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254 Cards in this Set
- Front
- Back
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What is the US appearance of ARPKD
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enlarged, hyperechoic kidneys
(very tiny cyst may or may not be discernable) |
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Do fetuses with ARPKD seen in the setting of oligohydramnios
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yes, alwas
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What other condition do fetuses tend to get secondary to oligohydramnios
2 |
pulmonary hypoplasia
potter facies |
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What is meckel-gruber syndrome triad
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renal cystic dysplasia
encaphalocele polydactyly |
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What is the kidney appearance in meckel gruber syndrome
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Renal appearance is variable, from large, echogenic kidneys to kidneys completely replaced by macroscopic cysts
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Do fetuses with MG syndrome causes increase AFP
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Elevated maternal serum alpha-fetoprotein from encephalocele
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What region of the calvarium is the encphalocele most commonly seen
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occiptial region
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What is the ddx of an obstruction iin the IVC
3 |
bland thrombos
tumor thrombus membranous (congenital web) |
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What type of thrombus tends to expand the blood vessel
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tumor
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What are the 2 MCC of tumor thrombus in an adult
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HCC and RCC
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What is the MCC of tumor thrombus in a child
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Wilms Tumor
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Do tumor thrombus tend to have flow
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yes
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What are 3 findings associated with Bud chiari
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ascites
abdominal pain hepatomegaly |
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What is budd chiari
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obstruction of the venous outflow of the liver (hepatic veins or IVC)
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Describe the findings of a lymphocele
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Lymphocele (MC, 4-8 w): well-defined, large anechoic or heavily septated
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Describe the findings of a urinoma
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Urinoma (within 3 w): localized or free anechoic collections without septations
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Describe the findings of a post transplant hematoma
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Hematoma (early postop): echogenicity depends on age of collections
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Describe the findings of a post transplant seroma
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Seroma (early postop): typically anechoic
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Describe the findings of a post transplant abscess
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Abscess: typically complex cystic with irregular outline, thick wall and echogenic internal debris
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What 3 fluid collections will typically occur early post op
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hematoma
seroma abscess |
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When do urimoma and lymphoceles tend to occur
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later
urinoma- within 3 weeks lymphocele-4-8 weeks |
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Are epididymal cyst common
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yes (20-40% of asymptomatic males)
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Where is the MC location of an epididymal cyst
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epididymal head
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Describe the findings on US of a epididymal cyst
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well defined and anechoic
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How do you differentiate a spermatocele from an epididymal cyst
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spermatocele tends to have low level echoes
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What is the expected doppler finding in the feeding vessel of a vein of galen malformation
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Pulsed Doppler ultrasound depicts turbulent arterial flow within a feeding vessel, confirming an arteriovenous fistula.
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What are the US findings of a vein of galen malformaiton
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cystic structure posterior ot the 3rd ventricle
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Describe the classic echogenicity and borders of testicluar lymphoma
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ill defined
hypoechoic |
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What percent of testicular lymphoma involve both testicles
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50%
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What is the ddx of multiple testicular lesions
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leukemia
lymphoma mets abscesses adrenal rest |
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What is a rhabdomyoma
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Congenital myocardial mass (hamartoma)
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Can a rhabdomyoma be intramural and exophytic
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yes
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What is the MC pediatric cardiac tumor
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rhadomyoma
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What percent of rhabdomyomas are associated with TSC
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85%
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Can a fetal rhabdomyoma be cause hydrops
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yes
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If you see an in utero cardiac mass in a fetus what is the most likely diagnosis
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cardiac rhabdomyoma
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What is the US appearance of a rhabdomyoma
