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ARDMS AE-Adult-Echocardiography Exam
AE Adult Echocardiographyination (Page 3 )

Updated On: 7-Feb-2026
Page 3 of 29
PDF with 139 Questions

Which finding is shown in this image?

  1. Chiari network
  2. Left atrial thrombus
  3. Cor triatriatum
  4. Artifact

Answer(s): A

Explanation:

The echocardiographic image shows a mobile, highly echogenic, mesh-like structure within the right atrium consistent with the Chiari network. The Chiari network is an embryologic remnant of the right valve of the sinus venosus, appearing as a fenestrated, reticulated membrane that is usually thin and mobile, found near the orifice of the inferior vena cava or the coronary sinus.

This structure is benign and often an incidental finding but can be confused with thrombus or atrial tumors. Unlike left atrial thrombus, which appears as a more solid, immobile mass often located in the left atrial appendage, the Chiari network is mobile and located in the right atrium. Cor triatriatum is a rare congenital membrane dividing the left atrium into two chambers and appears differently on echocardiography. Artifact refers to non-anatomic echoes which do not persist or move consistently.

Recognition of Chiari network is important to avoid misdiagnosis, and its characteristics are well described in echocardiography literature such as the "Textbook of Clinical Echocardiography" and ASE
16:Textbook of Clinical Echocardiography, 6ep.400-40212:ASE Guidelines imaging guidelines.
on Cardiac Massesp.150-155



Which is the most likely abnormality represented in these images from a 48-year-old man with shortness of breath?



  1. Loeffler syndrome
  2. Hypertrophic cardiomyopathy
  3. Left ventricular noncompaction
  4. Ischemic cardiomyopathy

Answer(s): C

Explanation:

The echocardiographic images show prominent trabeculations and deep intertrabecular recesses communicating with the left ventricular cavity, best seen on contrast-enhanced images. This finding is characteristic of left ventricular noncompaction (LVNC), a cardiomyopathy resulting from arrested myocardial compaction during embryogenesis.

LVNC is diagnosed by visualizing a two-layered myocardium with a thin compacted epicardial layer and a thicker noncompacted endocardial layer with deep trabecular recesses. The use of contrast echocardiography enhances endocardial border delineation and recess visualization, increasing diagnostic accuracy.

Loeffler syndrome (hypereosinophilic cardiomyopathy) often shows endomyocardial fibrosis and restrictive physiology but not prominent trabeculations. Hypertrophic cardiomyopathy shows asymmetric septal hypertrophy without deep recesses. Ischemic cardiomyopathy shows wall motion abnormalities but not characteristic trabecular patterns.

These diagnostic criteria and imaging features are well documented in the "Textbook of Clinical
16:Textbook
Echocardiography" and ASE guidelines on cardiomyopathies and use of contrast echo

12:ASE Contrast of Clinical Echocardiography, 6eChapter on LV Noncompaction.
Echocardiography Guidelinesp.180-190



The variables necessary to calculate mitral regurgitant (MR) effective orifice area by the proximal isovelocity surface area (PISA) equation include MR aliasing hemispheric radius, the aliasing velocity, and which other parameter?

  1. Mitral annular diameter
  2. Time velocity integral of pulsed wave at mitral annulus
  3. Maximum mitral regurgitant velocity
  4. Left ventricular outflow tract diameter

Answer(s): C

Explanation:

The proximal isovelocity surface area (PISA) method estimates the effective regurgitant orifice area (EROA) in mitral regurgitation by measuring the radius of the hemispheric flow convergence region (aliasing radius) and incorporating the aliasing velocity and the peak velocity of the MR jet.

The equation for EROA is:

EROA = (2 × r² × Va) / Vmax

Where:

r = radius of the PISA hemisphere (aliasing radius)

Va = aliasing velocity (the velocity at which color aliasing occurs)

Vmax = peak MR velocity obtained by continuous wave Doppler

This calculation does not involve the mitral annular diameter, time velocity integral of mitral annulus, or left ventricular outflow tract diameter.

Thus, the third necessary parameter after aliasing radius and velocity is the maximum MR velocity measured by continuous wave Doppler, which allows determination of flow rate through the regurgitant orifice.

This formula and its clinical application are well established in adult echocardiography literature and 12:ASE Valvular Regurgitation Guidelinesp.210-ASE valvular regurgitation guidelines

16:Textbook of Clinical Echocardiography, 6eChapter on Mitral Regurgitation .
Assessment



Which of the following are key features of an unrepaired tetralogy of Fallot?

  1. Displaced tricuspid valve, atrialization of the right ventricle, severe tricuspid regurgitation, and a secundum atrial septal defect
  2. Supravalvular mitral valvular ring, subaortic membrane, bicuspid aortic valve, and aortic coarctation
  3. Inlet ventricular septal defect, common atrioventricular valve, atrioventricular valve regurgitation, and primum atrial septal defect
  4. Outlet ventricular septal defect, overriding aorta, right ventricular outflow tract obstruction, and right ventricular hypertrophy

Answer(s): D

Explanation:

Comprehensive and Detailed Explanation From Exact Extract:

Tetralogy of Fallot (TOF) is a congenital heart defect characterized by four key anatomical abnormalities: an outlet (malalignment) ventricular septal defect (VSD), an overriding aorta that receives blood from both ventricles, right ventricular outflow tract (RVOT) obstruction (commonly infundibular stenosis), and resultant right ventricular hypertrophy. These defects cause cyanosis due to right-to-left shunting and impaired pulmonary blood flow.

Option A describes Ebstein anomaly, characterized by a displaced tricuspid valve and atrialization of the right ventricle.

Option B describes features more consistent with Shone complex or other left heart obstructive lesions.

Option C describes atrioventricular septal defect (AVSD), seen in conditions like Down syndrome.

In unrepaired TOF, echocardiography demonstrates the large malalignment VSD, overriding aorta, RVOT obstruction, and hypertrophied right ventricle. These are classic textbook findings described in adult and pediatric echocardiography literature, including "Textbook of Clinical Echocardiography"
16:Textbook of Clinical
(Chapter on Congenital Heart Disease) and ASE guidelines

12:ASE Adult Congenital Guidelinesp.400-410.
Echocardiography, 6ep.560-565



The 'P' wave of an electrocardiogram relates to which echocardiography event?

  1. Atrial contraction
  2. Ventricular contraction
  3. Atrial relaxation
  4. Ventricular diastole

Answer(s): A

Explanation:

Comprehensive and Detailed Explanation From Exact Extract:

The P wave on the ECG corresponds to atrial depolarization, which precedes atrial contraction (atrial systole). On echocardiography, atrial contraction can be observed as the atrial "kick," contributing to ventricular filling during late diastole.

Ventricular contraction (QRS complex) and ventricular relaxation (T wave) correspond to other phases of the cardiac cycle. Atrial relaxation occurs during ventricular systole but is not represented by the P wave.

This timing relationship is critical for correlating echocardiographic Doppler inflow patterns, such as the late diastolic A wave, with the ECG. These concepts are outlined in the foundational echocardiography references, including ASE guidelines and the "Textbook of Clinical
16:Textbook of Clinical Echocardiography, 6ep.150-15512:ASE Echocardiography".
Echocardiography Guidelinesp.50-55






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