ARDMS Abdominal Sonography Review Study Guide
Gonadal Arteries -
✔Arise from distal AO & rarely imaged
Inferior Mesenteric Artery -
✔Arise from distal anterior AO
Small, but easy to image, especially with SMA & CA stenosis/occlusion, it becomes enlarged
IVC Major Branches -
✔Hepatic -> Renal -> Gonadal
Hepatic Veins -
✔3 Branches: Right, Middle, Left
Drain into IVC
Renal Veins -
✔Right RV: Short, drains into IVC
Left RV: Long, passes b/t SMA & AO to the L. kidney
Left renal vein courses ________ to the AO. -
✔anteriorly
Gonadal Veins -
✔Right GV: drains into IVC
Left GV: drains into L. renal vein
Nutcracker Syndrome -
✔the engorgement of the L renal vein due to compression b/t the SMA & AO
Cardiac failure & fluid overload will cause the IVC to ____. -
✔dilate
The most common tumor to involve the IVC is the _______. -
✔renal cell carcinoma
Name 5 reasons the IVC is commonly displaced: -
✔Liver mass
R. renal artery aneurysm
Lymphadenopathy
Tortuous AO
R renal/adrenal mass
Greenfield Filter is used for what? How is it done? -
✔To prevent the ascent of lower ext vein thrombus
Inserted using catheters thru the femoral vein/internal jugular vein & placed inferior to renal veins.
What kind of mass causes an arc of the IVC on ultrasound? -
✔Retrocaval lymphadenopathy
Retroperitoneal fibrosis -
✔- (Ormond's Disease or Inflammatory Aneurysm)
- Dense fibrous tissue growth in the paravertebral region near the AO bifurcation.
- Sonographically, hypoechoic midline mass
- Assoc w/ bilateral ureteral obstruction as it envelopes structures
- IVC & lymphatic compression leads to LE edema & scrotal swelling
,- Most are idiopathic
Azygous/Hemiazygous Veins -
✔Azygous: right-sided vein
Hemiazygous: left-sided vein
Alternate venous return when there is IVC obstruction
Ascending Lumbar Vein -
✔- Branches of common iliac veins
- R. ascending joins w/ R. subcoastal vein to form azygous vein.
- L. ascending joins w/ L. subcoastal vein to for hemiazygous vein.
Adrenal Glands -
✔Right:
- Triangle/pyramid shaped
- Located superior, anterior, & medial to upper pole
- Crus of the diaphragm lies medial & posterior to gland
Left:
- Cescent shaped
- Located anteriomedial to upper pole
- Crus of diaphragm & AO lies medial to gland
- Pancreas tail lies anterior to gland
Crus of Diaphragm -
✔Location:
- Anterior to AO
- Superior to CA
- Posterior to IVC
It is located medial & posterior to all structures except AO.
What's the sonographic appearance of the adrenal cortex? -
✔Hypoechoic, less echogenic than surrounding retroperitoneal fat
What's the sonographic appearance of the adrenal medulla? -
✔Echogenic linear structure in adrenal gland
What vessels supply blood to each adrenal gland? -
✔3 arteries: Suprarenal branch of the inferior phrenic art, AO, & renal art.
1 vein: R. suprarenal into IVC and L. suprarenal into L. renal vein
What 2 glands function together to regulate hormone production, like aldosterone, cortisol, & androgen? -
✔adrenal gland
anterior pituitary gland
The adrenal cortex produces _______ . -
✔steroid hormones:
- mineralocorticoids (aldosterone)
- glucocorticods (cortisol)
- androgens
The adrenal medulla produces ________ . -
✔catecholamines:
- epinephrine (adrenalin)
- norepinephrine
Name 3 syndromes that are the result of adrenal adenomas hyperfunctioning. -
✔1. Cushing's
,2. Conn
3. Hirsutism
Cushing's syndrome caused by ________ . -
✔- excessive cortisol
- look for adrenal cortical carcinoma
Conn syndrome caused by ___________ . -
✔excessive aldosterone
Hirsutism -
✔- excessive androgen
- overabundance of hair
- congenital adrenal hyperplasia
- adrenocortical carcinoma
- pituitary/ovarian tumor
- polycystic ovarian syndrome (PCOS)
Adrenal cortical carcinoma is a ___ tumor with _____ prognosis. Majority present with ______ syndrome. -
✔rare; poor; Cushing's
Pheochromocytoma -
✔- originate in adrenal medulla
- usually benign
- secrete catecholamines
What is the most common childhood adrenal mass? -
✔Adrenal neuroblastoma
Adrenal neuroblastoma -
✔- malignant
- commonly a palpable abd mass
- occurs b/t 2 mo - 2yr (infancy)
- most common childhood adrenal mass
- increased urine & blood catecholamines
- maintains normal, bilateral renal contour
What's the difference b/t adrenal neuroblastoma & Wilm's tumor? -
✔Adrenal neuroblastoma displaces the ipsilateral kidney inferiorly into pelvis.
