1
Q
What is considered a normal diameter for the Common Bile Duct (CBD)?
A
A normal CBD measures less than 6 mm.
2
Q
What is the acceptable diameter for the CBD after a cholecystectomy?
A
After a cholecystectomy, the CBD can be up to 7-8 mm because it dilates after losing its reservoir function.
3
Q
What does a dilated CBD (greater than 6-8 mm) suggest?
A
A dilated CBD suggests obstruction.
4
Q
What is choledocholithiasis?
A
Choledocholithiasis is a stone in the distal common bile duct.
5
Q
How is choledocholithiasis identified on ultrasound?
A
It is identified by an echogenic focus with shadowing within the duct lumen.
6
Q
What associated finding might be present with a pancreatic head mass causing CBD obstruction?
A
Dilated intrahepatic ducts can be an associated finding.
7
Q
How is a pancreatic head mass identified as a cause of CBD obstruction?
A
It is identified as a hypoechoic mass compressing the duct.
8
Q
What are signs of pancreatitis that might indicate pancreatic inflammation as a cause of CBD obstruction?
A
Signs include an enlarged, edematous pancreas with visible peripancreatic fluid and edema.
9
Q
What might cause a stricture leading to CBD obstruction?
A
Strictures can be caused by post-sphincterotomy changes or malignancy.
10
Q
How is a stricture identified on ultrasound?
A
It is identified by an abrupt narrowing of the duct, often with a history of ERCP.
11
Q
What is Mirizzi syndrome?
A
Mirizzi syndrome occurs when a large stone impacted in the gallbladder neck compresses the CBD externally.
12
Q
How does the ‘Probe Trick’ help differentiate obstruction from non-obstruction?
A
If the duct compresses easily, it may not be obstructed. If it resists compression, it is likely obstructed and tense.
13
Q
Why is the pancreas considered a challenging organ to visualize with ultrasound?
A
It lies deep in the retroperitoneum, is often obscured by bowel gas, and is surrounded by fat which makes contrast difficult.
14
Q
What scanning tip can be used to improve visualization of the pancreas?
A
Using the left kidney or spleen as an acoustic window can help, as these are anechoic structures that transmit sound well.
15
Q
What are the normal size ranges for the different parts of the pancreas?
A
Head: 2-3 cm, Body: 1.5-2.5 cm, Tail: 2-3 cm.
16
Q
What is the normal echotexture of the pancreas?
A
It is hypoechoic to the liver (darker) with a homogeneous granular echo pattern.
17
Q
How does the echotexture of the pancreas change with age?
A
It becomes more echogenic with age due to fat infiltration.
18
Q
What is the normal diameter of the Main Pancreatic Duct?
A
The Main Pancreatic Duct measures less than 3 mm in diameter.
19
Q
What are the characteristic features of the Main Pancreatic Duct on ultrasound?
A
It has echogenic walls (bright lines) and runs horizontally through the pancreatic body towards the ampulla.
20
Q
What are the classic patient presentation symptoms of acute pancreatitis?
A
Severe epigastric pain, elevated lipase/amylase.
21
Q
What is a significant USG finding for acute pancreatitis, and what does it indicate?
A
Enlarged pancreas (body >4 cm), indicating edema from inflammation and serving as a severity marker.
22
Q
What does decreased echogenicity (hypoechoic) of the pancreas on USG suggest in acute pancreatitis?
A
Inflammation and edema, indicating an active process.
23
Q
What does blurred pancreatic borders on USG signify in the context of acute pancreatitis?
A
Edema spreading beyond the organ, indicating severe inflammation.
24
Q
What is the significance of peripancreatic fluid found on USG in acute pancreatitis?
A
It is exudate from the inflamed pancreas and indicates severity.
25
What does a non-dilated main pancreatic duct on USG suggest in acute pancreatitis?
The duct is patent, meaning there is no obstruction. This helps distinguish it from chronic pancreatitis.
26
In the provided example, what was the measurement of the pancreas body, and what did it indicate?
The pancreas body was 4.8 cm, which is dilated from a baseline of 1.5 cm, indicating edema.
27
What was the echotexture of the pancreas in the example, and what does this suggest?
The echotexture was uniformly hypoechoic, suggesting inflammation and edema.
28
What was observed about the pancreatic borders in the example, and what does this imply?
The borders were blurred, not sharp, implying severe inflammation spreading beyond the organ.
29
What was the measurement of the pancreatic duct in the example, and what was its significance?
The duct was 2.5mm, which is normal and not dilated, indicating no obstruction.
30
What was noted about the peripancreatic fat in the example, and what does this suggest?
The peripancreatic fat showed edematous, hypoechoic streaks, indicating inflammation.
