Abdominal and Pelvic Radiology Practice Questions

Q: Which of the following findings is NOT associated with carcinoma of the esophagus?

Esophageal varices. ***Esophageal varices*** - **Esophageal varices** are typically a complication of **portal hypertension**, often due to cirrhosis of the liver, not directly caused by esophageal carcinoma [1]. - While both can occur in the esophagus, varices represent dilated submucosal veins and are distinct from a primary malignant tumor. *Distortion of the esophageal lumen* - Carcinoma of the esophagus often causes **stenosis** or **obstruction**, leading to a distorted lumen as the tumor grows and invades the esophageal wall [2]. - This distortion can be seen on imaging as an irregular narrowing or fixed filling defect. *Edges of filling defect are not clear-cut* - The **infiltrative nature** of esophageal carcinoma results in **ragged, ill-defined tumor margins** and irregular filling defects when viewed on barium swallow [2]. - Unlike benign lesions, malignant tumors typically lack clear, sharp borders. *Irregular "rat-tail" filling defect of the distal esophagus* - An **irregular "rat-tail" appearance** in the distal esophagus on barium swallow is characteristic of certain types of esophageal carcinoma, particularly those involving the gastroesophageal junction [2]. - This describes a tapered, irregular narrowing indicative of an infiltrating lesion. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Liver And Biliary System Disease, pp. 396-398. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Gastrointestinal Tract, pp. 765-767.

Q: String of beads sign is seen in:

Genital TB. ***Genital TB*** - The "string of beads sign" in **genital tuberculosis** refers to the characteristic appearance of multiple small, nodular lesions along the **fallopian tube** on **hysterosalpingography (HSG)**. - This results from **alternating areas of stricture and dilatation** due to chronic **tuberculous salpingitis** with granulomatous inflammation. - Among tuberculosis manifestations, this sign is specifically associated with female genital TB. - **Note:** The "string of beads" sign is also classically seen in **fibromuscular dysplasia of renal arteries**, but in the context of tuberculosis, it refers to genital TB. *Gastroduodenal TB* - Gastroduodenal TB typically manifests as ulcers, strictures, or mass lesions in the stomach or duodenum. - The "string of beads sign" is not a characteristic finding for tuberculosis in this location. *Spinal tuberculosis* - Spinal tuberculosis (Pott's disease) primarily affects the vertebrae, leading to vertebral collapse, kyphosis, and paraspinal abscesses. - Imaging shows vertebral destruction, disc space narrowing, and paravertebral soft tissue shadows. - The "string of beads sign" is not associated with spinal TB. *Ileocaecal TB* - Ileocaecal TB commonly presents with bowel wall thickening, ulcerations, strictures, and lymphadenopathy. - While strictures can occur, the specific "string of beads sign" is not a recognized feature of ileocaecal TB.

Q: What is the primary imaging modality used for diagnosing urethral trauma?

Ascending urethrogram. ***Ascending urethrogram*** - An **ascending urethrogram** (also known as a retrograde urethrogram) is the **gold standard** for diagnosing urethral trauma. - It involves injecting contrast material directly into the urethra to visualize its integrity and identify any extravasation, strictures, or ruptures. *Descending urethrogram* - A descending urethrogram (or voiding cystourethrogram) is primarily used to evaluate the **bladder and urethra during urination**, often for vesicoureteral reflux or bladder neck dysfunction. - It is not the primary diagnostic tool for acute urethral trauma, as it requires the patient to void, which might be painful or difficult with an injured urethra. *USG* - **Ultrasound** (USG) can be used to assess the presence of peri-urethral hematomas or fluid collections but is generally **not sufficient to definitively diagnose urethral integrity** or the exact location and extent of a tear. - Its utility in urethral trauma is limited compared to direct contrast imaging of the urethra. *CT scan* - A **CT scan** of the pelvis can identify associated injuries, such as **pelvic fractures** or hematomas, that often accompany urethral trauma. - However, it is **less sensitive for direct visualization of the urethral lumen** and diagnosing the extent of a urethral injury compared to an ascending urethrogram.

Q: Which of the following conditions is associated with the "Rim sign" in a nephrogram?

