Abdominal and Pelvic Radiology Practice Questions

Q: An elderly woman presented with abdominal pain and vomiting for three days. A computed tomogram of the abdomen was obtained. What is the diagnosis?

Obturator hernia. ***Obturator hernia*** - Classic **CT appearance** shows a **bowel loop** herniating through the **obturator foramen** between the **pectineus** and **obturator externus muscles**. - Typically occurs in **elderly, thin women** and can cause **small bowel obstruction** with the characteristic **Howship-Romberg sign** (medial thigh pain). *Cecal volvulus* - CT shows a **dilated cecum** in an abnormal position, often in the **left upper quadrant** with a **whirl sign** at the point of torsion. - Creates a **closed-loop obstruction** with characteristic **coffee bean** or **kidney-shaped** appearance on imaging. *Intussusception* - CT demonstrates the pathognomonic **target sign** or **bowel-within-bowel** appearance with alternating layers of bowel wall. - More commonly seen in **pediatric patients** and would show a **sausage-shaped mass** rather than herniation through anatomical foramina. *Mesenteric ischemia* - CT findings include **bowel wall thickening**, **pneumatosis**, **portal venous gas**, and **lack of bowel wall enhancement** with contrast. - Would show **mesenteric vessel occlusion** or **bowel wall necrosis** rather than mechanical obstruction from herniation.

Q: What is the gold standard investigation for renal artery stenosis in a 21-year-old girl?

Renal angiography. **Explanation:** **1. Why Renal Angiography is the Correct Answer:** Digital Subtraction Angiography (DSA) or **Renal Angiography** remains the **"Gold Standard"** for diagnosing renal artery stenosis (RAS). It provides the highest spatial resolution, allowing for the visualization of the main renal artery and its intrarenal branches. In a 21-year-old female, the most likely etiology is **Fibromuscular Dysplasia (FMD)**, which typically presents with a "string of beads" appearance. Angiography is not only diagnostic but also therapeutic, as it allows for immediate intervention via percutaneous transluminal angioplasty (PTA). **2. Why Other Options are Incorrect:** * **Renal Scan (Captopril Renography):** This is a functional test, not an anatomical one. While it helps assess the physiological significance of a known stenosis, it lacks the anatomical detail required for a definitive diagnosis. * **Ultrasound Doppler:** This is the preferred **initial screening test** because it is non-invasive and cost-effective. However, it is operator-dependent and frequently limited by bowel gas or patient habitus, making it less definitive than angiography. * **3D Contrast-enhanced MRA:** This is an excellent non-invasive alternative with high sensitivity. However, it can overestimate the degree of stenosis and is contraindicated in patients with metallic implants or severe renal failure (due to Nephrogenic Systemic Fibrosis). It remains secondary to the gold standard of invasive angiography. **3. Clinical Pearls for NEET-PG:** * **Most common cause of RAS:** Atherosclerosis (Elderly males; involves the ostium/proximal 1/3rd). * **Second most common cause:** Fibromuscular Dysplasia (Young females; involves the distal 2/3rd/branches). * **Screening Test of Choice:** Color Doppler Ultrasound. * **Investigation of Choice (Non-invasive):** CT Angiography (CTA) or MRA. * **Gold Standard:** Conventional Renal Angiography.

Q: Which of the following is the earliest sign of ulcerative colitis on a double contrast barium enema (DCBE) study?

Fine mucosal granularity. **Explanation:** **1. Why "Fine Mucosal Granularity" is correct:** Ulcerative Colitis (UC) is a mucosal disease that starts in the rectum and spreads proximally in a continuous fashion. On a Double Contrast Barium Enema (DCBE), the earliest detectable change is the loss of the normal smooth mucosal outline. This is replaced by a **fine, sand-like granularity** (stippling). This appearance is caused by mucosal edema and hyperemia, which creates a hazy or "pitted" surface before frank ulceration occurs. **2. Why the other options are incorrect:** * **Loss of haustrations:** This occurs as the disease progresses to a chronic stage. The bowel wall becomes thickened and fibrotic, leading to the disappearance of normal folds. * **Collar-button ulcers:** These represent deeper ulcerations where the inflammatory process penetrates through the mucosa into the submucosa, creating a "T-shaped" or "mushroom" appearance. This indicates more advanced, active disease rather than the earliest stage. * **Lead pipe colon:** This is a classic **late-stage/chronic** finding. It refers to a featureless, shortened, and rigid colon caused by chronic inflammation, fibrosis, and loss of haustrations. **3. Clinical Pearls for NEET-PG:** * **Distribution:** UC always involves the rectum (proctitis) and extends proximally without "skip lesions" (unlike Crohn’s). * **Backwash Ileitis:** Seen in ~10% of patients with pancolitis; the terminal ileum appears dilated and patulous. * **Pseudopolyps:** These are islands of regenerating normal mucosa surrounded by areas of denuded, ulcerated mucosa. * **Toxic Megacolon:** A life-threatening complication where the transverse colon diameter exceeds **6 cm** on a plain X-ray.