Wilm's tumor originates from & destroys the kidney.
Myelolipoma -
✔- benign
- hyperechoic in adrenal bed
- associated with propagation speed artifact due to fat composition
Adrenal lymphoma -
✔- common
- bilateral
- most common cell type = Non-Hodgkin disease
Adrenal metastases is the ____ most common metastatic site. -
✔4th
What is the most common adrenal mass in a newborn? -
✔Adrenal hemorrhage
, What is the most likely diagnosis in a newborn with an abd mass & decreasing hematocrit?
A) Wilm's tumor
B) Adrenal neuroblastoma
C) Hepatoblastoma
D) Adrenal hemorrhage -
✔D) Adrenal hemorrhage
With lymphadenopathy which direction is the IVC & SMA displaced? -
✔anteriorly
What direction will the splenic vein be displaced by a left adrenal mass? -
✔anteriorly
What direction will the bladder be displaced by a hematoma in the Pouch of Douglas? -
✔anteriorly
With a gastric outlet obstruction & dilation of the stomach, what direction will the pancreatic tail be
displaced? -
✔posteriorly
What direction will a mass in the uncinate process displace the SMV? -
✔anteriorly
What direction will a neuroblastoma displace the ipsilateral kidney? -
✔inferiorly
What direction will a mass in the left lobe of the liver displace the gastroesophageal junction? -
✔posteriorly
Which direction will the IVC be displaced with a ...
... right liver mass?
... right renal artery aneurysm?
... tortuous aorta?
... right adrenal mass?
... right renal mass? -
✔posterior
anterior
right
medial/anterior
medial/left
What are the 3 types of aneurysms? -
✔1. True
2. False (Pseudoaneurysms)
3. Dissecting
Berry Aneursym -
✔small saccular aneurysm commonly in the cerebrum
Mycotic aneurysm -
✔infected aneurysm
Atherosclerotic aneurysm -
✔results from weakening of the media in severe atherosclerosis
Fusiform aneurysm -
✔spindle-shaped dilatation where the stretching affects the entire circumference
Gonadal Arteries -
✔Arise from distal AO & rarely imaged
Inferior Mesenteric Artery -
✔Arise from distal anterior AO
Small, but easy to image, especially with SMA & CA stenosis/occlusion, it becomes enlarged
IVC Major Branches -
✔Hepatic -> Renal -> Gonadal
Hepatic Veins -
✔3 Branches: Right, Middle, Left
Drain into IVC
Renal Veins -
✔Right RV: Short, drains into IVC
Left RV: Long, passes b/t SMA & AO to the L. kidney
Left renal vein courses ________ to the AO. -
✔anteriorly
Gonadal Veins -
✔Right GV: drains into IVC
Left GV: drains into L. renal vein
Nutcracker Syndrome -
✔the engorgement of the L renal vein due to compression b/t the SMA & AO
Cardiac failure & fluid overload will cause the IVC to ____. -
✔dilate
The most common tumor to involve the IVC is the _______. -
✔renal cell carcinoma
Name 5 reasons the IVC is commonly displaced: -
✔Liver mass
R. renal artery aneurysm
Lymphadenopathy
Tortuous AO
R renal/adrenal mass
Greenfield Filter is used for what? How is it done? -
✔To prevent the ascent of lower ext vein thrombus
Inserted using catheters thru the femoral vein/internal jugular vein & placed inferior to renal veins.
What kind of mass causes an arc of the IVC on ultrasound? -
✔Retrocaval lymphadenopathy
Retroperitoneal fibrosis -
✔- (Ormond's Disease or Inflammatory Aneurysm)
- Dense fibrous tissue growth in the paravertebral region near the AO bifurcation.
- Sonographically, hypoechoic midline mass
- Assoc w/ bilateral ureteral obstruction as it envelopes structures
- IVC & lymphatic compression leads to LE edema & scrotal swelling
,- Most are idiopathic
Azygous/Hemiazygous Veins -
✔Azygous: right-sided vein
Hemiazygous: left-sided vein
Alternate venous return when there is IVC obstruction
Ascending Lumbar Vein -
✔- Branches of common iliac veins
- R. ascending joins w/ R. subcoastal vein to form azygous vein.
- L. ascending joins w/ L. subcoastal vein to for hemiazygous vein.
