URR PATHOLOGY: SCROTUM, THYROID, VASC

Gonadal stromal tumors should be suspected in a patient with a painless testicular mass and:

gynecomastia

A significant increase in blood supply/drainage to thyroid will be seen with thyroiditis. This can be demonstrated with _________ Doppler and is called the ________ sign.

Color

inferno

Medullary carcinoma of the thyroid is a common occurence with:

MEN syndrome

According to the DeBakey Classification system, what type of aortic dissection is most commonly associated with Marfan syndrome?

Type II

(Type I = involves ascending & descending aorta

Type 2 = involve ascending aorta; associated with Marfan syndrome

Type III = involves the descending aorta; lowest mortality rate)

The most common benign, solid lesion of the thyroid is ____________.

Adenoma

The mass on the image is confirmed embryonal cell tumor. What statement is true regarding this type of neoplasm?

most aggressive testicular malignancy

The most common location of ectopic thyroid tissue formation outside the neck is the _____________.

chest

What is the best way to differentiate an undescended testicle from other inguinal masses?

identify the mediastinum testis

The most common cause of acute scrotal pain in postpubertal men is:

acute epididymitis

A patient presents with fever, fatigue, hoarseness, and a painful thyroid on clinical examination. The lab results indicate low levels of thyroid stimulating hormone and high levels of T3 and T4. These findings are most suggestive of:

Dequervain thyroiditis (painful thyroiditis)

A patient presents for a scrotal ultrasound following a recent herniorrhaphy. The findings on the image are most consistent with:

Intratesticular varicocele

Zenker diverticulum can be mistaken for:

a thyroid mass

Increased thyroid volume is associated with::

chronic renal failure

Hashimoto disease is the most common type of __________ and leads to ___________.

hypothyroidism, diffuse enlargement of the gland

What is the arrow pointing to on the midline view of the abdomen?

IVC thrombosis

What best describes the findings on the image?

There are several colloid cysts present within the thyroid and some demonstrate the comet tail artifact

The bell clapper deformity is a predisposing factor for testicular torsion. It is defined as:

the tunica vaginalis completely encircles the epidiymis, distal spermatic cord, and testis

The most common cause for fluid collection in the perirenal space is ___________. The most common cause for fluid collection in the posterior pararenal space is _________.

renal abnormalities

aortic disease

Aneurysms of the iliac and popliteal arteries are commonly associated with:

aortic aneurysms

What describes tubular ectasia of the rete testis?

bilateral and associated with spermatocele formation

A right renal mass will displace the IVC:

medially

A patient presents for a thyroid US due to increased T3 and T4 levels in the blood. Additional symptoms include weight loss, night sweats and exophthalmos. The thyroid demonstrates an increase in size and a diffuse decrease in echogenicity with a coarse, heterogeneous texture. What best describes these findings?

Grave's disease

If an abdominal aortic aneurysm is identified, what two other vessels should be evaluated for associated aneurysm formation?

common femoral and popliteal arteries

What is the most common occuring germ cell tumor of the testicle?

seminoma

Which of the following is NOT a medication that can be used to treat patients with hypothyroidism?

a. coumadin

b. iodine supplements

c. iron supplements

d. levothyroxine

Coumadin

Which of the following has the highest risk of developing thyroid cancer?

a. cirrhosis

b. grave's disease

c. parathyroid adenoma

d. hashimoto's thyroiditis

Hashimotos thyroiditis

The halo sign is a sonographic characteristic of what thyroid abnormality?

adenoma

What is correct regarding testicular seminoma?

associated with cryptorchidism, trisomy 21, Klinefelter syndrome, and smoking

What best describes the Doppler tracing found within the body of a pseudosneurysm?

low resistance to and fro flow

What describes an adenomatoid tumor?

a benign intrascrotal tumor

A thyroglossal duct cys is most commonly found:

on the midline neck, superior to the thyroid gland

What describes how to aid in differentiation of a thyroid adenoma in the lower pole from a parathyroid adenoma?

thyroid adenomas are hypovascular and parathyroid adenomas are hypervascular

What is associated with an increased risk of thyroid malignancy?

psammoma bodies and intranodular flow patterns

A 1yr old presents for a testicular sonogram due to a palpable lump. The lab work in the chart indicates high levels of alpha fetoprotein. A mostly solid intratesticular mass is identified in the right testicle. There is a small area of possible necrosis centrally. These findings are most consistent with:

Yolk sac tumor

A mass is identified in the left testicle. It is rounded with well-defined borders. There are internal rings of hyperechoic and hypoechoic tissues giving the appearance of an onion. No color flow is demonstrated within the mass. These findings are most consistent with:

Epidermoid cyst

What statement best describes the appearance of color Doppler evaluation of a testicular abscess?

