Ultrasound Abdomen

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Ultrasound Abdomen
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2010-12-08 12:21:51
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Abdomen quiz Ultrasound
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Abdomen quiz Ultrasound
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  1. Hyperechoic
    Greater than reference structure
  2. Hypoechoic
    Less than reference structure
  3. Anechoic
    Absence of echoes.
  4. Isoechoic
    Equal echogenicity
  5. Order of echogenicity
    Renal sinus – Pancreas – Liver – Spleen – Renal Cortex.
  6. Couinaud’s anatomy
    Localization of liver by functional distribution of portal veins.
  7. Caudate lobe
    Receives branches from both, right and left portal veins and getting drained by emissary veins.
  8. Liver is covered by
    Glisson’s capsule or Vesceral peritoneum.
  9. The lining of Abdominal cavity
    Parietal peritoneum.
  10. Where is liver
    Liver invaginates into peritoneum, which covering the liver surface.
  11. Hepatopedal
    Portal v. flow to transducer.
  12. Hepatofugal
    Portal v. flow away from transducer.
  13. 3 lobes of liver
    Left lobe, Right lobe, caudate lobe.
  14. 9 segments
    Caudate, left lateral superior, left lateral inferior, left medial superior, left medial inferior, right anterior superior, right anterior inferior, right posterior superior, right posterior inferior.
  15. Intersegmental vessels
    Hepatic veins.
  16. Intrasegmental vessels
    Portal veins.
  17. Portal triad
    Portal vein, hepatic artery, bile duct.
  18. Main lobar fissure
    Imaginary line from GB to IVC, middle hepatic vain is landmark for it.
  19. Main lobar fissure separates
    Right and left lobes of the liver.
  20. Main lobar fissure separates
    Right anterior segment from left medial segment.
  21. Right Intersegmental fissure
    Coronal division of the right lobe of the liver, dividing right lobe to anterior and posterior, right hepatic vein is landmark for right Intersegmental fissure.
  22. Left Intersegmental fissure
    Sagittal division of the left lobe of the liver, divides the left lobe to medial and lateral, the left hepatic vein, ligamentum teres, falciform ligament, assending segment of the left portal vein are landmarks.
  23. Ligamentum venosum
    Remnant of ductus venosus, conducts blood from the left portal vein to IVC, separates medial segment of left lobe from caudate lobe.
  24. Caudate lobe is
    Posteriorly by IVC.
  25. Caudate lobe is
    Anterioinferiorly by proximal left portal vein.
  26. Caudate lobe is
    Anteriolaterally by ligamentum venosum.
  27. Caudate lobe is
    Inferiorly by main portal vein.
  28. Bare area
    Posterior portion of liver that is not covered by peritoneum.
  29. Coronary ligament
    Reflection of parietal peritoneum onto liver surface, visceral peritoneum.
  30. Left and Right triangular ligaments
    Reflection or coronary ligaments at each corner of the bare area.
  31. Raidel’s lobe
    Inferior tongue like projection, superior-inferior increasement. In right lobe of the liver, beyond lower pole of right kidney. More in women.
  32. Hepatomegaly
    If its greater than 15.5cm
  33. Pyogenic Abscess (Bacterial)
    Solitary, in right lobe, caused by bacteria that reaches the liver via the bile ducts, portal veins, hepatic arteries or lymphatic channels.
  34. Pyogenic Abscess (Bacterial)
    Hypoechoic, rounded, fluid-filled masses with variable degrees of internal echoes or debris, may be seen as a result of gas-producing organism.
  35. Acute Hepatitis
    Hypoechoic liver parenchyma, liver enlargement, Hyperechoic portal vein walls.
  36. Chronic Hepatitis
    Hyperechoic liver parenchyma, small liver, Hypoechoic portal vein walls (decreased echogenicity).
  37. Mycotic infection (fungal abscess)
    The patient is generally imunocompromised. Wheel within a wheel, bull’s eye, Hypoechoic mass.
  38. Amoebic abscesses
    Due to protorzan parasites, entameoba histolytica, enter the intestinal tract and resides in colon. Get’s to liver via portal vein. Generally occurs in the right lobe of the liver. Indirect hemagglutination test is used for diagnosis.
  39. Amoebic abscess within the liver
    Round or oval shaped Hyperechoic mass, absence of prominent wall, fine low-level internal echoes, distal enhancement, contiguous with diaphragm.
  40. Hydatid disease (echinococcal cyst)
    Prevalent in sheep and cattle raising countries. The embryos travel from gastrointestinal tract to the liver via portal vein.
  41. Hydatid disease (echinococcal cyst)
    Large (pericyst) cyst, with one or more daughter cysts (endocysts). Fine internal echoes (Hydatid sand), ends as collapsed calcified mass.
  42. Scistosomiasis
    Most common parasitic infection worldwide. Portal vein occlusion by larvae which leads to portal hypertension, splenomegaly, varices and ascites.
  43. Scistosomiasis
    Sonographically appears as distended, echogenic debris-filled intrahepatic portal vein.
  44. Pmeumocystis carinii
    Most common organism causing infection in imunocompromised (or AIDS) patients.
  45. Pmeumocystis carinii
    Nonshadowing echogenic foci.
  46. Focal Fatty Infiltration
    Regions of increased echogenicity on normal liver, commonly at porta hepatis.
  47. Focal Fatty Sparing
    Regions of normal liver that will appear as Hypoechoic masses over dense fatty liver, commonly seen at adjacent to the gallbladder.
  48. Glycogen storage disease
    Is deposit of glycogen in the hepatocytes of the liver and convoluted tubes of liver
  49. Hepatic adenomas
    Associated with Glycogen storage disease. Usage of oral contraceptive agents
  50. Hepatic adenomas
    Due to hemorrhage and malignant transformation risk surgical resection is recommended
  51. Hepatic adenoma
    Is hard to distinguish from focal nodular hyperplasia
  52. Cirrhosis: 3 major pathologic mechanisms of
    Hepatocellular death, fibrosis and regeneration
  53. Cirrhosis: clinic presentation
    Hepatomegaly, jaundice, ascites
  54. Portal hypertension: clinical signs
    Ascites, splenomegaly, varices.
  55. Portal vein thrombosis
    • Associated with Hepatocellular carcinoma, metastatic liver disease, pancreatic carcinoma,
    • pancreatitis ….
  56. Portal vein thrombosis: sonographic findings
    Intraluminal thrombus, increased vein diameter, cavernous transformation.
  57. Budd-Chiari syndrome
    Occlusion of hepatic veins.
