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Ultrasound

ACoreReview

Ultrasound

ACoreReview

EDITORS

RuchiShrestha,MD

AssistantProfessor DivisionofAbdominalImaging DepartmentofRadiology UniversityofPittsburghSchoolofMedicine Pittsburgh,Pennsylvania

Ka-KeiNgan,MD

AssistantProfessor DivisionofAbdominalImaging DepartmentofRadiology UniversityofPittsburghSchoolofMedicine Pittsburgh,Pennsylvania



SeniorAcquisitionsEditor:SharonZinner EditorialCoordinator:LaurenPecarich ProductionProjectManager:LindaVanPelt DesignCoordinator:HollyMcLaughlin ManufacturingCoordinator:BethWelsh MarketingManager:DanDressler PrepressVendor:SPiGlobal

Allrightsreserved.Thisbookisprotectedbycopyright.Nopartofthisbookmaybereproducedortransmittedinanyformorbyanymeans, includingasphotocopiesorscanned-inorotherelectroniccopies,orutilizedbyanyinformationstorageandretrievalsystemwithoutwritten permissionfromthecopyrightowner,exceptforbriefquotationsembodiedincriticalarticlesandreviews.Materialsappearinginthisbook preparedbyindividualsaspartoftheirofficialdutiesasU.S.governmentemployeesarenotcoveredbytheabove-mentionedcopyright.To requestpermission,pleasecontactWoltersKluweratTwoCommerceSquare,2001MarketStreet,Philadelphia,PA19103,viaemailat

permissions@lww.com,orviaourwebsiteatlww.com(productsandservices).

987654321

PrintedinChina

LibraryofCongressCataloging-in-PublicationData

Names:Shrestha,Ruchi,editor.|Ngan,Ka-Kei,editor. Title:Ultrasound:acorereview/editors,RuchiShrestha,Ka-KeiNgan. Othertitles:Ultrasound(Shrestha)|Corereviewseries. Description:Philadelphia:WoltersKluwerHealth,[2018]|Series:Corereviewseries|Includesbibliographicalreferencesandindex. Identifiers:LCCN2017032189|ISBN9781496309815(paperback) Subjects:|MESH:Ultrasonography|ExaminationQuestions Classification:LCCRC78.7.U4|NLMWN18.2|DDC616.07/543076—dc23LCrecordavailableathttps://lccn.loc.gov/2017032189

Thisworkisprovided“asis,”andthepublisherdisclaimsanyandallwarranties,expressorimplied,includinganywarrantiesastoaccuracy, comprehensiveness,orcurrencyofthecontentofthiswork.

Thisworkisnosubstituteforindividualpatientassessmentbaseduponhealthcareprofessionals’examinationofeachpatientandconsideration of,amongotherthings,age,weight,gender,currentorpriormedicalconditions,medicationhistory,laboratorydataandotherfactorsuniqueto thepatient.Thepublisherdoesnotprovidemedicaladviceorguidanceandthisworkismerelyareferencetool.Healthcareprofessionals,and notthepublisher,aresolelyresponsiblefortheuseofthisworkincludingallmedicaljudgmentsandforanyresultingdiagnosisandtreatments.

Givencontinuous,rapidadvancesinmedicalscienceandhealthinformation,independentprofessionalverificationofmedicaldiagnoses, indications,appropriatepharmaceuticalselectionsanddosages,andtreatmentoptionsshouldbemadeandhealthcareprofessionalsshould consultavarietyofsources.Whenprescribingmedication,healthcareprofessionalsareadvisedtoconsulttheproductinformationsheet(the manufacturer’spackageinsert)accompanyingeachdrugtoverify,amongotherthings,conditionsofuse,warningsandsideeffectsand identifyanychangesindosagescheduleorcontraindications,particularlyifthemedicationtobeadministeredisnew,infrequentlyusedorhasa narrowtherapeuticrange.Tothemaximumextentpermittedunderapplicablelaw,noresponsibilityisassumedbythepublisherforanyinjury and/ordamagetopersonsorproperty,asamatterofproductsliability,negligencelaworotherwise,orfromanyreferencetoorusebyany personofthiswork.

LWW.com

Contributors

AnilK.Dasyam,MD

AssociateProfessor DivisionofAbdominalImaging DepartmentofRadiology UniversityofPittsburghSchoolofMedicine Pittsburgh,Pennsylvania

MyraFeldman,MD

AssistantProfessorofRadiology ClevelandClinicImagingInstitute SectionofAbdominalImaging Cleveland,Ohio

KellyHaarer,MD

AssistantProfessor DivisionofAbdominalImaging DepartmentofRadiology UniversityofPittsburghSchoolofMedicine Pittsburgh,Pennsylvania

SafwanS.Halabi,MD

ClinicalAssistantProfessor DivisionofFetalandPediatricRadiology DepartmentofRadiology StanfordUniversitySchoolofMedicine Stanford,California

MatthewT.Heller,MD,FSAR

AssociateProfessor DivisionofAbdominalImaging DepartmentofRadiology UniversityofPittsburghSchoolofMedicine Pittsburgh,Pennsylvania

MadeleneC.Lewis,MD

AssociateProfessor Women’sImaging

DepartmentofRadiology MedicalUniversityofSouthCarolina Charleston,SouthCarolina

Ka-KeiNgan,MD

AssistantProfessor DivisionofAbdominalImaging DepartmentofRadiology UniversityofPittsburghSchoolofMedicine Pittsburgh,Pennsylvania

