AB-Abdomen Practice Exam Questions with Answers Abdomen Sonography Examination Certification

Transudative pleural effusions result from imbalances in hydrostatic and oncotic pressures, most commonly caused by congestive heart failure (CHF). In CHF, elevated hydrostatic pressure in the pulmonary capillaries leads to fluid leakage into the pleural space without significant protein or cellular content (hence, transudate). Exudative effusions (associated with infections, malignancy, and inflammation) are more often seen with pulmonary emboli, lymphoma, or empyema.

According to Light’s criteria (which differentiates transudates from exudates):

"Congestive heart failure remains the leading cause of transudative pleural effusions." (Light RW. Pleural Diseases, 6th ed.).

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.”

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.

The main pancreatic duct (duct of Wirsung) runs through the central portion of the pancreas, medial and slightly posterior to the superior mesenteric vein (SMV). It converges with the common bile duct near the ampulla of Vater.

According to Moore’s Clinically Oriented Anatomy:

“The main pancreatic duct runs centrally within the gland and lies medial to the superior mesenteric vein.”

The seminiferous tubules are coiled structures located within the testes where spermatogenesis (sperm production) occurs. They are surrounded by Sertoli and Leydig cells that support spermatogenesis and testosterone production.

Gubernacula (A) are fetal structures involved in testicular descent.

Efferent ductules (B) connect the rete testis to the epididymis but are not located within the testicular parenchyma.

Aberrant ductules (C) are accessory ducts found outside the testis.

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.

Salivary glands are superficial structures, and high-frequency transducers (10–15 MHz) are optimal to obtain high spatial resolution. Lower frequencies are inappropriate as they lack sufficient resolution for superficial structures. A 12 MHz transducer provides excellent detail necessary for detecting small lesions, duct abnormalities, and vascular structures.

According to Rumack et al., Diagnostic Ultrasound:

"High-frequency linear transducers (10–15 MHz) are recommended for evaluating superficial structures such as salivary glands." (Rumack CM et al., Diagnostic Ultrasound, 5th ed.).

A wandering spleen occurs when the spleen is not adequately anchored by its supporting ligaments, allowing it to move freely within the abdomen. This increases the risk of splenic torsion, which compromises vascular supply and may result in infarction if not corrected.

According to Rumack’s Diagnostic Ultrasound:

“The most serious complication of a wandering spleen is torsion, which may result in splenic infarction.”

Lipase is the most sensitive and specific laboratory marker for diagnosing acute pancreatitis. It rises earlier, remains elevated longer (up to 14 days), and is more pancreas-specific than amylase. Amylase may normalize within 48-72 hours and may also be elevated in non-pancreatic conditions.

According to ACG (American College of Gastroenterology) Guidelines:

“Serum lipase is preferred over amylase due to its higher sensitivity, specificity, and prolonged elevation in pancreatitis.”

The left lobe of the thyroid is located anterolateral to the esophagus. On transverse ultrasound imaging, the esophagus can often be seen posterior to the left thyroid lobe as a circular structure with echogenic mucosa and hypoechoic muscular layer. The longus colli muscle lies posterior to the thyroid. The thyroid is anterior to the trachea but this refers more to the isthmus or midline portion.

According to Rumack’s Diagnostic Ultrasound:

“The esophagus is seen as a target-shaped structure posterior to the left thyroid lobe; thus, the thyroid lobe is anterolateral to the esophagus.”

The ultrasound image labeled “SAG RUQ KIDNEY” demonstrates a midline sagittal view showing a renal parenchymal structure that extends across the midline anterior to the aorta and vertebral bodies, suggesting the presence of a horseshoe kidney.

A horseshoe kidney is a congenital renal anomaly in which the lower poles of both kidneys are fused across the midline by a parenchymal or fibrous isthmus. This isthmus typically lies anterior to the aorta and inferior vena cava and can be seen as a hypoechoic band of tissue crossing the midline on ultrasound.

