Which vessel is typically seen with an echogenic ring of fat when imaging the upper abdominal mesenteric circulation?
Answer(s): D
The superior mesenteric artery (SMA) is typically visualized surrounded by an echogenic fat pad in the mesentery, producing a characteristic "echogenic ring" appearance on ultrasound. This is a helpful landmark for identifying the SMA in the transverse abdominal aortic plane.According to Rumack's Diagnostic Ultrasound:"The superior mesenteric artery is often seen as a round anechoic structure surrounded by echogenic fat at its origin from the anterior aorta."
Rumack CM, Wilson SR, Charboneau JW, Levine D. Diagnostic Ultrasound. 5th ed. Elsevier, 2017.Moore KL, Clinically Oriented Anatomy. 8th ed. Wolters Kluwer, 2018.
What is the location of the left lobe of the thyroid gland?
Answer(s): C
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."
Rumack CM, Wilson SR, Charboneau JW, Levine D. Diagnostic Ultrasound. 5th ed. Elsevier, 2017.AIUM Practice Parameter for Thyroid Ultrasound, 2020.
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?
Answer(s): B
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."
Zwiebel WJ, Pellerito JS. Introduction to Vascular Ultrasound. 6th ed. Elsevier, 2019.AIUM Practice Parameter for Renal Transplant Ultrasound, 2020.
Which type of hernia is located medial to the inferior epigastric artery?
Answer(s): A
Direct inguinal hernias protrude through Hesselbach's triangle, which lies medial to the inferior epigastric artery. In contrast, indirect inguinal hernias pass lateral to the inferior epigastric artery via the deep inguinal ring.According to Moore's Clinically Oriented Anatomy:"Direct inguinal hernias occur medial to the inferior epigastric vessels, within Hesselbach's triangle."
Moore KL, Dalley AF, Agur AMR. Clinically Oriented Anatomy. 8th ed. Wolters Kluwer, 2018.Gray's Anatomy for Students, 4th ed., Elsevier, 2019.
Which description is associated with the normal sonographic appearance of a tendon?
On ultrasound, tendons appear as cord-like hyperechoic structures with linear fibrillar echotexture when imaged in long axis. The fibrils are highly reflective, creating the typical hyperechoic appearance. Posterior shadowing is not typical unless there is calcification.According to Rumack's Diagnostic Ultrasound:"Tendons have a highly organized hyperechoic linear fibrillar pattern when examined along their long axis."
Rumack CM, Wilson SR, Charboneau JW, Levine D. Diagnostic Ultrasound. 5th ed. Elsevier, 2017.AIUM Practice Parameter for Musculoskeletal Ultrasound, 2020.
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