abdomen/neuro final review winter

Clinical findings of breast cancer?

Surface nipple lesions

New nipple retraction

New focal skin dimpling or retraction

Unilateral new or growing axillary lump

Hot, red breast (inflammatory cancer)

Common types of breast cancers?

invasive ductal carcinoma

invasive lobular carcinoma

ductal carcinoma in situ

most common malignant tumor of the breast?

infiltrating ductal carcinoma

most common benign tumor of the breast?

fibroadenoma

Who is more likely to get fibroadenomas in the breast?

African American women

Sono features of fibroadenoma

round, smooth, lobulated, mobile, asymptomatic

What are fibrocystic diseases/changes?

variations of breast tissue depending on hormonal fluctuations

What is an intracapsular rupture?

The shell of a breast implant develops a tear, gel goes between shell and capsule

Sono appearance/sign of an intracapsular rupture

step ladder/spaghetti sign

What is an extracapsular rupture?

tear in capsule and shell, gel extravasates into breast tissue

Order of lymph drainage in the breast?

retromammary

contralateral flow

interpectoral

supraclavicular

diaphragmatic

Sentinel node

first lymph node involved by metastases

supraclavicular node

 metastases from breast cancer can involve these

interpectoral (Rotter’s) nodes

located between pectoralis major and minor muscles

Athelia

absence of nipple

polythelia

additional nipples

polymastia

growth of extra breast tissue in axilla

amazia

absence of breast tissue, but nipple remains intact

Where are we going to see METS in the breast?

axilla

RRA courses ____ to IVC

posterior

LRV courses ____ to AO

anterior

LRV courses ____ to SMA

posterior

SMA courses _____ to pancreas

posterior

Renal arteries lie _____ and _____ to SMA

posterior and lateral

Criteria for an AAA?

>3 cm or 1.5x the diameter of prox aorta

pancreas head relationship to PV?

right

pancreas head relationship to SMV?

anterior

pancreas head relationship to aorta?

anterior

IVC will ____ with inhalation, AO will ____

dilate, not change

Most common location for AAA?

infrarenal

Normal AO measurement for women?

<2.0 cm

Normal AO measurement for men?

<2.5 cm

Structures in the spermatic cord?

vas deferens, testicular vessels, pampiniform plexus

normal testicle measurements?

3-5 cm long, 2-4 cm wide, 3 cm AP

Mediastinum testis sono appearance

linear echogenic band within the testis

Testicular appendix origin/location

remnant of Mullerian duct; small ovoid structure located on superior pole of testis and epi head

tunica albuginea

inner layer of testis, forms septa

What is the function of the seminal vesicles?

produce fluid of semen

Sono appearance of seminal vesicles

hypoechoic

Rete testis sono apperance

hypoechoic region near mediastinum testis, drains into epi head

Normal prostate measurements?

4 × 3 × 3.8 cm

Peripheral zone

contains 70 percent of glandular tissue

Which zone is the site of the majority of prostate cancers?

Peripheral zone

Central zone

contains 25% of glandular tissue, 10% of prostate cancers

Transitional zone

5% of glandular tissue, 20% of prostate cancer

Which zone has the second most prostate cancer?

transitional zone

Where is BPH located most often?

Transitional zone

Anterior fibromuscular stroma of prostate

resistant to disease, non glandular region

Most common testicular neoplasm?

Germ cell tumor (seminoma)

Most common epididymal neoplasm

adenoma

What elevates PSA?

Prostate cancer, BPH, inflammation prostatitis, prostate manipulation, biopsy, cystoscopy

Cryptorchidism

Undescended testis

Largest zone of the prostate?

peripheral

Sono features of acute prostatitis?

Hypoechoic gland, geographic hypoechoic areas, may mimic carcinoma

Testicular torsion sono signs?

Torsion knot/whirlpool

enlarged/hetero epididymis

Reactive hydrocele

Skin thickening

Age range for germ cell tumor?

