ARDMS Abdomen review 복부 초음파 시험 정리

7 MHz linear	intra operative
7-8 MHz	transrectal prostate
10 MHz linear	endoscopic ultrasound, during surgery insulinoma, thyroid, breast
12 MHz linear	Achilles tendon
5 MHz curved	to evaluate GB, pancreas, spleen, liver
5 MHz linear with short focus	for evaluation of acute appendicitis
13 mm	cutoff for portal vein enlargement
>10 mm	normal renal cortex
6 mm (7 mm)	appendix diameter normal limit
3-5 mm	normal average gut wall
2 mm	normal pancreatic duct limit
10-12Cm (9 -14 )	normal kidney length
3 mm	gallbladder wall normal limit
8-12 hour	for gallbladder scan preparation
60 degree	or less accurate velocity measurement
no other prep	only renal sonogram, moderated hydration
I. Liver (16%-24%)
Inferior vena cava	three hepatic vein drain into
Kupper cell	macrophage in liver
Middle hepatic vein	the left medial segment separate form the right anterior segment
	courses within the main lobar fissure
Ligamentum venosum	the anterior border of the caudate lobe
	the left of ligamentum venosum mass in the left lobe
Ligamentum teres	the presence of a recannalized paraumbilical
	divide into medial and lateral segment in the left lobe
	caudal border of the lest portal vein
Recannalized paraumbilical	sagittal subcostal view through left lobe at the ligamentum teres
Blood supply of Liver	Portal vein and hepatic artery
Reidel's lobe	the inferior aspect of the right lobe, usually shown in slender female
Hepatic Vs portal vein	the portal veins are accompanied by branches of the biliary tree and hepatic artery
Grisson's capsule	surrounding the liver
Hepatic vein	course interlobar and intersegmental within the liver
3 hepatic vein and IVC view	subcostal oblique the probe angle superiorly and patient's right side
High liver patient or dome	scan the patient in deep inspiration with superior angle
High frequency transducer	can detect posterior shadow and enhancement
Hepatocellular carcinoma	associated with serum alpha-fetoprotein
	most commonly associated with invasion of the portal vein
GGT and alkaline phosphates	elevation of both them indicates the source of the elevated alkaline phosphates is the liver
Liver function	GGT, AST, direct bilirubin, indirect bilirubin ……
Hepatic adenoma	oral contraceptive, hypoechoic mass, solid
Fatty liver(focal)	diffuse increase echogenicity with focal hypoechoic area
	most commonly found in anterior to porta vein at the porta hepatis
Fatty liver	may caused by obesity, diffuse or focal, rapid change with time, increase attenuation
	hepatomegaly, echogenicity, decrease vascularity
Liver cirrhosis	increased risk for hepatocellular carcinoma
	surface nodularity, shrunken right lobe, altered echo texture, ascites
	need to evaluate the hepatic vein and IVC with color Doppler to confirm patency
	associated with portal hypertension, splenomegaly
	irregularity of the surface, a nodular liver, regenerating nodule
	luminal narrowing of the hepatic vein, high velocities through the strictures
Right side heart failure	enlargement of the hepatic vein and inferior vena cava
Hepatomegaly	rounding of inferior border, longitudinal right lobe exceeding 15.5 cm
	extension of the right lobe inferior to the lower pole of the right kidney
	increased anteroposterior measurement of the right lobe
Cavernous hemangioma	single homogeneous hyperechoic , small, well-define
	most common benign tumor in the liver, consist of vascular network
	more common in women than men, usually asymptomic
Liver metastatic	single hypoechoic, multiple hyperechoic, mixed echogenicity, cystic masses
Liver cyst	thin wall, anechoic, increase through transmission, posterior acoustic enhancement
Hemorrhagic cyst	well-define mass with smooth wall, homogeneous low level echo, no Doppler signal
Hepatitis	fever, abnormal liver function, pain
	decreased echogenicity, GB wall thickened, thick echogenic bands around portal vein
Hydatid disease	infestation by parasite, sheep and cattle
Kaposi's sarcoma	associated with AIDS patient
Meta from adenoma of colon	markedly heterogeneous, numerous calcified lesions
