Ultrasound review

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Ultrasound review
2015-05-28 17:49:06
Ultrasound review

Ultrasound Review
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  1. What is the ultrasound appearance of retained products of conception?
    Echogenic mass within uterine cavity

    Blood flow from the myometrium
  2. What is the definition of varicocele?
    Tubular veins that are greater than 2-3 mm

    Increase with Valsalva
  3. What type of thyroid tumor is associated with microcalcifications?
    Papillary carcinoma
  4. What are spermatoceles?
    Cystic lesions closely associated with epididymis
  5. Where does the fluid in the hydrocele reside?
    Fluid goes around the tunica vaginalis
  6. What is the most common neural tube defect?
    Anencephaly  - absence of brain above orbits
  7. What are classic findings of chronic pancreatitis?
    Pancreatic duct dilatation

    Coarse calcifications
  8. What is the most common post partum cause of fever?
  9. How does the clinical presentation in patients with retained products of conception differ from patients with endometritis?
    Retained products of conception > heavy bleeding

    Endometritis > fever and purulent discharge
  10. What is the most common cancer to metastasize to the gallbladder?
  11. What are imaging findings of a malignant thyroid nodule?
    Taller than wide shape


    Capsular invasion
  12. What is the urachus?
    Connection between bladder and umbilicus
  13. What is the blood supply to the ovary?
    Ovarian artery

    Uterine artery
  14. What are ultrasound findings of ovarian torsion?
    Enlarged ovary

    Peripheral cysts (due to central edema)
  15. What is the best measure of gestational age in a FIRST trimester pregnancy?
    Crown rump length
  16. How does the venous drainage of the caudate lobe of the liver differ from the rest of the liver?
    Caudate lobe drains directly into the IVC
  17. What is a potential hematologic complication of rapidly growing hemangiomas?
    Large hemangioma sequestering and destroying platelets

    (Kasabach-Merritt syndrome)
  18. What is the most common ovarian neoplasm in women of reproductive age?
  19. What is the most common ovarian mass (not neoplasm) seen in pregnancy?
    Corpus luteum cyst
  20. What is Mirizzi syndrome?
    Obstruction of the common hepatic duct by an impacted cystic duct stone
  21. What is the most important parameter to assess renal artery stenosis on ultrasound?
    Peak systolic velocity of main renal artery

    >200 considered elevated
  22. What is the most common cause of an enlarged UNILATERAL kidney?
    Acute renal vein thrombosis
  23. What is the most sensitive and specific finding of ectopic pregnancy on ultrasound?
    Nonovarian complex adnexal mass
  24. What are hepatobiliary signs of congestive heart failure?
    Gallbladder wall thickening

    Pulsatile portal flow
  25. What vessels are normally present in the umbilical cord?
    2 arteries

    1 vein
  26. What is the pathophysiology of lymphoproliferative disorder?
    Antigenic stimulation of lymphoid tissue leading to lymphoproliferative response

    In patients with autoimmune or immunosuppressed conditions
  27. What is the definition of placenta accreta?
    Abnormal proliferation of placental tissue beyond endometrial lining of uterus
  28. What is the definition of placenta previa?
    Placenta implants in lower uterine segment
  29. What are characteristic findings of polycystic ovarian syndrome on ultrasound?
    Increased central stroma (echogenic)

    Peripheral follicles
  30. What is vasa previa?
    Fetal vessels near cervical os
  31. What is a succenturiate lobe?
    Accessory placental lobe
  32. What are virtually diagnostic findings to rule out endometrial cancer in post menopausal women with bleeding?
    Endometrial stripe less than 4 mm virtually excludes endometrial cancer
  33. What happens to flow in the renal artery when the renal vein is thrombosed?
    Outflow (renal vein) is blocked so flow becomes reversed during diastole
  34. What are signs of portal venous gas on ultrasound?
    Small echogenic foci in portal vein

    Bi-directional spike like waveform
  35. What are the most common risk factors for hepatic adenoma?
    Oral contraceptives

    Glycogen storage disease
  36. What types of cells in the ovary account for most ovarian neoplasms?
    Epithelial cells (~80%)

    Germ cells (~20%)
  37. What are the major types of ovarian epithelial cell neoplasms?