  58. Budd-Chiari syndrome: sonographic findings include
    Hepatic vein thrombosis, ascites, Hepatomegaly (acute phase), caudate lobe enlargement (chronic phase), portal hypertension.
  59. Cavernous hemangioma
    Most common benign liver tumors. Usually small and asymptomatic. May enlarge during pregnancy or estrogen replacement therapy.
  60. Cavernous hemangioma: sonographically
    Small, well-defined, Hyperechoic mass with posterior acoustic enhancement.
  61. Focal Nodular Hyperplasia
    Common benign liver mass.
  62. Focal Nodular Hyperplasia
    Solitary mass, less than 5 cm in diameter, central fibrous scar. Difficult to differentiate from adjacent liver parenchyma.
  63. Well-defined Hyperechoic liver masses
    Hemangioma, hepatic Lipoma, echogenic metastasis, focal fatty infiltration, they all appear well-defined Hyperechoic masses within the liver.
  64. Hepatocellular carcinoma
    Most common primary malignant tumor of the liver.
  65. Hepatocellular carcinoma
    Alcoholic cirrhosis, chronic hepatitis B and C. Its seen as an Hypoechoic mass.
  66. 5 surgically placed shunts:
    Portocaval shunt, Proximal splenorenal shunt, Distal splenorenal (Warren) shunt, Mesocaval shunt, Transjugular intrahepatic portosystemic shunt.
  67. Shunt patency is confirmed by:
    Demonstration of flow in shunt, Hepatofugal portal vein flow.
  68. Junctional fold
    Gallbladder neck fold.
  69. Phrygian fold
    Gallbladder fundus fold.
  70. Stone filled gallbladder
    Wall-echo-shadow (WES sign) or double arc shadow sign.
  71. Fatty meal is helpful in assessing biliary obstruction
    Obstructed bile duct should increase, non-obstructed bile duct should decrease.
  72. Significant elevation of direct bilirubin indicates
    Obstructive jaundice, intrahepatic cholestasis, biliary tree obstruction.
  73. Gallbladder wall thickening
    If its >3mm it is abnormal.
  74. Causes of gallbladder wall thickening
    Cholecystitis (inflammation), ascites, hypoalbuminemia, hepatitis, congestive heart failure, renal disease, AIDS, sepsis.
  75. Sonographic criteria for gallstones
    Mobile, echogenic structure with posterior acoustic shadowing.
  76. Gallstones are composed of
    Cholesterol, calcium bilirubinate, calcium carbonate.
  77. Acute cholecystitis
    Obstructed cystic duct by a precipitated stone, obstruction of venous drainage, inflammation of GB wall, various degrees of necrosis and infection.
  78. Acute cholecystitis: symptoms
    RUQ tenderness, guarding, fever, chills, leukocytosis.
  79. Acute cholecystitis: sonographic
    Gallstones, sonographic Murphy’s sign, diffuse wall thickening, gallbladder dilatation, and sludge.
  80. Emphysematous cholecystitis
    Infection associated with gas-forming bacteria, in wall of GB.
  81. Emphysematous cholecystitis: sonographically
    Gas shadowing from the wall of the GB.
  82. Hydrops of GB
    Distended, noninflamated GB due to obstruction of the cystic duct. Trapped bile is reabsorbed and the GB is filled with a clear mucinous secretion.
  83. Hydrops of GB
    Asymptomatic, may present as a palpable, RUQ mass. Diagnosis should be suspected on ultrasound when stone is noted in an enlarged, non-tender GB.
  84. Rokitansky-Aschoff Sinuses
    Are diverticula within the wall of GB.
  85. Rokitansky-Aschoff Sinuses
    Pathology associated with adenomyomatosis.
  86. Rokitansky-Aschoff Sinuses
    Sludge and stones accumulate within the sinuses, and present as focal wall thickening. Echogenic foci are visible within the thickened wall, reverberation artifact.
  87. GB carcinoma: sonographically
    Intraluminal mass, asymmetric wall thickening or a mass-filled GB.
  88. GB carcinoma: other findings
    Liver metastases, lymphadenopathy, and bile duct dilatation.
  89. Biliary tract obstruction
    Gallstones (choledocholithiasis) and carcinoma of the pancreas.
  90. Biliary tract obstruction: Lab values
    Alkaline phosphate, conjugated (direct) bilirubin, gamma glutyml transpeptidase.
  91. Intrahepatic bile duct dilatation
    Shotgun sign and parallel channel sign (dilated bile duct adjacent to a portal vein).
  92. Intrahepatic bile duct dilatation
    Irregular path compared to portal veins, stellate or star shape configuration of bile ducts and acoustic enhancement associated with bile ducts.
  93. Mirizzi’s syndrome
    Extrahepatic bile duct obstruction, because of a stone within the cystic duct. The stone causes external mechanical compression of the CHD.
  94. Mirizzi’s syndrome: associated
    Intrahepatic bile duct dilatation, normal size CBD, large stone in the cystic duct of the GB.
  95. Extrahepatic bile ducts
    CHD, Cystic duct, CBD
  96. Klatskin tumor
    Intrahepatic biliary duct dilatation. Specific type of cholangiocarcinoma. Located at the hepatic helium, at junction of the right and left hepatic ducts.
  97. Pneumobilia: sonographically
    Variable length echogenic foci in the distribution of the biliary tree, resulting in acoustic shadowing and reverberation artifact (comet-tail).
  98. Pneumobilia
    Commonly seen in the helium of the liver, direction of bile flow.
  99. Pneumobilia
    Seen after endoscopic retrograde cholangiopancreatogram (ERCP). It’s also can be due to surgically created biliary-enteric anastomosis, incompetence of the sphincter of Oddi, wall erosion by gallstone or ulcer into the CBD.
  100. Choledochal cysts
    Usually occur in Asian women, pain, jaundice, abdominal mass.
  101. Choledochal cysts: sonographically
    Two cyst-like structures in RUQ: GB and dilated CBD.
  102. Caroli’s disease: sonographically
    Saccular, communicating intrahepatic bile duct dilatation.
  103. Caroli’s disease is associated with
    Infantine polycystic kidney disease, congenital hepatic fibrosis, choledochal cysts.
  104. Courvoiser GB
    Enlarged, nondiseased GB, associated with an extrinsic obstruction of the distal CBD.
  105. Milk of calcium bile
    Fluid field level that produces acoustic shadowing.
  106. Bile duct carcinoma (cholangiocarcinoma)
    Uncommon cancer, ulcerative colitis, sclerosing colangitis, Caroli’s disease, choledochal cyst, parasitic infections.
  107. Cholangiocarcinoma
    Commonly located in CHD and CBD.
