ARDMS AB-Abdomen Exam Dumps

Retroperitoneal fibrosis can encase and compress the ureters, leading to obstructive uropathy and hydronephrosis. It may also involve other retroperitoneal structures but hydronephrosis is the most common significant complication.

According to Rumack's Diagnostic Ultrasound:

''Retroperitoneal fibrosis frequently results in ureteral obstruction, leading to hydronephrosis.''

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

AIUM Practice Parameter for Abdominal Ultrasound, 2020.

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Hepatic adenomas are benign liver tumors strongly associated with long-term use of oral contraceptives and are most frequently found in women under 40. Hepatoblastoma is seen in children; hepatoma (HCC) is a malignant tumor typically found in cirrhotic livers. Cavernous hemangioma is unrelated to oral contraceptives.

According to Rumack's Diagnostic Ultrasound:

''Hepatic adenomas occur predominantly in young women with a history of oral contraceptive use.''

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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The ultrasound image demonstrates a classic example of ascites, shown by the anechoic (dark) fluid located between bowel loops or surrounding abdominal organs. In this case, there appears to be a small fluid collection in the peritoneal cavity.

One of the key maneuvers used to differentiate free fluid (such as ascites) from loculated fluid or other structures is to reposition the patient. Asking the patient to ''turn from side to side'' (Option D) can help in assessing whether the fluid shifts position --- a hallmark feature of free intraperitoneal fluid. This positional change is highly useful in confirming the diagnosis and distinguishing ascites from other potential mimics (e.g., cystic masses, lymphoceles, or bowel wall thickening).

In contrast:

Drinking water (A) is often used in imaging the urinary bladder or gastrointestinal tract but not for fluid characterization.

Standing upright (B) may shift fluid but is less practical during real-time ultrasound.

Breathing quietly (C) doesn't significantly aid in visualizing peritoneal fluid mobility.

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 Diagnostic and Screening Ultrasound Examinations of the Abdomen and/or Retroperitoneum (2020).

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.

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).

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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