1
Q
What Doppler finding indicates significant renal artery stenosis (>60%) based on Peak Systolic Velocity (PSV)?
A
A PSV greater than 200 cm/s indicates narrowing causing acceleration.
2
Q
What Resistive Index (RI) value suggests severe stenosis or post-stenotic dilation in renal arteries?
A
An RI greater than 0.8 suggests high resistance, indicating severe stenosis or post-stenotic dilation.
3
Q
What is the significance of a tardus parvus waveform in the context of renal artery stenosis?
A
A tardus parvus waveform, characterized by a delayed systolic rise time, indicates a dampened and sluggish acceleration, suggesting a distal stenotic effect.
4
Q
What is considered an abnormal acceleration time in Doppler assessment for renal artery stenosis?
A
An acceleration time greater than 0.09 seconds is considered abnormal, with a normal value being less than 0.06 seconds.
5
Q
What is the reported sensitivity of Doppler ultrasound for renal artery stenosis when optimally performed?
A
The sensitivity of Doppler US for renal artery stenosis is 85-98% when optimally performed.
6
Q
What is the most critical finding related to the aorta that requires immediate attention in radiology?
A
Abdominal Aortic Aneurysm (AAA) is the most critical finding, as missing it can be fatal.
7
Q
When measuring an abdominal aorta for aneurysm, what is the CRITICAL measurement rule to follow?
A
You should measure from OUTER wall to OUTER wall, not the lumen.
8
Q
What is considered a normal outer-to-outer wall measurement for the aorta?
A
A normal aorta measures less than 3 cm from outer-to-outer wall.
9
Q
What is the definition of an Abdominal Aortic Aneurysm (AAA) based on outer-to-outer wall measurement?
A
An AAA is defined as a focal dilation of the aorta measuring greater than or equal to 3 cm (outer-to-outer wall), representing a >150% increase from normal.
10
Q
What clinical signs might suggest that a patient is at imminent risk of AAA rupture?
A
A tender pulsatile mass and hemodynamic shock are signs that rupture is imminent.
11
Q
Why is it important to measure the aorta from outer wall to outer wall when assessing for AAA?
A
Measuring outer-to-outer wall is crucial because wall thickness contributes to the total diameter and the rupture strength of the aorta.
12
Q
What is the most common shape of an AAA?
A
Fusiform (90%)
13
Q
What does a fusiform shape in an AAA indicate?
A
Circumferential dilation - symmetric
14
Q
What is the less common shape of an AAA?
A
Saccular (10%)
15
Q
What does a saccular shape in an AAA indicate?
A
Focal bulge on one side - asymmetric
16
Q
What is the most common location of an AAA?
A
Infrarenal (90%)
17
Q
What does an infrarenal location of an AAA mean?
A
Below renal arteries - easier to repair
18
Q
What is the less common location of an AAA?
A
Suprarenal (10%)
19
Q
What does a suprarenal location of an AAA mean?
A
Above renal arteries - risky repair
20
Q
What is the typical appearance of the blood lumen in an AAA?
A
Anechoic blood lumen
21
Q
What may be seen within the wall of an AAA?
A
May show echogenic thrombus
22
Q
What does echogenic thrombus in the AAA wall represent?
A
Mural thrombus lining wall
23
Q
What is the female cutoff size for surveillance management of an AAA?
A
<5.0 cm
24
Q
What is the male cutoff size for surveillance management of an AAA?
A
<5.5 cm
25
What is the annual rupture risk for AAAs smaller than the surveillance cutoff?
<1%/year
26
What is the recommended management for AAAs <5.0 cm (F) or <5.5 cm (M)?
Surveillance (US/CT q6-12 mo)
27
What are the size ranges for considering surgery for an AAA?
5.0-5.5 cm (F), 5.5-7 cm (M)
28
What is the annual rupture risk for AAAs in the 5.0-5.5 cm (F) or 5.5-7 cm (M) range?
5-10%/year
29
What is the size cutoff for urgent surgery for an AAA?
>5.5 cm (F), >7 cm (M)
30
What is the annual rupture risk for AAAs larger than the urgent surgery cutoff?
