Abdominal and Pelvic Radiology Practice Questions

Q: A 28-year-old male patient presents with colicky abdominal pain along with vomiting. X-ray abdomen shows:

Small bowel obstruction. ***Small bowel obstruction*** - The X-ray image shows multiple **dilated loops of small bowel** with **air-fluid levels** and prominent **valvulae conniventes** (herringbone pattern), which are classic signs of small bowel obstruction. - The clinical presentation of **colicky abdominal pain** and **vomiting** is highly consistent with a small bowel obstruction. *Pseudo-obstruction* - Pseudo-obstruction, or Ogilvie's syndrome, primarily affects the **large bowel**, leading to colonic dilation without a mechanical obstruction. - While it can cause abdominal pain and vomiting, the X-ray findings would typically show marked dilation of the colon rather than predominantly small bowel loops. *Cancer colon* - Colon cancer, if it causes obstruction, typically presents as a **large bowel obstruction**, with colonic dilation proximal to the tumor. - While severe cases could lead to cecal dilation and subsequent small bowel obstruction, the primary radiographic findings would focus on the colon. *Paralytic ileus* - Paralytic ileus, or adynamic ileus, involves generalized bowel dilation (both small and large bowel) due to **impaired peristalsis**, without mechanical obstruction. - Although it causes abdominal pain and vomiting, it usually presents with more continuous, less colicky pain, and the X-ray often shows gas in the colon, which is typically absent or minimal in a complete small bowel obstruction.

Q: This young patient presented with acute right lower abdominal pain. What is the possible diagnosis?

Acute appendicitis. ***Acute appendicitis*** - The CT scan shows a dilated, **thickened appendix** measuring 17 mm in diameter, which is a classic finding for acute appendicitis. - The patient's presentation with acute right lower abdominal pain is highly consistent with this diagnosis. *Acute salpingo-oophoritis* - This condition involves inflammation of the **fallopian tubes and ovaries** due to infection, typically causing bilateral lower abdominal pain and fever. - The image does not show findings specific to salpingo-oophoritis, such as **tubo-ovarian abscess** or significant adnexal inflammation. *Ruptured ectopic pregnancy* - A ruptured ectopic pregnancy would typically present with severe lower abdominal pain, **vaginal bleeding**, and hemodynamic instability in a female patient, none of which are described. - Imaging would typically show **pelvic free fluid** and an adnexal mass, rather than an inflamed appendix. *Intestinal obstruction due to Meckel's diverticulum* - Intestinal obstruction would present with **abdominal distension**, vomiting, and changes in bowel habits, which are not mentioned in the patient's presentation. - While Meckel's diverticulum can cause obstruction, the primary finding on this CT is a **dilated appendix**, not bowel obstruction.

Q: The given barium enema is diagnostic of:

Toxic megacolon. ***Toxic megacolon*** - The barium enema shows **marked colonic dilatation** and loss of **haustral folds** (the normal sacculations of the colon), which are classic features of toxic megacolon. - The dilated colon with absent haustrations indicates severe inflammation and paralysis of the colonic smooth muscle, often seen in severe inflammatory bowel disease. *Carcinoma colon* - Colorectal carcinoma typically presents as a **focal mass**, **apple-core lesion**, or a stricture with irregular borders on barium enema, not diffuse dilatation. - It would not cause the widespread loss of haustral markings seen in the image. *Angiodysplasia colon* - **Angiodysplasia** is characterized by submucosal vascular malformations and is usually diagnosed by **colonoscopy** with characteristic red spots or bleeding from the lesion. - It does not typically cause luminal changes visible on barium enema, nor diffuse colonic dilatation. *Normal study* - A normal barium enema would show consistently sized colon with **intact haustral markings** throughout. - The imaging clearly demonstrates significant abnormalities, including dilatation and loss of haustrations, ruling out a normal study.

Q: The following barium meal shows:

Gastric outlet obstruction. ***Gastric outlet obstruction*** - The barium meal shows a **markedly distended stomach** with a large amount of retained contrast material filling the stomach, indicating impaired emptying. - There is minimal or no passage of barium into the duodenum, characteristic of a **physical barrier** preventing gastric emptying. *Normal study* - A normal barium meal would show the contrast passing readily from the stomach into the **duodenum and small bowel** within a short period. - The stomach size and emptying rate would be within typical physiological limits, unlike the distension seen here. *Esophageal varices* - Esophageal varices would appear as **irregular, serpiginous filling defects** within the esophagus, which is not the primary finding in this image. - The major abnormality seen is related to gastric emptying, not esophageal morphology. *Gastric antral vascular ectasia* - Gastric antral vascular ectasia (water-melon stomach) typically appears as **longitudinal red streaks or spots** in the antrum on endoscopy. - It would not manifest as severe gastric distention and obstruction to outflow on a barium meal; radiological findings are often subtle or related to mucosal abnormalities.

