1
Q
equipment used for small part sonography
A
high frequency linear probe
- wide near field
- excellent resolution
- excellent color Doppler
2
Q
thyroiditis / hashimoto’s appear as
A
swiss cheese appearance
3
Q
MNG
A
multi-nodular goiter
4
Q
thyroid shape
A
butterfly
5
Q
thyroid spans ___ vertebrae
A
C5-T1
6
Q
thyroid location
A
- around cricoid cartilage & superior tracheal rings
- inferior to thyroid cartilage of larynx
7
Q
thyroid blood supply
A
- superior & inferior thyroid arteries
- superior & middle thyroid veins
8
Q
thyroid nerve supply
A
recurrent laryngeal nerve
9
Q
thyroid function
A
produces T3 & T4 to regulate body temperature, growth & metabolism
10
Q
what resolution probe for US thyroid
A
high resolution linear probe: 5 - 18 MHz
Curve linear probe with small footprint: 5 - 9 MHz for enlarged thyroid lobes
11
Q
patient position for US thyroid
A
patient supine with head slightly hyperextended and turn head to contralateral side
12
Q
US thyroid scanning protocol
A
CALI VDF
- isthmus measurement
- color doppler of both lobes
- longitudinal scans through each lobe
- axial scans of whole gland
- focal lesions
- vascular flow
- document abnormalities
13
Q
longitudinal scan starts from
A
right lobe
14
Q
what does longitudinal scan & measure
A
scans medial, mid, lateral plane & measures length
15
Q
what does axial scan & measure
A
scans upper pole, interpolar, lower pole, and measures width & AP diameter
16
Q
how does normal thyroid (transverse) appear as
A
WESH
- echogenic thyroid capsules
- well circumscribed
- smooth & homogenous echotexture
- hyperechoic to adjacent muscles
17
Q
difference between pyramidal & normal thyroid lobe
A
pyramidal has persistent remnant of thyroglossal duct whereas normal does not
18
Q
reporting of thyroid gland includes
A
position, shape, size, content, echogenicity, vascular pattern
19
Q
reporting of thyroid nodule
A
size, location, margin, composition
20
Q
US thyroid scans can evaluate the following:
A
- thyroid parenchyma & gland size
- nodule size, location & sono characteristic
- presence of sus cervical lymph nodes
21
Q
ACR TI-RADS assess for
A
composition, echogenicity, shape, margin, echogenic foci
22
Q
how does MNG appear as
A
enlarged thyroid gland
23
Q
common causes of MNG is
A
insufficient thyroid hormone & tracheal and esophageal compression
24
Q
sono features of MNG
A
- enlarged & heterogenous thyroid
- focal / diffused replacement of thyroid parenchyma
- nodules may contain cystic degeneration
- calcifications
- hemorrhage
25
thyroiditis
inflammation of thyroid gland that causes temporary / permanent of thyroid function
26
thyroiditis impairments include:
hyperthyroidism & hypothyroidism
27
causes of thyroiditis
infection, autoimmune, meds, ionizing radiation
28
different forms of thyroiditis distinguished using
clinical findings, lab results, US
29
grave's disease
autoimmune disease commonly in women with generalized thyroid enlargement & thyrotoxicosis
30
most common cause of Grave's disease
hyperthyroidism
31
sonography features of Grave's disease
- enlarged thyroid
- hypoechoic & coarse texture
- thyroid inferno
- gland size proportional to vascular activity
- increased velocities in inferior thyroid artery
- lobulated gland surfaces
32
most common type of thyroiditis
hashimoto's thyroiditis
33
hashimoto's thyroiditis leads to increased risk of __
non-Hodgkin's lymphoma
34
acute hashimoto's thyroiditis appear as
- focal with small, hypoechoic, avascular nodules with ill defined outlines
- diffused with multiple nodules of reduced echogenecity & vascularity separated by echoic, thickened fibrous septae, lobulated margins & generalized enlargement
35
chronic hashimoto's thyroiditis appear as
- densely echogenic, small glands
- discrete thyroid nodules develop & associated with cervical lymphadenopathy
36
hyperplastic / colloid nodules
overgrowth / involution of normal follicular tissue; commonly seen in MNG
37
what is common with hyperplastic / colloid nodules
hemorrhage & necrosis
38
sono features of hyperplastic / colloid nodules
- well defined, smooth wall
- mixed echo texture, low level
- hypoechoic peripheral rim with egg-shell calcifications
- comet tail artifacts
39
sono features of adenoma / follciular adenoma
solid mass with smooth peripheral halo, increased flow if hyperfunctioning
40
sono features of papillary carcinoma
- predominantly hypoechoic
- incomplete peripheral halo
- septa with vascularity
41
FNA / Fine Needle Aspiration
minimally invasive, US is best to obtain adequate info for accurate cytologic evaluation
42
parathyroid function