20%+/year
31
What is the mortality rate if a ruptured AAA is untreated?
90% mortality
32
What is the immediate management for a ruptured AAA?
STAT OR
33
What is the recommended surveillance interval for an AAA of 3.5 cm?
US q6-12 months
34
When should surgery be considered for an AAA of 5.3 cm?
When the risk of rupture is greater than the risk of surgery.
35
What is the indication for taking an AAA of 7.2 cm with hypotension to the OR?
Ruptured/free rupture imminent
36
What are the classic signs of a ruptured AAA?
Pulsatile abdominal mass, severe sudden back pain + hypotension
37
What is the approximate mortality if a patient presents with a pulsatile mass and shock due to AAA rupture and is not operated on?
Near-100% mortality
38
What USG finding suggests a ruptured AAA?
Massive free retroperitoneal fluid (blood)
39
What does hemodynamic shock in the context of a ruptured AAA indicate?
Patient in extremis
40
When should imaging be bypassed for a suspected ruptured AAA?
When the patient is unstable and needs immediate surgical intervention.
41
What is the normal direction of portal vein flow?
Hepatopetal, meaning toward the liver.
42
What color typically represents normal portal vein flow on color Doppler?
Red, indicating flow coming toward the transducer.
43
What is the normal velocity range for portal vein flow?
15-25 cm/s.
44
What is the normal diameter of the portal vein at the porta?
Less than 10 mm.
45
What is the typical waveform of a normal portal vein?
Slightly pulsatile, due to transmission from the heart.
46
What is the clinical significance of hepatopetal flow in the portal vein?
It indicates normal liver perfusion.
47
What are common causes of Portal Vein Thrombosis (PVT)?
Malignancy (pancreatic > hepatic > splenic), cirrhosis, pancreatitis, and hypercoagulable states (e.g., myeloproliferative disorders, Factor V Leiden).
48
How does echogenic thrombus appear on ultrasound in the portal vein?
As bright material inside the portal vein lumen, with no flow signal on Doppler.
49
What is observed on Doppler when there is absent flow in the portal vein lumen?
The portal vein lumen is visible but empty, and there is no spectral waveform on pulsed-wave (PW) Doppler.
50
What USG finding is associated with a dilated portal vein?
A diameter greater than 13 mm, often indicating congestion proximal to a thrombus.
51
What is 'cavernous transformation' of the portal vein?
Multiple small vessels that replace a thrombosed vein, appearing as collateral vessels on ultrasound.
52
What are the reported sensitivity and specificity of Doppler for detecting PVT?
Sensitivity is 89% and specificity is 92%.
53
What is a potential pitfall when interpreting 'no flow' on Doppler in the portal vein?
It does not always mean thrombosis; it can indicate slow flow, especially in cirrhosis, requiring clinical correlation.
54
Which malignancy is most commonly associated with PVT?
Pancreatic malignancy.
55
What is the most common cause of PVT in cirrhotic patients?
Cirrhosis itself.
56
How does local inflammation from pancreatitis contribute to PVT?
The inflammation can lead to thrombus formation in the portal vein.
57
What type of hypercoagulable state can lead to PVT?
Myeloproliferative disorders and Factor V Leiden mutation.
58
What does 'hepatopetal' flow signify?
Flow directed towards the liver.
59
What does 'hepatofugal' flow signify?
Flow directed away from the liver (abnormal).
60
What is the typical appearance of a thrombosed portal vein on grayscale ultrasound?
Echogenic material filling the lumen.
61
What is the significance of a dilated portal vein (>13 mm)?
It can indicate obstruction or thrombus, leading to congestion proximal to the blockage.
62
What is the role of pulsed-wave (PW) Doppler in assessing portal vein flow?
It allows for measurement of flow velocity and assessment of the waveform.
63
Why is clinical correlation important when interpreting 'no flow' on Doppler of the portal vein?
Because slow flow, which may not be detected by Doppler, can occur in conditions like cirrhosis and mimic thrombosis.
64
What is the normal direction of blood flow in the portal vein?
Hepatopetal (red)
65
What does a hepatofugal (blue, reversed) direction of blood flow in the portal vein indicate?
