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11. AnswerB. Selectingalower-frequency transducerdecreases theDopplershiftand will leadtoa
reductioninaliasing.
Decreasing the scale (answer choice A) would lead to increased aliasing, whereas increasing the
scale would reduce aliasing. Choosing a sample volume at a greater depth (answer choice C) would
increase aliasing, whereas sampling at a less depth would lead to an increase of pulse repetition
frequency and serve to decrease aliasing. Answer choice D is incorrect as this would lead to higherfrequency Doppler signaldetectedandwouldincreasealiasing;however,increasingthe Doppler angle
wouldleadtodecreasesinDopplershiftandwouldservetoreducealiasing.
References:BooteEJ.DopplerUStechniques:conceptsofbloodflowdetectionandflowdynamics.RadioGraphics2003;23:1315–1327.
KruskalJB,etal.OptimizingDopplerandcolorflowUS:applicationtohepaticsonography.RadioGraphics2004;24:656–675.
12.AnswerD.Imagesshowechogenicmaterialintheleftportalvenoussystemwithinternalvascularity
oncolorDopplerinterrogation,concerningformalignantportalvenousthrombosis.
Tumoral neovascularityresultsinthe disorganized formation of arteriesand veinswithin themass.
TheabilityofspectralDopplerinterrogationtoshowanarterialwaveformwithinanoccludedportalvein
isthemostspecificsignofmalignantportalvenousthrombosis.
Echogenic clot (answer choice B) within theportalveincanbe seen in bothbenignandmalignant
etiologiesandthedegreeofechogenicityisnotadistinguishingfeature.Additionally,theechogenicityof
aclotwillvarydependingonitsage.Becausetumorthrombuscanbeseeninthesettingofanormal-sized
portal vein, vessel diameter is not considered to be a distinguishing feature, thereby making answer
choiceCincorrect.Cavernous transformation(answerchoiceA)referstothedevelopmentofcollateral
vessels in or around the occluded portal vein. Although cavernous transformation tends to be more
associated with bland thrombus, it has also been documented in cases of malignant portal vein
thrombosis.
Reference:McNaughtonDA,etal.DopplerUSofthelivermadesimple.RadioGraphics2011;31:161–188.
13.AnswerA.ThecolorprioritythresholdsettingcanbeadjustedtoeliminateunwantedcolorDoppler
signal from a color flow image. Assuming that color flow should only be seen in an anechoic blood
vessel, the color priority can be decreased to the point where color signal is only displayed within
anechoicstructures.Anypixelwithagray-scalevalueabovethatofthecolorprioritythresholdlevelwill
display the gray-scale informationonly, evenifthereiscorrespondingcolorDopplerinformation. This
canbeusefultoeliminateunwantedsignaloutsideofaknownvessel.However,whenattemptingtodetect
flowwithinsmallvessels,atoolowcolorprioritythresholdcanleadtosuppressionofdesiredsignal.
Shown aretwo imagesfrom a scrotal ultrasound. The first image shows nocolorsignal withinthe
testes.Afterincreasingthecolorprioritythreshold(yellowarrow),vascularflowisdemonstrated.
Reference:HertzbergBS,MiddletonWD.Ultrasound:therequisites,3rded.Philadelphia,PA:Elsevier,2016:19.
14. AnswerB. Ensemble length (also known as dwell time) is the number of sound pulses used to
generate each individual line on a color Doppler image. Increasing the number of pulses per line
increasesthesensitivityforthedetectionofaDopplershiftatanygivenlocation.
Increasingthewallfilter(answerchoiceA)willincreasethethresholdbelowwhichfrequencyshifts
are not displayed, filtering out signal from slower flow. Increasing the PRF (answer choice C) will
decreasethesensitivityforthedetectionofslowflow.Increasingsteeringoftheultrasoundbeam(answer
choiceD)usingalineararrayprobewilldecreaseDopplersensitivityforseveralreasons.First,beams
thatare steeredlosemoreoftheir energytosidelobes thanbeamsthat are notsteered.Second,echoes
returningtotheprobefromthepatientreachthesurfaceofthetransduceratanangle,alsoresultingina
weakersignal.
Reference:HertzbergBS,MiddletonWD.Ultrasound:therequisites,3rded.Philadelphia,PA:Elsevier,2016:18–19.