Meta from lung ca	bull's eye, target lesion, anterior right lobe
Focal nodular hyperplasia(FNH)	second most common liver mass, a well define solitary mass, prominent vessels within scar
Budd-chiari syndrome	sudden onset ascites and hepatomegaly, pain
	need Doppler to determine patency of the portal and hepatic venous system
	may seen biloma, hematoma, located ascites, abscess
Liver transplantation	complication: malignant, hepatic artery thrombosis, portal thrombosis, pseudoaneurysm
	biliary sludge, portal stenosis
	should be evaluate IVC, portal vein, hepatic artery, bile duct
	rejection can not detected by ultrasound, cholecystitis can not exist(excise)
Portal hypertension	hepatofugal sign, spleen enlarged, a recannalized paraumbilical vein
	should be evaluate presence of portosystemic collaterals
	ETOH alcohol abuse and cirrhosis, not associated with cyst
	splenic and retroperitoneal varices, need color Doppler
Abscess	a large, round, homogeneous, adjacent to the capsule
TIPS	transjugular intrahepatic portosystemic shunt, portal vein and hepatic vein
Coronary vein	portal hypertension, left gastric, spleen, esophageal
	a sagittal view of the splenic vein near midline
Porta hepatis	cavernous transformation, portal vein thrombosis
II. Gallbladder and Biliary Tree (10%-18%)
Interlobar hepatic fissure	anatomic landmark to identify the gallbladder = main lobar fissure
Phrygian cap	the fundus of gallbladder folded
Gallbladder artifact	reverberation, side lobe, slice thickness ……
Cholelithiasis	Gall stone
Choledocholithiasis	stones within the common bile duct, may be post cholecystectomy
GB wall thickness	associated with inflammation, hepatic dysfunction, heart failure, GB wall varice
	not associated with malignant ascites
Porcelain gallbladder	contain varying calcification, increase risk of carcinoma
CBD location	posterior and slightly lateral to the pancreas head
	junction of the cystic duct and common hepatic duct
	is anterior to the hepatic artery and portal vein
	is posterior to head of pancreas
Acute cholecystitis	most common cause is calculus obstruction neck or cystic duct
	nausea, vomiting, epigastric pain, right upper quadrant pain
	associated with pancreatitis, GB perforation, gangrenous cholecystitis, emphysematous
	need to evaluate cystic artery(feed GB wall, a branch of right hepatic artery)
Emphysematous cholecystitis	gas forming bacteria, common in male diabetics, surgical emergency
	ring down artifact, nondependent hyperechoic foci, bright echo in the GB wall
Murphy's sign	tenderness with probe pressure
Pancreas head mass	dilated, nontender gallbladder
Hydropic gallbladder	GB measured over 5cm (fasting)
	choledocholithiasis, pancreatic carcinoma, chronic pancreatitis with stricture formation
Bile stasis (sludge)	not thickened wall, low-level echo
Tumefactive sludge	an avascular mass with low-level echoes
Adenomyomatosis	a comet tail, V-shape reverberation, form of the hyperplastic cholesystoses
	associated with Rokitansky-Aschoff sinus
GB perforation	thick wall and adjacent compiles fluid collection, commonly multiparous woman
GB carcinoma	hypervascularity, multiple stones, asymmetric wall thickness, may detected liver meta
	a mass replacing gallbladder
Intra hepatic biliary system	identify below intrahepatic portal vein
Pneumobilia	air in the bile duct
Differentiate bile Vs vein, artery	with color Doppler, bile duct demonstrate irregular and tortuous walls
Bile duct wall thickening	sclerosing cholangitis, pancreatitis, choledocholithiasis, cholangiocarcinoma
Choledochal cyst	cystic dilatation of the common bile duct
Cholecintigraphy	Tc99m most accurate test for acute cholecystitis
Cholecystokinin	associate with GB contraction, from duodenum
Pancreatitis	complication of stone impacted in the distal CBD
Cholangiocarcinoma	associated with dilatation of the biliary tree
	located in an intrahepatic or extra hepatic bile duct
Sickle cell anemia	GB wall thickening, check pericholecystic fluid
Identificated GB	interlobar fissure, wall-echo shadow sign, bowel dirty), stone clean)
Hyperplastic cholecystoses	is benign tumor
