Abdominal and Pelvic Radiology Practice Questions

Q: What is the diagnosis based on the barium meal study shown below?

Peptic ulcer disease. ***Peptic ulcer disease*** - The barium meal study shows a distinct **niche** (pocket of barium) within the gastric wall, indicated by the arrow, consistent with an **ulcer crater** - Additionally, there is evidence of **gastric wall edema** and possibly **converging folds** around the ulcer, which are typical radiographic findings in peptic ulcer disease - The smooth, round contour of the niche with radiating folds is characteristic of a **benign gastric ulcer** *Gastric carcinoma* - Gastric carcinoma typically appears as an **irregular, nodular filling defect** with shouldering and abrupt transitions - Malignant ulcers have **irregular margins**, do not show converging folds, and lack the smooth contour seen in this image - The benign features of the ulcer crater here make carcinoma unlikely *Esophageal varices* - Esophageal varices would appear as **serpiginous filling defects** or a "rosary bead" appearance within the esophagus - They are not typically seen in the stomach and do not create a niche or ulcer crater - This image shows findings in the stomach or duodenum, not the esophagus *Hiatal hernia* - Hiatal hernia presents as **herniation of the gastric fundus** through the diaphragmatic hiatus into the thoracic cavity - It appears as a **retrocardiac gas bubble** or mass above the diaphragm on barium studies - No evidence of herniation or diaphragmatic abnormality is seen in this image; the findings are localized to an ulcer crater

Q: A 62-year-old male presented with signs and symptoms of intestinal obstruction. Radiological image of the patient is given. What is the sign that is illustrated in the image?

Apple core sign. ***Apple core sign*** - This sign, also known as the **"napkin ring" sign**, is characteristic of a **constricting colorectal carcinoma** seen on barium enema. - The lesion causes a sharp, irregular narrowing of the bowel lumen with overhanging edges, resembling an apple core after a bite has been taken. *Lead pipe sign* - The **"lead pipe" sign** refers to the loss of **haustral markings** and colonic shortening, giving the colon a smooth, rigid, and narrow appearance. - This finding is typically associated with **chronic ulcerative colitis**. *Saw tooth sign* - The **"saw tooth" sign** is characteristic of **diverticulosis**, where the muscular layers of the colon hypertrophy, creating a serrated appearance in the barium column. - This is due to the presence of sacculations and spiky muscular contractions. *Cobble stone* - The **"cobblestone" appearance** describes the irregular, nodular pattern of the mucosal surface of the colon due to **deep ulcerations** crisscrossing with **edematous mucosa**. - This finding is typically seen in **Crohn's disease**, particularly in the small bowel and colon.

Q: A 26-year-old construction worker with a previous history of recurrent kidney stones presents with flank pain. What is the radiological sign demonstrated in the IVP image shown below?

Rim sign. ***Rim sign*** - The image shows a **calcified rim around a radiolucent (non-calcified) center**, which is characteristic of a **calcium oxalate monohydrate stone** on an intravenous pyelogram (IVP). - This sign is also known as the **"lucent-centered calculus"** or **"target sign"** and indicates a partially calcified stone. *Ring sign* - The **ring sign** can refer to various appearances in medical imaging, often indicating a **ring-enhancing lesion** on CT or MRI, which is not applicable to a kidney stone on IVP. - In renal imaging, a ring sign might describe a collection of contrast medium around a tumor or cyst, but not typically a stone with a radiolucent center. *Egg in cup appearance* - This sign is typically associated with **osteochondroma or enchondroma** lesions in bone imaging, where the cartilage cap creates a "cup" for the medullary bone to grow into. - It is not a recognized sign for kidney stones. *Sun burst appearance* - The **sun burst appearance** is characteristic of certain **bone tumors**, particularly **osteosarcoma**, where new bone forms perpendicular to the bone surface. - This description does not apply to the radiological features of kidney stones on IVP.

Q: What is the radiological sign shown in the image?

Adder head. ***Adder head*** - The image displays an **intravenous pyelogram (IVP)**, and the "adder head" sign refers to the characteristic appearance of the dilated ureter and renal pelvis (renal collecting system) due to an **ureterocele**. - An **ureterocele** is a congenital dilatation of the distal part of the ureter as it enters the bladder, causing a filling defect and proximal hydronephrosis resembling a **snake's head** on an IVP. *Flower vase* - This is not a recognized radiological sign for the pathology shown. - The appearance of the collecting system, specifically the ureter proximal to the ureterocele, does not resemble a flower vase. *Spider leg* - The "spider leg" or "spidery" appearance is associated with **polyarteritis nodosa (PAN)** in renal angiography, where multiple microaneurysms and stenoses of small renal arteries give a spidery pattern. - The image here is an IVP showing the collecting system, not an angiogram of renal vessels. *Flower bouquet* - This is not a recognized radiological sign for the pathology shown. - The configuration of the collecting system in this IVP does not depict a flower bouquet.

Q: What is the radiological sign that could best describe this image?