  108. Klatskin tumor
    Specific type of cholangiocarcinoma at hepatic helium, intrahepatic bile duct dilatation without extrahepatic bile duct dilatation.
  109. Head of pancreas is
    Anterior to IVC
  110. Head of pancreas is
    Medial to second portion of the duodenum
  111. CBD is
    Posterolateral to the head of the pancreas
  112. GDA is
    Anteriolaterally to the head of the pancreas
  113. SMA and SMV are
    Posterior to the neck of the pancreas
  114. Uncinate process is
    Posterior to SMA and SMV
  115. Aorta is
    Posterior to the body of pancreas
  116. CT arises from the aorta
    Superior to pancreas
  117. GDA and CBD run
    Posterior to the first portion of the duodenum
  118. Splenic vein is
    Posteroinferior to the pancreas
  119. SMA arises from the aorta
    Inferior to the pancreas
  120. SMA and SMV are
    Anterior to the third portion of the duodenum
  121. SMV is
    To the right of the SMA
  122. PV is the
    Combination of SMV and Splenic vein
  123. Pancreatitis
    Alcohol abuse and biliary calculi most causes
  124. Acute pancreatitis
    Diagnosed by clinical and lab findings
  125. Acute pancreatitis (mild)
    Normal pancreas view
  126. Acute pancreatitis (increased)
    Decreased echogenicity, increased gland size
  127. Chronic pancreatitis
    Progressive, irreversible destruction of pancreas
  128. Chronic pancreatitis
    Sonographically: small echogenic gland, calcification, pancreatic duct dilatation, pseudocyst formation
  129. Pancreatic adenocarcinoma: sonographically
    Solid focal Hyperechoic mass usually in the head of the pancreas
  130. Pancreatic adenocarcinoma: sonographically
    Dilated biliary system, dilated pancreatic duct, liver metastases, ascites, lymphadenopathy, pseudocyst formation
  131. Pancreatic adenocarcinoma
    Associated with Courvoisier’s sign: palpable, nontender gallbladder due to pancreatic head obstruction, biliary tract is obstructed resulting in jaundice.
  132. Pancreas – nonencapsulated, retroperitoneal structure located between the second portion of the duodenum and Splenic helium, at anterior pararenal space of retroperitoneum.
  133. Pancreas
    Head, neck, body, tail, uncinate process.
  134. Pancreas
    Endocrine portion of the pancreas consists of the islet cells of Langerhans which secretes insulin.
  135. CT
    Divides to left gastric, common hepatic and Splenic artery
  136. Common hepatic artery
    Divides to proper hepatic and gastroduodenal arteries
  137. SMA and Splenic vein
    Join to form Main portal vein
  138. Islet Cell Tumor
    Small, well circumscribed masses, usually in pancreatic body and tail
  139. Islet Cell Tumor
    Most common benign tumor of pancreas, but can be malignant too
  140. Islet cell Tumor
    Insulinoma and Gastrinoma most common tumors
  141. Insulinoma
    Hyperinsulinism and hypoglycemia
  142. Gastrinoma
    Associated with gastric hypersecretion and peptic ulter disease – Zollinger-Ellison syndrome
  143. Multiple Endocrine Neoplasma
    Pituitary adenoma, parathyroid adenoma, medullary thyroid carcinoma, pancreatic islet cell tumor, pheochromocytoma, ganglioneuromatosis.
  144. Pancreatic Pseudocyst
    Collection of pancreatic fluid encapsulated by fibrous tissue
  145. Pancreatic pseudocyst
    Caused by acute pancreatitis, chronic pancreatitis, trauma, pancreatic cancer
  146. Pancreatic pseudocyst locations
    Pancreas(most common), intraperitoneal, retroperitoneal, intraperchymal (liver, spleen, kidney), thorax (passage through diaphragm)
  147. Spleen functions
    Breakdown of hemoglobin, formation of bile pigment and antibodies, reservoir for blood.
  148. Stomach
    Anterior, medial to Splenic helium
  149. Pancreatic tail
    Posterior to stomach
  150. Left kidney
    Inferior, medial to spleen
  151. Pancreatic tail
    Anterior to upper pole of kidney
  152. Structure that appears as cystic Splenic mass
    Cystic degeneration of infarcts or hematomas
  153. Structure that appears as cystic Splenic mass
    Cysts associated with adult polycystic kidney disease
  154. Structure that appears as cystic Splenic mass
    Parasitic cysts of the spleen (echinococcal cysts)
  155. Structure that appears as cystic Splenic mass
    Epidermoid cyst of the spleen
  156. Structure that appears as cystic Splenic mass
    Pancreatic pseudocyst
  157. Splenic infarct
    Peripheral wedge-shaped Hypoechoic lesion
  158. Intrapararenchymal or sabcapsular hematoma
    Splenic trauma in which splenic capsule remains intact
  159. Perisplenic or intraperitoneal hematoma
    Splenic trauma in which splenic capsule ruptures
  160. Multiple pancreatic cysts associated with
    Autosomal dominant polycystic kidney disease and Von Hippel-Lindau syndrome
  161. Pancreatic insufficiency
    Cystic fibrosis is characterized by viscous secretion
  162. Increased echogenicity of the pancreatic parenchyma
    Appearance of pancreas in patent with cystic fibrosis
  163. Portal vein thrombosis indication
    Echogenic thrombus within vessel lumen, increased portal vein diameter, portosystemic collateral circulation, cavernous transformation
  164. Structures posterior to the kidney
    Diaphragm, quadratus lumborum muscle, psoas muscle
  165. Kidney hilum traffic
    Anterior vein exit, middle artery enter, posterior ureter exit
  166. Renal artery brunches
    Main renal artery brunches from aorta, after entering the kidney it divides into five segments, which divide into interlobar arteries
  167. Interlobar arteries
    Seen between medullary pyramids. At base of the medullary pyramids arcuate arteries branch perpendicular from interlobar arteries, and run parallel to the renal capsule
  168. Interlobular arteries
    Branch off the arcuate arteries and run perpendicular to renal capsule
  169. Perirenal space or Gerota’s fascia – sheathe that covers kidney and adrenal glands
  170. Medullary pyramids
    Collecting tubules, Hypoechoic triangles in newborns and infants, not visualized in adults
  171. Bilateral renal agenesis
    Oligohydramnios and pulmonary hyperplasia, incomplete wit life
  172. Unilateral renal agenesis
    Uterine duplication (bicornuate uterus) and seminal vesicle agenesis
  173. Crossed renal ectopia
    Kidney ascends to other side, ureters are in proper places on bladder, displaced kidneys ureter crosses midline, sonographically two kidneys on one side of abdomen
  174. Crossed fused renal ectopia
    Kidneys fuse in the pelvis, one kidney ascends to normal position and carries the other across the midline, sonographically two kidneys fused at the upper and lower poles on one side
  175. Horseshoe kidney
    Fused lower poles, kidney in retroperitoneum, lower poles are closer to the midline, isthmus is anterior to distal aorta, mimics lymphadenopathy
  176. Duplex kidney
    Upper pole collecting system
  177. Duplex kidney
    Complete duplication of ureters, the upper one always enters the bladder in ectopic location and there is a complication named uretrocele: cystic dilation.