31
Based on the USG findings in the example, what was the interpretation?
Acute pancreatitis (edema type).
32
What is the recommended next step for grading severity if acute pancreatitis is severe or complicated, according to the example?
CT scan for grading severity using the Balthazar score.
33
What is a key distinction made by a normal pancreatic duct on imaging in acute pancreatitis?
It differentiates acute pancreatitis from obstruction-related causes.
34
What is the primary characteristic of chronic pancreatitis in contrast to acute pancreatitis?
Chronic pancreatitis is characterized by progressive, irreversible damage to the pancreas, whereas acute pancreatitis is a sudden, reversible inflammation.
35
How does the pancreas size typically change in chronic pancreatitis compared to acute pancreatitis?
In chronic pancreatitis, the pancreas typically becomes shrunken (less than 2 cm), while in acute pancreatitis, it is often enlarged (greater than 4 cm).
36
What does a shrunken pancreas size in chronic pancreatitis signify?
A shrunken pancreas size in chronic pancreatitis signifies atrophy due to fibrosis.
37
Describe the typical echotexture of the pancreas in chronic pancreatitis.
In chronic pancreatitis, the pancreas typically has a hyperechoic (bright) echotexture, indicating fatty infiltration.
38
How does the echotexture of the pancreas in chronic pancreatitis differ from acute pancreatitis?
In chronic pancreatitis, the echotexture is hyperechoic (bright) due to fatty infiltration, while in acute pancreatitis, it is hypoechoic (dark).
39
What is the typical appearance of the main pancreatic duct in chronic pancreatitis?
The main pancreatic duct in chronic pancreatitis is typically dilated (greater than 3-5 mm) due to obstruction from fibrosis.
40
How does the main pancreatic duct in chronic pancreatitis compare to acute pancreatitis?
In chronic pancreatitis, the main pancreatic duct is dilated, whereas in acute pancreatitis, it is usually normal (less than 3 mm).
41
What causes the dilation of the main pancreatic duct in chronic pancreatitis?
The dilation of the main pancreatic duct in chronic pancreatitis is caused by obstruction from fibrosis.
42
Describe the characteristic appearance of the pancreatic duct in chronic pancreatitis.
The pancreatic duct in chronic pancreatitis often appears as a 'chain of lakes,' characterized by alternating dilations and strictures.
43
What does the 'chain of lakes' sign in the pancreatic duct indicate?
The 'chain of lakes' sign indicates alternating dilations and narrowings (strictures) within the pancreatic duct.
44
Are calcifications typically present in chronic pancreatitis?
Yes, calcifications are typically present in chronic pancreatitis.
45
What do calcifications in the pancreas represent in chronic pancreatitis?
Calcifications in the pancreas represent pancreatic stones formed from inspissated secretions.
46
How do calcifications appear on ultrasound in chronic pancreatitis?
Calcifications appear as echogenic foci with posterior shadowing on ultrasound.
47
What is the 'Chain of Lakes' Sign and what condition is it pathognomonic for?
The 'Chain of Lakes' Sign refers to alternating echo-lucent (cystic) areas within the pancreatic duct and is pathognomonic for chronic pancreatitis.
48
What is the meaning of a shrunken pancreas in chronic pancreatitis?
A shrunken pancreas in chronic pancreatitis means atrophy due to fibrosis.
49
What is the meaning of a hyperechoic echotexture in chronic pancreatitis?
A hyperechoic echotexture in chronic pancreatitis means fatty infiltration.
50
What is the meaning of a dilated main duct in chronic pancreatitis?
A dilated main duct in chronic pancreatitis means duct obstruction from fibrosis.
51
What is the meaning of the 'chain of lakes' appearance of the duct in chronic pancreatitis?
The 'chain of lakes' appearance signifies alternating dilations and narrowings of the duct due to fibrosis.
52
What is the meaning of calcifications in chronic pancreatitis?
Calcifications in chronic pancreatitis mean pancreatic stones from inspissated secretions.
53
How does the pancreas size differ between acute and chronic pancreatitis?
In acute pancreatitis, the pancreas is typically enlarged (>4cm), while in chronic pancreatitis, it is shrunken (<2 cm).
54
How does the echotexture differ between acute and chronic pancreatitis?
In acute pancreatitis, the echotexture is hypoechoic (dark), while in chronic pancreatitis, it is hyperechoic (bright).
55
How does the main pancreatic duct character differ between acute and chronic pancreatitis?
In acute pancreatitis, the main pancreatic duct is normal (<3mm) and has smooth borders, while in chronic pancreatitis, it is dilated (>3-5mm) and has a 'chain of lakes' appearance.
