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96 Cards in this Set

  • Front
  • Back
Cystic lesions of liver

DDx
Grouped by how common
COMMON – simple cysts
UNCOMMON –
-abscess
-hematoma
-cystic mets (ovar, lung, sarc)
-biloma
RARE –
-aneurysm / AVF
-adenoma
-echinococcus
-biliary cystadenoma
Calcified hepatic masses
* Large +/- mass
– mets (col, mucin ovar, brst, stom)
- fibrolamellar HCC
- old hematoma
- old abscess
* Small w/o mass
– granulomas
- PCP
- biliary stones
Hepatic target lesions
* Common – mets, HCC

* Uncommon – lymphoma, adenoma, FNH, fungal microabscesses
Diffuse hepatic inhomogeneity
* Common – cirrhosis, mets (breast), fatty change

* Uncommon – HCC, hep fibrosis, lymphoma
Homogeneous hyperechoic lesions in liver
* Common – hemangioma

* Uncommon – mets, fatty change, HCC

* Rare – adenoma, FNH
GB masses
common – polyps, adenomyomatosis, GB CA, tumefactive sludge

uncommon – mets (melanoma), chronic GBitis
GB wall thickening
biliary vs non-biliary causes
* biliary – GBitis, adenomyo, CA, HIV cholangiopathy, sclerosing cholangitis

* nonbiliary – hepatitis, pancreatitis, CHF, hypoproteinemia, cirrhosis, portal HTN, lymphatic obstr
GB fossa shadowing
stone-filled GB
porcelain GB
emphysematous cholecystitis
Intrahepatic biliary ductal echogenic foci
pneumobilia
stones
calcified HA
PV gas
Bile duct wall thickening
-CBD stones
-cholangioCA
-cholangitis (scler, asc, HIV, orient)
-pancreatitis
Porta hepatis cystic lesion

DDx
choledochal cyst
liver cyst
duodenal duplication cyst
omental or mesenteric cyst
pancreatic pseudocyst
R renal cyst
HA aneurysm
DDx simple renal cyst
caliceal diverticula
aneurysm/pseudoaneurysm
AVM
papillary necrosis
obstr upper pole duplication
lymphoma
Renal cystic disease
ADPKD
acquired cystic disease
VHL
TS
MCDK
Solid renal mass
RCC
AML
TCC
oncocytoma
lymphoma
mets
Intraluminal mass in collecting system
TCC
blood clot
fungus ball
fibroepithelial polyp
malacoplakia
stone
sloughed papilla
Complex cystic renal masses
hemorrhagic cyst
infected cyst
multiseptated cyst
abscess
hematoma
cystic RCC
multilocular cystic nephroma
cystic Wilm’s
Urothelial thickening
pyelonephritis
ureteral calculi
relieved obstruction
transplant rejection
transplant ischemia
TCC
Nephrocalcinosis DDx
medullary sponge kidney
RTA
HPT
Lasix therapy in kids
Renal parenchymal disease seen on ultrasound
GN
AIDS
amyloid
drugs
HTN
DM
Solid hypoechoic pancreatic mass
CA
focal pancreatitis
lymphoma
mets
islet cell tumor
thrombosed aneurysm
peripancreatic lymph node
Cystic pancreatic lesions
pseudocyst
micro / macrocystic tumor
IPMT
SPEN
ADPKD
VHL
CF
tortuous splenic artery
splenic artery aneurysm
Splenic cyst
epidermoid
trauma
parasitic
Splenic solid lesion
hemangioma
lymphoma
infarct
abscess
granulomatous/sarcoid
extramed hematopoeisis
mets (melanoma)
Splenomegaly
*COMMON
- CHF, portal HTN
- lymphoma, leukemia
- hepatitis, mono
- hemolytic anemias

*UNCOMMON
- glycogen storage dz
- malaria
- myelofibrosis
Cystic scrotal lesions
hydrocele
varicocele
spermatocele
epididymal cyst
intratesticular cyst
tubular ectasia of rete testis
tunica albuginea cyst
Solid testicular lesions
seminoma
mixed germ cell tumor
epidermoid cyst
mets
lymphoma
microlithiasis

mimics of tumor – focal orchitis, atrophy, infarct, abscess, hematoma, adrenal rests
Solid extratesticular lesions
adenomatoid tumor of epididymis
chronic inflammatory mass
sperm cell granuloma
scrotal pearl
Enlarged hypoechoic testis
orchitis
torsion
lymphoma
diffuse seminoma
Hypoechoic prostate nodule
CA
prostatitis
atrophy
fibrosis
infarct
BPH
Bladder wall thickening

DDx
Bladder outlet obstruction
tumor
infection
RTx
neurogenic
Bladder wall calcification

DDx
Schistosomiasis
cytoxan
RTX
interstitial cystitis
TB
TCC
Thickened hyperechoic endometrial stripe
*Pregnancy related
– nl early IUP
- ectopic
- incomplete Ab or RPOC
- endometritis
- molar preg

*Postmenopausal
– hyperplasia /polyps /CA
- tamoxifen
- HRT
Hypoechoic structures in hyperechoic endometrium
*Premenopausal
– molar pregnancy
- RPOC
- degenerated fibroid
- degenerated placenta

