Pediatric Radiology Practice Questions

Q: In croup, the characteristic radiographic finding of subglottic narrowing on a frontal chest X-ray creates a tapering appearance of the upper trachea. This diagnostic sign is commonly referred to as which of the following?

Steeple sign. ***Steeple sign*** - The **steeple sign** on a frontal chest radiograph refers to the **subglottic narrowing of the trachea**, resembling a church steeple or an inverted V, which is characteristic of **croup**. - This narrowing is caused by **edema** in the subglottic region, typically due to **parainfluenza virus infection**. *Ballooning of the hypopharynx* - **Ballooning of the hypopharynx** is not a characteristic radiographic sign of croup. - This finding is sometimes associated with **epiglottitis**, a different airway emergency, but not croup. *Narrowing of the subglottic trachea* - While **narrowing of the subglottic trachea** is the underlying pathology in croup and the visual finding of the steeple sign, this option is too general. - The term "steeple sign" specifically describes the **radiographic appearance** of this narrowing, making it the more precise answer. *Tonsillar exudates* - **Tonsillar exudates** refer to pus or fluid on the tonsils, which are a common finding in **pharyngitis** or **tonsillitis**. - This is a clinical finding related to tonsil inflammation and is not a radiographic sign of croup.

Q: The neck X-ray of a patient shows:

Steeple sign. ***Steeple sign*** - The image shows a **narrowing of the subglottic trachea**, which resembles a "steeple" or a church spire on a frontal neck X-ray. - This sign is highly suggestive of **croup** (laryngotracheobronchitis), caused by inflammation and edema of the subglottic region. *Zenker's diverticulum* - This is an **outpouching of the posterior pharyngeal wall** through Killian's triangle, typically seen as a fluid or air-filled sac posterior to the esophagus. - It would appear inferior to the larynx and esophagus, not as a tracheal narrowing within the airway. *Laryngocele* - A laryngocele is an **abnormal air-filled dilation of the laryngeal saccule**, usually appearing as a radiolucent mass in the neck, often extending into the soft tissues. - It would be located more superiorly and laterally to the trachea and does not present as a classic subglottic narrowing. *Thumb sign* - The **"thumb sign"** refers to the appearance of an **enlarged, edematous epiglottis** on a lateral neck X-ray, resembling a thumb. - This sign is characteristic of **epiglottitis**, a different condition affecting the supraglottic region, not the subglottic trachea.

Q: The following image shows presence of:

Vesico-ureteric reflux. ***Vesico-ureteric reflux*** - The image, likely a **voiding cystourethrogram (VCUG)**, shows **contrast material filling the bladder and extending upwards into both ureters and renal pelves**. This **retrograde flow of urine** from the bladder into the upper urinary tract is diagnostic of **vesicoureteral reflux (VUR)**. - VUR can lead to **recurrent urinary tract infections** and potential **kidney damage** due to pressure and infection. *Posterior urethral valves* - Posterior urethral valves typically cause an obstruction to urine flow from the bladder, leading to marked bladder distension and often significant bilateral hydronephrosis and hydroureter. - While VUR can coexist with PUV, the primary finding in this image is the reflux itself rather than signs of distal urethral obstruction. *Bladder stone* - A bladder stone would appear as a filling defect or a high-density area within the bladder, which is not depicted in this image. - The image shows the bladder uniformly filled with contrast, with no obvious intraluminal masses or calcifications. *Bladder rupture* - Bladder rupture would demonstrate extravasation of contrast material outside the confines of the bladder into the surrounding peritoneum or retroperitoneum, which is not seen here. - The contrast remains contained within the bladder and refluxes only into the collecting systems.

Q: The ultrasound finding of a 7 -month-old child with abdominal pain and mass in the upper abdomen is shown below. What is the diagnosis? (NEET Pattern 2018)

Intussusception. ***Intussusception*** - The ultrasound image clearly shows a "target sign" or "doughnut sign," which is pathognomonic for **intussusception**, where one segment of the intestine telescopes into another. - This condition commonly presents in infants (around 6-36 months) with **abdominal pain**, an abdominal mass, and sometimes **currant jelly stools**. *Intestinal volvulus* - **Intestinal volvulus** involves the twisting of the intestine around its mesentery, which would typically show a "whirlpool sign" on ultrasound due to twisted mesenteric vessels, not the "target sign." - It usually presents with sudden onset of severe abdominal pain, bilious vomiting, and signs of intestinal obstruction and ischemia. *Pyloric stenosis* - **Pyloric stenosis** is characterized by hypertrophy of the pyloric muscle, which would appear as an elongated, thickened pyloric canal on ultrasound with increased pyloric muscle thickness (>3mm) and length (>15mm). - Clinical presentation involves non-bilious projectile vomiting in infants, typically between 2 and 8 weeks of age, not at 7 months with an abdominal mass and the bowel-within-bowel appearance shown. *None of above* - The classic ultrasound findings and clinical presentation strongly point to intussusception, making this option incorrect.

