Abdominal and Pelvic Radiology Practice Questions

Q: The best investigation for air in the peritoneal cavity is:

X-ray. ***X-ray*** - An **X-ray**, particularly an erect chest X-ray or an erect abdominal X-ray, is the **most sensitive and readily available investigation** to detect **free air under the diaphragm** (pneumoperitoneum). - This free air, indicating a perforated viscus, appears as a **Crescent-shaped lucency** shadowing the diaphragm. *USG* - While ultrasound can sometimes detect free air, it is **less sensitive and specific** than X-ray for this purpose, especially in early or small perforations. - Its utility is more in detecting other intra-abdominal pathologies like fluid collections or organomegaly. *Laparoscopy* - **Laparoscopy** is a **surgical procedure** that allows direct visualization of the peritoneal cavity. - While it can definitively identify free air and its source, it is an **invasive procedure** and not the primary diagnostic investigation for suspected pneumoperitoneum. *Laparotomy* - **Laparotomy** is an **open surgical procedure** involving a large incision to access the abdominal cavity. - It is used for definitive diagnosis and treatment, but it is **highly invasive** and not a diagnostic investigation in the initial workup for air in the peritoneal cavity.

Q: In which of the following conditions is the lead pipe appearance of the colon seen on a barium enema?

Ulcerative colitis. **Ulcerative colitis** - The **"lead pipe" appearance** on a barium enema is indicative of **loss of haustra**, foreshortening, and rigidity of the colon due to chronic inflammation and fibrosis, which are characteristic features of extensive ulcerative colitis. - This appearance reflects a smooth, tube-like colon without the normal sacculations, resulting from **mucosal damage** and subsequent scarring. *Amoebiasis* - While amoebiasis can cause colonic inflammation, it typically presents with **flask-shaped ulcers** and sometimes strictures on barium enema, not a diffuse loss of haustra leading to a "lead pipe" appearance. - The disease is more commonly associated with changes like **filling defects** or **segmental narrowing** rather than overall colonic rigidity. *Tuberculosis of the colon* - Tuberculosis of the colon often causes **strictures**, ulcerations, and sometimes **hypertrophic lesions**, particularly affecting the ileocecal region. - It does not typically result in the widespread mucosal damage and loss of haustra seen in the "lead pipe" appearance of ulcerative colitis, but rather **focal deformities**. *Crohn's involvement of the colon* - Crohn's disease is characterized by a **"cobblestoned" appearance** due to deep ulcerations and transmural inflammation, skip lesions, and **fistulae**. - While it can cause strictures and bowel wall thickening, the diffuse loss of haustra leading to the "lead pipe" sign is more specific to **ulcerative colitis**, which primarily affects the mucosa.

Q: X-ray given below suggestive of:

Gas mimicking peritoneal presence (Pseudopneumoperitoneum). * ***Gas mimicking peritoneal presence (Pseudopneumoperitoneum)*** * The X-ray shows **Chilaiditi's sign**, where the **colon is interposed between the liver and diaphragm**. * This interposition of bowel gas can mimic **free intraperitoneal gas** (pneumoperitoneum) creating a false appearance. * *Gas mimicking mediastinal presence (Pseudopneumomediastinum)* * This term refers to **gas in a location that looks like the mediastinum** but is not truly there, which is not depicted in this image. * The radiological findings are specifically related to the **subdiaphragmatic region**. * *Free gas in the mediastinum (Pneumomediastinum)* * **Pneumomediastinum** is characterized by air within the mediastinal structures, often seen outlining the **aorta or heart borders**. * The provided X-ray demonstrates gas below the diaphragm, not within the mediastinum. * *Free gas in the peritoneal cavity (Pneumoperitoneum)* * **Pneumoperitoneum** is the presence of free air in the peritoneal cavity, typically indicated by **air under the diaphragm** (e.g., **"football sign"** in upright films). * While there is gas under the diaphragm, it is **intraluminal bowel gas** rather than free intraperitoneal gas, which is the key distinction for pseudopneumoperitoneum.

