Winter Exam 1 Flashcards
anechoic
describes the portion of an image that appears echo-free
echogenic
describes an organ or tissue that is capable of producing echoes by reflecting the acoustic beam
echopenic
describes a structure that is less echogenic or has few internal echoes
heterogeneous
describes tissue or organ structures that have several different echo characteristics
homogeneous
refers to imaged echoes of equal intensity
hyperechoic
describes image echoes brighter than surrounding tissues or brighter than is normal for that tissue or organ
hypoechoic
describes portions of an image that are NOT as bright as surrounding tissues or are LESS bright than normal
isoechoic
describes structures of equal echo density
Superior (cranial)
Toward the head, closer to the head, the upper portion of the body, the upper part of a structure, or a structure higher than another structure
inferior (caudal)
Toward the feet, away from the head, the lower portion of the body, toward the lower part of a structure, or a structure lower than another structure
Anterior (ventral)
Toward the front or at the front of the body or a structure in front of another structure
Posterior (dorsal)
Toward the back or the back of the body or a structure behind another structure
Medial
Toward the middle or midline of the body or the middle of a structure
Lateral
Away from the middle or the midline of the body or pertaining to the side
Ipsilateral
Located on the same side of the body or affecting the same side of the body
Contralateral
Located on the opposite side of the body or affecting the opposite side of the body
Proximal
Closer to the attachment of an extremity to the trunk or the origin of a body part
Distal
Farther from the attachment of an extremity to the trunk or the origin of a body part
Superficial
Toward or on the body surface or external
Deep
Away from the body surface or internal
sagittal
the plane that courses vertically through the body and separates it into right and left portions. “Flight of an arrow”
Transverse
plane passes through the body from anterior to posterior and divides the body into superior and inferior portions and courses parallel to the surface of the ground.
Supine or dorsal
Lying on the back
RPO
Lying on the right posterior surface,
the left posterior surface is elevated
LPO
Lying on the left posterior surface, the
right posterior surface is elevated
RAO
Lying on the right anterior surface, the
left anterior surface is elevated
LAO
Lying on the left anterior surface, the
right anterior surface is elevated
increased acoustic signal amplitude returning from regions lying beyond an object that causes little or no attenuation of the sound beam such as fluid-filled structures
Enhancement
reduced echo amplitude from sound not transmitting due to attenuation or low reflectivity; Echogenic calculi attenuate sound is an example
Shadowing
retain an anechoic center even at high instrument gain settings.
Cysts
has sharply defined posterior wall indicative of a strong interface between cyst fluid and tissue or parenchyma
Mass
may have a hyperechoic, hypoechoic, echopenic, or anechoic homogeneous echo texture, or it may be heterogeneous because it contains many different types of interfaces. Usually exhibit the following characteristics
●Internal echoes that increase with an increase in instrument gain settings
●Irregular, often poorly defined walls and margins
●Low-amplitude echoes or shadowing posterior to the mass due to increased acoustic attenuation by soft tissue or calculi
Solid structure
usually exhibits both anechoic and echogenic areas on the image, originating from both fluid and soft tissue components within the mass.
Relative echogenicity complex soft tissue mass is related to a variety of constituents, including
●Collagen content
●Interstitial components
●Vascularity
●Degree and type of tissue degeneration
Complex structure
Refers to the gradual loss of ultrasound energy as it travels through tissue. This loss occurs due to several factors, including: absorption, reflection, scattering and reflection.
Attenuation
The sonography findings were positive, and the patient does have the disease or pathology.
True-positive result
The sonography findings were negative, and the patient does not have the disease or pathology.
True-negative result
The sonography findings were positive, but the patient does not have the disease or pathology.
False-positive result
The sonography findings were negative, but the patient does have the disease or pathology.
False-negative result
describes how well the sonography examination documents whatever disease or pathology is present.
Sensitivity: If number of false-negative examinations decreases, sensitivity of the examination increases.
describes how well the sonography examination documents normal findings or excludes patients without disease or pathology
Specificity: If the number of false-positive examinations decreases, the specificity of the examination increases.