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hyperechoic and arises fromt eh muscles of the walls or septum
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What vessesl is the AVF in vein of galen malformation
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Arteriovenous fistula (AVF) between deep choroidal arteries and embryonic median prosencephalic vein of Markowski (MPV)
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What is the MCC of extracardiac high output cardiac failure in a newborn
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Vein of galen malformation
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What are complications of VOGM
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cerebral ischemia and atrophy leading to brain damage
hydrocephalus |
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What is the tx for VOGM
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transarterial embolization at 4-5 months
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What percent of children are neurologicaly normal after VOGM embolization
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60%
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What is the MC congenital tumor
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sacrococygeal teratoma
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What is the US appearance of a sacrococcygeal teratoma
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solid and cyst mass in sacral region
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What is the main ddx of a sacrococcygeal teratoma
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myelomeningocele
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How many types of sacrococcygeal teratomas are there
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4 (types 3 and 4 have the highest chance of becoming malignanty if not removed)
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What are 2 examples of hyperplastic cholecystosis
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cholesterolosis
adenomyomatosis |
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Describe the findings of adenomyomatosis
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mural GB wall thickening due to exaggeration of normal luminal epithelial folds (Rokitansky-Aschoff sinuses) in conjunction w/smooth muscle proliferation
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Describe the findings of cholesterolosis
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deposition of foamy cholesterol-laden histiocytes in subepithelium of GB; numerous small accumulations (strawberry GB) or larger polypoid deposit (cholesterol polyp)
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Do both adenomyomatosis and cholesterolosis cause comet tail artifact
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no, only adenomyomatosis
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How do you distinuishe cholesterolosis and adenomyomatosis if they both have wall thickening
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cholesterolosis will have polyps
adenomyomatosi will have comet tail artifacts and cystic spaces in the walls |
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What is the ddx of gallbladder wall thickening
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Biliary—cholecystitis, adenomyomatosis, AIDS cholangitis
Edema—hypoproteinemia (cirrhosis, nephrotic syndrome), congestive heart failure Hepatitis |
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What is the ddx of bilateral multiple renal cyst
4 |
Acquired cystic disease of dialysis—small kidneys, increased risk of RCC
ADPKD—enlarged kidneys, liver cysts, berry aneurysms Von-Hippel Lindau—pancreatic cysts, increased risk of RCC, CNS hemangioblastomas, pheos Tuberous sclerosis in kids—AMLs, cortical tubers, giant cell astrocytomas, periventric ular nodules, cardiac rhabdomyomas, pulmonary LAM |
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What is hematometrocolpos
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Echogenic fluid within distended uterus ± vagina (blood, mucus, purelent material)
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What is Hematometra
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blood in endometrial cavity
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What is Hematocolpos
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blood filling the vagina
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What is the ddx of fluid in the endometrial canal in a post menopausal women
5 |
Postmenopausal causes of fluid in uterine cavity: cervical stenosis, cervical CA, endometrial CA, endometrial polyps, pyometrium
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What is the ddx of fluid in the endometrial canal in a premenopausal women
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Premenopausal: congenital obstruction (imperforate hymen, vaginal septum, vaginal or cervical atresia), acquired cervical obstruction (instrumentation, radiation, or CA), menorrhagia, and pregnancy
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Describe 4 congenital obstructions that may lead to increased fluid in the endometrial canal
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imperforate hymen
vaginal septum vaginal atresia cervical atresia |
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Name 2 causes of aquired cervical obstruction that may lead to increased fluid in the endometrial canal
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instrumentation
radiation cervical CA |
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What is a varicocele
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dilated serpinginous veins of pampiniform plexus
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What percent of males develop a varicocele
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15-20%
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What is the MC correctable cause of male infertility
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varicocele
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What percent of varicoceles occur on the left side and why
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85% occur on left (left spermatic vein drains into left renal vein; because SMA compresses left renal vein, pressure on left > right),
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What are common causes of an isolated right sided varicocele
2 |
retroperitoneal mass
situs inversus |
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What are the US findings of a varicocele
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Gray-scale: numerous, dilated, tortuous, tubular channels in peritesticular tissues
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What is the normal size of a scrotal vein (diameter)
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Upper limit of normal caliber scrotal veins is 2 mm
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What manuever can be utilized to attempt to detect varicoceles
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Valsalva-induced flow augmentation on color Doppler when patient is supine
