Final Case Studies

A 50 year old woman with AUB undergoes a pelvic US. TV reveals a thick endo w/a single vascular feeding vessel apparent on color Doppler. What is the most likely diagnosis?

Endometrial polyp

A 48 year old woman undergoes a pelvic US b/c of AUB. The uterus is homogenous, and endo thickness is 1.7cm. Sonohysterography reveals diffuse endo thickening w/no intraluminal masses. What is the most likely diagnosis?

Endometrial hyperplasia

A 30 year old woman 2 months postpartum w/AUB undergoes TV US. The exam reveals a normal size uterus, a 12cm thick endo, and an echogenic mass w/in the uterine cavity. Serum B HCG testing negative. What is the most likely cause of AUB?

RPOC (Retained products of conception)

A 42 year old woman w/hx of breast cancer undergoes a pelvic US, which demonstrates cystic changes w/in the endo. Which of the following is the most likely cause of the endo appearance?

• Submucosal fibroid

• Tamoxifen changes

• Adenomyosis

• Intramural fibroid

Tamoxifen

A 30 year old woman w/menorrhagia undergoes a pelvic US that reveals a hypoechoic mass distorting the endo. This mass attenuates the sound beam, it has a broad base, and the endo courses over it. What is most likely the diagnosis?

Submucosal fibroid

A 45 year old woman w/intramenstrual spotting undergoes a TV US. Endo thickness is 20mm, and saline introduced during hysterosonography outlines a focal mass isoechoic to the endo. What is the most likely diagnosis?

Endometrial polyp

A 25 year old woman w/menorrhagia undergoes a pelvic US, which demonstrates multiple intramural and subserosal fibroids, w/the largest measuring 8cm. The physician presents several treatment options. The pt wishes to maintain fertility. Which of the following is NOT a treatment option likely offered?

• Myomectomy

• Endometrial ablation

• Uterine artery ablation

• Progestin-releasing IUD

Endometrial ablation

A 75 year old woman w/postmenopausal bleeding undergoes pelvic US which reveals a 1.5cm endo. What is the most likely diagnosis?

Endometrial carcinoma

An adnexal mass is palpated in a 34 year old woman w/pelvic pressure. Pelvic sonography reveals a 4cm solid adnexal mass w/a normal appearing ovary adjacent to the mass. What is the most likely diagnosis?

Pedunculated fibroid

A 50 year old woman experiencing AUB undergoes pelvic US. The uterine body is globular and slightly heterogeneous, with several myometrial cysts identified, and the endometrial-myometrial junction is not clearly delineated. What is the most likely diagnosis?

Adenomyosis

A 31 year old woman w/irregular menses and infertility problems presents for a pelvic US. The ovaries have eight follicles measuring 3-6mm in diameter. The most likely reason for this finding is?

PCOS

A 13 year old girl started menses 6 months ago and has cyclic pain on the left side during menses. On the US, an endometrial echo is present in addition to a thick-walled oblong mass attached to the uterus on the left side. What is the most likely diagnosis?

Uterus didelphys

A 26 year old woman has abnormal hair growth on her chin and elevated serum testosterone levels. Her last menses was over 2 years ago. Her urine pregnancy test was negative. On the TV US, both ovaries are enlarged, measuring greater than 15mL in volume. What is the most likely cause for her symptoms and sonographic findings?

PCOS

A 22 year old woman w/irregular menses presents for a TV US. The right ovary contains 15 follicles in the periphery measuring 3-6mm in diameter. The left ovary and the uterus appear normal. The sonographic findings are compatible w/:

PCOS

For evaluation of infertility, 3D US of the pelvis has the most utility for the diagnosis of:

Septate uteri

A 27 year old w/recurrent miscarriages presents for a pelvic US. US reveals a subtle fundal indentation on the uterus w/a slightly concave uterine cavity. These findings are associated w/what uterine anomaly?

Arcuate uterus

A 37 year old woman is undergoing IVF. After receiving gonadotrophins, her Dr. orders a TV US. The purpose of this sonogram is to:

Measure follicle size

Which uterine anomaly is characterized by two cervices and two vaginas?

Uterus didelphys

A 30 year old woman w/pelvic pain and dyspareunia presents for a pelvic US. US demonstrates a thin-walled cystic mass w/low level internal echoes and through transmission in LT adnexa. The RT ovary and uterus appear normal, what is the most likely diagnosis?