Q: Which of the following liver metastases appear hypoechoic on ultrasound?

Breast cancer. **Breast cancer** - Liver metastases from **breast cancer** frequently present as **hypoechoic lesions** on ultrasound, due to the tumor's cellular composition and vascularity. - This appearance helps differentiate them from other more commonly echogenic or mixed metastatic patterns. *RCC* - **Renal cell carcinoma (RCC)** metastases to the liver often appear **hyperechoic** or **mixed echogenicity** on ultrasound due to their rich vascularity. - This is a distinct characteristic, different from the predominantly hypoechoic nature seen with breast cancer metastases. *Colon cancer* - Liver metastases from **colon cancer** are typically **echogenic** or **mixed echogenicity** on ultrasound, sometimes with a hypoechoic rim ("target sign"). - Their presentation is generally not purely hypoechoic, making them distinguishable from breast cancer metastases. *Mucinous adenocarcinoma* - Liver metastases from **mucinous adenocarcinoma** can be quite variable, but they often appear **complex**, possibly with **cystic components** or mixed echogenicity, rather than uniformly hypoechoic. - The mucin content can create a distinct internal architecture on ultrasound that differs from solid hypoechoic lesions.

Q: Micturating cystourethrogram shows filling defect in the urinary bladder. Likely diagnosis is________

Ureterocele. ***Ureterocele*** - The image shows a **filling defect** within the urinary bladder, which is characteristic of a **ureterocele**, an abnormal ballooning of the distal ureter into the bladder lumen. This appears as a round or oval lucency surrounded by contrast medium. - The presence of the arrow pointing to this lucency within the contrast-filled bladder strongly supports a ureterocele. *Duplication of ureter* - Ureteral duplication involves two ureters draining a single kidney, which would not typically present as a filling defect in the **bladder lumen** itself, but rather as two separate ureteral orifices. - While it can be associated with other anomalies like ureterocele, the primary finding described and visualized is the **filling defect**, not the duplication of the ureter. *Sacrococcygeal teratoma* - A sacrococcygeal teratoma is a **tumor** located at the base of the spine (sacrum and coccyx), which would not be seen as a **filling defect within the urinary bladder** on a micturating cystourethrogram (MCU). - Its effects on the urinary tract would typically be due to **external compression** or displacement, not an intrinsic bladder lumen anomaly. *Vesicoureteric reflux grade II* - Vesicoureteric reflux (VUR) is the **backward flow of urine** from the bladder into the ureters and potentially kidneys, which would be visualized as contrast filling the ureters during bladder opacification or voiding, not as a filling defect within the bladder itself. - Grade II VUR specifically means reflux into the ureter and collecting system **without dilation**, which is a functional issue, not a structural filling defect within the bladder lumen.

Q: What is the diagnosis based on the following X-ray?

Bladder stone. ***Bladder stone*** - A large, **radiopaque opacity** positioned centrally within the **pelvis**, overlying the anticipated location of the **urinary bladder**, is highly suggestive of a bladder stone. - The **smooth, calcified appearance** on X-ray is characteristic of many types of bladder calculi. *Renal Tuberculosis* - Renal tuberculosis typically presents with **calcifications in the kidneys** themselves, or shows signs of **hydronephrosis** or **ureteral strictures**. - It does not usually manifest as a single, large, well-defined calcification within the bladder lumen on a plain X-ray. *Uterine Fibroid* - Calcified uterine fibroids (leiomyomas) would appear as **speckled, popcorn-like calcifications** in the **pelvis**, often superior to the bladder, and not as a single, large, well-defined stone-like opacity within the bladder region. - Their location is also often distinct from the central bladder space. *Bladder Carcinoma* - Bladder carcinoma is rarely visible as a **dense, central calcification** on a plain X-ray. - While some tumors can calcify, they typically present as **filling defects**, **wall thickening**, or **irregular soft tissue masses**, which are best visualized with contrast studies or cross-sectional imaging, not a single large stone-like opacity.

