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180 Cards in this Set
- Front
- Back
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What doppler findings are suggestive of renal artery stenosis |
peak MRA (main renal artery) of greater than 200 cm/s
peak MRA/aorta velocity >3.5 |
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When should renal artery stenosis be suspected
|
Suspect w/new onset HTN at extremes of age, or HTN that is very difficult to treat |
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What r the findings of renal artery stenosis
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>200cm/sec
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What is the normal peak main renal artery velocity
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75-125 |
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What artifact may be seen in a patient with renal artery stenosis
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aliasing
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do you see tardus parvus waveform after the stenotic area in RAS
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yes
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What happens to the RI in renal artery stenosis
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decrease (less than 0.5)
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What are choroid plexus cyst associated with
5 |
trisomy 18
downs turners klinefelters |
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When is amniocentesis offered in for choroid cyst
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if the choroid cyst is greater than 1cm (controversial)
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What percent of trisomy 18 have choroid cyst
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30%
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What percent of normal babies have a choroid plexus cyst
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2%
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What are the findings of trisomy 18
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choroid plexus cyst
increased nuchal translucency cardiac defect clenched hands and overlapping fingers rockerbottom feet dandy walker variant omphalocele single umbilical artery strawberry shaped calvarium |
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What percent of babies with trisomy 18 have clenched hands and overlapping index fingers
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50%
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Is dandy walker variant common in trisomy 18
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yes
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What percent of babies with trisomy 18 have strawberry shaped calvarium
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45%
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Are choroid plexus cyst often bilateral
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yes
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Do trisomy 18 children get AV canal defects
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yes
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What is a high resistance doppler waveform
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A high-resistance |
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What is a low resistance doppler waveform
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A low-resistance
waveform is characterized by relatively high flow velocities throughout diastole (curved arrow). The narrow spectrum and clean systolic window are characteristic of laminar blood flow ex: carotid artery. |
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What is A/B ratio
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(peak systolic velocity /end diastolic velocity
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What is the pulsatility index
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(peak systolic velociy-end diastolic velocity)
/ (temporal mean velocity) |
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What is resistance index
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(peak systolic velociy-end diastolic velocity)
/ (peak systolic velocity) |
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What is biphasic flow
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flow that is goes in both directions
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Is there biphasic flow in subclavian steal
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yes
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What vessel is used to check for subclavian steal
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Reversal of flow in vertebral artery indicates stenosis or occlusion at origin of subclavian or innominate artery
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What is a complication of subclavian steal
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May cause symptoms of vertebrobasilar insufficiency, especially with arm exercise
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What do you see in flow in the vertebral arteries compared to the carotids in a pt with subclavian steal
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color flow in both carotid & vertebral – should be going in the same direction
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What is the cause of the reversal of flow in subclavian steal
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Collateral blood flow to the arm via the vertebral artery (VA) as a result of proximal subclavian artery (SCA) stenosis or occlusion |
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Can you have complete reversal of flow in severe subclavian steal
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yes
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What are the 2 causes of ventriculomegaly
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increased pressure or absence of brain tissue
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What regions are typically affected first in hydrocephalus
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atrio-occipital region
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What are the 2 findings indicative of hydrocephalus
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atria greater than 1cm
dangling choroid plexus |
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What type of hydrocephalus does aqueductal stenosis cause
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non-communicating hydrocephalus
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What are the findings of aqueductal stenosis
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Ventriculomegaly of lateral and 3rd ventricles with normal-sized 4th ventricle
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What is affected first in epididymo-orchitis
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epididymis first
testicles secondarily |
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What are the US of epididymo-orchitis
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enlarged
hypoechoic epididymis and testicle hypervascular scrotal wall thickening hydrocele |
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What is the measurement for scrotal wall thickening
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>8mm
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What are 2 findings in a duplicate collecting system
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Cystic structure in upper pole of kidney (obstructed upper pole collecting system)
Cystic structure in bladder (ectopic ureterocele) |
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What is the drainage of a duplicate collecting system
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Upper pole drained by ectopic ureter
Lower pole drained by normotopic ureter |
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What is the insertion of the ectopic ureter
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Ectopic ureter inserts inferior and medial to normotopic ureter, in trigone of bladder