makes PTH in response to low Ca2+ levels
43
normal parathyroid sono features
- usually not seen & homogeneously hypoechoic
- echogenic thyroid capsule separates thyroid from parathyroid gland
44
cervical lymph node on gray scale
- oval shape
- echogenic helium
- hypoechoic compared with adjacent muscles
45
cervical lymph node on color & power doppler
- hilar vascularity / appears avascular reactive nodes predominantly show hilar vascularity
46
breast are anchored to __ by __
pec muscles; suspensory / Cooper's ligaments
47
breast zones
premammary, mammary, retromammary zones
48
where do most breast pathology arise from
mammary zone
49
what does mammary zone contain
lobar ducts, branches, most of TDLU, most of fibrous stromal tissue
50
blood supply of breasts
axillary, internal thoracic, anterior intercostal arteries
51
lymphatic drainage of lateral quadrant breasts
anterior axillary & pectoral nodes
52
lymphatic drainage of medial quadrant breasts
internal thoracic nodes
53
lymphatic drainage of posterior portions of breasts
posterior intercostal nodes
54
nipple sono feature
hypoechoic as intense acoustic shadow with presence of retroareaolar ducts & blood vessels
55
what lymph nodes seen at axillary tail
hypoechoic cortex & hyperechoic fat hilum
56
breast US in young patients
very little fat in subcutaneous / glandular layer as homogeneously dense or hyperechoic
57
breast US in middle aged patients
dense glandular tissue with some fatty displacement as hyperechoic areas with some hypoechoic area between
58
breast US in older patients
mainly hypoechoic
59
breast US in pregnant & lactating patients
enlarged breasts & dilated milk ducts appear as cystic spaces within breasts
60
breast US patient positioning
patient supine with arm of examined side above hear & resting on pillow
small pillow placed under patient's shoulder on side being examined & allow breast to be flattened over chest wall
61
breast US equipment
high resolution linear probe: 7 - 17 MHz
curvilinear probe: 2 - 9 MHz
62
Breast US concerned lesions should be imaged in 2 planes with 3D measurement & described by:
clockface position, distance from nipple + skin surface + pectoralis muscle
63
Breast US scanning movements include
radial, anti-radial, longitudinal, transverse
64
US breast simple cyst sono features
anechoic, imperceptible back wall, enhanced transmission of sound, oval or round shape with circumscribed margins
65
US breast complex cyst sono features
internal echoes within cyst, avascular, posterior acoustic enhancement, debris mobile / stationary
66
US breast complex mass sono features
heterogenous echotexture, complex echogenicity, posterior acoustic enhancement, avascular
67
fibroadenoma US sono features
well circumscribed, homogeneous echogenicity from isoechoic to hypoechoic, thin, pseudo echogenic capsule
68
types of breast cancer
- ductal
- mucinous
- lobular
- mixed tumor
- inflammatory
69
US breast ductal carcinoma in situ
microcalcifications, echogenic material within duct, internal vascularity
70
US breast invasive ductal carcinoma
- spiculated / microlobulated margins
- posterior shadowing
- markedly hypoechoic / heterogenous
- micro-calcifications
- thick echogenic halo
71
US breast invasive carcinoma
- taller than wide
- subtle hypoechoic mass with irregular margins
- internal vascularity
- posterior shadowing
72
lesion description
- echogenicity
- margins
- artifacts
- dimensions
- shape
- compressibility
- presence of lobulations
- capsular thickening
- vascularity
73
intracapsular breast implant sono features
stepladder sign
- when implant shell ruptures but fibrous capsule formed by breast remains intact
74
extracapsular breast implant sono features
snowstorm
- change in implant contour & implies intracapsular rupture
75
how does hashimoto's thyroiditis appear as
swiss cheese apperance
76
how does grave's disease appear as
marked increase vascularity = thyroid inferno
77
how does thyroid nodule appear as
multiple thyroid nodules
78
how does goiter appear as
enlarged homogenous gland
79
how does MNG appear as
enlarged heterogenous gland with ill defined nodules
80
TIRADS
thyroid image reporting and data system
81
thyroid gland reporting consists of
position, shape, size, content, echogenicity, vascularity
82
thyroid nodules reporting consists of
size, location, margins, composition
83
reporting guidelines used are ___
ATA, TIRADS, BTA
84
difference between ATA & TIRADS
ATA focuses on vascularity whereas TIRADS does not
85
taller than wide or wide than taller is dangerous
taller than wide
DRG3007 Sono
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