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What is the MC appearance of hashimotos thyroiditis
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multiple ill-defined hypoechoic areas separated by thickened fibrous strands, but with no discrete nodules
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What is a worrisome complication of hashimotos thyroiditis
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increased risk of primary lymphoma
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What is the MC demographic affected by hashimotos thyroiditis
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women between 40-60y
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What is the pathophysiology of hashimotos thyroiditis
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autoantibodies to thyroid protien (esp thyroglobulin)
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What is the MCC of hypothyroidism in the US
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MC cause of hypothyroidism, goiter in adults in US
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What are 6 additional diseases that may be associated with hashimotos thyroiditis
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Sjögren syndrome, lupus, rheumatoid arthritis, fibrosing mediastinitis, sclerosing cholangitis, pernicious anemia
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Describe the US appearance of hashimotos thyroidtis
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Diffuse thyroid enlargement with inhomogeneous low-density parenchyma
Thin, echogenic fibrous strands may cause a multilobulated or micronodular appearance |
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What is the doppler findings with hashimotos
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hypervascular
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Do patients with hashimotos thyroiditis have multiple tiny (1-6mm) nodules
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yes
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What happens to the thyroid size in endstage hashimotos
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atrophy
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What is a hydrocele
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Hydrocele: accumulation of serous fluid b/w visceral and parietal layers of tunica vaginalis
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What is the MCC of painless scrotal swelling
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hydrocele
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Is hydrocele often idiopathic
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yes
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What are some pathological causes of a hydrocele
3 |
malignant tumor
torstion inflammation |
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What is a funiculocele
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(hydrocele of cord): hydrocele fluid accumulates in spermatic cord in unobliterated portion of tunica vaginalis
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What is a funiculocele and how is it distinuished from a spermatocele
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Appears superior to the testis
Distinguished from spermatocele because does not arise from epididymis |
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Besides a hydrocele what are 2 other cause of scrotal fluid collection
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hematocele
pyocele |
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What are the US findings that are commonly found with hematocele and pyocele
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Internal septations and loculations common with hematoceles and pyoceles, often in conjunction with scrotal wall hyperemia
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When are hemotceles commonly found
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in the setting of recent surgery or trauma
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When are pyoceles found
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infection; usually result from rupture of an abscess into space b/w layers of tunica vaginalis
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What is the MC malignant tumor and the 2nd MC cause of cancer related mortality in men
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prostate carcinoma
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What are the percentatges by DOL that will have atleast microscopic foci of pancreatic cancer
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50% in the 50s
80% in the 80s |
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Is most prostate cancer clinically occult
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yes
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What are normal and abnormal screening values in pts with prostate cancer
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Normal serum PSA level is 0 to 4 ng/mL; borderline 4-10 ng/mL; abnormal > 10 ng/mL
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Where do 70% of prostate cancer occur
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peripheral zone
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What percent of prostate cancer occur in the central and transitional zones
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20% in transitional
5% in the central |
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Describe the US findings of prostate cancer
6 |
Distinct hypoechoic nodule
Poorly marginated hypoechoic area in peripheral zone Mass effect on surrounding tissues Asymmetric enlargement of the prostate Deformation of prostatic contour Focal increased vascularity in peripheral zone with color flow US |
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What is the typical echotexture and margination of prostate cancer
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poorly marginated and hypoechoic
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Is there increased vascularity with prostate cancer
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yes
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What is the ddx of a hypoechoic nodule in the prostate
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carcinoma
benign prostatic hypertrophy, prostatitis atrophy fibrosis infarction fibromuscular hyperplasia |
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What is the indication for US guided needle biopsy of the prostate
2 |
suspicious nodule by US
elevated PSA |
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What are the findings of tubular ectasia of rete testis
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Multiple small spherical or tubular cystic structures in region of mediastinum of testis
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Is tubular ectasia of the rete testes usually bilateral
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yes