No color flow demonstrated centrally

Increased color flow displayed around the periphery of the abscess

A 30 yr old male presents with fever, malaise, and mild to moderate right scrotal pain that began 3 days ago. Lab results indicate leukocytosis is present. The right testicle demonstrates mild diffuse heterogenicity. PW Doppler evaluation of the affected side produces a waveform with peaked antegrade systolic flow and diastolic flow reversal. These findings are most suggestive of:

acute orchitis with venous infarction

What statement describes the Doppler tracing found in the stalk of a pseudoaneurysm?

high resistance to and fro flow

Cervical lymphadenopathy is a common finding with:

Papillary thyroid carcinoma

A scrotal pearl refers to:

a large extra-testicular calcification

What are the most common primary carcinomas to metastasize to the thyroid?

breast and lung

A 28yr old presents for a testicular sonogram due to a palpable lump. The lab work in the chart indicates high levels of alpha fetoprotein and b-hCG. A mostly solid intratesticular mass is identified in the right testicle that disrupt the smooth contour of the teste. There is a small cystic area centraly. The findings are most suggestive of:

Embryonal cell carcinoma

Primary testicular carcinoma is usually _________ and secondary testicular malignancy is usually _________.

unilateral

bilateral

What statement is true regarding the abnormality on the image?

it can be caused by nutcracker syndrome

A benign thyroid adenoma is associated with ________ calcification(s), while malignant adenomas are associated with __________ calcification(s).

Eggshell

Punctate

A lab report demonstrates that a testicular tumor contains choriocarcinoma cells and embryonal cell carcinoma. WHat best describes the tumor?

mixed germ cell tumor

A solid nodule in the left lobe of the thyroid that measures 2cm AP and 1cm width is most suggestive of:

A. papillary carcinoma

B. adenoma

C. anaplastic carcinoma

D. colloid cyst

papillary carcinoma

Serpingious vessels are identified on the examinations of patients with:

portal HTN or testicular varicoceles

What is indicated by the arrow in the image?

parathyroid adenoma

You are scanning a patient that had a bilateral thyroidectomy 3 years ago. There are 3 round, anechoic lymph nodes identified between the mid common carotid artery and the sternocleidomastoid muscle. How will you report these findings?

Possible abnormal lymph nodes in level III.

Upper base of skull to hyoid bone (level II)

Hyoid bone to cricoid cartilage (level III)

From cricoid cartilage to clavicle (level IV)

What is most likely to cause anterior displacement of the abdominal aorta?

lymphadenopathy

A patient presents for their annual screening ultrasound after a complete thyroidectomy due to papillary carcinoma. You identify a 1cm uniformly hypoechoic mass lateral to the trachea. The mass is painful with transducer pressure and pain radiates to the head and chest. These findings are most suggestive of:

post traumatic neuroma

The most common extra testicular neoplasm is?

adenomatoid tumor

When evaluating a patient with an aortic endograft, what is the minimum increase in aortic size that indicates a possible endoleak?

0.6cm

regarding the aorta, fusiform aneurysm formation usually occurs in the ____________ while dissecting aneurysms usually occur in the _____________

distal abdominal aorta

aortic arch

A referring doctor requests a scrotal US to rule out orchitis. Which of the following is an expected sonographic finding for this abnormality?

increased intratesticular vascularity

A patient presents with mild testicular pain that has increased over the last few months. The US exam demonstrates a normal right testicle. The left testicle demonstrates many tiny cysts clustered centrally along the mediastinum. No color flow is identified within the cystic structures. What best describes the findings?

tubular ectasia

What is an intratesticular mass associated with Cushing syndrome and adrenal hyperplasia?

adrenal rest

What correctly describes Marfan syndrome?

genetic disorder that affects connective tissues of the heart, vessels, and bones

Lack of tapering of the aorta as it travels distally, without focal dilatation indicates:

ectasia

A patient presents with a new onset of scrotal pain and a low grade fever. Which statement below offers the most accurate summary of findings?

there is a complicated fluid collection compressing the testicle

All of the following are associated with an increased risk of thyroid malignancy, except:

a. psammoma bodies

b. intranodular flow patterns

c. absence of the halo sign

d. wider than tall mass orientation

wider than tall mass orientation

What Doppler finding is most suggestive of partial testicular torsion?

asymmetric resistive indices on the intratesticular Doppler evaluations

___________ artery aneurysms are commonly associated with pancreatitis and peptic ulcer, while ________ artery aneurysms are usually caused by cystic medial necrosis.

Splenic

Superior mesenteric

What therapeutic device is implanted inside the distal IVC?

greenfield filter

Patients with __________ have a significant increased risk of developing a seminoma

cryptorchidism

What correctly describes a difference between DeQuervain and Hashimoto thyroiditis?