A connection between
Anastomosis
Dilation, expansion, or distention
Ectasia
A metallic stent covered with fabric and placed inside an aneurysm to prevent rupture
Endograft
Any tissue or organ for implantation or transplantation
Graft
an artificial substitute for a body part
prosthesis
caused by a hematoma that forms as a result of a leaking hole in an artery; this pulsating, false aneurysm forms outside the arterial wall
pseudoaneurysm
the formation of a clot in a blood vessel
thrombosis
Three blood vessel layers
- Tunica intima: innermost, endothelial lining, and elastic tissue
- Tunica media: middle, thickest layer, elastic fibers, and smooth muscle.
- Tunica adventitia: outer collagen fibers.
Differences in arteries and veins
Arterial walls:
- thicker, elastic, and smooth muscle fibers
-Tend to maintain constant shape; do not readily collapse in conjunction with low blood pressure due to wall thickness
Vain walls:
-Let’s smooth muscle and less elastic tissue
-Unable to contract to force blood flow
-Requires pressure, gradient, breathing, skeletal muscle, contractions, and valves in extremities to return blood to heart
Originate from the anterior aspect of the aorta and is usually found within the first 2 cm
Celiac axis or trunk
CA is a short vessel, approximately 1 cm long. It divides into three branches.
Common Hepatic artery, left gastric artery, splenic artery
The left renal vein being compressed between the AO and superior mesenteric artery is known as the
Nutcracker phenomenon
Anterior to the portal vein, left of the common bile duct, superior to the head of the pancreas
Hepatic artery
Superior to the body and tail of the pancreas
Splenic artery
Posterior to the pancreas and anterior to uncinate process and branches into mesentery and colon. Supplies blood to right side of the cecum, asending and transverse colon and small intestines.
Superior mesenteric artery
Posterior to the inferior vena cava
Right renal artery
Posterior to the body and tail of the pancreas, inferior to the splenic artery
Splenic vein
Right of and parallel to the superior mesenteric artery
Superior mesenteric vein
Anterior to the aorta, posterior to the SMA, anterior to the right renal artery
Left renal vein
Anterior to the IVC
Portal vein
Anterior to the main portal vein, right of the hepatic artery
Common bile duct
A form of arterial sclerosis, in which intimal lining of arteries is altered by the presence of any combination of the following:
-Focal accumulation of lipids
-complex carbohydrates
-Blood and blood product
-smoking
-calcium deposits
Atherosclerosis
Focal abnormal dilation of a blood vessel caused by a structural weakness in its walls,
Aneurysm
A.k.a. false aneurysm, is an extra vascular hematoma, communicating with the intravascular space
Pseudoaneurysm
This type of aneurysm involves all three layers of the arterial wall; the most common cause is atherosclerosis.
True aneurysm
Sac like protrusion of aorta toward one side or the other, usually larger than a circumferential and connected to the aorta by a channel or opening that varies in size
Saccular aneurysm
Occurs when there is a separation of the layers of the arterial wall by blood or hemorrhage, which generally begins in the proximal portion of the aorta
Aortic dissection
Abdominal aortic aneurysms of any size may rupture, but the risk increases with aneurysms larger than
7 cm in diameter
Enveloped by a dense, fibrotic reaction, may include inflammatory cell infiltrates, and fatty tissue; are uncommon in less than 20% of all aortic aneurysms
Inflammatory aneurysms
A type of aneurysm that involves a circumferential dilation of a blood vessel, meaning the entire vessel wall expands outward in a spindle like or elongated shape.
Fusiform aneurysm
Is the thickening, hardening, and loss of elasticity of the walls of arteries. Affects small arteries in arterials, often associated with high blood pressure, hypertension or diabetes
Arteriosclerosis
These aneurysms are rare, but potentially life-threatening vascular abnormalities that affect the arteries supply the gastrointestinal organs
Splanchnic artery aneurysms
Renal artery aneurysms require surgical intervention in the presence of an aneurysm greater than
1.5 cm
The second most common type of splanchnic vessel aneurysms encountered is
Hepatic artery aneurysm
This aneurysm is often associated with the continuation of abdominal aortic aneurysms
Iliac artery aneurysms
A minimally invasive surgical procedure involves deploying a stent graft into the aorta with exclusion of the aneurysm
Endovascular repair of abdominal aortic aneurysm (EVAR)
Which aortic graft complication is suspected if duplex Doppler cannot confirm the presence of blood flow?