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What is a reason why the lower pole of a duplicated collecting system kidney system might be dilated
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reflux
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Is there a band of tissue seperating the duplicate collecting system in a kidney
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yes
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If you see a dilated upper pole of a kidney what should you search for
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a ureterocele
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What does a ureterocele look like
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a thin walled cystic structure in the bladder
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Explain the doppler frequency shift
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The transmitted Doppler US |
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What is the doppler angle
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The Doppler angle (θ) is defined as the
angle between the Doppler US beam and the direction of blood flow, which is assumed to be parallel to the walls of the blood vessel. The Doppler sample volume is indicated by two parallel lines. The Doppler angle indicator is displayed as a dashed line within the sample volume. The US unit has a control knob that is used to align the Doppler angle indicator with the blood vessel walls. |
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Explain spectral doppler
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US image shows the Doppler
spectrum of the common carotid artery. The vertical scale shows blood flow velocity in meters per second. The horizontal scale shows time in seconds. The Doppler trace demonstrates peak velocities in systole (S) and low flow velocities in diastole (D) |
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Explain characteristics of the flow of blood before and after a plaque
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To assess a vessel |
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Explain the progression of altered parenchyma in a renal vein thrombosis
3 |
Diffusely hypoechoic, no corticomedullary differentiation
Diffusely heterogeneous (if extensive hemorrhage and necrosis) Linear echogenic "streaks" radiating from hilum (thrombosed parenchymal veins) |
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What is the most noticeable feature of renal vein thrombosis
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kidney enlargement
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What happens to the spectral waveform in renal vein trhrombosis
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↑ Systolic pulsatility (narrow, sharp systolic peaks)
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Is there retrograde or abscent renal vein flow in renal vein thrombosis
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yes
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Where is the splenic vein in relation to the to the SMA
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Splenic vein anterior to superior mesenteric artery
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Where is the RV in relation to the SMA
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RV posterior to superior mesenteric artery
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When does renal vein thrombosis tend to occur
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1st week after transplant
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What are the findings of renal vein thrombosis
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enlargment of the kidney
absent of venous flow high resistance waveforms and reversal of renal arterial flow in diastole |
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What should you look for with grey scale in the renal vein following transplant
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thrombosis
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What is the ddx of reversal of arterial flow in diastole following renal transplant
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ATN
rejection |
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What tends to happen to the pyramids in acute rejection
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swollen
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What happens to the cortical medullary differentiation in rejection
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dimininished
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Is increased RI specific for acute rejection
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no, also seen in ATN
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What are the findings of Acute rejection
5 |
swelling of both parenchyma and urothelium |
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Why does RI increase in acute rejection
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reduced or absent diastolic flow
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What are the findings of ATN
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swollen kidneys with enlarged hypoechoic pyramids
decreased diastolic flow (increased RI) |
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What is the best way to differentiate ATN from Acute rejection
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time course: |
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Does the timing of cyclosporin toxicity overlap with acute rejection
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yes (but not ATN)
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What is the MC vascular transplant complication
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RAS
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Describe 2 characteristics of intratesticular neoplasm
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solid
hypervascular |
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What is the MC testicular tumor
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seminoma
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What is the 2nd MC testicular tumor
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mixed germ cell
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What is the classic appearance of a seminoma
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homogenous hypoechoic
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Are teratomas of the testicle generally malignant
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yes
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Are embryonal or chorioCA generally more aggressive looking than a seminoma
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yes
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What are the MC non-germ cell tumors
2 |
leydig and seritoli
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What do leydig and seritoli tumors look like on US
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variable echotecture
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What are other neoplasms of the testicle that may be solid
2 |
leukemia and lymphoma
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Describe the findings of leukemia and lymphoma of the testicle
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Diffuse enlargement, heterogeneity, or focal mass
Both hypervascular |
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What is the DDX of a testicular mass
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testicular CA, epidermoid, lymphoma/leukemia, mets, focal infection, hematoma, contusion, infarct
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Are epidermoid cyst vascular
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no
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What is the appearance of an epidermoid cyst on doppler
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hypoechoic testicular 'mass' with a concentric lamellar pattern AKA onion-ring appearance.