Renal cell carcinoma (hypernephroma). ***Renal cell carcinoma (hypernephroma)*** - The **"Rim sign"** (also called **peripheral capsular enhancement**) on a nephrogram refers to the **peripheral enhancement pattern** seen in **renal cell carcinoma**, particularly during the early arterial phase of contrast-enhanced CT. - This sign reflects the **hypervascular nature** of RCC and its **fibrous pseudocapsule** that enhances peripherally, creating a rim of enhancement around the tumor. - This is distinct from central heterogeneous enhancement and is a helpful diagnostic feature in differentiating RCC from other renal masses. *Pyelonephritis* - Acute pyelonephritis typically presents with **wedge-shaped areas of decreased enhancement** or **striated nephrogram** pattern, not the peripheral rim enhancement seen in RCC. - The inflammation primarily involves the **renal parenchyma** and collecting system with patchy, striated areas rather than a defined peripheral rim. *Polycystic kidney disease* - This condition is characterized by **multiple cysts** of varying sizes throughout both kidneys, which appear as **non-enhancing, fluid-filled lesions** on imaging. - The cysts themselves may show **thin septations** but do not demonstrate the tumor-associated rim sign of RCC. *None of the options* - This option is incorrect as **renal cell carcinoma** is indeed associated with the peripheral rim enhancement pattern on nephrogram.

Q: What is the most likely diagnosis in a jaundiced patient with an AP view from a percutaneous transhepatic cholangiogram? (Refer to the image)

Cholangiocarcinoma. ***Cholangiocarcinoma*** - The image shows a **focal stricture** in the extrahepatic bile duct, with **proximal biliary dilatation**, which is highly suggestive of a cholangiocarcinoma. - This type of cancer often presents with **painless jaundice** due to bile duct obstruction. *Pancreatic adenocarcinoma* - While it can cause biliary obstruction and jaundice, it typically presents with a more **distal common bile duct obstruction** (e.g., at the head of the pancreas), which is not the primary finding here. - A pancreatic mass would usually be seen on cross-sectional imaging, not directly implied by this cholangiogram alone. *Primary sclerosing cholangitis* - Characterized by **multiple, diffuse strictures** and dilatations throughout the biliary tree (a "beaded" appearance), rather than a single, focal stricture as seen. - Often associated with **inflammatory bowel disease**, but the imaging pattern is distinct. *Biliary colic due to cholelithiasis* - Biliary colic is usually due to temporary obstruction of the cystic duct or common bile duct by **gallstones**, leading to intermittent pain. - While it can cause jaundice, the cholangiogram would typically show **filling defects** (stones) or a more abrupt, often temporary, obstruction, not a fixed, focal stricture.

Q: A 30-year-old female patient presents with nonprogressive dysphagia for both solids and liquids. The characteristic finding on barium swallow that will confirm the probable diagnosis is:

Dilated esophagus with a tapering lower end. ***Dilated esophagus with a tapering lower end*** - This description, often referred to as a **"bird's beak"** or **"rat's tail"** appearance, is characteristic of **achalasia** on barium swallow. - Achalasia is a motility disorder where the **lower esophageal sphincter (LES) fails to relax**, and there is a loss of peristalsis in the esophageal body, leading to dilation and dysphagia for both solids and liquids. *Irregular narrowing of the esophageal lumen* - **Irregular narrowing** is more suggestive of an **esophageal tumor** or a **malignant stricture**, which would typically present with progressive dysphagia, primarily for solids. - The dysphagia described in the patient is nonprogressive for both solids and liquids, making a malignant stricture less likely. *Ulceration with stricture in the esophagus* - The presence of **ulceration and stricture** is commonly seen in **peptic strictures** due to **gastroesophageal reflux disease (GERD)** or **esophagitis**, which usually cause progressive dysphagia and heartburn. - This presentation does not fit the patient's nonprogressive dysphagia for both solids and liquids. *Multiple sacculations and pseudodiverticulae in the esophagus* - **Multiple sacculations and pseudodiverticulae** are characteristic findings in **diffuse esophageal spasm**, where uncoordinated, high-amplitude contractions occur. - While diffuse esophageal spasm can cause dysphagia and chest pain, the classical barium swallow finding is a **"corkscrew esophagus"**, not the dilated esophagus seen in achalasia.

Q: In the context of abdominal imaging, which condition is associated with the 'Claw sign'?

