Biology

The capsule of the prostate gland should appear

and without .

10. The most common of the pelvic cystic masses are the

duct and cysts.

11. A utricle cyst is in origin and is

typically associated with genital anomalies such as

, testicles, and

anomalies.

12. The majority of patients with seminal vesicle cyst

also have ipsilateral .

13. The most common cysts are typically the result of

BPH and are seen in the zone of

the prostate.

14. Prostatic calculi are divided into

calculi and calculi.

calculi are found within the

prostate gland and form from

fl uid. calculi are found within the

urethra and are derived from .

15. calculi can produce what is known

as the “Eiffel Tower” appearance.

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116 PART 1 — ABDOMINAL SONOGRAPHY

16. Patients with acute bacterial prostatitis present with

a , along with

and pain. Large numbers of

will be present within the urine.

17. The prostate is infected by organisms ascending from

the . There is a greater incidence of

prostatitis within the zone.

18. The most common sonographic fi nding in patients

with a history of prostatitis is a in

the periurethral area. The peripheral zone may also

have a echo pattern.

19. The most common cancer in American men is

. The majority are diagnosed in

men over the age of .

20. The most common type of prostate cancer is

and occurs most commonly in the

zone. Most are ,

as opposed to solitary lesions.

SHORT ANSWER

1. What are the most common indications for sonography of the prostate? Is TRUS of the prostate typically used for screening purposes?

2. Describe the sonographic technique used to evaluate the prostate gland, including patient preparation, positioning, image orientation, and any contraindications to the study.

3. Calcifi cations are commonly seen in the prostate gland. What conditions can cause calcifi cations within the prostate?

4. Prostate cancer is the second most deadly male cancer, making its diagnosis an important one. Describe the sonographic appearance of prostate cancer. Is ultrasound a good screening tool for prostate cancer? Why or why not?

5. Describe the method most commonly used for ultrasound-guided prostate biopsy, including patient preparation and technique.

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12 — The Prostate Gland 117

IMAGE EVALUATION/PATHOLOGY

Review the images and answer the following questions.

1. This image was taken lateral to the base of the prostate. What structure is imaged here? Does this structure appear normal? If not, what could cause this?

2. A cystic structure is demonstrated in this male pelvis between the bladder and the rectum. What is the likely diagnosis? What type of symptoms might the patient experience?

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118 PART 1 — ABDOMINAL SONOGRAPHY

3. This image demonstrates cystic structures in the base of the prostate gland in an asymptomatic patient. What is a possible diagnosis?

4. This 55-year-old patient has a history of severe BPH. What could cause the changes seen in the center of this prostate gland? How does this work?

CASE STUDIES

1. A 54-year-old patient presents with symptoms of urinary frequency and nocturia. What is seen in this image of the prostate gland? In what age range does this typically occur? Which zone is typically affected?

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119

REVIEW OF GLOSSARY TERMS

MATCHING

Match the terms with their defi nitions.

Key Terms Defi nitions

1. ACTH

2. Adrenal cortex

3. Adrenal medulla

4. Endoscopic ultrasound

5. MEN

a. An ultrasound transducer that is inserted in the mouth or anus to visualize the walls of the digestive tract and surrounding organs

b. Inner portion of the adrenal gland that secretes the catecholamines epinephrine and norepinephrine

c. A group of autosomal dominant disorders characterized by benign and malignant tumors of the endocrine glands

d. Hormone secreted by the pituitary gland that causes the adrenal gland to produce and release corticosteroids

e. Outer parenchyma of the adrenal gland that secretes corticoids, including cortisol and aldosterone

13 The Adrenal Glands

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120 PART 1 — ABDOMINAL SONOGRAPHY

ANATOMY AND PHYSIOLOGY REVIEW

IMAGE LABELING

Complete the labels in the images that follow.

A

B

C

E

D

1. Adrenal anatomy

H

F

G B

C

D E

A

2. Retroperitoneal anatomy

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13 — The Adrenal Glands 121

LEFT

RIGHT

PO STER

IO R

E B

C

A

D AN

TER IO

R

3. Right scan plane

LEFT

RIGHT

C

G

A

F

E

D

B

PO STER

IO R

AN TER

IO R

4. Left scan plane

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122 PART 1 — ABDOMINAL SONOGRAPHY

CHAPTER REVIEW

MULTIPLE CHOICE

Complete each question by circling the best answer.

