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254 Cards in this Set
- Front
- Back
What is the US appearance of ARPKD |
enlarged, hyperechoic kidneys
(very tiny cyst may or may not be discernable) |
|
Do fetuses with ARPKD seen in the setting of oligohydramnios
|
yes, alwas
|
|
What other condition do fetuses tend to get secondary to oligohydramnios
2 |
pulmonary hypoplasia
potter facies |
|
What is meckel-gruber syndrome triad
|
renal cystic dysplasia
encaphalocele polydactyly |
|
What is the kidney appearance in meckel gruber syndrome
|
Renal appearance is variable, from large, echogenic kidneys to kidneys completely replaced by macroscopic cysts
|
|
Do fetuses with MG syndrome causes increase AFP
|
Elevated maternal serum alpha-fetoprotein from encephalocele
|
|
What region of the calvarium is the encphalocele most commonly seen
|
occiptial region
|
|
What is the ddx of an obstruction iin the IVC
3 |
bland thrombos
tumor thrombus membranous (congenital web) |
|
What type of thrombus tends to expand the blood vessel
|
tumor
|
|
What are the 2 MCC of tumor thrombus in an adult
|
HCC and RCC
|
|
What is the MCC of tumor thrombus in a child
|
Wilms Tumor
|
|
Do tumor thrombus tend to have flow
|
yes
|
|
What are 3 findings associated with Bud chiari
|
ascites
abdominal pain hepatomegaly |
|
What is budd chiari
|
obstruction of the venous outflow of the liver (hepatic veins or IVC)
|
|
Describe the findings of a lymphocele
|
Lymphocele (MC, 4-8 w): well-defined, large anechoic or heavily septated
|
|
Describe the findings of a urinoma
|
Urinoma (within 3 w): localized or free anechoic collections without septations
|
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Describe the findings of a post transplant hematoma
|
Hematoma (early postop): echogenicity depends on age of collections
|
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Describe the findings of a post transplant seroma
|
Seroma (early postop): typically anechoic
|
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Describe the findings of a post transplant abscess
|
Abscess: typically complex cystic with irregular outline, thick wall and echogenic internal debris
|
|
What 3 fluid collections will typically occur early post op
|
hematoma
seroma abscess |
|
When do urimoma and lymphoceles tend to occur
|
later
urinoma- within 3 weeks lymphocele-4-8 weeks |
|
Are epididymal cyst common
|
yes (20-40% of asymptomatic males)
|
|
Where is the MC location of an epididymal cyst
|
epididymal head
|
|
Describe the findings on US of a epididymal cyst
|
well defined and anechoic
|
|
How do you differentiate a spermatocele from an epididymal cyst
|
spermatocele tends to have low level echoes
|
|
What is the expected doppler finding in the feeding vessel of a vein of galen malformation
|
Pulsed Doppler ultrasound depicts turbulent arterial flow within a feeding vessel, confirming an arteriovenous fistula.