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Besides Onion-skin what else is an epidermoid described as
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target or bulls eye
sharply circumscribed encapsulated mass |
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What 3 findings of testicullar rupture
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-loss of definition of testicular margins
-loss of normal oval shape -protrusion of parenchyma beyond the margins of the the testicle |
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Besides testicular rupture what are other sequeli of trauma to the testicle
3 |
edema
contusion hematoma |
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What is the tx of testicular rupture
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surgical repair
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What is the normal appearance of a neonatal adrenal gland
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the echogenic central medullary portion of the gland surrounded by hypoechoic fetal cortex.
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What is neonatal adrenal hemorrhage associated with
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Associated with many perinatal stressors: Asphyxia, sepsis, birth trauma, coagulopathies
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What percent of neonatal hemorrhage is bilateral
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10%
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How does adrenal hemorrhage appear acutely
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Acutely the hemorrhage appears echogenic and mass-like
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What does adrenal hemorrhage look like subacutely
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Subacutely blood products begin to liquefy and contract creating a mixed echotexture mass
eventually it will turn hypoechoic |
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What is the DDX of an enlarged adrenal gland in a child
2 |
hematoma
neuroblastoma |
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What is the ddx of an enlarged adrenal gland in an adult
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adenoma
met carcinoma pheo myelolipoma hyperplasia cyst hematoma |
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What is the classic appearance of a myelolipoma
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Well-defined, homogeneous, echogenic mass
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What are the normal doppler findings in a peripheral artery
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triphasic waveform
no spectral broadening |
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What are the doppler findings if 1-19% diameter reduction
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Triphasic waveform with minimal spectral broadening
PSV increase < 30% relative to adjacent proximal segment Proximal and distal waveforms remain normal |
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What are the doppler findings if 20-49% diameter reduction
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Triphasic waveform, but reverse flow diminished
Spectral broadening prominent PSV increase 30-100% relative to adjacent proximal segment Proximal and distal waveforms remain normal |
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What are the doppler findings if 50-99% diameter reduction
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Monophasic waveform, loss of reverse flow and forward flow throughout cardiac cycle |
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What are the doppler findings if Occlusion
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No flow
Distal waveform monophasic with reduced systolic velocity |
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Where does bypas graft stenosis MC occur
2 |
proximal or distal anastomosis
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what are the early causes of bypass graft stenosis
3 |
surgical problem with anastomosis
clamp injury AV fistula |
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What is a late cause of bypass graft stenosis
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intimal hyperplasia
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What should you suspect if there is calcification in the medullary portion of the kidney
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medullary nephrocalcinosis
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What are the findings of medullary nephrocalcinosis
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hyperechoic rim surrounding pyramids (will eventually involve the entire pyramid)
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What is the MCC of medullary nephrocalcinosis in adults
3 |
Renal tubular acidosis
Medullary sponge kidney Hyperparathyroidism |
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What is the MCC of medullary nephrocalcinosis in a baby
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lasiz
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What is the ddx of hyperechogenicity of the renal medullary in a child
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lasix
transient renal medullary hyperechogenicity |
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What percent of nephrocalcinosis is medullary and cortical
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medullary 95%
cortical 5% |
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Does nephrocalcinosis shadow on US
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no early on but eventually yes
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What is the ddx of cortical nephrocalcinosis
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COAGS
Cortical necrosis Oxalosis Alports Glomerulonephritis Sickle cell disease |
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What are the US of cortical nephrocalcinosis
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Cortex calcifies, and entire kidney may look echogenic or kidney may be almost entirely obscured by shadowing |
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What is the MCC of portal venous gas
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NEC
bowel infarction |
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What are the US of PV gas
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Moving hyperechoic foci in the lumen of main portal vein and portal vein branches |
