Pass the ARDMS RDMS AB-Abdomen Questions and answers with CertsForce

An accessory spleen (splenule) is a congenital variant, commonly located near the splenic hilum, and has identical echogenicity to the native spleen. This finding is benign and often incidental.

According to Rumack’s Diagnostic Ultrasound:

“Accessory spleens are typically found near the splenic hilum and are isoechoic to the normal splenic parenchyma.”

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.”

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.”

Hepatic adenomas are benign liver tumors strongly associated with long-term use of oral contraceptives and are most frequently found in women under 40. Hepatoblastoma is seen in children; hepatoma (HCC) is a malignant tumor typically found in cirrhotic livers. Cavernous hemangioma is unrelated to oral contraceptives.

According to Rumack’s Diagnostic Ultrasound:

“Hepatic adenomas occur predominantly in young women with a history of oral contraceptive use.”

A varicocele is an abnormal dilatation of the pampiniform plexus veins, usually seen on the left side due to the perpendicular insertion of the left testicular vein into the left renal vein, making it more susceptible to elevated venous pressure. Sonographically, varicoceles appear as multiple serpiginous anechoic tubular structures that show venous flow on color Doppler, often accentuated with Valsalva maneuver.

Hydrocele (A) is a fluid collection surrounding the testis.

Hematocele (C) is blood within the tunica vaginalis.

Spermatocele (D) is a cystic lesion arising from the epididymis.

Reference Extracts:

Dogra VS, Bhatt S. "Sonographic evaluation of testicular varicoceles." Journal of Ultrasound in Medicine. 2004;23(6): 829-838.

Rumack CM, Wilson SR, Charboneau JW, Levine D. Diagnostic Ultrasound. 5th ed. Elsevier, 2017.

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The normal gallbladder wall measures up to 3 mm. Thickening beyond 3 mm may suggest cholecystitis, heart failure, hepatitis, or hypoalbuminemia. Measurements should be taken with the patient fasting, using the anterior gallbladder wall.

According to Rumack’s Diagnostic Ultrasound:

“The gallbladder wall is considered thickened if it measures greater than 3 mm.”

The ultrasound image demonstrates a longitudinal view of the right kidney. Within the renal pyramids, there are multiple echogenic foci, some showing posterior acoustic shadowing—findings characteristic of medullary nephrocalcinosis. This sonographic appearance is strongly associated with medullary sponge kidney (MSK).

Medullary sponge kidney is a congenital disorder of the renal tubules that results in ectatic (dilated) collecting ducts in the renal medulla. The dilated ducts frequently become calcified, leading to the "paintbrush" or "bouquet of flowers" appearance seen in the renal pyramids on ultrasound. These calcifications are most often bilateral and symmetrical, further aiding the diagnosis.

Comparison of answer choices:

A. Fungal balls (mycetomas) typically appear as mobile, non-shadowing echogenic masses within the collecting system, often in immunocompromised patients.

B. Renal cell carcinoma usually presents as a solid mass with irregular borders and variable echogenicity—this image does not show a mass.

C. Acute pyelonephritis may show renal enlargement, decreased echogenicity, or loss of corticomedullary differentiation—but not calcification of the pyramids.

D. Medullary sponge kidney is correct due to the punctate echogenic foci within the medullary pyramids, consistent with nephrocalcinosis.

The ultrasound image demonstrates a well-defined, ovoid, hypoechoic to isoechoic mass within the subcutaneous tissue of the abdominal wall. The lesion appears compressible and shows linear striations parallel to the skin surface — a classic appearance of a lipoma.

Lipomas are the most common benign soft tissue tumors and frequently arise in the subcutaneous tissue. They are composed of mature adipose tissue and are typically asymptomatic unless large or compressing adjacent structures.

Sonographic features of a lipoma:

Isoechoic to mildly hyperechoic or hypoechoic relative to subcutaneous fat

Oval or elliptical in shape with well-defined margins

Internal linear striations or “feathered” echotexture

Compressible and non-vascular on Doppler imaging

Located in subcutaneous fat plane parallel to the skin surface

Differentiation from other options:

B. Fibroma: Typically appears as a homogeneous, hypoechoic mass but is far less common in the abdominal wall.

C. Desmoid: Appears as an ill-defined or infiltrative mass within deeper soft tissues; more heterogeneous and may distort surrounding tissue planes.

D. Metastasis: Often more irregular, heterogeneous, and may show increased vascularity or invasion into adjacent structures.

Acute tubular necrosis (ATN) is the most common cause of early graft dysfunction following renal transplantation. It results from ischemia-reperfusion injury during the transplantation process. Ultrasound findings may be nonspecific but Doppler may show elevated resistive indices.

Ureterocele (A) is a congenital anomaly.

Transplant artery stenosis (C) is a late complication.

Transitional cell carcinoma (D) is rare and not typically an early complication.

Reference Extracts:

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

Rumack CM, Wilson SR, Charboneau JW, Levine D. Diagnostic Ultrasound. 5th ed. Elsevier, 2017.

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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.”