[Apr 28, 2026] AB-Abdomen PDF Recently Updated Questions Dumps to Improve Exam Score
AB-Abdomen Dumps Full Questions with Free PDF Questions to Pass
ARDMS AB-Abdomen Exam Syllabus Topics:
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NEW QUESTION # 86
Which neoplasm is a benign tumor of the spleen?
- A. Angiosarcoma
- B. Metastasis
- C. Littoral cell angioma
- D. Lymphoma
Answer: C
Explanation:
Littoral cell angioma is a rare, benign vascular tumor of the spleen, arising from the littoral cells lining the splenic sinusoids. In contrast, lymphoma, metastasis, and angiosarcoma are malignant splenic neoplasms.
According to WHO Classification and Rumack's Diagnostic Ultrasound:
"Littoral cell angioma is a rare benign vascular neoplasm of the spleen with characteristic imaging findings." Reference:
Rumack CM, Wilson SR, Charboneau JW, Levine D. Diagnostic Ultrasound. 5th ed. Elsevier, 2017.
WHO Classification of Tumours of the Digestive System, 5th ed., IARC, 2019.
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NEW QUESTION # 87
Which finding is an indication for renal biopsy to assess for renal failure?
- A. Leukocytosis
- B. Hypercalcemia
- C. Proteinuria
- D. Hematuria
Answer: C
Explanation:
Significant proteinuria, especially if persistent or in the nephrotic range, may indicate glomerular disease and is a common indication for renal biopsy. Leukocytosis and hypercalcemia are not specific for renal biopsy.
Hematuria may warrant biopsy if accompanied by proteinuria.
According to KDIGO Clinical Practice Guidelines:
"Persistent proteinuria is one of the strongest indications for renal biopsy to evaluate underlying glomerular pathology." Reference:
Kidney Disease: Improving Global Outcomes (KDIGO) Clinical Practice Guideline for Glomerulonephritis,
2021.
American Society of Nephrology (ASN) Nephrology Board Review, 2021.
NEW QUESTION # 88
Which condition is demonstrated in this image of the groin?
- A. Orchiectomy
- B. Hematocele
- C. Testicular rupture
- D. Indirect hernia
Answer: D
Explanation:
The ultrasound image demonstrates bowel loops with peristalsis visualized within the inguinal canal, which is diagnostic of an inguinal hernia-more specifically, an indirect inguinal hernia. Indirect hernias pass through the deep inguinal ring and may extend into the scrotum, appearing sonographically as bowel-containing masses adjacent to or within the scrotal sac. Peristaltic motion confirms the presence of viable bowel content.
This finding is typical in indirect inguinal hernias, which are more common in males and often congenital due to a patent processus vaginalis. The herniated bowel can be traced through the inguinal canal, as seen in this image.
Comparison of answer choices:
* A. Hematocele presents as a complex fluid collection surrounding the testis, often due to trauma-no complex fluid or trauma is apparent here.
* B. Testicular rupture shows discontinuity of the tunica albuginea and irregular testicular contour-none of which is seen.
* C. Orchiectomy would show an absent testis-this is not the case here.
* D. Indirect hernia is correct. The presence of bowel with peristalsis in the inguinal canal is diagnostic.
References:
Rumack CM, Wilson SR, Charboneau JW, Levine D. Diagnostic Ultrasound, 5th ed. Elsevier; 2017.
AIUM Practice Parameter for the Performance of Scrotal Ultrasound Examinations (2021).
Dogra VS, Gottlieb RH, Rubens DJ, Oka M. Sonography of the scrotum. Radiology. 2003;227(1):18-36
NEW QUESTION # 89
Which structure is indicated by the arrow on this image?
- A. Inferior vena cava
- B. Middle hepatic vein
- C. Left portal vein
- D. Proper hepatic artery
Answer: B
Explanation:
The structure indicated by the arrow is the middle hepatic vein. This is confirmed by both its anatomical location within the liver and its Doppler waveform characteristics.
