URR 17 Flashcards
1
Q
When a pyogenic abscess is caused by ____, the infection is carried by the biliary tree into the liver
A
ascending cholangitis
2
Q
When a pyogenic abscess is caused by _____/____, infection is carried by the portal vein into the liver
A
appendicitis/diverticulitis
3
Q
When a pyogenic abscess is caused by ____/____, the infection is carried by the hepatic artery into the liver
A
osteomyelitis/bacterial endocarditis
4
Q
Pyogenic abscess are most commonly found in the ___ lobe of the liver
A
right
5
Q
Pyogenic abscesses show an elevated:
A
white blood cell count
6
Q
Sonographic appearance of pyogenic abscess
A
complex cystic mass, cluster sign, debris, gas producing organisms that cause reverberation/ringdown artifact
7
Q
The “____” sign usually presents as a cluster of small abscesses
A
cluster
8
Q
aka candidiasis
A
fungal infection/abscess
9
Q
Fungal infection/abscess more commonly found in:
A
immunocompromised patients
10
Q
Fungal abscesses are caused by:
A
fungus
11
Q
Symptoms of fungal abscesses
A
fever with LOW white blood cell count
12
Q
leads to the formation of multiple small abscess formations within the liver
A
fungal infection
13
Q
Fungal abscesses are associated with “_____” sign
A
wheel within a wheel
14
Q
The “wheel within a wheel” sign is described as:
A
hypoechoic ring around a hyperechoic center, mass with internal septations resembling spokes of a wheel
15
Q
Late fungal abscess sonographic appearance
A
uniformly hypoechoic mass, calcifications
16
Q
caused by protozoan parasites in contaminated water
A
amebic abscess
17
Q
Amebic abscesses are most commonly seen in what location of the world?
A
countries outside of the US
18
Q
Amebic abscesses enter the body through the:
A
colon
19
Q
Amebic abscesses enter the liver through the:
A
portal vein
20
Q
Amebic abscesses are usually found in the _____ of the liver
A
right dome
21
Q
Most common symptom of amebic abscess
A
pain
22
Q
Amebic abscess can cause ____ due to blood loss with diarrhea
A
mild anemia
23
Q
Amebic abcesses show ____ white blood cell count
A
elevated
24
Q
Sonographic appearance of amebic abscess
A
round mass with distinct walls, low level internal echoes, can see echogenic foci with posterior reverberation artifact
25
Amebic abscess is usually associated with ______
elevated diaphragm
26
Triglysceride accumulation in liver cells is called:
a. amyloidosis
b. Wilson disease
c. sarcoidosis
d. steatosis
d
27
The use of ultrasound contrast to evaluate an isolated case of diffuse steatosis will demonstrate:
a. areas of inhomogeneity due to irregular contrast material distribution
b. the liver tissue will demonstrate a consistent appearance of contrast distribution
c. contrast washout in the affected areas
d. excessive contrast pooling in affected areas
b
28
Which of the following is evaluated when assessing the liver for severity of steatosis?
a. fine echoes of parenchyma
b. visualization of the diaphragm
c. visualization of the vessel borders
d. all the above
d
29
What is the primary finding that differentiates focal steatosis from mass formation?
a. no vascularity within the area of focal steatosis, while a mass will demonstrate internal vascularity
b. focal steatosis demonstrates posterior shadowing, while a mass will demonstrate posterior enhancement
c. no displacement of vascular structures of the liver with focal steatosis, while mass formation will disrupt vessel pathways as it forms
d. focal steatosis demonstrates posterior enhancement, while a mass will demonstrate posterior shadowing
c
30
Glycogen storage disease may have a similar sonographic appearance to what two liver abnormalities?
a. acute hepatitis and steatosis
b. hepatocellular carcinoma and liver metastasis
c. fungal or bacterial abscesses
d. cirrhosis and portal hypertension
a
31
Wilson disease indicates the abnormal collection of ____ in the liver, while hemochromatosis indicates the abnormal collection of ____ in the liver.
a. fat, iron
b. copper, glycogen
c. glycogen, albumin
d. copper, iron
d
32
Cirrhosis caused by alcoholism will cause a noticeably marked increase in what liver function test compared to cirrhosis caused by viral hepatitis?
a. GGTP
b. bilirubin
c. AST
d. ALT
c
33
Decreased albumin levels cause what complication of cirrhosis?