Endometrioma

A 28 year old w/dysmenorrhea since age 14 comes in for a pelvic sonogram. A RT ovarian cyst is seen w/thick walls and a fluid/debris level. This same mass was seen sonographically 3 months ago. It is tender on imaging w/the vaginal probe. What is the most likely diagnosis?

Endometrioma

A 25 year old woman is referred for a pelvic US b/c of LLQ pain. A pregnancy test was negative. The US reveals a 2cm unilocular simple cyst, adjacent to left ovary. Which of the following statements is true?

This is most likely represents a paraovarian cyst, and no treatment necessary

A 75 year old woman undergoes a pelvic sonogram b/c of increasing abdominal girth and complaints of feeling exhausted. US reveals a 20cm, complex, predominately cystic mass occupying her pelvis and abdomen. Multiple papillary projections and septations are evident w/in the mass, which demonstrate vascularity. What is the most likely diagnosis?

Cystadenocarcinoma

A 45 year old woman w/mild pelvic discomfort undergoes an US, and a 3cm hypoechoic solid ovarian mass is discovered. The images also demonstrate ascites and marked attenuation posterior to the mass. Which of the following is the most likely diagnosis?

Fibroma w/Meigs syndrome

A pediatric pt w/elevated estrogen levels is referred for a pelvic US after receiving a diagnosis of precocious puberty. A solid mass is discovered in the left adnexa, w/no evidence of a normal left ovary. What is the most likely diagnosis?

Granulosa cell tumor

A 55 year old woman with stomach cancer is referred for a pelvic US b/c of pelvic discomfort. The US reveals bilateral solid ovarian masses. This finding is most consistent with?

Mets

A 19 year old is referred for a pelvic US b/c of a palpable rt adnexal mass and no other symptoms. The sonographer was unable to identify a normal right ovary but noticed a discrete area w/hyperechoic dots and lines, including a rounded echogenic area producing a shadow. At first, the area that produced a shadow was thought to be the bowel, but no peristalsis occurred. These findings are consistent with which type of ovarian mass?

Cystic teratoma

A 45 year old woman with menorrhagia undergoes a pelvic sonogram that reveals a multiloculated cystic mass adjacent to the rt ovary. The pts medical hx includes prior pelvic surgery for endometriomas 15yrs ago. The pt denies any RLQ pain. What is the most likely diagnosis?

Peritoneal inclusion cyst

The sonographic images of a unilateral ovarian mass in a 25yr old woman w/menstrual irregularities demonstrate a well-defined, 5cm homogeneous unilocular mass containing low-level internal echoes and posterior acoustic enhancement. These findings are most consistent with:

Endometrioma

A 45 year old woman undergoes a pelvic US b/c of family hx of ovarian cancer. Her CA 125 levels are not elevated, and she is not experiencing any unusual symptoms other than wt gain. US reveals a 1.5cm, predominately cystic mass w/multiple septations, several papillary projections, and low-level echoes w/in the mass. Color reveals vascularity within the solid components. Given the pt’s hx and US findings, what is the most likely diagnosis?

Mucinous cystadenocarcinoma

A 29 year old woman with LLQ pain is referred for a pelvic US to r/o torsion. The images demonstrate a 4cm lt ovarian mass containing a reticular pattern of echoes w/posterior enhancement and peripheral ovarian flow. A f/u performed 2 months later reveals a normal lt ovary and a 2.5cm dominant follicle on the rt ovary. By the time of the f/u US, the pt was asymptomatic. Which of the following would be the diagnosis for the 1st exam?

Hemorrhagic ovarian cyst

The cystic space w/in the embryonic head visualized approximately 8wks gestational age is the developing:

Rhombencephalon

Evidence of a developing IUP should be endovaginally seen with a serum hGC level of:

1000-2000 mIU/mL

In the early 1st tri, the GS is expected to grow at a rate of:

1mm/day

The absence of the thick echogenic rim surrounding the early GS w/in the endo is sus for:

Pseudogestational sac of ectopic pregnancy

In the development of a normal IUP, the yolk sac should be seen TV in a GS with what minimal measurement?

8mm

The occipitofrontal diameter may be measured in the 2nd/3rd tri of pregnancy. This measurement in conjunction w/BPD is best used to:

Determine fetal head shape (CI)

The NT thickness used for gestational screening in the 1st tri must be obtained in the:

Sagittal plane

The fetal thoracic circumference should be closely evaluated and compared with the abdominal circumference in the event of a suspected:

Chromosomal abnormality

A secondary yolk sac measuring greater than what measurement is considered to be abnormal and sus for an abnormal pregnancy development?