III. Pancreas (6%-14%)
Uncinate process	inner medial of pancreas head
Pancreas view	midline oblique left side of probe slightly caudal to the right side
Wirsung duct	the main pancreatic duct
Santorini duct	the accessory pancreatic duct
Pancreatic divisum	the two pancreatic ducts have not fused
Head of pancreas	anterior aspect of head = gastroduodenal artery
	posterior aspect of head = common bile duct, posterior border = IVC
	coursing transversely at the level of the upper pancreas head = left renal vein
Neck of pancreas	portal-splenic confluence is a prominent vessel just posterior to the pancreatic neck
	superior mesenteric artery is located posterior to the neck
Tail of pancreas	contact with left kidney, splenic flexure, spleen
Pancreas Doppler	improve detestability of possible pseudoaneurysm
Adenocarcinoma	most commonly occurring malignant tumor of pancreas
	most common malignant tumor of the gastrointestinal tract
	most common appearance is hypoechoic mass
	associated with Lymphadenopathy and liver metastasis
Pancreatic cancer risk	smoking, high fat diet, diabetes, chronic pancreatitis, peptic ulcer, cholecystectomy
	exposure Benzedrine, gasoline derivatives
Chronic pancreatitis	associated with alcohol abuse, a hyperechoic mass, dilatation pancreatic and CBD
	diffuse calcification, heterogeneous echo texture
Acute pancreatitis	increase pancreas enzyme and white blood cell count,
	most common cause is calculus obstruction pancreatic duct by biliary calculi > alcohol abuse
Wipple procedure	the remove of GB, CBD, part of duodenum and pancreatic head
CT	most accurate in staging pancreatic adenocarcinoma
Islet sell tumor	is endocrine tumor
Complications of pancreatitis	pseudoaneurysm, pseudocyst, plegmon, abscess, ascites, necrosis, biliary obstruction
	gastrointestinal hemorrhage, hydronephrosis(ureteral obstruction)
Pancreas transplant	the patient probably have type I diabetes mellitus, look for iliac fossa
	rejection = high-resistance Doppler signal, heterogeneous parenchyma
Phlegmon	a nonencapsulated collection of necrotic and edematous peripancreatic tissue
Pseudocyst	may be associated with acute or chronic pancreatitis, pacreatic cancer
	may be well-define wall, anechoic, low-level echoes, internal septations
Insulinoma	small, hypoechoic, located tail?, obese
Celiac trunk	superior border of the pancreas
	go through splenic, left gastric, common hepatic artery
Superior mesenteric vein	coursing anterior to the uncinate process
	supplies the small intestine, right colon and most of the transverse colon
Gastroduodenal artery	tubular structure coursing cephalocaudad anterior to pancreas
	has a caudal course, anterior to the pancreatic head
IV. Kidneys and Urinary Tract (16%-24%)
Systemic lupus erythemotosus	hyper echoic
Left renal vein	is longer than right renal vein, anterior to the aorta
	posterior to the superior mesenteric artery and anterior to the aorta
Right renal artery	Posterior to the inferior vena cava, right renal vein lies anterior to the renal artery
False hydronephrosis	distended bladder, large extrarenal pelvis, parapelvic cyst, prominent hilar vessels
Papilloma	benign in bladder by pappilloma virus
Horseshoe kidney	right and left are attached at their lower pole, the isthmus located anterior abdominal aorta
Angiomyolipoma	a speed propagation artifact, high-fat content
	a solid, hyperechoic mass with tuberous sclerosis
Dromedary hump	thickening of renal cortex
Hypertrophy	Nephrectomy, renal agenesis, renal hyperplasia, renal atrophy (compensatory)
Central sinus	highly echogenic compare to renal cortex
Renal cyst	anechoic, acoustic enhancement, define smooth wall, round or ovoid shape
	50% of people over age 50
	post biopsy and discover a cystic mass = using color Doppler
Hydronephrosis	ureteral stone, uterine fibroid, ureteropelvic junction obstruction,ovarian mass,aorta aneurysm
	not associated with acute pyelonephritis
Column of Bertin pseudomass	compare with cortex(echogenicity), continuity with cortex, normal vascularity by C Doppler
	lack of mass effect or splaying of central sinus fat
