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Questions and Answers
What can be evaluated with sonography?
What can be evaluated with sonography?
- Only retroperitoneal hemorrhage and retroperitoneal fibrosis
- Retroperitoneal hemorrhage, retroperitoneal fibrosis, and presacral tumors (correct)
- Only retroperitoneal fibrosis and presacral tumors
- Only presacral tumors
What is the most common location for abscess or changes related to neoplasm in the retroperitoneal muscles?
What is the most common location for abscess or changes related to neoplasm in the retroperitoneal muscles?
- Duodenum
- Pancreas
- Psoas muscle (correct)
- Spinal column
What is the significance of finding multiple or large retroperitoneal lymph nodes in an infant or child during abdominal sonography?
What is the significance of finding multiple or large retroperitoneal lymph nodes in an infant or child during abdominal sonography?
- It is abnormal and generally associated with lymphoma, Wilms tumor, and neuroblastoma (correct)
- It is a sign of gastroenteritis
- It is a normal finding
- It is a sign of systemic infection
What can cause abscesses in the retroperitoneal muscles?
What can cause abscesses in the retroperitoneal muscles?
What can displace vessels and bowel anteriorly and the kidneys laterally in the retroperitoneum?
What can displace vessels and bowel anteriorly and the kidneys laterally in the retroperitoneum?
What is the appearance of enlarged retroperitoneal lymph nodes on sonography?
What is the appearance of enlarged retroperitoneal lymph nodes on sonography?
Which condition is characterized by a markedly enlarged spleen that is echogenic with possible small hypoechoic or hyperechoic foci?
Which condition is characterized by a markedly enlarged spleen that is echogenic with possible small hypoechoic or hyperechoic foci?
Which of the following is a hallmark of the most common form of Gaucher disease?
Which of the following is a hallmark of the most common form of Gaucher disease?
What imaging modality is best suited for depicting the extent of splenic fibrosis and infarction in Gaucher disease?
What imaging modality is best suited for depicting the extent of splenic fibrosis and infarction in Gaucher disease?
What malignancy is associated with enlarged retroperitoneal lymph nodes and splenomegaly caused by multiple hypoechoic splenic masses?
What malignancy is associated with enlarged retroperitoneal lymph nodes and splenomegaly caused by multiple hypoechoic splenic masses?
Which of the following pathologies is a lysosomal storage disorder?
Which of the following pathologies is a lysosomal storage disorder?
What is the primary reason for performing sonographic evaluation of the retroperitoneum?
What is the primary reason for performing sonographic evaluation of the retroperitoneum?
What other structures, besides the kidneys, ureters, and urinary bladder, are included in the retroperitoneum?
What other structures, besides the kidneys, ureters, and urinary bladder, are included in the retroperitoneum?
Which of the following is NOT a characteristic of acute splenic sequestration as seen on ultrasound?
Which of the following is NOT a characteristic of acute splenic sequestration as seen on ultrasound?
What is the primary imaging modality used for evaluating pediatric urinary tract and adrenal glands?
What is the primary imaging modality used for evaluating pediatric urinary tract and adrenal glands?
How do benign teratomas typically present when assessed?
How do benign teratomas typically present when assessed?
What is a common reason for performing a renal ultrasound in pediatric patients?
What is a common reason for performing a renal ultrasound in pediatric patients?
What clinical findings may necessitate a renal ultrasound in younger children?
What clinical findings may necessitate a renal ultrasound in younger children?
Which of the following statements about malignant teratomas is true?
Which of the following statements about malignant teratomas is true?
What imaging technique is useful for detecting and monitoring hemorrhage from renal trauma?
What imaging technique is useful for detecting and monitoring hemorrhage from renal trauma?
What complication may arise due to bladder rupture in patients with teratomas?
What complication may arise due to bladder rupture in patients with teratomas?
Why is sonography preferred over other imaging modalities for pediatric evaluation?
Why is sonography preferred over other imaging modalities for pediatric evaluation?
What is the term for RLQ lymphadenopathy without associated appendicitis?
What is the term for RLQ lymphadenopathy without associated appendicitis?
Which of the following bacteria may be cultured from stool in patients with bacterial ileocolitis?
Which of the following bacteria may be cultured from stool in patients with bacterial ileocolitis?
What is the characteristic of abnormal lymph nodes in mesenteric adenitis?
What is the characteristic of abnormal lymph nodes in mesenteric adenitis?
What is the term for mild wall thickening of the ileum, cecum, or both, along with lymphadenopathy?
What is the term for mild wall thickening of the ileum, cecum, or both, along with lymphadenopathy?
What is the anatomic landmark located over the right side of the abdomen one-third of the distance from the anterior superior iliac spine to the umbilicus?