Key ultrasound and Doppler features:
* The middle hepatic vein runs between the right and left hepatic lobes and drains into the inferior vena cava (IVC). On grayscale imaging, it appears as a tubular anechoic structure extending toward the IVC.
* On spectral Doppler, hepatic veins (including the middle hepatic vein) demonstrate a characteristic triphasic waveform due to pressure changes in the right atrium. This triphasic pattern is clearly visible in the Doppler tracing below the image.
* This differs significantly from the monophasic low-resistance flow of the hepatic artery or the continuous hepatopetal flow of the portal vein.
Differentiation from other options:
* A. Left portal vein: Would show continuous, hepatopetal flow (toward the liver) and lies more anterior and medial within the liver.
* C. Proper hepatic artery: Small-caliber vessel with low-resistance pulsatile waveform (not triphasic).
* D. Inferior vena cava: Lies posterior to the liver and demonstrates phasic flow with respiration, but this vessel is more centrally located and not shown in this field of view.
References:
Rumack CM, Wilson SR, Charboneau JW, Levine D. Diagnostic Ultrasound. 5th Edition. Elsevier, 2018.
Chapter: Hepatic Vasculature, pp. 90-95.
AIUM Practice Parameter for the Performance of Hepatic Doppler Ultrasound Examinations, 2020.
Radiopaedia.org. Hepatic vein Doppler waveform: https://radiopaedia.org/articles/hepatic-vein-doppler- waveform
NEW QUESTION # 90
Which sonographic finding distinguishes focal nodular hyperplasia from hepatic adenoma?
- A. Thin peripheral hypoechoic halo
- B. Target pattern
- C. Central calcifications
- D. Stellate area within the central portion of the mass
Answer: D
Explanation:
The hallmark feature of focal nodular hyperplasia (FNH) is a central stellate scar seen on imaging. This fibrous scar may not always be seen on ultrasound but is a classic distinguishing feature from hepatic adenomas, which usually lack a central scar.
According to Rumack's Diagnostic Ultrasound:
"Focal nodular hyperplasia often demonstrates a central stellate scar, which may be echogenic or isoechoic." Reference:
Rumack CM, Wilson SR, Charboneau JW, Levine D. Diagnostic Ultrasound. 5th ed. Elsevier, 2017.
WHO Classification of Digestive System Tumors, 5th ed., IARC, 2019.
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NEW QUESTION # 91
During a renal artery Doppler study, which vessel should also be sampled to verify patency?
- A. Main renal vein
- B. Inferior vena cava
- C. Portal vein
- D. Iliac vein
Answer: A
Explanation:
The main renal vein should be assessed in addition to the renal arteries during renal Doppler exams. Venous thrombosis may coexist with arterial abnormalities and can impact renal perfusion. Evaluation of both arterial inflow and venous outflow ensures a comprehensive assessment of renal vascular patency.
According to Zwiebel's Introduction to Vascular Ultrasound:
"Renal vein assessment should be performed during renal artery Doppler studies to exclude venous thrombosis or outflow obstruction." Reference:
Zwiebel WJ, Pellerito JS. Introduction to Vascular Ultrasound. 6th ed. Elsevier, 2019.
AIUM Practice Parameter for Renal Artery Duplex Sonography, 2020.
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NEW QUESTION # 92
Which malignancy most commonly metastasizes to the testes?
- A. Hodgkin lymphoma
- B. Bladder cancer
- C. Prostate cancer
- D. Non-Hodgkin lymphoma
Answer: C
Explanation:
Testicular metastases are rare and usually identified in older patients. The most frequent primary site of malignancies metastasizing to the testes is theprostate. Studies (Ulbright and Young, 2008; Mosharafa et al.,
2003) indicate that prostatic adenocarcinoma accounts for the highest number of testicular metastases, with lung and gastrointestinal tract malignancies also contributing less frequently. These metastases can be unilateral or bilateral and are often discovered incidentally during surgical intervention for prostate cancer.