Multicystic dysplastic kidney	multiple variably sized cysts, nonmedial location large cyst, no identify renal sinus
	bright echogenic tissue interface cyst, not associated with dilatation of ureter
	usually diagnosed in early childhood or in utero
Crossed renal ectopia	both kidney are on the same side of the abdomen
Wilm's tumor	most common in children aged 2-5
Renal sinus	fat, calyce, infudibuli of the collecting system, vessels
Uretral Jet	periodic ureteral jet is normality, determine if a ureter is obstructed
	in the examine the urinary bladder with color Doppler
	ureteral orifices are located base of the trigone along posterior aspect
Polycystic kidney	hypertension and impaired renal function, too numerous cyst, enlarged kidney
	may be 30% liver cyst, may be complicated bleeding infection, bilateral, progressive failure
Evaluation of renal mass	extension of tumor into renal vein, liver metastasis, search for retroperitoneal adenophathy
Ureteropelvic junction obstruction	pelvicaliectasis to the level of the junction of the renal pelvis and ureter
Acute pyelonephritis	most common appearance is normal
	may enlargement, compression of sinus, alteration texture, hypoechogenicity
Main renal artery	Low resistance with forward flow throughout the cardiac cycle
Muscular hypertrophy	bladder outlet obstruction and thickening bladder wall
Chronic renal disease	small hyperechoic kidney, dialysis, multiple cyst of vary sizes.
Nephrocalcinosis	highly echogenic renal pyramid with or without posterior acoustic shadowing
Ureterocele	a small round cystic into urinary bladder
Transitional cell carcinoma	with hydronephrosis, a mass within the urinary bladder
	irregular thickening of bladder wall, dilated ureter
Lymphocele	post renal transplant, a fluid collection with septation, internal debis adjacent to the kidney
Interlobar artery(in intrarenal)	coursing alongside the renal pyramids
Renal lymphoma	multiple, bilateral, hyperchoic masses in enlarged kidney
Arcuate artery	coursing on top of the renal pyramid and give rise to the tiny intralobular artery
Morrison's pouch	the space between the liver and right kidney
Renal artery stenosis	Doppler renal study for uncontrolled hypertension
	to rule out renal artery stenosis, compare with renal artery and abdominal aorta
	60% or greater, a ratio 3.5 or greater is considered abnormal
	SMA is immediately superior to origin of the renal arteries
	damped with decrease diastolic flow
	the normal waveform of the main renal artery is Low resistance
Resistive index	0.7 or less is normal, RI =1 indicates a diastolic flow of 0
	if RI = 1, chronic renal disease, renal vein thrombosis, renal obstruction
	measure to look for rejection in a renal transplant
Pyelonephritis	an ascending urinary tract infection
Chronic renal artery occlusion	in a smaller than the other side, echogenic
Acute renal artery occulusion	may show no abnormality
Kidney Doppler	posterior oblique, coronal view through posterior axiliary line
	inadequate fill in intrarenal vasculature = decrease pulse repetition frequency
Atypical cyst	internal septation, wall calcification, internal echo, irregular walls
Renal cell carcinoma	most common solid renal mass, most common renal tumor
Emphysematous pyelonephritis	multiple echogenic foci within the renal sinus or parenchyma with dirty acoustic shadow
Medullary nephrocalcinosis	calcified pyramids
Subcapsular hematoma	trauma, perirenal fluid collection that flattens the underlying renal contour
Acute tubular necrosis	the most common cause of acute renal failure
Post renal transplant	volume may increase 5-15% in the first 2weeks
	renal artery is usually amastomesed to external iliac artery
V. Scrotum (3%-7%)
Mediastinum testis	Prominent echogenic linear echo in the midline of the testis
Orchitis	inflammation of testicle, hyperemic flow on color Doppler
	most common associated with a large complex hydrocele
	hyprechoic testis, enlargement testis, thickened scrotal wall
Seminoma	the most common germ cell testicular tumor
	hyprechoic, well demarcated margins, sometimes multi focal, homogenous texture
