AB-Abdomen Sample Questions Answers

A thyroglossal duct cyst is the most common congenital cystic anomaly in the anterior midline neck. It arises from persistent remnants of the thyroglossal duct, typically located inferior to the hyoid bone.

According to Rumack’s Diagnostic Ultrasound:

“Thyroglossal duct cysts are located in the midline anterior neck and are the most common congenital cystic neck lesions.”

The sonographic image shows a complex fluid collection within the liver parenchyma, with internal echoes and possibly septations, consistent with an abscess. In the clinical context of post-procedural fever following a liver biopsy, a liver abscess is the most likely diagnosis.

A liver abscess appears on ultrasound as a hypoechoic or complex fluid collection that may contain internal debris, septations, or gas (which may produce reverberation artifacts). These features distinguish it from other post-procedural complications.

A cyst (Option A) typically appears as an anechoic, well-defined lesion with posterior acoustic enhancement and no internal debris—this does not match the image or clinical setting.

A biloma (Option B) is a bile collection that can appear similar to a cyst or fluid collection but typically occurs due to bile leak; however, fever and internal complexity on ultrasound more strongly suggest abscess.

A hematoma (Option D) may also appear complex but usually presents with pain and not fever unless secondarily infected. Over time, hematomas evolve in appearance but lack septations and gas unless superinfected.

A tumor (such as cholangiocarcinoma, pancreatic head carcinoma, or metastases) is a common cause of biliary duct obstruction. It can compress or invade the bile ducts, leading to intrahepatic and extrahepatic duct dilatation.

Cholecystitis (B) typically affects the gallbladder but may rarely cause duct obstruction if complicated.

Pneumobilia (C) refers to air in the biliary tree, not obstruction.

Hepatitis (D) causes liver inflammation but not mechanical biliary obstruction.

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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A urachal cyst arises from incomplete closure of the urachus, a remnant of the fetal allantoic duct connecting the bladder to the umbilicus. It appears as a midline, anechoic, nonvascular mass located between the bladder dome and the umbilicus.

According to Rumack’s Diagnostic Ultrasound:

“A urachal cyst is a midline, anechoic structure located between the bladder and umbilicus, resulting from incomplete obliteration of the urachus.”

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.

A normal renal artery waveform demonstrates rapid systolic upstroke (acceleration) with continuous forward flow in diastole due to the kidney's low-resistance vascular bed. Slow acceleration or blunted peaks may indicate significant renal artery stenosis.

According to Zwiebel’s Introduction to Vascular Ultrasound:

“Normal renal artery waveforms demonstrate a rapid systolic acceleration with a sharp systolic peak.”

The ultrasound image demonstrates multiple parallel echogenic lines within the gallbladder lumen, extending distally and diminishing in intensity. These equidistant lines are classic for a reverberation artifact.

Reverberation occurs when the ultrasound beam reflects multiple times between two strong reflectors (such as the anterior gallbladder wall and the transducer), creating repeating echoes that appear as equally spaced lines. This is frequently seen in:

The gallbladder (especially when collapsed or near the wall)

Near air-filled structures

With metallic objects or surgical clips

Reverberation does not represent a true anatomical structure and should be distinguished from real pathology.

Comparison of answer choices:

A. Banding refers to speed displacement or slice-thickness artifacts and typically does not appear as repetitive lines.

B. Shadowing is a dark band posterior to highly attenuating structures like gallstones or bone, not present here.

C. Attenuation is a general term for the reduction in sound energy as it travels—posterior acoustic shadowing is one type.

D. Reverberation — Correct. The characteristic bright, parallel lines within the gallbladder lumen confirm this artifact.

Courvoisier sign describes the clinical finding of painless jaundice combined with a palpable, distended gallbladder. This typically results from obstruction at the distal common bile duct, often due to pancreatic head carcinoma or cholangiocarcinoma, leading to bile accumulation and gallbladder distention. In contrast, Mirizzi syndrome involves compression of the common hepatic duct by an impacted stone in the cystic duct.

According to Rumack's Diagnostic Ultrasound and standard clinical references:

“Courvoisier sign refers to a palpable, enlarged gallbladder due to obstruction of the distal bile duct, often from malignancy.”

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 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.”

Nutcracker syndrome results from compression of the left renal vein between the superior mesenteric artery (SMA) and the aorta. This can cause hematuria, flank pain, and pelvic congestion due to impaired venous drainage.

According to Zwiebel’s Introduction to Vascular Ultrasound:

“In nutcracker syndrome, the left renal vein is compressed between the aorta and SMA, resulting in venous hypertension.”

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 image provided is a right upper quadrant (RUQ) ultrasound—typically performed during a FAST (Focused Assessment with Sonography in Trauma) exam or for abdominal assessment. The arrow points to an anechoic (black) fluid collection seen above the diaphragm and posterior to the liver.

