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ARDMS Abdomen Sonography Examination Sample Questions (Q119-Q124):

NEW QUESTION # 119
Which condition of the transplant kidney is indicated by the arrows on these images?

A. Subcapsular hematoma
B. Urinoma
C. Lymphocele
D. Renal cell carcinoma

Answer: A

Explanation:
The CT and ultrasound images show a lenticular-shaped, hypoechoic fluid collection compressing the renal parenchyma from the periphery. The location-between the renal capsule and the renal parenchyma- strongly suggests a subcapsular hematoma.
Subcapsular hematomas in transplant kidneys are uncommon but important postoperative complications, often resulting from trauma, biopsy, or surgical manipulation. They typically present as a crescent-shaped, low- attenuation collection beneath the renal capsule and may cause mass effect on the underlying renal parenchyma. This can impair renal perfusion and function-a phenomenon known as "Page kidney." Ultrasound findings:
* Anechoic to hypoechoic, crescent-shaped collection surrounding or compressing the transplant kidney.
* Deformation or flattening of the renal contour due to the compressive effect of the hematoma.
CT findings:
* Hyperdense collection (if acute) or hypodense (if subacute/chronic) located subcapsularly.
* May be seen distorting the renal capsule and compressing renal tissue.
Differentiation from other options:
* A. Urinoma: Typically appears as a perinephric fluid collection and may result from urine leak. Not usually subcapsular.
* B. Lymphocele: Develops in the post-transplant period due to lymphatic disruption. Appears as a well- defined perinephric fluid collection and tends to be medial to the kidney or between the bladder and the kidney.
* C. Renal cell carcinoma: Would appear as a solid mass with variable enhancement and not a simple fluid collection. RCC is rare in transplant kidneys and usually detected much later post-transplant.
References:
Radiopaedia.org. Subcapsular renal hematoma. https://radiopaedia.org/articles/subcapsular-renal-haematoma Rumack CM, Wilson SR, Charboneau JW, Levine D. Diagnostic Ultrasound. 5th Edition. Elsevier, 2018.
Chapter: Kidney Transplant Imaging, pp. 524-530.
American Institute of Ultrasound in Medicine (AIUM) Practice Parameter for the Performance of an Ultrasound Examination of the Abdomen and/or Retroperitoneum. 2020.

NEW QUESTION # 120
Which arterial branches lie at the base of the renal pyramids?

A. Segmental
B. Interlobular
C. Interlobar
D. Arcuate

Answer: D

Explanation:
The arcuate arteries are located at the corticomedullary junction, arching over the base of the renal pyramids.
They form as the interlobar arteries reach the boundary between the cortex and medulla. The arcuate arteries give rise to the interlobular arteries, which supply the renal cortex.
* Segmental arteries (A) branch directly from the renal artery.
* Interlobar arteries (B) course between the renal pyramids.
* Interlobular arteries (D) extend into the cortex from the arcuate arteries.
Reference Extracts:
* Moore KL, Dalley AF, Agur AM. Clinically Oriented Anatomy. 7th ed. Lippincott Williams & Wilkins, 2013.
* Rumack CM, Wilson SR, Charboneau JW, Levine D. Diagnostic Ultrasound. 5th ed. Elsevier, 2017.
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NEW QUESTION # 121
Which is the most likely etiology of a spherical mass near the splenic hilum that is isoechoic to the normal spleen in a 55-year-old female?

A. Pancreatic mass
B. Lymph node
C. Kidney mass
D. Accessory spleen

Answer: D

Explanation:
An accessory spleen (splenule) is a congenital variant, commonly located near the splenic hilum, and has identical echogenicity to the native spleen. This finding is benign and often incidental.
According to Rumack's Diagnostic Ultrasound:
"Accessory spleens are typically found near the splenic hilum and are isoechoic to the normal splenic parenchyma." Reference:
Rumack CM, Wilson SR, Charboneau JW, Levine D. Diagnostic Ultrasound. 5th ed. Elsevier, 2017.
AIUM Practice Parameter for Abdominal Ultrasound, 2020.
-

NEW QUESTION # 122
Which finding is demonstrated in this image?