  178. Urinary obstruction in male neonates
    Posterior urethral valves, flap of mucosa with a slit like opening in prostatic urethra area
  179. Urinary obstruction in male neonates: sonographically
    Dilated urinary bladder, hydroureter, hydronephrosis, possible urinoma
  180. Dromedary hump
    Thickening of the lateral aspect of the left kidney
  181. Junctional parenchymal defect
    Triangular echogenic area in anterior aspect of the right upper pole of kidney
  182. Column of Bertin
    Hypertrophy of renal cortical parenchyma located between two medullary pyramids. Appearance of mass effect although the echogenicity is equal to cortical tissue
  183. External pelvis
    Common anomaly, renal pelvis protrudes outside the renal hilum. Sonographically: cystic collection medial to the renal hilum
  184. Simple cyst
    Round or ovoid shape, thin wall thickness, anechoic, acoustic enhancement
  185. Atypical, possible malignant cyst
    Multiple thick septations, irregular walls, large solid components
  186. Autosomal dominant polycystic kidney disease
    Bilateral enlargement of adult kidney caused by multiple cysts of varying sizes. Cysts may be seen in liver, pancreas spleen
  187. ADPKD
    Also associated with aneurysm development, cerebral (berry) aneurysm of the circle of Willis
  188. Infantine polycystic kidney disease
    Bilaterally enlarged echogenic kidneys with loss of the cortical medullary boundary
  189. Infantine polycystic kidney disease
    Associated with: lung hypoplasia, periportal hepatic fibrosis, olingohydramnios
  190. Medullary sponge kidney –
    Dysplastic cystic dilation of the collecting tubules of the medullary pyramids
  191. Multicystic dysplastic kidney disease
    Most common cause of an abdominal mass in newborn
  192. Multicystic dysplastic kidney disease: sonographically
    Cysts of varying shape and size, absence of communication between cysts, absence of renal sinus, absence of renal parenchyma
  193. Contralateral renal abnormalities: associated with unilateral Multicystic dysplastic kidney disease: uretropelvic junction obstruction, renal agenesis or hypoplasia, pelvocalectasis
  194. Pseudotumors of kidney
    Column of Bertin, dromedary hump, fetal lobation
  195. Acquired cystic disease
    Patient on chronic hemodialysis. This cyst may hemorrhage resulting in flank pain, hematuria and intracystic echogenic collections.
  196. Acquired cystic disease
    Slightly higher incidence of renal cell carcinoma
  197. Tuberous sclerosis
    Multisystemic disorder associated with renal cyst formation and multiple renal angiomyolipomas.
  198. Renal cell carcinoma
    Hypernephromas – adenocarcinomas - von Growitz tumor
  199. Renal cell carcinoma: associated with
    Adult polycystic kidney disease, acquired cystic disease, von Hippel-Lindau syndrome, tuberous sclerosis
  200. Renal cell carcinoma: sonographically
    Encapsulated, solid mass, Hypoechoic relative to normal, adjacent renal parenchyma.
  201. When solid renal mass is detected
    Need to evaluate: ipsilateral renal vein and IVC for tumor invasion, Contralateral kidney and renal vein, retroperitoneum for lymphadenopathy, liver for metastases
  202. Renal angiomyolipomas, hepatic Lipoma, adrenal myelolipoma
    Fat containing tumor, propagation speed artifact
  203. Filling defect in bladder
    Transitional cell carcinoma, blood clots, fungal balls – same similar appearance
  204. Most common solid tumor in children
    Wilm’s tumor (nephroblastoma), most patients less than 3 years
  205. Acute pyelonephritis
    Renal enlargement, Hypoechoic parenchyma, absence of sinus echoes
  206. Pyonephrosis
    Presence of pus in dilated renal collecting system, secondary to infected hydronephrosis
  207. Pyonephrosis: sonographically
    Dependent echoes within dilated pelvocaliceal system, shifting urine-derbis level, gas shadowing from infection
  208. Transitional cell carcinoma
    Malignant tumor associated with urinary collecting system, usually in bladder, can arise in the ureter and renal pelvis
  209. Hodgkin’s disease(malignant lymphoma), metastases
    Most common explanation for bilateral renal masses
  210. Mycetoma (Fungal Ball)
    Hyperechoic, nonshadowing masses. Same appearance as angiomyolipomas, blood clots, Pyogenic derbis, sloughed papilla, nonshadowing renal stones
  211. Von Hippel-Lindau syndrome associated
    REnal cell carcinoma, hemangioma, pheochromocytoma, pancreatic cystadenoma/cystadenocarcinoma, adenoma, islet cell tumor, cysts associated with variety of organs.
  212. Prehepatic portal hypertension
    Portal vein thrombosis
  213. Intrahepatic portal hypertension
    Cirrhosis, Scistosomiasis
  214. Posthepatic portal hypertension
    Budd-Chiari syndrome
  215. Renal vein thrombosis can be result of
    IVC or renal vein extrinsic compression, nephritic syndrome, renal tumors, renal allografts, trauma
  216. Renal vein thrombosis: Sonographically
    Dilated thrombosed renal vein, absence of venous flow within the kidney, enlarged Hypoechoic kidney, high resistive renal artery waveform
  217. Acute renal failure
    Acute tubular necrosis is the most common cause. Cause includes shock, trauma, sepsis and drug toxicity. Renal enlargement and increased resistive index may be seen associated with ATN
  218. Obstructive nephropathy (hydronephrosis)
    Diagnosed using an intrarenal resistive index (RI) grater than 0.7
  219. Nonobstructive nephropathy
    Resistive index less than 0.7
  220. Uteropelvic junction obstruction
    Common congenital anomaly.
  221. Unilateral Multicystic dysplastic kidney
    Associated with Contralateral uretropelvic junction obstruction
  222. Renal calculi
    Most common cause of obstruction in patients with acute flank pain.