This fluid collection lies within the thoracic cavity, confirming the diagnosis of a pleural effusion. Pleural effusions are seen sonographically as an anechoic or hypoechoic area superior to the diaphragm in the thoracic cavity and often appear triangular or crescent-shaped. The diaphragm is visualized as a curvilinear echogenic structure separating the liver (or spleen) below from the lung space above.

Comparison of answer choices:

A. Retroperitoneal hemorrhage would be seen in the posterior abdomen, not above the diaphragm.

B. Pleural effusion is correct—anechoic fluid above the diaphragm is classic for this condition.

C. Mirror image artifact occurs when liver echoes are mirrored across the diaphragm and lung—this is not a mirror artifact.

D. Ascites collects inferior to the diaphragm and around the abdominal organs, not in the thoracic cavity.

Annular pancreas is a congenital anomaly in which pancreatic tissue encircles the second part of the duodenum, potentially causing partial or complete duodenal obstruction (atresia). It is due to abnormal migration of the ventral pancreatic bud.

According to Rumack’s Diagnostic Ultrasound:

“Annular pancreas results from failure of the ventral pancreatic bud to rotate properly, leading to encirclement of the duodenum.”

The ultrasound image labeled “SAG LT KIDNEY MID” demonstrates a left kidney with two separate, centrally located echogenic renal sinuses separated by intervening renal parenchyma. This appearance is classic for a duplicated collecting system.

A duplicated collecting system (also known as duplex kidney) is a congenital anomaly in which a single kidney contains two separate pelvicalyceal systems. It may be complete (with two ureters) or incomplete (partial duplication of ureters). This condition is one of the most common congenital anomalies of the urinary tract.

Sonographic Features of a Duplicated Collecting System:

Two separate central echogenic renal sinus regions seen within one kidney

Intervening parenchyma between the two sinuses

May show associated findings: hydroureteronephrosis (especially of upper pole moiety), ureterocele

Best visualized in sagittal plane

Differentiation from other options:

A. Horseshoe kidney: Shows fusion of the lower poles of the kidneys, typically located anterior to the aorta in the midline—not demonstrated here.

B. Crossed renal ectopia: One kidney is located on the opposite side of the body; this image shows a normally positioned kidney.

C. Prominent renal column (column of Bertin): May mimic a mass, but does not produce two separate sinuses as shown here.

A common bile duct (CBD) measuring up to 5 mm is considered normal in most patients under age 60. Some references allow for up to 6 mm, especially post-cholecystectomy or in older individuals. Significant dilation (suggestive of obstruction) typically exceeds these measurements.

According to Rumack’s Diagnostic Ultrasound:

“The normal common bile duct measures up to 5–6 mm, with slight increases considered normal after cholecystectomy or with advancing age.”

Histoplasmosis is a fungal infection that can lead to granulomatous disease. Chronic granulomatous infections may result in multiple splenic calcifications that appear as small echogenic foci with shadowing on ultrasound. Other infectious granulomas (e.g., tuberculosis) may present similarly.

According to Rumack's Diagnostic Ultrasound:

“Granulomatous infections such as histoplasmosis and tuberculosis may produce multiple splenic calcifications, often with shadowing.”

The superior mesenteric vein (SMV) lies directly anterior to the uncinate process of the pancreas. The uncinate process wraps around the posterior aspect of the SMV and SMA. The portal vein and IVC lie more posteriorly in relation to the pancreatic head.

According to Moore’s Clinically Oriented Anatomy:

“The superior mesenteric vein crosses anterior to the uncinate process of the pancreas.”

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 ultrasound image demonstrates a fluid-filled structure in the posterior knee region, consistent with a Baker cyst (also called a popliteal cyst). A Baker cyst is a synovial fluid-filled sac arising from the posterior medial aspect of the knee joint, typically extending between the medial head of the gastrocnemius and the semimembranosus tendon.

The history of delayed-onset claudication (pain in the calf when walking) two weeks after this image was obtained is strongly suggestive of a ruptured Baker cyst. When a Baker cyst ruptures, synovial fluid may track inferiorly into the calf, producing pain, swelling, and clinical symptoms that mimic deep vein thrombosis (DVT) or arterial insufficiency (e.g., pseudothrombophlebitis syndrome).

Ultrasound findings consistent with a ruptured Baker cyst:

Complex fluid collection tracking along muscle fascial planes (hypoechoic to anechoic)

Posterior calf swelling and tenderness

Absence of thrombus in the deep venous system

Crescent-shaped fluid may be seen between muscle compartments

Why the other choices are incorrect:

A. Neuropathy: Would not show fluid-filled structures on ultrasound and would not present with calf swelling.

B. Infected hematoma: May appear complex, but would require a history of trauma or anticoagulation and systemic signs (fever, redness).