TheodoreSchroeder,MD

DivisionofAbdominalImaging DepartmentofRadiology AlleghenyHealthNetwork AssistantProfessor DepartmentofRadiologicSciences DrexelUniversityCollegeofMedicine Pittsburgh,Pennsylvania

BiattaSholosh,MD

AssistantProfessor DivisionofAbdominalImaging DepartmentofRadiology UniversityofPittsburghSchoolofMedicine Pittsburgh,Pennsylvania

RuchiShrestha,MD

AssistantProfessor DivisionofAbdominalImaging DepartmentofRadiology UniversityofPittsburghSchoolofMedicine Pittsburgh,Pennsylvania

ChrisSomerville,MD

CommonwealthRadiology Richmond,Virginia

PaulJ.Spicer,MD

AssistantProfessor DivisionsofBreastandMusculoskeletalImaging DiagnosticRadiologyResidentProgramDirector DepartmentofRadiology UniversityofKentucky

Lexington,Kentucky

JulianaJ.Tobler,MD

AssistantProfessor AbdominalImagingSection DepartmentofRadiology UniversityofCincinnatiMedicalCenter Cincinnati,Ohio

SeriesForeword

Ultrasound: A Core Review covers the most important aspects of ultrasound in a manner that I am confidentwillserveasausefulguideforresidentstoassesstheirknowledgeandreviewthematerialina question-styleformatthatissimilartothecoreexamination.

Dr. RuchiShrestha and Dr. Ka-Kei Ngan havesucceeded inproducing a bookthatexemplifiesthe philosophyandgoalsoftheCoreReviewSeries.Theyhavedoneameticulousjobincoveringkeytopics andprovidingsuperbimages.Themultiple-choicequestionshavebeendividedlogicallyintochaptersso astomakeiteasyforlearnerstoworkonparticulartopicsasneeded.Eachquestionhasacorresponding answerwithanexplanationofnotonlywhyaparticularoptioniscorrectbutalsowhytheotheroptions are incorrect.There are also referencesprovided for eachquestion for those who want todelve more deeplyintoaspecificsubject.

The intent of the Core Review Series is to provide the resident,fellow, or practicing physician a reviewoftheimportantconceptual,factual,andpracticalaspectsofasubjectbyprovidingapproximately 300multiple-choicequestions,inaformatsimilartothecoreexamination.TheCoreReviewSeriesisnot intendedtobeexhaustivebuttoprovidemateriallikelytobetestedonthecoreexamandthatwouldbe requiredinclinicalpractice.

AsSeriesEditoroftheCoreReviewSeries,ithasbeenrewardingnotonlytobeanauthorofoneof the booksbut alsotobe able toworkwithmanyoutstandingindividualsinthe professionofradiology across the country who contributed to the series. This series represents countless hours of work and involvementbysomanythatitcouldnothavecometogetherwithouttheirparticipation.Ithasbeenvery gratifyingtoseethegrowingpopularityandpositivefeedbacktheauthorsoftheCoreReviewSerieshave receivedfrommanyreviews.

Dr. Ruchi Shrestha, Dr. Ka-Kei Ngan, and their contributors are to be commended on doing an outstandingjob.IbelieveUltrasound:A CoreReviewwillserve asanexcellentresourceforresidents duringtheirboardpreparationandavaluablereferenceforfellowsandpracticingradiologists.

BirenA.Shah,MD,FACR

Director,BreastImaging

Director,BreastImagingFellowship

AssociateProfessorofRadiology

VirginiaCommonwealthUniversity

SchoolofMedicine Richmond,Virginia

Preface

TheABRCoreExaminationisanimage-rich,computer-basedmultiple-choicetestthathasreplacedthe oralboardsasthequalifyingexaminationforradiologyresidents.Thechangefromanoralexaminationto the Core Examinationhasledtosignificant changesin boththe contentand formatofthetest.Thereis nowanincreasedemphasisontheunderstandingofimagingasitrelatestothebroaderclinicalcontextas wellasnoninterpretiveskills,whichimpactthepracticeofradiology,especiallywithrespecttophysics, quality,andsafety.Asaresult,thetraditionalmethodsofboardreviewarenolongersufficientforexam preparation.

This book has been designed as a comprehensive studyguide for radiology residents with a vast collectionofimage-richmaterialadheringtotheABRquestionandanswerformat.Concisebutthorough explanations focused on bothimaging features andrelevant clinical considerationsare provided along withsource references.Thisguidecanalsoserveas preparation fortheCertifying andMaintenance of Certification(MOC)examinations.

Wededicatethisbooktoourresidentsandfellows,who,withtheircuriosityandenthusiasm,inspire ustobebettereducatorseveryday.Wewouldliketothankandcommendourcolleaguesfromthevarious institutionsaroundthecountryfortheircontributionstothisbook.Theirexpertiseandattentiontodetail hasbeengreatlyappreciated.Thisbookwouldnotexistwithouttheirefforts.Wearealsoverygratefulto Dr. Biren Shah and the staff at LWW for their guidance. Finally, we are eternally thankful to our wonderfulfamiliesfortheirsupportandpatiencethroughcountlesshoursofwork.

RuchiShrestha,MD

Ka-KeiNgan,MD

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