Torsion	bell clapper deformality, do not detect flow with Doppler
Testicular artery	branch from abdominal aorta, connect to capsular artery, low resistance
	a common anatomic variant, opposite direction of the centripetal arteries
	enters the testicular parenchyma at the mediastinum testis, a large vein frequently accompany
Testicular parenchyma artery	Low resistance
Spermatic cord	Vas deferns, testicular artery, cremasteric artery, deferential artery within spermatic cord
Centripetal artery	the intertesticular arteries that arise from the capsular artery
	course within testicular parenchyma
Left testicular vein	drain into left renal vein
Sensitivity slow flow	Low PRF, Low filter, High gain, High packet size
Infertility work up	associated with varicocele
Hydroceles form	between the two layer of the tunica vaginals
Rete testis	mediastinum testis
Testicular malignancy	irregular shape of testis, intratesticular location of mass, not associated with hydrocele
Scrotal Doppler	epididymits orchitis Vs torsion
Hematocele	a large hydrocele with prominent internal echoes, trauma, pain, swelling
VI. Prostate (1%-2%)
Rectum	posterior to the prostate gland
Peripheral zone	most likely involved with prostate cancer
Transition zone	most commonly involved with benign prostatic hypertrophy
Seminal vesicles	posterior and superior to the prostate gland
	hypoechoic, symmetrical, irregularly shaped structure
Transretal sonogram	(left) lateral decubitus, 7-8 MHz
	rectal exam, high PSA, guidance for biopsy, monitor treatment prostate cancer
	with color Doppler allow improved perception of pathologic vessels associated with cancer
	the rectum is shown at bottom of the screen
Prostatism	difficult initiation of voiding, nocturia, small stream
Prostate cancer	Hypoechoic, Isoechoic, hyperechoic lesion, looking for unknown metastasis
Transrectal biopsy	cleansing enema, antibiotics prior and following the exam
Zonal anatomy	most commonly used to describe the prostate
Prostaticovesical arteries	supply from internal iliac artery
Benign prostatic hyperplasia	enlarged prostate gland which may be diffuse or focal
Ejaculatory duct cyst	may be associated with infertility
Abscess	acute prostatitis, anechoic mass within prostate
VII. Spleen (1%-5%)
Contacted with spleen	left hemidiaphragm, stomach, pancreas, splenic flexure
Long axis spleen	intercostal coronal view with patient supine
Moderate splenomegaly	portal hypertension, infection, AIDS,
Markly splenomegaly	leukemia, lymphoma, myelofibrosis
Accessory spleen	at the splenic hilum that is homogeneous and isoechoic with the spleen
Splenic infarction	a hypoechoic, wedge shaped lesion, evaluate the lesion with color Doppler
Portal hypertension	moderate splenomegaly, dilated, tortuous vessels at the splenic hilum
	need to evaluate the liver and portal vein
Splenic vein	detect at the splenic hilum, drain into the portal vein, join SMV underneath pancreatic neck
Pancreatic tail	is inferomedial to the spleen
Spleen echogenicity	homogeneous with mid to low level echogenicity
Spleen	located intraperitoneal, 12Cm length, fundus of stomach and the diaphragm, decrease
Pitfall	rib shadow, in hepatomegaly the left lobe, mass of pancreatic tail, enlarged lymph node
Histoplasmosis	multiple focal, bright echoic masses throughout the spleen
Recent trauma	laceration, subcapsular hematoma of the spleen, free fluid, perisplenic hematoma
	past history calcified splenic cyst( nor a acute )
Metastasis in spleen	multiple hyperechoic masses from malignant melanoma
Splenic artery aneurysm	portal hypertension, splenomegaly, calcified ring at the splenic hilum
	evaluate the area with color Doppler
	most commonly involved, in women (pregnancy)
Splenic cyst	smooth border, anechoic, posterior acoustic enhancement, round shape
Splenic hemangioma	most common primary tumor of the spleen
VIII. Retroperitoneum (3%-7%)
Retroperitoneal located	kidney, pancreas, aorta, psoas muscles
Quadratus lumborum muscle	a striated, hypoechoic immediately posterior to both kidney, retrofacial space