Q: Focal and diffuse thickening of gallbladder wall with high amplitude reflections and 'comet tail' artifacts on USG suggest the diagnosis of –

Adenomyomatosis. ***Adenomyomatosis*** - This condition is characterized by **hyperplasia of the muscular layer** and **outpouchings of the mucosa** through the muscular wall (Rokitansky-Aschoff sinuses). - The thickened wall with **Rokitansky-Aschoff sinuses** containing bile or cholesterol crystals causes **high-amplitude reflections** and **comet tail artifacts** on ultrasound. *Carcinoma of gall bladder* - While carcinoma can also cause focal or diffuse thickening of the gallbladder wall, it typically appears as a **mass lesion** and **does not usually demonstrate comet-tail artifacts**. - **Comet-tail artifacts** are pathognomonic for **adenomyomatosis**, indicating gas, cholesterol crystals, or inspissated bile within Rokitansky-Aschoff sinuses. *Cholesterolosis* - This condition, also known as **strawberry gallbladder**, involves the deposition of **cholesterol esters in the lamina propria** of the gallbladder wall. - It usually presents as **multiple small polyps** on ultrasound, without the diffuse wall thickening or classic "comet tail" artifact seen with adenomyomatosis. *Xanthogranulomatous cholecystitis* - This is a rare, severe form of chronic cholecystitis characterized by **lipid-laden macrophages** and significant **fibrosis** in the gallbladder wall. - It causes **marked, diffuse mural thickening** or **nodular lesions** which can mimic carcinoma, but it typically **lacks the specific acoustic shadowing and comet tail artifacts** associated with adenomyomatosis.

Q: All are sonological features of Budd Chiari syndrome, EXCEPT:

Diffusely dilated hepatic veins. ***Diffusely dilated hepatic veins*** - **Diffusely dilated hepatic veins** are *not* a sonological feature of **Budd-Chiari syndrome**, as the primary pathology is **hepatic venous obstruction**, which leads to *narrowing, stenosis, or absence of flow* rather than generalized dilatation. - In Budd-Chiari syndrome, hepatic veins are typically **compressed, thrombosed, or stenotic**, not uniformly dilated throughout their course. - While **focal proximal dilatation** can occur upstream of a stenotic segment (see option below), **diffuse dilatation** of all hepatic veins is not characteristic of this condition. *Intraluminal echogenicity of hepatic vein* - **Intraluminal echogenicity** within the hepatic veins indicates the presence of **thrombus** or **fibrin**, which is a direct cause of **Budd-Chiari syndrome**. - This finding is crucial for diagnosing **acute hepatic venous thrombosis** and is a classic sonographic feature. *Stenosis and proximal dilatation of the hepatic veins* - **Stenosis** (narrowing) of the hepatic veins is a hallmark finding due to **thrombus formation**, **webs**, or **fibrosis** causing obstruction. - **Proximal dilatation** refers to localized dilation of the vein segment *upstream* from the point of obstruction as blood backs up, which is a classic sign of venous outflow obstruction. - This combination of focal stenosis with proximal dilatation is characteristic and different from diffuse dilatation of all veins. *Thickened walls of hepatic vein* - **Thickened walls** of the hepatic veins can be seen in **chronic Budd-Chiari syndrome** due to **inflammation** and **fibrosis** resulting from long-standing venous congestion and remodeling. - This finding suggests a more established or advanced stage of the disease.

Q: What is the structure seen in the given X-ray below?

Stent. ***Stent*** - The image likely shows a **tubular structure** placed within a lumen, consistent with the appearance of a medical stent on X-ray. - Medical stents, often made of **radiopaque materials**, are used to maintain patency of vessels or ducts. *Foley catheter* - A Foley catheter is typically a **flexible tube** with an inflatable balloon at its tip, inserted into the bladder for urine drainage. - While it has a radiopaque tip, its overall appearance and typical placement *within the bladder* would differ from the structure shown. *Intravesical wire* - An intravesical wire suggests a wire placed **within the bladder**, which is not a standard long-term therapeutic device and would have a distinct, finer appearance than the displayed structure. - There is no common medical device referred to as an "intravesical wire" as a distinct structure, and any wire would appear as a **thin, linear density**. *Surgical clips* - Surgical clips are **small, metallic fasteners** used to ligate vessels or mark tissue during surgery. - They appear as distinct, small, and often multiple **bright densities** on X-ray, not as a continuous tubular structure.

