The Vascular System

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1

What is the sonographic appearance of the Aorta?

left to midline

straight

no calcifications

no dilatations

smaller as progression

bifurcation at umbilicus

can curve slightly anterior

2

What is the sonographic appearance of the IVC?

right to midline

curves anteriorly as approaches the diaphragm

no calcifications

no dilatations

larger in diameter as it ascends

anastomoses at umbilicus

3

Where are iliac & hypogastric nodes found?

along IVC & aorta

4

Where are paraaortic lymph nodes?

wraps around aorta

5

What is the sonographic appearance of lymph nodes?

ill defined

homogeneous

echo poor lesion

round or oblong - every dimension

6

What indicates lymphadenopathy?

nodes larger than 1 cm - 3 cm

7

What should you do when there is lymphadenopathy?

examine spleen

8

What are the layers of vessels from outside to inside?

tunica adventitia

tunica media

tunica intima

9

What does the tunica intima of a vessel consists of?

endothelial cells

connective tissue

elastin fibers

10

How are veins different than arteries?

tunica adventitia is no stretchy

tunica media is not well developed

tunica intima has valves

veins are larger

veins are compressable

11

How are arteries different than veins?

tunica adventitia is stretchy

tunica media is well developed (muscular)

arteries are round

arteries do not compress

arteries expand to accomadate blood

12

What is the size of the aorta at the diaphragm?

2-3 cm

narrows as branches arise

13

What are the parts of the aorta?

arch

ascending

descending

abdominal

bifurcation

14

What are the branches off the aortic arch?

brachiocephalic

left carotid

left subclavian

15

What are the major branches off the abdominal aorta?

celiac

SMA

renal

IMA

16

What are the minor branches off the abdominal aorta?

gonadal

lumbar

suprarenal

17

What are the images required of the aorta?

Aorta sag left

Prox

Mid

Distal

Aorta trans left

Prox

Mid

Distal

18

How is the aorta measured?

in trans

outer to outer

19

What are the landmarks of the mid sag aorta?

celiac

SMA

level of pancreas

20

What are the landmarks of the mid trans aorta?

splenic

SMA

21

What is the size of the aorta at the level of the bifurcation?

>1

22

What happens to the IVC on expiration?

colapse

23

What is the shape of the IVC?

almond

24

What caused dilatation of the IVC?

Rt ventricular heart failure

CHF

Constrictive Pericarditis

tricuspid disease

Rt heart tumors

25

What artery leads to the arms?

subclavian

26

Name the arteries of the arms.

subclavian

auxiliary

brachial

radial & ulnar

27

thumb side?

radial

28

What is the venous arm protocol?

subclavian

axillary

cephalic, brachial, basilic

radial & ulnar

images with/without compression

images with augmentation

29

Aorta lies ______ to the crus of the diaphragm.

posterior

30

Vena Cava lies ______ to the crus of the diaphragm.

anterior

31

What are the branches of the celiac trunk?

Common hepatic

Lt. Gastric artery

Splenic artery

32

What is the branches of the Common Hepatic artery?

Gastroduodenal

33

What does the Common Hepatic turn into after the branch of the gastroduodenal artery?

Proper Hepatic artery

34

What are the branches of the Proper Hepatic artery?

supraduodenal

Rt. Gastric

35

The Proper Hepatic artery bifurcates into what two arteries?

Left & Right Hepatic arteries

36

Where does the cystic vein drain?

into the portal vein

37

What does the Lt. Gastric artery serve?

esophagus and lesser curvature

38

The splenic artery is very ______ and has many branches.

tortuous

39

Explain the view of the celiac truck on longitudinal images.

just caudel to diaphragm

Caudate lobe of the liver

Very short

40

Explain the view of the celiac truck on transverse images.

seagull

41

What is the sonographic appearance of the Lt. Gastric artery

very difficult to see

42

Explain the route of the SMA.

arises 1 cm below celiac

anteriorly

courses for a while above aorta

43

What are the branches of the SMA?

inferior pancreatic

duodenal

colic

iliocolic

intestinal

44

What does the SMA provide blood to?

2nd portion of the duodenum to 2/3 of transverse colon.

45

Where does the IMA arise?

anteriorly from aorta

just above bifurcation

46

What are the branches of the IMA?

superior left gastric

sigmoid

superior rectal

47

What is the sonographic appearance of the IMA?

difficult to see

48

What does the IMA feed?

last 3rd of transverse colon to rectum

49

What is the best viewing plane for the renal arteries?

transverse scan

50

Where does the right renal artery lie to the IVC?

under

51

Where does the left renal vein run between?

aorta & SMA

52

Why is the left renal artery bigger than the right?

flow from the

adrenal

gonadal

lumbar

53

What is Nutcracker syndrome?

