Sonography ARDMS Exam Questions & Answers 2026 (21–30)

Question 1

Which vessel lies immediately posterior to the body of the pancreas and is a key landmark for pancreatic identification?

TheoryPractice · Accepted Answer

Splenic vein. The splenic vein courses along the posterior surface of the pancreatic body and tail, making it the primary landmark for identifying the pancreas on transverse sonography.

Question 2

The pancreatic head is defined anteriorly by the gastroduodenal artery and posteriorly by which vessel?

TheoryPractice · Accepted Answer

Inferior vena cava. The inferior vena cava lies posterior to the pancreatic head. The portal vein is formed just posterior-superior to the head by the confluence of the SMV and splenic vein, but the IVC is the direct posterior relationship.

Question 3

Acute pancreatitis most commonly appears on ultrasound as:

TheoryPractice · Accepted Answer

Enlarged, hypoechoic, edematous pancreas with peripancreatic fluid. In acute pancreatitis the pancreas typically enlarges and becomes hypoechoic due to edema; peripancreatic fluid collections may be present. However, bowel gas frequently obscures the pancreas so a normal US does not exclude pancreatitis.

Question 4

Chronic pancreatitis is sonographically characterized by all of the following EXCEPT:

TheoryPractice · Accepted Answer

Hypoechoic, enlarged, edematous parenchyma. Chronic pancreatitis produces a shrunken, hyperechoic (fibrotic) or heterogeneous gland with calcifications and duct dilation. A hypoechoic enlarged pancreas is the hallmark of ACUTE pancreatitis, not chronic disease.

Question 5

A 67-year-old male with painless jaundice and weight loss has a hypoechoic mass at the pancreatic head with upstream bile duct and pancreatic duct dilation. This 'double duct sign' is MOST consistent with:

TheoryPractice · Accepted Answer

Pancreatic ductal adenocarcinoma. The double duct sign (simultaneous dilatation of the CBD and main pancreatic duct) strongly suggests obstruction at the head of the pancreas, most commonly from pancreatic ductal adenocarcinoma. Insulinomas are typically small and hypervascular.

Question 6

On ultrasound, the normal spleen echotexture is:

TheoryPractice · Accepted Answer

Homogeneous and slightly more echogenic than the normal liver. The normal spleen has homogeneous, fine-grained echogenicity that is slightly greater than the normal liver and greater than the renal cortex. Comparing spleen to liver is a quick reference for both organs.

Question 7

The upper limit of normal splenic length in adults measured by sonography is:

TheoryPractice · Accepted Answer

12 cm. A splenic length > 12 cm is considered splenomegaly in adults. The spleen is measured in its long axis on a coronal or oblique view. Values 12–15 cm represent mild-to-moderate enlargement; > 15 cm is marked splenomegaly.

Question 8

Splenic calcifications producing curvilinear shadowing along the periphery of the spleen are MOST consistent with:

TheoryPractice · Accepted Answer

Prior infarction or granulomatous disease (e.g., histoplasmosis). Peripheral or punctate splenic calcifications most often represent healed granulomatous disease (histoplasmosis, tuberculosis) or old infarcts. Hemangiomas calcify centrally and angiosarcomas have aggressive imaging features.

Question 9

An accessory spleen (splenunculus) is most commonly located:

TheoryPractice · Accepted Answer

In the left renal hilum. Accessory spleens are congenital ectopic splenic tissue found in up to 30% of individuals, most frequently at the splenic hilum or along the splenic pedicle. They are identical in echogenicity to the main spleen.

Question 10

The abdominal aorta bifurcates into the common iliac arteries at approximately which vertebral level?

TheoryPractice · Accepted Answer

L4. The abdominal aorta bifurcates at approximately the L4 vertebral level (near the umbilicus) into the right and left common iliac arteries. The celiac axis arises at T12–L1.

Sonography ARDMS Exam Questions & Answers 2026 (21–30)

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