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What are the doppler findings of portal venous gas
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Doppler: sharp bidirectional spikes superimposed on usual portal vein waveform |
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How do you determine if a fetus has oligohydramnios
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amniotic fluid index (add largest vertical fluid pocket in each quadrant)
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What is amniotic fluid index measurement for oligohydramnios
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less than 5cm
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What is the DDX of oligohydramnios
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Demise of fetus, drugs |
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When does symmetric IUGR occur
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early in pregnancy |
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Is the head and body equally affected in symmetric IUGR
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yes
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What is the ddx of IUGR
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Placental insufficiency—hypertension, diabetes |
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What is the definition of IUGR
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Fetal weight < 10th percentile
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What is the majority of IUGR cases ; asymmetric or symmetric
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asymmetric (90%) |
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What is the cause of polyhydramnios
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TARDI
Twins Anomalies (fetal): esophageal atresia, duodenal/proximal small bowel obstruction, omphalocele, non-immune hydrops, anencephaly, hydranencephaly, holoprosen cephaly, myelomeningocele, ventriculomegaly, agenesis of CC, encephalocele, microcephaly, diaphragmatic hernia, CCAM, tracheal atresia, extralobar sequestration, trisomy (13,18,21) Rh incompatibility Idiopathic (60%)—associated with macrosomia |
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What percent of cases of polyhydramnios are idiopathic
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33%
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What percent of polyhydramnios are in pt with DM
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25%
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What is placental abruption
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premature seperation of the placenta from the uterus
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What are the 3 locations of placental abruption
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marginal
retroplacental preplacental |
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What is the MC type of placental abruption
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marginal
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What are the risk factors of placental abruption
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prior hx |
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What are the US findings of placental abruption
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Hypoechoic blood clot near or behind placenta
(variable echotecture depends on age of blood) |
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What is a pitfall for diagnosing placental abruption
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when isoechoic it can look like an enlarged placenta
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What are the findings of an inguinal hernia
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Echogenic mass with shadowing (mesentery) and peristalsis if it contains bowel
May increase in size if pt stands or Valsalvas |
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How do you differentiate a biliary duct from a vessel
4 |
No flow w/Doppler
Good through transmission Tortuous w/irregular walls Stellate configuration centrally, near porta hepatis |
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What 2 characteristic may cause a bile stone not to shadow on US
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Small (< 5 mm) or soft pigmented stones may not produce posterior shadowing
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What is the appearance of the majority of choledocholithiais
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Majority appear as highly echogenic foci with posterior acoustic shadowing
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Where is the MC location of choledocholithiasis
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MC in region of ampulla of Vater, high chance of being obscured by bowel gas
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What is the ddx of echogenic kidneys
4 |
GLAD
Glomerulonephritis Lupus AIDS Diabetes nephropathy |
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Can HIV result in echogenic kidneys
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yes
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What is the MCC of cervical incompetence
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Often result of trauma to cervix from prior abortion or surgery
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What are the normal and abnormal measurements of the cervical length
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Cervical length: normal > 3 cm, 2-3 cm borderline, < 2 cm incompetent
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What if the internal os is wide
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Opening of internal os > 3-6 mm also = incompetence
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What is the proper technique to image the cervix for cervical incompetence
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Image TV w/empty bladder or translabial
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What is brachydytly
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shortness of fingers or toes
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What are the skull findings of achondroplasia on fetal US
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frontal bossing
depressed nasal bridge |
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What are the hand findings of achondroplasia on fetal US
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'trident hands (brachydactyly and mild splayed appearance) |