Cobra head sign. ***Cobra head sign*** - This sign is seen in the setting of a **ureterocele**, which is a cystic dilatation of the intravesical (within the bladder) portion of the ureter. - On intravenous urography (IVU) or retrograde pyelography, the dilated ureterocele appears as a filling defect within the bladder, outlined by contrast, creating the characteristic "cobra head" or "spring onion" appearance. *Rim sign* - The **rim sign** is typically associated with **renal calculi** (kidney stones). - It refers to a thin rim of soft tissue or gas surrounding a radiolucent stone, which can sometimes be seen on CT scans. *Fish hook bladder* - This term describes the shape of the bladder in cases of **benign prostatic hyperplasia (BPH)**. - Due to the enlarged prostate elevating and distorting the bladder base, the contrast-filled bladder appears elongated and curved, resembling a fish hook on a cystogram. *Soap bubble* - The "soap bubble" appearance is often used to describe **multiloculated cystic masses** or certain types of tumors, particularly in bone lesions (e.g., aneurysmal bone cyst, fibrous dysplasia). - It refers to multiple small, rounded lucencies giving a bubbly or multicystic appearance on imaging.

Q: The given CT abdomen shows:

Acute pancreatitis. ***Acute pancreatitis*** - The CT image reveals signs of acute pancreatitis, characterized by diffuse **enlargement and blurring of the pancreatic margins**, along with **peripancreatic fat stranding** and **fluid collections**, particularly around the tail of the pancreas. - These findings are indicative of **inflammation and edema** within and around the pancreas, consistent with an acute inflammatory process. *Acute hepatitis* - Acute hepatitis typically presents with **diffuse liver enlargement**, **edema**, and sometimes periportal edema or gallbladder wall thickening, which are not the primary findings here. - While the liver appears somewhat enlarged and heterogeneous, the extensive peripancreatic inflammation and fluid collections point away from primary liver pathology. *Acute cholecystitis* - Acute cholecystitis is characterized by **gallbladder wall thickening**, **pericholecystic fluid**, and sometimes gallstones, which are not visible or prominent enough to be the primary diagnosis in this image. - The pathology seen is clearly centered around the pancreas, not the gallbladder. *Pseudo-pancreatic cyst* - A pancreatic pseudocyst would appear as a **well-defined, encapsulated fluid collection**, often occurring weeks after an episode of acute pancreatitis. - In this image, the fluid collections are **ill-defined** and appear to be part of an acute inflammatory process with fat stranding rather than a mature, encapsulated pseudocyst.

Q: CECT abdomen of a patient with acute abdomen is given below. What is the diagnosis?

Acute pancreatitis. ***Acute pancreatitis*** - The CECT image shows **peripancreatic fat stranding** and **fluid collection** (highlighted by the arrow), which are classic signs of acute pancreatitis. - The pancreas itself appears **enlarged** and **edematous** with areas of inflammatory changes. *Renal colic* - Renal colic typically presents with a **calculus (kidney stone)** in the ureter or renal pelvis, possibly with **hydronephrosis**. - No such features are visible in the provided image; the kidneys appear unremarkable. *PUD perforation* - A perforated peptic ulcer would show **free air under the diaphragm** on an upright chest X-ray or **free intra-abdominal air** on CT. - The image does not demonstrate any free intra-abdominal air, and the stomach and duodenum do not show signs of perforation. *Rectus sheath hematoma* - A rectus sheath hematoma would present as a **well-defined, high-density collection within the rectus abdominis muscle** or between the muscle and its sheath. - This image shows diffuse retroperitoneal inflammation and fluid collection, not confined to the rectus sheath.

Q: The CT abdomen of a 10-year-old child with high grade fever for last 5 days shows:

Liver abscess. ***Liver abscess*** - The CT image shows a well-defined, **hypodense lesion** within the right lobe of the liver, consistent with the characteristic appearance of a **liver abscess**, especially in a child presenting with **high-grade fever**. - Liver abscesses are collections of pus that can form in the liver, often presenting with fever, abdominal pain, and leukocytosis. *Typhlitis* - This condition involves inflammation of the **cecum** and ascending colon, often seen in **immunocompromised patients** (neutropenic enterocolitis). - CT findings would typically show **cecal wall thickening** and surrounding inflammation, which is not depicted in the image. *Acute pancreatitis* - This is an inflammation of the pancreas, usually presenting with severe **epigastric pain** radiating to the back. - CT findings would include **pancreatic edema**, fat stranding, and potentially fluid collections around the pancreas, none of which are evident in the provided image. *Biloma* - A biloma is a collection of **bile** that occurs due to leakage from the biliary tree, usually after trauma or surgery. - While it appears as a fluid collection, it typically lacks the often **irregular enhancing rim** or internal septations sometimes seen in abscesses, and the clinical context of high fever points more towards an infectious process.