|
|
What are the US findings of a vein of galen malformaiton
|
cystic structure posterior ot the 3rd ventricle
|
|
Describe the classic echogenicity and borders of testicluar lymphoma
|
ill defined
hypoechoic |
|
What percent of testicular lymphoma involve both testicles
|
50%
|
|
What is the ddx of multiple testicular lesions
|
leukemia
lymphoma mets abscesses adrenal rest |
|
What is a rhabdomyoma
|
Congenital myocardial mass (hamartoma)
|
|
Can a rhabdomyoma be intramural and exophytic
|
yes
|
|
What is the MC pediatric cardiac tumor
|
rhadomyoma
|
|
What percent of rhabdomyomas are associated with TSC
|
85%
|
|
Can a fetal rhabdomyoma be cause hydrops
|
yes
|
|
If you see an in utero cardiac mass in a fetus what is the most likely diagnosis
|
cardiac rhabdomyoma
|
|
What is the US appearance of a rhabdomyoma
|
hyperechoic and arises fromt eh muscles of the walls or septum
|
|
What vessesl is the AVF in vein of galen malformation
|
Arteriovenous fistula (AVF) between deep choroidal arteries and embryonic median prosencephalic vein of Markowski (MPV)
|
|
What is the MCC of extracardiac high output cardiac failure in a newborn
|
Vein of galen malformation
|
|
What are complications of VOGM
|
cerebral ischemia and atrophy leading to brain damage
hydrocephalus |
|
What is the tx for VOGM
|
transarterial embolization at 4-5 months
|
|
What percent of children are neurologicaly normal after VOGM embolization
|
60%
|
|
What is the MC congenital tumor
|
sacrococygeal teratoma
|
|
What is the US appearance of a sacrococcygeal teratoma
|
solid and cyst mass in sacral region
|
|
What is the main ddx of a sacrococcygeal teratoma
|
myelomeningocele
|
|
How many types of sacrococcygeal teratomas are there
|
4 (types 3 and 4 have the highest chance of becoming malignanty if not removed)
|
|
What are 2 examples of hyperplastic cholecystosis
|
cholesterolosis
adenomyomatosis |
|
Describe the findings of adenomyomatosis
|
mural GB wall thickening due to exaggeration of normal luminal epithelial folds (Rokitansky-Aschoff sinuses) in conjunction w/smooth muscle proliferation
|
|
Describe the findings of cholesterolosis
|
deposition of foamy cholesterol-laden histiocytes in subepithelium of GB; numerous small accumulations (strawberry GB) or larger polypoid deposit (cholesterol polyp)
|
|
Do both adenomyomatosis and cholesterolosis cause comet tail artifact
|
no, only adenomyomatosis
|
|
How do you distinuishe cholesterolosis and adenomyomatosis if they both have wall thickening
|
cholesterolosis will have polyps
adenomyomatosi will have comet tail artifacts and cystic spaces in the walls |
|
What is the ddx of gallbladder wall thickening
|
Biliary—cholecystitis, adenomyomatosis, AIDS cholangitis
Edema—hypoproteinemia (cirrhosis, nephrotic syndrome), congestive heart failure Hepatitis |
|
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 |
|
What is hematometrocolpos
|
Echogenic fluid within distended uterus ± vagina (blood, mucus, purelent material)
|
|
What is Hematometra
|
blood in endometrial cavity
|
|
What is Hematocolpos
|
blood filling the vagina
|
|
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
|
|
What is the ddx of fluid in the endometrial canal in a premenopausal women
|
Premenopausal: congenital obstruction (imperforate hymen, vaginal septum, vaginal or cervical atresia), acquired cervical obstruction (instrumentation, radiation, or CA), menorrhagia, and pregnancy
|
|
Describe 4 congenital obstructions that may lead to increased fluid in the endometrial canal
|
imperforate hymen
vaginal septum vaginal atresia cervical atresia |
|
Name 2 causes of aquired cervical obstruction that may lead to increased fluid in the endometrial canal
|
instrumentation
radiation cervical CA |
|
What is a varicocele
|
dilated serpinginous veins of pampiniform plexus
|
|
What percent of males develop a varicocele
|
15-20%
|
|
What is the MC correctable cause of male infertility
|
varicocele
|
|
What percent of varicoceles occur on the left side and why
|
85% occur on left (left spermatic vein drains into left renal vein; because SMA compresses left renal vein, pressure on left > right),
|
|
What are common causes of an isolated right sided varicocele
2 |
retroperitoneal mass
situs inversus |
|
What are the US findings of a varicocele
|
Gray-scale: numerous, dilated, tortuous, tubular channels in peritesticular tissues
|
|
What is the normal size of a scrotal vein (diameter)
|
Upper limit of normal caliber scrotal veins is 2 mm
|
|
What manuever can be utilized to attempt to detect varicoceles
|
Valsalva-induced flow augmentation on color Doppler when patient is supine
|
|
What is the MC appearance of hashimotos thyroiditis
|
multiple ill-defined hypoechoic areas separated by thickened fibrous strands, but with no discrete nodules
|
|
What is a worrisome complication of hashimotos thyroiditis
|
increased risk of primary lymphoma