a. ascites
b. portal vein thrombosis
c. hepatic artery aneurysm
d. nodular changes to parenchyma
a
34
The most definitive sonographic sign of cirrhosis is decreased liver size with:
a. complex cystic mass formation
b. coarse texture and nodule formation
c. decreased echogenicity and prominent vasculature
d. multiple masses with a target appearance
b
35
Patients with cirrhosis should have their liver vasculature evaluated regularly due to an increased risk of:
a. formation of varices
b. formation of thrombus
c. tumoral invasion
d. all the above
d
36
Which of the following increase in size with late-stage cirrhosis?
a. right and left lobes of the liver
b. hepatic and emissary veins
c. caudate lobe and portal vein
d. caudate lobe and emissary veins
c
37
What effect will deep inspiration have on the main portal vein in a patient with advanced cirrhosis?
a. no change in diameter
b. increase diameter
c. decrease diameter
d. complete collapse of lumen
a
38
What does portalization of the hepatic vein indicate in a patient with cirrhosis?
a. flow reversal in hepatic veins so it moves into the liver like portal flow
b. wall thickening of the hepatic veins
c. triphasic flow in the hepatic veins
d. loss of respiratory and cardiac variation in the hepatic vein flow pattern
d
39
Acoustic Radiation Forced Impulse (AFRI) and Shear Wave Elastography are used to assess what characteristic of the liver?
a. presence of nodule formation
b. presence of fibrosis
c. oxygen levels in liver tissue
d. bilirubin levels in liver tissue
b
40
Which of the following is a complication of hepatitis?
a. reduced bile production
b. hepatic encephalopathy
c. calcification of Glisson capsule
d. leukopenia
b
41
All the following are correct regarding hepatitis, except?
a. symptoms of intrahepatic cholestasis include jaundice, dark urine, and pale stool
b. infectious causes include viral, bacterial, fungal, and parasitic organisms
c. decreased direct bilirubin because the liver cells produce less bile
d. prolonged prothrombin time
c
42
What type of hepatitis is caused by Acetaminophen overdose?
a. alcoholic hepatitis
b. viral hepatitis
c. fulminant hepatitis
d. nonalcoholic steatohepatitis
c
43
Elastography measurements of the liver include all of the following, except:
a. the sample box must be at least 2 cm from the skin surface and 2 cm from Glisson capsule
b. Patient should perform a neutral breath hold for a few seconds
c. Record 10 measurements from the same ROI
d. Decreased elastography values indicate tissue stiffening and more severe fibrosis
d
44
What causes the Starry Sky appearance of a liver with acute viral hepatitis?
a. periportal cuffing
b. multiple calcifications
c. Triglyceride infiltration of the liver cells
d. portal thrombosis
a
45
What type of lab testing would indicate results that suggest echinococcal cyst formation in the liver?
a. white blood cell count
b. Casoni test
c. ELISA test
d. all the above
d
46
All of the following are sonographic signs of a hydatid cyst, except:
a. hydatid sand
b. seagull sign
c. water lilly sign
d. daughter cyst
b
47
Schistosomiases infections are caused by parasites that enter the digestive system are a carried to the liver by the:
a. hepatic artery
b. biliary system
c. portal vein
d. hepatic veins
c
48
The primary sonographic finding with schistosomiasis is:
a. periportal thickening
b. portal thrombosis
c. severely dilated portal vein
d. hepatic vein thrombosis
a
49
Pneuocystic Carinii is a common infection seen in patients with:
a. hepatitis
b. cirrhosis
c. diabetes
d. AIDS
d
50
The most common cause of a pyogenic abscess is:
a. biliary disease
b. hepatitis
c. cirrhosis
d. parasites
a
51
Leukopenia is a symptom of ____ infection, while leukocytosis is a symptom of _____
a. hepatitis, cirrhosis
b. bacterial infection, viral infection
c. fungal abscess, bacterial abscess
d. cirrhosis, hepatitis
c
52
The cluster sign in seen by ultrasound with a _____ abscess, while the wheel within a wheel sign in seen with a ____ abscess
a. bacterial, fungal
b. amebic, bacterial
c. fungal, amebic
d. viral, bacterial
a
53
____ lesions can push outward toward the liver capsule causing irregular contour or bulging
intrahepatic
54
____ lesions can compress the liver capsule causing irregular contour and indentations
extrahepatic
55
Lesions of the liver can cause ____ and distort ____ patterns.