Occlusion (graft thrombosis)
Usually caused by atherosclerotic plaque generally located at origin or first 2 cm from aorta
Renal Artery Stenosis
Results from lack of adequate blood supply to intestinal tract due to underlying vascular compromise
Mesenteric Artery Stenosis
Indicates proximal arterial obstruction or stenosis, leading to distal damping of blood flow. Common causes include:
-Severe aortic or renal artery stenosis, > 50%
Aortic graft stenosis or kinking
-Aortic dissection
Tardus-parvus waveform
Delayed systolic upstroke (tardus); low amplitude and low velocity (parvus)
A rare disorder characterized by hepatic venous outflow obstruction, leading to liver congestion, hepatomegaly, and portal hypertension
Budd-Chiari
Is defined as elevated pressure in the portal venous system, typically exceeding 10 mmHG. It results from obstruction or increase resistance to blood flow within the portal system, leading to complications such as ascites, varices, and splenomegaly.
Portal Venus hypertension
Bones of the bony pelvis
- two innominate bones
-sacrum
-coccyx
Greater (false) pelvis vs. Lesser (true) pelvis
- Greater (False) Pelvis – Superior portion that supports abdominal organs.
-Lesser (True) Pelvis – Inferior portion that houses the pelvic organs and forms the birth canal.
Pelvic Inlet vs Pelvic Outlet
-Pelvic Inlet → This is the upper opening of the pelvis. It is the space where the baby’s head first enters during childbirth. It is shaped like an oval and is formed by the sacrum (back), pubic bones (front), and ilium (sides).
-Pelvic Outlet → This is the lower opening of the pelvis. It is the space where the baby exits during birth. It is formed by the pubic arch (front), ischial tuberosities (sides), and the coccyx (back).
is the diamond-shaped area between the thighs, located at the bottom of the pelvis. It is the region between the genitals and the anus and plays an important role in supporting pelvic organs and bodily functions like childbirth, urination, and defecation.
Perineum
Supports the bladder, uterus (in females), and rectum.
Help control urination, bowel movements, and childbirth.
Assist in sexual function and stability of the core.
Pelvic Floor Muscles
Muscles that make up the Levator ani
pubococcygeus, puborectalis, and iliococcygeus
What two triangles compose the perineum
- Urogenital triangle (front, containing external genitalia)
- Anal triangle (back, containing the anus)
It serves both urinary and reproductive functions, as semen also passes through it.
Urethra
Male Reproductive Structures (7)
1.Testes – Located in the scrotum, they produce sperm and testosterone.
2.Epididymis – A coiled tube on the back of each testis, where sperm matures.
3.Vas deferens – A duct that carries sperm from the epididymis to the urethra.
4.Seminal Vesicles – Located behind the bladder; produce fluid that nourishes sperm.
5.Prostate Gland – Below the bladder; secretes a fluid that enhances sperm mobility.
6.Bulbourethral (Cowper’s) Glands – Small glands near the urethra that secrete lubricating fluid.
7.Penis – The external organ that delivers sperm and urine through the urethra.
Female Reproductive Structures (6)
1.Ovaries – Located on either side of the uterus; produce eggs and hormones.
2.Fallopian Tubes – Extend from the ovaries to the uterus; the site of fertilization.
3.Uterus – A muscular organ located behind the bladder, where a fertilized egg implants and grows during pregnancy.
4.Cervix – The lower part of the uterus that connects to the vagina.
5.Vagina – A muscular canal that connects the cervix to the external body; serves as the birth canal and passage for menstruation.