*Postmenopausal
– hyperplasia /polyps/ CA
Fluid in endometrial cavity
*Acquired (cervical sten) – cervical CA, endometrial CA, endometritis, PID, RTX
*Pregnancy related – early IUP, pseudogestational sac, blighted ovum
*Congenital – imperforate hymen, vaginal septum, vaginal atresia, rudimentary uterine horn
Uterine enlargement or distortion DDx
fibroids (#1)
adenomyosis
pregnancy
Uterine bleeding
endometrial atrophy
hyperplasia
polyps
CA
adenomyosis
submucosal fibroid
Uterine and vaginal cystic masses
Nabothian cyst
Gartner’s duct cyst
Bartholin cyst
hydrometrocolpos
Shadowing in endometrial cavity
IUD
Ca++ from fibroids or TB
gas
Congenital uterine anomalies
septate
bicornuate
didelphys
arcuate
unicornuate
hypoplastic
in-utero DES exposure
Cystic adnexal masses
Endometrioma
Hemorrhagic ovarian cyst
Dermoid
Abscess
Cystadenocarcionoma
Ectopic pregnancy
Complex pelvic masses
*Ovarian – ectopic, TOA, endometrioma, hemorrhagic cyst, torsion, dermoid, CA
*Tubal – pyosalpinx
*Uterine – pedunculated fibroid, extruded IUD, CA
*Other – pelvic abscess, appy, tic-itis, hematoma, pelvic kidneys, iliac aneurysm
Pelvic masses with homogeneous low-level echoes
TOA
endometrioma
hemorrhagic cyst
Solid ovarian masses
fibroma
thecoma
endometrioma
germ cell tumor
CA
mets

mimics - pedunc fibroid, LAD
Endometrial filling defect by HSG
submucosal fibroid
air bubble
endometrial polyp
blood clot
retained POC
IUP
synechiae
Tubal filling defects by HSG
polyp
CA
tubal pregnancy
air bubble
Tubal irregularity by HSG
SIN
tubal diverticula
endometriosis
post-op changes
TB
Diverticula seen on HSG
uterus – adenomyosis
isthmus – SIN, TB
Pseudokidney sign on US
IBD
Tumor
Intussusception
Always exclude pelvic kidney
1st trimester bleeding DDx
normal IUP
abortion
ectopic
GTD
subchorionic hemorrhage
Signs of spontaneous abortion
TV 18mm MGSD without embryo
13 mm MGSD without YS
5 mm CRL without heart motion
Empty gestational sac
normal early IUP
blighted ovum
pseudosac with ectopic
Echogenic central cavity of uterus
decidual reaction
hemorrhage
RPOC
Complex intrauterine mass
missed abortion
fetal demise
molar pregnancy
degenerated fibroid
endometrial CA
Elevated MSAFP
incorrect dates
multiple gestation
NTD
abd wall defect
GI obstruction
renal anomalies
fetal hepatitis
placental hemorrhage
Low MSAFP DDx
Downs
trisomy 18
incorrect dates
fetal death
hydatidiform mole
not pregnant
Hydrops DDx
*Immune
*Nonimmune (most)
– cardiac tachyarrh or defect
- chromosomal
- twin-twin transf
- anemias
- infection
- idiopathic
Polyhydramnios DDx
*Maternal – DM, HTN
*Fetal – NTD, prox GI obstr, chest masses, twin-twin transf, nonimmune hydrops, chromosomal, infection
*Idiopathic
Oligohydramnios DDx
(DRIPPC)
Demise
Renal anomalies
IUGR
PROM
Post-dates
Chromosomal anomalies
Placentomegaly
>4cm thick

DDx
hydrops
maternal DM
maternal anemia
TORCH
intraplacental hematoma
Small placenta DDx
maternal HTN
toxemia
severe DM
IUGR
Abnormal placental echotexture
*partial mole
*hydropic placenta
*hemorrhage or abruption
*chorioangioma
*common but minor findings (venous lakes, infarcts)
Umbilical cord abnormalities
-single artery
-enlarged cord
-other
solitary artery - trisomy 13, 18, structural anomalies
enlarged cord – edema, hematoma, cysts, mucoid degeneration of Wharton’s jelly
other – knots, varices, straight cord, nuchal cord, vasa previa
Abnormal lower uterine segment
*cord prolapse (T-burg & call OB)
*incompetent cervix
*placenta previa
*cerclage
*low fibroid
3rd trimester bleeding
placenta previa
abruption
cervical lesions
idiopathic
Masses during pregnancy
-uterus
-adnexal
-other
*uterus – fibroid, focal contraction, GTD, hemorrhage
*adnexal – CLC, dermoid, theca lutein cysts, other ov neoplasms
*other – PID, appendiceal abscess
Signs of fetal death
no fetal heartbeat
absent fetal movement
overlapping skull bones (Spalding’s sign)
gross distortion of anatomy (maceration)
soft tissue edema
Cystic CNS structures
*Supratent – CPC, hydroceph, hydranenceph, porenceph, holoprosenceph, arachnoid cyst, teratoma
*Posterior fossa – DW malf, arachnoid cyst, mega cisterna magna
*Midline cysts – cavum septum pellucidum, dorsal cyst in ACC, vein of Galen AVM
Hydrocephalus seen on prenatal US
obstructive - NTD (Chiari II), DW cplx, aqueductal stenosis, ACC (colpocephaly)

