Which syndrome is characterized by right upper quadrant pain, ascites, and hepatocellular dysfunction?
Answer(s): A
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."
Rumack CM, Wilson SR, Charboneau JW, Levine D. Diagnostic Ultrasound. 5th ed. Elsevier, 2017.AIUM Practice Parameter for Liver Ultrasound, 2020.
Which mechanism is used for a fine needle aspiration?
Answer(s): C
Fine needle aspiration (FNA) uses a thin needle to aspirate cells, which are then packed into the lumen of the needle for cytological evaluation. It is distinct from core biopsy, which uses cutting needles to obtain tissue cores.According to AIUM Practice Parameters:"Fine needle aspiration involves insertion of a thin needle into a lesion to aspirate cells for cytologic analysis. The cells are collected inside the needle lumen."
AIUM Practice Parameter for the Performance of Ultrasound-Guided Percutaneous Needle Biopsy, 2020.Rumack CM, Diagnostic Ultrasound, 5th ed. Elsevier, 2017.
Which portion of the biliary system is last to become dilated with biliary obstruction at the ampulla of Vater?
Answer(s): D
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."
Rumack CM, Wilson SR, Charboneau JW, Levine D. Diagnostic Ultrasound. 5th ed. Elsevier, 2017.AIUM Practice Parameter for the Performance of Abdominal Ultrasound, 2020.
Which gray scale artifact is caused by the oscillation of gas bubbles?
Ring-down artifact occurs when gas bubbles resonate or oscillate, creating continuous echoes distal to the structure that appear as a vertical, echogenic band extending posteriorly. This is distinct from reverberation, which produces multiple discrete reflections.According to Zwiebel's Introduction to Vascular Ultrasound:"Ring-down artifact results from resonance of gas bubbles, producing a continuous, echogenic tail distal to the reflecting interface."
Zwiebel WJ, Pellerito JS. Introduction to Vascular Ultrasound. 6th ed. Elsevier, 2019.AIUM Practice Parameter for Abdominal Ultrasound, 2020.
Which sonographic finding is associated with normal postprocedural Doppler of a transjugular intrahepatic portosystemic shunt (TIPS)?
After successful TIPS placement, the intrahepatic portal venous branches continue to exhibit hepatopetal (toward the liver) flow, while the stent itself shows continuous, relatively high-velocity monophasic flow. Hepatofugal flow in intrahepatic branches may indicate shunt dysfunction.According to Zwiebel's Introduction to Vascular Ultrasound:"Normal post-TIPS Doppler shows hepatopetal flow in the intrahepatic portal veins and continuous high-velocity flow within the stent."
Zwiebel WJ, Pellerito JS. Introduction to Vascular Ultrasound. 6th ed. Elsevier, 2019.AIUM Practice Parameter for the Performance of Portal Venous Ultrasound, 2020.
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