6.External Genitalia (Vulva) – Includes the labia, clitoris, and vaginal opening, which protect internal structures.
a tumor marker frequently elevated in cases of hepatocellular carcinoma and certain testicular cancers
AFP alpha-fetoprotein
an enzyme found in liver tissue that can be elevated with biliary obstruction
ALP alkaline phosphatase
a liver enzyme most specific to hepatocellular damage
ALT alanine aminotransferase
an enzyme found in all tissues, but in largest amounts in the liver; an increase can indicate hepatocellular damage
AST aspartate aminotransferase
fold in the parietal peritoneum that extends from the umbilicus to the diaphragm and contains the ligamentum teres
falciform ligament
blood flow away from the liver
hepatofugal
blood flow toward the liver
hepatopetal
remnant of the obliterated left umbilical vein seen as a triangular echogenic focus dividing the medial and lateral segments of the left lobe of the liver in the transverse plane
ligamentum teres
remnant of the ductus venosus seen as an echogenic line separating the caudate lobe from the left lobe
ligamentum venosum
Direction of blood flow also dictates the caliber of the venous radicles. Caliber of hepatic veins becomes _______ as it courses toward the IVC and diaphragm, and has a pulsatile waveform. Caliber of the portal veins ________ further from its point of origin, the porta hepatis, and has a continuous waveform
-increased
-decrease
are interlobar and intersegmental, coursing between lobes and segments
Hepatic veins
are intrasegmental, coursing within lobar
segments.
Portal veins
The difference between the bunny sign versus the deer horn sign on a sonographic liver image
-the bunny sign is a normal liver image of the hepatic veins resembling a bunny
-the deer horn sign is of an abnormal liver image observed in portal hypertension
Sonographically, identified as finger-like or tongue-like projection of right liver lobe extending distally and may reach as far as iliac crest; More common in women
Riedel lobe
Hepatic arterial blood is ______ rich
Portal venous blood is _______ rich after it traverses the walls of the gastrointestinal tract.
-oxygen
-nutrient
-Rt. Portal Vein divides into the _______ and _______ branches
-Lt. Portal Vein divides into the ______ and _______ branches
-Anterior and Posterior branches
-Medial and Lateral branches
The parallel channel sign in liver sonography refers to the appearance of dilated bile ducts, running parallel to the portal vein branches. This abnormality is referred to as?
Biliary ductal dilation
is largest and courses between anterior and posterior branches of the Hepatic Veins
RHV
is largest and courses between anterior and posterior branches of the Hepatic Veins
RHV
This Hepatic V. is located in main lobar fissure. Divides liver into right and left lobes.
Middle Hepatic Vein
Located in the cephalic portion of left intersegmental fissure dividing left liver lobe into lateral and medial segments
LHV
Which ligament surrounds the portal triad?
Hepatoduodenal
Which cell type is most abundant in the liver, and carries out most metabolic functions?
Hepatocyte
Is a yellow pigment that results from the breakdown of heme in red blood cells. It is processed by the liver and excreted in bile. There are two types, unconjugated (indirect), and conjugated (direct).
Biliruben
Excessive accumulation of fat in hepatocytes. Caused by alcoholic liver disease, non-alcoholic fatty liver disease, obesity, and diabetes. Can progress to fibrosis/cirrhosis.
-increased echogenicity
-blurry or obscured vasculature
-posterior attenuation due to excessive fat absorption of sound waves
Fatty Liver Infiltration
Areas of normal liver tissue in a background of fatty infiltration. Thought to be due to altered perfusion in certain regions of the liver. Can mimic liver lesions but lacks a true mass-like appearance. A benign abnormality.
-Hypoechoic regions
-commonly seen near the porta hepatis, gallbladder fossa, or periportal area
Fatty sparing (Focal Fatty Sparring)
A genetic metabolic disorder caused by enzyme deficiencies affecting glycogen metabolism in the liver muscles or both. These lead to abnormal glycogen accumulation, causing hepatomegaly, hypoglycemia, and metabolic complications. Most common form GSD is type 1 Von Gierke Disease
-Marked diffuse increase in parenchymal echogenicity and decreased penetration indicating a fatty liver; Possible solid liver masses
Glycogen Storage Disease
Inflammation of the liver which can be caused by viral infections, toxins, autoimmune disorders, or metabolic conditions. It leads to liver cell damage, impairing liver function, and potentially progressing to fibrosis, cirrhosis, or liver failure. There are five different variations, two of which are incurable.