What is the anatomic landmark located over the right side of the abdomen one-third of the distance from the anterior superior iliac spine to the umbilicus?
Which of the following is NOT a characteristic of bacterial ileocolitis?
Which of the following is NOT a characteristic of bacterial ileocolitis?
What is the normal upper limit measurement for an appendix?
What is the normal upper limit measurement for an appendix?
What is the appearance of the ileocecal valve in ileocolitis?
What is the appearance of the ileocecal valve in ileocolitis?
Which of the following is an indicator of appendicitis?
Which of the following is an indicator of appendicitis?
What is the term for the abnormal accumulation of mucus in the appendix?
What is the term for the abnormal accumulation of mucus in the appendix?
Why is CT currently considered superior to sonography in evaluating acute appendicitis?
Why is CT currently considered superior to sonography in evaluating acute appendicitis?
What is the significance of McBurney point?
What is the significance of McBurney point?
What is the Murphy sign associated with?
What is the Murphy sign associated with?
What is the normal anatomy of the vermiform appendix?
What is the normal anatomy of the vermiform appendix?
What is the sonographic technique used to evaluate the small bowel?
What is the sonographic technique used to evaluate the small bowel?
What is the significance of the ligament of Treitz?
What is the significance of the ligament of Treitz?
What is a potential complication of Inflammatory Bowel Disease (IBD) that can be visualized on sonography?
What is a potential complication of Inflammatory Bowel Disease (IBD) that can be visualized on sonography?
Which of the following conditions is characterized by inflammation of the colon that can extend to the entire colon, but usually begins in the rectum?
Which of the following conditions is characterized by inflammation of the colon that can extend to the entire colon, but usually begins in the rectum?
Which of the following is a characteristic of Crohn Disease?
Which of the following is a characteristic of Crohn Disease?
Which of the following would be a common sonographic finding in a patient suspected of having Crohn Disease?
Which of the following would be a common sonographic finding in a patient suspected of having Crohn Disease?
Which of the following is a potential complication of both Ulcerative Colitis and Crohn Disease?
Which of the following is a potential complication of both Ulcerative Colitis and Crohn Disease?
What is a sonographic finding that might suggest a possible colonic disorder?
What is a sonographic finding that might suggest a possible colonic disorder?
Which of the following is a typical sonographic finding in a patient with suspected colonic diverticulitis?
Which of the following is a typical sonographic finding in a patient with suspected colonic diverticulitis?
Which of the following is a possible sonographic finding in a patient with suspected intestinal obstruction due to a stricture?
Which of the following is a possible sonographic finding in a patient with suspected intestinal obstruction due to a stricture?
Which condition can lead to posterior perforation of the stomach?
Which condition can lead to posterior perforation of the stomach?
What is the length of the normal small bowel?
What is the length of the normal small bowel?
Which of the following is NOT a disorder of the small bowel?
Which of the following is NOT a disorder of the small bowel?
What is a common feature of inflammatory bowel disease?
What is a common feature of inflammatory bowel disease?
Which imaging technique is primarily used for evaluating colonic disorders?
Which imaging technique is primarily used for evaluating colonic disorders?
What diameter is typical for the small bowel?
What diameter is typical for the small bowel?
Which condition is associated with a tubular structure of the gastrointestinal tract?
Which condition is associated with a tubular structure of the gastrointestinal tract?
Which of these conditions commonly entails sonographic evaluation of the bowel?
Which of these conditions commonly entails sonographic evaluation of the bowel?
What is a common characteristic of intestinal obstruction as seen on sonography?
What is a common characteristic of intestinal obstruction as seen on sonography?
Which sonographic finding is most indicative of Crohn Disease?
Which sonographic finding is most indicative of Crohn Disease?
What is a potential complication of Ulcerative Colitis that can be observed through sonography?
What is a potential complication of Ulcerative Colitis that can be observed through sonography?
Which of the following best describes a typical sonographic manifestation of a colonic disorder?
Which of the following best describes a typical sonographic manifestation of a colonic disorder?
In a patient with suspected Inflammatory Bowel Disease, which ultrasound finding is least likely?
In a patient with suspected Inflammatory Bowel Disease, which ultrasound finding is least likely?
What is a common sonographic characteristic associated with diverticulitis?
What is a common sonographic characteristic associated with diverticulitis?
Which statement about Crohn Disease is correct regarding sonographic evaluation?
Which statement about Crohn Disease is correct regarding sonographic evaluation?
During an ultrasound, which feature would most likely indicate the presence of Ulcerative Colitis?
During an ultrasound, which feature would most likely indicate the presence of Ulcerative Colitis?
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Study Notes
Benign and Malignant Teratomas
- Benign teratomas are primarily cystic, exhibiting varied solid components.