Q: The following ERCP report is diagnostic of:

Choledochal cyst. ***Choledochal cyst*** - The ERCP image shows a **fusiform dilatation of the common bile duct**, which is characteristic of a choledochal cyst (specifically, a Type I cyst). - The arrow points to this **saccular or fusiform dilation** of the extrahepatic biliary tree. *Stone* - Biliary stones would appear as **filling defects** within the bile duct, often creating a meniscus sign or an abrupt interruption of contrast flow. - The image does not show any such defects or sudden obstructions but rather a smooth, expanded segment. *Stricture* - A stricture would manifest as a **narrowing** of the bile duct, typically with proximal dilatation due to obstruction. - The image clearly demonstrates a **dilated segment**, not a constriction. *Cholangitis* - Cholangitis is an **inflammation of the bile ducts**, often due to obstruction (e.g., by stones or strictures) but is a clinical diagnosis and not typically directly depicted as a specific morphological finding on ERCP, but rather its underlying cause. - While ERCP can help diagnose the *cause* of cholangitis (e.g., stones or strictures), the primary finding here is a structural anomaly (dilatation) rather than inflammatory changes themselves.

Q: A 50-year-old man went for his annual medical check-up. CT scan is shown below. Diagnosis is?

Renal angiomyolipoma. ***Renal angiomyolipoma*** - The CT scan shows a renal mass with areas of **macroscopic fat density**, which is the hallmark of an angiomyolipoma. - Angiomyolipomas are **benign renal tumors** composed of variable amounts of smooth muscle, vascular tissue, and mature adipose tissue. *Renal cell carcinoma* - While renal cell carcinoma can present as a solid renal mass, it typically does **not contain macroscopic fat**. - It usually enhances heterogeneously with contrast and may show areas of necrosis or hemorrhage, but the presence of fat rules out typical RCC. *Renal cyst* - Renal cysts are typically **simple fluid-filled structures** with very low attenuation values (close to water) and **do not contain solid components or fat**. - They also have thin, imperceptible walls and do not enhance with contrast. *Rhabdomyosarcoma* - Rhabdomyosarcomas are **malignant soft tissue tumors** rarely found in the kidney, and would appear as a solid, often heterogeneous mass on CT. - They do **not contain fat** and are aggressive tumors, often associated with a different patient demographic (e.g., children).

Q: The following image shows the presence of?

Bladder stone. ***Bladder stone*** - The image displays multiple **radiopaque densities** (stones) clustered within the pelvic cavity, specifically in the region where the urinary bladder is anatomically located. - The aggregation and rounded shapes are characteristic of **vesical calculi** (bladder stones). *Ureter stone* - **Ureteral stones** would typically appear as a single or a few stones following the course of the ureters, which are tubular structures extending from the kidneys to the bladder. - The diffuse, multi-focal collection seen in the image is not consistent with the typical presentation of a ureteric calculus. *Urethral stone* - A **urethral stone** would be located within the urethra, which is inferior to the bladder and would typically present as a single, elongated calculus in the distal urinary tract. - The location and multiple, scattered appearance in the image do not match a urethral stone. *Prostate calcification* - **Prostatic calcifications** are usually smaller, often punctate, and concentrated within the confines of the prostatic gland, typically inferior to the bladder neck. - The calcifications in the image are larger and more widely distributed, not confined to the typical anatomical borders of the prostate.

Q: Identify the grade of vesico-ureteric reflux in the picture below?

Grade V. ***Grade V*** - This image shows **severe dilation** and **tortuosity of the ureter**, along with **blunting of the renal calyces** and loss of papillary impressions, extending all the way to the renal pelvis. - Grade V VUR indicates the most severe form of reflux, with significant distortion of the pelvicalyceal system, often associated with **renal parenchymal damage**. *Grade II* - Grade II VUR involves reflux into the **ureter, renal pelvis, and calyces**, but with **no dilation** and normal calyces. - The image clearly displays significant dilation and blunting of calyces, which is beyond Grade II. *Grade III* - In Grade III VUR, there is reflux into the **ureter** and **pelvicalyceal system (renal pelvis and calyces)** with **mild to moderate dilation** and slight blunting of the calyces. - The marked tortuosity and severe dilation seen in the image exceed the characteristics of Grade III. *Grade IV* - Grade IV VUR is characterized by **moderate to severe dilation** and **tortuosity of the ureter** and pelvicalyceal system, with **moderate blunting** of the calyces. - While there is severe dilation and tortuosity, the extent of calycial blunting and loss of papillary impressions in the image is more consistent with Grade V.

