Which finding is helpful to differentiate postsurgical breast scarring from a recurrent tumor?
Correct Answer: C
Postsurgical breast scarring may appear hypoechoic and irregular but typically shows no internal vascularity on Doppler imaging. In contrast, recurrent tumors generally exhibit increased internal vascular flow due to neovascularization. Therefore, absent Doppler signal helps suggest scar tissue rather than malignancy. According to Stavros' Breast Ultrasound: "The absence of internal Doppler flow favors scar tissue, whereas recurrent malignancy typically demonstrates internal vascularity." Reference: Stavros AT. Breast Ultrasound. Lippincott Williams & Wilkins, 2004. AIUM Practice Parameter for Breast Ultrasound, 2020. -
Question 2
What is the most common ultrasound appearance of the pancreas in mild acute pancreatitis?
Correct Answer: A
In mild acute pancreatitis, the pancreas often appears diffusely enlarged and slightly hypoechoic due to edema and inflammation. However, in very early or mild cases, the pancreas may still appear normal. Heterogeneous echotexture may develop in more severe or necrotizing pancreatitis. According to Rumack's Diagnostic Ultrasound: "In mild pancreatitis, the pancreas is commonly enlarged and hypoechoic due to inflammatory edema." Reference: Rumack CM, Wilson SR, Charboneau JW, Levine D. Diagnostic Ultrasound. 5th ed. Elsevier, 2017. AIUM Practice Parameter for the Performance of an Ultrasound Examination of the Abdomen, 2020. -
Question 3
Which condition is most likely associated with this image of the common bile duct?
Correct Answer: C
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. References: Rumack CM, Wilson SR, Charboneau JW, Levine D. Diagnostic Ultrasound, 5th ed. Elsevier; 2017. Lee JK, Sagel SS, Stanley RJ.Computed Body Tomography with MRI Correlation, 4th ed. Lippincott Williams & Wilkins; 2006. ACR Appropriateness Criteria Right Upper Quadrant Pain (2021).
Question 4
Which vascular condition is most consistent with patent cutaneous para-umbilical channels and portal hypertension?
Correct Answer: A
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. -
Question 5
Which sonographic appearance of the bile ducts is demonstrated in this image?
Correct Answer: B
The image shows a transverse view of the left lobe of the liver with the portal triads clearly visible. The "parallel channel" or "double barrel" sign is observed-where dilated intrahepatic bile ducts run alongside the portal veins, creating a characteristic sonographic pattern of paired anechoic (black) tubular structures. This sonographic feature is diagnostic for dilated intrahepatic bile ducts and is typically seen in obstructive jaundice or biliary obstruction from conditions such as: * Choledocholithiasis (stone in the common bile duct) * Stricture or mass compressing the bile ducts * Cholangiocarcinoma The intrahepatic bile ducts normally are too small to visualize clearly unless dilated. Their dilation gives the liver a "too many tubes" appearance, where bile ducts become as prominent as the portal veins. Comparison of answer choices: * A. Normal intrahepatic ducts are not usually seen this clearly or prominently on ultrasound. * B. Dilated intrahepatic - Correct. The parallel channel sign supports this diagnosis. * C. Dilated common bile duct would be visualized extrahepatically, typically anterior to the portal vein near the head of the pancreas. * D. Dilated common hepatic duct is also extrahepatic and seen in the porta hepatis, not within the liver parenchyma. References: 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. Taylor KJW, Burns PN, Wells PNT. Clinical Applications of Doppler Ultrasound. Raven Press; 1990.