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What are 3 associated abnormalities of tubular ectasia of the rete testis
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spermatocele
epididiymal cyst h/o epididiymitis or vasectomy |
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What are 2 predisposing factors to tubular ectasia of the rete testes
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epididymitis
vasectomy |
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Does tubular ectasia of the rete testis require further evaluation
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no
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What are 2 potential complications of IUD
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migration to low lying position
perforation |
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What is the MC time of presentation of hypertrophic pyloric stenosis
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2-10 weeks
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What are the US findings of pyloric stenosis
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>3mm in thickness
>greaterthan 18mm in length |
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What is the treatment for HPS
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pyloromyotomy
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What are 4 signs of HPS found on UGI
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double/triple track sign
string sign mushroom sign catepillar sign |
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What is the double/triple track sign
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Double/triple track sign”: crowding of mucosal folds in pyloric channel
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What is the string sign
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passing of barium streak through pyloric channel
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What is the mushroom sign
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indentation of base of duodenal bulb
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What is the caterpillar sign
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gastric hyperperistaltic waves
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What is the normal appearance of a acute pancreas
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hyperechoic
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What is the typical appearance of the pancreas in acute pancreatitis
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hypoechoic
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What is the ddx of a intrathoracic mass in a fetus
6 |
CPAM
Pulmonary sequestration Laryngeal/tracheal/bronchial atresia Congenital diaphragmatic hernia Bronchopulmonary foregut abnormality Teratoma |
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Describe CPAM
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Abnormal mass of lung tissue with varying degrees of cystic change
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What was the old name of CPAM
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CCAM
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Can a CPAM be both cystic and solid
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yes
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What is the US appearance of CPAM
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Single multiseptate cysts, multiple cysts
Variable cyst size (if solid it is echogenic) |
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What type of CPAM has larger cyst 1 or 3
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1 larger cyst
2 smaller cyst 3 solid |
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What is a pulmonary sequestration
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Congenital area of abnormal lung that does not connect to the bronchial tree or pulmonary arteries
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Where is the arterial supply in pulmonary sequestration
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Arterial supply is typically from systemic source arising from descending aorta
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What are the 2 types of Pulm sequestrations
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Divided into intralobar and extralobar types
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What is the drainage pattern of intralobar
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Intralobar type has venous drainage into inferior pulmonary vein
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What is the drainage pattern of extralobar sequestration
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Extralobar type has venous drainage often systemic, however drainage variable
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Where is the MC location of a pulmonary sequestration
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Most common location is left lower lobe, followed by right lower lobe
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Can the systemic arterial supply arise from below the diaphragm
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May arise from below the hemidiaphragm in 20% of cases
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What is the diagnostic feature of a sequestration
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Diagnostic feature: Systemic artery arising from the aorta and feeding sequestration
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Name 3 foregut abnormalities
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Bronchogenic cyst
Esophageal duplication cyst Neurenteric cyst |
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Describe 5 common features of foregut abnormalities
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Typically homogeneous, fluid-attenuating mass
Well defined Thin walled Nonenhancing May become superinfected |
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Can a foregut abnormality mimic a lung mass
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Typically mediastinal in location but can mimic lung mass (although 15% are within the lung)
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What is hypoplastic left heart syndrome
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Hypoplasia/atresia of the ascending aorta, aortic valve, left ventricle (LV) and mitral valve
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What is the presentation of hypoplastic left heart syndrome
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Most severe congenital heart lesion presenting in neonatal period with congestive heart failure, cardiogenic shock and cyanosis
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What are 3 features of hypoplastic left heart syndrome that are used to categorize it
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Cyanotic, cardiomegaly, increased pulmonary vascularity
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If hypoplastic left heart syndrome leads to obstruction to pulmonary flow how does the body get oxygenated blood