DeQuervain thyroiditis is caused by a virus, Hashimoto thyroiditis is caused by bacteria

A 16yr old male presents with acute onset of significant left scrotal pain. The US exam reveals a 1cm

hypoechoic, heterogeneous mass located between the head of the epididymis and the testicle. The mass

demonstrates no vascularity with color Doppler evaluation. Normal flow is demonstrated in the epididymis and

testicle. Which of the following could describe the findings?

A. adenomatoid tumor

B. sarcoidosis

C. seminoma

D. torsion of the appendix testis

torsion of the appendix testis

What Doppler findings is most consistent with uncomplicated epididiymo-orchitis?

low resistance flow, resistive index 0.4

a hypoechoic thyroid mass with microcalcifications, hypervascularity and no halo sign is most consistent with

papillary carcinoma

A patient presents with an enlarged left scrotum and palpable mass. The US demonstrates an intratesticular mass that is hypoechoic and heterogeneous with multiple coarse calcifications. There is also an irregular central cystic area. These findings are msot suggestive of:

embryonal cell tumor or teratoma

Retrograde flow in the common hepatic artery and splenic artery is highly suggestive of:

celiac artery occlusion

What is most likely to be affected by a mumps infection?

parotid gland

The msot common secondary malignancy of the testicles is:

lymphoma

What best describes the findings on the image?

the arrows indicate a remnant of the Mullerian duct and a scrotal calcification

A patients presents with a small, palpable extratesticular mass on the left side. The US exam demonstrates a mobile, hyperechoic mass with posterior shadowing. What best describes the findings?

scrotal pearl

What type of thyroid cancer is most lethal?

Anaplastic

Epididymitis most commonly results from __________ in males 14-35yrs and ___________ in men over 35yrs.

sexually transmitted disease

bladder infection

A patient with a seminoma of the left testicle will usually be treated by ___________, while a patient with a non-seminomatous tumor of the left testicle will usually be treated by _____________.

unilateral orchidectomy and chemotherapy

unilateral orchidectomy

Chronic moderate congestive heart failure can cause this tributary of the IVC to be visualized sonographically due to the formation of a collateral pathway.

azygous vein

An abdominal US is ordered for a patient with bilateral pedal edema. The abdomen demonstrates mild ascites

but otherwise normal organs. The IVC appears prominent with a constant diameter of 2.8cm. A continuous venous

waveform is demonstrated on Doppler evaluation. These findings are most suggestive of:

A. congestive heart failure

B. portal HTN

C. malignant HTN

D. all of the above

congestive heart failure

Extrinsic compression of the IVC is an expected finding with:

large abdominal aortic aneurysm and large hepatoma

A heterogeneous, hypervascular mass with microcalcifications is identified in the left upper pole of the thyroid gland. Left side lymphadenopathy is also present. These findings are most suggestive of:

papillary carcinoma

The abnormality on the image is a confirmed sperm granuloma. This is a common chronic complication of what procedure?

vasectomy

All of the following are risk factors of thyroid cancer, except:

a. personal history of radiation treatment of a cerebral malignancy

b. personal history of previous papillary cancer

c. diagnosis of multiple endocrine neoplasm (MEN) syndrome

d. family history of hypercalcemia

family history of hypercalcemia

What is true regarding hydrocele formation?

accumulation of serous fluid between the two laters of the tunica vaginalis

What testicular tumor is composed of bone, cartilage, and smooth muscle fibers?

teratoma

What is an immune system disorder that commonly affects the salivary glands?

Sjogren syndrome

A patient presents with a hisotry of a 5mm Leydig cell tumor identified on an exam 6 months ago. What is a common complication of this type of neoplasm?

gynecomastia

A 65yr old male patient presents with bilateral scrotal swelling and mild pain. The US exam demonstrates bilateral hypoechoic, solid masses within the testicular parenchyma. What is the most likely diagnosis for the findings?

lymphoma

What vessels are a common source of a Type II endoleak?

inferior mesenteric artery and lumbar arteries

A patient presents for a neck ultrasound that has a history of papillary carcinoma and bilateral thyroidectomy. What area of the neck is most commonly involved in recurrence?

level III and IV lymph nodes between the carotid artery and the sternocleidomastoid muscle

Medial arcuate ligament syndrome involves compression of which vessel during respiration?

celiac axis

Leydig cell tumors of the testicle demonstrate high serum levels of __________ which can lead to __________.

testosterone

precocious puberty

When an AAA ruptures, which retroperitoneal space will fill with blood first?

perirenal

A right adrenal mass will displace the IVC

anteriorly

A small, hypoechoic testicular mass with a large calcification in a patient with gynecomastia is most likely a:

Sertoli cell tumor

What statement is true regarding this image?

The mass on the image is most likely a non-seminomatous germ cell tumor because of the characteristic heterogeneous texture with areas of cystic degeneration

A vein in the pampiniform plexus is considered abnormally dilated when the diameter exceeds:

2mm

What testicular tumor will cause b-hCG levels to rise but AFP levels will be normal?

choriocarcinoma