  38. What is the natural history of a hemorrhagic cyst?
    Regresses within 14-16 weeks typically spontaneously

    Hormone therapy can cause regression by 6 weeks
  39. What syndrome includes benign ovarian tumors combined with excess pleural and peritoneal cavity?
    • Meigs syndrome
    • 1)Benign tumor (fibroma)
    • 2) Pleural effusion
    • 3) Ascites
  40. Homogeneous, low level echoes

  41. What genetic abnormality is associated with: choroid plexus cysts, clenched hands, club feet, hyperechogenic kidneys and brachycephaly (strawberry shaped head/early fusion of coronal suture)?
    Trisomy 18
  42. What is the most common cause of fetal abdominal cysts in a female?
    Ovarian cysts
  43. What is the most common benign liver neoplasm?
  44. How large can a dominant follicle grow at ovulation?
    3 cm
  45. What is the size of cyst at which mural nodules can be obscured?
    7 cm

    (Hence above 7 cm, cysts need MR for further evaluation)
  46. What are imaging findings of hydrosalpinx?
    Dilated adnexal tubular structure separate from and leading to ovary
  47. What are features of an indeterminate ovarian cyst?
    Multiple thin septations

    Solid nodule without detectable flow
  48. What is the appropriate workup for an indeterminate ovarian cyst?
    Follow up US in 6-12 weeks

    Lesion resolves > hemorrhagic cyst

    Unchanged > surgical evaluation if lesion is not endometrioma or dermoid
  49. Pelvic inflammatory disease

    Fluid distended fallopian tube

  50. Hemorrhagic cyst

    Fishnet/lacelike pattern - comes from retraction/hemolysis of clot
  51. What is the most common cause of delayed graft function in a transplant kidney?
    Acute tubular necrosis
  52. What are features that can help to distinguish follicular adenoma versus an adenomatoid nodule?
    • Follicular adenoma -
    • Hypoechoic halo
    • Well defined
  53. What are the most common types of thyroid cancer?
    Papillary (75%)

    Follicular (10%)

    Medullary (5%)
  54. What is the difference between the spread of papillary versus follicular thyroid carcinoma?
    Papillary spreads via lymph nodes

    Follicular has a hematogenous spread
  55. Homogeneous echotexture replaced by heterogeneous echotexture

    Fibrous strands

    Hashimoto's thyroiditis
  56. What clinical history may be helpful in evaluating an ill defined hypoechoic lesion in the thyroid?
    Preceding viral infection

    Is the thyroid painful?
  57. What are the most common salivary gland neoplasms?
    Pleomorphic adenomas

    Warthin's tumors
  58. What are the most common sites for an ectopic parathyroid adenoma?
    Behind trachea, medial to carotid
  59. What syndrome is medullary thyroid cancer associated with?
    20% seen in patients with MEN-IIa and IIb
  60. What are signs of TIPS malfunction in the main portal vein and in the shunt?
    Main portal vein velocity < 35 cm/sec

    Shunt velocity < 90 cm/sec
  61. Where do most TIPS occlusions occur?
    Hepatic venous side
  62. At what Beta-HCG level should you see a gestational sac?
  63. At a Beta-HCG level of 10,000 what structure should you see?
  64. If you have a beta HCG level greater than 100,000, what should you suspect?
    Molar pregnancy
  65. What are the top three causes of polyhydramnios?


    Fetal anomalies - structural anomalies that inhibit swallowing or intestinal absorption
  66. What are the effects of tamoxifen on the breast versus the uterus?
    Breast - acts as antagonist

    Uterus - acts as agonist
  67. What is the demarcation point for central versus lateral neck?
    Carotid artery
  68. What is the differential for large, hyperechoic kidneys (bilateral) found on obstetric ultrasound and how can one differentiate these causes?
    • Autosomal recessive polycystic kidney disease
    • Trisomy 13 (multiple additional anomalies)
    • Meckel-Gruber syndrome (polydactyly, encephalocele)
  69. What are doppler findings of fetal anemia?
    Elevated peak systolic velocity of the middle cerebral artery
  70. How can one distinguish serous cystadenoma of the pancreas from mucinous cystadenoma?
    Serous - microcysts, pancreatic head

    Mucinous - larger cysts, pancreatic tail
  71. What is the ultrasound appearance of acute hepatitis?

    Diffusely decreased echogenicity > more prominent portal triads
  72. What are characteristic velocities suggestive of carotid artery stenosis on duplex ultrasound?
    125 cm/sec - suggests greater than 50% stenosis

    230 cm/sec - suggests greater than 70% stenosis.
  73. What is the definition of resistive index?
    (Peak systolic velocity - Diastolic velocity)/ (Peak systolic velocity)
  74. What can elevated resistive indices signify in a transplant kidney?

    Acute tubular necrosis
  75. Mass with lamellated wall in testicle - Epidermoid cyst
  76. What are the findings of hepatic arterial thrombosis after transplant?
    Biliary leaks/complications (hepatic artery is only blood supply for biliary system after transplant)

    Parvus tardus waveform
  77. What genetic syndrome is associated with holoprosencephaly (~50%), cleft lip/palate, echogenic intracardiac focus, polydactyly, rocker bottom feet?
    Trisomy 13
  78. What genetic syndrome is associated with echogenic intracardiac focus, nuchal thickening, echogenic bowel, cardiac defects and the double bubble sign?
    Trisomy 21