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ductus
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What is the treatment for a hypoplastic left heart
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Norwood: Atrial septectomy, construction of neo-aorta from pulmonary artery, Blalock-Taussig shunt for pulmonary perfusion (3 weeks)
Conversion to hemi-Fontan (Glenn shunt between superior vena cava and right PA, 4-6 months) Fontan: Fenestrated venous conduit through right atrium of inferior caval flow to right PA (1.5-2 years) |
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How does the right heart get oxygenated blood
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Flow admixture in right atrium form atrial septal defect
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How are the coronary arteries perfused in hypoplastic left heart syndrome
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Retrograde flow in hypoplastic aortic arch and ascending aorta for cranial and coronary perfusion
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What is the US appearance of transpostion of the arteries
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Best diagnostic clue: Outflow tracts parallel as they exit heart
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What is L-transposition AKA
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Congenitally corrected transposition of great arteries (CTGA)
L-transposition Levotransposition |
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What is the is the cause of D-transposition
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Ventriculoarterial (VA) discordance in TGA
Aorta arises from right ventricle Pulmonary artery (PA) arises from left ventricle |
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What is the cause of L-transpostion
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Atrioventricular (AV) and VA discordance in CTGA (ventricular inversion)
Right atrium → left ventricle → pulmonary artery Left atrium → right ventricle → aorta |
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Can the 4 chamber view appear normal in TGA
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In TGA "normal" four chamber view
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What is the major clue on US that there is TGA
|
outflow tracts are parrell as they exit the heart
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What is another name for club foot
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talipes equinovarus
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What are the abnormalities of a clubfoot
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Hindfoot equinus, hindfoot varus, and forefoot varus
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What is rocker bottom foot associated with
|
trisomy 18
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Describe a rocker bottom foot
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bottom of the foot is convex with protrusion of the heel
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What percent of fetuses with a 2 vessel cord have additional anomalies
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50%
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What are the findings of a two vessel cord
|
look for two images
-Axial image of pelvis shows 1 umbilical artery -Color Doppler shows 2 vessels in umbilical cord |
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What is the ddx of a proximal neonatal bowel obstruction
4 (4 most common) |
esophageal atresia
duodenal atresia/stenosis duodenal web jejunal atresia less common (hiatal hernia, midgut volvulus, annular pancreas) |
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What other finding is a proximal bowel obstruction associated with
|
polyhydramnios
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What are 3 findings of Osteogenesis imperfecta
|
Compressibility of skull with external pressure
Easy visibility of intracranial structures due to poor ossification Fractures |
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What is a placental chorioangioma
|
Vascular mass-like lesion in placenta supplied by fetal circulation
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Is a placental chorioangioma worrisome if small
|
Usually not clinically significant when smaller than 4-5 centimeters
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What is a potential complication of placenta chorioangioma
2 |
cardiomegaly (high output state) generalized edema (hydrops)
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What are 4 US findings of a placental chorioangioma
|
Solid intraplacental mass
Hypoechoic to isoechoic to normal placenta Bulging protuberance on fetal surface of placenta Usually solitary but may be multiple Shows vascularity throughout mass on color Doppler US |
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Can doppler help diagnose a placental chorioangioma
|
yes, vascularity may help differentiate from other placental masses
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Does the amount of flow on doppler indicate prognosis
|
yes, more flow the more chance of developing hydrops
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What are the findings of DW malformation
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Cisterna magna is enlarged and communicates directly with fourth ventricle through its absent roof
Posterior fossa is enlarged, and tentorium is elevated Hypoplasia or absence of cerebellar vermis and cerebellar hemispheres Hydrocephalus is usually present |
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What is the DDX of dandy walker
|
mega cisterna magna
arachnoid cyst |
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What is the measurement for megacisterna
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Cisterna magna measuring > 10 mm
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How is megacisterna magna measured
|
Measured in axial oblique plane at level of cerebellar hemispheres
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What is the MC neonatal renal tumor
|
mesoblastic nephroma
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What cells do both mesoblastic nephroma and wilms tumor arise from
|
metanephric blastema
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What are the 2 most common findings of mesoblastic nephroma
|
Solid renal mass + polyhydramnios
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What percent of fetuses with mesoblastic nephroma have polyhydramnios
|
70%
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What is the ddx of mesonephric blastoma
|
wilms tumor
crossed fused ectopy |
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What are the US findings of mesoblastic nephroma
|
Iso- to slightly hyperechoic compared to normal renal parenchyma
May rarely have cystic areas may displace vesels and obstruct bowel polyhydramnios vascular |
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What is cross fused ectopia
|
Abnormal location of kidney due to developmental anomaly.