15. Answer B. The yellow arrow shows the a wave, which occurs in late diastole during atrial
contraction;thenormala wave correspondstoretrogradehepaticvenous flow andis shownabovethe
baseline.The S wave (annotatedbyblue arrowbelow)occursin midsystole andrepresents antegrade
hepaticvenousflowbecauseofmovementoftheatrioventricularseptumtowardthecardiacapex.TheD
wave (annotated by red arrow below) occurs in early diastole because of rapid filling of the right
ventricle.Normally, theS waveextends furtherbelow the baselinethanthe Dwave.Thetransitionalv
wave occurs between systole and diastole and may extend above or below the baseline. An initial
upward-slopingcomponentrepresentscontinuedbutslowingrightatrialfillingagainstaclosedtricuspid
valve. Thepeakofthe vwavesignalsopeningofthetricuspidvalve.Bloodthenmovesfrom the right
atriumintotherightventricle,resultinginthedownward-slopingcomponentofthevwave.
References:McNaughtonDA,etal.DopplerUSofthelivermadesimple.RadioGraphics2011;31:161–188.
Scheinfeld MH, et al. Understanding the spectral Doppler waveform of the hepatic veins in health and disease. RadioGraphics
2009;29:2081–2098.
16. AnswerC. Thesharp, bidirectional spikes superimposed on the normal monophasic portal vein
waveform are duetointraluminalgasbubbles.Duringgray-scale evaluation, thegasbubblesappear as
highlyechogenicparticlesflowingwithintheportalvein.Portalvenousgasmaybeduetolife-threatening
(i.e., bowelischemia) andbenignetiologies. Intraluminalclot(answer choiceB) is stationary andmay
appearashypoechoicorechogenic,dependingontheageandcompositionofthebloodproducts.Septic
emboli (answer choice D) are not typicallydetected by US unless sufficiently large.Stenosis (answer
choiceA)canresultinturbulent,disorganizedflowandresultinelevatedpeakvelocities.However,clot,
septic emboli, and stenosis do not produce the narrow, high-velocityspikes on the waveform that are
showninthiscase.
Reference: Abboud B, et al. Hepatic portal venous gas: physiopathology, etiology, prognosis and treatment. World J Gastroenterol
2009;15(29):3585–3590.
17.AnswerC. In tricuspidregurgitation (TR), atrialcontraction forces blood antegradeintotheright
ventricle and also retrograde toward the liver producing a taller than normal retrograde (above the
baseline) a wave. During systole, the ventricle contracts and the tricuspid annulus moves toward the
cardiacapex.Becauseoftheincompetenttricuspidvalve,bloodregurgitatesthroughthetricuspidvalve
intotherightatrium,IVC,andhepaticveins;thisresultsinanabnormallybluntedorretrograde(abovethe
baseline)Swave.Astheventriclebeginstorelax,thetricuspidannulusreturnstoanormalposition,and
bloodisforcedoutoftheatriumandintotheIVCandliver;thisproducesanabnormallytall,retrogradev
wave.Althoughtheatriumandventriclearerelaxedandthetricuspidvalveopenduringdiastole,blood
passively flows out of the liver and IVC into the heart; this produces the D wave, which is the only
antegradewave(belowthebaseline).
Insummary,thesalientDopplerspectralfindingsareapulsatilewaveform,exaggerated(i.e.,tall)a
andvwaves,andadecreasedorreversedSwave.WithmoderateTR,theSwaveisnotasdeepastheD
wave;withsevereTR,theSwavereverses(i.e.,appearsabovethebaseline)andmergeswiththeaandv
wavestoformaretrograde,complexa–S–vwaveasinthiscase.
In right-sidedheartfailure (answer choice B),thea andv waves are exaggerated,but theS andD
wavesmaintainanormalrelationship(i.e.,theSwaveextendsfurtherbelowbaselinethantheDwave).
Mitralregurgitation (answer choice A)affectsthe leftsideoftheheartandtypicallydoesnot alterthe
hepaticvenouswaveform.Compressionofthehepaticvein(answer choiceD)resultsinbluntingofthe
waveform (i.e., loss of phasicity) evidenced by reversal of the a wave and eventual inability to
distinguishtheindividualcomponentsofthenormallyphasichepaticvenouswaveform.
References: Abu-Yousef MM. Duplex Doppler sonography of the hepatic vein in tricuspid regurgitation. AJR Am J Roentgenol
1991;156(1):79–83.
McNaughtonDA,etal.DopplerUSofthelivermadesimple.RadioGraphics2011;31:161–188.
