ARDMS AB-Abdomen Exam Dumps

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.

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).

Angiomyolipomas are benign renal tumors composed of fat, smooth muscle, and blood vessels. They are strongly associated with tuberous sclerosis and may be multiple and bilateral in these patients. While RCC may occur, angiomyolipomas are much more characteristic.

According to Rumack's Diagnostic Ultrasound:

''Angiomyolipomas are frequently multiple and bilateral in patients with tuberous sclerosis.''

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

AIUM Practice Parameter for Renal Ultrasound, 2020.

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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:

Trauma may cause subcapsular hematomas or lacerations, but not chronic atrophy with calcifications.

Immunocompromised patients may develop abscesses or infections but not the classic features of autosplenectomy.

Portal hypertension typically causes splenomegaly and varices, not atrophic and calcified spleens.

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.

In hepatic steatosis (fatty liver), increased echogenicity can obscure visualization of deeper structures like the common bile duct. Lowering the transducer frequency increases sound wave penetration, allowing better visualization of deep structures despite increased liver echogenicity. Decreasing gain or increasing dynamic range primarily adjusts image brightness and contrast but does not improve penetration.

According to Rumack's Diagnostic Ultrasound:

''Lower frequency transducers are used to improve penetration and visualization of deeper structures in patients with fatty liver.''

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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