RVT Vascular Pathology and Aneurysms 3 — Questions and Answers
Question 1: Which connective tissue disorder is most strongly associated with annuloaortic ectasia and ascending aortic aneurysm?
- Ehlers-Danlos syndrome type IV
- Marfan syndrome (Correct answer)
- Loeys-Dietz syndrome
- Pseudoxanthoma elasticum
Correct answer: Marfan syndrome
Marfan syndrome causes fibrillin-1 deficiency, leading to cystic medial necrosis and characteristic annuloaortic ectasia of the ascending aorta.
Question 2: A popliteal artery aneurysm is found incidentally. Which complication is the most frequent cause of morbidity in popliteal aneurysms?
- Rupture
- Distal embolization and acute limb ischemia (Correct answer)
- Venous compression causing DVT
- Femoral nerve compression causing foot drop
Correct answer: Distal embolization and acute limb ischemia
Popliteal aneurysms most commonly cause morbidity through thrombus embolization leading to acute or chronic limb ischemia, not rupture.
Question 3: On color Doppler imaging, the classic 'yin-yang' sign is associated with which vascular abnormality?
- Arteriovenous malformation
- Pseudoaneurysm (Correct answer)
- Dissecting aneurysm
- Venous varicosity
Correct answer: Pseudoaneurysm
The yin-yang sign represents bidirectional swirling flow within a pseudoaneurysm sac, with red and blue halves on color Doppler.
Question 4: Visceral artery aneurysms of the splenic artery are most commonly associated with which clinical condition?
- Portal hypertension and multiparity (Correct answer)
- Hypertension and diabetes mellitus
- Renal artery stenosis and smoking
- Marfan syndrome and bicuspid aortic valve
Correct answer: Portal hypertension and multiparity
Splenic artery aneurysms are strongly associated with portal hypertension (increased splenic blood flow) and multiparity (hormonal/hemodynamic effects).
Question 5: Which ultrasound measurement technique is recommended for standardized AAA surveillance to minimize inter-observer variability?
- Inner wall to inner wall (I-I) measurement on axial view
- Outer wall to outer wall (O-O) measurement perpendicular to the aortic axis (Correct answer)
- Anterior-posterior diameter on longitudinal view
- Maximum circumference divided by pi
Correct answer: Outer wall to outer wall (O-O) measurement perpendicular to the aortic axis
Outer-to-outer wall measurement perpendicular to the vessel axis (true cross-sectional AP diameter) is the recommended standard for reproducibility.
Question 6: An aortic aneurysm that extends above the renal arteries is classified as:
- Infrarenal
- Juxtarenal
- Pararenal
- Suprarenal (Correct answer)
Correct answer: Suprarenal
A suprarenal aneurysm involves aortic dilation above the level of the renal artery origins.
Question 7: Which duplex ultrasound finding in an arteriovenous fistula (AVF) differentiates it from a pseudoaneurysm?
- To-and-fro waveform at the communication neck
- Arterialized (pulsatile, low-resistance) flow in the adjacent vein (Correct answer)
- Absence of color flow within the lesion
- High-resistance waveform in the feeding artery
Correct answer: Arterialized (pulsatile, low-resistance) flow in the adjacent vein
The hallmark of an AVF is arterialized (pulsatile, high-velocity, low-resistance) flow detected in the draining vein due to direct arteriovenous communication.
RVT Vascular Pathology and Aneurysms 3
Which connective tissue disorder is most strongly associated with annuloaortic ectasia and ascending aortic aneurysm?