18. Answer A. “Tardus” refers to a slow systolic upstroke, resulting in a longer acceleration time.
“Parvus”referstodampeningofthesystolicpeak,leadingtoadecreaseinamplitudeandroundingofthe
systolicpeak.Tardus–parvuswaveformscommonlyoccurdownstreamtoasignificantarterialstenosis.In
thisexample,theslantedconfigurationoftheinitialsystolicupstrokewaveformcomponentisindicative
of a slow systolic upstroke (tardus). The top of the waveform is dampened and rounded rather than
sharplydefinedandpeaked(parvus).
ThecauseoftheparvusettarduswaveforminthiscasewasproximalICAstenosis.Thisisseeninthe
image.
The peak systolic velocity within the proximal internal carotid artery was markedly elevated.
Accordingtoaconsensuspaperwrittenin2003,followingaconferenceoftheSocietyofRadiologistsin
Ultrasound, a velocity measurement of >230 cm/s is consistent with a stenosis >70%. The measured
velocity in this case met these criteria. Gray-scale information also shows luminal narrowing by
atheroscleroticplaque.
Reference: GrantEG, etal. Carotid arterystenosis:gray-scaleandDopplerUSdiagnosis—Society of RadiologistsinUltrasoundConsensus
Conference.Radiology2003;229:340.
19.AnswerB.Spatialcompoundingisatechniqueinwhichimagesacquiredfrommultiplescanangles
are summed to produce the final image. Signal from strong reflectors is reinforced, whereas random
speckle noise is not, thereby significantly improving the signal-to-noise ratio. Additionally, artifacts
relatedtononperpendicularreflectorsarereduced,improvingedgedetail.
ThisincreasedSNRratiocomesattheexpenseoftemporalresolution(answerchoiceA),becauseof
the increased time required for signal acquisition from multiple projections. The field of view is
unchanged in compound imaging (answer choice C). Imaging deep structures in obese patients is
compromisedduetobeamattenuation.Compoundimagingisnotveryeffectiveinimprovingthesignalto
noise inthesecasesbecauseall ofthe transmittedbeamsareseverelyattenuated.In thiscircumstance,
speckleandnonperpendicularreflectorsplayarelativelyminorroleinimagedegradation.
Reference:HertzbergBS,MiddletonWD.Ultrasound:therequisites,3rded.Philadelphia,PA:Elsevier,2016:9.
20a.AnswerB.Imagesshowconcentricdilatationoftheabdominalaortaupto6.6cm,representinga
fusiformaneurysm.EccentricechogenicthrombusisshownalongwithturbulentDopplerflow.
In contrast to fusiform aneurysms, saccular aneurysms exhibit eccentric dilatation and outpouching
alongonlyaportionofthevesselwallcircumference.Onultrasound,findingsofarupturedaneurysmmay
includeheterogeneouslyhypoechoiccomplexfluidaroundtheaortainasymptomaticpatient.Findingsof
aneurysmruptureareusuallymoreeasilyseenonCT.
Pseudoaneurysmsoftheabdominalaortaarerare,andtraumaticandautoimmuneetiologieshavebeen
described.
References: Borioni R, Garofalo M, Seddio F, et al. Posttraumatic infrarenal abdominal aortic pseudoaneurysm. Tex Heart Inst J
1999;26(4):312–314.
KaufmanJA,LeeMJ.Vascularandinterventionalradiology:therequisites.St.Louis,MO:Mosby,2004.
Okita Y,AndoM,Minatoya K, etal. Multiplepseudoaneurysmsoftheaortic arch,rightsubclavian artery, and abdominal aortain a patient
withBehçet’sdisease.JVascSurg1998;28(4):723–726.
20b.AnswerD.Theriskofruptureofanabdominalaorticaneurysm(AAA)varieswithdiameter.The
abdominalaortaisconsideredaneurysmalwhenitsdiameterreaches3cm.Foraneurysms<4cm,annual
risk of spontaneous ruptureis near0%. It increases to 1% to 3% for aneurysms measuring 4 to5 cm.
Smallaneurysms<5cmshouldundergoimagingsurveillanceevery6to12months.Annualruptureriskis
6% to11% at5 to 7 cm, and20% foraneurysms equaltoor largerthan7 cm. Openor endovascular
repairisusuallyperformedwhentheaneurysmreaches5cm.
References: BrownPM,ZeltDT, SobolevB. The riskof rupturein untreatedaneurysms: the impact ofsize,gender,and expansion rate. J
VascSurg2003;37(2):280–284.