The metastatic route involves retrograde venous extension, arterial embolism, or lymphatic dissemination.
Histologically, prostatic adenocarcinoma in the testis can be confirmed viaimmunohistochemical markers like prostate-specific antigen (PSA), supporting its prostatic origin.
References:
Ulbright TM, Young RH. Tumors of the Testis, Adnexa, Spermatic Cord, and Scrotum. AFIP Atlas of Tumor Pathology, 4th Series, Fascicle 18. Armed Forces Institute of Pathology, 2008.
Mosharafa AA, Foster RS, Bihrle R, et al. Clinical and pathologic features of testicular metastases from solid tumors: a 40-year review. Urology. 2003;61(5): 1064-1068.
NEW QUESTION # 93
A lactating female presents with a tender, swollen breast, erythema, and fever. Which condition is most likely present in this image?
- A. Abscess
- B. Galactocele
- C. Ductal carcinoma
- D. Mastitis
Answer: D
Explanation:
The clinical presentation-tender, swollen breast with erythema and fever-in a lactating female strongly suggests acute mastitis. The sonographic findings support this diagnosis. In the image, the breast parenchyma shows diffuse, hypoechoic, and heterogeneous echotexture with increased vascularity, which is consistent with inflammatory changes typical of mastitis.
Mastitis is a common complication during lactation, particularly in the first few weeks postpartum. It results from milk stasis and subsequent bacterial infection, commonly due to Staphylococcus aureus. Ultrasound features of mastitis include:
* Ill-defined, hypoechoic, edematous areas in the breast parenchyma
* Increased Doppler flow due to hyperemia
* Skin thickening
* Ductal dilatation may also be present
If left untreated, mastitis may progress to abscess formation, which would appear as a localized, complex fluid collection with peripheral hyperemia and internal debris. However, the image does not show a well- formed fluid collection consistent with abscess.
Option B (Ductal carcinoma): Inappropriate here due to the acute clinical scenario and patient age. Ductal carcinoma typically presents as a hypoechoic mass with irregular margins and posterior shadowing, not diffuse edema or inflammatory changes.
Option D (Galactocele): This benign milk-filled retention cyst typically appears anechoic or with fluid-fluid levels but lacks signs of inflammation and systemic symptoms such as fever.
Option A (Abscess): This could be a differential, but abscesses usually present with a well-defined anechoic or complex mass. The absence of a discrete collection and the diffuse appearance makes mastitis more likely.
References:
Mendelson EB. Practical Ultrasound: An Illustrated Guide. Springer, 2004. Chapter: Breast Ultrasound.
American College of Radiology (ACR). ACR Practice Parameter for the Performance of a Breast Ultrasound Examination, 2022.
Rumack CM, Wilson SR, Charboneau JW, Levine D. Diagnostic Ultrasound. 5th Edition. Elsevier, 2018.
Chapter: Breast, pp. 1169-1175.
NEW QUESTION # 94
In which position should a patient be placed when internal echoes are seen within a fluid-filled bladder?
- A. Trendelenburg
- B. Lateral decubitus
- C. Fowler
- D. Erect
Answer: B
Explanation:
Lateral decubitus positioning allows shifting of internal echoes within the bladder, helping differentiate mobile debris (such as blood clots or sediment) from adherent masses like tumors. This technique is helpful in evaluating questionable bladder filling defects.
According to Rumack's Diagnostic Ultrasound:
"Changing the patient's position, such as turning to the lateral decubitus, can help distinguish mobile debris from attached bladder wall lesions." Reference:
Rumack CM, Wilson SR, Charboneau JW, Levine D. Diagnostic Ultrasound. 5th ed. Elsevier, 2017.
AIUM Practice Parameter for Bladder Ultrasound, 2020.
NEW QUESTION # 95
Which vessel is indicated by the arrow on this image?