Psoas muscle	a striated, posteromedial in relation to the kidney, retrofacial space
Perirenal space	kidney, adrenal gland, proximal ureter and perirenal fat
Para-aortic lymph node	several hypoechoic, slightly greater than 2cm, adjacent to the celiac trunk and SMA
Pancreatic pseudocyst	a fluid pocket in the left pararenal space, amylase
Retroperitoneal fibrosis	hypoechoic smooth margin, commonly involved abdominal aorta
Lymph node	need to measure of each lymph node
Pheochromocytoma	associated with adrenal glands
Adrenal gland	common site for metastasis from the lung
Right adrenal gland	posterior to the inferior vena cava, superomedial to upper kidney pole
	lateral to crus of the diaphragm
Left adrenal gland	lateral to the abdominal aorta and diaphragmatic crus
Lymphadenopathy	located splenic hilum, porta hepatis, renal hilum, para-aortic area
	multiple hypoechoic nodules, surrounding the aorta and separating the mesenteric vessels
Renal Vs adrenal	deep inspiration and expiration scan
Left adrenal pseudo mass	thickened diaphragmatic crus, accessory spleen, gastric diverticulum
	retroperitoneal Lymphadenopathy
Right diaphragmatic crus	posterior to the inferior vena cava and right renal artery
Nodal disease	greater than 1.0cm are considered to be abnormal
Lymphocele	a palpable mass, anechoic mass with multiple, around abdominal wall, following surgery
No solid organ space	posterior pararenal space, retrofascial space
Anterior pararenal space	most frequently involved with pseudocyst, a leaking abdominal aortic aneurysm
Cushing's disease	excessive production of ATCH from pituitary, associated with pituitary adenoma
IX. Abdominal Vascular (7%-15%)
Portal vein thrombus	must evaluate superior mesenteric vein and splenic vein
Atherosclerosis	the most common cause of aortic aneurysm
Confluence portal and splenic	anterior to the uncinate process and posterior to the neck
Low flow detect	decrease PRF, increase gain, decrease incidence angle, decrease high pass filter
Abdominal aorta	normally tapers in diameter from its cranial to its caudal extent
Common iliac artery	divide into internal and external iliac artery
Abdominal bruit	vascular compromise involving the aorta or its branches
	with chronic pancreatitis = pseudoaneurysm of hepatic or splenic artery
MedianArcuateLigamentSyndrom	diaphragm lies anterior to the abdominal aorta just proximal to origin of celiac trunk
	during both inspiration and expiration and in both the supine and upright
Mesenteric artery Doppler	in a fasting High resistance
Common hepatic artery	proper hepatic artery and left gastric artery
Replace hepatic artery	from superior mesenteric artery
Chronic mesenteric ischemia	postprandial abdominal pain and weigh loss
	celiac trunk, superior mesenteric and inferior mesenteric artery
Portal venous system Doppler	mild undulating, low velocity
Aneurysm	aneurysm size is biggest risk factor for rupture, >3cm in any dimension
	most common location of abdominal aortic aneurysm = infrarenal aorta
	evaluation of common iliac arteries, measure diameter, assessment intraluminal thrombus
Aortic dissection	Mafan's syndrome, linear band throughout the length of the abdominal aorta relation cardiac
Hepatic vein Doppler	triphasic
Variceal hemorrhage	the most significant clinical consequence of portal hypertension
Portalveincavernous transformation	network of vessels replacing obliterated portal vein
Portal vein Vs Hepatic artery	the flow direction is same
Aortic graft	a pseudoaneurysm at the graft site wave form = high velocity, bidirectional
	the graft site near a pulsating hematoma wave form prominent peak = neck of pseudoaneurysm
Fusiform aortic aneurysm	dilatation with a gradual transition between the normal and abnormal segment
X. Gastrointestinal Tract (1%-5%)
Gut layer five	inner mucosa(echogenic), deepmucosa(hypoechoic), submucosa(echogenic)
	muscularis proria(hypoechoic), serosa(echogenic)
Exophytic mass	perform compression sonography over the suspicious area
Gut mass color Doppler	differentiation between ischemic and inflammatory
Appearance of gut	target, asymmetric target, pseudokidney
