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Questions and Answers

What is the definition of a ureterocele?

A congenital abnormality in which the distal ureter balloons at its opening into the bladder, forming a pouch within the bladder.

What is the classic nickname for the appearance of a ureterocele on ultrasound?

Cobra head

What is the 'gut signature'?

A hyperechoic mucosal surface with a hypoechoic submucosa just below that.

What is a sex cord-stromal tumor?

<p>A group of tumors from the stromal component of the ovary and testis.</p> Signup and view all the answers

What is the ultrasound appearance of an ovarian fibroma?

<p>Solid, hypoechoic ovarian mass with marked posterior acoustic shadowing.</p> Signup and view all the answers

What is a bladder diverticulum?

<p>A fluid-filled mass that can occur anywhere within the bladder.</p> Signup and view all the answers

What is the ultrasound finding of the spleen in mononucleosis?

<p>Splenomegaly</p> Signup and view all the answers

What is the management for serous cystadenoma of the pancreas when diagnosed?

<p>Usually nothing, but surgical excision if they become larger and cause symptoms.</p> Signup and view all the answers

What is the diagnosis for a pancreatic mass with honeycombed, cystic components?

<p>Serous cystadenoma.</p> Signup and view all the answers

What does a 'spongiform' thyroid nodule indicate?

<p>It indicates internal cysts and may have comet tail artifact.</p> Signup and view all the answers

Most gallbladder polyps are < ____ mm in size.

<p>10</p> Signup and view all the answers

A mixed solid and cystic nodule does not meet biopsy criteria until size is > ____ cm.

<p>2</p> Signup and view all the answers

Is endometritis a clinical or sonographic diagnosis?

<p>False (B)</p> Signup and view all the answers

The difference sonographically between retained products of conception and endometritis is clear.

<p>False (B)</p> Signup and view all the answers

What characterizes xanthogranulomatous pyelonephritis?

<p>Fatty replacement of the renal parenchyma due to long-standing struvite stones.</p> Signup and view all the answers

What are US findings of acute pyelonephritis?

<p>Focal or diffuse enlargement of the kidneys, loss of corticomedullary differentiation, thickening of the renal pelvis.</p> Signup and view all the answers

What are the findings and management of emphysematous pyelonephritis?

<p>Air in the renal parenchyma with dirty shadowing; management includes medicine or surgical resection.</p> Signup and view all the answers

What is the US appearance of a corpus luteum?

<p>Thick-walled, unilocular, with echogenic contents due to internal hemorrhage.</p> Signup and view all the answers

Describe the characteristic description of an ovarian endometrioma.

<p>Unilocular ovarian cyst with homogeneous low-level echoes and increased through transmission.</p> Signup and view all the answers

Define hydrosalpinx and its main cause.

<p>A Fallopian tube filled with serous or clear fluid, usually due to blockage from PID.</p> Signup and view all the answers

What is the US appearance of hydrosalpinx?

<p>A thin-walled, tubular, anechoic structure, usually adjacent to an ovary.</p> Signup and view all the answers

What are the US findings of varicocele?

<p>Paratesticular veins with increased flow during Valsalva.</p> Signup and view all the answers

What does the 'tip of the iceberg' sign refer to?

<p>In a dermoid tumor.</p> Signup and view all the answers

Which tumor is found in the ovary: a dermoid or a desmoid?

<p>A dermoid is found in the ovary.</p> Signup and view all the answers

What is the US appearance of a pyogenic liver abscess?

<p>A complex, cystic mass containing air, which creates dirty shadowing, within the liver.</p> Signup and view all the answers

Do urinary tract stones almost always display twinkling artifact?

<p>True (A)</p> Signup and view all the answers

What does twinkle artifact look like?

<p>Alternating colors on Doppler, behind the calcium lesion.</p> Signup and view all the answers

Is choledocholithiasis usually painful or painless?

<p>Painful.</p> Signup and view all the answers

What is the US appearance of testicular infarction?

<p>Atrophic, hypoechoic, and calcified testis.</p> Signup and view all the answers

To diagnose a varicocele, the dilated veins in the pampiniform plexus should technically be greater than _____ mm.

<p>3</p> Signup and view all the answers

What does the term 'cavernous transformation' mean in relation to portal hypertension?

<p>Reversal of portal vein flow leading to dilation of collateral vessels.</p> Signup and view all the answers

What is cumulus oophorus?