nonobstructive – hemorrhage, infection
Cystic head and/or neck masses on prenatal US
cystic hygroma
encephalocele
hemangioma
teratoma
branchial cleft cyst
thyroglossal duct cyst
nuchal cord
Cystic back masses seen on prenatal US
NTD
cystic teratoma
Hyperechoic brain mass seen on prenatal US
hemorrhage
teratoma
callosal lipoma
Incomplete skull mineralization seen on prenatal US
OI
hypophosphatasia
achondrogenesis
Skull deformities seen on prenatal US
-Lemon sign
-Cloverleaf skull
*Lemon sign – normal, myelomeningocele, encephalocele

*Cloverleaf skull – craniosyn, thanatophoric dwarf
Kyphoscoliosis seen on prenatal US
isolated – hemivertebra, butterfly vertebra

complex – VACTERL, limb-body wall complex, skeletal dysplasias
Cystic thoracic masses seen on prenatal US
CDH
CCAM (types 1,2)
cysts (bronch, duplic, pericard)
cystic hygroma
Solid echogenic thoracic masses seen on prenatal US
*CDH
*CCAM (type 3)
*Sequestration
*Tumors (teratoma, neurogenic tumors, cardiac rhabdomyoma)
Pleural effusion seen on prenatal US
*unilat usu due to lung masses – CDH, CCAM, sequestration

*bilateral – hydrops, lymphangiectasia

*uni or bilateral – infection, chromosomal, idiopathic
Absent stomach bubble on prenatal US
oligohydramnios
swallowing prob - CNS defect
EA
CDH
situs abnormality
trisomy 18
Double bubble sign on prenatal US
assoc with polyhydramnios

duodenal atresia
annular pancreas
proximal jejunal atresia
gut duplication
Dilated bowel seen on prenatal US
atresia / stenosis
volvulus
meconium ileus
enteric duplication
Hirschsprung’s

proximal obstructions usu a/w polyhydramnios
distal obstructions usu a/w nl amniotic fluid
Echogenic bowel seen on prenatal US (as bright as bone)

DDx?
normal variant in 2nd trimester
CF (common)
Downs
IUGR
CMV
SB atresia or volvulus
swallowed blood in amn fluid
Abdominal calcification seen on prenatal US
meconium peritonitis (most common)
meconium ileus
atresias
volvulus
renal
liver TORCH
neuroblastoma
teratoma
fetal gallstones
Hydronephrosis seen on prenatal US
UPJ (#1)
UVJ
duplex collecting system
BOO (PUV, prune belly)
Common renal anomalies detected by prenatal US
agenesis
ectopic kidney
hydronephrosis
ARKD
MCDK
Cystic abdominal structures on prenatal US
hydronephrosis
fluid-filled dilated bowel
ascites
meconium pseudocyst
cysts (mesent, urachal, duplication, ovarian, choledochal)
Liver abnormalities on prenatal US
*calcification – TORCH
*cysts – simple, polycystic dz, choledochal cyst, Caroli’s, hamartoma
*masses – teratoma, hepatoblastoma, hemangioma, hemangioendothelioma, hamartoma
Splenomegaly seen on prenatal US
immune hydrops
PROM
TORCH
Ascites seen on prenatal US
hydrops
meconium peritonitis
urine ascites
infection
pseudoascites
Anterior wall defects
midline – omphalocele

lateral – gastroschisis, amniotic band syndrome

infraumbilical – bladder or cloacal exstrophy
Sacral region anomalies seen on prenatal US
teratoma
meningocele
duplication cyst
caudal regression syndrome
Polydactyly on prenatal US
familial
trisomy 18, 13
Meckel-Gruber syndrome
chondroectodermal dysplasia
Clubfoot seen on prenatal US
amniotic band syndrome
trisomy 18
meningocele
idiopathic
Features of trisomy 21
–ECD
–echogenic bowel
–nuchal tranlucency/thickening
–short humerus and femur
–pyelectasis
–cystic hygroma
–duodenal atresia
–echogenic cardiac focus
–widened iliac angle
trisomy 18 features
–clenched fists
–cardiac anomalies
–cystic hygroma
–omphalocele
–strawberry shaped calvarium
–choroid plexus cyst
–enlarged cisterna magna
–myelomeningocele
–rocker-bottom and clubfoot
trisomy 13 features
–IUGR
–Holoprosenceph, Mega cisterna magna
–cleft lip/palate, cyclopia
–hypotelorism
–nuchal thickening
–hydrops
–enlarged echogenic kidneys
–omphalocele
–polydactyly, rocker/ clubfoot
-clenched overlapping digits
–cardiac anomalies
Turner’s features
–coarctation
–bicuspid aortic valve
–nuchal thickening
–cystic hygroma