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96 Cards in this Set
- Front
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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 |
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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 |
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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 |
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Homogeneous hyperechoic lesions in liver
|
* Common – hemangioma
* Uncommon – mets, fatty change, HCC * Rare – adenoma, FNH |
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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 |
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GB fossa shadowing
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stone-filled GB
porcelain GB emphysematous cholecystitis |
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Intrahepatic biliary ductal echogenic foci
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pneumobilia
stones calcified HA PV gas |
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Bile duct wall thickening
|
-CBD stones
-cholangioCA -cholangitis (scler, asc, HIV, orient) -pancreatitis |
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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 |
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Renal cystic disease
|
ADPKD
acquired cystic disease VHL TS MCDK |
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Solid renal mass
|
RCC
AML TCC oncocytoma lymphoma mets |
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Intraluminal mass in collecting system
|
TCC
blood clot fungus ball fibroepithelial polyp malacoplakia stone sloughed papilla |
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Complex cystic renal masses
|
hemorrhagic cyst
infected cyst multiseptated cyst abscess hematoma cystic RCC multilocular cystic nephroma cystic Wilm’s |
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Urothelial thickening
|
pyelonephritis
ureteral calculi relieved obstruction transplant rejection transplant ischemia TCC |
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Nephrocalcinosis DDx
|
medullary sponge kidney
RTA HPT Lasix therapy in kids |
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Renal parenchymal disease seen on ultrasound
|
GN
AIDS amyloid drugs HTN DM |
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Solid hypoechoic pancreatic mass
|
CA
focal pancreatitis lymphoma mets islet cell tumor thrombosed aneurysm peripancreatic lymph node |
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Cystic pancreatic lesions
|
pseudocyst
micro / macrocystic tumor IPMT SPEN ADPKD VHL CF tortuous splenic artery splenic artery aneurysm |
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Splenic cyst
|
epidermoid
trauma parasitic |
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Splenic solid lesion
|
hemangioma
lymphoma infarct abscess granulomatous/sarcoid extramed hematopoeisis mets (melanoma) |
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Splenomegaly
|
*COMMON
- CHF, portal HTN - lymphoma, leukemia - hepatitis, mono - hemolytic anemias *UNCOMMON - glycogen storage dz - malaria - myelofibrosis |
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Cystic scrotal lesions
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hydrocele
varicocele spermatocele epididymal cyst intratesticular cyst tubular ectasia of rete testis tunica albuginea cyst |
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Solid testicular lesions
|
seminoma
mixed germ cell tumor epidermoid cyst mets lymphoma microlithiasis mimics of tumor – focal orchitis, atrophy, infarct, abscess, hematoma, adrenal rests |
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Solid extratesticular lesions
|
adenomatoid tumor of epididymis
chronic inflammatory mass sperm cell granuloma scrotal pearl |
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Enlarged hypoechoic testis
|
orchitis
torsion lymphoma diffuse seminoma |
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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 |
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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 |
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Uterine bleeding
|
endometrial atrophy
hyperplasia polyps CA adenomyosis submucosal fibroid |
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Uterine and vaginal cystic masses
|
Nabothian cyst
Gartner’s duct cyst Bartholin cyst hydrometrocolpos |
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Shadowing in endometrial cavity
|
IUD
Ca++ from fibroids or TB gas |
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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 |
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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 |