Ultrasound findings characteristic of a horseshoe kidney:

Abnormally low position of the kidneys in the abdomen

Renal tissue (isthmus) bridging the lower poles anterior to the great vessels

Renal axes may be more horizontal than usual

Kidneys may appear closer together or “kissing” the spine anteriorly

Differentiation from other options:

A. Duplicated collecting system: Manifests as two separate collecting systems within one kidney, often with a central renal sinus split into two — not typically midline bridging.

B. Crossed renal ectopia: Involves one kidney crossing midline and fusing with the other on the opposite side, but they do not form a midline isthmus.

D. Pelvic kidney: A single kidney located in the pelvis due to failed ascent — it does not appear as midline fusion of two kidneys.

Caput medusae refers to dilated paraumbilical veins due to portal hypertension. When portal venous pressure rises, collateral channels may open along the ligamentum teres and recanalized paraumbilical vein, resulting in visible dilated veins radiating from the umbilicus.

Esophageal varices (B) are gastroesophageal collaterals.

Coronary vein varices (C) involve gastric veins.

Splenic vein varices (D) are typically localized to the splenic hilum.

Reference Extracts:

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

Gore RM, Levine MS. Textbook of Gastrointestinal Radiology. 4th ed. Saunders, 2015.

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The ultrasound image shows the liver in a transverse view with the arrow pointing to the middle hepatic vein (MHV). The MHV is a key sonographic landmark that anatomically divides the right and left lobes of the liver.

According to Couinaud's segmental anatomy, which is the basis for surgical and radiological liver segmentation:

The middle hepatic vein runs within the main lobar fissure.

It separates the right lobe (segments V–VIII) from the left lobe (segments II–IV).

This division is crucial in liver surgery and interventional procedures.

Comparison of answer choices:

A. Right anterior and posterior segments are divided by the right hepatic vein, not the middle hepatic vein.

B. Right and left lobes — Correct. The middle hepatic vein, shown by the arrow, defines this boundary.

C. Left medial and lateral segments are divided by the left hepatic vein or falciform ligament.

D. Left superior and inferior is not a standard anatomic division in liver segmentation.

Downstream from a significant renal artery stenosis, the acceleration time is prolonged due to delayed systolic upstroke (“tardus-parvus waveform”). This is a sensitive Doppler parameter for detecting hemodynamically significant stenosis. Spectral broadening usually occurs at the stenotic site, not distal to it.

According to Zwiebel’s Introduction to Vascular Ultrasound:

“Prolonged acceleration time and reduced acceleration index characterize tardus-parvus waveforms distal to renal artery stenosis.”

The image demonstrates a gallbladder with a possible echogenic focus (likely a gallstone) and posterior acoustic shadowing. This is suggestive of cholelithiasis. To differentiate uncomplicated gallstones from acute cholecystitis, the most effective technique is to assess for a positive sonographic Murphy sign.

A positive sonographic Murphy sign refers to the presence of focal tenderness over the gallbladder when it is directly palpated with the ultrasound transducer. It is a strong indicator of acute cholecystitis when combined with other features such as gallbladder wall thickening, pericholecystic fluid, and gallstones.

Sonographic Murphy sign — key points:

Assessed during real-time scanning

Localized tenderness when pressure is applied over the gallbladder

Highly sensitive for acute cholecystitis (especially in the presence of stones)

Differentiation from other options:

A. Use compound imaging: Improves image quality by reducing artifacts but does not verify tenderness or confirm acute inflammation.

B. Change the patient’s position: Helpful to confirm mobility of gallstones, but not diagnostic of inflammation.

C. Ask patient to perform Valsalva: Used primarily in vascular studies (e.g., assessing for varicocele or venous reflux), not relevant here.

The ultrasound image shows a blind-ending, non-compressible, tubular structure in the right lower quadrant with a target or bullseye appearance in transverse section — highly suggestive of the appendix.