|
|
What is the MC demographic affected by hashimotos thyroiditis
|
women between 40-60y
|
|
What is the pathophysiology of hashimotos thyroiditis
|
autoantibodies to thyroid protien (esp thyroglobulin)
|
|
What is the MCC of hypothyroidism in the US
|
MC cause of hypothyroidism, goiter in adults in US
|
|
What are 6 additional diseases that may be associated with hashimotos thyroiditis
|
Sjögren syndrome, lupus, rheumatoid arthritis, fibrosing mediastinitis, sclerosing cholangitis, pernicious anemia
|
|
Describe the US appearance of hashimotos thyroidtis
|
Diffuse thyroid enlargement with inhomogeneous low-density parenchyma
Thin, echogenic fibrous strands may cause a multilobulated or micronodular appearance |
|
What is the doppler findings with hashimotos
|
hypervascular
|
|
Do patients with hashimotos thyroiditis have multiple tiny (1-6mm) nodules
|
yes
|
|
What happens to the thyroid size in endstage hashimotos
|
atrophy
|
|
What is a hydrocele
|
Hydrocele: accumulation of serous fluid b/w visceral and parietal layers of tunica vaginalis
|
|
What is the MCC of painless scrotal swelling
|
hydrocele
|
|
Is hydrocele often idiopathic
|
yes
|
|
What are some pathological causes of a hydrocele
3 |
malignant tumor
torstion inflammation |
|
What is a funiculocele
|
(hydrocele of cord): hydrocele fluid accumulates in spermatic cord in unobliterated portion of tunica vaginalis
|
|
What is a funiculocele and how is it distinuished from a spermatocele
|
Appears superior to the testis
Distinguished from spermatocele because does not arise from epididymis |
|
Besides a hydrocele what are 2 other cause of scrotal fluid collection
|
hematocele
pyocele |
|
What are the US findings that are commonly found with hematocele and pyocele
|
Internal septations and loculations common with hematoceles and pyoceles, often in conjunction with scrotal wall hyperemia |
|
When are hemotceles commonly found
|
in the setting of recent surgery or trauma
|
|
When are pyoceles found
|
infection; usually result from rupture of an abscess into space b/w layers of tunica vaginalis
|
|
What is the MC malignant tumor and the 2nd MC cause of cancer related mortality in men
|
prostate carcinoma
|
|
What are the percentatges by DOL that will have atleast microscopic foci of pancreatic cancer
|
50% in the 50s
80% in the 80s |
|
Is most prostate cancer clinically occult
|
yes
|
|
What are normal and abnormal screening values in pts with prostate cancer
|
Normal serum PSA level is 0 to 4 ng/mL; borderline 4-10 ng/mL; abnormal > 10 ng/mL
|
|
Where do 70% of prostate cancer occur
|
peripheral zone
|
|
What percent of prostate cancer occur in the central and transitional zones
|
20% in transitional
5% in the central |
|
Describe the US findings of prostate cancer
6 |
Distinct hypoechoic nodule |
|
What is the typical echotexture and margination of prostate cancer
|
poorly marginated and hypoechoic
|
|
Is there increased vascularity with prostate cancer
|
yes
|
|
What is the ddx of a hypoechoic nodule in the prostate
|
carcinoma
benign prostatic hypertrophy, prostatitis atrophy fibrosis infarction fibromuscular hyperplasia |
|
What is the indication for US guided needle biopsy of the prostate
2 |
suspicious nodule by US
elevated PSA |
|
What are the findings of tubular ectasia of rete testis
|
Multiple small spherical or tubular cystic structures in region of mediastinum of testis
|
|
Is tubular ectasia of the rete testes usually bilateral
|
yes |
|
What are 3 associated abnormalities of tubular ectasia of the rete testis
|
spermatocele
epididiymal cyst h/o epididiymitis or vasectomy |
|
What are 2 predisposing factors to tubular ectasia of the rete testes
|
epididymitis |
|
Does tubular ectasia of the rete testis require further evaluation
|
no
|
|
What are 2 potential complications of IUD
|
migration to low lying position
perforation |
|
What is the MC time of presentation of hypertrophic pyloric stenosis
|
2-10 weeks
|
|
What are the US findings of pyloric stenosis
|
>3mm in thickness
>greaterthan 18mm in length |
|
What is the treatment for HPS
|
pyloromyotomy
|
|
What are 4 signs of HPS found on UGI
|
double/triple track sign
string sign mushroom sign catepillar sign |
|
What is the double/triple track sign
|
Double/triple track sign”: crowding of mucosal folds in pyloric channel
|
|
What is the string sign
|
passing of barium streak through pyloric channel
|
|
What is the mushroom sign
|
indentation of base of duodenal bulb
|
|
What is the caterpillar sign
|
gastric hyperperistaltic waves
|
|
What is the normal appearance of a acute pancreas
|
hyperechoic |
|
What is the typical appearance of the pancreas in acute pancreatitis
|
hypoechoic
|
|
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 |
|
Describe CPAM
|
Abnormal mass of lung tissue with varying degrees of cystic change |
|
What was the old name of CPAM
|
CCAM |
|
