The Vascular System
What is the sonographic appearance of the Aorta?
left to midline
smaller as progression
bifurcation at umbilicus
can curve slightly anterior
What is the sonographic appearance of the IVC?
right to midline
curves anteriorly as approaches the diaphragm
larger in diameter as it ascends
anastomoses at umbilicus
Where are iliac & hypogastric nodes found?
along IVC & aorta
Where are paraaortic lymph nodes?
wraps around aorta
What is the sonographic appearance of lymph nodes?
echo poor lesion
round or oblong - every dimension
What indicates lymphadenopathy?
nodes larger than 1 cm - 3 cm
What should you do when there is lymphadenopathy?
What are the layers of vessels from outside to inside?
What does the tunica intima of a vessel consists of?
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
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
What is the size of the aorta at the diaphragm?
narrows as branches arise
What are the parts of the aorta?
What are the branches off the aortic arch?
What are the major branches off the abdominal aorta?
What are the minor branches off the abdominal aorta?
What are the images required of the aorta?
Aorta sag left
Aorta trans left
How is the aorta measured?
outer to outer
What are the landmarks of the mid sag aorta?
level of pancreas
What are the landmarks of the mid trans aorta?
What is the size of the aorta at the level of the bifurcation?
What happens to the IVC on expiration?
What is the shape of the IVC?
What caused dilatation of the IVC?
Rt ventricular heart failure
Rt heart tumors
What artery leads to the arms?
Name the arteries of the arms.
radial & ulnar
What is the venous arm protocol?
cephalic, brachial, basilic
radial & ulnar
images with/without compression
images with augmentation
Aorta lies ______ to the crus of the diaphragm.
Vena Cava lies ______ to the crus of the diaphragm.
What are the branches of the celiac trunk?
Lt. Gastric artery
What is the branches of the Common Hepatic artery?
What does the Common Hepatic turn into after the branch of the gastroduodenal artery?
Proper Hepatic artery
What are the branches of the Proper Hepatic artery?
The Proper Hepatic artery bifurcates into what two arteries?
Left & Right Hepatic arteries
Where does the cystic vein drain?
into the portal vein
What does the Lt. Gastric artery serve?
esophagus and lesser curvature
The splenic artery is very ______ and has many branches.
Explain the view of the celiac truck on longitudinal images.
just caudel to diaphragm
Caudate lobe of the liver
Explain the view of the celiac truck on transverse images.
What is the sonographic appearance of the Lt. Gastric artery
very difficult to see
Explain the route of the SMA.
arises 1 cm below celiac
courses for a while above aorta
What are the branches of the SMA?
What does the SMA provide blood to?
2nd portion of the duodenum to 2/3 of transverse colon.
Where does the IMA arise?
anteriorly from aorta
just above bifurcation
What are the branches of the IMA?
superior left gastric
What is the sonographic appearance of the IMA?
difficult to see
What does the IMA feed?
last 3rd of transverse colon to rectum
What is the best viewing plane for the renal arteries?
Where does the right renal artery lie to the IVC?
Where does the left renal vein run between?
aorta & SMA
Why is the left renal artery bigger than the right?
flow from the
What is Nutcracker syndrome?
SMA and Aorta put pressure on Lt. renal vein causing it to constrict
What is the presentation of Nutcracker syndrome?
left flank pain
What is another name for Nutcracker syndrome?
Renal Vein Entrapment syndrome
Where does the gonadal artery arise?
inferior to renals
Where does the right gonadal vein drain?
Where does the left gonadal vein drain?
into left renal vein
What do the hepatic veins drain?
Which of the hepatics veins is the largest?
Which of the hepatics veins is the smallest?
What is the largest branch into the IVC?
What is the sonographic appearance of the Hepatic Veins?
What forms the Portal Vein?
The Portal vein lies _____ to the IVC
What is the flow of the portal vein
What does the splenic vein drain?
Where does the splenic vein lie to the pancreas?
What does the SMV drain?
Where does the SMV drain into?
Portal splenic confluence
Which is larger the SMV or SMA?
Where does the SMV lie to the aorta?
Where does the SMA lie to the aorta?
AMV is _____ to SMA
What does the aorta bifurcates into?
What forms the IVC?
anastomoses of the two common iliac veins
What do the common iliacs divide into?
internal & external iliac arteries
What does the external iliacs turn into?
Common femoral arteries
Where does an aortic aneurysm usually occur?
between the renal arteries and the bifurcation
What are the main causes of an aneurysm?
cystic medial necrosis
What layer of the vessel does an aneurysm effect?
What is an aneurysm?
permanent dilation greater than 1.5 times normal size
What is the most common form of an an aneurysm?
What is a fusiform aneurysm?
bright wall echos
What is a saccular aneurysm?
spherical in shape
frequently filled with a thrombus
What are the shapes of aneurysms?
what is the symptoms of an aortic dissection?
sudden onset of excruciating pain
What is the sonographic appearance of an aortic dissection?
Who usually has an aortic dissection?
40 - 60 year old men with a history of HTN
When is there a 75% chance of rupture in an aneurysm?
greater than 7 cm
1% of aneurysm under ______ cm rupture
What is done for an aneurysm under 5 cm?
U/S exam every 6 months
What is done for an aneurysm under 6 cm?
What percent of ruptured aneurysm patients die in surgery?
What is the #1 cause of an aneurysm?
What are some mimicking pulsatile masses?
What is the 2nd most common cause of pulsatile abdominal mass after triple A?
retroperitoneal lymph nodes
What is triple A?
abdominal aortic aneurysm
What is the sonographic appearance of an aortic grafts?
bright reflective walls
can have hematoma, infection, or degeneration of graft material
What is an AV fistula?
abnormal connection between artery and vein
What usually causes an AV fistula?
secondary to trauma
What is the sonographic appearance of an AV fistula?
multiple anechoic tubular structures creating a mass effect
What are the congenital abnormalities of the IVC?
obstruction by congenital webs (Bud Chari)
Who does Budd Chari usually effect?
30 - 40 year olds
What is the pathology of the IVC?
What are the two types of a caval tumor?
What are the clinical findings of a renal vein thrombosis?
low back pain
What is the sonographic appearance of a renal vein thrombosis?
What is the RI for good perfusion?
under .7 RI
What is the RI for possible rejection?
.7 - .9 RI
What is the RI for probable rejection?
over .9 RI