Ultrasound Trivia Flashcards
GB wall thickening > 3 mm
cholecystitis GB CA adenomyomatosis PSC AIDS cholangitis Hepatitis ascites cirrhosis Portal HTN Hypoproteinemia lymphatic obstruction
Cystic lesions in the porta hepatis
hepatic cyst enteric duplication cyst pancreatic pseudocyst biliary cysts hepatic artery aneurysm
MC complication of choledochoceles
biliary and pancreatic calculus followed by cholangiocarcinoma
MCP of GB carcinoma
mass replacing a majority of GB lumen
Parvus tardus waveform
upstream stenosis
Treatment of GB polyps > 1 cm
surgery
FU imaging for polyps > 6 mm but < 10 mm
Reversal of portal vein flow in setting of chemo/radiation
Sinusoidal obstruction syndrome (venoocclusive disease)
Cholesterolosis
“balls on the wall” of the GB = cholesterol polyps
Speed of sound in ST
1540 m/s
What artifact can cause pseudo-sludge
side lobe artifact
Caroli disease
multiple coarse shadowing calcs in the liver within tubular anechoic structures (bile ducts)
assoc with ARPCKD, medullary sponge and cystic kidney
central dot sign
reverse target sign of liver
hypoechoic center and hyperechoic periphery = cavernous hemangioma
cluster of grapes sign of liver
pyogenic abscesses
Water-lily sign
echinococcal infections (membranes floating in water)
Target sign in liver
echogenic center with thick hypoechoic halo = suggestive of malignancy
ST mass in GB in setting of mets
Melanoma
Acoustic shadowing
absorption
shadowing at the edges of fluid filled structures
refraction
Ring down artifact
fluid trapped between multiple gas bubbles
Fresnel zone
near field US beam
Appendicitis on US
> 6 mm in diamter lack of compressibility echogenic inflamed periappendiceal fat hyperemia appendicolith adjacent fluid
Increasing transducer frequency
improve axial resolution (closely spaced objects)
pancreatic CA on US
hypoechoic and hypovascular
Plan - Do - Study - Act
Quality improvement
Pseudokidney sign
hypoechoic, concentric, long-segement wall thickening, central dirty shadowing = lymphoma of the colon
Multiple splenic calcs
Histoplasmosis
TB
Brucellosis
MCC of splenic cysts
Trauma
Anechoic pancreatic head lesion with lobulated margins and several internal septations that converge centrally (stellate scar appearance)
Pancreatic serous cystadenoma
Medullary nephrocalcinosis
echogenic renal pyramids with posterior acoustic shadowing = calcium deposits
- primary hyperparathyroidism
- RTA 1
- medullary sponge kidney
MCC of CA in bladder
transitional cell carcinoma (90%)
Hyperechoic renal mass
usually AML, but can be RCC = get CT
30% of AMLs can have acoustic shadowing
Large anechoic peri-renal transplant fluid collection with a few internal septations
Peritransplant lymphocele MCC (1-3 wks after surgery)
Long term lithium and the kidney
Renal microcysts - multiple punctate echogenic foci in renal medulla and cortex
Drop out artifact
dead element in the US probe = dark band on the US that radiates from the surface
calcification of the renal cortex and medulla in normal sized kidneys
Oxalosis = liver and kidney transplant needed
Bilateral perinephric rind-like hypoechoic tissue
renal lymphoma
retroperitoneal fibrosis
Erdheim-Chester disease
disadvantage of harmonic imaging
decreased penetration
what US should be done before surgery to remove a thyroglossal duct cyst
normal thyroid by US
Warthin tumor and pleomorphic adenoma on US
circumscribed hypoechoic lesion with posterior acoustic enhancement
can have cystic change (usually warthin)
warthin more oval shape
Warthin bilateral 10-15%
MI, TSI and TIB of US
Mechanical index = risk of damage by cavitation and radiation pressure
Thermal index soft tissue = potential risk of heat damage
Thermal index of bone
(THI = tissue harmonic imaging)
how many gray levels are in US images
256 (or 2^8)
On steroids for life with lumpy testicles
congenital adrenal hyperplasia = testicular adrenal rests
- usually bilateral (cancer not usually bilateral)
- sharply demarcated hypoechoic lesions
- can get bigger = infertility and pain
MCL of undescended tesitis
caudal to the external inguinal ring
MC malignancy in undescended testits
Seminoma
Mixed germ cell tumor of testitis
