Case Study Review Session 2

Front

The mass identified in this sonogram is most consistent with a(n):

a. biloma

b. simple cyst

c. resolving hematoma

d. echinococcal cyst

Back

b. simple cyst

A single anechoic area demonstrating posterior acoustic enhancement is identified in the area in question. This finding is most consistent with a simple hepatic cyst. A biloma is associated with recent biliary surgery. A resolving hematoma can appear anechoic but is not as likely a diagnosis as a simple cyst. An echinococcal cyst demonstrates a septated appearance.

Front

Which of the following sonographic features is most characteristic of this lesion? (What is the lesion seen?)

a. Hypoechoic mass with irregular borders

b. Anechoic lesion with posterior enhancement

c. Well-defined, hyperechoic lesion

d. Multiloculated cystic mass

Back

c. Well-defined, hyperechoic lesion; (hepatic hemangioma)

Hepatic hemangiomas typically appear as well-defined, hyperechoic lesions on ultrasound. They are the most common benign liver tumors and usually have a homogeneous echotexture.

Front

On ultrasound, which feature best distinguishes a simple hepatic cyst from this type of cyst? (What type of cyst is this?)

a. Presence of septations

b. Anechoic appearance

c. Posterior shadowing

d. Irregular margins

Back

a. Presence of septations; (hydatid (echinococcal) cyst)

Hydatid (echinococcal) cysts often have internal septations or daughter cysts, whereas simple hepatic cysts are anechoic and lack internal structures.

Front

A patient comes in for an ultrasound 2 weeks post biliary surgery; what is the most likely diagnosis?

a. Biloma

b. Hemorrhagic cyst

c. Simple Cyst

d. Hemangioma

Back

a. Biloma

Bilomas are localized collections of bile, most commonly occurring after biliary tract surgery or injury. They appear as anechoic or hypoechoic fluid collections near the liver.

Front

A 30-year-old female patient presents to the ultrasound department with postprandial pain. The patient has been taking oral contraceptives for 10 years. Based on this clinical history and sonogram, the mass is most suspicious for:

a. an adenoma

b. a hepatoma

c. a cavernous hemangioma

d. focal nodular hyperplasia

Back

a. an adenoma

A long history of oral contraceptive use is a predisposing factor for developing a hepatic adenoma. A hypoechoic liver mass demonstrating a hypoechoic halo is identified in the right lobe of the liver. This is characteristic of an adenoma. Focal nodular hyperplasia is influenced by hormones but presents as (a) well-defined isoechoic or hyperechoic mass(es). A hepatoma could be a differential consideration but not a likely diagnosis in this case. Cavernous hemangiomas can undergo degeneration, changing the echo pattern, but are not associated with a hypoechoic halo. Adenoma is the most likely diagnosis for this liver mass with these sonographic findings and clinical history.

Front

What is the most common benign liver tumor identified on ultrasound seen here?

a. Hepatic adenoma

b. Focal nodular hyperplasia

c. Hepatic hemangioma

d. Hepatocellular carcinoma

Back

c. Hepatic hemangioma

Hepatic hemangiomas are the most common benign liver tumors and typically appear as well-defined, hyperechoic lesions on ultrasound.

Front

The sonographic findings are most consistent with which of the following pathologies?

a. cirrhosis

b. fatty infiltration

c. candidiasis

d. liver metastasis

Back

d. liver metastasis

The liver parenchyma appears heterogeneous, demonstrating multiple hyperechoic masses throughout the right lobe. This is most consistent with liver metastasis. Cirrhosis is associated with a hyperechoic liver parenchyma irregular nodular contour, and the inability to distinguish portal vein wall margins. Hypoechoic or target lesions are characteristic of candidiasis.

Front

Which of the following ligaments is demonstrated in this transverse image of the liver?

a. coronary

b. venosum

c. falciform

d. triangular

Back

c. falciform

The falciform ligament attaches the liver to the anterior abdominal wall, extending from the diaphragm to the umbilicus. The ligamentum venosum separates the left lobe of the liver from the caudate lobe. The triangular ligament is the most lateral portion of the coronary ligament, which connects the liver to the diaphragm.

Front

A patient presents with a history of elevating insulin levels. Based on this history, the sonographic finding is most suspicious for a(n):

a. adenoma

b. focal pancreatitis

c. islet cell tumor

d. adenocarcinoma

Back

c. islet cell tumor

The sonogram demonstrates a small, well-defined mass in the tail of the pancreas. History of elevating insulin levels and a solid hypoechoic mass in the tail of the pancreas are most suspicious for a functioning islet cell tumor (insulinoma). Adenocarcinoma and focal pancreatitis are differential considerations but not as likely a diagnosis with a clinical history of elevating insulin levels.

Front

The sonographic appearance of the pancreas in this asymptomatic patient is most suspicious for:

a. a phlegmon

b. microlithiasis

c. chronic pancreatitis

d. normal pancreas parenchyma

Back

c. normal pancreas parenchyma

The tail of the pancreas is demonstrating a cobblestone appearance, a common variant in normal pancreatic parenchyma.