Fused lower pole. Kidney located on opposite side of midline from its ureteral orifice |
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What is amniotic band syndrome
|
Caused by early (before 10 w GA) disruption of amnion allows fetus to enter chorionic cavity
Fetus becomes entangled in fibrous bands that cross chorionic cavity |
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What is the result of amniotic band syndrome
|
Entrapment of fetal parts results in amputation deformities
Asymmetric absence of cranium resembling anencephaly, encephaloceles, gastroschisis and truncal defects, spinal deformities, and extremity amputations |
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What is the ddx of amniotic band syndrome
|
amnion synechia
circumvallete placenta |
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What is circumvallate placenta
|
Elevated placental margin
Peripheral echogenic rim Short bands of tissue Shelf attaches on placenta |
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What is a major difference between amniotic band sydrome and amniotic synechia
|
Amniotic syniechia has shelf or band-like structure, which does not restrict fetal movement
Amniotic band will amputate |
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What are 3 US of amniotic synechia
|
Straight, bulbous free edge with thinner sheet extending to endometrial surface
Hypoechoic central area (synechiae) between more hyperechoic layers (membranes) Y-shaped notch at endometrial base, created by membranes separating at endometrial margin |
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How is an amniotic synechiae formed
|
Created when amnion and chorion drape over fibrous band (synechiae)
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What is thicker amniotic bands or synechiae
|
bands are difficult to see and do not attach to both uterine walls
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What attaches to both uterine walls synechiae or bands
|
synechiae
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What does a circumvallate placenta look like
|
a placenta will have a curled up edge
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What is the cause of meconium peritonitis
|
perforation of bowel segment with spillage of meconium into peritoneal cavity
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What are findings associated with meconium peritonitis
5 |
Ca+ in peritoneal cavity
meconium pseudocysts, ascites bowel dilatation polyhydramnios |
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What are 3 causes of meconium peritonitis
|
meconium ileus
bowel atresia volvulus |
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What is diastematomyelia
|
Spinal cord is “split” into two hemicords by a sagittal bony or cartilaginous spur
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Where does diastematomyelia most commonly occur
|
Most occur in lower thoracic region and are accompanied by vertebral segmentation abnormalities
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What percent of diastematomyelia develop a syrinx
|
Syrinx develops in 50%
|
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If you see calcifications in a fetal liver what are 2 things to suspect
|
meconium peritonitis
gallstones |
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Is ascites associated with tracheal atreasia
|
yes it is common
|
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What happens to the position of the heart in tracheal atresia
|
the heart will shift midline
|
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What is the sonographic appearance of the lungs in tracheal atresia
|
Symmetric, homogeneous lung enlargement is essentially pathognomonic
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What are other names for tracheal atresia
|
Tracheal atresia
Laryngeal atresia Congenital high airway obstruction (CHAOS) |
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What are causes of tracheal atresia
|
High airway obstruction caused by atresia, stenosis, or web
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Can tracheal atresia result in hydrops
|
yes
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What happens to the distal trachea and bronchi (beyond obstruction)
|
they are fluid filled
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What is the US appearance of a splenic hemangioma
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Variable size & echogenicity, well defined hyperechoic solid to mixed to purely cystic lesion
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What is the US appearance of a splenic hamartoma
|
Well-defined, homogeneous echogenic mass, good through transmission & posterior enhancement
Increased blood flow on color Doppler |
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Will a splenic hemangioma have blood flow on doppler
|
no
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What are the 3 radiographic appearances of splenic lymphoma
|
