Abdominal and Pelvic Radiology Practice Questions

Q: A pseudo gestational sac is seen on ultrasonography in which of the following conditions?

Ectopic gestation. **Explanation:** In **Ectopic Gestation**, a **pseudo gestational sac** is a common sonographic pitfall. It represents an intra-uterine fluid collection (blood or secretions) surrounded by a single layer of decidua, mimicking an early pregnancy. Unlike a true gestational sac, it is **centrally located** within the endometrial cavity and lacks the "Double Decidual Sign" (the two concentric rings representing the decidua capsularis and decidua parietalis). **Analysis of Options:** * **Ectopic Gestation (Correct):** Hormonal changes in ectopic pregnancy cause the endometrium to undergo a decidual reaction. Fluid or blood trapped within this decidualized endometrium creates the pseudo-sac appearance. * **Missed Abortion:** This involves a non-viable **true** gestational sac (often with a fetal pole but no cardiac activity) that remains within the uterus. It is not a "pseudo" sac. * **Complete Abortion:** On ultrasound, this typically shows an empty uterus with a thin, regular endometrial stripe. No sac-like structures (true or pseudo) should be visible if the products of conception are entirely expelled. * **Hematometra:** This is a collection of blood within the uterine cavity, usually due to an imperforate hymen or cervical stenosis. While it is a fluid collection, it lacks the specific decidualized rim and clinical context of a pregnancy-related sac. **High-Yield Clinical Pearls for NEET-PG:** * **Double Decidual Sign:** The hallmark of a **true** intrauterine pregnancy (IUP) on USG. * **Yolk Sac:** Its presence is the first definitive sign of an IUP (visible at ~5.5 weeks). * **Intrauterine Fluid + Empty Adnexa:** In a patient with positive β-hCG, always differentiate between a very early IUP and a pseudo-sac of ectopic pregnancy. * **Location:** True sacs are usually **eccentric** (embedded in the decidua); pseudo-sacs are **central**.

Q: Which of the following radiographic presentations cannot be seen in a patient with intussusception?

Corkscrew sign. **Explanation:** Intussusception occurs when a proximal segment of the bowel (intussusceptum) invaginates into a distal segment (intussuscipiens). **Why Corkscrew Sign is the Correct Answer:** The **Corkscrew sign** is a classic radiological finding seen on a barium swallow or follow-through in cases of **Midgut Volvulus** (associated with malrotation). It represents the spiral appearance of the distal duodenum and jejunum as they wrap around the superior mesenteric artery (SMA). It is not a feature of intussusception. **Analysis of Incorrect Options:** * **Target Sign (or Bull’s eye sign):** This is a hallmark of intussusception. On a plain radiograph or CT, it represents the layers of the intussusceptum and intussuscipiens seen in cross-section. On ultrasound, it is often called the "Doughnut sign." * **Crescent Sign (Meniscus sign):** This occurs when the leading edge of the intussusceptum protrudes into a gas-filled pocket in the distal bowel, creating a crescent-shaped lucency. It is a highly specific sign for intussusception on plain X-rays. * **Normal Radiograph:** In the early stages of intussusception, up to **25% of plain abdominal radiographs can appear completely normal**. A normal X-ray does not rule out the diagnosis, which is why ultrasound is the gold standard for screening. **Clinical Pearls for NEET-PG:** * **Gold Standard Investigation:** Ultrasound (look for the "Pseudokidney" or "Target" sign). * **Classic Triad:** Colicky abdominal pain, palpable sausage-shaped mass, and "red currant jelly" stools (though the full triad is seen in <40% of cases). * **Treatment:** Non-operative reduction using **Hydrostatic (saline/barium)** or **Pneumatic (air) enema** is the first-line treatment in stable patients. * **Lead Point:** In children, it is usually idiopathic (hypertrophied Peyer’s patches); in adults, it is usually due to a pathological lead point (e.g., malignancy or Meckel’s diverticulum).

Q: What condition is indicated by the thumb print sign on an abdominal radiograph?