Sonographic features of the appendix (especially in suspected appendicitis):

Blind-ending tubular structure arising from the cecum

Non-compressible on graded compression

Diameter >6 mm is suggestive of appendicitis

May demonstrate a “target sign” in transverse view (concentric ring-like appearance)

Increased echogenicity of surrounding fat in cases of inflammation

May contain an appendicolith or show hyperemia on color Doppler if inflamed

The location (right lower quadrant) and appearance in this case are classic for the normal or potentially inflamed appendix.

Differentiation from other options:

A. Fallopian tube: Located more in the adnexal regions and usually not visible unless distended (e.g., hydrosalpinx).

B. Ureter: Usually not visualized on ultrasound unless dilated due to obstruction.

D. Jejunum: Has valvulae conniventes ("keyboard sign") and peristalsis; does not present with a blind-ending tubular appearance from the cecum.

The ultrasound image shown is a transverse endorectal (transrectal) ultrasound, commonly used to evaluate the prostate and adjacent structures. The two hypoechoic (dark) oval-shaped structures seen superior and posterior to the prostate are characteristic of the seminal vesicles.

The seminal vesicles are paired, elongated glands located superior and posterior to the base of the prostate and are best visualized in transverse planes on endorectal imaging. They appear as hypoechoic or anechoic structures with internal septations, depending on the degree of fluid content.

In contrast:

The urethra appears as a central echogenic linear structure within the prostate.

The prostate base is more inferior in the scan and is visualized just above the urethra.

The ejaculatory ducts are usually not as prominently visualized and are located medial to the seminal vesicles, entering the prostate near the verumontanum.

This image most clearly demonstrates the bilateral seminal vesicles.

Power Doppler measures the amplitude (strength) of Doppler signals rather than frequency shift, making it more sensitive to low-velocity and small-vessel blood flow. Its primary advantage is an improved signal-to-noise ratio, allowing for better visualization of slow or weak flow.

A: Power Doppler is more sensitive to motion artifacts, not less.

B: It is still angle dependent, though somewhat less so than color Doppler.

D: Power Doppler does not display flow direction (a limitation).

Reference Extracts:

Kremkau FW. Sonography Principles and Instruments. 9th ed. Elsevier, 2015.

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

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.”

Budd-Chiari syndrome is caused by hepatic venous outflow obstruction, resulting in hepatomegaly, ascites, right upper quadrant pain, and liver dysfunction. It may be due to thrombosis or compression of the hepatic veins or IVC.

According to Rumack’s Diagnostic Ultrasound:

“Budd-Chiari syndrome results from hepatic venous outflow obstruction and presents with hepatomegaly, ascites, and right upper quadrant pain.”

The ultrasound images show a heterogeneous, solid-appearing mass within the right kidney. The patient has a history of hypertension and hematuria—classic clinical features that raise suspicion for renal cell carcinoma (RCC), especially in an adult.

Renal cell carcinoma is the most common primary malignant tumor of the kidney in adults. Common presenting symptoms include:

Hematuria (most frequent symptom)

Flank pain

Palpable abdominal mass

Hypertension (due to increased renin secretion)

Sometimes paraneoplastic syndromes (e.g., polycythemia due to erythropoietin production)

Ultrasound Features of RCC:

Solid renal mass, often with heterogeneous echotexture

May contain cystic components, calcifications, or necrotic areas

May distort the renal contour

Doppler may show internal vascularity

Differentiation from other options:

B. Adenoma: Rare and typically small, benign cortical lesions. They do not typically present with hematuria or hypertension and cannot be reliably distinguished from RCC on ultrasound.

C. Nephroblastoma (Wilms tumor): Pediatric renal tumor seen almost exclusively in children under age 5.

D. Pheochromocytoma: Arises from the adrenal gland (not the kidney); associated with hypertension but not hematuria.

Von Hippel-Lindau (VHL) syndrome is a genetic disorder associated with multiple pancreatic cysts, pancreatic neuroendocrine tumors, and other systemic neoplasms. While cystic fibrosis can produce thickened pancreatic secretions, it rarely causes true pancreatic cysts.