56
Are calcifications present in acute or chronic pancreatitis?
Calcifications are typically absent in acute pancreatitis and present in chronic pancreatitis.
57
What is the normal length of a kidney?
9-12 cm
58
Which kidney is typically larger, the left or the right?
The left kidney is usually larger than the right by 0.5-1 cm.
59
What is the approximate anterior-posterior diameter of a normal kidney?
~5 cm
60
What is the normal width of a kidney?
~3-4 cm
61
How is the echotexture of the renal cortex described in relation to the liver?
Hypoechoic to liver (darker).
62
How is the echotexture of the renal cortex described in relation to the spleen?
Hyperechoic to spleen (brighter).
63
What is the echotexture of the renal cortex compared to the splenic cortex at the same depth?
Isoechoic to splenic cortex on same depth.
64
What are the medullary pyramids in the context of renal echotexture?
Hypoechoic (dark triangular areas pointing toward the pelvis).
65
How is the renal cortex's echotexture described relative to the medullary pyramids?
Slightly hyperechoic relative to the pyramids.
66
What does clear corticomedullary differentiation (CMD) indicate?
Preserved renal function.
67
What can a loss of corticomedullary differentiation (CMD) indicate?
Chronic kidney disease, fibrosis, or atrophy.
68
What is hydronephrosis?
Hydronephrosis is the dilation of the renal pelvis and calyces due to urine obstruction.
69
What grading system is commonly used for hydronephrosis?
The SFU grading system (Society for Fetal Urology) is the standard for all ages.
70
What is the definition of SFU Grade 1 hydronephrosis?
Grade 1 is defined by a dilated renal pelvis only, with no dilation of the calyces.
71
What is the parenchyma and prognosis for SFU Grade 1 hydronephrosis?
The parenchyma is normal thick cortex with sharp papillae, and the prognosis is mild, likely resolves, with monitoring recommended.
72
What characterizes SFU Grade 2 hydronephrosis?
Grade 2 involves a dilated renal pelvis and a few dilated calyces.
73
What is the parenchyma and prognosis for SFU Grade 2 hydronephrosis?
The cortex is still adequate with visible papillae, and the prognosis is moderate, requiring observation and follow-up.
74
How is SFU Grade 3 hydronephrosis defined?
Grade 3 is characterized by a dilated renal pelvis and dilation of all calyces.
75
What are the parenchyma and prognosis for SFU Grade 3 hydronephrosis?
The papillae are becoming blunt, the cortex is thinner, and the prognosis is severe with a risk of obstruction, requiring urgent imaging.
76
What defines SFU Grade 4 hydronephrosis?
Grade 4 involves massive dilatation with no distinction between the renal pelvis and calyces.
77
What is the parenchyma and prognosis for SFU Grade 4 hydronephrosis?
The cortex is thin and atrophic with greater than 75% loss, and the prognosis is critical with a risk of renal failure, requiring emergency intervention.
78
How does stone detection sensitivity change with SFU grades 1-3?
Stone detection sensitivity increases from Grade 1 to Grade 3 (50% to 71%).
79
What happens to stone detection sensitivity in SFU Grade 4 hydronephrosis?
Stone detection sensitivity drops significantly to 42% in Grade 4.
80
What are possible reasons for the drop in stone detection sensitivity in Grade 4 hydronephrosis?
Chronic obstruction can lead to stone resorption, passage, or initial misdetection. The chronic dilated system can also obscure a fresh stone.
81
What is the urgency for SFU Grade 1 hydronephrosis?
The urgency is to monitor.
82
What is the urgency for SFU Grade 2 hydronephrosis?
The urgency is to follow.
83
What is the urgency for SFU Grade 3 hydronephrosis?
The urgency is urgent imaging due to the risk of obstruction.
84
What is the urgency for SFU Grade 4 hydronephrosis?
The urgency is emergency due to the risk of renal failure.
85
What does a hyperechoic kidney (brighter than the liver) suggest?
Medical renal disease.
86
What are common causes of medical renal disease leading to a hyperechoic kidney?
Chronic glomerulonephritis, diabetic nephropathy, chronic hypertensive damage, and end-stage renal disease (ESRD).
87
What clinical findings, when combined with a small (<8 cm) and hyperechoic kidney, suggest Stage 4-5 CKD?
A small (<8 cm) kidney size and a hyperechoic cortex.
88
What is the implication of a small (<8 cm) hyperechoic kidney with a hyperechoic cortex?
It indicates a high risk of needing dialysis, likely Stage 4-5 CKD.
89
What management steps should be taken for a patient with findings suggestive of Stage 4-5 CKD?
Check creatinine and GFR, and refer to nephrology.