- A. Superior mesenteric artery
- B. Left renal vein
- C. Right renal artery
- D. Proper hepatic artery
Answer: A
Explanation:
The ultrasound image demonstrates a transverse view of the abdominal vasculature, where the arrow is pointing to a circular vascular structure anterior to the aorta and posterior to the body of the pancreas - consistent with the superior mesenteric artery (SMA).
The SMA originates from the anterior aspect of the abdominal aorta just below the level of the celiac trunk and courses anterior to the left renal vein and uncinate process of the pancreas. On transverse ultrasound, it is often seen in cross-section as a round, pulsatile structure with echogenic walls, situated just anterior to the aorta. This appearance is known as the "target sign" or "bull's-eye" appearance.
Vessel Position Landmarks (transverse plane):
* Aorta: Posterior and central
* SMA: Just anterior to the aorta
* Left renal vein: Passes between the aorta and SMA (nutcracker location)
* Right renal artery: Courses posterior to the IVC toward the right kidney Differentiation from other options:
* A. Proper hepatic artery: Typically visualized within the liver hilum (portal triad), not in this anatomic location.
* C. Left renal vein: Seen in transverse as a longer, oval structure crossing anterior to the aorta and posterior to the SMA.
* D. Right renal artery: Arises laterally from the aorta and courses posterior to the IVC - not visualized in this axial midline location.
References:
Rumack CM, Wilson SR, Charboneau JW, Levine D. Diagnostic Ultrasound. 5th Edition. Elsevier, 2018.
Chapter: Vascular Anatomy and Abdominal Vessels, pp. 471-475.
American Institute of Ultrasound in Medicine (AIUM) Practice Parameter for the Performance of an Ultrasound Examination of the Abdomen and/or Retroperitoneum, 2020.
Radiopaedia.org. Superior mesenteric artery: https://radiopaedia.org/articles/superior-mesenteric-artery
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NEW QUESTION # 96
Which clinical finding is most likely associated with the splenic pathology demonstrated in this image?
- A. Trauma
- B. Sickle cell anemia
- C. Portal hypertension
- D. Immunocompromised
Answer: B
Explanation:
The ultrasound image demonstrates a heterogeneous and echogenic spleen with evidence of atrophy and multiple areas of calcification-consistent with autosplenectomy. This appearance is classically associated with chronic sickle cell anemia.
In sickle cell disease, repeated vaso-occlusive episodes result in infarctions, fibrosis, and progressive calcification of the spleen. Over time, this leads to functional asplenia or complete autosplenectomy (involution and shrinkage of the spleen). The hallmark sonographic features include:
* A small, echogenic spleen
* Multiple coarse calcifications
* Irregular contour or atrophic appearance
These findings are not typically seen in other conditions:
* A. Trauma may cause subcapsular hematomas or lacerations, but not chronic atrophy with calcifications.
* C. Immunocompromised patients may develop abscesses or infections but not the classic features of autosplenectomy.
* D. Portal hypertension typically causes splenomegaly and varices, not atrophic and calcified spleens.
References:
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.
Kellenberger CJ. Imaging of the spleen in children. Eur Radiol. 2004;14(5):92-102.
NEW QUESTION # 97
How are portal veins differentiated from hepatic veins?
- A. Portal veins branch horizontally
- B. Hepatic veins have more echogenic walls
- C. Hepatic veins are oriented towards the porta hepatis
- D. Portal veins vary in size during respiration
Answer: A
Explanation:
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." Reference:
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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NEW QUESTION # 98
Which type of artifact is indicated by the arrows on this image?
- A. Edge shadow
- B. Focal enhancement
- C. Comet tail
- D. Speed error
Answer: A
Explanation:
The ultrasound image of the thyroid clearly shows posterior shadowing originating from the lateral edges of a rounded structure, which is indicative of edge shadow artifact. Edge shadowing occurs when an ultrasound beam passes tangentially to a rounded or curved structure, such as a cyst or blood vessel. The difference in sound wave refraction and beam divergence at the edges leads to decreased echo signals deep to the edges, creating linear hypoechoic bands - which is exactly what the arrows are pointing to in the image.
