Sonography ARDMS Exam Questions & Answers 2026 (11–20)

Question 1

A hepatic hemangioma most typically appears on gray-scale ultrasound as:

TheoryPractice · Accepted Answer

Hyperechoic mass with well-defined margins and posterior acoustic enhancement. Hepatic hemangiomas are typically uniformly hyperechoic with well-defined margins and may show mild posterior enhancement due to their blood-filled sinusoids. This appearance is most common in non-fatty livers.

Question 2

A 52-year-old with chronic hepatitis B presents with a 3 cm arterially enhancing liver mass. Which finding on gray-scale sonography would MOST raise suspicion for hepatocellular carcinoma (HCC)?

TheoryPractice · Accepted Answer

Hypoechoic mass with a peripheral hypoechoic halo and internal vascularity. HCC in a cirrhotic liver often appears as a hypoechoic or heterogeneous mass with a peripheral hypoechoic halo (fibrous capsule) and internal vascularity on Doppler. Uniform hyperechogenicity is more typical of hemangioma.

Question 3

The normal intrahepatic bile duct diameter relative to the adjacent portal vein branch should be:

TheoryPractice · Accepted Answer

Less than 40% of the diameter of the adjacent portal vein (< 2 mm). Normal intrahepatic ducts are less than 40% of the adjacent portal vein diameter (usually < 2 mm). Ducts appearing parallel to portal veins ('parallel channel sign') suggest biliary dilatation.

Question 4

What is the upper limit of normal for the common bile duct (CBD) diameter in an adult without prior cholecystectomy?

TheoryPractice · Accepted Answer

7 mm. The CBD is considered normal up to 6–7 mm in adults without cholecystectomy. Post-cholecystectomy the duct may measure up to 10 mm. Values > 7 mm (non-surgical patient) warrant further investigation.

Question 5

Choledocholithiasis (stone in the common bile duct) is best characterized sonographically by:

TheoryPractice · Accepted Answer

Echogenic focus within the CBD lumen casting a posterior acoustic shadow. CBD stones appear as echogenic foci that produce posterior acoustic shadowing, identical to gallstones. The absence of vascular flow (versus a polyp) and the shadow help differentiate stone from sludge or polyp.

Question 6

A Klatskin tumor is best described as a cholangiocarcinoma arising at which location?

TheoryPractice · Accepted Answer

Confluence of the right and left hepatic ducts (hepatic hilum). Klatskin tumors are hilar cholangiocarcinomas that arise at or near the confluence of the right and left hepatic ducts. They typically obstruct the biliary system at the hilum and are associated with a poor prognosis.

Question 7

The normal gallbladder wall thickness, measured in a fasting patient, should not exceed:

TheoryPractice · Accepted Answer

3 mm. In a properly fasted patient (minimum 6 hours), the gallbladder wall should measure ≤ 3 mm. Wall thickening > 3 mm is abnormal, though it can be caused by many conditions beyond cholecystitis.

Question 8

Which sonographic finding is considered pathognomonic for acute cholecystitis?

TheoryPractice · Accepted Answer

Sonographic Murphy's sign combined with gallstones. A positive sonographic Murphy's sign (maximal tenderness with direct probe pressure over the gallbladder) combined with gallstones is considered pathognomonic for acute cholecystitis, having high specificity.

Question 9

Adenomyomatosis of the gallbladder is characterized by which specific sonographic finding?

TheoryPractice · Accepted Answer

Ring-down or comet-tail artifacts within the gallbladder wall. Adenomyomatosis shows cholesterol crystals and Rokitansky-Aschoff sinuses within the wall that produce ring-down (comet-tail) artifacts. This finding helps distinguish adenomyomatosis from acute cholecystitis.

Question 10

A 'WES' (wall-echo-shadow) triad on sonography of the gallbladder indicates:

TheoryPractice · Accepted Answer

Gallbladder completely filled with stones. The WES sign (echogenic curvilinear near wall, then echo, then acoustic shadow) occurs when stones fill the gallbladder lumen, making it appear contracted with no visible bile. This is often called a 'porcelain gallbladder' mimic.

Sonography ARDMS Exam Questions & Answers 2026 (11–20)

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