Lange Review Ultrasonography Examination, 4th Edition

Case Studies Answer Sheet

Case 1

1-1. D

1-2. B

1-3. A

There is both intrahepatic and extrahepatic bile duct dilatation. The color Doppler sonogram shows the multiple tubular structures to be dilated with intrahepatic and extrahepatic bile ducts. The transverse midline image shows a hypoechoic mass in the pancreatic head.

Case 2

2-1. A

2-2. C

2-3. E

This is typical of focal nodular hyperplasia. These lesions typically have a central vessel. Computed tomography or magnetic resonance can confirm the diagnosis.

Case 3

3-1. B

3-2. C

3-3. C

This is an example of a diffusely irregular liver texture due to hepatitis. The common bile duct is of normal caliber.

Case 4

4-1. B

4-2. D

4-3. A

There is an hypoechoic mass that shows peripheral “cloud”-like arterial enhancement on arterial-phase computed tomography consistent with the diagnosis of a hemangioma.

Case 5

5-1. A

5-2. A

5-3. C

There is a revised flow in the portal vein secondary to portal hypertension. There is diffuse fatty change in the liver, which has a variety of causes including rejection, hepatitis, and vascular insult.

Case 6

6-1. A

6-2. D

6-3. A

Portal vein thrombosis may be associated with extension of tumor into the portal vein or “bland” due to hypercoagulability of blood or associated with gastrointestinal inflammatory disease. If present, hepatic transplantation cannot occur since this requires anastomosis of recipient portal vein to donor portal vein.

Case 7

7-1. C

7-2. A

7-3. D

This patient has a nonobstructing stone in the left kidney and one at the distal ureter. The “twinkle” is created on color Doppler due to reverberation within the stone and thus can overestimate its true size. The presence of a ureteral jet is seen even when there is near occlusion of the ureter by the stone.

Case 8

8-1. A

8-2. E

8-3. B

There is marked thickening of the gallbladder wall, which is a nonspecific finding. If there is localized pain when scanning directly over the gallbladder (“Murphy’s sign”), acute cholecystitis may be present.

Case 9

9-1. C

9-2. C

9-3. B

This is a well-defined mass with a hypoechoic halo typical of a metastatic lesion. Sonography provided guidance for biopsy.

Case 10

10-1. A

10-2. A

10-3. A

Color Doppler and spectral Doppler are important in establishing flow within a TIPS shunt. Normal velocities range from 50 to 150 cm/s and may vary depending on respiration.

Case 11

11-1. A

11-2. C

11-3. C

There is a thickened loop of bowel in the right lower quadrant. Although this could also be seen in appendicitis, this was an intussuscepted Meckel’s diverticulum.

Case 12

12-1. C

12-2. D

12-3. A

This is an example of chronic lymphocystic thyroiditis. There is diffuse irregularity of the mid and lower portion of the right lobe. Biopsy is not indicated.


1. Rumack CM, Wilson SR, Charboneau JW Levine D. Diagnostic Ultrasound. 4th ed. Mosby; 2011.

2. Hagen-Ansert SL. Textbook of Diagnostic Ultrasonography. 6th ed. St. Louis: CV Mosby; 2006.

3Dorland’s Illustrated Medical Dictionary. 30th ed. Philadelphia: WB Saunders; 2003.

4. NCER National Certification Examination Review. Dallas: Society of Diagnostic Medical Sonography; 2009.

5. Mc Gaham JP Goldberg BB. Diagnostic Ultrasound: A logical Approach. Philadelphia PA: Lippincott-Raven Publishers. 1998.

6. Gill K. Abdominal Ultrasound A Practitioner’s Guide. Philadelphia: WB Saunders; 2001.

7. Kawamura DM. Diagnostic Medical Sonography: A Guide to Clinical Practice: Abdomen and Superficial Structures. 2nd ed. Philadelphia: Lippincott; 1997.

8. Curry RA, Tempkin BB. Sonography: Introduction to Normal Structure and Function. 3rd ed. Saunders; 2011.

9. Krebs CA, Giyanani VL, Eisenberg RL. Ultrasound Atlas of Disease Processes. Norwalk, CT: Appleton & Lange; 1993.

10. Kremnau F. Sonography: Principles and Instruments. 8th ed. Saunders; 2011.

11. Criner GJ, Alonzo GE. Critical Care Guide: Text and Review. New York: Springer-Verlag; 2002.

12. Mc Catehey KD. Clinical Laboratory Medicine. 2nd ed. Philadelphia: Lippincott-Williams & Wilkins; 2002.

* Kerry E. Weinberg wrote the previous-edition version of this chapter.