Edge shadow artifact is purely a result of beam physics and not a real anatomic or pathologic finding.
Key characteristics of edge shadowing:
* Appears as a narrow, linear hypoechoic (dark) shadow extending deep to the edge of a curved interface (e.g., cyst, vessel, thyroid nodule)
* Caused by refraction and beam deflection, leading to reduced beam intensity distal to the edges
* Most commonly seen adjacent to cysts or fluid-filled structures
Differentiation from other options:
* A. Focal enhancement: Appears as increased echogenicity distal to a fluid-filled structure due to lower attenuation of the sound beam through fluid (opposite of shadowing).
* C. Speed error: A less common artifact that results in displacement of structures due to variation in assumed sound speed.
* D. Comet tail: A reverberation artifact that appears as a series of closely spaced bright echoes, often associated with metallic objects or cholesterol crystals in adenomyomatosis.
References:
Rumack CM, Wilson SR, Charboneau JW, Levine D. Diagnostic Ultrasound. 5th Edition. Elsevier, 2018.
Chapter: Ultrasound Physics and Artifacts, pp. 38-42.
Kremkau FW. Sonography Principles and Instruments. 9th Edition. Elsevier, 2015. Chapter: Image Artifacts, pp. 132-136.
NEW QUESTION # 99
Which outcome would be present if the sample volume gate is larger than the examined vessel?
- A. Spectral noise
- B. Spike turbulence
- C. Aliasing
- D. Indeterminate flow direction
Answer: A
Explanation:
When the sample volume (gate) is too large, it captures signals from both the vessel and surrounding tissues or adjacent flows. This leads to a broadening of the spectral waveform and produces "spectral noise" or
"spectral broadening," reducing the accuracy of velocity measurements and waveform analysis. Aliasing results from high velocity relative to the Nyquist limit, not from gate size.
According to Zwiebel's Introduction to Vascular Ultrasound:
"Increasing the sample volume beyond the vessel size causes spectral broadening, resulting in spectral noise and inaccurate Doppler measurements." Reference:
Zwiebel WJ, Pellerito JS. Introduction to Vascular Ultrasound. 6th ed. Elsevier, 2019.
AIUM Practice Parameter for Spectral Doppler Ultrasound, 2021.
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NEW QUESTION # 100
Which common congenital anomaly is typically seen as a cystic midline anterior neck structure?
- A. Thyroglossal duct cyst
- B. Cystic follicular adenoma
- C. Cystic hygroma
- D. Branchial cleft cyst
Answer: A
Explanation:
A thyroglossal duct cyst is the most common congenital cystic anomaly in the anterior midline neck. It arises from persistent remnants of the thyroglossal duct, typically located inferior to the hyoid bone.
According to Rumack's Diagnostic Ultrasound:
"Thyroglossal duct cysts are located in the midline anterior neck and are the most common congenital cystic neck lesions." Reference:
Rumack CM, Wilson SR, Charboneau JW, Levine D. Diagnostic Ultrasound. 5th ed. Elsevier, 2017.
AIUM Practice Parameter for Thyroid and Neck Ultrasound, 2020.
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NEW QUESTION # 101
Where is the most common location for a branchial cyst in relation to the thyroid?
- A. Posterior
- B. Anterior
- C. Medial
- D. Lateral
Answer: D
Explanation:
Branchial cleft cysts are congenital epithelial cysts that typically occur laterally in the neck, often anterior to the sternocleidomastoid muscle, and lateral to the thyroid gland. The second branchial cleft cyst is the most common type and is found in the lateral neck region.
* Medial (B) would be more consistent with thyroglossal duct cysts.
* Anterior (C) or posterior (D) do not specifically describe branchial cyst location relative to the thyroid.