C. Thrombophlebitis: Involves a thrombosed superficial vein with wall thickening and surrounding inflammation, which is not seen in this image.

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.”

Pancreas divisum occurs when the dorsal and ventral pancreatic ducts fail to fuse during embryologic development. This results in most pancreatic secretions draining through the minor papilla via the dorsal duct (duct of Santorini).

According to Rumack’s Diagnostic Ultrasound:

“In pancreas divisum, the dorsal and ventral pancreatic ducts fail to fuse, resulting in separate drainage systems.”

The most serious long-term complication of undescended testis (cryptorchidism) is an increased risk of testicular malignancy, especially seminoma. Although torsion and hernia may also occur, seminoma is the most concerning complication due to its life-threatening potential.

According to Rumack’s Diagnostic Ultrasound:

“Cryptorchidism is associated with a significantly increased risk of seminoma, the most common malignancy in undescended testes.”

The ultrasound image demonstrates a transverse view of the abdominal vasculature, where the arrow is pointing to a circular vascular structure anterior to the aorta and posterior to the body of the pancreas — consistent with the superior mesenteric artery (SMA).

The SMA originates from the anterior aspect of the abdominal aorta just below the level of the celiac trunk and courses anterior to the left renal vein and uncinate process of the pancreas. On transverse ultrasound, it is often seen in cross-section as a round, pulsatile structure with echogenic walls, situated just anterior to the aorta. This appearance is known as the “target sign” or “bull's-eye” appearance.

Vessel Position Landmarks (transverse plane):

Aorta: Posterior and central

SMA: Just anterior to the aorta

Left renal vein: Passes between the aorta and SMA (nutcracker location)

Right renal artery: Courses posterior to the IVC toward the right kidney

Differentiation from other options:

A. Proper hepatic artery: Typically visualized within the liver hilum (portal triad), not in this anatomic location.

C. Left renal vein: Seen in transverse as a longer, oval structure crossing anterior to the aorta and posterior to the SMA.

D. Right renal artery: Arises laterally from the aorta and courses posterior to the IVC — not visualized in this axial midline location.

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.

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 tunica albuginea is the dense fibrous capsule that directly surrounds the testicular parenchyma. The tunica vaginalis is a serous covering surrounding the testis externally, and the dartos fascia and pampiniform plexus are part of the scrotal wall and spermatic cord, respectively.

According to Rumack’s Diagnostic Ultrasound:

“The tunica albuginea is the fibrous capsule surrounding the testis and forming septa within the gland.”

Adrenal adenomas are the most common adrenal tumors in adults. They are often discovered incidentally (adrenal incidentalomas) and are usually nonfunctioning, though some may secrete cortisol or aldosterone. Neuroblastoma is common in children, pheochromocytomas are rarer catecholamine-producing tumors, and adrenal cortical carcinoma is malignant but much less common than adenomas.

According to Rumack’s Diagnostic Ultrasound:

“Adrenal adenomas are the most common adrenal masses in adults, frequently identified incidentally on imaging studies.”

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 ultrasound image reveals a well-defined, anechoic (black), thin-walled fluid collection located in the subcutaneous or parenchymal plane of the breast. This is most consistent with a seroma, particularly in the context of recent breast surgery.

A seroma is a common postsurgical finding, representing a sterile collection of serous fluid that accumulates in the surgical bed. It typically appears:

Anechoic (or hypoechoic if older)

Well circumscribed

Without internal septations or debris

Lacking hyperemia or surrounding inflammatory changes

This contrasts with:

A. Carcinoma — typically presents as an irregular, hypoechoic mass with angular margins, internal vascularity, and shadowing.

B. Blood clot (hematoma) — often appears heterogeneous, with internal echoes and variable echotexture depending on the age of the clot.

C. Abscess — appears as a complex fluid collection with thick walls, internal debris, septations, and surrounding hyperemia (often with clinical signs of infection).

D. Seroma — Correct. The described anechoic, clean-walled fluid collection is classic for a postoperative seroma.

Thyroid adenomas typically present as well-defined nodules surrounded by a thin, hypoechoic peripheral halo representing compressed thyroid parenchyma or fibrous capsule. Irregular margins suggest malignancy.

According to Rumack’s Diagnostic Ultrasound:

“A thin hypoechoic halo is characteristic of benign thyroid adenomas.”

The ultrasound image shows a hypoechoic, round structure with internal microcalcifications — hallmarks of recurrent papillary thyroid carcinoma (PTC) metastasis in a lymph node.

