Case%Report%for%Case%Presentation%Clinic%I%

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Student:(Teresa(Montano(
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(
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Date:((11/14/13(
Clinical(Site:(BMH:Memphis(( (
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Type(of(Examination:(US(Abdominal(Complete(
(
Complete(the(following(required(elements(regarding(the(pathology(case(being(presented(during(case(
presentations.((Information(provided(must(be(accurate(and(applicable(to(the(pathology(case.(
(
PATIENT%INFORMATION:(
Age:(( 74(
Race:( White( Sex:( Male( DOS:(9/19/13(
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CASE%HISTORY:%%In(bullet(point(format,(describe(reason(for(exam,(previous(imaging,(pertinent(labs,(
medical(history,(symptoms,(etc.((
Reason(for(the(exam:(Based(on(the(patients(history(with(cirrhosis(and(elevated(LFTs(the(US(was(
ordered(to(HCC((Hepatocellular(Carcinoma(Screening)(
Medical(History:(History(of(cirrhosis,(with(elevated(ammonia,(anemia,(diabetes,(heart(disease,(
hypertension,(former(smoker,(diuretic(resistant(ascites,(chronic(kidney(failure,(portal(vein(
thrombosis((
Symptoms:(pedal(edema,(tachycardia,(acute(chest(pain,(right(arm(pain(,(elevated(troponin,(mild(
hepatic(encephalopathy((
Labs:(elevated(ammonia,(BUN,(creatinine,(and(BUN(to(creatinine(ratio,(AST,(Alk(Phos,(Troponin(
Magnesium,(Saturated(Iron(
Previous(surgeries:Cardiac(Bypass(1993(&(2005,(Cholecystectomy(
Previous(ABD(US(Exam(August(2012(
Findings:(
o Nonocclusive(thrombus(in(the(main(portal(vein(
o Nodular,(irregular(liver(contour(and(ascites,(compatible(with(cirrhosis(
(
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EXAMINATION%TECHNIQUES:%%In(bullet(point(format,(identify(the(machine,(transducer,(and(frequency(
used,(an(explanation(of(patient(set(up,(and(instrumentation(used(during(the(exam.((

Machine:(Logic(GE(E9(
Transducer:(Curved(C1:5(
Frequency:(5(MHz(then(reduced(to(4(MHhz(
Patient(set(up:(Supine(with(abdomen(exposed((
Instrumentation:(Spectral(&(Color(Doppler(,(Dual(Screen(to(show(kidney(cyst(measurements(in(
two(planes,(Reduced(the(field(of(view,(zoom(

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PATHOLOGY%SONOGRAPHIC%FINDINGS:%%%In(bullet(point(format,(describe(the(pertinent(structures(
visualized,(location,(size,(shape,(borders,(vascularity,(composition,(echogenicity,(etc.

Liver:13.99cm(echogenic(liver,(atrophic,(nodular(borders(
Portal(Vein:(velocity(18.7(cm/s((with(Non:occlusive(material(at(porta(hepatis(
o Color(Doppler:(Displayed(hepatopedal(flow,(visually(see(echogenic(thrombus(with(blood(filling(
the(vessel(around(the(thrombus(
o Spectral(Doppler:(Decreased(velocity,(phasic(flow(
Spleen:(14.72(cm=(enlarged((
Ascites(was(noted(within(the(abdominal(cavity

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PATHOLOGY:%%%In(bullet(format,(identify(and(define(the(pathology,(common(clinical(symptoms,(common,(
and(sonographic(findings(of(the(pathology.((
Pathology:(Non:occlusive(portal(vein(thrombus((
o Definition:(Echogenic(thrombus(in(the(Portal(Vein(lumen(

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Common(Clinical(Symptoms:(hematemesis,(encephalopathy,(portal(hypertension(symptoms:
ascites,(varices,((
Sonographic(findings(of(the(pathology:(echogenic(thrombus(within(the(lumen(of(the(vein,(
cavernous(transformations(worm(like(vessels(at(the(porta(hepatis),(splenomegaly,(increased(PV(
caliber,(Spectral(Doppler(will(display(absence(of(flow(when(thrombus(is(occlusive(
Commonly(associated(with(malignancy,(including(HCC,(metastatic(liver(disease,(carcinoma(of(the(
pancreas,(chronic(pancreatitis,(cirrhosis(((