All the above. **Explanation:** The **"Thumbprinting sign"** is a classic radiologic finding on a plain abdominal X-ray that represents **focal thickening of the colonic wall** due to submucosal edema and hemorrhage. On a radiograph, the haustral folds appear thickened and blunted, resembling the impression of a thumb pressed into the bowel wall. **Why "All of the above" is correct:** Thumbprinting is a non-specific sign of **severe colonic wall inflammation**. It occurs when any pathological process causes significant submucosal fluid accumulation: * **Ischemic Colitis (Option A):** This is the most common association. Reduced blood flow leads to submucosal hemorrhage and edema. * **Crohn’s Disease (Option B):** Transmural inflammation during an acute flare-up can cause significant wall thickening and edema. * **Pseudomembranous Colitis (Option C):** Severe *Clostridioides difficile* infection causes profound mucosal edema and "shaggy" wall thickening, often presenting with prominent thumbprinting. **Clinical Pearls for NEET-PG:** 1. **Differential Diagnosis:** Beyond the options provided, thumbprinting can also be seen in **Ulcerative Colitis**, **Amoebic Colitis**, and **Lymphoma**. 2. **Clinical Correlation:** While the sign is non-specific, the clinical context is key. Sudden onset abdominal pain in an elderly patient with thumbprinting highly suggests **Ischemic Colitis**. 3. **Next Step:** If thumbprinting is seen on a plain film, the next gold-standard imaging is usually a **CT scan with IV contrast** to better visualize bowel wall enhancement and mesenteric vessels. 4. **Lead Pipe Appearance:** Contrast this with the "Lead Pipe" colon (loss of haustrations), which is characteristic of chronic Ulcerative Colitis.

Q: Which condition is characterized by a 'doughnut' sign and 'coiled spring' appearance on imaging?

Intussusception. ### Explanation **Correct Answer: A. Intussusception** Intussusception occurs when a proximal segment of the bowel (intussusceptum) invaginates into a distal segment (intussuscipiens). This creates characteristic imaging patterns: * **Doughnut/Target Sign:** On **ultrasound** (transverse view), the concentric layers of the bowel walls appear as a hypoechoic outer ring and a hyperechoic center. * **Coiled Spring Appearance:** On a **barium or air enema**, the contrast trickles into the narrow space between the intussusceptum and the intussuscipiens, resembling a coiled spring. * **Pseudokidney Sign:** On longitudinal ultrasound, the layered bowel resembles a kidney. **Why the other options are incorrect:** * **B. Meckel’s Diverticulum:** Typically diagnosed via a **Technetium-99m pertechnetate scan** (Meckel’s scan), which identifies ectopic gastric mucosa. It does not produce concentric ring signs. * **C. Intestinal Malrotation:** Characterized by the **Whirlpool sign** (SMV twisting around the SMA) on ultrasound/CT and a "corkscrew" appearance of the duodenum on upper GI contrast studies. * **D. Volvulus:** Sigmoid volvulus classically shows a **"Coffee Bean" sign** or "Omega" sign on X-ray and a "Bird’s Beak" appearance on contrast enema. **High-Yield Clinical Pearls for NEET-PG:** * **Classic Triad:** Intermittent abdominal pain, palpable "sausage-shaped" mass, and **"Red currant jelly" stools**. * **Lead Point:** In children, it is usually idiopathic (preceded by viral URTI/hypertrophied Peyer’s patches); in adults, it is often due to a malignancy. * **Treatment:** Non-operative reduction using **hydrostatic (saline) or pneumatic (air) enema** is the first-line treatment in stable pediatric cases.

Question 1

A pseudo gestational sac is seen on ultrasonography in which of the following conditions?

Accepted Answer

Ectopic gestation

Answer

Missed abortion

Answer

Complete abortion

Answer

Hematometra

Question 2

Which of the following radiographic presentations cannot be seen in a patient with intussusception?

Accepted Answer

Corkscrew sign

Answer

Target sign

Answer

Crescent sign

Answer

Normal radiograph

Question 3

Which of the following conditions typically presents with a 'pseudokidney sign' on ultrasound?

Accepted Answer

Carcinoma of the stomach

Answer

Trichobezoar

Answer

Carcinoma of the kidney

Answer

Polycystic kidney disease

Question 4

What condition is indicated by the thumb print sign on an abdominal radiograph?

Accepted Answer

All the above

Answer

Ischemic colitis

Answer

Crohn's disease

Answer

Pseudomembranous colitis

Question 5

Which condition is characterized by a 'doughnut' sign and 'coiled spring' appearance on imaging?

Accepted Answer

Intussusception

Answer

Meckel's diverticulum

Answer

Intestinal malrotation

Answer

Volvulus

Abdominal and Pelvic Radiology — MCQs

Abdominal and Pelvic Radiology — MCQs

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