  223. Most common locations for obstruction of urinary tract from renal calculi
    URetrovesical junction (the most common), uteroppelvic junction, ureteric obstruction at the level of pelvic inlet
  224. RI=
    Peak S Fr-End S Fr/Peak S Fr
  225. Arteriovenous fistula
    Demonstrates abnormally low resistive arterial waveform flow pattern, which means increased and sustained diastolic flow
  226. Arteriovenous fistula
    Demonstrates increased velocity waveform flow, pulsality and spectral broadening due to turbulence
  227. Renal artery stenosis: sonographic criteria
    Kidney size less than 9cm in length, peak velocity of main renal artery >180cm/sec, renal artery/aorta ratio >3.5, intrarenal parvus tardus waveform
  228. Ureterocele: sonographically
    Round, cystic structures that project into the bladder lumen at the uretrovesical junction
  229. Median umbilical ligament (urachus)
    Suspends the bladder, connects the apex to umbilicus.
  230. Urachus (median umbilical ligament)
    Lies in the space of Retzius
  231. Urachal cyst
    Dilation of the median umbilical ligament.
  232. Urachal cyst: sonographically
    Echofree tubular structure in lower abdomen, from umbilicus to the dome of the bladder
  233. Greenfield filter (IVC filter)
    Placed in IVC to prevent the ascension of thrombus into the lungs
  234. IVC filter –Ultrasound
    Location is determined by ultrasound inferior to renal vein, can detect complications: thrombosis around the filter or perforation around the filter or through IVC wall that may be associated with retroperitoneal hematoma.
  235. Branching of renal arteries
    Main renal artery – segmental artery – interlobar artery – arcuate arteries – interlobar arteries
  236. Interlobar arteries
    Positioned between the medullary pyramids
  237. Arcuate arteries
    Parallel to the base of the medullary pyramids
  238. AIDS disorder
    Pneumocystic carinii, fatty liver infiltration, hepatitis, non-Hodgkin’s lymphoma, candidiasis, cholangitis, cholecystitis, Kaposi’s sarcoma
  239. Lymphoceles
    Pelvic surgery common complication
  240. Lymphoceles
    Caused by leakage of lymph from a renal allograft, by surgical disruption lymphatic channels
  241. Acute rejection of a renal transplant sonographically
    Enlarged transplant, decreased cortical echogenicity, indistinct corticomedullary boundary, prominent hypoechoic medullary pyramids, peritransplant fluid collections
  242. Alanine Aminotransferase (ALT)
    Serum glutamic pyruvic transaminase (SGPT) most specific for Hepatocellular damage.
  243. Aspartate Aminotransferase (AST)
    Wide tissue distribution. Present in liver, heart, skeletal muscle, kidney and brain. AST is non-specific for liver, but it’s very sensitive for liver disease.
  244. Decrease renal function
    Creatinine and blood urea nitrogen are removed by kidney filtration, and in decrease of renal function they increase
  245. Alpha-fetoprotein
    Increase is associated with masses: hepaocellular carcinoma, metastatic liver disease, hepatoblastoma
  246. PSA increase (Prostate Specific Antigen)
    Patient age, prostate volume, benign prostatic hyperplasia, prostate cancer
  247. Crus of diaphragm
    Anterior to the aorta
  248. Crus of diaphragm
    Superior to the CT
  249. Crus of diaphragm
    Posterior to IVC
  250. Crus of diaphragm
    Medial posterior to the adrenal glands
  251. Adrenal gland bilateral arterial supply
    Suprarenal branch of the inferior phrenic artery
  252. Adrenal gland bilateral arterial supply
    Suprarenal branch of the aorta
  253. Adrenal gland bilateral arterial supply
    Suprarenal branch of the renal artery
  254. Right suprarenal (adrenal) vein
    Drains directly to IVC
  255. Left suprarenal (adrenal) vein
    Drains into the left renal vein
  256. Pheochromocytomas can be found in
    Adrenal medulla, organ of Zuckerkandl near the aortic bifurcation, paravertebral sympathetic ganglia
  257. Pheochromocytoma cause
    Hypersecretions of catecholamines (dopamine, norepinephrine, epinephrine)
  258. Nonfunctioning cortical adenoma
    Unilateral mass, no other malignancy history, no biochemical evidence of adrenal hyperfunctioning, adrenal mass less than cm in diameter
  259. Most common primary sources that metastasize to the adrenal gland
    Lung, breast, melanoma
  260. Adrenal myelolipoma
    Usually seen as an echogenic mass in the adrenal bed, contains both fatty and bone marrow elements, presence of a propagation speed artifact is mass containing fat tissue
  261. Pheochromocytoma and neuroblastoma
    Originate from adrenal medulla
  262. Retroperitoneum dividing
    Perirenal space, anterior pararenal space, posterior pararenal space
  263. Retroperitoneum structures (11)
    Kidney and ureters, adrenal glands, IVC, aorta, pancreas, portions of duodenum, ascending & descending colon, prostate, lymph nodes, uterus, bladder
  264. Celiac axis brunches (3)
    Common hepatic artery, left gastric artery, splenic artery
  265. True aneurism
    Dilation of all three layers of the aorta, most aortic aneurisms are distal, don’t involve renal arteries
  266. Fusiform aneurysm
    Spindle-shaped dilatation
  267. Saccular aneurism
    Localized spherical outpouching of the vessel wall
  268. False aneurysm (pseudoaneurysms)
    Injury to the vessel wall where blood extravasates from vessel, the blood surrounding the vessel is retained and walled off by the surrounding tissues
  269. False aneurysm can mimic
    True aneurisms
  270. Pseudoaneurysms
    Commonly found in groin, resulting from catheters to common femoral artery, during angiographic procedures.