Can a CPAM be both cystic and solid
|
yes
|
|
What is the US appearance of CPAM
|
Single multiseptate cysts, multiple cysts
Variable cyst size (if solid it is echogenic) |
|
What type of CPAM has larger cyst 1 or 3
|
1 larger cyst
2 smaller cyst 3 solid |
|
What is a pulmonary sequestration
|
Congenital area of abnormal lung that does not connect to the bronchial tree or pulmonary arteries
|
|
Where is the arterial supply in pulmonary sequestration
|
Arterial supply is typically from systemic source arising from descending aorta
|
|
What are the 2 types of Pulm sequestrations
|
Divided into intralobar and extralobar types
|
|
What is the drainage pattern of intralobar
|
Intralobar type has venous drainage into inferior pulmonary vein
|
|
What is the drainage pattern of extralobar sequestration
|
Extralobar type has venous drainage often systemic, however drainage variable
|
|
Where is the MC location of a pulmonary sequestration
|
Most common location is left lower lobe, followed by right lower lobe
|
|
Can the systemic arterial supply arise from below the diaphragm
|
May arise from below the hemidiaphragm in 20% of cases
|
|
What is the diagnostic feature of a sequestration
|
Diagnostic feature: Systemic artery arising from the aorta and feeding sequestration
|
|
Name 3 foregut abnormalities
|
Bronchogenic cyst
Esophageal duplication cyst Neurenteric cyst |
|
Describe 5 common features of foregut abnormalities
|
Typically homogeneous, fluid-attenuating mass
Well defined Thin walled Nonenhancing May become superinfected |
|
Can a foregut abnormality mimic a lung mass
|
Typically mediastinal in location but can mimic lung mass (although 15% are within the lung)
|
|
What is hypoplastic left heart syndrome
|
Hypoplasia/atresia of the ascending aorta, aortic valve, left ventricle (LV) and mitral valve
|
|
What is the presentation of hypoplastic left heart syndrome
|
Most severe congenital heart lesion presenting in neonatal period with congestive heart failure, cardiogenic shock and cyanosis
|
|
What are 3 features of hypoplastic left heart syndrome that are used to categorize it
|
Cyanotic, cardiomegaly, increased pulmonary vascularity
|
|
If hypoplastic left heart syndrome leads to obstruction to pulmonary flow how does the body get oxygenated blood
|
ductus
|
|
What is the treatment for a hypoplastic left heart
|
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) |
|
How does the right heart get oxygenated blood
|
Flow admixture in right atrium form atrial septal defect
|
|
How are the coronary arteries perfused in hypoplastic left heart syndrome
|
Retrograde flow in hypoplastic aortic arch and ascending aorta for cranial and coronary perfusion
|
|
What is the US appearance of transpostion of the arteries
|
Best diagnostic clue: Outflow tracts parallel as they exit heart
|
|
What is L-transposition AKA
|
Congenitally corrected transposition of great arteries (CTGA) |
|
What is the is the cause of D-transposition
|
Ventriculoarterial (VA) discordance in TGA
Aorta arises from right ventricle Pulmonary artery (PA) arises from left ventricle |
|
What is the cause of L-transpostion
|
Atrioventricular (AV) and VA discordance in CTGA (ventricular inversion) |
|
Can the 4 chamber view appear normal in TGA
|
In TGA "normal" four chamber view
|
|
What is the major clue on US that there is TGA
|
outflow tracts are parrell as they exit the heart
|
|
What is another name for club foot
|
talipes equinovarus
|
|
What are the abnormalities of a clubfoot
|
Hindfoot equinus, hindfoot varus, and forefoot varus
|
|
What is rocker bottom foot associated with
|
trisomy 18
|
|
Describe a rocker bottom foot
|
bottom of the foot is convex with protrusion of the heel
|
|
What percent of fetuses with a 2 vessel cord have additional anomalies
|
50%
|
|
What are the findings of a two vessel cord
|
look for two images |
|
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) |
|
What other finding is a proximal bowel obstruction associated with
|
polyhydramnios
|
|
What are 3 findings of Osteogenesis imperfecta
|
Compressibility of skull with external pressure
Easy visibility of intracranial structures due to poor ossification Fractures |
|
What is a placental chorioangioma
|
Vascular mass-like lesion in placenta supplied by fetal circulation
|
|
Is a placental chorioangioma worrisome if small
|
Usually not clinically significant when smaller than 4-5 centimeters
|
|
What is a potential complication of placenta chorioangioma
2 |
cardiomegaly (high output state) generalized edema (hydrops)
|
|
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 |
|
Can doppler help diagnose a placental chorioangioma
|
yes, vascularity may help differentiate from other placental masses
|
|
Does the amount of flow on doppler indicate prognosis
|
yes, more flow the more chance of developing hydrops
|
|
What are the findings of DW malformation
|