Q: An abdominal X-ray of a patient with ulcerative colitis shows peripheral placed bowel dilatations with loss of haustrations. The transverse colon diameter measures 7 cm. The image shown is characteristic of:

Toxic megacolon. ***Toxic megacolon*** - The description of **peripheral placed bowel dilatations**, loss of haustrations, and large bowel dilatation with a transverse/ascending colon diameter >6cm are classic radiological signs of **toxic megacolon**. - This condition is often seen in patients with **ulcerative colitis (UC)** and can be triggered by factors like electrolyte abnormalities and narcotics, as mentioned in the question. *Intestinal pneumatosis* - This condition is characterized by the presence of **intramural bowel gas**, which means gas within the wall of the intestine. - While it can be a severe condition and is seen in some acute abdominal pathologies like necrotizing enterocolitis, it is not primarily described by the given features of lumenal dilatation and loss of haustrations. *Volvulus* - **Volvulus** refers to the twisting of a section of the bowel on its mesentery, leading to obstruction and potentially ischemia. - The radiological hallmark is often a **"coffee bean sign"** (in sigmoid volvulus) or a significantly dilated loop of bowel at the site of torsion, which is distinct from the diffuse peripheral dilatation and loss of haustrations described. *Ileus* - **Ileus** is a functional obstruction of the bowel due to the temporary arrest of intestinal peristalsis. - While it involves bowel dilatation, it typically affects both small and large bowel somewhat uniformly, and the description of **loss of haustrations** and specific diameter cutoffs for the transverse/ascending colon are more indicative of toxic megacolon.

Q: The image shows:

Acute pancreatitis. ***Acute pancreatitis*** - The image shows an **enlarged, edematous pancreas** with surrounding **stranding of the peripancreatic fat**, indicated by the white arrows and suggesting inflammation. - There is also evidence of **fluid collection** adjacent to the pancreas, a common finding in acute pancreatitis. *Chronic pancreatitis* - Chronic pancreatitis typically presents with pancreatic **atrophy**, **calcifications** within the parenchyma and ducts, and **ductal dilation**. - While calcifications are present, the primary findings of a swollen pancreas and peripancreatic edema are more indicative of an acute process. *Pancreatic divisum* - Pancreatic divisum is a **congenital anomaly** where the dorsal and ventral pancreatic ducts fail to fuse, and it is a predisposing factor for pancreatitis, but the image shows findings of an inflammatory process rather than an anatomical variant. - The image exhibits signs of inflammation and fluid collection, not the distinct ductal anatomy of pancreatic divisum itself. *Artefact* - Artefacts on a CT scan can include **beam hardening**, **motion artefacts**, or **streak artefacts**, which typically appear as streaks, distorted images, or areas of abnormal signal. - The observed features—pancreatic enlargement, peripancreatic fat stranding, and fluid collection—are clear anatomical and pathological changes, not image anomalies.

Question 1

A 28-year-old male patient presents with colicky abdominal pain along with vomiting. X-ray abdomen shows:

Accepted Answer

Small bowel obstruction

Answer

Pseudo-obstruction

Answer

Cancer colon

Answer

Paralytic ileus

Question 2

This young patient presented with acute right lower abdominal pain. What is the possible diagnosis?

Accepted Answer

Acute appendicitis

Answer

Acute salpingo-oophoritis

Answer

Ruptured ectopic pregnancy

Answer

Intestinal obstruction due to Meckel's diverticulum

Question 3

The given barium enema is diagnostic of:

Accepted Answer

Toxic megacolon

Answer

Carcinoma colon

Answer

Angiodysplasia colon

Answer

Normal study

Question 4

The following barium meal shows:

Accepted Answer

Gastric outlet obstruction

Answer

Normal study

Answer

Esophageal varices

Answer

Gastric antral vascular ectasia

Question 5

The following ERCP report is diagnostic of:

Accepted Answer

Choledochal cyst

Answer

Stone

Answer

Stricture

Answer

Cholangitis

Question 6

A 50-year-old man went for his annual medical check-up. CT scan is shown below. Diagnosis is?

Accepted Answer

Renal angiomyolipoma

Answer

Renal cell carcinoma

Answer

Renal cyst

Answer

Rhabdomyosarcoma

Question 7

The following image shows the presence of?

Accepted Answer

Bladder stone

Answer

Ureter stone

Answer

Urethral stone

Answer

Prostate calcification

Question 8

Identify the grade of vesico-ureteric reflux in the picture below?

Accepted Answer

Grade V

Answer

Grade II

Answer

Grade III

Answer

Grade IV

Question 9

An abdominal X-ray of a patient with ulcerative colitis shows peripheral placed bowel dilatations with loss of haustrations. The transverse colon diameter measures 7 cm. The image shown is characteristic of:

Accepted Answer

Toxic megacolon

Answer

Intestinal pneumatosis

Answer

Volvulus

Answer

Ileus

Question 10

The image shows:

Accepted Answer

Acute pancreatitis

Answer

Chronic pancreatitis

Answer

Pancreatic divisum

Answer

Artefact

Abdominal and Pelvic Radiology — MCQs

Abdominal and Pelvic Radiology — MCQs

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