Three macroscopic patterns: diffuse/infiltrative, miliary/nodular, focal hypoechoic/cyst-like (without posterior acoustic enhancement)
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What is the appearance of leukemia or Myeloproliferative disorders of the spleen on US
|
Diffuse enlargement of spleen with variable echogenicity
Very rarely focal hypoechoic nodular lesions |
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Do splenic hamartomas have increased vascularity
|
yes
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If you see multiple cystic lesion of the spleen what should be considered
4 |
MATE
Metastasis Abscess Traumatic Cyst/Congenital Cyst Echinocococcal |
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What are the doppler findings of hepatic artery stenosis after surgery
|
stenotic area with turbulent flow and elevated peak systolic velocity
Post stenotic parvus tardus wave form with dampened flow |
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What is the treatment for transplant related stenosis of the hepatic artery
|
stenting or angioplasty
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What are the post liver transplant liver collections that are most common
|
Peritransplant fluid collections common in immediate posttransplant period
-Simple anechoic: ascites, bile, and lymph -Fluid w/particulate matter: pus or blood |
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What consitituets 60% of complications of a hepatic transplant
|
hepatic artery complication
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Describe 3 hepatic artery complications
|
thrombosis, stenosis, and pseudoaneurysm
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Are portal vein complications following a transplant common
|
no
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What consitutes 25% of liver transplant complications
|
Bile leaks, bile duct anastomotic strictures, necrosis of bile ducts, and stones in bile ducts account (25% of complications)
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When does post transplant lymphoproliferative disorder occcur
|
Posttransplant lymphoproliferative disorder occurs 4 to 12 m after transplantation
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What is the parvus tardus waveform
|
the parvus–tardus waveform is characterized by a small, smooth, and rounded systolic peak
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What is the wave form proximal to a significant stenosis
|
Proximal to a significant stenosis, the waveform may be normal or
demonstrate a monophasic waveform, decreased PSV, and no diastolic flow |
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What is the normal flow of the liver
|
hepatopetal
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What causes hepatofugal flow
|
Portal htn and AV fistula
Blood flow reverses to go to the systemic system (to IVC) via portosystemic shunts (splenorenal shunt, coronary vein, or patent umbilical vein) |
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When do you want hepatofugal flow
|
after a tips procedure
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What is an elevated PSV at a > than 50% stenotic area of the hepatic artery
|
PSV > 200 cm/s or focal increases of greater than threefold suggest stenosis > 50%
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If there is portal vein stenosis what are the expected findings
|
Portal vein stenosis: threefold to fourfold focal increase in flow velocity in portal vein
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What are the findings of stenosis of the IVC at the superior anastomosis
|
Stenosis of IVC at superior anastomosis: focal velocity elevation, loss of pulsations in hepatic veins and proximal IVC, hepatic vein flow reversal
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When is parvus tardus seen
|
distal to an obstruction
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What is the ddx of a RI >.7
|
Acute tubular necrosis
Renal vein thrombosis Obstruction Complication in transplanted kidney = rejection, perinephric collection, cyclosporin toxicity |
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What is the ddx of a cystic structure adjacent to the renal hilum
4 |
Hydronephrosis
Peripelvic cysts Papillary necrosis Dilated renal vein |
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What is the ddx of a hyperechoic renal mass
4 |
Stone (shadow)
AML RCC Lobar nephronia |
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What is the ddx of a solid renal mass
|
Tumor
RCC Lymphoma or mets—multiple AML—hyperechoic Oncocytoma—central scar Lobar nephronia Hypertrophic column of Bertin—extend into renal sinus Focal parenchymal hypertrophy in atrophic kidney |
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What is the ddx of a complex cystic renal mass
|
Tumor—RCC, multilocular cystic nephroma
Hemorrhage into cyst Abscess—fever Hematoma—biopsy, trauma Hemorrhage into mass—e.g., AML |