90
What is the medical term for a kidney infection?
Acute pyelonephritis.
91
What are the classic clinical symptoms of acute pyelonephritis?
Fever, flank pain, pyuria, and a positive urine culture.
92
What does an enlarged kidney on ultrasound suggest in the context of a kidney infection?
Edema from inflammation.
93
What might a hypoechoic focal area, usually in the pyramidal region, indicate on ultrasound for a kidney?
A pyelonephritis focus.
94
What is the classic ultrasound pattern for inflammation in the kidney's pyramid region?
A triangular shape.
95
What does loss of normal striation in the kidney on ultrasound indicate?
Edema obscuring corticomedullary differentiation.
96
What does decreased perfusion on power Doppler of the kidney suggest?
Reduced blood flow due to edema and inflammation.
97
What can acute pyelonephritis progress to if left untreated?
Renal abscess.
98
How does a renal abscess typically appear on ultrasound?
As a hypoechoic complex collection inside the kidney.
99
What is the required management for a renal abscess?
Drainage.
100
What is the most common type of kidney stone?
Calcium oxalate stones are the most common type, accounting for 75% of cases.
101
What is the appearance of calcium oxalate stones on ultrasound?
Calcium oxalate stones appear echogenic and cast a strong shadow on ultrasound.
102
What is the frequency of struvite stones?
Struvite stones account for 15% of kidney stones.
103
What is a predisposing factor for struvite stones?
Recurrent urinary tract infections (UTIs) are a predisposition for struvite stones.
104
What is the appearance of uric acid stones on ultrasound?
Uric acid stones appear echogenic on ultrasound.
105
What is a key characteristic of uric acid stones on CT scans?
Uric acid stones are lucent (do not absorb X-rays) on CT scans, despite being visible on ultrasound.
106
What is the frequency of cystine stones?
Cystine stones account for 2% of kidney stones.
107
What genetic condition is associated with cystine stones?
Inherited cystinuria is associated with cystine stones.
108
Which location is the most common for kidney stones to lodge?
The ureterovesical junction (UVJ) is the most common location, accounting for 36.5% of lodges.
109
What is the second most common location for stones to lodge?
The renal pelvis is the second most common location, accounting for 23% of lodges.
110
What are the three key findings that suggest a kidney stone?
Pain, hydronephrosis, and an echogenic focus (especially with acoustic shadow) are indicative of a stone.
111
What is the diagnosis for a patient with acute flank pain, a visible echogenic stone with acoustic shadow in the renal pelvis, and no fever or elevated WBC?
This presentation is consistent with uncomplicated renal colic (nephrolithiasis).
112
What is the next imaging study recommended for assessing stone size and burden in a patient with suspected nephrolithiasis?
A CT KUB (Kidney, Ureter, Bladder) is recommended.
113
What is the success rate of medical expulsive therapy for stones less than 6mm?
Medical expulsive therapy is effective in passing approximately 80% of stones less than 6mm.
114
What is the appearance of struvite stones on ultrasound?
Struvite stones appear echogenic with variable shadowing on ultrasound.
115
What is the appearance of uric acid stones on CT?
Uric acid stones are lucent on CT scans.
116
What is the appearance of cystine stones on ultrasound?
Cystine stones appear echogenic with variable shadowing on ultrasound.
117
What is the percentage of stones found in the ureteropelvic junction (UPJ)?
16.7% of stones lodge in the ureteropelvic junction (UPJ).
118
What is the percentage of stones found in the upper ureter?
11.9% of stones lodge in the upper ureter.
119
What is the risk factor for uric acid stones?
A history of gout and acidic urine are risk factors for uric acid stones.
120
What is the risk factor for calcium oxalate stones?
Hypercalcemia is a risk factor for calcium oxalate stones.
121
What is the appearance of stones on USG that have a strong shadow?
Calcium oxalate stones typically have a strong shadow on ultrasound.
122
What is the appearance of stones on USG that have a weak or absent shadow?
Uric acid stones often have a weak or absent shadow on ultrasound.
123
What is the typical appearance of a kidney stone on ultrasound?
Kidney stones typically appear as echogenic foci with acoustic shadowing on ultrasound.
Radio diagnosis
flashcards
Decks in class (21)
# Cards
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basics and usg abdo184
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usg abdo 2123
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usg abdo 3156
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machines161
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MRI150
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mri and c270
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usg145
-
contrast media78
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GI131
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Intestine156
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gallbladder117
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gallbladder 232
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Kidneysss158
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Uretheral trauma ovaries and pregnancy130
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thoracic radio210
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thoracic park 2108
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neuroradio139
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neuroradio 296
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MSK145
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nuclear radio155
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nuclear radio 2119