Q: All are important ultrasound findings of amebic liver abscess, EXCEPT:

Located in the left hepatic lobe. ***Located in the left hepatic lobe*** - While amebic liver abscesses can occur in the left lobe, they are **much more common in the right hepatic lobe** due to the preferential blood flow from the portal vein's superior mesenteric branch. - Therefore, location in the left lobe is not an *expected* or typical finding for an amebic liver abscess. *Round or oval in shape* - **Amebic liver abscesses typically present as round or oval lesions** on ultrasound due to their expanding nature within the liver parenchyma. - This morphology is a common characteristic used for their sonographic identification. *Single lesion* - **Amebic liver abscesses are usually solitary**; multiple abscesses are less common. - This characteristic helps differentiate them from other liver pathologies, such as pyogenic abscesses, which are often multiple. *Hypoechoic with irregular ill defined margins initially* - In their early stages, amebic liver abscesses are **hypoechoic (darker) on ultrasound** because of the initial inflammatory response and presence of necrotic material. - They also tend to have **ill-defined and irregular margins** initially as the infection is spreading through the liver tissue.

Question 1

The best investigation for air in the peritoneal cavity is:

Accepted Answer

X-ray

Answer

USG

Answer

Laparoscopy

Answer

Laparotomy

Question 2

In which of the following conditions is the lead pipe appearance of the colon seen on a barium enema?

Accepted Answer

Ulcerative colitis

Answer

Amoebiasis

Answer

Tuberculosis of the colon

Answer

Crohn's involvement of the colon

Question 3

X-ray given below suggestive of:

Accepted Answer

Gas mimicking peritoneal presence (Pseudopneumoperitoneum)

Answer

Gas mimicking mediastinal presence (Pseudopneumomediastinum)

Answer

Free gas in the mediastinum (Pneumomediastinum)

Answer

Free gas in the peritoneal cavity (Pneumoperitoneum)

Question 4

Which of the following liver metastases appear hypoechoic on ultrasound?

Accepted Answer

Breast cancer

Answer

RCC

Answer

Colon cancer

Answer

Mucinous adenocarcinoma

Question 5

Micturating cystourethrogram shows filling defect in the urinary bladder. Likely diagnosis is________

Accepted Answer

Ureterocele

Answer

Duplication of ureter

Answer

Sacrococcygeal teratoma

Answer

Vesicoureteric reflux grade II

Question 6

What is the diagnosis based on the following X-ray?

Accepted Answer

Bladder stone

Answer

Renal Tuberculosis

Answer

Uterine Fibroid

Answer

Bladder Carcinoma

Question 7

Focal and diffuse thickening of gallbladder wall with high amplitude reflections and 'comet tail' artifacts on USG suggest the diagnosis of –

Accepted Answer

Adenomyomatosis

Answer

Carcinoma of gall bladder

Answer

Cholesterolosis

Answer

Xanthogranulomatous cholecystitis

Question 8

All are sonological features of Budd Chiari syndrome, EXCEPT:

Accepted Answer

Diffusely dilated hepatic veins

Answer

Intraluminal echogenicity of hepatic vein

Answer

Stenosis and proximal dilatation of the hepatic veins

Answer

Thickened walls of hepatic vein

Question 9

What is the structure seen in the given X-ray below?

Accepted Answer

Stent

Answer

Foley catheter

Answer

Intravesical wire

Answer

Surgical clips

Question 10

All are important ultrasound findings of amebic liver abscess, EXCEPT:

Accepted Answer

Located in the left hepatic lobe

Answer

Round or oval in shape

Answer

Single lesion

Answer

Hypoechoic with irregular ill defined margins initially

Abdominal and Pelvic Radiology — MCQs

Abdominal and Pelvic Radiology — MCQs

On this page

Practice by Chapter

Want unlimited practice?