Lange Review Ultrasonography Examination, 4th Edition

Case Studies Answer Sheet

Case 1

1-1. A

1-2. B

1-3. B

This is a well-circumscribed hypoechoic area with decreased flow. This can occur as a sequela of infarction or tumor. The sonographer should scan an area of concern and endeavor an abnormality. This is a case of dilated rete testes, a normal variant in older men.

Case 2

2-1. D

2-2. A

2-3. A

This testicle contains a well-circumscribed hypoechoic, hypovascular area in the upper pole that is hypovascular. Though hypovascular, this could have a similar appearance to a testicular tumor such as a seminoma; this represented testicular infarction to lifting weights.

Case 3

3-1. C

3-2. D

3-3. D

This is an enlarged and distorted lymph node. This can be associated with metastatic spread of follicular papillary cancer or can be “reactive” due to inflammation.

Case 4

4-1. B

4-2. A

4-3. B

This is a large papillary thyroid cancer containing numerous vessels. A fine needle aspiration could be performed safely.

Case 5

5-1. B

5-2. D

5-3. B

There is an ill-defined group of hypervascular nodules in the upper pole. Fine needle aspiration would be indicated for further evaluation.

Case 6

6-1. C

6-2. D

6-3. A

This sonogram shows a parathyroid mass inferior to the left lobe.

Case 7

7-1. B

7-2. C

7-3. A

This is a typical thyroglossal duct cyst. They are usually found in the midline and can contain some low-level echoes.

Case 8

8-1. A

8-2. D

8-3. C

This is a solid nodule that was found to represent a metastatic lesion to the thyroid.


1. Reading CC, Charboneau JW Hay ID, Sebo TJ. Sonography of thyroid nodules—A “classic pattern” diagnostic approach. Ultrasound Q. 205; 21(3).

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

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

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

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

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