According to Rumack’s Diagnostic Ultrasound:

“Multiple pancreatic cysts are strongly associated with Von Hippel Lindau syndrome.”

In biliary obstruction (such as at the ampulla of Vater), dilation begins proximally and progresses peripherally. The intrahepatic peripheral bile ducts are the last to dilate because backpressure takes time to propagate. Early dilation is typically seen in the common bile duct and common hepatic duct.

According to Rumack’s Diagnostic Ultrasound:

“The intrahepatic peripheral bile ducts dilate last in the setting of progressive biliary obstruction.”

The ultrasound image provided shows a transverse view of the abdominal aorta, with a clearly measured aortic diameter of 5.71 cm. A normal adult abdominal aorta should measure less than 3.0 cm in anterior-posterior diameter. Any measurement exceeding this threshold is defined as an abdominal aortic aneurysm (AAA).

In this case, the dilation is well beyond the 3.0 cm threshold, confirming the presence of an aneurysm. The rounded, anechoic/heterogeneous central lumen surrounded by echogenic arterial wall layers further supports this diagnosis.

Comparison of answer choices:

A. Stenosis: Would show a narrowed lumen with turbulent, aliasing flow on Doppler, not a dilated aorta.

B. Dissection: Typically shows an echogenic intimal flap separating true and false lumens; no flap is visible here.

C. Aneurysm: Correct. The aorta’s transverse diameter (5.71 cm) confirms the presence of an aneurysm.

D. Occlusion: Would appear as a lack of flow with thrombus or echogenic content filling the lumen, not dilation.

Conn syndrome (primary hyperaldosteronism) results from excessive aldosterone secretion, often due to an adrenal adenoma, leading to hypertension, hypokalemia, and metabolic alkalosis. Cushing disease involves cortisol, Addison disease involves adrenal insufficiency, and Waterhouse-Friderichsen is associated with adrenal hemorrhage.

According to Rumack’s Diagnostic Ultrasound:

“Conn syndrome is due to excessive secretion of aldosterone, often secondary to adrenal cortical adenoma.”

Acute pyelonephritis is a bacterial infection of the renal parenchyma and collecting system. Classic clinical findings include fever, flank pain, leukocytosis (elevated white blood cells), and pyuria (white blood cells in urine). Ultrasound may demonstrate renal enlargement, decreased echogenicity, and loss of corticomedullary differentiation.

Nephrocalcinosis (A) involves calcium deposition without infection.

Staghorn calculus (B) may lead to infection but is primarily characterized by obstructive uropathy.

Renal cell carcinoma (C) presents with hematuria and mass formation rather than infection symptoms.

Reference Extracts:

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

Middleton WD, Kurtz AB, Hertzberg BS.Ultrasound: The Requisites. 3rd ed. Elsevier, 2015.

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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.

The spleen lies in the left hypochondrium, superior and lateral to the fundus of the stomach, and directly contacts the diaphragm. It occupies the space between the stomach and diaphragm. The liver and kidneys are located more medially or inferiorly.

According to Gray’s Anatomy for Students:

“The spleen lies posterolateral to the fundus of the stomach, separated from the diaphragm by its fibrous capsule.”

The correct sequence of renal arterial branching is: renal artery ? segmental arteries ? interlobar arteries ? arcuate arteries ? interlobular arteries. This branching pattern is important for understanding renal perfusion and evaluating vascular disorders.

According to Moore’s Clinically Oriented Anatomy:

“Renal arteries divide into segmental branches, which give rise to interlobar arteries, then arcuate arteries, and finally interlobular arteries.”

When measuring the abdominal aorta (or any vessel diameter for aneurysm evaluation), calipers should be placed from outer wall to outer wall to ensure inclusion of the full vessel diameter, including any mural thrombus. This is the standard method accepted by professional societies.

According to AIUM and SRU Guidelines:

“Vessel diameter measurements should be performed from outer wall to outer wall to avoid underestimation of aneurysm size.”