<p>Tiny peripheral curved lines within an ovarian follicle.</p> Signup and view all the answers

What is the cutoff for abnormal endometrial thickening in a postmenopausal woman?

<p>5 mm.</p> Signup and view all the answers

What is the US appearance of testicular abscess?

<p>Hyperemic testis and scrotal edema.</p> Signup and view all the answers

A testicle in torsion is usually salvageable if treated within _____ hours of symptom onset.

<p>6</p> Signup and view all the answers

Which of the following can have a 'ring of fire' sign?

<p>Both A and B (A)</p> Signup and view all the answers

Define 'caliectasis'.

<p>A slight ballooning of the collecting system within the kidney due to obstruction.</p> Signup and view all the answers

What is the major finding in chronic renal allograft rejection?

<p>Calcification with shadowing.</p> Signup and view all the answers

What is the US finding in tubo-ovarian abscess?

<p>Often you cannot see the ovary; instead there is pyosalpinx.</p> Signup and view all the answers

What is the US appearance of testicular carcinoma?

<p>A hypoechoic, solid testicular mass with internal vascularity.</p> Signup and view all the answers

What causes a junctional parenchymal defect?

<p>Embryonic fusion of the upper and lower kidney poles.</p> Signup and view all the answers

Surgical intervention within _____ hours is needed to salvage a ruptured testis.

<p>72</p> Signup and view all the answers

What is the actual covering of the testis?

<p>The tunica albuginea.</p> Signup and view all the answers

Are abscesses vascular or avascular on color Doppler?

<p>Avascular.</p> Signup and view all the answers

What findings are very specific for testicular rupture?

<p>Tunica albuginea rupture, heterogeneous testicular echotexture, disruption of the testicular contour.</p> Signup and view all the answers

What is the US appearance of hepatic laceration/trauma?

<p>Wedge-shaped hypoechoic area, without vascularity on color Doppler.</p> Signup and view all the answers

What can cause multiple bacterial micro abscesses in the liver in an immunocompetent patient?

<p>All of the above (D)</p> Signup and view all the answers

What is a ureterocele and what other congenital state is it associated with?

<p>A ureterocele is a cystic dilatation of the distal ureter associated with duplicated ureters.</p> Signup and view all the answers

Study Notes

US Findings and Conditions

  • Acute Pyelonephritis:

    • Focal or diffuse kidney enlargement and loss of corticomedullary differentiation.
    • Thickening of renal pelvis and wedge-shaped distribution of parenchyma echogenicity.
    • High resistive index (RI) due to vasoconstriction.

  • Emphysematous Pyelonephritis:

    • Presence of air in renal parenchyma with dirty shadowing.
    • Managed with medication or surgical resection.
    • Common among diabetic patients.

  • Corpus Luteum Cyst:

    • Thick-walled, unilocular structure with echogenic contents, often due to internal hemorrhage.

  • Endometrioma:

    • Unilocular ovarian cyst characterized by homogeneous low-level echoes and increased through transmission.
    • Comet tail artifact is very specific for endometriomas.

  • Hydrosalpinx:

    • Defined as a fallopian tube filled with clear fluid due to obstruction, typically from pelvic inflammatory disease (PID).
    • Appears as thin-walled, anechoic tubular structure near the ovary.

Testicular and Ovarian Conditions

  • Epididymitis:

    • Notable for enlargement and hyperemia of the epididymis compared to the opposite side.

  • Varicocele:

    • Increased flow in paratesticular veins during Valsalva maneuver indicates the presence of varicocele.

  • Dermoid Tumor:

    • The "tip of the iceberg" sign results from dense shadowing caused by the tumor.

  • Tubo-Ovarian Abscess:

    • Often obscures ovary visibility; characterized by pyosalpinx filled with echogenic debris.

Cysts and Growths

  • Intraductal Lesions Differentiation:

    • Choledocholithiasis shows mobile stones with shadowing; cholangiocarcinoma appears immobile with potential for internal vascularity.

  • Nabothian Cyst:

    • Peripherally located simple cyst within the cervical wall; features include anechoic interior and posterior acoustic enhancement.

  • Junctional Parenchymal Defect:

    • Caused by embryonic fusion of kidney poles leading to mild echogenic contour on renal surface.

Miscellaneous Findings

  • Hematocele:

    • Blood collection within the scrotal sac outside the testis; suggests ruptured testis when present within the tunica albuginea.