Emergency - severe decompensation
66
What is the normal diameter of the portal vein?
<10 mm
67
What portal vein diameter is considered elevated in portal hypertension?
>13 mm
68
What is the normal hepatic vein waveform?
Triphasic (pulsatile)
69
What does a monophasic or reversed hepatic vein waveform suggest?
Outlet obstruction from fibrosis
70
What is a normal Doppler velocity in the portal vein?
Normal
71
What does reduced or reversed Doppler velocity in the portal vein indicate?
Poor hepatic clearance
72
What is the clinical significance of reversed portal flow on Doppler in a cirrhotic patient?
High risk of variceal bleed, indicating endoscopy is indicated.
73
What is the volume range for Grade 1 (Mild) ascites?
200-600 mL
74
Where is Grade 1 (Mild) ascites typically located?
Pelvic cul-de-sac ONLY
75
How does Grade 1 (Mild) ascites appear clinically?
Not clinically apparent - incidental finding
76
What is the volume range for Grade 2 (Moderate) ascites?
600-800 mL
77
Where is Grade 2 (Moderate) ascites typically located?
Paracolic gutters + pelvis
78
How does Grade 2 (Moderate) ascites appear clinically?
Mild abdominal distention
79
What is the volume range for Grade 3 (Moderate-Severe) ascites?
800-1000 mL
80
Where is Grade 3 (Moderate-Severe) ascites typically located?
All quadrants
81
How does Grade 3 (Moderate-Severe) ascites appear clinically?
Obvious distention, umbilical protrusion
82
What is the volume range for Grade 4 (Severe) ascites?
>1200-1900 mL
83
Where is Grade 4 (Severe) ascites typically located?
All quadrants, loculated
84
How does Grade 4 (Severe) ascites appear clinically?
Severe distention, dyspnea, respiratory embarrassment
85
What is the minimum detectable volume of ascites on transvaginal ultrasound?
10 mL
86
What is the minimum detectable volume of ascites on transabdominal ultrasound?
~50 mL
87
When is ascites usually clinically apparent?
Usually >1500 mL (Grade 4)
88
What bedside test for ascites indicates at least 1000 mL of fluid when a patient has obvious abdominal distention?
Percussion fluid wave present
89
What bedside test for ascites indicates at least 500 mL of fluid when a patient has obvious abdominal distention?
Shifting dullness present
90
What does an anechoic (black) appearance of ascites fluid suggest?
It suggests clear fluid, likely a transudate, which is benign and has low protein content (less than 2.5 g/dL). This is often seen in conditions like cirrhosis or heart failure.
91
What does echogenic or debris-filled ascites indicate?
Swirling echoes inside the fluid suggest it is hemorrhagic or exudate, indicating bleeding (from trauma or malignancy) or infection.
92
What are septations within ascites fluid indicative of?
Visible divisions or septations suggest loculated ascites, which can be associated with TB peritonitis, malignancy, or post-operative adhesions.
93
What does the presence of mobile bowel loops in ascites suggest?
Bowel loops floating freely indicate an open peritoneal cavity and simple ascites, suggesting that the fluid can be accessed safely.
94
What does the FAST exam stand for?
FAST stands for Focused Assessment with Sonography for Trauma.
95
What is the primary purpose of the FAST exam?
The primary purpose of the FAST exam is to look for free intraperitoneal fluid, specifically blood in trauma patients.
96
What are the four zones examined during a FAST exam?
The four zones are the RUQ (Morrison's pouch), LUQ (splenorenal pouch), Pelvic (pelvic cul-de-sac), and Pericardial (around the heart).
97
Where is Morrison's pouch located and why is it important in a FAST exam?
Morrison's pouch is located in the RUQ, between the kidney and the liver. It is the best place to detect free fluid during a FAST exam.
98
What is the splenorenal pouch and where is it found?
The splenorenal pouch is located in the LUQ, between the spleen and the kidney.
99
What part of the body is examined in the pelvic view of a FAST exam?
The pelvic cul-de-sac is examined in the pelvic view of a FAST exam. In women, this is also known as the pouch of Douglas.
100
What is being assessed in the pericardial view of a FAST exam?