-Parenchymal pattern ranges from normal to hypoechoic secondary to diffuse swelling of liver cells caused by inflammation.
-Portal vein walls appear more hyperechoic against hypoechoic background of edematous parenchyma, called “starry star” sign.
Hepatitis
The five types of viral hepatitis
● Hepatitis A: highly contagious liver infection caused by fecal or oral transmission, acute only
● Hepatitis B: serious liver infection caused by blood-borne sexual transmission can be chronic; preventable by vaccine
●Hepatitis C: infection caused by platform, sexual transmission, virus that attacks liver and leads to inflammation; chronic
●Hepatitis D: serious liver disease; requires HBV co-infection.
● Hepatitis E: caused by fecal or oral transmission, more severe in pregnancy
Seen in cirrhosis or portal hypertension, were increased arterial flow compensates for reduced portal vain flow. The hepatic artery becomes enlarged and tortuous, leading to a __________ appearance.
Corkscrew-like
Are dilated submucosal veins in the esophagus, usually due to portal hypertension from liver cirrhosis. They pose a high risk of rupture and life-threatening bleeding. On an ultrasound image will appear superior to the aorta and posterior to the left liver lobe.
esophageal varices
A rare genetic disorder, characterized by multiple fluid, filled cysts in the liver without significant kidney involvement. It differs from autosomal dominant polycystic kidney disease where liver occur, secondary to kidney cysts.
Isolated polycystic liver disease (PCLD)
Aka echinococcus cyst; is a parasitic infection caused by a tapeworm through the ingestion of contaminated food or water containing dog or fox feces. The cysts remain asymptomatic for a long time, but symptoms can include abdominal pain, nausea, vomiting, feeling of fullness. The most significant complication arises from cyst rupture, which can trigger severe allergic reactions due to the release of cyst fluid. Geographically prevalent in the Middle East, Mediterranean, and South America. On a sonographic appears, depending on the level of larval maturation, will include:
-(1) Solitary cyst with possible mural or shell-like calcification
(2) Mother cyst containing internal, peripherally placed daughter cysts
(3) Fluid collections with septa—honeycomb appearance
(4) Solid-looking cysts, with or without calcification
Hydatid Disease
Is a pus-filled cavity in the liver caused by Entamoeba histolytica, a protozoon parasite. It is the most common extra intestinal manifestation, occurring when the parasite spreads from the intestines to the liver via the portal vein. It is spread through fecal-oral transmission from contaminated food and water. Geographically prevalent in tropical and subtropical regions with poor sanitation’s. Lead to necrosis and abscess formation in the liver, filled with anchovy-paste like pus. However, if caught early, can be treated with an excellent prognosis.
Amoebic Liver Abscess
Is a common parasitic infection in third world countries. It is transmitted by skin contact with freshwater containing infected snails. Larvae develop into adult worms in the venous system and lay eggs which get trapped in surrounding liver tissue, triggering inflammation and fibrosis. Can lead to urinary bladder cancer if not treated
Sonographic Features
●Irregular hepatic surface, hyperechoic thickened walls of portal venules, appears as a network-like or “turtle-back” fibrosis pattern
●Splenomegaly with portal vein and splenic vein dilatation with maintained continuous hepatopetal flow maintaining normal velocity
Schistosomiasis
Is a pus filled cavity in the liver caused by a bacterial infection, usually from E.coli or often due to biliary track disease. It is a serious condition that requires urgent treatment with antibiotics and drainage. May include fever, leukocytosis, elevated LFT values, RUQ pain, hepatomegaly, sepsis, and septic shock.
Sonographic appearance :
-Hypoechoic, complex cystic mass with internal debris or septations
-Mass can contain gas bubbles if bacterial growth is present.