Key sonographic features supporting recurrent papillary thyroid cancer:

Hypoechoic round lymph node (loss of normal oval shape and hilum)

Microcalcifications (punctate echogenic foci) – highly suggestive of metastatic PTC

Abnormal morphology (loss of fatty hilum, rounded shape, increased vascularity if Doppler used)

Seen in the thyroid bed or lateral neck post-thyroidectomy

Why the other options are incorrect:

B. Normal postsurgical lymph node – Would be oval with echogenic hilum and no microcalcifications

C. Residual glandular tissue – Would have a more homogeneous echotexture similar to thyroid tissue and be located at the thyroid bed, not necessarily nodal

D. Reactive lymph node – May be enlarged but retain a normal hilum and vascular pattern, and lack microcalcifications

De Quervain thyroiditis (subacute granulomatous thyroiditis) is often triggered by a viral infection. Patients may present with painful thyroid enlargement, elevated inflammatory markers, and transient hyperthyroidism. Hashimoto’s and Graves' diseases are autoimmune in nature.

According to Braverman’s The Thyroid:

“Subacute (De Quervain) thyroiditis typically follows a viral upper respiratory tract infection and is characterized by thyroid pain and transient thyrotoxicosis.”

The main renal vein should be assessed in addition to the renal arteries during renal Doppler exams. Venous thrombosis may coexist with arterial abnormalities and can impact renal perfusion. Evaluation of both arterial inflow and venous outflow ensures a comprehensive assessment of renal vascular patency.

According to Zwiebel’s Introduction to Vascular Ultrasound:

“Renal vein assessment should be performed during renal artery Doppler studies to exclude venous thrombosis or outflow obstruction.”

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 Duct of Santorini is the accessory pancreatic duct that drains the superior portion of the pancreatic head into the minor duodenal papilla. The main pancreatic duct (Duct of Wirsung) drains into the major papilla, often joining the common bile duct at the Ampulla of Vater.

According to Moore’s Clinically Oriented Anatomy:

“The accessory pancreatic duct (Duct of Santorini) may be present and drains into the minor duodenal papilla.”

In the presence of a nonocclusive thrombus, Doppler waveform above the thrombus typically shows dampened flow with loss of normal respiratory phasicity due to partial venous outflow obstruction. Complete absence of flow is typically seen with occlusive thrombus.

According to Zwiebel’s Introduction to Vascular Ultrasound:

“Partial obstruction produces dampened and continuous flow patterns superior to a nonocclusive thrombus.”

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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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 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.

The tunica albuginea is a dense fibrous capsule surrounding the testis. Discontinuity of the tunica albuginea on ultrasound is diagnostic of testicular rupture — a urologic emergency that requires immediate surgical repair to preserve testicular function and viability. Early surgical intervention within 72 hours has a high success rate for testicular salvage (up to 90%).

Intratesticular hematoma (A) may be managed conservatively if the tunica albuginea is intact.

Heterogeneity of the parenchyma (C) indicates injury but not necessarily rupture.

Increased vascularity (D) may be seen with inflammation or reperfusion but does not mandate surgery unless rupture is present.

Reference Extracts:

Dogra VS, Bhatt S. "Acute painful scrotum: ultrasound evaluation." Radiologic Clinics of North America. 2004; 42(2):349-363.

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

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Patients with liver disease often have coagulopathy due to impaired synthesis of clotting factors. This places them at greater risk for bleeding or hematoma formation after biopsy. While hypertension may increase bleeding risk slightly, liver disease presents a significantly higher risk due to impaired coagulation.

According to the Society of Interventional Radiology (SIR) guidelines:

“Liver dysfunction is a significant risk factor for post-biopsy hemorrhage due to associated coagulopathy.”

Tissue harmonic imaging significantly reduces reverberation and side-lobe artifacts by utilizing nonlinear propagation of ultrasound waves. This produces clearer images of fluid-filled structures like the gallbladder, improving visualization of wall thickness and intraluminal contents.

According to Zwiebel’s Introduction to Vascular Ultrasound:

“Harmonic imaging effectively reduces reverberation artifact, improving image quality in gallbladder and cystic structure evaluation.”

The renal arteries originate from the abdominal aorta just inferior to the superior mesenteric artery (SMA). The SMA arises anteriorly from the abdominal aorta at the level of L1, and just below it, the renal arteries branch laterally. The splenic vein, portal vein, and hepatic artery are located more superiorly in relation to the renal arteries.

According to Moore's Clinically Oriented Anatomy:

"The superior mesenteric artery arises from the anterior surface of the abdominal aorta just above the renal arteries." (Moore KL et al., Clinically Oriented Anatomy, 8th ed.)

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.

Most thyroid cancer recurrences are found in the ipsilateral neck—particularly in the central (level VI) or lateral (levels II-V) compartments on the same side as the original malignancy.

According to AIUM Practice Parameters:

“Post-thyroidectomy recurrence most frequently occurs ipsilateral to the original tumor, commonly involving regional lymph nodes.”