What does hypoechoic fluid adjacent to the left lateral aspect of an abdominal aortic aneurysm (AAA) suggest?
- Pseudoaneurysm
- Chronic contained retroperitoneal haematoma
This indicates potential complications such as rupture, requiring further assessment.
What is the systematic assessment for a suspected AAA with adjacent hypoechoic fluid?
- Scan AAA in multiple planes
- Apply graded pressure
- Compare bilateral retroperitoneal regions
- Assess aortic wall integrity
Document AAA diameter, location, and extent of fluid collection.
True or false: A pseudoaneurysm typically appears anechoic and demonstrates internal flow on colour Doppler.
TRUE
This indicates ongoing communication with the aortic lumen.
What are the characteristics of a retroperitoneal haematoma?
- Hypoechoic
- Ill-defined
- Located lateral to the AAA
- Often tracks along the psoas muscle
It typically has no internal vascular flow.
What is the initial interpretation of hypoechoic peri-aortic fluid adjacent to an AAA?
- Red flag for contained rupture
- Differential diagnoses: Pseudoaneurysm, Chronic contained retroperitoneal haematoma
This finding has a high rupture risk.
What does a normal Valsalva manoeuvre indicate during DVT assessment?
- Patency of inferior vena cava
- Patency of common iliac veins
- No proximal obstruction
It tests venous flow continuity between the CFV and the right atrium.
What does augmentation test in DVT assessment?
- Patency between popliteal vein and CFV
A normal response indicates unobstructed proximal pathway.
Why do normal Valsalva and augmentation responses not exclude calf DVT?
- Calf veins are paired and parallel
- Flow can bypass an occluded calf vein
Symptoms can persist due to local calf vein thrombosis.
What should be done next clinically if DVT is suspected despite normal Valsalva and augmentation?
- Extend compression below the knee crease
- Assess gastrocnemius, posterior tibial, peroneal, and anterior tibial veins
Use symptom-guided scanning and apply compression every 1–2 cm.
What is the most likely cause of a 13 mm smaller left kidney in an older patient?
Unilateral renal artery stenosis (RAS) secondary to atherosclerosis
Chronic reduced perfusion leads to ischaemic atrophy.
What imaging techniques are used to assess renal artery stenosis (RAS)?
- B-mode imaging of bilateral kidneys
- Colour Doppler of main renal arteries
- Spectral Doppler from origin to distal segments
Measure peak systolic velocity (PSV) and renal-to-aortic ratio (RAR).
What does a tardus parvus waveform indicate in intrarenal arteries?
Delayed systolic upstroke
This is caused by reduced inflow through a proximal stenosis.
What does an elevated resistive index suggest in renal assessment?
Chronic parenchymal damage
It indicates reduced compliance of the kidney.
What is the high-distinction rescue line for assessing AAA with adjacent hypoechoic fluid?
“Any peri-aortic hypoechoic collection adjacent to an AAA must be treated as a contained rupture until proven otherwise.”
This emphasizes the urgency of the finding.
What does the renal-to-aortic ratio (RAR) indicate when calculated?
Significance of renal artery stenosis
RAR >3.5 suggests significant RAS.
What is the purpose of evaluating intrarenal arteries?
- Assess downstream haemodynamic effect of renal artery stenosis
- Confirm functional significance of stenosis
Useful when the main renal artery is difficult to visualize.