SMA and Aorta put pressure on Lt. renal vein causing it to constrict

54

What is the presentation of Nutcracker syndrome?

left flank pain

hematuria

55

What is another name for Nutcracker syndrome?

Renal Vein Entrapment syndrome

56

Where does the gonadal artery arise?

inferior to renals

57

Where does the right gonadal vein drain?

into IVC

58

Where does the left gonadal vein drain?

into left renal vein

59

What do the hepatic veins drain?

liver

60

Which of the hepatics veins is the largest?

Right

61

Which of the hepatics veins is the smallest?

Left

62

What is the largest branch into the IVC?

Hepatic veins

63

What is the sonographic appearance of the Hepatic Veins?

playboy bunny

reindeer

64

What forms the Portal Vein?

splenic

IMV

SMV

65

The Portal vein lies _____ to the IVC

anterior

66

What is the flow of the portal vein

hepatopetal

67

What does the splenic vein drain?

spleen

into portal

68

Where does the splenic vein lie to the pancreas?

posteromedial

69

What does the SMV drain?

Gut

70

Where does the SMV drain into?

Portal splenic confluence

71

Which is larger the SMV or SMA?

SMV

72

Where does the SMV lie to the aorta?

parallel

73

Where does the SMA lie to the aorta?

angles away

74

AMV is _____ to SMA

anterior

75

What does the aorta bifurcates into?

common illiacs

76

What forms the IVC?

anastomoses of the two common iliac veins

77

What do the common iliacs divide into?

internal & external iliac arteries

78

What does the external iliacs turn into?

Common femoral arteries

79

Where does an aortic aneurysm usually occur?

between the renal arteries and the bifurcation

80

What are the main causes of an aneurysm?

arteriosclerosis

syphilis

cystic medial necrosis

81

What layer of the vessel does an aneurysm effect?

all three

82

What is an aneurysm?

permanent dilation greater than 1.5 times normal size

83

What is the most common form of an an aneurysm?

fusiform

84

What is a fusiform aneurysm?

spindle shaped

general enlargement

bright wall echos

decreased pulsatility

85

What is a saccular aneurysm?

spherical in shape

large

frequently filled with a thrombus

86

What are the shapes of aneurysms?

cylindrical

saccular

fusiform

87

what is the symptoms of an aortic dissection?

sudden onset of excruciating pain

88

What is the sonographic appearance of an aortic dissection?

intimal flow

intimal flap

89

Who usually has an aortic dissection?

40 - 60 year old men with a history of HTN

90

When is there a 75% chance of rupture in an aneurysm?

greater than 7 cm

91

1% of aneurysm under ______ cm rupture

5 cm

92

What is done for an aneurysm under 5 cm?

U/S exam every 6 months

93

What is done for an aneurysm under 6 cm?

surgical repair

94

What percent of ruptured aneurysm patients die in surgery?

40%

95

What is the #1 cause of an aneurysm?

smoking

96

What are some mimicking pulsatile masses?

lymphoma

pancreatic carcinoma

retroperitoneal carcoma

97

What is the 2nd most common cause of pulsatile abdominal mass after triple A?

retroperitoneal lymph nodes

98

What is triple A?

abdominal aortic aneurysm

99

What is the sonographic appearance of an aortic grafts?

bright reflective walls

can have hematoma, infection, or degeneration of graft material

100

What is an AV fistula?

abnormal connection between artery and vein

101

What usually causes an AV fistula?

secondary to trauma

102

What is the sonographic appearance of an AV fistula?

multiple anechoic tubular structures creating a mass effect

103

What are the congenital abnormalities of the IVC?

double IVC

obstruction by congenital webs (Bud Chari)

104

Who does Budd Chari usually effect?

30 - 40 year olds

105

What is the pathology of the IVC?

congenital abnormalities

IVC dilatation

Caval tumor

106

What are the two types of a caval tumor?

intrinsic

extrinsic

107

What are the clinical findings of a renal vein thrombosis?

leg edema

low back pain

pelvic pain

GI problems

108

What is the sonographic appearance of a renal vein thrombosis?

echogenic lumen

large vein

obstructed lumen

109

What is the RI for good perfusion?

under .7 RI

110

What is the RI for possible rejection?

.7 - .9 RI

111

What is the RI for probable rejection?

over .9 RI