The transverse ultrasound image of the liver shows a solid, hypoechoic mass located in the posterior aspect of the right lobe of the liver. In this view:

The anterior aspect of the liver is at the top of the image (near the transducer).

The posterior aspect is at the bottom (deeper).

The right lobe occupies the majority of the screen on transverse imaging when the probe is placed in the epigastrium or right upper quadrant.

Anatomically, the right lobe of the liver is divided into anterior and posterior segments by the right hepatic vein in the coronal plane. In transverse imaging:

The right anterior segment lies closer to the anterior abdominal wall.

The right posterior segment lies deeper (posteriorly).

Given that the mass is seen deep within the liver on the right side of the image, it is best localized to the right posterior segment (Segment VI or VII depending on the exact craniocaudal level).

Comparison of answer choices:

A. Left lateral is located far to the left of the image and typically appears higher and more anterior on transverse scans.

B. Left medial lies near the midline and would appear adjacent to the ligamentum teres or falciform ligament.

C. Right anterior lies closer to the transducer (top of the image), not posteriorly.

D. Right posterior — Correct. This is the segment shown deep in the right lobe of the liver.

An intimal flap in the aorta is a hallmark ultrasound finding of aortic dissection, which can present with tearing chest/abdominal pain and differential blood pressures between arms. The flap represents separation of the intimal and medial layers of the aortic wall.

According to Rumack’s Diagnostic Ultrasound:

“An intimal flap visualized within the aorta is diagnostic of an aortic dissection.”

The spectral Doppler image demonstrates excessive noise along the baseline, including a “fuzzy” or filled-in spectral window. This artifact is known as spectral broadening or “blossoming,” and it typically results from excessive Doppler gain.

When Doppler gain is set too high, it amplifies not only the true Doppler signal but also the background noise. This results in a falsely broadened waveform that can obscure diagnostic information such as peak velocities or flow turbulence. The best way to correct this artifact is to reduce the Doppler gain (Option A).

Key points regarding gain-related artifact:

Excessive gain exaggerates spectral display by amplifying weak signals and noise.

Reducing gain restores the clarity of the spectral window and accurate envelope definition.

The goal is to optimize gain just enough to see the real flow signals without cluttering the display.

Differentiation from other options:

B. Adjust baseline: Useful in avoiding aliasing but does not affect gain-related noise.

C. Increase wall filter: Removes low-frequency signals from vessel wall motion but not background spectral noise.

D. Increase pulse repetition frequency (PRF): Used to reduce aliasing in high-velocity flow, not to address gain-related spectral clutter.

A complex pleural effusion often contains internal septations or fibrin strands, distinguishing it from simple anechoic effusion. These septations suggest exudative processes such as infection, malignancy, or hemothorax.

According to Rumack’s Diagnostic Ultrasound:

“Complex pleural effusions demonstrate internal septations or loculations, often related to infection or malignancy.”

The ultrasound image demonstrates findings consistent with hypertrophic pyloric stenosis (HPS). This condition typically affects infants between 2 and 8 weeks of age and presents clinically with non-bilious projectile vomiting, weight loss, and dehydration.

In the ultrasound image, the classic “target” or “donut” sign can be seen in the transverse view of the hypertrophied pyloric muscle. Key sonographic criteria for HPS include:

Pyloric muscle thickness ?3 mm

Pyloric channel length ?15–18 mm

This imaging appearance strongly correlates with the clinical presentation of projectile vomiting (Choice D), which is the hallmark symptom of HPS.

Comparison of answer choices:

A. Abnormal prenatal ultrasound (Choice A) is not typically associated with HPS, which develops postnatally.

B. Neonatal hyperbilirubinemia (Choice B) is not an indication for a pyloric ultrasound and affects liver/biliary imaging.

C. Red currant jelly stools (Choice C) are indicative of intussusception, not HPS.

D. Projectile vomiting (Choice D) is the most common clinical indication leading to an ultrasound exam that reveals HPS.

The inferior vena cava (IVC) is formed by the confluence of the right and left common iliac veins at the level of approximately L5. The hepatic veins drain into the IVC superiorly but do not form it. The superior mesenteric and splenic veins join to form the portal vein, not the IVC.