1. The adrenal gland is really two glands in one organ. What is the adrenal gland composed of? a. Two endocrine glands

b. Two exocrine glands

c. One exocrine gland and one endocrine gland

d. None of the above

2. The adrenal cortex is made up of all of the following zones EXCEPT: a. Zona glomerulosa

b. Zona fasciculata

c. Zona muscularis

d. Zona reticularis

3. Which of the following regarding the anatomy of the adrenal glands is FALSE? a. The right adrenal gland lies posterior and lateral

to the IVC

b. The right adrenal gland has a triangular shape

c. The right adrenal gland is larger than the left

d. The left adrenal gland has a crescent or semilunar shape

4. Which of the following is NOT a cortical hormone? a. Cortisol

b. Adrenalin

c. Androgen

d. Estrogen

5. Which of the following statements regarding the medulla is FALSE? a. The medulla synthesizes epinephrine and

norepinephrine

b. Release of the hormones is stimulated through the sympathetic nervous system

c. The medullary hormones are essential to life and must be replaced if the adrenal glands are removed

d. The anticipation of stress or pain causes the release of the medullary hormones

6. Which of the following statements regarding sonographic evaluation of the adrenal gland is FALSE? a. The liver can frequently be used as an acoustic

window when evaluating the right adrenal gland

b. The right adrenal gland can be visualized posterior to the crus of the diaphragm

c. The left adrenal gland can be visualized between the left kidney and the aorta

d. The left adrenal gland may be imaged with the patient in the cava-suprarenal line position

7. Which of the following statements regarding adrenal pathology is TRUE? a. A right-sided adrenal mass may displace the

kidney anteriorly

b. A left-sided adrenal mass may displace the splenic vein anteriorly

c. A left-sided adrenal mass may displace the kidney superiorly

d. A right-sided adrenal mass may displace the right renal vein posteriorly

8. In hypoadrenalism, patients have a decreased steroid output. Which of the following conditions is a form of hypoadrenalism? a. Conn’s syndrome

b. Cushing’s syndrome

c. Aldosteronism

d. Addison’s disease

9. Which of the following is NOT a form of hyperadrenalism? a. Conn’s syndrome

b. Cushing’s syndrome

c. Aldosteronism

d. Addison’s disease

10. A patient presents with elevated serum glucose levels, hyperpigmentation of the skin, and thinning of the abdominal tissue with red striations seen on the abdominal wall. Which of the following could cause these symptoms? a. Addison’s disease

b. Cushing’s syndrome

c. Pheochromocytoma

d. Conn’s syndrome

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13 — The Adrenal Glands 123

11. A patient presents with hyperpigmentation of the skin, decreased kidney function, fatigue, and hypotension. The patient also complains of gastrointestinal concerns such as diarrhea and weight loss. Which of the following could cause these symptoms? A. Addison’s disease

B. Cushing’s syndrome

C. Pheochromocytoma

D. Conn’s syndrome

12. What is the most common cause of Cushing’s syndrome? a. Long-term use of insulin

b. Tuberculosis infection

c. Alcoholism

d. Long-term use of steroids such as prednisone

13. What is the most common cause of Conn’s syndrome? a. Long-term use of steroids such as prednisone

b. Tuberculosis infection

c. Aldosterone-producing adrenal adenoma

d. Pheochromocytoma

14. What are the principle clinical symptoms of Conn’s syndrome? a. Diabetes

b. Hypernatremia and hypokalemia

c. Hypertension and headaches

d. Hypercalcemia and hypovolemia

15. A patient presents with a history of highly elevated blood pressure, headache, and rapid heartbeat. What are these symptoms common with? a. Conn’s syndrome

b. Cushing’s syndrome

c. Pheochromocytoma

d. Cortical adenoma

16. Which of the following tumors occurs in the adrenal medulla? a. Adenoma

b. Pheochromocytoma

c. Myelolipoma

d. Adenocarcinoma

17. Which of the following describes the most common appearance of the adrenal adenoma? a. Small, round, homogeneous hypoechoic lesions

b. Large hyperechoic lesion with irregular borders

c. Complex lesion of varying size with increased through transmission

d. Small hypoechoic lesion with a calcifi ed rim

18. Which of the following may be seen in patients with MEN syndrome? a. Pheochromocytoma

b. Cortical adenoma

c. Adrenal myelolipoma

d. Both A and B

19. A patient presents for an abdominal sonogram to rule out a pheochromocytoma. Which of the following increases a person’s risk of developing a pheochromocytoma? a. MEN syndrome

b. Von Hippel-Lindau disease

c. Tuberous sclerosis

d. All of the above are associated with pheochromocytoma

20. Which of the following statements regarding pheochromocytoma is FALSE? a. All pheochromocytomas are malignant

b. Pheochromocytomas may be unilateral or bilateral

c. Pheochromocytomas occur more frequently in patients with hereditary endocrine tumor syndromes

d. Patients with a pheochromocytoma have elevated levels of urinary catecholamines

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