Q: The figure shows:

Sail sign. ***Sail sign*** - The image displays a prominent triangular shadow in the right upper mediastinum, consistent with the **thymus gland** in a pediatric chest X-ray. - This characteristic appearance, resembling a **sailboat's sail**, is a normal finding in infants and young children and is known as the sail sign. *Right upper lobe consolidation* - **Consolidation** would appear as an area of increased opacity in the lung parenchyma, which is not clearly visible in the right upper lobe. - The opacity present is specifically located in the mediastinal region and has the typical shape and borders of the normal thymus. *Gas under diaphragm* - **Gas under the diaphragm** is typically seen as a crescent-shaped lucency beneath the diaphragm, usually indicative of a **pneumoperitoneum**. - No such free air is visible below either hemidiaphragm in this image. *Box shaped heart* - A **box-shaped heart** is a classic finding in **Ebstein's anomaly**, where the heart appears enlarged and more square due to atrialization of the right ventricle. - The cardiac silhouette in this image does not exhibit this specific morphology and appears within normal limits for a pediatric patient.

Q: Infantogram shows presence of:

Sacrococcygeal teratoma. ***Sacrococcygeal teratoma*** - The image shows a large, well-defined mass extending from the **sacrococcygeal region** of the infant. The presence of both soft tissue and calcifications within the mass (suggesting varying tissue types) is characteristic of a **teratoma**. - **Sacrococcygeal teratomas (SCTs)** are the most common germ cell tumors of childhood, typically presenting as external masses projecting from the lower back/buttocks. *Hemangioma* - A hemangioma is a **benign vascular tumor** that would typically appear as a soft tissue mass without the presence of internal calcifications or complex structures visible on plain radiography. - While they can be large, their radiological appearance would be primarily of **soft tissue density**, and they don't commonly arise with such distinct bony involvement or complex internal architecture. *Myelomeningocele* - A myelomeningocele is a form of **spina bifida** where the spinal cord and meninges protrude through a defect in the vertebral column, often presenting as a fluid-filled sac. - While it occurs in the same anatomical region, the image depicts a **solid, heterogeneous mass** with calcifications rather than a herniated neural tissue with cerebrospinal fluid. *Arnold-Chiari malformation* - Arnold-Chiari malformation is a structural defect in the **cerebellum**. - It involves the downward displacement of the cerebellar tonsils through the foramen magnum and would not present as an external mass in the sacrococcygeal region.

Q: Identify the condition on the basis of infantogram shown in the image:

Congenital diaphragmatic hernia. ***Congenital diaphragmatic hernia*** - The infantogram shows loops of **bowel within the thoracic cavity**, displacing the heart and mediastinum. - This classic appearance, with visible **gas-filled loops** in the chest, is characteristic of a congenital diaphragmatic hernia, typically on the left side (Bochdalek hernia). *Cystic adenomatoid malformation* - This condition involves an abnormal growth of lung tissue forming **cysts**; these cysts typically appear as discrete radiolucencies or a solid mass within the lung. - Unlike in the image, it does not typically show distinct **bowel loops in the chest cavity**. *Pneumomediastinum* - This condition is characterized by air in the **mediastinum**, which would appear as lucency outlining the mediastinal structures, such as the heart and great vessels. - It does not involve the presence of **abdominal contents** within the chest cavity. *Congenital lobar emphysema* - This condition presents with **hyperinflation of a single lobe** (usually left upper lobe) causing mass effect and mediastinal shift. - It appears as a hyperlucent, overexpanded lobe, but does not show **bowel gas pattern** or abdominal contents in the thorax.

Q: What does the following image show?