Pyogenic abscess
Is a parasitic infection caused by fasciola hepatica. It is transmitted by ingesting contaminated water or raw aquatic plants that carry the infective larva. Geographical prevalence is worldwide, especially in livestock rearing regions. The liver and bile ducts may show signs of inflammation obstruction or fibrosis, depending on how long the infection has been present.
Sonographic appearance :
-hypoechoic lesions in the liver, often with a halo effect due to inflammatory reaction
-Biliary dilatation might be visible if there is obstruction due to the presence of flukes or inflammation
-Hepatomegaly with a slightly heterogeneous echo texture
Liver fluke disease, aka fascioliasis
Is a retro virus that targets the immune system, making the body more susceptible to opportunistic infections and certain cancers. Transmitted through unprotected sexual contact, sharing needles or syringes, contaminated blood transfusions, mother-to-child during childbirth pregnancy or breast-feeding.
Sonographic appearance :
-hepatomegaly
-hypoechoic or hyperechoic lesions within the liver
-Fatty infiltration of the liver
-cirrhosis
-splenomegaly
-Enlarged lymph nodes
-nephropathy
-cardiomyopathy
HIV/AIDS
Refers to an abnormal growth of tissue that does not spread to other parts of the body and typically does not pose a life-threatening risk. It can develop in virtually any tissue or organ, grow slowly, maintain a well defined border.
Benign neoplasm’s
Is a type of benign vascular tumor, composed of large dilated blood vessels. It is one of the most common types of hemangioma’s and can occur in various organs. These type of hemangiomas are 5× more common in women. Location is typically in the posterior segment of the right lobe and in subcapsular locations along the periphery of the liver and appearing hyperechoic.
Cavernous Hemangioma
Excess fluids in extracellular compartments, causing swelling or enlargement of the tissues. It may be isotonic, hypotonic, or hypertonic, depending on the cause. Will cause restriction of movements, interference with digestion and absorption, accumulation of fluids around the heart, lungs, and general organs.
Edema
A byproduct of cell breakdown excreted by the kidneys. Used in laboratory tests to determine kidney health.
Blood urea nitrogen BUN
A byproduct of protein breakdown eliminated by the kidneys
Creatinine
is a fungal infection caused by Candida species, primarily Candida albicans. It commonly affects immunocompromised patients such as patients with AIDS. Types of Candidiasis include:
-Superficial (oral thrush, vaginal candidiasis, skin infections)
-Invasive/Disseminated (affecting liver, spleen, kidneys, CNS, etc.)
Sonographic appearance:
-Multiple small, hypoechoic lesions (1-2 cm) in the liver and spleen
-“Target lesions” or “wheel-within-wheel” appearance
-Central hypoechoic necrosis
-Middle echogenic inflammatory zone
-Outer hypoechoic ring
-Hyperechoic calcifications in chronic cases
-Splenomegaly may be present
Candidiasis
is a benign liver lesion caused by a hyperplastic response to abnormal blood flow, typically from an arterial malformation. It is the second most common benign liver tumor after hepatic hemangioma and occurs predominantly in young women (30–50 years old).
Sonographic appearance:
-Well-defined, iso- or hypoechoic lesion (compared to surrounding liver)
-“Spoke-wheel” vascular pattern (on Doppler imaging)
-Central scar (hyperechoic or hypoechoic)
-No significant mass effect or capsule
-No internal calcifications or necrosis
Focal Nodular Hyperplasia (FNH)
is a benign liver tumor that has a strong association/long-term use from ORAL CONTRACEPTIVES, anabolic steroids, and metabolic conditions. Most common in women 20-40 years old. Composed of normal hepatocytes, but lacks bile ducts and portal tracts. It is uncommon but has a risk of malignant transformation (HCC), hemorrhage, or necrosis.
Sonographic appearance:
-Well-defined, hyperechoic or isoechoic lesion
-Heterogeneous if hemorrhage or necrosis present
-No central scar (unlike FNH)
-Peripheral vascularity on Doppler
Hepatic Adenoma
