Abdominal and Pelvic Radiology Practice Questions

Q: Chain of lakes appearance is seen in?

Chronic pancreatitis. ***Chronic pancreatitis*** - The **"chain of lakes" appearance** refers to the characteristic imaging finding of **multiple dilated pancreatic ducts** with intervening strictures, indicative of chronic inflammation and fibrosis. - This morphology is a hallmark of advanced chronic pancreatitis on **ERCP or MRCP**, reflecting irreversible damage to the pancreatic ductal system. *Gallstone ileus* - Characterized by **mechanical obstruction of the small intestine** by a gallstone that has entered the bowel lumen through a cholecystoenteric fistula. - Imaging shows signs of small bowel obstruction, pneumobilia, and ectopic gallstone, not pancreatic ductal abnormalities. *Sub-acute intestinal obstruction* - Refers to partial or intermittent bowel obstruction with features like abdominal pain, distension, vomiting, and altered bowel habits. - Imaging findings relate to dilated bowel loops proximal to the obstruction, not pancreatic duct changes. *Acute pancreatitis* - While acute pancreatitis can involve ductal inflammation and occasionally transient dilation, it does not present with the **permanent "chain of lakes" morphology** seen in chronic disease. - Acute pancreatitis shows peripancreatic inflammation, fluid collections, or necrosis rather than chronic ductal strictures and dilatations.

Q: What are the bilateral radiopaque structures extending from the renal pelvis to the bladder seen in this abdominal X-ray?

Stent. ***Stent*** - The image shows **bilateral coiled structures** (pigtail curls) in the renal pelvis and bladder, connected by a thin tube. This morphology is characteristic of **double-J ureteral stents**, which are used to maintain patency of the ureters. - The stents are radiopaque, as commonly seen in their composition (e.g., silicone with a metallic core or specific polymers), making them visible on X-ray. *Surgical clips* - **Surgical clips** are typically small, metallic, and used to ligate vessels or mark surgical sites. They appear as tiny, dense, uniform structures and do not have the elongated, coiled appearance seen here. - While there may be clips elsewhere in the abdomen, the prominent tubular structures with coiled ends are not surgical clips. *Foley catheter* - A **Foley catheter** is a tube placed in the bladder, typically with an inflatable balloon to secure it, and is visible as a single tube. - It would not extend up into the renal pelvis bilaterally and does not have the double-coiled configuration seen in the image. *Intravesical wire* - An **intravesical wire** (e.g., a guide wire used during a procedure) would appear as a single, thin, metallic, flexible line, often without the distinct coils at both ends. - The structures present are more substantial and clearly designed to maintain luminal patency over time, unlike a temporary guide wire.

Q: Which of the following HSG findings is most suggestive of genital tuberculosis?

Beaded tubes. ***Beaded tubes*** - **Beading** of the fallopian tubes on hysterosalpingography (HSG) is **the most characteristic finding** of **genital tuberculosis (GTB)**, representing multiple strictures and dilatations. - This appearance is due to the characteristic **granulomatous inflammation** and subsequent fibrosis that occur with tuberculous salpingitis, creating a **"rosary bead" or "string of pearls"** pattern. - This is considered the **most specific HSG sign** for genital TB. *Honeycomb uterus* - A **honeycomb uterus** appearance on HSG shows multiple small filling defects in the endometrial cavity. - This is more commonly associated with **synechiae (Asherman's syndrome)** or advanced **endometrial tuberculosis**, but is not the most suggestive finding. *Golf club tube* - A **golf club tube** appearance refers to a **dilated fallopian tube with a rounded, blunt end** that has lost its fimbrial integrity, seen in **hydrosalpinx**. - While hydrosalpinx can occur due to GTB, this finding is **non-specific** and can result from any chronic salpingitis (PID, post-infectious). *Pipe stem tubes* - **Pipe stem** or **rigid tubes** show straightened, non-dilated fallopian tubes due to fibrosis. - While this can be seen in genital TB, it is **less specific** than the beaded appearance and can occur in other chronic inflammatory conditions.

Q: Which imaging modality is considered the best for staging rectal carcinoma?

MRI. ***MRI*** - **Magnetic Resonance Imaging (MRI)** provides excellent soft tissue contrast, allowing for detailed visualization of the rectal wall layers, mesorectal fascia, and adjacent structures. - This high resolution is crucial for accurate **T-staging (tumor depth of invasion)** and assessment of **nodal involvement**, guiding treatment decisions like neoadjuvant therapy. *CT Scan* - **CT scans** are better for detecting distant metastases (e.g., in the liver or lungs) and assessing vascular involvement, rather than local staging of the primary tumor. - Its soft tissue resolution is inferior to MRI for distinguishing between the different layers of the rectal wall and for precise mesorectal fascia involvement. *TRUS* - **Transrectal ultrasound (TRUS)** is effective for evaluating superficial tumors and their depth of invasion within the rectal wall. - However, it has a limited field of view and is less reliable for assessing mesorectal fascia involvement or metastatic lymph nodes far from the rectal wall. *None of the options* - This option is incorrect because MRI is indeed the preferred imaging modality for precise local staging of rectal carcinoma due to its superior soft tissue resolution. - Accurate staging is critical for determining the appropriate treatment strategy, including the need for neoadjuvant chemoradiotherapy.