cystic and solid and calcified in younger person (DDX lymphoma and leukemia in older people)
Pure seminomas
usually uniformly hypoechoic on US
Bicornuate vs Septate vs Didelphys
look at fundal contour
- cleft > 1 cm = bicornuate or didelphys
US parameters for < 10 wks gestation
TIS (Thermal index of ST) for < 10 wks
TIB (thermal index of bone) for > 10 wks
Velamentous insertion of umbilical cord
insertion of cord beyond the placental edge
Eccentric insertion of the umbilical cord
1 cm from placental edge
Umbilical cord cysts
most found in 1st trimester resolve
thin walled cyst at fetal insertion of cord
Decreasing mechanical index
Increase the center frequency of the beam (inversely proportion to MI)
set the focal zone further away from the transducer
Highly echogenic yolk sac
calcified yolk sac = fetal demise
If fetal myelomeningocele in spine
look in head for brain abnormalities
Fetal ventriculomegaly
> 10 mm across the atria
Chiari II malformation prenatal US
Lemon sign (concave frontal bone deformity) Banana sign (abnormal curve of the cerebellar hemispheres and smaller posterior fossa)
MC fetal cardiac masses
rhabdomyoma
teratoma
fibroma
Fetal cardiac masses most associated with what syndrome
Tuberous sclerosis
What is the most important predictor of mortality in skeletal dysplasia
Pulmonary hypoplasia (short long bones = femur length < 5th percentile)
Trisomy 18 (Edwards)
choroid plexus cysts
VSD
clenched hands
RI in transplant hepatic artery
0.55 - 0.80
RI elevated in immediate post op due to edema
normalize in 72 hours
persistently low suggest arterial stenosis
Reversal of diastolic flow in transplant kidney
Rejection
renal vein thrombosis
external compression
acute tubular necrosis
MCC of vascular complication in orthotopic liver transplant
hepatic artery thrombosis
Renal AVF after biopsy, recommend what?
do short term follow up US as most are small and resolve on their own
what adjustments should be made to see slow flow in vessels
decrease the wall filter and RPF
Lower frequency transducer does what to doppler shift
decreases doppler shift and reduces aliasing
how to increase doppler sensitivity
increase dwell time (ensemble length)
Expansile heterogeneous mass with central calcification in the IVC
highly suggestive of neoplasm than bland thrombus
Leiomyosarcoma MCC
Increased peak systolic velocity that improves with inspiration
Median arcuate ligament compression (SMA gives collateral flow through pancreaticoduodenal arcade)
Monophasic flow in a vein
raises suspicion for downstream thrombus or narrowing
changing doppler scale changes what
PRF (pulse repetition frequency)
Decreasing RPF = improves doppler sensitivity
AVF on US
show abnormal high velocity and low resistance waveforms (difficult to tell between artery and vein)
Psudoaneurysms
yin yang flow
show to and fro waveforms with antegrade flow during systole and retrograde flow during diastole
Blooming artifact
color beyond the vessel wall making it look larger
gain dependent = lowering gain = decrease blooming
Large vessel extending from the left hepatic lobe in cirrhosis
recanalized paraumbilical vein
(look for hepatofugal flow in PV)
(also look for direction of flow in recanalized vein)
Hepatic venous flow dampening
metastatic infiltration
cirrhosis
hepatic vein stenosis
venocclusive disease
primary factor for grading carotid artery stenosis
Peak systolic velocity
normal = < 125 cm/s with no intimal thickening or plaque
Augmentation during DVT studies
pushing on ipsilateral extremity distal to the transducer
sign on acute DVT
vessel expansion
Anisotropy artifact in tendon
beam off by >/= 5 degrees
Cartilage interface sign
reflection of beam from the surface of the hyaline articular cartilage = MCC is full thickness tear of supraspinatous
Baker cyst
distention of the semimembranosus-medial gastrocnemius bursa = must communicate with the joint space
Increased flow in a tendinotic tendon on power doppler
neovascularity = severe tendinosis
Plantar faciits
thickening of the facia > 4 mm
Male with irregular peritoneal ST thickening and small volume ascites
GI primary is MCC of peritoneal carcinomatosis in men
Sharply define deep lung margins on chest US
suspicious for lung tumor