The pericardial view assesses the area around the heart, checking for pericardial tamponade.
101
What does a positive FAST exam indicate?
A positive FAST exam means that free fluid has been visualized, which likely indicates intra-abdominal bleeding resulting from trauma.
102
What are the classic patient presentation symptoms of a Small Bowel Obstruction (SBO)?
Abdominal pain, vomiting, abdominal distention, and changes in bowel sounds (from hyperactive to absent).
103
What is the primary imaging modality used to diagnose SBO based on the provided criteria?
Ultrasound (USG).
104
What is the threshold for dilated small bowel loops to be considered significant in SBO diagnosis?
Greater than 2.5 cm in diameter.
105
What does abnormal or absent peristalsis (akinetic loops) suggest in the context of SBO?
It suggests a risk of strangulation and ischemic injury to the bowel.
106
What is the significance of free extraluminal fluid in the USG diagnosis of SBO?
It indicates a risk of ischemia or perforation.
107
What parietal wall thickening is considered indicative of ischemic injury to the bowel in SBO?
Thickening greater than 3-4 mm.
108
What are prominent and thickened valvulae conniventes (plicae) suggestive of in SBO?
Ischemic changes in the bowel.
109
What is a 'caliber jump' in the context of SBO imaging?
An abrupt transition from dilated small bowel loops (proximal) to collapsed bowel (distal), indicating the site of obstruction.
110
What are the characteristics of a 'Simple SBO' according to the severity grading?
Dilated loops (>2.5 cm), normal or hyperkinetic peristalsis, and minimal free fluid.
111
What is the typical prognosis and initial management for a Simple SBO?
Usually resolves with nasogastric (NG) tube decompression.
112
What are the USG findings for a 'Decompensated SBO'?
Dilated loops, decreased peristalsis, and moderate free fluid.
113
What is the prognosis and potential management for a Decompensated SBO if there is no improvement?
May require surgery if no improvement is seen within 24-48 hours.
114
What are the key USG findings suggestive of a 'Strangulated/Ischemic SBO'?
Dilated loops, akinetic (no peristalsis) bowel, copious free fluid, thickened bowel walls (>4mm), and echogenic mesentery (indicating edema).
115
What is the prognosis and immediate management for a Strangulated/Ischemic SBO?
It is an EMERGENCY requiring immediate surgery due to the high risk of perforation and sepsis.
116
What is the normal diameter of an appendix?
The normal appendix diameter is 2-6 mm, but can be up to 10 mm if filled with stool.
117
What are the key characteristics of a normal appendix's appearance on ultrasound?
A normal appendix is small, easily compressible, has a 5-layer concentric structure, is mobile, blind-ending, shows no vascular signal on Doppler, and has no surrounding inflamed fat. Its key feature is compressibility.
118
What is the primary diagnostic criterion for acute appendicitis based on outer diameter?
An outer diameter greater than 6 mm that is uncompressible is a primary diagnostic criterion for acute appendicitis.
119
Describe the 'target sign' as a diagnostic criterion for appendicitis.
The target sign is characterized by a hypoechoic center, a hyperechoic ring, and a hypoechoic outer ring.
120
What wall thickness is considered indicative of inflammation in appendicitis?
A wall thickness of 3 mm or greater suggests inflammation.
121
Why is non-compressibility a key feature in diagnosing appendicitis?
Non-compressibility, meaning the appendix cannot be compressed with probe pressure, is a key feature that differentiates appendicitis from a normal appendix.
122
What ultrasound finding confirms the diagnosis of appendicitis if present?
The presence of an appendicolith, which appears as an echogenic focus with an acoustic shadow, highly suggests appendicitis and can confirm the diagnosis.
123
What does the 'A' stand for in the 'A-FIRED' mnemonic for appendicitis?
The 'A' stands for Appendix >6mm.
124
What does the first 'F' stand for in the 'A-FIRED' mnemonic?
The first 'F' stands for 'Fired up,' referring to echogenic periappendiceal fat.
125
What does the 'I' stand for in the 'A-FIRED' mnemonic?
The 'I' stands for 'Inflamed,' indicating a thickened wall greater than 3 mm.