6mm

The sonographic measurement of what fetal biometric parameter is least influenced by shape?

HC

A 24 yr old woman with a positive pregnancy test and pelvic pain is seen for an US. She has a hx of PID. The US reveals a UT containing anechoic sac that lacks a double decidual sign w/moderate amount of cul-de-sac fluid. This is most suspicious for?

Ectopic pregnancy

A 28 year old pregnant women presents to ED at 30wks gestation with knifelike abd. pain following a MVA. Her abdomen is tense and hard on palpation. US reveals a large hypoechoic collection of fluid in the retroplacental region. This is consistent with which of the following?

Placental abruption

A 19 year old woman, gravida 2, para 1, presents to the ED at 11wks gestation with vaginal bleeding. Lab test result reveals a b-hCG level of 219,000 IU/mL. A sonogram is ordered to confirm which of the following?

Molar preganacy

A pt is seen with heavy bleeding 7 days after delivery of a 36wk-infant. US reveals an enlarged postpartum UT containing an echogenic mass. This suggests:

Retained products of conception

An 18 year old is seen by her gynecologist w/a 1wk Hx of spotting. She reports that she had a positive pregnancy test result after a missed period 7 weeks ago. US eval reveals an intrauterine sac w/an embryo, w/out a heart beat, measuring 6wks. This is consistent with which of the following?

Missed abortion

A 41 year old woman is seen by her OB w/vaginal bleeding and hyperemesis. Clinical exam reveals a UT consistent w/a 12 week gestation, which is inconsistent w/her predicted 10wk gestation by LMP. An US is performed and reveals a fetus w/out heart motion and CRL is consistent w/8wk gestation. An enlarged placenta is identified containing numerous small cystic lesions. This is most suggestive of:

Partial hydatidiform mole

A 35 year old multiparous women is seen for an OB exam w/bleeding at 32 weeks gestation. TV US reveals a placenta on the anterior UT wall, crossing the internal cervical os and extending 2cm on the posterior UT wall. This is consistent w/which of the following?

Complete previa

][-A 22 year old pregnant women is seen in the sonography department w/heavy bleeding and cramping. She had a US 1wk prior b/c of an episode of spotting, which revealed a 6wk embryo. The current US reveals a UT w/out evidence of an embryo or GS. What is consistent with …

SAB (spontaneous abortion)

A 39 year old woman, G4, P3, is seen for an OB US at 33wks for late prenatal care. The sonographer identifies placenta previa and observes a C-section scar, which is confirmed by the patient. The sonographer should also look for signs suggestive of which abnormality?

Placenta accreta

A pt presents with pain and spotting at 7wks. US confirms a viable IUP consistent with the pt’s LMP. An adnexal “ring sign” is seen in the left adnexal region adjacent to the LT ovary. The sonographic finding described which of the following?

Heterotopic gestation

A 10 year old boy is referred for an US b/c on clinical exam, only one of his testicles was palpable w/in the scrotal sac. A homogeneous ovoid mass is identified w/in the left inguinal canal. Surgical repair is recommended b/c this condition is associated with increased risk of…

Cancer

A 52 year old man is diagnosed w/epididymo-orchitis after sonographic eval. His clinical S/S most likely includes which of the following?

Painful enlargement of the scrotum

A 25 year old man has sudden onset of scrotal pain during a soccer game. During exam in ED, the right hemiscrotum is still painful. A sonogram reveals slight enlargement of the RT testicle and on color Doppler exam, no color flow can be found in the right testicle. What is the diagnosis?

Testicular torsion

A 43 year old man is seen w/a mobile painless mass at the upper pole of his right testis. Sonographic exam reveals 1.5cm, round anechoic lesion that demonstrates acoustic enhancement. No other abnormalities are apparent. This probably represents a:

Spermatocele

A 30 year old man undergoes sonographic exam for painless mass in the right hemiscrotum. The sonogram reveals multiple punctuate hyperechoic nonshadowing foci and hypoechoic mass w/in the rt testis. What is the most likely diagnosis?

Seminoma with microliths

A 32 year old man undergoes eval for infertility, and his Dr. orders a sonogram. The exam shows a collection of vessels measuring 2.0 to 2.5mm in the LT hemiscrotum. What Doppler findings w/in this collection of vessels would suggest a primary varicocele?