Cisterna magna is enlarged and communicates directly with fourth ventricle through its absent roof |
|
What is the DDX of dandy walker
|
mega cisterna magna
arachnoid cyst |
|
What is the measurement for megacisterna
|
Cisterna magna measuring > 10 mm
|
|
How is megacisterna magna measured
|
Measured in axial oblique plane at level of cerebellar hemispheres
|
|
What is the MC neonatal renal tumor
|
mesoblastic nephroma |
|
What cells do both mesoblastic nephroma and wilms tumor arise from
|
metanephric blastema
|
|
What are the 2 most common findings of mesoblastic nephroma
|
Solid renal mass + polyhydramnios
|
|
What percent of fetuses with mesoblastic nephroma have polyhydramnios
|
70%
|
|
What is the ddx of mesonephric blastoma
|
wilms tumor
crossed fused ectopy |
|
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 |
|
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 |
|
What is amniotic band syndrome
|
Caused by early (before 10 w GA) disruption of amnion allows fetus to enter chorionic cavity |
|
What is the result of amniotic band syndrome
|
Entrapment of fetal parts results in amputation deformities |
|
What is the ddx of amniotic band syndrome
|
amnion synechia
circumvallete placenta |
|
What is circumvallate placenta
|
Elevated placental margin
Peripheral echogenic rim Short bands of tissue Shelf attaches on placenta |
|
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 |
|
What are 3 US of amniotic synechia
|
Straight, bulbous free edge with thinner sheet extending to endometrial surface |
|
How is an amniotic synechiae formed
|
Created when amnion and chorion drape over fibrous band (synechiae) |
|
What is thicker amniotic bands or synechiae
|
bands are difficult to see and do not attach to both uterine walls
|
|
What attaches to both uterine walls synechiae or bands
|
synechiae |
|
What does a circumvallate placenta look like
|
a placenta will have a curled up edge |
|
What is the cause of meconium peritonitis
|
perforation of bowel segment with spillage of meconium into peritoneal cavity
|
|
What are findings associated with meconium peritonitis
5 |
Ca+ in peritoneal cavity
meconium pseudocysts, ascites bowel dilatation polyhydramnios |
|
What are 3 causes of meconium peritonitis
|
meconium ileus |
|
What is diastematomyelia
|
Spinal cord is “split” into two hemicords by a sagittal bony or cartilaginous spur |
|
Where does diastematomyelia most commonly occur
|
Most occur in lower thoracic region and are accompanied by vertebral segmentation abnormalities
|
|
What percent of diastematomyelia develop a syrinx
|
Syrinx develops in 50%
|
|
If you see calcifications in a fetal liver what are 2 things to suspect
|
meconium peritonitis
gallstones |
|
Is ascites associated with tracheal atreasia
|
yes it is common
|
|
What happens to the position of the heart in tracheal atresia
|
the heart will shift midline
|
|
What is the sonographic appearance of the lungs in tracheal atresia
|
Symmetric, homogeneous lung enlargement is essentially pathognomonic
|
|
What are other names for tracheal atresia
|
Tracheal atresia |
|
What are causes of tracheal atresia
|
High airway obstruction caused by atresia, stenosis, or web
|
|
Can tracheal atresia result in hydrops
|
yes
|
|
What happens to the distal trachea and bronchi (beyond obstruction)
|
they are fluid filled
|
|
What is the US appearance of a splenic hemangioma
|
Variable size & echogenicity, well defined hyperechoic solid to mixed to purely cystic lesion |
|
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 |
|
Will a splenic hemangioma have blood flow on doppler
|
no
|
|
What are the 3 radiographic appearances of splenic lymphoma
|
Three macroscopic patterns: diffuse/infiltrative, miliary/nodular, focal hypoechoic/cyst-like (without posterior acoustic enhancement)
|
|
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 |
|
Do splenic hamartomas have increased vascularity
|
yes
|
|
If you see multiple cystic lesion of the spleen what should be considered
4 |
MATE
Metastasis Abscess Traumatic Cyst/Congenital Cyst Echinocococcal |
|
What are the doppler findings of hepatic artery stenosis after surgery
|
stenotic area with turbulent flow and elevated peak systolic velocity |
|
What is the treatment for transplant related stenosis of the hepatic artery
|
stenting or angioplasty
|
|
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 |
|
What consitituets 60% of complications of a hepatic transplant
|
hepatic artery complication
|
|
Describe 3 hepatic artery complications
|
thrombosis, stenosis, and pseudoaneurysm |
|
Are portal vein complications following a transplant common
|
no
|
|
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) |
|
When does post transplant lymphoproliferative disorder occcur
|
Posttransplant lymphoproliferative disorder occurs 4 to 12 m after transplantation
|
|
What is the parvus tardus waveform
|