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What is the inheritance pattern of brachydactyly
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AD
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What is rihizomelic long bones
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Rhizomelia refers to either a disproportion of the length of the proximal limb
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Do achondraplasia fetuses have rhizomelic long bones
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yes, they are disproportionate
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Do fetuses with achondraplasia have abnormal ossifications and fxs
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no, they have normal ossification and no bowing, angulation or fx
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What is a spine finding of achondroplasia
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kyphosis
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What is the main feature of OI that seperates it from other skeletal dysplasias
|
the presence of fx
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what is the appearance of callus formation on fetal US look like
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'crumpled
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What is the rib appearance on fetal US in a pt with OI
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beaded, thin and poorly minineralized
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What happens to the skull when tranducer pressure is applied in pts with fetal OI
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skull deformity (2/2 soft bones)
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What is platyspondyly
|
describes a flattened vertebral body shape with reduced distance beween the endplates
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What is the DDX for platyspondyly
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MODIC
Morquio Osteogenesis imperfecta Dwarf (thanatophoric) Cushing’s syndrome |
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What is the ddx for tibial bowing
|
FONAR
Fibrous dysplasia Osteogenesis imperfecta Neurofibromatosis Achrondroplasia Rickets |
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What are the vetebral body findings in a pt with thanatophoric dysplasia
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Platyspondyly with rounded anterior vertebral bodies
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What are 2 long bone findings in patients with thanatophoric dysplasia
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Short, bowed limbs, "French telephone receiver femurs"
Flared metaphyses |
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What are the 2 types of thanatophoric dysplasia
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TD type I: “Telephone receiver” femur
TD type II: Kleeblattschädel (“cloverleaf”) skull |
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What is thanatophoric dysplasia
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Lethal skeletal dysplasia due to mutation of fibroblast growth factor receptor 3 gene (FGFR3)
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Do fetuses with thanatophoric dysplasia have trident hands
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no
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Describe the thorax and ribs in thanatophoric dysplasia
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Narrow thorax and short ribs
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Do fetuses with thanatophoric dysplasia have kyphosis
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yes
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What is the MC non-lethal skeletal dysplasia
|
achondrogenesis
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Can you diagnose achondrogenesis in the 1st trimester
|
no, Normal early scan, with long bone shortening noted after 22 weeks |
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What is micromelia
|
Shortening of both proximal and distal segments of limb
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Can micromelia be detected in both achondrogenesis and OI type 2
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yes
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What are the characteristic findings of achondroplasia
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Characterized by disproportionately short limbs (rhizomelia), large head with frontal bossing, depressed nasal bridge, and short digits
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fix card achondroplasia is mc not achondrogenesis also description given is for achondroplasia
|
d
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What is achondrogenesis
|
3 main subtypes based on clinical features
Group of lethal osteochondrodysplasias due to failure of cartilaginous matrix formation 2nd most common lethal short-limb chondrodysplasia |
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Describe the findings of achondroplasia
|
Severe micromelia |
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Do fetuses with achondrogenesis have clubbed feet and severe micromelia
|
yes
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What should be suspected if you see a large fetal head compared to the rest of the body
|
achondrogenesis
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Are there increased incidence of cystic hygroma in achondrogenesis
|
yes
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What is the ddx of a cystic mass of the liver
|
Infection |
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What is a clue that a cystic liver lesion is an abscess
|
thick wall and some may have fluid fluid levels or gas
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What should be done everytime something cystic is seen on US
|
put doppler on it to make sure it is not an aneurysm
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Describe echinococcal cyst
4 |
Anechoic cyst with double echogenic lines separated by a hypoechoic layer |
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What is another name for an echinococcal cyst
|
hydatid
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What are two types of echinococcal cyst (hydatid)
|
E. granulosus: Most common form of hydatid disease, unilocular form |
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Describe the findings of amebic abscess
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Peripherally located, isoechoic mass, most often solitary (85%) |
