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The Aorta and Inferior Vena Cava

Doppler examination in the abdomen is associated with specific problems which are not encountered in peripheral vascular examinations and these are particularly relevant to examinations of the aorta, inferior vena cava and their associated vessels. Respiratory motion and cardiac pulsation impair the examination, but getting the patient to suspend respiration for any length of time results in relative hypoxia and subsequently increased respiratory movement. It is…

The Peripheral Veins

The peripheral veins may be affected by a variety of disorders which can be assessed by ultrasound. Deep vein thrombosis (DVT) and thromboembolic disease are the most common indications for investigation of the peripheral veins but venous insufficiency and vein mapping are also reasons for examining the veins. Anderson et al. found an average annual incidence of 48 initial cases, 36 recurrent cases of DVT and…

The Peripheral Arteries

Atheroma occurs to different degrees in different parts of an individual’s cardiovascular system and the lower limb arteries are particularly prone to the development of atherosclerosis. Approximately 2% of adults in late middle age in Western countries have intermittent claudication and each year in England and Wales around 50 000 patients are admitted to hospital with a diagnosis of peripheral arterial disease; 15 000 of these…

The Carotid and Vertebral Arteries; Transcranial Colour Doppler

The Carotid and Vertebral Arteries CAROTID DISEASE AND STROKE Stroke is a major cause of morbidity and mortality. In the United Kingdom, there are approximately 150 000 first strokes each year and some 53 000 deaths a year as a result of stroke; in the United States the equivalent figures are 795 000 strokes and 137 000 deaths each year. There are significant direct and indirect…

Haemodynamics and Blood Flow

Principles of Blood Flow This section describes the simple principles of blood flow which are of value in understanding the role of Doppler and for performing vascular ultrasound examinations. The underlying principles of fluid mechanics applied to the flow of blood are complex, and discussed in detail in a number of texts including those by McDonald, Caro et al., Strackee & Westerhof and chapters in the…

Physics: Principles, Practice and Artefacts

A number of techniques have been developed which exploit the shift in frequency of ultrasound when it is reflected from moving blood. This frequency shift is known as the ‘Doppler effect’. Five types of diagnostic Doppler instrument are usually distinguished: 1. Continuous wave (CW) Doppler 2. Pulsed wave (PW) Doppler 3. Duplex Doppler 4. Colour Doppler imaging (CDI; colour velocity imaging, colour flow imaging) 5. Power…

Multiple Lucent Lesions

Questions 1. Refer to Fig. 24.1 . Which of the following is the best diagnosis? a. Adult respiratory distress syndrome. b. Pneumatoceles. c. Multiple abscesses. d. Bronchopleural fistula. e. Necrotizing pneumonia, abscesses, and bronchopleural fistula. 2. Which is the most likely diagnosis in the case illustrated in Fig. 24.2, A and B ? a. Metastatic squamous cell carcinoma. b. Histoplasmosis. c. Tuberculosis. d. Necrotizing pneumonia. e.…

Solitary Lucent Defect

Questions 1. Match the cases shown in Fig. 23.1, A – D , with the following diagnoses: ____Bronchogenic carcinoma. ____Pneumonia with abscess. ____Bronchopleural fistula with hydropneumothorax. ____Pulmonary gangrene. 2. Which one of the following pulmonary infections is least likely cause of necrotizing pneumonia? a. Streptococcus pneumoniae. b. Pseudomonas. c. Klebsiella. d. Staphylococcus aureus. e. Mixed gram-negative pneumonia. 3. Refer to Fig. 23.2 . Which one of…

Hyperlucent Thorax

Questions 1. Match the abnormal thoracic lucencies seen in Fig. 22.1, A to C , with the following diagnoses. ____ Bilateral pneumothorax. ____ Bullous emphysema. ____ Ruptured subpleural bullae with pneumothorax. 2. Asymmetric air trapping may be confirmed by which of the following radiographic techniques? a. Lateral decubitus view. b. Forced inspiratory view. c. Forced expiratory view. d. Overpenetrated view. e. Oblique view. 3. Mosaic attenuation…

Multiple Nodules and Masses

Questions 1. A 50-year-old man admitted with a history of weight loss had the examinations shown in Fig. 21.1, A and B . Which one of the following procedures would most likely determine the site of a primary tumor? a. Physical examination of the testis. b. Total spine radiograph. c. Radionuclide bone scan. d. Computed tomography (CT) scan of the brain. e. Magnetic resonance imaging (MRI)…

Solitary Pulmonary Nodule

Questions 1. Refer to Fig. 20.1, A and B . Which one of the following is the most likely diagnosis? a. Invasive mucinous adenocarcinoma. b. Adenocarcinoma in situ. c. Minimally invasive adenocarcinoma. d. Invasive adenocarcinoma. e. Lymphoma. 2. The changing pattern illustrated in Fig. 20.2, A and B , is most suspicious for which one of the following? a. Carcinoid. b. Granuloma. c. Hamartoma. d. Lung…