Reference Extracts:
* Som PM, Curtin HD. Head and Neck Imaging. 5th ed. Elsevier, 2011.
* Rumack CM, Wilson SR, Charboneau JW, Levine D. Diagnostic Ultrasound. 5th ed. Elsevier, 2017.
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NEW QUESTION # 102
Which best describes the Doppler waveform findings in this image?
- A. Increased resistance
- B. Normal
- C. Triphasic
- D. Tardus parvus
Answer: B
Explanation:
The Doppler spectral waveform shown in this image of the right testis demonstrates low-resistance, forward- flowing arterial waveforms with continuous diastolic flow - this is characteristic of normal testicular perfusion. The presence of both color Doppler flow and a resistive index (RI) of 0.66 further supports normal testicular arterial circulation.
Key Doppler features of a normal testicular waveform:
* Low-resistance waveform (RI typically 0.5-0.75)
* Continuous diastolic flow
* No reversal of flow or spectral broadening
* Color Doppler confirms uniform intratesticular vascularity
Clinical context:
* Normal testicular flow on Doppler imaging excludes testicular torsion, infarction, or significant inflammation.
* Testicular torsion would show either absent or very high-resistance (reduced or absent diastolic flow) waveform.
* Epididymo-orchitis may show hyperemia with low resistance but often presents with other gray-scale findings like heterogeneous echotexture or scrotal wall thickening.
Differentiation from other options:
* B. Increased resistance: RI >0.75 and reduced or reversed diastolic flow; may indicate impending torsion or ischemia.
* C. Tardus parvus: A slow systolic upstroke and diminished amplitude; indicates proximal arterial stenosis.
* D. Triphasic: Normal waveform in peripheral arteries, such as extremities, not seen in testicular circulation.
References:
Rumack CM, Wilson SR, Charboneau JW, Levine D. Diagnostic Ultrasound. 5th Edition. Elsevier, 2018.
Chapter: Male Pelvis - Testis and Scrotum, pp. 793-800.
AIUM Practice Parameter for the Performance of Scrotal Ultrasound Examinations, 2020.
Radiopaedia.org. Testicular Doppler assessment: https://radiopaedia.org/articles/testicular-doppler-assessment
NEW QUESTION # 103
Which vessel is most likely to display hepatofugal flow in the presence of portal hypertension?
- A. Splenic vein
- B. Inferior vena cava
- C. Coronary vein
- D. Inferior epigastric vein
Answer: C
Explanation:
The coronary vein (left gastric vein) is a common collateral pathway in portal hypertension. It often becomes dilated and may demonstrate hepatofugal (reversed) flow as blood diverts from the high-pressure portal system into systemic collaterals.
According to Zwiebel's Introduction to Vascular Ultrasound:
"The left gastric (coronary) vein is a frequent site of hepatofugal flow in portal hypertension, reflecting collateral development." Reference:
Zwiebel WJ, Pellerito JS. Introduction to Vascular Ultrasound. 6th ed. Elsevier, 2019.
AIUM Practice Parameter for Portal Venous Doppler Ultrasound, 2020.
NEW QUESTION # 104
Which abnormality is depicted in this image of a patient who presents with a fever following a liver biopsy?
- A. Biloma
- B. Hematoma
- C. Abscess
- D. Cyst
Answer: C
Explanation:
The sonographic image shows a complex fluid collection within the liver parenchyma, with internal echoes and possibly septations, consistent with an abscess. In the clinical context of post-procedural fever following a liver biopsy, a liver abscess is the most likely diagnosis.
A liver abscess appears on ultrasound as a hypoechoic or complex fluid collection that may contain internal debris, septations, or gas (which may produce reverberation artifacts). These features distinguish it from other post-procedural complications.
* A cyst (Option A) typically appears as an anechoic, well-defined lesion with posterior acoustic enhancement and no internal debris-this does not match the image or clinical setting.
* A biloma (Option B) is a bile collection that can appear similar to a cyst or fluid collection but typically occurs due to bile leak; however, fever and internal complexity on ultrasound more strongly suggest abscess.
