2004 Radiology Exam - Ultrasound Case 1

A short digital videoclip was provided for each case. Videoclips were either played on a digital cassette recorder and displayed on a television screen or were displayed as digital movies on a computer monitor. No other images were provided to candidates during the 2004 examination. Figures included here show frames captured from videotapes used for the examination or images saved to the ultrasound machine’s hard drive when the videotape was being recorded. Sufficient time was provided to allow each videoclip to be reviewed twice and candidates were able to fast forward or backup the videoclip as they wished. Candidates were given signalment, history, and (in some cases) physical examination findings for each case. Information was provided on positioning of the patient and the location of the probe during imaging.

Objective of the Case:
The case was intended to test the candidate’s knowledge of basic cardiac anatomy on echocardiograms and to evaluate his or her knowledge of a common acquired cardiac condition (endocarditis).

Information provided to Candidate
Candidates were given written instructions to identify valves as they appeared, to describe abnormalities, and to generate a list of differentials.

Signalment:

  • Intact, male Labrador retriever, 4 years old

History:

  • Lethargy, reluctance to rise, shaking in hindquarters, anorexia four days
  • Semen analysis month earlier showed poor motility of spermatozoa
  • Physical Examination:
  • Possible grade I murmur, T104.6, prostate gland was enlarged on palpation

Patient and Probe Position:
Left parasternal long axis view. Patient is in left lateral recumbency with probe coming from under the table against the left chest wall. Probe is aimed at the right shoulder with the reference mark pointing at the elbows.

See images below. Click to enlarge.

Findings Expected from Candidate
Candidates were expected to correctly identify anatomical features. The main findings included a thickened irregular aortic valve, aortic insufficiency, and mitral regurgitation. The tricuspid valve was also shown and was normal.

Conclusion Expected from Candidate:
The clinical history of fever and the sonographic findings should lead the candidate to suspect endocarditis resulting in aortic insufficiency and mitral regurgitation.

Summary of Overall Candidate Performance
The question was worth a total of 10 points. The average score was 69%. There were two cardiac cases. Candidates who scored poorly on this question often had difficulty with the other cardiac case. It might be helpful for candidates who perform few echocardiograms to practice the interpretation of echocardiograms by reviewing cases recorded on videotape.