Coarse Reticular Opacities (Honeycomb Lung)

Questions 1. Refer to Fig. 19.1, A-C . The term honeycomb lung indicates which one of these processes? a. Emphysema. b. Cystic bronchiectasis. c. Paraseptal emphysema. d. End-stage interstitial fibrosis. e. Multiple cavities. 2. Which one of the following diagnoses is the least likely in the case shown in Fig. 19.2 ? a. Lymphangitic metastases. b. Sarcoidosis. c. Asbestosis. d. Usual interstitial pneumonia (UIP). e. Rheumatoid…

Fine Reticular Opacities

Questions 1. Kerley B lines ( Fig. 18.1 ) represent which one of the following? a. Thick interlobular septa. b. Dilated lymphatic vessels. c. Dilated venules. d. Thick alveolar walls. e. Fibrosis. 2. Which one of the following statements is not true? a. Kerley B lines are perpendicular to the pleura. b. Kerley A lines are deep in the lung parenchyma. c. Kerley lines are diagnostic…

Diffuse Fine Nodular Opacities

Questions 1. Based on the radiologic appearance of the case illustrated in Fig. 17.1 , which one of the following diagnoses is the most urgent one? a. Miliary tuberculosis. b. Silicosis. c. Langerhans cell histiocytosis. d. Hypersensitivity pneumonitis. e. Sarcoidosis. 2. Regarding Fig. 17.2 , which of the following is the most likely diagnosis? a. Sarcoidosis. b. Metastatic carcinoma. c. Langerhans cell histiocytosis. d. Hypersensitivity pneumonitis.…

Multifocal Ill-Defined Opacities

Questions 1. Which one of the following is the most likely diagnosis in the case seen in Fig. 16.1 ? a. Tuberculosis. b. Lung cancer c. Melanoma. d. Silicosis. e. Pneumonia. 2. Referring to Fig. 16.2 , the combination of hilar adenopathy and multifocal ill-defined opacities is most consistent with which one of the following? a. Granulomatosis with polyangiitis. b. Sarcoidosis. c. Hypersensitivity pneumonitis. d. Langerhans…

Diffuse Air Space Opacities

Questions 1. The images in Fig. 15.1, A and B , were of a patient who presented in the emergency department with a known diagnosis of granulomatosis with polyangiitis. Which one of the following complications is most likely? a. Pneumonia. b. Hemorrhage. c. Diffuse alveolar damage (DAD). d. Pulmonary edema. e. Acute interstitial pneumonia (AIP). 2. Which one of the following is not a sign of…

Segmental and Lobar Consolidations

Questions 1. Homogeneous, left lower lobe consolidation, as seen in Fig. 14.1, A and B , is the typical radiologic manifestation of community-acquired lobar pneumonia. What is the most likely causal agent? a. Mycoplasma pneumoniae. b. Streptococcus pneumoniae. c. Mycobacterium avium intracellulare. d. Legionella pneumophilia. e. Klebsiella pneumoniae. 2. Refer to Fig. 14.2, A and B . An expanded lobe with interspersed lucent spaces (shown by…

Atelectasis

Questions 1. Which of the following abnormalities are present on the posteroanterior (PA) chest radiograph in Fig. 13.1 ? a. Right upper lobe opacification. b. Juxtaphrenic peak. c. Displacement of the horizontal fissure. d. Deviation of the trachea. e. All of the above. 2. Which one of the following is most likely to cause atelectasis? a. Metastasis. b. Adenocarcinoma. c. Lymphoma. d. Squamous cell carcinoma. e.…

Posterior Mediastinal Mass

Questions 1. Which one of the following diagnoses is most likely for the case illustrated in Fig. 12.1, A-C ? a. Neuroblastoma. b. Paraspinal abscess. c. Schwannoma. d. Paraganglioma. e. Neurenteric cyst. 2. Which one of the following neural tumors is most likely in a 6-year-old patient ( Fig. 12.2, A and B )? a. Ganglioneuroma. b. Neurofibroma. c. Ganglioneuroblastoma. d. Schwannoma. e. Chemodectoma. 3. Which…

Hilar Enlargement

Questions 1. The most likely cause of unilateral hilar enlargement in the adult in Fig. 11.1, A-C , is: a. Bronchogenic cyst. b. Lung cancer. c. Large right pulmonary artery. d. Pulmonary varix. e. Aneurysm of the descending aorta. 2. The most likely cause of the bilateral hilar enlargement in the asymptomatic young adult in Fig. 11.2 is: a. Metastasis. b. Primary tuberculosis. c. Sarcoidosis. d.…