* A hematoma (Option D) may also appear complex but usually presents with pain and not fever unless secondarily infected. Over time, hematomas evolve in appearance but lack septations and gas unless superinfected.
Reference:
Rumack, Carol M., et al. Diagnostic Ultrasound.5th ed., Elsevier, 2018. Chapter: Hepatobiliary System, pp.
107-111.
American Institute of Ultrasound in Medicine (AIUM) Practice Parameter for the Performance of an Ultrasound Examination of the Abdomen and/or Retroperitoneum.
NEW QUESTION # 105
Which scanning approach was utilized to obtain this image?
- A. Posterior
- B. Right coronal
- C. Anterior
- D. Left coronal
Answer: B
Explanation:
The ultrasound image provided shows the liver and diaphragm imaged in a coronal plane with characteristic rib shadows and costophrenic angles. The orientation of the image and the structures visualized suggest that the transducer is placed in the right mid-axillary line, with the sound beam directed coronally - this is a classic right coronal scanning approach.
Key features supporting this:
* The liver appears superiorly in the image.
* Multiple echogenic lines (representing the ribs) run obliquely, casting acoustic shadows.
* The diaphragm and adjacent lung base are seen clearly, which is commonly imaged through the right intercostal spaces in a coronal plane.
Comparison of answer choices:
* A. Anterior: Would show a more transverse view of the liver and not typically image the diaphragm and lung this way.
* B. Posterior: Not used for upper abdominal scanning due to shadowing from the spine and posterior ribs.
* C. Left coronal: Would show the spleen and left kidney - not the liver as seen here.
* D. Right coronal - Correct. This image was obtained using the right coronal (intercostal) approach through the right flank.
References:
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.
AIUM Practice Parameter for the Performance of an Ultrasound Examination of the Abdomen and/or Retroperitoneum (2020).
NEW QUESTION # 106
Which condition is most consistent with the findings in the image below?
- A. Adenomyomatosis
- B. Porcelain gallbladder
- C. Gangrenous cholecystitis
- D. Emphysematous cholecystitis
Answer: D
Explanation:
The ultrasound image shows echogenic foci with dirty shadowing and reverberation artifacts within the gallbladder wall and lumen. These features are characteristic of emphysematous cholecystitis, a severe, life- threatening variant of acute cholecystitis caused by gas-forming organisms (e.g., Clostridium or E. coli) infecting the gallbladder wall.
Sonographic features of emphysematous cholecystitis:
* Echogenic gas within the gallbladder wall or lumen
* Reverberation or "dirty" shadowing artifacts
* May show intramural gas bubbles or "ring-down" artifact
* Often seen in diabetic or immunocompromised patients
* No gallstones may be present ("acalculous cholecystitis")
Clinical context:
* More common in elderly men and diabetics
* Presents with right upper quadrant pain, fever, and leukocytosis
* Surgical emergency due to risk of perforation and sepsis
Differentiation from other options:
* A. Adenomyomatosis: Involves gallbladder wall thickening with "comet tail" artifacts due to Rokitansky-Aschoff sinuses, not intramural gas.
* B. Porcelain gallbladder: Shows curvilinear calcification of the gallbladder wall - dense echogenic rim with posterior shadowing.
* C. Gangrenous cholecystitis: May show wall irregularity, intraluminal membranes, and absence of Doppler flow but lacks intramural gas.
References:
Rumack CM, Wilson SR, Charboneau JW, Levine D. Diagnostic Ultrasound. 5th Edition. Elsevier, 2018.
Chapter: Gallbladder and Biliary System, pp. 155-160.
American College of Radiology (ACR). Appropriateness Criteria for Right Upper Quadrant Pain, 2022.
Radiopaedia.org. Emphysematous cholecystitis: https://radiopaedia.org/articles/emphysematous-cholecystitis
NEW QUESTION # 107
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