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17 Cards in this Set
- Front
- Back
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Angiomyelolipoma
Case findings: Hyperechoic lesion in right kidney Risk of hemorrhage (> 4cm), treat with arterial embolization Fat within a RCC is extremely rare Do not mistake trapped renal sinus fat within a RCC as an AML Associated with tuberous sclerosis |
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XGP with staghorn calculus
Types: diffuse and focal (DDX: RCC) Secondary to chronic UTI (Proteus, E. coli) Features: Renal enlargement Dilated calyces, thin cortex Staghorn calculi (renal pelvis) US: loss of corticomedullary differentiation Struvite stone: composed of magnesium ammonium phosphate, sequela of UTI Proteus mirabilis: MC organism associated with urolithiasis |
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Gangrenous cholecystitis
Case findings: Irregular intraluminal echoes that fail to move gangrenous necrosis or empyema of the GB Acute cholecystitis: Gallstones GB wall thickening Gallbladder distention Focal RUQ pain (may be absent in DM) Contracted GB and GB wall thickening favors hepatitis DDX GB wall thickening Acute and chronic cholecystitis Hepatitis, cirrhosis Heart failure Hypoproteinemia GB cancer Adenomyomatosis Hemorrhagic acute acalculous cholecystitis |
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Hepatitis
Case findings: GB wall thickening with a lamellated or striated appearance No GB distention Hyperechoic halos around PV: periportal edema secondary to hepatits and liver enlargement DDX marked GB wall thickening (> 1 cm) Hepatitis Hepatic venous occlusion Acute cholecystitis: also exhibits focal RUQ tenderness, GB distention |
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Mirizzi syndrome
Impacted cystic duct stone leading to extrinsic compression or to inflammatory stricture of the CBD |
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Primary sclerosing cholangitis
Idiopathic, associated with IBD (MC UC) Perihepatic fibrosis: irregular, multi-segmental areas of narrowing with intervening areas of biliary ductal dilatation (beaded appearance) |
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Acute hepatitis
Increased number of visible portal venules with bright hyperechoic walls (starry sky pattern) Appearance NOT seen in alcoholic hepatitis since fatty infiltration will predominate |
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Focal fatty sparing
Focal periportal sparing: Hypoechoic well-marginated area Medial segment of the left lobe Focal fatty infiltration: Hyperechoic Geographic and/or interdigitating margination Lobar distribution Lack of mass effect |
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Cavernous transformation of PV (portal cavernoma)
Case findings: PV thrombosis Cavernous transformation of MPV: seen with chronic PV thrombosis as collaterals develop Venous network of collaterals to bypass thrombosed PV: represent dilated right gastric and common bile duct veins Etiology of PV thrombosis: Children Sepsis, appendicitis Umbilical vein catheterization in neonates Adults MC cirrhosis Sepsis, pancreatitis, hypercoagulable states Idiopathic |
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Hepatic microabscess, Candida
Case findings: Multiple small round lesions: hypoechoic with central hyperechoic lesion (bull’s eye lesion) Most of lesions do not have posterior enhancement (not cystic) |
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Biliary cystadenoma/cystadenocarcinoma
Multilocular tumor MC solitary and large with a smooth or lobulated surface Variable number of internal septa Contain mucinous or hemorrhagic contents MC women DDX septated hepatic cystic lesion: Necrotic metastasis Hydatid cyst Biliary cystadenoma/cystadenocarcinoma Children and young adults: Mesenchymal hamartoma (neonate) Embryonal sarcoma (child, adolescent) |
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Hemangioma
Classic appearance (seen 2/3 of cases) Well-defined, solid mass Not necessarily round, but can be lobulated Hyperechoic homogeneous mass Posterior acoustical enhancement Most show no change in appearance over months to years MC posterior right lobe Types of liver hemangioma: Cavernous: MC benign liver tumor of adults Hemangioendothelioma: seen only in children DDX: HCC, metastasis, FNH Hyperechoic homogeneous mass Central hypoechoic lesion, target lesion (LC appearance) |
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Hypoechoic lesion
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Focal nodular hyperplasia (FNH)
MC women 20 to 40 years of age US appearances (3 types) Isoechoic (40%): FNH is visible only if there are contour changes in the normal liver outline Hypoechoic (40%) Hyperechoic (20%) Regardless of which pattern is present, FNH will appear homogeneous MC well defined with sharp margination due to the capsule May have a stellate-shaped central scar (20%) DDX: Fibrolamellar HCC Abscess Necrotizing malignancy Hepatic adenoma Hyperechoic lesion in lateral segment of left lobe |
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Hepatic adenoma
Case findings: Heterogeneous mass with mixed echogenicity, but mostly hypoechoic MC women on oral contraceptives Complication: hemorrhage |
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T2-weighted
T1-weighted fat saturation |
Adrenal myelolipoma
Case findings: US: circumscribed echogenic mass, superior to the right kidney, no internal flow in lesion MR: right adrenal mass follow that of fat on all pulse sequences, including fat suppression DDX: Retroperitoneal liposarcoma Teratoma of the adrenal glands (rare) Liposarcoma of the adrenal glands (rare) |
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Metastatic testicular GCT
Regressed left testicular germ cell tumor with retroperitoneal metastasis US: microcalcifications and possible slight inhomogeneity of left testicular echotexture without evidence of a discrete mass CT: low density mass inferior to left renal vein and artery |
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Testicular microlithiasis
Case findings: Innumerable punctate areas of increased echogenicity Calcifications in seminal vesicle tubules Seen with: Normal testes Cryptorchid testes Klinefelter's syndrome Male pseudohermaphroditism Testicular neoplasm |
