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ARDMS Abdomen Sonography Examination Sample Questions (Q33-Q38):

NEW QUESTION # 33
Which retroperitoneal finding is most likely associated with trauma?

• A. Fibrosis
• B. Urinoma
• C. Neuroblastoma
• D. Adenoma

Answer: B

Explanation:
Urinomas are collections of urine in the retroperitoneum that result from trauma, surgery, or obstruction causing urine leakage. Trauma is a frequent cause of urinoma formation due to disruption of the urinary tract.
According to Rumack's Diagnostic Ultrasound:
"Urinomas may develop as a complication of trauma, surgery, or obstructive uropathy with urinary extravasation into the retroperitoneum." Reference:
Rumack CM, Wilson SR, Charboneau JW, Levine D. Diagnostic Ultrasound. 5th ed. Elsevier, 2017.
AIUM Practice Parameter for Renal Ultrasound, 2020.
-

NEW QUESTION # 34
Which area of the spleen is not covered by visceral peritoneum?

• A. Inferior border
• B. Capsule
• C. Gastric surface
• D. Hilum

Answer: D

Explanation:
The spleen is almost entirely covered by visceral peritoneum, except at the hilum where vessels, nerves, and lymphatics enter and exit. This area lacks peritoneal covering to allow vascular connection to the splenic artery and vein.
According to Moore's Clinically Oriented Anatomy:
"The spleen is entirely covered by visceral peritoneum except at its hilum where the vascular structures enter." Reference:
Moore KL, Dalley AF, Agur AMR. Clinically Oriented Anatomy. 8th ed. Wolters Kluwer, 2018.
Gray's Anatomy for Students, 4th ed., Elsevier, 2019.
-

NEW QUESTION # 35
What is the normal Doppler waveform signature of the hepatic veins?

• A. Triphasic
• B. Low resistant
• C. Monophasic
• D. Turbulent

Answer: A

Explanation:
The normal hepatic vein Doppler waveform is triphasic, reflecting cardiac cycle variations in central venous pressure transmitted from the right atrium through the IVC. Loss of triphasicity may suggest elevated right atrial pressures or hepatic venous obstruction.
According to Rumack's Diagnostic Ultrasound:
"The normal hepatic vein waveform is triphasic due to transmitted right atrial pressure variations." Reference:
Rumack CM, Wilson SR, Charboneau JW, Levine D. Diagnostic Ultrasound. 5th ed. Elsevier, 2017.
AIUM Practice Parameter for Abdominal Vascular Ultrasound, 2020.

NEW QUESTION # 36
Which condition is most consistent with thinning of the renal cortex, reduction in renal length, and prominence of the renal sinus fat in a patient presenting four months after renal transplant with slightly reduced renal function?

• A. Acute rejection
• B. Arterial stricture
• C. Chronic rejection
• D. Normal findings

Answer: C

Explanation:
Chronic rejection presents sonographically as cortical thinning, decreased renal size, and increased echogenicity of the renal sinus fat. Acute rejection typically causes an enlarged, edematous kidney with increased parenchymal echogenicity but preserved size early on.
According to Zwiebel's Introduction to Vascular Ultrasound:
"In chronic rejection, the allograft becomes smaller with cortical thinning, increased echogenicity, and prominence of the central sinus fat." Reference:
Zwiebel WJ, Pellerito JS. Introduction to Vascular Ultrasound. 6th ed. Elsevier, 2019.
AIUM Practice Parameter for Renal Transplant Ultrasound, 2020.
-

NEW QUESTION # 37
Which condition of the transplant kidney is indicated by the arrows on these images?

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

Answer: C

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 # 38
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