Further dilation and increased blood flow during Valsalva maneuver

A 15 year old boy is seen in the ED after falling and straddling a bicycle cross-bar. He has pain and swelling of the scrotum. The US reveals heterogenicity in area of the RT testicle and hypervascularity on color Doppler exam. An area of echogenic material is seen just outside the upper margin if the right testicle. What is the most likely diagnosis

Testicular rupture

A 28 year old man undergoes clinical eval, for a palpable mass in the LT testicle. US reveals a solid mostly hypoechoic mass including a shadowing calcification w/in the LT testicle. A small amount of fluid also surrounds the left testicle. These findings are suggestive of:

Embryonal cell carcinoma

A 61 year old man is seen w/intermittent pain and welling of the RT scrotum, radiating to the rt inguinal canal. A US is performed is ordered b/c a scrotal hernia is suspected. Which of the following US findings is suggestive of a scrotal hernia?

Tubular structures that demonstrate peristalsis w/in the scrotum

A 30 yr old man w/gynecomastia, elevated hCG and no palpable scrotal mass presents for an US. The most significant sonogram finding includes a 1.5cm heterogenous mass w/in the RT testicle. After orchiectomy, the prognosis remains poor b/c this type of cancer does not respond well to radiation and chemotherapy. The clinical and sonographic findings suggest which type of cancer?

Choriocarcinoma

A postmenopausal pt w/hypercalcemia and hypophosphatasia is referred for US of the neck. An oval shaped, hypoechoic mass is seen posterior to the mid-lower rt lobe of the thyroid. The clinical findings of hypercalcemia and hypophosphatasia along with the shape and location of this mass are most suggestive of:

Parathyroid adenoma

A 31 year old woman is referred for a sonogram after bilateral neck fullness is noted during a routine physical exam. The sonographic appearance of the thyroid gland is diffuse, hypoechoic enlargement of both lobes and the isthmus and “coarse” parenchyma. The USA of the mass along w/the pt’s gender and age are suspicious for…

Hashimoto's thyroiditis

A 19 year old man w/no significant medical Hx is seen with a palpable nodule in the region of the RT inferior lobe of the thyroid. On sonographic exam, the corresponding nodule is found to be slightly less echogenic than the surrounding thyroid parenchyma. There is a wide, irregular halo surrounding the nodule and fine punctuate internal calcifications throughout the nodule. What is the most likely diagnosis?

Papillary thyroid cancer

A 63 year old man in apparent good health is seeking a second opinion for a thyroid nodule that was diagnosed elsewhere. He was told that the nodule contained "psammoma bodies” This finding refers to:

Macrocalcifications in a nodule

A 10 year old girl presents w/a vary tender, high-midline neck mass. Her parents report feeling a small limp in this location since she was a baby, but it has enlarged and is now painful. The sonogram reveals an oval, 1×1.5cm cystic mass w/a thin wall and some internal debris. It is located approximately 3cm superior to the thyroid isthmus. What is the most likely cause of this cystic mass?

Infected thyroglossal duct cyst

A 35 year old man presents w/symptoms consistent w/hyperthyroidism. He is referred for a neck sonogram. The thyroid appears diffusely hypoechoic w/a lobulated contour. No discrete nodules are seen. Color Doppler shows a dramatic increase in flow throughout the gland. What is the most likely cause for these findings?

Graves' disease

Incidental bilateral thyroid nodules are noted on a 75 year old man who is undergoing carotid artery eval. B/c the pt’s wife recently died of breast cancer he is concerned about cancer and has asked that these nodules be investigated. The nodules in the Rt lobe is noted to be mostly cystic but contains debris. The nodule in the Lt lobe contains multiple microcystic spaces separated by thin septa. These findings almost certainly suggest:

Bilateral benign thyroid nodules

An elderly man w/a painless, palpable thyroid nodule is referred for thyroid US. Previous imaging studies have reported a thyroid nodule w/calcification. The images are not available for review. A second US is performed and reveals a 2cm x 3cm solid, hypoechoic nodule w/a hypoechoic halo and disruption of peripheral, eggshell calcification. These findings make this nodule sus for:

Malignant nodule

A young man is referred to the US department for eval of the lateral neck mass that is nontender. The sonogram reveals a solitary thyroid nodule and multiple rounded masses that follow the carotid-jugular areas. Both the intrathyroidal and extrathyroidal masses contain microcalcifications. This should represent:

Metastatic thyroid cancer

A young woman presents w/a painless, diffusely enlarged thyroid glans on physical exam. The USA confirms diffuse enlargement w/a micronodular pattern and increased vascularity. Which of the following conditions should the sonographer suggest to the Dr.

Chronic thyroiditis