Adrenal Glands -
✔Right:
- Triangle/pyramid shaped
- Located superior, anterior, & medial to upper pole
- Crus of the diaphragm lies medial & posterior to gland
Left:
- Cescent shaped
- Located anteriomedial to upper pole
- Crus of diaphragm & AO lies medial to gland
- Pancreas tail lies anterior to gland
Crus of Diaphragm -
✔Location:
- Anterior to AO
- Superior to CA
- Posterior to IVC
It is located medial & posterior to all structures except AO.
What's the sonographic appearance of the adrenal cortex? -
✔Hypoechoic, less echogenic than surrounding retroperitoneal fat
What's the sonographic appearance of the adrenal medulla? -
✔Echogenic linear structure in adrenal gland
What vessels supply blood to each adrenal gland? -
✔3 arteries: Suprarenal branch of the inferior phrenic art, AO, & renal art.
1 vein: R. suprarenal into IVC and L. suprarenal into L. renal vein
What 2 glands function together to regulate hormone production, like aldosterone, cortisol, & androgen? -
✔adrenal gland
anterior pituitary gland
The adrenal cortex produces _______ . -
✔steroid hormones:
- mineralocorticoids (aldosterone)
- glucocorticods (cortisol)
- androgens
The adrenal medulla produces ________ . -
✔catecholamines:
- epinephrine (adrenalin)
- norepinephrine
Name 3 syndromes that are the result of adrenal adenomas hyperfunctioning. -
✔1. Cushing's
,2. Conn
3. Hirsutism
Cushing's syndrome caused by ________ . -
✔- excessive cortisol
- look for adrenal cortical carcinoma
Conn syndrome caused by ___________ . -
✔excessive aldosterone
Hirsutism -
✔- excessive androgen
- overabundance of hair
- congenital adrenal hyperplasia
- adrenocortical carcinoma
- pituitary/ovarian tumor
- polycystic ovarian syndrome (PCOS)
Adrenal cortical carcinoma is a ___ tumor with _____ prognosis. Majority present with ______ syndrome. -
✔rare; poor; Cushing's
Pheochromocytoma -
✔- originate in adrenal medulla
- usually benign
- secrete catecholamines
What is the most common childhood adrenal mass? -
✔Adrenal neuroblastoma
Adrenal neuroblastoma -
✔- malignant
- commonly a palpable abd mass
- occurs b/t 2 mo - 2yr (infancy)
- most common childhood adrenal mass
- increased urine & blood catecholamines
- maintains normal, bilateral renal contour
What's the difference b/t adrenal neuroblastoma & Wilm's tumor? -
✔Adrenal neuroblastoma displaces the ipsilateral kidney inferiorly into pelvis.
Wilm's tumor originates from & destroys the kidney.
Myelolipoma -
✔- benign
- hyperechoic in adrenal bed
- associated with propagation speed artifact due to fat composition
Adrenal lymphoma -
✔- common
- bilateral
- most common cell type = Non-Hodgkin disease
Adrenal metastases is the ____ most common metastatic site. -
✔4th
What is the most common adrenal mass in a newborn? -
✔Adrenal hemorrhage
, What is the most likely diagnosis in a newborn with an abd mass & decreasing hematocrit?
A) Wilm's tumor
B) Adrenal neuroblastoma
C) Hepatoblastoma
D) Adrenal hemorrhage -
✔D) Adrenal hemorrhage
With lymphadenopathy which direction is the IVC & SMA displaced? -
✔anteriorly
What direction will the splenic vein be displaced by a left adrenal mass? -
✔anteriorly
What direction will the bladder be displaced by a hematoma in the Pouch of Douglas? -
✔anteriorly
With a gastric outlet obstruction & dilation of the stomach, what direction will the pancreatic tail be
displaced? -
✔posteriorly
What direction will a mass in the uncinate process displace the SMV? -
✔anteriorly
What direction will a neuroblastoma displace the ipsilateral kidney? -
✔inferiorly
What direction will a mass in the left lobe of the liver displace the gastroesophageal junction? -
✔posteriorly
Which direction will the IVC be displaced with a ...
... right liver mass?
... right renal artery aneurysm?
... tortuous aorta?
... right adrenal mass?
... right renal mass? -
✔posterior
anterior
right
medial/anterior
medial/left
What are the 3 types of aneurysms? -
✔1. True
2. False (Pseudoaneurysms)
3. Dissecting
Berry Aneursym -
✔small saccular aneurysm commonly in the cerebrum
Mycotic aneurysm -
✔infected aneurysm
Atherosclerotic aneurysm -
✔results from weakening of the media in severe atherosclerosis
Fusiform aneurysm -
✔spindle-shaped dilatation where the stretching affects the entire circumference