According to Moore’s Clinically Oriented Anatomy:

“The IVC begins at the level of L5 by the union of the right and left common iliac veins.”

The ultrasound image demonstrates a dilated common bile duct (CBD), measuring approximately 7.7 mm in diameter. A normal CBD should generally measure less than 6 mm in a patient under 60 years old and may increase approximately 1 mm per decade thereafter or after cholecystectomy.

In the absence of gallstones within the CBD, one of the most concerning causes of CBD dilation is distal obstruction due to an extrinsic compressive lesion. The most common and clinically significant cause of distal CBD obstruction is a mass at the head of the pancreas.

A pancreatic head mass (e.g., adenocarcinoma) may compress the distal CBD and pancreatic duct simultaneously, resulting in the “double duct sign” — dilation of both the CBD and pancreatic duct. This is a classic finding in pancreatic cancer.

Comparison of answer choices:

A. Liver mass — unlikely to cause isolated CBD dilation unless invading the porta hepatis.

B. Cystic duct stone — may cause gallbladder hydrops but typically not CBD dilation unless Mirizzi syndrome is present.

C. Pancreatic head mass — Correct. This is the most likely cause of painless progressive CBD dilation without visible intraductal stones.

D. Gallbladder stones — These may be associated with biliary colic or cholecystitis but typically do not cause CBD dilation unless the stone has migrated and obstructed the distal duct.

Exudative ascites is characterized by high protein content and cellular debris, typically resulting from infections (e.g., peritonitis, tuberculosis), malignancy, or inflammatory conditions. Transudative ascites is more commonly seen in conditions such as liver failure, renal failure, and hypoproteinemia due to changes in hydrostatic or oncotic pressure.

According to Light's Criteria:

“Infection and malignancy are common causes of exudative ascites, distinguished by high protein content and elevated LDH.”

The ultrasound image demonstrates a complex, heterogeneous hypoechoic collection within the abdominal wall, with mixed echogenicity and ill-defined margins. The lesion appears to contain internal debris but lacks definitive signs of vascularity or air (which would be seen in an abscess). There is no peristalsis, herniated bowel, or fat to suggest hernia.

Given the history of atrial fibrillation — a condition commonly treated with anticoagulation therapy (e.g., warfarin, apixaban) — this clinical background raises high suspicion for a rectus sheath or abdominal wall hematoma.

Key ultrasound features of hematomas:

Early (acute): hyperechoic or heterogeneous

Chronic/resolving: complex or cystic with fluid-debris levels

No internal vascularity on Doppler

May be confined to muscle or fascial planes

This is consistent with a hematoma, particularly in patients on anticoagulation therapy.

Comparison of answer choices:

A. Hernia — typically shows bowel or fat with movement/peristalsis passing through a fascial defect.

B. Lipoma — usually homogeneous and echogenic, not complex or fluid-filled.

C. Abscess — often presents as a complex fluid collection with peripheral hyperemia and possibly air, plus systemic signs of infection.

D. Hematoma — Correct. The image and clinical history (anticoagulation due to atrial fibrillation) strongly support this diagnosis.

Color Doppler imaging can detect ureteral jets, which represent urine entering the bladder from the ureters. The presence of bilateral ureteral jets confirms ureteral patency. Gray scale may show hydronephrosis but does not directly assess flow.

According to Rumack’s Diagnostic Ultrasound:

“Color Doppler demonstrates ureteral jets within the bladder, confirming ureteral patency.”

A ultrasound image of a person's body AI-generated content may be incorrect.

The origin of the superior mesenteric artery (SMA)

The image provided is a color Doppler ultrasound scan of the abdominal aorta and its major branches. In the center of the image, just anterior to the aorta, we see the superior mesenteric artery (SMA) arising in the sagittal plane. This is the critical area for Doppler sampling in a patient with symptoms suggestive of mesenteric ischemia.