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What is the ddx of an enlarged kidney with loss of corticomedullary architecture
4 |
Infection
Renal vein thrombosis Rejection, ATN, or cyclosporin toxicity in renal Tx Lymphoma |
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What is the ddx of echogenic material in the collecting system
5 |
Stone
Clot TCC Pus Fungus ball |
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What is the ddx of a thickened bladder wall
4 |
Bladder outlet obstruction
Posterior urethral valves Prostatic hypertrophy Neurogenic bladder |
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What is the ddx of diffusely enlarged hypoechoic testis
3 |
Torsion—decreased flow
Orchitis Tumor—lymphoma, seminoma |
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What is the ddx of hyperechoic foci of the testicles
4 |
Testicular microlithiasis
Microcalcifications in undescended testis Kleinfelter’s Syndrome Sarcoid |
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What is the ddx of an epididymal mass
3 |
Focal epididymitis
Sperm cell granuloma—post-vasectomy Benign adenomatoid tumor |
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What does spectral analysis of a umbilical artery and vein of a baby with IUGR demonstrate
|
loss of diastolic flow and pulsatility of the umbilical vein both suggest severe IUGR
|
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When is the umbiical artery S/D ratio considered abnormal
|
Umbilical artery S/D ratio considered abnormal if > 3 at 30 w
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What happens to the resistance of the UA as pregnancy progresses
|
placental resistance should decrease
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Why is the MCA of the brain analyzed with doppler
|
provides measure of fetal vascular resistance and can determine if anemic
|
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What is the MCA formula of PSV that determines if the fetus is anemic
|
Increased PSV seen w/fetal anemia
PSV (cm/s) ~ 2 x GA (w) = moderate to severe anemia |
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Generally speaking what indicates worse anemia; high or low PSV
|
High
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What is the ddx of causes of IUGR
4 |
Placental insufficiency—hypertension, diabetes
Smoking, drug abuse Chromosomal anomalies |
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What is the ddx of cystic structures adjacent to the skull
3 |
Cystic hygroma
Encephalocele or myelomenigocele—calvarial defect; signs of open neural tube defect Teratoma |
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|
What are 4 causes of cystic hygroma
|
Turner’s
Trisomy 21 Lymphangiectasia Hydrops |
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|
What is the ddx of ventriculomegaly
6 |
TORCH
Trisomy 21 Intracranial bleed Dandy-Walker Chiari Aqueductal stenosis |
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|
What is ddx of cystic structures in the posterior fossa
4 |
Normal before 8 wk
Dandy-Walker malformation or variant Mega cisterna magna Arachnoid cyst |
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|
What is the ddx of calcificatons of the liver
2 |
Incidental
TORCH—esp. CMV or Toxoplasmosis gallbladder meconium peritonitis |
|
|
What are the clinical findings of PCOS
4 |
Clinical and biochemical dx based on findings of
hirsutism, amenorrhea, infertility, obesity |
|
|
What do polycystic kidneys look like on US
|
Polycystic ovaries defined as 12 or more follicles in at least 1 ovary measuring 2-9 mm in diameter or a total ovarian volume of > 10 cm3
|
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What is the name of the finding of the polycystic ovary
|
string of pearls
|
|
|
What is the rotterdam criteria
|
Rotterdam criteria (2 out of 3)
Oligoovulation and/or anovulation Excess androgen activity Polycystic ovaries + Exclude other endocrine disorders (hyperprolactinemia, hypothyroidism, congenital adrenal hyperplasia) |
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|
What is a scrotal pearl (scrotolith)
|
Calcified bodies within the scrotum
|
|
|
Is there clinical significance of a scrotolith
|
no
|
|
|
What causes a scrotolith
|
May represent a loose body caused by torsion of appendix testis or epididymis
|
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|
What are the findings of torsion of the testicular appendix
|
Ultrasound showing enlarged appendage, spherical shape and periappendiceal hyperemia. No flow in torsed portion. Hydrocele
|
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|
What is the cause of torsion of the testicular appendage
|
Spontaneous twisting of one of the pedunculated vestigial remnants of tissue extending from the testicle or epididymis, which causes ischemia and pain
|
|
|
What is the MCC of acute scrotal pain in a pediatric
|
testicular appendage torstion
|
|
|
Is there a hydrocele associated with testicular appendage torstion
|
yes
|
|
|
What does a calcified testicular appendage indicate
|
a remote torsion
|