extrinsic compression
normal flow
56
Extrinsic compression of the ducts may lead to:
dilatation
57
Connection of liver lesion to _____ can indicate biliary origin
biliary tree
58
#1 benign lesion of the liver
hemangioma
59
Hemangiomas are associated with ____ and ___
focal nodular hyperplasia
Kasabach-Merritt syndrome
60
Hemangiomas are more commonly found in:
women
61
Hemangiomas are usually found in the ___ lobe of the liver
right
62
usually solitary subcapsular mass, <3 cm diameter
Hemangioma
63
Hemangiomas show ___ LFTs
normal
64
Clinical symptoms of hemangiomas
asymptomatic
65
Hemangiomas can increase in size with ____ and ____
pregnancy
estrogen therapy
66
Hemangiomas can be similar in appearance to ____ and ____
small hepatocellcular carcinoma
metastasis from colon cancer
67
____ is helpful in determining the type of tissue in the hyperechoic mass (hemangioma)
Cat scan
68
A hemangioma can be differentiated from ____ by the presence of mass effect with hemangioma
focal fatty replacement
69
____ exam demonstrates enhancement of the hemangioma throughout the arterial and portal venous phases of imaging
Contrast ultrasound
70
There is ____ of the contrast in the early arterial phase followed by ____ of the contrast
peripheral puddling
central proliferation
71
The contrast may partially or completely fill the hemangioma and enhancement is sustained through the _____ phase
portal venous
72
Benign nodules on contrast ultrasound usually demonstrate ____ enhancement
isovascular
73
Malignant tumors usually demonstrate ____ enhancement (rapid uptake of more contrast than the normal liver tissue
hypervascular
74
Most malignant masses of the liver demonstrate contrast enhancement during the ____ but rapid contrast washout during the ____
arterial phase
venous phase
75
seen as a focal concentration of blood vessels in the liver
hemangioma
76
Sonographic appearance of hemangioma
homogeneous, hyperechoic (70%), well defined borders, posterior enhancement
77
Some hemangiomas have areas of ____, _____, and ____ which are demonstrated as hypoechoic
degeneration
necrosis
fibrosis
78
Can hemangiomas demonstrate the mass effect?
yes
79
Color Doppler is not useful for evaluation of a hemangioma because:
internal blood flow is too slow within the tiny vessels
80
also called hemangioma thrombocytopenia syndrome
Kasabach-Merritt Syndrome
81
____ is seen in infants with large hemangioma
Kasaback-Merritt Syndrome
82
sequestration and destruction of platelets within the large cavernous hemangioma causes significant thrombocytopenia
Kasabach-Merritt Syndrome
83
With Kasabach-Merritt Syndrome, visualized cuteaneous ___ or ___ lesions usually present on the extremities
blue
reddish-brown
84
____ or ___ can also be identified with Kasabach-Merritt Syndrome
hepatomegaly
jaundic
85
If the skin lesions are present with significant thrombocytopenia, the ___ and ___ should be evaluated for related hemangioma formation
liver
spleen
86
Most common benign vascular liver tumor in infancy
Infantile Hemangioendothelioma
87
Infantile Hemangioendothelioma normally occurs at what age
first six months of life
88
Infantile Hemangioendothelioma usually presents with ____ early in life due to the AV malformation within tumor
cardiac failure
89
Infantile Hemangioendothelioma spontaeously regresses in the most patients before the age of __
2
90
#2 most common benign liver mass
focal nodular hyperplasia
91
Focal nodular hyperplasia is most common in women in _____ years
childbearing
92
Focal nodular hyperplasia is associated with
oral contraceptive
93
Focal nodular hyperplasia shows _____ masses
non-encapsulated
94
Clinical symptoms of focal nodular hyperplasia
asymtompatic
95
Focal nodular hyperplasia clinical symtoms
normal LFTs
96
____ is used to detect FNH
Nuclear medicine exam
97
In most patients, the FNH mass will absorb the sulfur colloid at the same rate as the normal liver tissue which indicates:
warm nodule
98
In some patients the FNH mass will absorb the colloid imaging at a higher rate than the normal liver tissue which indicates a:
hot nodule
99
Focal nodular hyperplasia is considered a "____" because it is difficult to differentiate from liver tissue
stealth lesion
100
Usually a solitary mass, <5cm, demonstrates a central scar with radial vascularity
focal nodular hyperplasia