Crohn's disease	gut wall thickening, strictures, creeping fat, increase vascularity, chronic diarrhea
Acute appendicitis	gradual and uniformly pressure with probe over the area of interest
	diameter greater than or equal 6mm, noncompressible appendix
	there are no pathognomonic laboratory value for acute appendicitis
Appendicolith	hyperechoic focus with posterior shadowing
Stomach Vs pathology mass	drink some water while imaging the suspicious area
Obstruction, Ileus	hypersecretion, may detect multiple dilated fluid-filled loop of bowl
Haustra	dilated loops of bowel in colon
Intussusceptions	dilated bowel with multiple concentric rings
Creeping fat	Crohn's disease, hyperechoic mass effect, thyroid-like appearance in adjacent to the bowel
Mucosa	the innermost lining of the gut, Outer most is serosa
Adventitia	the outer most connective tissue covering of any organ
XI. Neck (1%-3%)
Sternohyoid and sternothyroid	strap muscle of the neck, located medial to the sternocleidomastoid and anterior of thyroid
Internal jugular vein	most lateral vessels, the most medial vessels are common carotid artery
Longus coli	posterior to each lobe of the thyroid
Thyroid nodule Doppler	to be sensitive in determining if a thyroid nodule is benign or malignant
Hashimoto's thyroiditis	diffuse enlargement of the thyroid with heterogeneous echo texture
	hypoechoic thyroid, coarsened parenchymal echo texture
Graves disease	an enlarged gland, markedly increased vascularity of both lobe
Parathyroid adenoma	associated with serum calcium
Hyperparathyroidism	usually caused by enlargement One parathyroid gland
Parathyroid hyperplasia	usually involved four parathyroids
Nodal malignancy in the neck	rounded lymph node, heterogeneous echo texture, intranodal calcification, absence echo hilum
Esophagus Vs nodule	swallow while scanning the area
Vertebral artery	courses through the transverse foramina of the cervical spine
Superior thyroid artery	is a branch of external carotid artery
Papillary carcinoma	the most common form of thyroid cancer
Subclavian artery	thyrocervical trunk arises from subclavian artery
Left common carotid artery	arises from aortic arch
XII. Abdominal wall, superficial and muscular structures(1%-5%)
Baker's cyst	popliteal fossa, behind knee
Parotid gland	between the external auditory canal and the inferior edge of the mandible
Normal breast lymph node	small, ovoid with hypoechoic rim and echogenic hilum
Rectus sheath hematoma	mid abdominal wall
Lateral breast mass	opposite posterior oblique with arm abducted
Carotid body tumor	at the level of the carotid bifurcation between the internal and external carotid arteries
Malignancy of a solid mass	taller than wide, spiculation, angular margins, markedly hypoechoic solid lesion
Terminal ductal lobular unit	lobule with its terminal branch, short intralobular and longer extralobular duct
Breast cyst	smooth walls, sharp anterior and posterior borders, no internal echo, posterior enhancement
Breast mass in a radial plane	obtain images in a projection 90 degree to the original plane
Muscular trauma	on sagittal scan, oblique, parallel, echogenic fibers are seen against a hypoechoic background
Peripheral nerve	markedly hyperechoic structure with parallel internal linear echoes
Tendonitis	tendons are highly echogenic with a fibillar echotexture
	vascularity, thickening tendon, decrease echo, blurred margins, calcification in chronic
False hypoechogenicity tendon	oblique incidence of the beam to the tendons axis
Ganglion cyst	usually in a wrist nodule or occurs adjacent to a joint
Rotator cuff	shoulder real time exam
XIII. Instrumentation (1%-2%)
Aliased wave form	the peak is cut off and shown below the base line, when sampling rate too low(PRF)
	the peak systolic velocity will be underestimated
	should do to correct = increase PRF
Quality control	monitor equipment performance
Biopsy during sonogram	image the needle at near perpendicular incidence
Color packet size	will increase the signal to noise ratio and result in a stronger signal
Frame rate	inverse field of view