KaufmanJA,LeeMJ.Vascularandinterventionalradiology:therequisites.St.Louis,MO:Mosby,2004.
SchwartzSA,TaljanovicMS,SmythS,etal.CTfindingsofrupture,impendingrupture,andcontainedruptureofabdominalaorticaneurysms.
AJRAmJRoentgenol2007;188(1):W57–W62.
20c.AnswerD.Poplitealarteryaneurysm(PAA)isthesecondmostcommonatheroscleroticaneurysm.
Thirty to fiftypercent ofpatientswith a PAA will also have anAAA. However,only10% to 14% of
patientswithanAAAwillhaveaPAA.AsopposedtoAAAs,PAAsarefoundalmostexclusivelyinmen.
TheotheraneurysmslistedoccurlessfrequentlyandhavealowerassociationwithAAA.
References: Diwan A, Sarkar R, Stanley JC, et al. Incidence of femoral and popliteal arteryaneurysms in patients with abdominalaortic
aneurysms.JVascSurg2000;31(5):863–869.
WrightLB,MatchettWJ,CruzCP,etal.Poplitealarterydisease:diagnosisandtreatment1.RadioGraphics2004;24(2):467–479.
21a. AnswerC. Multipletortuousvesselsareshownwithintheexpectedlocation ofthe portalvein,
representing dilated periportal and peribiliary veins. Cavernous transformation occurs as a result of
persistent occlusion or incomplete recanalization of the portal vein following portal vein thrombosis.
Thisnetworkofcollateral veins reconstitutes flowtodistalnonobstructed portal veins.Inspiteofthis
collateral pathway, most patients with cavernous transformation will still have portal hypertension.
Causes of portal vein thrombosis include cirrhosis, infection, hypercoagulable states, trauma, and
malignancy.
Periportalcollaterals arenot anexpected findinginthe settingofhepaticartery thrombosis (choice
A). Absenceofarterial signal alongtheportaltriads would suggesthepaticartery thrombosis, usually
occurringasacomplicationfollowinglivertransplantation.
Intrahepaticportosystemicshunting(choiceB)canoccur inthecirrhoticliver.However,ittypically
occursmoreperipherally,wheresimilar-sizedportalandhepaticveinscanformanaberrantconnection.
Here,thetortuousvesselsareintheportahepatis,distantfromthehepaticveins.
An arteriovenousmalformation(AVM)(choice D) is unlikely giventhatthetortuousvessels extend
fromtheportahepatisalongthecourseoftherightportalvein.Adilatedfeedingarteryanddrainingvein
areoftenseenleadingtowardandawayfromanAVM.
21b.AnswerA.Incavernous transformation oftheportal vein,thenativemain portal vein(MPV) is
typicallyscarreddownanddifficulttoseebyultrasoundorcross-sectionalimaging.Thecollateralveins
thathavedevelopedtoreplaceitintheportahepatisaresmallcaliber.
In acute portal vein thrombosis, the MPV is typically normal caliber or expanded. In portal
hypertension,the MPVmay be dilated duetoincreased pressure. In intrahepatic portosystemic shunts,
portal veins can be dilated due to increased flow.AVM would show disorganized tangles of smaller
calibervesselsaswellasfeedingarteryanddrainingvein.
References: De Gaetano AM, Lafortune M, Patriquin H, et al. Cavernous transformation of the portal vein: patterns of intrahepatic and
splanchniccollateralcirculationdetectedwithDopplersonography.AJRAmJRoentgenol1995;165(5):1151–1155.
GinatDT.Thoriumdioxide(thorotrast).InGinatDT,SmallJ, SchaeferPW(eds). Neuroimagingpharmacopoeia.Dordrecht,Netherlands:
SpringerInternationalPublishing,2015:119–122.
KauzlaricD,PetrovicM,BarmeirE.Sonographyofcavernoustransformationoftheportalvein.AJRAmJRoentgenol1984;142(2):383–384.
Raby N, Meire HB. Duplex Doppler ultrasound in the diagnosis of cavernous transformation of the portal vein. Br J Radiol
1988;61(727):586–588.
22. AnswerB. Axial resolution is the ability oftheultrasound beam toresolve two objects located
along the axis of the ultrasound beam. Axial resolution is half of the pulse length (pulse length ÷ 2).
LongerpulselengthsareusedinpulsedDopplertodecreasevariabilityinmeasurementofDopplershift.