  • Cavernous Transformation in Portal Hypertension:

    • Refers to dilated collateral vessels due to reversed portal vein flow.

  • Liver Abscess:

    • Presents initially as heterogeneous, later evolving into well-defined fluid collections with internal debris.

Imaging Characteristics

  • US Cut-off for Abnormal Endometrial Thickening:

    • 5 mm abnormal thickness in postmenopausal women requires further investigation.

  • Fibroids vs. Endometrial Polyps:

    • Fibroids are typically hypoechoic with peripheral vascularity; endometrial polyps present hyperechoic with central vascularity.

  • Testicular Carcinoma Appearance:

    • Solid, hypoechoic mass with internal vascularity, requiring orchiectomy for confirmation.

Special Signs and Artifacts

  • Twinkle Artifact:

    • Appears as alternating colors on Doppler behind calcium lesions, sensitive to detecting smaller stones.

  • Gut Signature:

    • Hints at appendicitis, characterized by a hyperechoic mucosal surface with a hypoechoic submucosa.

Surgery and Follow-Up

  • Timely Intervention in Testicular Torsion:

    • Must occur within 6 hours for salvageability; ruptured testes require surgical intervention within 72 hours.

  • Management of Chronic Allograft Rejection:

    • Removal of failed transplants improves long-term survival by reducing infectious complications.

  • Follow-Up for Ovarian Cysts:

    • Only required for cysts larger than 5 cm in reproductive age women.

Renal and Hepatic Considerations

  • Medullary Nephrocalcinosis Causes:

    • Common causes include medullary sponge kidney and hypercalcemia; less common factors involve renal tubular acidosis and hyperoxaluria.

  • Cystic Renal Cell Carcinoma (RCC) vs. Renal Abscess:

    • Differentiation relies on clinical history; RCC may showcase internal vascularity while abscesses are avascular.

These notes encapsulate significant findings and characteristics surrounding ultrasound imaging related to various medical conditions, crucial for effective understanding and retention for students.### Bladder Masses

  • Fluid-filled mass found in the bladder, anechoic internally and hyperechoic externally.
  • Often located near the ureterovesical junction.
  • Commonly acquired from bladder outlet obstruction, especially due to Benign Prostatic Hyperplasia (BPH).
  • More prevalent in men.

Splenomegaly

  • Key ultrasound finding in cases of mononucleosis.
  • Indicates an enlarged spleen.

Management of Serous Cystadenoma of the Pancreas

  • Typically, no treatment is needed for serous cystadenomas.
  • Surgical excision considered only if tumors grow larger or cause symptoms, such as abdominal fullness.

Diagnosis of Serous Cystadenoma

  • Identified by honeycombed, cystic components in a pancreatic mass.
  • Commonly referred to as the "grandmother tumor," with a higher incidence in women.
  • Median age at diagnosis is 68 years.

Thyroid Nodules

  • Spongiform nodules characterized by a honeycomb appearance with internal cysts.
  • Presence of comet tail artifact indicates a spongiform nodule, due to colloid production.
  • Mixed solid-cystic nodules show more confluent cyst areas that communicate, rather than being discrete.

Gallbladder Polyps

  • Most gallbladder polyps measure less than 10 mm.
  • Polyps greater than 10 mm raise suspicion for gallbladder cancer, recommending cholecystectomy.

Nodule Biopsy Criteria

  • A mixed solid and cystic nodule requires a size greater than 2 cm to meet biopsy criteria.

Endometritis Diagnosis

  • Primarily diagnosed clinically; ultrasound may show echogenic material and thickening but often lacks definitive findings.
  • Purpose of ultrasound is to check for complications like abscess formation.
  • Gas presence in ultrasound is infrequent, noted in only 20% of postpartum endometritis cases.

Differentiation between Retained POC and Endometritis

  • No distinct sonographic differences; clinical history is crucial.
  • Fever typically indicates endometritis, as both can present with echogenic material in the endometrial canal.

Xanthogranulomatous Conditions

  • Xanthogranulomatous pyelonephritis results in fatty replacement of renal parenchyma linked to long-standing struvite stones.
  • Xanthogranulomatous cholecystitis characterized by gallbladder inflammation, causing wall irregularity and thickening, which can mimic gallbladder carcinoma on imaging and pathology.
  • Both conditions have a etiology related to chronic stasis from partially obstructing stones.

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