15-35

Age range for teratoma?

infants or 3rd decade

Age range for choriocarcinoma?

2-3 decades

Age range for lymphoma of the testicle?

>60

Prostate cancer sono appearance?

isoechoic/hypoechoic

Capsular bulging

Glandular asymmetry

Areas of attenuation

Hyperechoic: starry sky appearance

Lab value for prostate cancer?

PSA >10 ng/mL

How often does acute epididymitis progress to epididymo-orchitis?

20%

Organisms causing epididymitis?

E. Coli, pseudomonas, Klebsiella, Neisseria gonorrhoeae, chlamydia trachomatis

Seminoma sono appearance?

Range from small, well circumscribed lesions to large masses replacing the testis

Pure seminomas: uniform, low level echoes without calcifications, hypoechoic

Larger tumors may have more hetero appearance

Indications for scrotal sonography

Scrotal masses, pain, trauma, varicocele, follow up of neoplasms, undescended testes

Where would hydrocele be located?

between the parietal and visceral layers of tunica vaginalis

Most common cause of painless scrotal swelling?

hydrocele

Congenital cause of hydrocele?

patent processus vaginalis

Acquired causes of hydrocele?

trauma, infection, torsion, neoplasm

Varicocele

>2 mm dilated, tortuous, elongated veins of pampiniform plexus

Most common correctable cause of male infertility?

Varicocele

What causes varicocele?

Absent/incompetent valves

Which side is varicocele more often? Why?

98% on the left (drains to LRV)

Most common location of undescended testes?

inguinal canal/upper groin

Problems with undescended testes?

48x more likely to undergo malignant change

10x likely for trosion

infertility

Acute epididymitis sono signs

Enlargement and thickened epididymis

Decreased echogenicity

Coarse, hetero texture

Reactive hydrocele

Scrotal wall thickening

Hyperemia with Color Doppler

Acute pancreatitis sono appearance?

enlarged, hypoechoic, hetero, anterior compression of IVC, dilated or narrowed pancreatic duct

Chronic pancreatitis sono appearance

hyperechoic foci, pancreatic duct dilatation, CBD dilatation, PV thrombosis, atrophy

Why would the pancreatic duct be dilated?

Obstruction of ducts proximal to the pancreatic duct

Why would the pancreatic duct be compressed?

pancreas can be enlarged and inflamed

How is the uncinate process best visualized?

Sag

Where is the uncinate process?

Caudal/posterior pancreatic head

Where are the SMA and SMV relative to the pancreatic head

anterior

Hyperfunctioning pancreatic islet cell tumor

insulinomas and gastrinomas

Nonhyperfunctioning pancreatic islet cell tumor

tend to be malignant

A 2x increase in amylase indicates what?

acute pancreatitis

Lipase rises with what pathologies?

acute pancreatitis and pancreatic carcinoma

Most common malignant lesion of the pancreas

adenocarcinoma

Most common location for pancreatic adenocarcinoma?

In the head (70%)

METS to pancreas locations

Liver, para aortic nodes, portal venous system

Pancreatic adenocarcinoma sono features?

poorly defined

inhomogenous

hypoechoic

dilated pancreatic and bile ducts

Doppler findings of pancreatic cancer

High velocity, low resistance

Differential dx for pancreatic cancer

focal pancreatitis

focal mass associated w chronic pancreatitis

peripancreatic lymphadenopathy

ampullary adenocarcinoma

Most common type of cholangiocarcinoma?

Klatskin tumor/hilar cholangiocarcinoma

Klatskin tumor location?

begins at confluence of R/L hepatic ducts where main bile duct is formed

Vessels involved with Klatskin tumor?

Portal veins and arteries

Mirizzi syndrome

Clinical syndrome of jaundice with pain

Mirizzi syndrome causes

impacted stone in cystic duct/GB neck, causes extrinsic obstruction of CHD

GB measurements

< 3 mm wall

2.5-4 cm diameter

7-10 cm length