Thetradeoffisdecreasedaxialresolution.
Reference:HertzbergBS,MiddletonWD.Ultrasound:therequisites,3rded.Philadelphia,PA:Elsevier,2016:4.
23. Answer D. The transjugular intrahepatic portosystemic shunt is the most commonly performed
invasiveprocedureforalleviatingthesymptomsofportalhypertension (varicesandrefractoryascites).
Complications that canoccurfollowing the TIPSplacement includestent occlusion, stent stenosis,and
hepaticveinstenosis.Signsofstentmalfunctionincludetheabsenceofin-stentflow,peakshuntvelocities
below 90 cm/s or above 190 cm/s, change in peak shunt velocity of 50 cm/s between two studies,
decreasedpeakvelocitieswithinthemainportalvein<30cm/s,hepatopetalintrahepaticportalflow,and
reversalofflowinthehepaticvein(suggestinghepaticveinstenosis).IndirectsignsofTIPSmalfunction
includeincreasingascitesandreappearanceofvarices(includingparaumbilicalveins).
The images demonstrate borderline elevated peak velocities within the TIPS with aliasing at the
hepaticvenousside.Additionally,hepatopetalflowisshownwithintherightportalvein.Thesefindings
areconcerningforaTIPSmalfunctionwithstenosisatthehepaticvenousend.
Reference: Darcy M. Review. Evaluation and Management of Transjugular Intrahepatic Portosystemic Shunts. AJR Am J Roentgenol
2012;199:730–736.
24.AnswerA. Superficial thrombophlebitisor superficial venousthrombosis(SVT),ischaracterized
bythrombosisofasuperficialveinandisassociatedwithinflammatoryreactionofadjacenttissue,though
the term has also been used to describe superficial vein thrombosis without associated surrounding
inflammatory changes. The ultrasound image in this patient demonstrates a long-segment occlusive
thrombus with hyperemia of the circumferentially thickened wall. Patients often complain of pain and
physical examination reveals a palpable, tender, “cord”-like subcutaneous structure. Overlying skin is
oftenerythematousandwarm.
The hyperemia is limited to the tubular vein. Surrounding subcutaneous fat does not demonstrate
edemaorhyperemiatosuggestcellulitis(choiceB).
The thrombosed vein is subcutaneous in location and does not represent deep venous thrombosis
(choiceC).
The tubular structure depicted intheultrasoundimageissubcutaneous inlocation, whereas median
nerveentrapmentinanteriorinterosseousnervesyndromealongthevolaraspectofforearmisdeeperin
location.Also,theperipheralhyperemiaisnotatypicalfeatureofanteriorinterosseousnervesyndrome
(choiceD).
Reference: Rumack CM, Wilson SR, Charboneau WJ. Diagnostic ultrasound, 4th ed. Philadelphia, PA: Elsevier Health Sciences,
2011:1031–1033.
25. Answer D. The expansile heterogeneous mass with central calcification within the retrohepatic
inferiorvenacavaishighlysuggestiveofaneoplasmratherthanblandthrombus.Thoughprimarytumors
ofinferiorvena cavaarerare,leiomyosarcomais the mostcommontumor ofthevenoussystem andits
mostcommonlocationistheinferiorvenacava.Tumorthrombusintheinferiorvenacavaismoreoftena
result of direct extension of renal cell carcinoma, hepatocellular carcinoma and primary adrenal
carcinoma.Expansion oftheinferior venacava lumenandthe presence ofinternalvascularityare two
featuresthatdistinguishtumorthrombusfromablandthrombus.
A.Tricuspidregurgitationcanresultindilatationofinferiorvenacavaandhepaticveinsbutisnot
associatedwithluminalthrombosis.
B.Abland thrombus ininferior venacava,unliketumorthrombus,should not cause such marked
expansionofthelumen.
C.AlthoughthecentralshadowingcalcificationwithinthemasscouldbeconfusedforanIVCfilter,
thesurroundingheterogeneousexpansilemassstronglysuggestsaneoplasticentity.
References:HertzbergBS,MiddletonWD.Ultrasound:therequisites,3rded.Philadelphia,PA:Elsevier,2016:220–221.
Rumack,CM,Wilson,SR,etal.Diagnosticultrasound,4thed.Philadelphia,PA:ElsevierMosby,2011:478–482.