Intussusception. ***Intussusception*** - The **"Claw sign"** is a radiologic finding observed in intussusception, where the invaginated segment of the bowel (intussusceptum) is surrounded by the receiving segment (intussuscipiens), creating a crescent-shaped or claw-like appearance. - This sign is crucial for diagnosing intussusception on imaging studies such as **CT scans** or **ultrasound**, indicating the telescoping of one bowel segment into another. *Volvulus* - Volvulus refers to the **twisting of a loop of bowel** around its mesentery, leading to obstruction and potential ischemia. - Imaging findings typically include a **"whirl sign"** (swirling of mesenteric vessels) or a **dilated U-shaped loop** of bowel, not a claw sign. *Pyloric stenosis* - Pyloric stenosis involves the **narrowing of the pyloric channel**, often seen in infants, leading to gastric outlet obstruction. - Characteristic imaging findings include an **elongated and thickened pyloric canal** (the "cervix sign" or "donut sign" on ultrasound), not the claw sign. *Peptic ulcer* - A peptic ulcer is an **open sore in the lining of the stomach or duodenum**, often caused by *H. pylori* infection or NSAID use. - Imaging may show **crater defects with surrounding edema** or signs of perforation, but it does not present with a "claw sign."

Q: A 46-year-old chronic diabetic presents to the emergency department with high-grade fever and dysuria. Urine analysis reveals multiple leukocytes and glycosuria. A CT scan of the abdomen shows the following image. What is the most likely diagnosis?

Emphysematous pyelonephritis. ***Emphysematous pyelonephritis*** - This condition is suggested by the presence of **gas within the renal parenchyma** on the CT scan, along with severe infection symptoms in a diabetic patient. - The combination of **diabetes**, high fever, dysuria, and a CT showing gas is highly indicative of this severe, life-threatening infection. *Acute pyelonephritis* - While patients present with similar symptoms like **fever, dysuria, and leukocytes in urine**, a CT scan would typically show **renal parenchymal inflammation** and edema without gas. - Acute pyelonephritis can be a precursor, but the distinct finding of **intraparenchymal gas** on CT excludes this diagnosis. *Perinephric abscess* - A perinephric abscess is characterized by a **collection of pus and inflammation surrounding the kidney**, outside the renal capsule. - The CT image would show a **fluid collection in the perinephric space**, not gas within the renal parenchyma itself. *Renal Abscess* - A renal abscess is a **localized collection of pus within the kidney parenchyma**, often appearing as a low-attenuation mass on CT. - While it involves the kidney parenchyma, it does not typically present with the characteristic **intraparenchymal gas** seen in emphysematous pyelonephritis.

Q: Which of the following statements about hepatocellular carcinoma (HCC) is true? 1. On CECT, rapid wash-in and washout of contrast are seen in HCC. 2. HCC is the most common primary malignant tumor of the liver. 3. LI-RADS provides an algorithm for the diagnosis of HCC. 4. Fibrolamellar HCC has a better prognosis than classic HCC. 5. Alpha-fetoprotein is raised in 50-60% of HCC cases.

1. True, 2. True, 3. True, 4. True, 5. True. ***All statements are TRUE (Option: 1. True, 2. True, 3. True, 4. True, 5. True)*** - This is the **correct answer** because all five statements about hepatocellular carcinoma (HCC) are medically accurate. - **Statement 1 (Contrast enhancement)**: HCC characteristically shows **arterial phase hyperenhancement** (rapid wash-in) followed by **washout** in portal venous or delayed phases on CECT, which is a key diagnostic feature. - **Statement 2 (Most common primary liver cancer)**: HCC accounts for approximately **75-85% of primary liver malignancies**, making it the most common primary hepatic malignancy worldwide. - **Statement 3 (LI-RADS system)**: The **Liver Imaging Reporting and Data System (LI-RADS)** provides a standardized algorithm for diagnosing and categorizing liver lesions, particularly HCC in at-risk patients. - **Statement 4 (Fibrolamellar variant)**: **Fibrolamellar HCC** is a rare variant (5% of HCC cases) that typically occurs in younger patients without cirrhosis and has a **better prognosis** than conventional HCC, with 5-year survival rates of 30-50% vs 10-20%. - **Statement 5 (Alpha-fetoprotein)**: **AFP is elevated** (>20 ng/mL) in approximately **50-70% of HCC cases**, though it has limited sensitivity for early detection and can be normal in small tumors. *Option stating Statement 2 is FALSE* - This is incorrect because HCC **is definitively the most common** primary malignant liver tumor, comprising the vast majority of primary liver cancers globally. *Option stating Statement 3 is FALSE* - This is incorrect because **LI-RADS is a well-established** imaging algorithm specifically developed for HCC diagnosis and risk stratification in at-risk populations. *Option stating Statement 4 is FALSE* - This is incorrect because fibrolamellar HCC **does have a better prognosis** than classic HCC, with improved resectability and survival outcomes, particularly in younger, non-cirrhotic patients.

