in secretory phase
Post-menopausal: bleeding <5mm, not bleeding can be 8-11 mm (controversial, can follow or refer to gyn)
** Cut off still 5 mm if on tamoxifen

27
Q

DDx theca-lutein cysts

A

Elevated bHCG - molar pregnancy, multiple gestations, infertility drugs (clomiphene)

28
Q

F/u of simple cysts in asymptomatic pre and post-menopausal women (on ultrasound)

A

Pre-menopausal
<3 cm, ignore
3-5 cm, report
>5 cm, follow (can use >7 cm if well visualized)

Post-menopausal
<1 cm, ignore
1-3 cm, report
>3 cm, follow (can use >5 cm if well visualized)

**only applies to simple, f/u in 1 year
if any complexity, shorter follow up (2-6 months)

29
Q

F/u of hemorrhagic cysts (if typical appearance)

A

In pre-menopausal:
<5 cm report, no f/u
>5 cm, short interval f/u

In peri-menopausal, any size need f/u
In post-menopausal, surgical referral

Recommend f/u in 8 weeks (i.e. 2 cycles)

30
Q

Criteria for diagnosing PCOS

A

If >8 years post-menarche:
>20 follicles, volume >10 cc
String of pearls, echogenic/hyperemic stroma
(if only in single ovary, still dx. of PCOS)

31
Q

Risk of malignant transformation of dermoid

A

1-2%, usu SCC (from epithelial elements)

Inc risk in older pt (post-menopause) and large size

32
Q

Types of primary ovarian malignancy

A

Epithelial stromal tumours (serous, mucinous, endometroid, clear cell, Brenner) - 60-70%

Germ cell (teratoma - mature, immature, struma ovarii; yolk sac; dysgerminoma; chorioCa) - 20%

Sex cord-stomal (fibrothecoma, sertoli-leydig, granulosa cell tumours - estrogen secreting) - 8-10%

33
Q

Commonest malignant ovarian tumour

A

Serous cystadenocarcinoma

34
Q

Commonest malignant sex cord tumour

A

Granulosa cell tumour of ovary

35
Q

Most common tumours to metastasize to ovaries

A

Gastric/colon (Krukenberg) and breast**

36
Q

Findings in Meigs syndrome

A

Ovarian fibroma, ascites, and right pleural effusion

37
Q

Differentiating features between serous and mucinous ovarian tumours

A

Serous - unilocular, smaller, calcs, often bilateral, peritoneal mets

Mucinous - multilocular/honeycomb, large size, no calcs, usually unilateral, high T1 signs, may have pseudomyxoma peritonei

38
Q

Distinguishing features in endometroid ca

A

Synchronous endometrial hyperplasia or carcinoma

Signs of endometriosis, bilateral in up to 40% of cases

39
Q

Ddx for solid ovarian tumour

A

Fibroma - hypoechoic/low T2
Fibrothecoma - areas of high T2 and enhancement
Brenner - hypoechoic, most have associated calcs
Other: pedunculated/exophytic fibroid, met

40
Q

Follow-up gallbladder polyps

A

<6 mm: no follow-up required

7-9 mm: high-risk patients (patient age >50 years, PSC, Indian ethnicity, sessile, and single polyps) should be performed at 6 months, 12 months, then yearly if the patient is a surgical candidate

> 1 cm: surgical referral

Body Imaging (11 decks)

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