Q: A patient presents with marked loin pain, tenderness, and pyrexia. Initial investigations reveal non-specific findings on IVP. Ultrasound shows a heterogeneous mass with posterior acoustic enhancement and central necrosis and internal debris. CT scan demonstrates marginal enhancement with air densities within. What is the likely diagnosis?

Renal abscess. **Explanation:** The clinical presentation of loin pain, pyrexia, and tenderness suggests an acute renal infection. The diagnosis of **Renal Abscess** is confirmed by the specific imaging triad described: 1. **Ultrasound:** A heterogeneous mass with **posterior acoustic enhancement** (indicating a fluid-filled/liquefied core) and internal debris (pus). 2. **CT Scan (Gold Standard):** Shows a well-defined, low-attenuation mass with **marginal (rim) enhancement** (the "ring-sign"). The presence of **air densities (gas)** within the collection is a classic, though not always present, sign of an abscess caused by gas-forming organisms. **Why other options are incorrect:** * **Emphysematous Pyelonephritis:** This is a life-threatening necrotizing infection characterized by *diffuse* gas within the renal parenchyma/collecting system, rather than a localized, rim-enhancing mass. * **Pyonephrosis:** This refers to infected, obstructed hydronephrosis. Imaging would show a dilated pelvicalyceal system with fluid-debris levels, rather than a parenchymal mass. * **Acute Pyelonephritis:** Typically shows an enlarged, edematous kidney with "striated nephrogram" on CT. It does not present as a localized, necrotic mass with rim enhancement unless it progresses to an abscess. **NEET-PG High-Yield Pearls:** * **CT scan** is the investigation of choice for renal abscess. * **Posterior acoustic enhancement** on USG is a key differentiator for fluid-filled structures (abscess/cyst) versus solid tumors. * Commonest causative organism: *Staphylococcus aureus* (via hematogenous spread) or *E. coli* (via ascending infection). * Management: Small abscesses ( 3cm) usually require percutaneous drainage.

Q: Ultrasound and radionuclide studies are primary imaging modalities used for the assessment of which of the following conditions?

Renal transplant. **Explanation:** **Renal Transplant (Correct Answer):** Ultrasound (USG) and Radionuclide studies are the mainstays for monitoring renal transplants because they are non-invasive, bedside-compatible, and avoid nephrotoxic contrast. * **USG with Color Doppler** is the initial investigation of choice to assess surgical complications (perinephric collections like hematomas or urinomas) and vascular complications (renal artery/vein thrombosis). * **Radionuclide scans (DTPA/MAG3)** are gold standards for assessing the functional status of the graft, helping differentiate between Acute Tubular Necrosis (ATN) and hyperacute/acute rejection based on perfusion and excretion patterns. **Why other options are incorrect:** * **Renal Trauma:** **Contrast-Enhanced CT (CECT)** is the gold standard. It accurately grades the severity of injury, detects active extravasation, and assesses the pedicle. USG (FAST) is used only for initial screening of hemoperitoneum. * **Renovascular Hypertension:** While Doppler can screen for Renal Artery Stenosis, **CT Angiography (CTA)** or **MR Angiography (MRA)** are the preferred diagnostic modalities. Digital Subtraction Angiography (DSA) remains the "gold standard." * **Renal Tuberculosis:** **Intravenous Urography (IVU)** or **CT Urography** are preferred to visualize the characteristic "moth-eaten" calyces, infundibular strictures, and phantom calyx. **High-Yield Clinical Pearls for NEET-PG:** * **Resistive Index (RI):** In a transplanted kidney, an RI > 0.7–0.8 on Doppler is a sensitive (though non-specific) indicator of graft dysfunction (e.g., rejection or obstruction). * **MAG3 Scan:** This is preferred over DTPA in transplants with poor function because it has higher extraction efficiency. * **Putty Kidney:** A classic radiological sign of end-stage Renal TB (autonephrectomy) seen on X-ray/CT.

Q: What is indicated by the arrow in the contrast X-ray abdomen?

Gastric ulcer. ***Gastric ulcer*** - Shows the classic **niche sign** on barium meal X-ray, appearing as a contrast-filled crater projecting beyond the normal gastric contour. - **Hampton's line** (thin radiolucent line at the base) and **mucosal folds radiating** toward the ulcer crater are characteristic features. *GIST* - Appears as a **submucosal filling defect** with smooth, well-defined margins on contrast studies. - Lacks the **niche sign** and mucosal fold convergence typical of ulcers, presenting as a mass lesion instead. *Carcinoma stomach* - Shows an **irregular filling defect** with **mucosal destruction** and **shouldering** (abrupt transition from normal to abnormal mucosa). - Demonstrates **loss of normal gastric distensibility** and rugal pattern destruction, unlike the focal crater of an ulcer. *Gastric polyp* - Presents as a **smooth, rounded filling defect** that projects into the gastric lumen without crater formation. - Shows **regular margins** and **mobile appearance** on fluoroscopy, contrasting with the fixed ulcer crater.