26.AnswerD.Theincreasedpeaksystolicvelocityintheceliacaxisthatimproveswithinspirationis
characteristic ofmedian arcuate ligamentcompression of celiac axis.Thevelocity also improveswith
erectpositioningofthepatient.Surgicalreleaseofthemedianarcuateligamentrelievescompressionof
celiacaxisandimprovesbloodflow.
A.Theincreased peaksystolicvelocity ofceliac axisinexpirationsuggestsluminalnarrowingof
celiac and not of superior mesenteric artery. Withmedian arcuate ligament compression ofthe
celiac axis, superior mesenteric artery provides collateral flow through pancreaticoduodenal
arcadeandgastroduodenalartery.
B. Although increased peak systolic velocity in the celiac axis can be seen with any etiology
including atherosclerotic narrowing and malignant infiltration, respiratory variation with
improvement of flow velocity in inspiration is seen only with median arcuate ligament
compressionandnotwiththeotherentities.
C.Increaseinbothpeaksystolicandend-diastolicvelocitiesisseenwithceliacaxisnarrowingof
anyetiology. Normalization ofvelocities duringsuspended inspirationor with erect positioning
indicatesmedianarcuateligamentcompression.
References:AbuRahmaAF,StonePA,SrivastavaM, et al. Mesenteric/celiacduplex ultrasoundinterpretationcriteria revisited.JVascSurg
2012;55:428–436,e6;discussion:435–436.
White RD, et al. The celiac axis revisited: anatomic variants, pathologic features,andimplications for modernendovascular management.
RadioGraphics2015;35(3):879–898.
27. Answer B. The ultrasound and MR images show diffuse homogeneous circumferential wall
thickeningwithmoderatenarrowingofthedistalaortaandseverenarrowingoftheleftiliacartery.These
findings indicate large vessel vasculitis, and in a young female patient, the most likely etiology is
Takayasuarteritis.
Takayasuarteritisisanidiopathiclarge-vesselarteritisthatinvolvestheaortaanditsmajorbranches,
pulmonaryarteries,andcoronaryarteries.Thediseaseoftenmanifestsbeforetheageof40yearswitha
distinctfemalepreponderance.Patientstypicallypresentwithnonspecificconstitutionalsymptomsduring
initialphaseofthedisease.Severestenosisandocclusionoftheproximalcarotidandsubclavianarteries
commonly lead to absence of pulses. Other characteristic clinical presentations of Takayasu arteritis
includeclaudication,vascularbruits,renalhypertension,andlimbbloodpressurediscrepancies.
Chronicgranulomatousandlymphocyticinflammationaffectstheintimaandmedialeadingtoarterial
wall thickening, focal stenosis, occlusion,or aneurysm formation. Sonographic findings includevessel
wallthickening,luminalnarrowingorstenosis,vesselocclusion,andreducedpulsatility.Managementof
Takayasu arteritis involves controlling the disease activity through medical therapy and decreasingthe
effectsofvascularcompromisethroughsurgicalorendovascularinterventions.Corticosteroidtherapyis
the mainstay of medical therapy. Other immune-modulating drugs (e.g., methotrexate,azathioprine) are
usedinpatientswhodonotrespondtosteroidtherapy.
Giantcellarteritis(GCA)(choiceA)isagranulomatousvasculitisaffectinglarge-tomedium-sized
arteries. It is also known as temporal arteritis and tends to involve the extracranial carotid artery
branchessuchasthetemporalartery.GCAtypicallyaffectsolderfemales,usuallyolderthan50yearsof
age,withapeakageof70to80years.
Polyarteritisnodosa(PAN)(choiceC)isasystemicinflammatorynecrotizingvasculitisthatinvolves
small-tomedium-sizedarterieseventuallyresultinginnecrosisandvesselwalldestruction.Ithasslight
malepredominanceandtypicallypresentsaroundthe6thdecade.Twentytothirtypercentofpatientsare
hepatitisBantigenpositive.
Granulomatosiswithpolyangiitis(GPA)(choiceD),previouslyknownasWegenergranulomatosis,is
a multisystem systemic necrotizing noncaseating granulomatous vasculitis affecting small- to mediumsizedarteries,capillaries,andveins,withapredilectionfortherespiratorysystemandkidneys.Thereis
involvement of the upper respiratory tract leading to necrosis of nasal septum, tracheal necrosis, lung
nodules,andnecrotizingglomerulonephritis.
Reference:KhoslaA,AndringB,AtchieB,etal.Systemicvasculopathies.RadiolClinNorthAm2016;54(3):613–628.
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