the parvus–tardus waveform is characterized by a small, smooth, and rounded systolic peak
|
|
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 |
|
What is the normal flow of the liver
|
hepatopetal
|
|
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) |
|
When do you want hepatofugal flow
|
after a tips procedure
|
|
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
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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
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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
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distal to an obstruction
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What is the ddx of a RI >.7
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Acute tubular necrosis |
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What is the ddx of a cystic structure adjacent to the renal hilum
4 |
Hydronephrosis |
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What is the ddx of a hyperechoic renal mass
4 |
Stone (shadow) |
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What is the ddx of a solid renal mass
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Tumor |
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What is the ddx of a complex cystic renal mass
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Tumor—RCC, multilocular cystic nephroma |
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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 |
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What is the ddx of diffusely enlarged hypoechoic testis
3 |
Torsion—decreased flow |
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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
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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
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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
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placental resistance should decrease
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Why is the MCA of the brain analyzed with doppler
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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
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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
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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 |
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What are 4 causes of cystic hygroma
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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 |
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What is the ddx of calcificatons of the liver
2 |
Incidental
TORCH—esp. CMV or Toxoplasmosis gallbladder meconium peritonitis |
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What are the clinical findings of PCOS
4 |
Clinical and biochemical dx based on findings of
hirsutism, amenorrhea, infertility, obesity |
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What do polycystic kidneys look like on US
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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
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string of pearls
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What is the rotterdam criteria
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Rotterdam criteria (2 out of 3) |
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What is a scrotal pearl (scrotolith)
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Calcified bodies within the scrotum
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Is there clinical significance of a scrotolith
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no |
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What causes a scrotolith
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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
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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
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Spontaneous twisting of one of the pedunculated vestigial remnants of tissue extending from the testicle or epididymis, which causes ischemia and pain |
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What is the MCC of acute scrotal pain in a pediatric
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testicular appendage torstion
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Is there a hydrocele associated with testicular appendage torstion
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yes
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What does a calcified testicular appendage indicate
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a remote torsion |