Q: Reflex nephropathy is diagnosed mainly by:

Micturating cystourethrogram. **Explanation:** **Reflux Nephropathy (RN)** is the result of chronic renal scarring caused by the retrograde flow of infected urine from the bladder into the kidneys, secondary to **Vesicoureteral Reflux (VUR)**. **Why Micturating Cystourethrogram (MCUG) is the Correct Answer:** MCUG (also known as Voiding Cystourethrogram/VCUG) is the **gold standard investigation** for diagnosing and grading VUR. It allows for the real-time visualization of the retrograde flow of contrast from the bladder into the ureters and renal pelvis during micturition. Identifying the presence and severity of reflux is the definitive step in diagnosing the underlying cause of reflux nephropathy. **Analysis of Incorrect Options:** * **X-ray KUB:** This is a plain radiograph primarily used to detect radiopaque calculi. It cannot visualize the ureters, bladder dynamics, or the presence of reflux. * **CT Scan:** While CT can show renal scarring or thinning of the cortex, it is not the primary modality for diagnosing VUR and involves high radiation exposure, which is undesirable in the pediatric population where RN is most commonly diagnosed. * **MRI Scan:** MR Urography can show structural changes, but it is expensive, often requires sedation in children, and is not the first-line diagnostic tool for reflux. **High-Yield Clinical Pearls for NEET-PG:** * **DMSA Scan:** While MCUG diagnoses the *reflux*, a **99mTc-DMSA scan** is the most sensitive investigation to detect the resulting **renal scarring** (the "nephropathy" component). * **Classic Presentation:** A child presenting with recurrent Urinary Tract Infections (UTIs) and hypertension. * **Radiological Sign:** Look for "clubbing" of the calyces and overlying cortical thinning on intravenous pyelography (IVP). * **Grading:** VUR is graded I to V based on the extent of contrast ascent and ureteral dilatation seen on MCUG.

Question 1

An elderly woman presented with abdominal pain and vomiting for three days. A computed tomogram of the abdomen was obtained. What is the diagnosis?

Accepted Answer

Obturator hernia

Answer

Cecal volvulus

Answer

Intussusception

Answer

Mesenteric ischemia

Question 2

What is the most sensitive and specific investigation for screening of renovascular hypertension?

Accepted Answer

Spiral CT Scan

Answer

MRI

Answer

Captopril enhanced radionuclide scan

Answer

Duplex – Doppler flow study

Question 3

What is the gold standard investigation for renal artery stenosis in a 21-year-old girl?

Accepted Answer

Renal angiography

Answer

Renal scan

Answer

Ultrasound Doppler

Answer

3D Contrast-enhanced MRA

Question 4

Which of the following is the earliest sign of ulcerative colitis on a double contrast barium enema (DCBE) study?

Accepted Answer

Fine mucosal granularity

Answer

Loss of haustrations

Answer

Collar-button ulcers

Answer

Lead pipe colon

Question 5

A patient presents with marked loin pain, tenderness, and pyrexia. Initial investigations reveal non-specific findings on IVP. Ultrasound shows a heterogeneous mass with posterior acoustic enhancement and central necrosis and internal debris. CT scan demonstrates marginal enhancement with air densities within. What is the likely diagnosis?

Accepted Answer

Renal abscess

Answer

Emphysematous pyelonephritis

Answer

Pyonephrosis

Answer

Acute pyelonephritis

Question 6

Ultrasound and radionuclide studies are primary imaging modalities used for the assessment of which of the following conditions?

Accepted Answer

Renal transplant

Answer

Renal trauma

Answer

Renovascular hypertension

Answer

Renal tuberculosis

Question 7

What is indicated by the arrow in the contrast X-ray abdomen?

Accepted Answer

Gastric ulcer

Answer

GIST

Answer

Carcinoma stomach

Answer

Gastric polyp

Question 8

A DTPA scan of a hypertensive young lady is normal, and the USG shows a small left kidney. What is the next investigation?

Accepted Answer

Digital subtraction angiography

Answer

CT scan of the abdomen

Answer

Retrograde pyelogram

Answer

DMSA scan

Question 9

Reflex nephropathy is diagnosed mainly by:

Accepted Answer

Micturating cystourethrogram

Answer

X-ray KUB

Answer

CT scan

Answer

MRI scan

Question 10

Imaging studies of a patient with a genetic disorder shows the 'central dot sign'. Which condition is characteristic of this finding?

Accepted Answer

Caroli's disease

Answer

Primary sclerosing cholangitis

Answer

Liver hemangioma

Answer

Polycystic liver disease

Abdominal and Pelvic Radiology — MCQs

Abdominal and Pelvic Radiology — MCQs

On this page

Practice by Chapter

Want unlimited practice?