RDMS AB-Abdomen Updated Exam

Adrenal adenomas are the most common adrenal tumors in adults. They are often discovered incidentally (adrenal incidentalomas) and are usually nonfunctioning, though some may secrete cortisol or aldosterone. Neuroblastoma is common in children, pheochromocytomas are rarer catecholamine-producing tumors, and adrenal cortical carcinoma is malignant but much less common than adenomas.

According to Rumack’s Diagnostic Ultrasound:

“Adrenal adenomas are the most common adrenal masses in adults, frequently identified incidentally on imaging studies.”

Nutcracker syndrome results from compression of the left renal vein between the superior mesenteric artery (SMA) and the aorta. This can cause hematuria, flank pain, and pelvic congestion due to impaired venous drainage.

According to Zwiebel’s Introduction to Vascular Ultrasound:

“In nutcracker syndrome, the left renal vein is compressed between the aorta and SMA, resulting in venous hypertension.”

The ultrasound image demonstrates a heterogeneous and echogenic spleen with evidence of atrophy and multiple areas of calcification—consistent with autosplenectomy. This appearance is classically associated with chronic sickle cell anemia.

In sickle cell disease, repeated vaso-occlusive episodes result in infarctions, fibrosis, and progressive calcification of the spleen. Over time, this leads to functional asplenia or complete autosplenectomy (involution and shrinkage of the spleen). The hallmark sonographic features include:

A small, echogenic spleen

Multiple coarse calcifications

Irregular contour or atrophic appearance

These findings are not typically seen in other conditions:

A. Trauma may cause subcapsular hematomas or lacerations, but not chronic atrophy with calcifications.

C. Immunocompromised patients may develop abscesses or infections but not the classic features of autosplenectomy.

D. Portal hypertension typically causes splenomegaly and varices, not atrophic and calcified spleens.

Downstream from a significant renal artery stenosis, the acceleration time is prolonged due to delayed systolic upstroke (“tardus-parvus waveform”). This is a sensitive Doppler parameter for detecting hemodynamically significant stenosis. Spectral broadening usually occurs at the stenotic site, not distal to it.

According to Zwiebel’s Introduction to Vascular Ultrasound:

“Prolonged acceleration time and reduced acceleration index characterize tardus-parvus waveforms distal to renal artery stenosis.”