A. Acute medical renal disease
B. Acute hepatitis
C. Medullary sponge kidney
D. Hepatic steatosis

Answer: D

Explanation:
The ultrasound image demonstrates diffuse increased echogenicity of the liver parenchyma with posterior beam attenuation (acoustic shadowing), findings that are consistent with hepatic steatosis (fatty liver disease).
The liver appears brighter than normal, and the vascular markings, particularly of the portal veins, are obscured due to the increased parenchymal echogenicity.
Hepatic steatosis refers to the abnormal accumulation of fat within hepatocytes and is commonly associated with obesity, diabetes, alcohol use, and metabolic syndrome.
Classic sonographic features of hepatic steatosis include:
* Diffuse hyperechogenicity ("bright liver")
* Poor visualization of intrahepatic vessels and diaphragm
* Posterior acoustic attenuation
* Increased hepatic echogenicity relative to the renal cortex
Differentiation from other options:
* A. Acute hepatitis: Usually presents with normal or slightly decreased echogenicity, "starry sky" appearance due to prominent portal triads and periportal edema.
* C. Medullary sponge kidney: A renal condition with echogenic medullary pyramids, not hepatic.
* D. Acute medical renal disease: Affects the kidneys, often with bilateral renal enlargement and increased cortical echogenicity-again not related to liver imaging.
References:
Rumack CM, Wilson SR, Charboneau JW, Levine D. Diagnostic Ultrasound. 5th Edition. Elsevier, 2018.
Chapter: Liver, pp. 93-97.
American College of Radiology (ACR) Practice Parameter for the Performance of an Ultrasound Examination of the Abdomen and/or Retroperitoneum, 2021.
Radiopaedia.org. Fatty liver (ultrasound): https://radiopaedia.org/articles/fatty-liver-ultrasound

NEW QUESTION # 123
Which congenital disorder is most consistent with the finding identified by the arrow on this image?

A. Biliary atresia
B. Sclerosing cholangitis
C. Alagille syndrome
D. Caroli disease

Answer: D

Explanation:
The image demonstrates a characteristic "central dot sign" - a hallmark finding of Caroli disease. This is best appreciated on ultrasound as a cystic dilation of the intrahepatic bile ducts with a central echogenic dot or linear structure (which corresponds to the portal vein and fibrous tissue within the dilated duct). The arrow in the image points to one such dilated duct.
Caroli disease is a rare congenital disorder characterized by segmental, saccular dilation of intrahepatic bile ducts. It is often associated with congenital hepatic fibrosis and may predispose to cholangitis, stone formation, and even cholangiocarcinoma.
Key ultrasound features of Caroli disease:
* Cystic or saccular dilations of the intrahepatic bile ducts
* The "central dot sign" - echogenic focus in the center of the dilated ducts (representing portal vein radicle or fibrous tissue)
* May show associated hepatosplenomegaly or signs of portal hypertension Differentiation from other options:
* A. Sclerosing cholangitis: Typically causes diffuse or segmental biliary ductal wall thickening and stricturing; does not present with cystic dilations.
* B. Alagille syndrome: A multisystem disorder often characterized by a paucity of intrahepatic bile ducts, not dilation.
* D. Biliary atresia: Presents in infancy with obliteration of extrahepatic bile ducts, echogenic "triangular cord" sign, and absence of a visible gallbladder. It does not cause ductal dilation.
References:
Rumack CM, Wilson SR, Charboneau JW, Levine D. Diagnostic Ultrasound. 5th Edition. Elsevier, 2018.
Chapter: Biliary System, pp. 152-155.
Radiopaedia.org. Caroli disease. https://radiopaedia.org/articles/caroli-disease American College of Radiology (ACR). ACR-SPR Practice Parameter for the Performance of Pediatric Abdominal Ultrasound, 2022.

NEW QUESTION # 124
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