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DDx Ureteral obstruction

Fungus ball
Ureteritis cystica

DDx Nonobstructive dilation of the ureter

Primary Megaureter

DDx Double bubble sign

Duodenal atresia (MC, is associated with Down syndrome)
Duodenal stenosis
Annular pancreas
Ladd bands (a fibrous stalk of peritoneal tissue that attaches the cecum to the abdominal wall, and creates an obstruction of the duodenum.)

Cause and Doppler of a Renal AVF

Cause: Biopsy or Trauma.
Doppler: High systolic flow, but low resistive index because the blood doesn't go through a capillary bed.
The draining veins will also either have pulsatility transmitted from the arterial system or lose respiratory phasicity.
TX: Embolization.

Doppler of a femoral pseudoaneurysm

Turbulent flow toward and away from the transducer at the neck. Systolic is higher than baseline and diastolic is lower than baseline due to the fact that it doesn't have a true way so it can't resist the blood pressure coming in or out as well as a vessel. TX: US guided thrombin injection.

Normal arterial velocity (Doppler)

75-125 cm/s.

Criteria for diagnosing Renal Arterial Stenosis

Ratio of main renal artery velocity/aortic velocity > 3.5

Choroid Plexus Cyst (>1cm) is concerning for what? What controversial next step could you offer?

Trisomy 18 (choroid plexus cyst occurs in 30% of cases.
Could offer an amniocentesis.

What Doppler ultrasound finding would you have with Subclavian Steal Syndrome?

Reversal of flow in the vertebral artery. If severe won't have any forward flow at all.
To confirm, Doppler the carotid and vertebrals, the flow should be in the same direction.

Criteria to diagnose Oligohydramnios and DDX

Amniotic fluid index (AFI) measured as the maximum vertical length from the four quadrants added being less than 5cm.
D - Demise, drugs
R - Renal problems, either agenesis or obstruction.
P - Premature rupture of membranes or postmaturity.

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