Q: A 25-year-old patient underwent surgery for scoliosis correction. 5 days post-operatively he develops voluminous bilious vomiting. The given CT abdomen shows:

SMA syndrome. ***SMA syndrome*** - The CT image shows significant **duodenal distention** proximal to the **superior mesenteric artery (SMA)**, characteristic of SMA syndrome. The arrow points to the **compressed third part of the duodenum** between the SMA and the aorta. - This condition is often seen post-scoliosis correction surgery due to rapid **spinal extension**, which can decrease the **aortomesenteric angle** and compress the duodenum, leading to **bilious vomiting**. *Paralytic ileus* - While ileus can cause vomiting and bowel distension, it typically involves **diffuse gaseous distension** of both small and large bowels without a discrete point of obstruction like the compressed duodenum seen here. - The clinical presentation of paralytic ileus post-operatively is more often characterized by generalized **absent bowel sounds** and abdominal distension, rather than specific bilious vomiting from high obstruction. *Pneumoperitoneum* - This refers to the presence of **free air in the abdominal cavity**, usually indicating a **visceral perforation**. - The provided CT image does not show any evidence of free air, and the presenting symptom of bilious vomiting is more indicative of obstruction. *Paravertebral abscess* - A paravertebral abscess would appear as a **fluid collection adjacent to the spine**, which is not depicted on this CT scan. - Clinical symptoms would likely include **fever, severe localized back pain**, and possibly neurological deficits, differing from the purely obstructive symptoms described.

Q: Identify the condition shown in the figure:

Pneumoperitoneum. ***Pneumoperitoneum*** - The image clearly demonstrates **free air** (dark, lucent areas) within the abdominal cavity, particularly seen under the **diaphragm** and anteriorly, which is characteristic of pneumoperitoneum. - The arrow specifically points to a bright, calcific density, which could represent a **gallstone** but the primary and most striking finding is the free air, consistent with perforation. *Calculous cholecystitis* - This condition is characterized by **gallstones** (which may or may not be seen in the image, although a calcification is pointed to) accompanied by gallbladder wall thickening and pericholecystic fluid, which are not the predominant findings here. - While a stone is visible near the gallbladder, the presence of diffuse free air throughout the abdomen makes calculous cholecystitis an unlikely primary diagnosis unless it has led to **perforation**. *Acute pancreatitis* - Acute pancreatitis typically presents with **pancreatic enlargement**, inflammation, and often peripancreatic fluid collections or necrosis. - These findings are not primarily depicted, and there is no evidence of the characteristic inflammation surrounding the pancreas in the given image. *Liver abscess* - A liver abscess would appear as a **hypodense (darker) lesion** within the liver parenchyma, often with a rim of enhancement, indicating a collection of pus. - Such a focal lesion within the liver is not the main finding, and the presence of widespread free air points to a different pathology.

Question 1

What is the diagnosis based on the barium meal study shown below?

Accepted Answer

Peptic ulcer disease

Answer

Esophageal varices

Answer

Gastric carcinoma

Answer

Hiatal hernia

Question 2

A 62-year-old male presented with signs and symptoms of intestinal obstruction. Radiological image of the patient is given. What is the sign that is illustrated in the image?

Accepted Answer

Apple core sign

Answer

Lead pipe sign

Answer

Saw tooth sign

Answer

Cobblestone appearance

Question 3

A 26-year-old construction worker with a previous history of recurrent kidney stones presents with flank pain. What is the radiological sign demonstrated in the IVP image shown below?

Accepted Answer

Rim sign

Answer

Ring sign

Answer

Egg in cup appearance

Answer

Sun burst appearance

Question 4

What is the radiological sign shown in the image?

Accepted Answer

Adder head

Answer

Flower vase

Answer

Spider leg

Answer

Flower bouquet

Question 5

What is the radiological sign that could best describe this image?

Accepted Answer

Cobra head sign

Answer

Rim sign

Answer

Fish hook bladder

Answer

Soap bubble

Question 6

The given CT abdomen shows:

Accepted Answer

Acute pancreatitis

Answer

Acute hepatitis

Answer

Acute cholecystitis

Answer

Pseudo-pancreatic cyst

Question 7

CECT abdomen of a patient with acute abdomen is given below. What is the diagnosis?

Accepted Answer

Acute pancreatitis

Answer

Renal colic

Answer

PUD perforation

Answer

Rectus sheath hematoma

Question 8

The CT abdomen of a 10-year-old child with high grade fever for last 5 days shows:

Accepted Answer

Liver abscess

Answer

Typhlitis

Answer

Acute pancreatitis

Answer

Biloma

Question 9

A 25-year-old patient underwent surgery for scoliosis correction. 5 days post-operatively he develops voluminous bilious vomiting. The given CT abdomen shows:

Accepted Answer

SMA syndrome

Answer

Paralytic ileus

Answer

Pneumoperitoneum

Answer

Paravertebral abscess

Question 10

Identify the condition shown in the figure:

Accepted Answer

Pneumoperitoneum

Answer

Calculous cholecystitis

Answer

Acute pancreatitis

Answer

Liver abscess

Abdominal and Pelvic Radiology — MCQs

Abdominal and Pelvic Radiology — MCQs

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