Q: Investigation of choice for detecting hepatic metastasis from stomach cancer is

CECT. ***CECT*** - **Contrast-Enhanced Computed Tomography (CECT)** is the **primary investigation of choice** for detecting **hepatic metastases from gastric cancer** due to its widespread availability, speed, and high spatial resolution. - Multi-phase CECT (arterial, portal venous, and delayed phases) effectively visualizes liver parenchyma and identifies most metastatic lesions with high sensitivity. - It provides excellent anatomical detail for **surgical planning** and **treatment decisions**. *Magnetic Resonance Imaging (MRI)* - While **MRI** with liver-specific contrast agents (e.g., gadoxetate disodium) offers superior **soft tissue contrast** and can be more sensitive for smaller or atypical lesions. - It is typically reserved as a **second-line investigation** when CECT findings are equivocal, for characterization of indeterminate lesions, or for detailed surgical planning, rather than the initial investigation of choice. *PET-CT* - **Positron Emission Tomography-Computed Tomography (PET-CT)** is highly effective for detecting metabolically active lesions and is useful for **whole-body staging and identifying distant metastases** beyond the liver. - However, it's not the primary investigation solely for **hepatic metastasis** due to lower spatial resolution compared to CECT, higher cost, limited availability, and greater radiation exposure. *Ultrasound (USG)* - **Ultrasound** is often used as an initial screening tool for abdominal pathologies due to its accessibility, low cost, and lack of radiation. - Its sensitivity for detecting small or deeply located **hepatic metastases** is limited compared to CECT, making it unsuitable as the definitive investigation of choice for staging gastric cancer.

Q: Which of the following is a direct (primary) sign of obstruction of the urinary tract on a CT scan?

Hydroureter. ***Hydroureter*** - **Hydroureter** (dilation of the ureter) is a **direct/primary sign** of urinary tract obstruction on CT scan. - It represents the physical consequence of upstream blockage and is a **direct visualization** of the obstructed collecting system. - On CT, a dilated ureter proximal to the point of obstruction is the most specific radiological evidence of ureteral obstruction. *Perinephric stranding* - **Perinephric stranding** represents edema in the perinephric fat and is a **secondary/indirect sign** of obstruction. - While commonly seen with acute ureteral obstruction (as part of renal inflammatory response), it is **not a direct sign** of the obstruction itself. - It can also occur with pyelonephritis, trauma, or other inflammatory processes, making it less specific. *Thickening of the lateroconal fascia* - **Lateroconal fascia thickening** is another **secondary/indirect sign** that can accompany urinary tract obstruction. - It reflects inflammatory changes in the retroperitoneal fascial planes adjacent to an obstructed kidney. - Like perinephric stranding, it is a non-specific finding that can occur with various retroperitoneal inflammatory processes. *None of the options* - This option is incorrect because **hydroureter** is a well-established direct sign of urinary tract obstruction on CT scan.

Q: Percentage of renal stones which are radio-opaque:

80. ***80*** - Approximately **80%** of renal stones are radio-opaque, making them visible on X-rays and CT scans [1]. - This high percentage is primarily due to the composition of most stones, such as **calcium oxalate** and **calcium phosphate** [1]. *20* - Only **20%** of renal stones are typically radio-opaque, which is significantly lower than the actual statistic. - This option fails to account for the majority of stones that are indeed visible on radiographic imaging. *40* - A **40%** radio-opacity would indicate a much larger proportion of stones being less visible on imaging, which is inaccurate. - The range for radio-opaque stones is considerably higher, primarily due to common stone types. *60* - While **60%** might suggest a considerable portion of stones are radio-opaque, it still underestimates the actual prevalence. - The more accurate figure reflects that at least **80%** of stones show radio-opacity which aids in diagnosis. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Diseases Of The Urinary And Male Genital Tracts, pp. 491-492.

Q: Which of the following is a radiological sign of acute pancreatitis on plain radiography?

Sentinel loop sign. ***Sentinel loop sign*** - The **sentinel loop sign** refers to a focally dilated segment of small bowel (usually proximal jejunum) adjacent to an inflamed pancreas due to localized ileus. - This sign is often visible on **plain abdominal radiographs** in cases of acute pancreatitis. *Murphy's sign* - **Murphy's sign** is a clinical finding, not a radiological sign, characterized by inspiratory arrest upon deep palpation of the right upper quadrant. - It is classically associated with **acute cholecystitis**, not acute pancreatitis. *Renal halo sign* - The **renal halo sign** is a radiological finding (typically on CT) describing perinephric fat stranding that can be seen in various renal pathologies, not acute pancreatitis. - It is not a characteristic sign of pancreatic inflammation on plain radiography. *Grey Turner's sign* - **Grey Turner's sign** is a clinical sign characterized by ecchymosis or discoloration of the flanks. - It indicates **retroperitoneal hemorrhage**, which can be a severe complication of acute pancreatitis but is not a radiological sign itself and is not specific to acute pancreatitis on plain X-ray.