Invertogram. ***Invertogram*** - An invertogram is a **lateral radiograph** of the abdomen with the patient **held upside down** to visualize the distal bowel gas pattern and evaluate for imperforate anus. - The image shows dilated bowel loops with gas, and the child's position (evident from the spinal curvature) is consistent with an inverted view. *Infantogram* - This term is **not a standard medical diagnostic procedure** or specific type of radiograph. - While it refers to an X-ray of an infant, it does not describe the specific technique or purpose shown. *Gynogram* - A gynogram is an older term for a radiological procedure involving the **injection of contrast material** to visualize female pelvic organs, particularly the uterus and fallopian tubes. - It is unrelated to the gastrointestinal tract or the patient's position in this image. *Vasogram* - A vasogram, also known as **vasography**, is a procedure that involves injecting contrast into the **vas deferens** or other vascular structures to visualize them. - This technique is used to assess male reproductive structures or blood vessels and is not applicable to evaluating bowel obstruction in an infant as depicted.

Q: USG abdomen of a 9-month-old child as shown below denotes:

Intussusception. ***Intussusception*** - The ultrasound image clearly shows a "target sign" or "doughnut sign" in transverse view, and a "pseudokidney sign" or "sandwich sign" in longitudinal view, which are **pathognomonic for intussusception**. - Intussusception is the telescoping of one part of the intestine into an adjacent part, commonly presenting in infants with **abdominal pain**, **vomiting**, and **currant jelly stools**. *Meckel's diverticulum* - A Meckel's diverticulum is a **remnant of the omphalomesenteric duct** and typically appears as a blind-ended pouch on imaging, not a concentrically layered mass. - While it can cause bleeding or obstruction, it generally does not produce the characteristic sonographic appearance seen here. *Rectal polyp* - A rectal polyp is an **abnormal growth of tissue** protruding from the lining of the rectum. - Ultrasound of a rectal polyp would show a distinct mass in the rectum, which is not depicted in this image of the small or large bowel. *Congenital hypertrophic pyloric stenosis* - This condition involves **thickening of the pyloric muscle**, leading to gastric outlet obstruction, and is characterized by a "cervix sign" or "target sign" in the pylorus on ultrasound. - The image shown depicts a larger, more complex bowel involvement (likely ileocolic), not a focal pyloric thickening.

Question 1

In croup, the characteristic radiographic finding of subglottic narrowing on a frontal chest X-ray creates a tapering appearance of the upper trachea. This diagnostic sign is commonly referred to as which of the following?

Accepted Answer

Steeple sign

Answer

Ballooning of the hypopharynx

Answer

Narrowing of the subglottic trachea

Answer

Tonsillar exudates

Question 2

The neck X-ray of a patient shows:

Accepted Answer

Steeple sign

Answer

Zenker's diverticulum

Answer

Laryngocele

Answer

Thumb sign

Question 3

The following image shows presence of:

Accepted Answer

Vesico-ureteric reflux

Answer

Posterior urethral valves

Answer

Bladder stone

Answer

Bladder rupture

Question 4

The ultrasound finding of a 7 -month-old child with abdominal pain and mass in the upper abdomen is shown below. What is the diagnosis? (NEET Pattern 2018)

Accepted Answer

Intussusception

Answer

Intestinal volvulus

Answer

Pyloric stenosis

Answer

None of above

Question 5

The figure shows:

Accepted Answer

Sail sign

Answer

Right upper lobe consolidation

Answer

Gas under diaphragm

Answer

Box shaped heart

Question 6

Infantogram shows presence of:

Accepted Answer

Sacrococcygeal teratoma

Answer

Hemangioma

Answer

Myelomeningocele

Answer

Arnold-Chiari malformation

Question 7

All statements about the disease shown are wrong except:

Accepted Answer

Loss of normal zone of provisional calcification adjacent to metaphysis

Answer

Nutritional rickets usually presents in school age, usually as widened wrists

Answer

Presentation in early infancy along with seizures or tetany

Answer

Excessive exposure to sunlight does not increase vitamin D production

Question 8

Identify the condition on the basis of infantogram shown in the image:

Accepted Answer

Congenital diaphragmatic hernia

Answer

Cystic adenomatoid malformation

Answer

Pneumomediastinum

Answer

Congenital lobar emphysema

Question 9

What does the following image show?

Accepted Answer

Invertogram

Answer

Infantogram

Answer

Gynogram

Answer

Vasogram

Question 10

USG abdomen of a 9-month-old child as shown below denotes:

Accepted Answer

Intussusception

Answer

Meckel's diverticulum

Answer

Rectal polyp

Answer

Congenital hypertrophic pyloric stenosis

Pediatric Radiology — MCQs

Pediatric Radiology — MCQs

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