Q: Which of the following is characterized by a "cobra head deformity"?

Ureterocele. ***Ureterocele*** - A "cobra head deformity" is a classic radiographic sign seen on an intravenous pyelogram (IVP) or ultrasound, referring to the characteristic appearance of a **ureterocele** within the bladder. - This appearance is due to the dilated, cystic end of the ureter that protrudes into the bladder lumen, surrounded by a thin, radiolucent halo created by the ureteral wall and urine. *Cystitis* - **Cystitis** is inflammation of the bladder and does not typically result in a "cobra head deformity" on imaging. - Inflammatory changes may lead to wall thickening or irregular contour but not to this specific type of filling defect. *Bladder tumour* - A **bladder tumour** can present as a filling defect within the bladder, but its appearance is usually irregular or polypoid, not resembling a "cobra head." - Tumours can vary widely in shape and size, and typically show enhancement on contrast imaging. *Posterior urethral valve* - **Posterior urethral valve** is a congenital obstructive lesion in the male urethra, primarily affecting urine outflow from the bladder. - It leads to bladder wall hypertrophy and reflux, but does not cause a "cobra head deformity" in the bladder.

Question 1

Which of the following findings is NOT associated with carcinoma of the esophagus?

Accepted Answer

Esophageal varices

Answer

Edges of filling defect are not clear-cut

Answer

Distortion of the esophageal lumen

Answer

Irregular "rat-tail" filling defect of the distal esophagus

Question 2

String of beads sign is seen in:

Accepted Answer

Genital TB

Answer

Gastroduodenal TB

Answer

Spinal tuberculosis

Answer

Ileocaecal TB

Question 3

What is the primary imaging modality used for diagnosing urethral trauma?

Accepted Answer

Ascending urethrogram

Answer

Descending urethrogram

Answer

USG

Answer

CT scan

Question 4

Which of the following conditions is associated with the "Rim sign" in a nephrogram?

Accepted Answer

Renal cell carcinoma (hypernephroma)

Answer

Polycystic kidney disease

Answer

Pyelonephritis

Answer

None of the options

Question 5

What is the most likely diagnosis in a jaundiced patient with an AP view from a percutaneous transhepatic cholangiogram? (Refer to the image)

Accepted Answer

Cholangiocarcinoma

Answer

Pancreatic adenocarcinoma

Answer

Primary sclerosing cholangitis

Answer

Biliary colic due to cholelithiasis

Question 6

A 30-year-old female patient presents with nonprogressive dysphagia for both solids and liquids. The characteristic finding on barium swallow that will confirm the probable diagnosis is:

Accepted Answer

Dilated esophagus with a tapering lower end

Answer

Irregular narrowing of the esophageal lumen

Answer

Ulceration with stricture in the esophagus

Answer

Multiple sacculations and pseudodiverticulae in the esophagus

Question 7

In the context of abdominal imaging, which condition is associated with the 'Claw sign'?

Accepted Answer

Intussusception

Answer

Volvulus

Answer

Pyloric stenosis

Answer

Peptic ulcer

Question 8

A 46-year-old chronic diabetic presents to the emergency department with high-grade fever and dysuria. Urine analysis reveals multiple leukocytes and glycosuria. A CT scan of the abdomen shows the following image. What is the most likely diagnosis?

Accepted Answer

Emphysematous pyelonephritis

Answer

Acute pyelonephritis

Answer

Perinephric abscess

Answer

Renal abscess

Question 9

Which of the following statements about hepatocellular carcinoma (HCC) is true? 1. On CECT, rapid wash-in and washout of contrast are seen in HCC. 2. HCC is the most common primary malignant tumor of the liver. 3. LI-RADS provides an algorithm for the diagnosis of HCC. 4. Fibrolamellar HCC has a better prognosis than classic HCC. 5. Alpha-fetoprotein is raised in 50-60% of HCC cases.

Accepted Answer

1. True, 2. True, 3. True, 4. True, 5. True

Answer

1. True, 2. False, 3. True, 4. True, 5. True

Answer

1. True, 2. True, 3. False, 4. True, 5. True

Answer

1. True, 2. True, 3. True, 4. False, 5. True

Question 10

Which of the following is characterized by a "cobra head deformity"?

Accepted Answer

Ureterocele

Answer

Cystitis

Answer

Bladder tumour

Answer

Posterior urethral valve

Abdominal and Pelvic Radiology — MCQs

Abdominal and Pelvic Radiology — MCQs

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