  271. Dissecting aneurysm
    Result of dissection of the intima away from the aortic wall, usually stat in the thoracic aorta
  272. Dissecting aneurysm type A
    Ascending thoracic aorta
  273. Dissecting aneurysm type B
    Starts in origin of the left subclavian artery
  274. Dissecting aneurysm sonographically
    Is seen as a septations dividing the aorta into a true lumen and a false lumen
  275. Ascending lumbar veins
    Branches of the common iliac veins, parallel the spine, and posterior to psoas muscle, superior to the diaphragm
  276. Right ascending lumbar vein
    Continues as the azygos vein
  277. Left ascending lumbar vein
    Continues as the hemiazgos vein
  278. Gonadal arteries
    Originate symmetrically from the aorta, below the origin of the renal arteries
  279. Right gonadal vein
    Drains the right ovary or testicle, inserts into the right side of the IVC below the right renal vein
  280. Left gonadal vein
    Drains the left ovary or testicle, inserts into the left renal vein, that drains into the IVC
  281. Retroperitoneal fibrosis (RPF)
    Dense, fibrosis tissue proliferation that is confined to the paravertebral and central abdominal region at the fourth or fifth lumbar vertebra, overlying the aortic bifurcation
  282. Retroperitoneal fibrosis: sonographically
    Smooth-marinated, hypoechoic soft-tissue mass encasing the aorta and IVC
  283. Retroperitoneal fibrosis etiology
    Usually idiopathic (of unknown origin), causes may include an autoimmune response, drugs, abdominal aortic aneurysm, infection, retroperitoneal malignancy, radiation therapy and chemotherapy
  284. Strap muscles of neck
    Anterior to the thyroid gland
  285. Stenocleidomastoid muscle of neck
    Anterolateral to the thyroid gland
  286. Common carotid artery and internal jugular vein
    Lateral to thyroid gland
  287. Longus colli muscle
    Posterior to the thyroid gland
  288. Minor neurovascular bundle
    Posterior to the thyroid gland
  289. Parathyroid glands (normally located)
    Posterior to the thyroid gland
  290. Thyroglossal duct
    Embryologically, as primitive cells migrate from the pharyngeal floor to become the thyroid, a residual thyroglossal duct is formed, normally becomes obliterated in fetal life
  291. Thyroglossal duct cyst
    Congenital anomaly that appears as a superficial cyst in the neck anterior to the trachea and superior to the thyroid. Commonly diagnosed in preschool-aged children or during mid-adolescence, and often following an upper respiratory infection
  292. Papillary carcinoma
    Most common malignancy (cancer) of thyroid gland, 75-90% of all cases
  293. Papillary carcinoma
    Spreads through the lympatics to nearby cervical lymph nodes
  294. Papillary carcinoma: sonographically
    Hypoechoic thyroid mass and adjacent enlarged cervical nodes
  295. Multiple Endocrine Neoplasia (MEN) Syndrome
    Pituitary adenoma, Parathyroid adenoma, Medullary thyroid carcinoma, Pancreatic islet cell tumor, Pheochromocytoma
  296. Chronic lymphocytic (Hashimotos ) thyroiditis – autoimmune disease, painless, diffuse enlargement of the thyroid gland in
    young or middle-aged women, associated with hypothyroidism
  297. Chronic lymphocytic (Hashimotos ) thyroiditis: sonographically – diffusely enlarged thyroid, homogeneous, coarse parenchymal echo texture, more hypoechoic than the normal thyroid
  298. Appendix testis
    Remnant of the Mullerian duct.
  299. Appendix testis: sonographically
    Small ovoid structure near the head of epididymis
  300. Appendix epididymis
    Detached efferent duct, small stalk projecting off the epididymis
  301. Tunica albuginea
    Fibrous capsule surrounding the testicle
  302. Tunica vaginalis
    Extension of the peritoneum into the scrotal chamber, resides along the side of testicle
  303. Tunica vaginalis
    Inner or visceral layer covers the testis and epididymis
  304. Tunica vaginalis
    Outer or parietal layer lines the walls of the scrotal chamber, small amount of fluid is commonly seen in this space
  305. Hydrocele
    Collection of serous fluid in within tunica vaginalis lining the scrotum, blood for hematocete, pus for pyocele
  306. Hydrocele: sonographically
    Fluid collection surrounding the testicle, low-level echoes from fibrin or cholesterol Chrystal’s may be visualized within hydrocele
  307. Hydrocele
    Congenital or acquired.
  308. Acquired hydrocele
    Often idiopathic, result of trauma, torsion, neoplasm, epididymitis or epididymorchitis
  309. Varicoceles
    Dilated, tortuous veins of pampiniform plexus, posterior to testis
  310. Varicoceles
    Associated with male infertility
  311. Varicoceles
    Caused by incompetent valves in the internal spermatic vein
  312. Varicoceles
    Commonly appear on the left side, left gonadal vein drains into the left renal vein, patient is upright, performing Vasalva or abdominal compression
  313. Acute scrotal pain
    Torsion of spermatic cord, epidiymo-orchitis
  314. Torsion of spermatic cord
    One to six hours after onset of torsion, testicle becomes enlarged, inhomogeneous and hypoechoic compared to the normal testis
  315. Torsion of spermatic cord: extratesticular
    Enlarged epididymis, skin thickening, reactive hydrocele formation
  316. Torsion of spermatic cord
    Presence of blood flow in testicle would exclude acute torsion, but presence of flow does not exclude partial torsion. 540 degree s of torsion is considered necessary to completely occlude testicular blood flow
  317. Acute epididymitis: sonographically – appears as an enlarged epididymitis, decreased echogenicity and inhomogeneous echo texture, reactive hydrocele formation and skin thickening are associated findings
  318. Enlarged hypoechoic testicle
    Orchitis and testicular torsion
  319. Orchitis
    Inflammatory disease which would cause hypervascularity, increased vascular flow should be noted with color flow
  320. Testicular torsion
    Absence of intratesticular flow
  321. Undescended testis (cryptorchidism)
    Common genitourinary anomaly. 80% of Undescended testes lie at the level of inguinal canal
  322. Cryptorchidism complications
    Infertility and cancer
  323. Infertility
    Result s from pathologic changes that develop in both the Undescended and Contralateral normal testis after the age of one year.
  324. Normally descended testis
    Increased risk if malignancy
  325. Undescended testis after orchiopexy
    Increased risk if malignancy
  326. Acute appendicitis
    Periumbilical pain, leukocytosis, fever, RLQ pain with rebound tenderness
  327. Acute appendicitis
    Develops from the obstruction of the appendiceal lumen.
  328. Acute appendicitis: sonographically
    Appendix grate than 6 mm in diameter.
  329. Acute diverticulitis
    Associated with the presentation of LLQ pain, fever leukocytosis
  330. Acute diverticulitis
    Thickened bowel or abscess formation in LLQ
  331. Target or pseudokidney sign
    Abnormal bowel wall thickening, hypoechoic external rim representing the thickened intestinal wall and an echogenic center relating to the residual gut lumen or mucosal ulceration
  332. Hypertrophic pyloric stenosis
    Hypertrophy of the circular pyloric muscle, resulting in elongation and constriction of the intestines between the stomach and the first portion of the duodenum.