Severe postprandial pain in a young woman may be a manifestation of median arcuate ligament syndrome (MALS) or chronic mesenteric ischemia. Both of these conditions are assessed via Doppler sampling of mesenteric vessels, specifically:

The origin and proximal segment of the SMA

The celiac artery (especially for MALS)

Doppler waveform analysis should assess:

Peak systolic velocity (PSV): >275 cm/s suggests ?70% SMA stenosis

Angle correction should be aligned properly

Sampling must be performed at the narrowest origin point (as shown in the image)

This type of Doppler interrogation is typically done in both fasting and postprandial states to evaluate changes in flow and symptom correlation.

Why this area?

The SMA is anterior to the aorta and travels inferiorly into the mesentery.

The site shown in the image is ideal for measuring PSV and evaluating for stenosis or extrinsic compression.

The ultrasound image shows disruption of the normal fibrillar echotexture of a muscle or tendon, consistent with a soft tissue injury such as a muscle or tendon tear. There is likely hypoechoic fluid consistent with a hematoma or edema, which commonly results from blunt or direct trauma.

This image is typical of a traumatic injury (e.g., partial or complete tendon rupture or muscle strain/tear). These findings are frequently encountered in athletic injuries or blunt force trauma and correlate strongly with the clinical history of trauma.

Key sonographic features suggestive of trauma:

Discontinuity or heterogeneity of normal striated muscle or tendon pattern

Hypoechoic or anechoic area representing hematoma or fluid collection

Retraction of muscle or tendon ends (in full-thickness tears)

Surrounding soft tissue edema

Differentiation from other options:

B. Focal pain: While pain may be a symptom, trauma is the more definitive and primary clinical indication for the findings shown.

C. Palpable abnormality: May suggest a mass or cystic lesion (e.g., lipoma, abscess), not typically the appearance shown here.

D. Decreased range of motion: May be present secondarily, but not the most consistent or primary clinical indication in this case.

The most common symptom of cholelithiasis (gallstones) is biliary colic, characterized by intermittent right upper quadrant or epigastric pain often triggered by fatty meals. Jaundice occurs in complications such as choledocholithiasis.

According to Rumack’s Diagnostic Ultrasound:

“Gallstones may cause biliary colic — episodic upper abdominal pain often related to food intake.”

The image shows a color Doppler ultrasound of the main portal vein (MPV), which appears irregular and replaced by multiple small, serpiginous vascular channels — a hallmark of cavernous transformation. Cavernous transformation of the portal vein is a late complication of chronic portal vein thrombosis, in which collateral vessels develop around the thrombosed portal vein to bypass the obstruction.

Key Doppler ultrasound features of cavernous transformation:

Absence of a normal portal vein

Multiple tortuous vessels in the porta hepatis

Color Doppler shows hepatopetal flow in these channels

Low velocity, continuous waveform flow in collateral vessels

Differentiation from other options:

B. Portal vein thrombosis: Would show an absence of color flow within the portal vein lumen and possibly echogenic material within the vessel. There would be no serpiginous collateral vessels yet if it's an acute process.

C. Portal hypertension: Often diagnosed with other sonographic findings (e.g., splenomegaly, reversed portal flow, varices) but not characterized by the replacement of the portal vein by collateral vessels.

D. Tumor extension: Typically appears as echogenic intraluminal material within the portal vein with arterial waveforms on Doppler due to neovascularity. Tumor thrombus can be seen in hepatocellular carcinoma or pancreatic cancer, not multiple small collateral vessels.

Prostate adenocarcinoma is by far the most common malignancy of the prostate gland, typically arising in the peripheral zone. Seminoma is a testicular tumor, sarcomas are rare in the prostate, and hamartomas are benign lesions.

According to Rumack’s Diagnostic Ultrasound:

“Adenocarcinoma accounts for the vast majority of prostate cancers and is typically located in the peripheral zone.”