Objectives
- Part 2: Recognize Pathologic Scans for Biliary, Renal, Early Pregnancy, and more!
Part 2 (presented by Dana Resop, MD)
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Biliary: Name key findings of cholelithiasis on ultrasound
- Hyperechoic stones seen within the lumen of the gallbladder
- Irregular lumen of the gallbladder walls (e.g., not smooth all the way around)
- Shadowing posterior to the gallbladder lumen (helpful for smaller/gravel stones)
Biliary: Name numerous causes of gallbladder wall thickening
- Physiologic: contracted gallbladder (patient recently ate)
- Edematous states: CHF, cirrhosis, nephrotic syndrome, pre-eclampsia
- Inflammatory conditions: cholecystitis, cholangitis, hepatitis, pancreatitis, perforated duodenal ulcer
- Neoplastic: gallbladder adenocarcinoma, metastasis
- Others: adenomyomatosis, cystic vein varices (from cirrhosis)
Biliary: Names sonographic signatures of cholecystitis on ultrasound
- Presence of gallstones
- Thickening of the gallbladder wall (>3mm), not specific
- Pericholecystic fluid
- Sonographic Murphy’s sign (abdominal tenderness from pressure of the US probe)
Renal: Name the three degrees of hydronephrosis
- Mild (slightly abnormal)
- Moderate (obviously abnormal)
- Severe (thinning of the renal cortex)
Renal: True or False: Color Doppler can be used to help with the identification of hydronephrosis
True!
Color doppler should be placed on areas concerning for hydronephrosis- prominent vasculature can be a ‘fakeout’ for hydronephrosis.
Renal: True or False: A view of the bladder is required to be considered a complete/comprehensive renal study.
True!
Visualization of the bladder can identify outlet obstruction (e.g., BPH causing bilateral hydronephrosis)
Nephrolithiasis can also be visualized at the ureterovesicular junction (UVJ), when stones commonly become obstructed and cause symptoms
Early pregnancy: What is the first definitive sign of intrauterine pregnancy seen on ultrasound?
A gestational sac WITH a yolk sac (small cheerio/circle within the gestational sac)
Early pregnancy: What disease state gives the classic "snowstorm" appearance of the uterus on ultrasound?
Molar pregnancy
Early pregnancy: True or False: Transabdominal ultrasound should always be performed prior to a Transvaginal ultrasound.
True!
If an interuterine pregnancy is seen on transabdominal views, then a transvaginal view is not necessary.
Remember:
- Transabdominal views: better visualized with a full bladder
- Transvaginal views: better visualized with an empty bladder
Early Pregnancy: Name the findings of an interstitial (corneal) ectopic pregnancy
These are pregnancies that appear to be intrauterine, but are not centrally located within the uterus.
Measure the endomyometrial mantle (the distance from the edge of the gestational sac to the external uterine wall)
- A measurement <5-7mm is concerning for an interstitial ectopic pregnancy
- A measurement >7-8mm is more reassuring (with increased sensitivity) for a normal intrauterine pregnancy
Ocular: Name findings that distinguish a retinal detachment from a vitreous detachment
- Retinal detachment: thicker cord, does not typically cross over the optic nerve. Easy to see with normal gain.
- Vitreous detachment: thin cord, may cross over the optic nerve. Requires high gain to visualize.
Ocular: True or False: Patients with posterior vitreous detachments do not require follow up/consultation with Ophthalmology
False!
Vitreous detachments can cause pulling on the retina, so these patients should be seen and evaluated for small retinal tears.
Central Lines: Name the artifact seen when confirming placement of the guidewire with ultrasound
Reverberation artifact!