126
What does the 'R' stand for in the 'A-FIRED' mnemonic?
The 'R' stands for 'Rigid,' referring to the non-compressible nature of the appendix.
127
What does the 'E' stand for in the 'A-FIRED' mnemonic?
The 'E' stands for 'Echogenic stones,' which are appendicoliths.
128
What does the 'D' stand for in the 'A-FIRED' mnemonic?
The 'D' stands for 'Distended.'
129
How many findings from the 'A-FIRED' mnemonic are typically needed to suggest appendicitis is likely?
A diagnosis of appendicitis is likely if there are three or more findings from the 'A-FIRED' mnemonic.
130
What is the sensitivity and specificity for an outer diameter >6 mm being uncompressible in diagnosing appendicitis?
An outer diameter >6 mm that is uncompressible has a sensitivity of 90-98% and a specificity of 98%.
131
What is the sensitivity and specificity of the target sign for appendicitis?
The target sign has a sensitivity of 80-90% and a specificity of 95%.
132
What is the sensitivity and specificity for a thickened wall (≥3 mm) in diagnosing appendicitis?
A thickened wall of 3 mm or greater has a sensitivity of 75-85% and a specificity of 85%.
133
How specific is the finding of an appendicolith for diagnosing appendicitis?
An appendicolith is highly specific, with a specificity of 95%.
134
What is considered a normal aorta size?
Less than 3 cm.
135
What is the definition of an AAA (Abdominal Aortic Aneurysm)?
Greater than or equal to 3 cm.
136
At what size should surgery be considered for an AAA in males?
Greater than 5.5 cm.
137
At what size should surgery be considered for an AAA in females?
Greater than 5.0 cm.
138
What is the immediate course of action for an AAA with any positive symptoms or signs of rupture?
STAT OR (Stat Operating Room).
139
What is considered a normal CBD (Common Bile Duct) size?
Less than 6 mm.
140
What CBD size is considered borderline or mild dilatation?
6-8 mm.
141
What CBD size suggests suspected obstruction?
Greater than 8 mm.
142
What is considered a normal spleen size?
Less than 12 cm.
143
What is the term for a spleen larger than 12 cm?
Splenomegaly.
144
What appendix size and compressibility is considered normal?
Less than 6 mm and compressible.
145
What appendix size and compressibility is indicative of appendicitis?
Greater than or equal to 6 mm and non-compressible.
146
What is considered a normal portal vein size?
Less than 10 mm.
147
What portal vein size is considered dilated and suggestive of portal hypertension?
Greater than 13 mm.
148
What does hepatopetal flow in the portal vein indicate?
Normal flow towards the liver (indicated by RED color on Doppler).
149
What does hepatofugal flow in the portal vein indicate?
Reversed flow away from the liver (indicated by BLUE color on Doppler), which is considered bad.
150
What is considered a normal gallbladder (GB) wall thickness?
Less than 3 mm.
151
What GB wall thickness suggests cholecystitis?
Greater than 3 mm.
152
What is Grade 1 hydronephrosis characterized by?
Mild dilatation, only in the renal pelvis.
153
What is Grade 3 hydronephrosis characterized by?
Severe dilatation, involving all calyces.
154
What is Grade 4 hydronephrosis characterized by?
Critical, massive dilatation.
155
What are the ultrasound findings suggestive of acute pancreatitis?
Enlarged pancreas (>4cm body), hypoechoic, and a normal pancreatic duct.
156
What are the ultrasound findings suggestive of chronic pancreatitis?
Shrunken pancreas (<2cm), hyperechoic, and a dilated pancreatic duct (>3mm).
Radio diagnosis
flashcards
Decks in class (21)
# Cards
-
basics and usg abdo184
-
usg abdo 2123
-
usg abdo 3156
-
machines161
-
MRI150
-
mri and c270
-
usg145
-
contrast media78
-
GI131
-
Intestine156
-
gallbladder117
-
gallbladder 232
-
Kidneysss158
-
Uretheral trauma ovaries and pregnancy130
-
thoracic radio210
-
thoracic park 2108
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neuroradio139
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neuroradio 296
-
MSK145
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nuclear radio155
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nuclear radio 2119