- Malignant teratomas are mostly solid, but may also display cystic areas.
- Associated complications can include hydronephrosis and urine ascites due to bladder rupture.
- Accurate preoperative assessment typically requires CT and/or MRI imaging.
Retroperitoneal Trauma
- Renal trauma initially causes hemorrhage that surrounds the kidney, later spreading into the retroperitoneal space.
- Sonography is effective for detecting fresh hemorrhage, characterized by anechoic areas, and monitoring changes in echogenicity over time.
Pediatric Imaging and Sonography
- Sonography is a key imaging method for assessing the pediatric urinary tract and adrenal glands; it avoids ionizing radiation risks.
- Portable, non-invasive, and cost-effective, sonography is suitable for serial follow-ups and is well-tolerated by children.
- Common indications for pediatric renal ultrasound include urinary tract infections, enuresis, dysuria, and urinary reflux.
- Other indications may involve potential renal anomalies, hypertension, and the need for biopsy guidance.
Retroperitoneal Lymph Nodes
- Abnormal lymph nodes in the retroperitoneum are commonly located near the aorta and inferior vena cava (IVC).
- Enlarged lymph nodes are typically associated with conditions like lymphoma, Wilms tumor, and neuroblastoma.
- These nodes appear as hypoechoic structures potentially merging into larger masses, which can displace nearby vessels and kidneys.
Retroperitoneal Muscles
- Diseases affecting retroperitoneal muscles can originate from lymph nodes, kidneys, pancreas, and other structures.
- Abscesses may develop from infections or adjacent inflammatory conditions, often seen in the psoas muscle, especially in hemophiliac patients.
Spleen and Gaucher Disease
- Gaucher disease is the most common lysosomal storage disorder, predominantly affecting individuals of Ashkenazi Jewish descent.
- Key characteristics include hepatosplenomegaly and bone marrow involvement, leading to anemia and thrombocytopenia.
- Splenic changes include marked enlargement relative to the liver, echogenicity, and possible hypoechoic or hyperechoic foci.
- MRI is best for depicting splenic fibrosis and infarction.
Review Questions
- Enlarged retroperitoneal lymph nodes and splenomegaly linked to multiple hypoechoic splenic masses can indicate lymphoma.
- Gaucher disease results from a lysosomal storage disorder, distinguishing it from conditions like sickle cell anemia.
Overview of Retroperitoneum
- The retroperitoneum is examined to assess the kidneys, ureters, and urinary bladder, also encompassing muscles and lymph nodes in the area.
Vermiform Appendix and Related Disorders
- Appendix adenocarcinoma can present as a large, complex mass in imaging studies.
- Mesenteric adenitis occurs when the appendix is intact yet shows adjacent enlarged lymph nodes in the right lower quadrant (RLQ).
- RLQ lymphadenopathy, without acute appendicitis, is termed mesenteric adenitis; round lymph nodes greater than 4 mm in anteroposterior (AP) diameter are considered abnormal.
- Bacterial ileocolitis may show mild wall thickening in the ileum and cecum, often associated with Yersinia, Campylobacter, or Salmonella.
- Bacterial ileocolitis is typically self-limited and does not necessitate surgical intervention.
Small Bowel Anatomy
- The small bowel consists of the jejunum and ileum, forming a tubular structure approximately 20 feet long and 1 inch in diameter.
- Jejunum constitutes about 40% of the small bowel, with thicker walls and wider lumens compared to the ileum.
- The ileum is the longest section and primarily located in the right inferior abdomen.
- Both segments of the small bowel are supported by mesentery, allowing mobility.
Sonographic Examination Techniques
- Sonographic evaluation of the small bowel is performed with the patient in a relaxed supine position, utilizing a systematic approach to examine the bowel starting from the ileocecal valve.
- The transducer should be positioned transversely, scanning upwards along the ascending colon, then moving across to the descending colon and examining inferiorly.
- Caution is necessary to ensure overlapping during the scanning process for a comprehensive examination.
Diagnostic Insights
- The upper limits for a normal appendix are generally considered to be 6 mm in diameter and 2 mm in wall thickness.
- Indicators of appendicitis may include a noncompressible appendix larger than 6 mm or associated fluid collections.
- CT imaging is currently favored for diagnosing appendicitis due to higher sensitivity and specificity compared to sonography, particularly in adult patients.
Summary of Important Techniques and Conditions
- Key sonographic techniques for gastrointestinal examination require proper patient preparation and understanding of the limitations of the method.
- Specific conditions related to the bowel, such as gastroduodenal Crohn disease, should also be systematically examined through ultrasound.
- Advances in sonographic techniques include visualization of the bowel wall layers, providing essential diagnostic information.
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