  333. Hypertrophic pyloric stenosis
    Neonates present with projective vomiting, palpable “olive-like” abdominal mass
  334. Hypertrophic pyloric stenosis: sonographically
    Pyloric muscle thickness >4mm, pyloric channel length >1.2cm, pyloric cross section >1.5cm
  335. Intussusceptions
    Most common cause of obstruction in infants
  336. Intussusceptions clinical findings
    Intermittent abdominal pain, vomiting, passage of blood through the rectum
  337. Intussusceptions: sonographically
    Oval, pseudokidney mass, central echoes on longitudinal imaging, sonolucent doughnut or target configuration on cross-sectional imaging
  338. Prostate zones
    Peripheral zone, transition zone, central zone, fibromuscular stroma
  339. Most prostate cancer source
    Peripheral zone 70% of cancer, hypoechoic, peripherally-oriented lesion
  340. Non affected prostate zone
    Fibromuscular stroma non-glandular, anterior portion of the prostate
  341. Benign prostatic hyperplasia (BHP) – enlargement of the inner gland, hypoechoic relative to the peripheral zone, originates exclusively from the inner gland. 95% transition zone, 5% periurethral glands or tissue
  342. Ejaculatory ducts
    Pass through the central zone and empties into the urethra
  343. Base of prostate
    Superior portion of the gland
  344. Apex of the prostate
    Inferior portion of the gland
  345. Surgical capsule
    Demarcation between the inner gland and the outer gland
  346. Prostate is bordered
    Anteriorly by the pubic bone
  347. Prostate is bordered
    Posteriorly by the rectum
  348. Prostate is bordered
    Superiorly by the bladder
  349. Prostate is bordered
    Inferiorly by the urogenital diaphragm
  350. Prostate-Specific Antigen (PSA)
    Produced only by prostatic acinar cells, and rises in relationship to the amount of benign or malignant tissue
  351. PSA level
    Will raise with age, prostate volume, benign prostatic hyperplasia, or prostate cancer
  352. PSA level
    Cancer elevates the PSA level app 10 times compare to benign prostatic hyperplasia
  353. Arcuate line
    End of the posterior sheath of the rectus muscle, above this line hematomas are confined within anterior and posterior rectus sheath, below this line hematomas protrude posteriorly into the pelvis due to the absence of the posterior rectus sheath
  354. Abscess: sonographically
    Complex collections containing cystic and solid components, derbis, septations, gas within abscess. Borders are irregular and thick, posterior enhancement.
  355. Abscess: clinically
    Fever and leukocytosis
  356. Lymphoceles
    Complications of renal transplantation, gynecologic, vascular or urological surgery. The etiology is leakage of lymph due to surgical disruption of the lymphatic channels
  357. Lymphoceles are similar to
    Fluid collections such as loculated ascites, urinomas, hematomas, abscesses. Internal echoes within the fluid collection is sign of abscesses or hematomas
  358. Urinomas
    Result from renal trauma, renal surgery, obstructing lesion
  359. Urinomas
    Associated with renal transplantation and posterior urethral valve obstruction
  360. Urinomas: sonographically
    Similar to Lymphoceles
  361. Hematoma: sonographically
    Variable, depends on the age of collection, echogenic collections due to rapid fibrin invasion. Gradual hemolysis eventually creates anechoic appearance, calcifications are associated with long-standing hematomas
  362. Hematoric
    Percentage of red blood cells per volume of blood, normal range from 40-50%
  363. Low Hematoric level
    Indicates red blood cell loss, caused by internal bleeding, iron deficiency and external blood loss
  364. Baker’s cyst
    Collection of synovial fluid which is found in the medial aspect of popliteal fossa
  365. Baker’s cyst
    May be caused by trauma or rheumatoid arthritis, synovial fluid is very inflammatory and can cause pain. Infection, venous thrombosis or compression of veins causes calf swelling
  366. Pseudomyxoma peritoneli
    Rare condition: filling of the peritoneal cavity with mucinous material and gelatinous ascites. Result of mucinous cystadenocarcinoma of the ovary, appendix …
  367. Pseudomyxoma peritoneli
    Cause rupture of a mucinous cystadenocarcinoma of the appendix or ovary
  368. Neonatal adrenal mass
    Most common cause of adrenal hemorrhage, occurs during the first week of the life, asymptomatic abdominal mass, or mass in the presence of jaundice or anemia
  369. Adrenal hemorrhage
    Depends on the age of hematoma
  370. Portal venous gas
    Indication of bowel infarction same as in ulcerative colitis or necrotizing enterocolitis
  371. Portal venous gas: sonographically
    Linear echogenic branches in the periphery of the liver, echogenic foci within the lumen of the portal vein is seen
  372. Portal vein gas
    Different from biliary gas
  373. Portal vein gas
    Within periphery of liver
  374. Biliary gas
    Located closer to the liver hilium
  375. Nutcracker syndrome
    Compression of left renal vein between SMA and aorta. Dilated left renal vein compared to right.
  376. Nutcracker syndrome
    Left-sided hematuria, abdominal pain, varicocele formation, infertility
  377. Diffuse lymphadenopathy of abdomen
    Layered or mantle appearance around vessels of the abdomen
  378. Lymphadenopathy
    Visualized anterior and posterior to vessels of the abdomen, creating sandwich sign
  379. Graves disease
    Thyroid hyperfunctioning, causing diffuse glandular hyperplasia
  380. Graves disease: clinically
    Exopthalmos, palpable lymph nodes, muscle atrophy, localized myxedema, weight loss, tremors, nervousness
  381. Graves disease: sonographically
    Diffusely enlarged, identical to multinodular goiter, increased vascularity by Doppler
  382. Branchial cleft cyst
    Arises in the left lateral aspect of neck, fromepithelial remnants of the second branchial cleft
  383. Islet cell tumor (insulinoma)
    Hypoglycemia and hypoechoic mass in the tail of pancreas, tumor in body or tail, causes hypersecretions of insulin that leads to hypoglycemia
  384. Pseudocysts and cystadenomas
    Cystic masses associated with pancreas, increased level of serum amylase, in patients without history a history of autosomal dominant polycystic kidney disease
  385. Pseudocysts
    Formed in association with acute or chronic pancreatitis, encapsulated collections of pancreatic enzymes
  386. Pseudocysts: sonographically
    Predominantly anechoic masses with or without dependent derbis, displaces structures like liver, lesser sac, stomach, left kidney or spleen
  387. Cystadenomas
    Rare fluid collection, arise from the epithelium of the pancreatic duct. Primarily cystic, septations and thick walls, easy confused with pseudocysts
  388. Emphysematous cholecystitis
    Acute infection of the gallbladder wall, vascular compromise, bacteria produces gas within the wall of the GB
