ARDMS Abdomen Sonography Examination AB-Abdomen Exam Questions

Answer : C

The ultrasound image shows a transverse view of the lower neck region at the thyroid level. The arrow is pointing to a round-to-oval structure located posterior and slightly to the left of the thyroid gland. The structure has a characteristic 'target' or 'bull's-eye' appearance with a hypoechoic outer ring and echogenic central mucosal interface --- this is classic for the esophagus when seen in transverse view.

Key sonographic features of the esophagus:

It lies posterior to the left lobe of the thyroid.

It demonstrates a layered wall structure ('target' or 'bull's-eye' appearance).

It may change shape or move during swallowing, and occasionally air bubbles or movement of fluid may be observed.

Comparison of answer choices:

A . Parathyroid glands are small, homogeneous, hypoechoic, and located posterior to the thyroid --- but do not have this layered target appearance.

B . Lymph nodes have a hypoechoic cortex and echogenic hilum and are typically oval or bean-shaped, without the concentric ring appearance.

C . Esophagus --- Correct. The location, appearance, and structure are consistent with the cervical esophagus.

D . Paragangliomas are highly vascular and more commonly located in the carotid body or adrenal region, not in this location or with this sonographic pattern.

Rumack CM, Wilson SR, Charboneau JW, Levine D. Diagnostic Ultrasound, 5th ed. Elsevier; 2017.

Grant EG, Tessler FN, Hoang JK, et al. Thyroid Ultrasound Reporting Lexicon: White Paper of the ACR TI-RADS Committee. J Am Coll Radiol. 2015.

Hagen-Ansert SL. Textbook of Diagnostic Sonography, 8th ed. Elsevier; 2017.

Answer : A

The ultrasound image shows a transverse section through the upper abdomen. The arrow is pointing to a vascular structure running posterior to the pancreas and anterior to the left kidney. This vessel is the splenic vein.

Anatomically:

The splenic vein runs along the posterior border of the pancreas.

It courses medially to join the superior mesenteric vein (SMV) and form the portal vein.

It receives tributaries from the spleen, short gastric veins (draining the stomach), and the inferior mesenteric vein.

In this case, the question asks which organ is primarily drained via the vessel marked by the arrow. The splenic vein's main tributary is from the spleen.

Comparison of answer choices:

Spleen --- Correct. The splenic vein is the primary drainage vessel for the spleen.

Stomach --- Some gastric veins drain into the splenic vein, but the primary drainage is via left and right gastric veins into the portal system.

Left kidney --- Drains into the left renal vein, not the splenic vein.

Duodenum --- Drains mainly into the superior mesenteric vein (SMV).

Rumack CM, Wilson SR, Charboneau JW, Levine D. Diagnostic Ultrasound, 5th ed. Elsevier; 2017.

Hagen-Ansert SL. Textbook of Diagnostic Sonography, 8th ed. Elsevier; 2017.

Netter FH. Atlas of Human Anatomy, 7th ed. Elsevier; 2018.

Answer : D

Portal veins course horizontally within the liver and have echogenic walls due to their fibrous sheath. In contrast, hepatic veins course vertically toward the IVC and lack echogenic walls. Hepatic veins also demonstrate a triphasic waveform.

According to Rumack's Diagnostic Ultrasound:

''Portal veins course horizontally within the liver and are easily recognized by their echogenic walls.''

Rumack CM, Wilson SR, Charboneau JW, Levine D. Diagnostic Ultrasound. 5th ed. Elsevier, 2017.

AIUM Practice Parameter for Liver Ultrasound, 2020.

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Answer : C

The ultrasound image demonstrates a dilated duodenum with a hypoechoic soft tissue structure encircling it. This is a classic sonographic appearance suggestive of an annular pancreas. In annular pancreas, pancreatic tissue completely or partially encircles the second portion of the duodenum, which can lead to duodenal narrowing or obstruction.

Annular pancreas is a congenital anomaly that results from failure of the ventral pancreatic bud to rotate properly during embryologic development. As a result, pancreatic tissue encircles the duodenum. It may present in neonates with symptoms of duodenal obstruction or in adults with abdominal pain, pancreatitis, or vomiting.

Ultrasound Findings:

Hypoechoic pancreatic tissue encircling the duodenum

Evidence of duodenal dilatation proximal to the obstruction

''Double bubble'' sign may be seen in neonates

Differentiation from other options:

Supernumerary kidney: Refers to an accessory kidney. It would be seen in the retroperitoneum and is unrelated to the duodenum or pancreas.

Pancreas divisum: A ductal anomaly best diagnosed on MRCP or ERCP. It is not typically visible on conventional ultrasound.

Horseshoe kidney: A renal fusion anomaly where the lower poles of the kidneys are fused. It is seen in the pelvis or lower abdomen and does not involve the duodenum or pancreas.

Rumack CM, Wilson SR, Charboneau JW, Levine D. Diagnostic Ultrasound. 5th Edition. Elsevier, 2018. Chapter: Pancreas, pp. 269--272.

Radiopaedia.org. Annular pancreas: https://radiopaedia.org/articles/annular-pancreas

AIUM Practice Parameter for the Performance of Abdominal and Retroperitoneal Ultrasound Examinations, 2020.

Answer : C

Histoplasmosis is a fungal infection that can lead to granulomatous disease. Chronic granulomatous infections may result in multiple splenic calcifications that appear as small echogenic foci with shadowing on ultrasound. Other infectious granulomas (e.g., tuberculosis) may present similarly.

According to Rumack's Diagnostic Ultrasound:

''Granulomatous infections such as histoplasmosis and tuberculosis may produce multiple splenic calcifications, often with shadowing.''

Rumack CM, Wilson SR, Charboneau JW, Levine D. Diagnostic Ultrasound. 5th ed. Elsevier, 2017.

AIUM Practice Parameter for the Performance of Abdominal Ultrasound Examinations, 2020.

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Answer : D

A urachal cyst arises from incomplete closure of the urachus, a remnant of the fetal allantoic duct connecting the bladder to the umbilicus. It appears as a midline, anechoic, nonvascular mass located between the bladder dome and the umbilicus.

According to Rumack's Diagnostic Ultrasound:

''A urachal cyst is a midline, anechoic structure located between the bladder and umbilicus, resulting from incomplete obliteration of the urachus.''

Rumack CM, Wilson SR, Charboneau JW, Levine D. Diagnostic Ultrasound. 5th ed. Elsevier, 2017.

AIUM Practice Parameter for the Performance of Ultrasound of the Pelvis, 2020.

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Answer : D

Scrotal inflammation, such as epididymitis or orchitis, typically presents with increased blood flow (hyperemia) on color Doppler sonography. This finding reflects the inflammatory process and vascular dilation. Abscesses, granulomas, or hydroceles may be present but are not as consistent or specific for inflammation.

According to AIUM Practice Parameters and Rumack's Diagnostic Ultrasound:

''In acute inflammation, color Doppler ultrasound demonstrates prominent hyperemia of the epididymis or testis.''

Rumack CM, Wilson SR, Charboneau JW, Levine D. Diagnostic Ultrasound. 5th ed. Elsevier, 2017.

AIUM Practice Parameter for Scrotal Ultrasound, 2020.

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