Q: The 'coffee bean sign' is typically seen in which condition?

Sigmoid volvulus. ***Sigmoid volvulus*** - The **coffee bean sign** is a classic radiographic finding in **sigmoid volvulus**, representing the hugely distended, gas-filled loop of bowel twisting on its mesentery. - This sign is due to the **two limbs of the distended sigmoid colon** converging towards the pelvis, creating a peculiar shape on an abdominal X-ray. *Gastric volvulus* - **Gastric volvulus** involves torsion of the stomach, which can appear as a massively dilated stomach with an air-fluid level or a "double bubble" sign if there is also duodenal obstruction. - It does not typically produce the **coffee bean appearance**, which is characteristic of colonic volvulus. *Hypertrophic pyloric stenosis* - **Hypertrophic pyloric stenosis** is a condition in infants characterized by a thickened pylorus, often leading to non-bilious projectile vomiting. - Imaging typically shows an elongated, narrowed pyloric channel (the "string sign") and a thickened pyloric muscle ("target sign" or "doughnut sign") on ultrasound, not a coffee bean sign. *Achalasia* - **Achalasia** is an esophageal motility disorder where the lower esophageal sphincter fails to relax, leading to food accumulation. - Radiographic findings include a dilated esophagus with a "bird's beak" appearance at the gastroesophageal junction, distinct from the coffee bean sign.

Q: In a voiding cystourethrogram (VCUG), which condition is characterized by an adder head appearance?

Ureterocele. ***Ureterocele*** - An **adder head appearance** on a VCUG is characteristic of a **ureterocele**, which is a cystic dilation of the distal intra-vesical ureter. - This appearance is due to the dilated ureterocele protruding into the bladder lumen, resembling the head of an adder. *Posterior urethral valve* - This condition presents as a **filling defect** or **narrowing of the posterior urethra** on VCUG, often with dilation of the prostatic urethra and reflux into the seminal vesicles. - It does not typically cause an "adder head" appearance. *Bladder tumour* - A bladder tumour typically appears as a **filling defect** within the bladder lumen or an **irregularity of the bladder wall** on a VCUG. - This morphology is distinctly different from the characteristic appearance of a ureterocele. *Horse shoe kidney* - Horseshoe kidney is a congenital anomaly where the **kidneys are fused**, usually at their lower poles, and is a finding on **renal imaging** (e.g., ultrasound, CT, IVP), not typically on a VCUG of the bladder and urethra alone. - It does not produce an "adder head" appearance as it relates to renal structure, not bladder or ureteral dilation.

Question 1

Chain of lakes appearance is seen in?

Accepted Answer

Chronic pancreatitis

Answer

Gallstone ileus

Answer

Sub-acute intestinal obstruction

Answer

Acute pancreatitis

Question 2

What are the bilateral radiopaque structures extending from the renal pelvis to the bladder seen in this abdominal X-ray?

Accepted Answer

Stent

Answer

Surgical clips

Answer

Foley catheter

Answer

Intravesical wire

Question 3

Which of the following HSG findings is most suggestive of genital tuberculosis?

Accepted Answer

Beaded tubes

Answer

Honeycomb uterus

Answer

Golf club tube

Answer

Pipe stem tubes

Question 4

Which imaging modality is considered the best for staging rectal carcinoma?

Accepted Answer

MRI

Answer

CT Scan

Answer

TRUS

Answer

None of the options

Question 5

Investigation of choice for detecting hepatic metastasis from stomach cancer is

Accepted Answer

CECT

Answer

Magnetic Resonance Imaging (MRI)

Answer

PET-CT

Answer

Ultrasound (USG)

Question 6

Which of the following is a direct (primary) sign of obstruction of the urinary tract on a CT scan?

Accepted Answer

Hydroureter

Answer

None of the options

Answer

Perinephric stranding

Answer

Thickening of the lateroconal fascia

Question 7

Percentage of renal stones which are radio-opaque:

Accepted Answer

80

Answer

20

Answer

60

Answer

40

Question 8

Which of the following is a radiological sign of acute pancreatitis on plain radiography?

Accepted Answer

Sentinel loop sign

Answer

Grey Turner's sign

Answer

Renal halo sign

Answer

Murphy's sign

Question 9

The 'coffee bean sign' is typically seen in which condition?

Accepted Answer

Sigmoid volvulus

Answer

Achalasia

Answer

Gastric volvulus

Answer

Hypertrophic pyloric stenosis

Question 10

In a voiding cystourethrogram (VCUG), which condition is characterized by an adder head appearance?

Accepted Answer

Ureterocele

Answer

Posterior urethral valve

Answer

Bladder tumour

Answer

Horse shoe kidney

Abdominal and Pelvic Radiology — MCQs

Abdominal and Pelvic Radiology — MCQs

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