  389. Emphysematous cholecystitis: sonographically
    Thickened gallbladder wall, gas within the wall produce comet-tail or reverberation artifact, “ring of air”
  390. Emphysematous cholecystitis
    High mortality, large percentage are diabetics, RUQ pain, fever, leukocytosis
  391. Main portal vein
    Splenic vein and SMA join at the confluence adjacent to the head of the pancreas to form MPV
  392. Renal artery
    Evaluation methods: direct evaluation, indirect evaluation
  393. Direct evaluation
    Renal artery velocity evaluation
  394. Indirect evaluation
    Intrarenal waveform evaluation
  395. Five techniques to access renal artery stenosis
    Main renal artery systolic velocity, renal artery/aorta velocity ratio, pulsus parvus at tardus, absent early systolic peak, acceleration (internal waveform)
  396. Degree of stenosis
    • To determine the degree of stenosis in renal arteries peak systolic velocity of mein renal arteries are
    • compared with peak systolic velocity of the aorta. Ratio peak systolic velocity of renal artery divided by peak systolic velocity of the aorta. Greater than 3.5 indicates hemodinamically significant stenosis
  397. Acceleration time
    The time from beginning of systole to the initial peak velocity
  398. Acceleration index
    Derived by dividing the acceleration slope by the transmitted frequency
  399. Acceleration calculations
    >0.1 or <3.78kHz/sec/MHZ indication of hemodinamically significant renal artery stenosis of 50% grater
  400. Tardus
    Prolonged, or delayed early systolic acceleration
  401. Parvus
    Decreased amplitude and rounding of systolic peak
  402. Mesenteric ischemia
    Postprandial intestinal angina, weight loss
  403. Mesenteric ischemia: sonographically
    Peak systolic velocity of SMA >275cm/sec with significant stenosis (70%), peak systolic velocity of CT >200cm/sec significant stenosis (70%)
  404. Mesenteric ischemia
    Intestinal angina, two of three arteries supplying mesentery are occluded or significantly stenosed. Arteries are SMA, CT , inferior mesenteric artery
  405. Gallbladder wall thickening causes (6)
    Ascites, cholecystitis, adenomyomatosis, hypoalbuminemia, congestive heart failure, acute hepatitis
  406. Enlarged gallbladder: causes
    Prolonged fasting, hydrops of the gallbladder (cystic duct obstruction), Courvoisier gallbladder (pancreatic carcinoma), diabetes
  407. Jaundice causes (3)
    Hepatocellular disease, hemolytic disease, surgical jaundice
  408. Hepatocellular disease
    Destruction of hepatocytes that interfere with the excretion of bilirubin (hepatitis, cirrhosis)
  409. Hemolytic disease
    Hepatocytes cannot conjugate bilirubin fast enough to keep up with an increase in red blood cell destruction, creates an increase in indirect or unconjugated bilirubin (sickle cell adenoma)
  410. Surgical jaundice
    Mechanical obstruction of biliary tree, causes increase in direct or conjugated bilirubin (choledocholithiasis, cholangiocarcinoma, pancreatic disease)
  411. Solid testicular mass
    Periaortic region should be evaluated for lymphadenopathy
  412. Solid renal mass
    IVC and renal veins evaluated for tumor extension
  413. Solid mass filling GB
    The liver should be evaluated for metastatic disease, for verifying the malignant nature of GB mass
  414. Solid pancreatic mass
    Need to evaluate liver for metastatic disease, biliary tree and pancreatic duct dilatation, regional lymphadenopathy, portal vein and splenic vein for thrombosis
  415. Endocrine
    Function of pancreas to produce insulin. Islets of langerhans are insulin producing cells
  416. Exocrine
    Function of pancreas to produce amylase, lipase, carboxypeptidase, trypsin, chymotrypsin. Acinar cells are producing enzymes
  417. Transplant kidney
    Located in the right pelvis within retroperitoneum.
  418. Transplant kidney: possible fluid collections
    Urinoma, lymphocele, hematoma, abscess
  419. Acute renal vein thrombosis: sonographically
    Dilated and echo-filled renal vein, absence of intrarenal venous flow, an enlarged kidney, hypoechoic renal parenchyma, highly resistive renal artery waveform
  420. Retroperitoneal lymphadenopathy
    Posterior to IVC displacing it anteriorly
  421. Lymph nodes: sonographically
    Anechoic or hypoechoic masses without acoustic enhancement
  422. Pancreatic head
    Anterior to the IVC
  423. Pancreatic head
    Inferior to the portal vein
  424. Pancreatic head
    Medial to second portion of the duodenum
  425. Uncinate process
    Posterior to SMV
  426. Right adrenal gland
    Superior anteromedial to the kidney
  427. Right adrenal gland
    Posterior to the IVC
  428. Right adrenal gland
    Anterior to the crus of diaphragm
  429. Left adrenal gland
    Posterior to the tail of pancreas
  430. Left adrenal gland
    Anterior to the crus of the diaphragm
  431. Hepatoblastoma
    Most common primary liver tumor in children
  432. Hydronephrosis
    Most common neonatal abdominal mass
  433. Wilm’s tumor
    Most common solid abdominal mass in children
  434. Neuroblastoma
    Is second most common solid mass in children
  435. Multicystic dysplastic kidney
    Most common form of cystic disease in infants
  436. Right renal artery and right adrenal gland
    Posterior to the IVC
  437. IVC
    Posterior to head of pancreas
  438. Cold nodule
    Seen in nuclear medicine thyroid scintigraphy, indicating hypofunctioning area
  439. Benign thyroid nodules
    Adenomas, commonly appear as hypofunctioning or cold thyroid nodules on a nuclear medicine thyroid scintigram
  440. Milk of calcium bile
    Precipitation of particulate material in GB, high concentration of calcium carbonate, calcium phosphate, calcium bilirubinate
  441. Milk of calcium bile: clinically
    Chronic cholecystitis due to gallstones or obstruction of cystic duct
  442. Multiple endocrine Neoplasia
    Familial, autosomal dominant, adenomatous hyperplasia
  443. Multiple endocrine Neoplasia: associated tumors(4)
    Parathyroid adenoma, medullary thyroid carcinoma, pancreatic islet cell tumor, pheochromocytoma
  444. Biliary obstruction elevating lab values(3)
    Conjugated bilirubin, alkaline phosphate, gamma glutamyl transpeptidase
  445. Tumor maker lab values
    Alpha-fetoprotein, carcinoembryonic antigen(CEA)
  446. Pseudokidney sign
    Inflammatory bowel
  447. Water lily sign
    Echinococcal cysts
  448. Parallel channel sign
    Intrahepatic duct dilatation
  449. Double bubble sign
    Duodenal atresia
  450. Olive sign
    Hypertrophic pyloric stenosis
  451. Comet tail or reverberation artifact makers
    Adenomyomatosis, emphysematous cholecystitis, Pneumobilia
  452. Propagation speed artifact making structures
    Hepatic Lipoma, angiomyolipomas, adrenal myelolipoma (common denominator = fatty tumors)

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