Abdominal and Pelvic Radiology Practice Questions

Q: The "Target sign" ultrasonographically means:

Intussusception. ***Intussusception*** - The **"target sign"** (also known as the **"donut sign"** or **"pseudokidney sign"**) on ultrasound is a classic finding for **intussusception**. - It represents concentric layers of bowel telescoping into an adjacent segment, creating a central hyperechoic core surrounded by hypoechoic rings. *Liver metastasis* - Liver metastases often appear as **hypoechoic, hyperechoic, or mixed echogenicity lesions** on ultrasound, and vary widely in appearance. - While some can have a "target-like" appearance with a hyperechoic rim, it's not the primary or most specific sign for liver metastasis and is less distinct than in intussusception. *Ectopic kidney* - An ectopic kidney is an anatomical variant where the kidney is located outside its normal position, most commonly in the **pelvis**. - On ultrasound, it would appear as a normally formed kidney in an atypical location, without the distinct concentric layers seen in the "target sign." *Ovarian carcinoma* - Ovarian carcinomas present with **complex masses** that can be solid, cystic, or mixed, often with septations, papillary projections, and areas of necrosis. - Their ultrasound appearance is highly variable but does not typically manifest as a "target sign" with concentric rings.

Q: Double decidual sac sign is indicative of?

Intrauterine pregnancy. ***Intrauterine pregnancy*** - The **double decidual sac sign** refers to the visualization of two concentric rings of decidua surrounding the gestational sac, which is a characteristic feature of an **early intrauterine pregnancy**. - It signifies the presence of both the **parietal decidua** (lining the uterine cavity) and the **capsular decidua** (surrounding the gestational sac), distinguishing a true gestational sac from a pseudogestational sac. *Ectopic pregnancy* - In an **ectopic pregnancy**, the gestational sac is located outside the uterus, and therefore, the double decidual sac sign will **not be present**. - A pseudogestational sac, which lacks the double decidual sac sign, can sometimes be seen in the uterus in cases of ectopic pregnancy. *H. mole* - A **hydatidiform mole** (H. mole) is characterized by abnormal proliferation of trophoblastic tissue and typically presents as a "snowstorm" appearance on ultrasound, with **no identifiable gestational sac or embryo**. - The double decidual sac sign is a marker of a well-formed gestational sac within the uterus and is absent in molar pregnancies. *Twin pregnancy* - While a twin pregnancy involves two gestational sacs or a single sac with two embryos, the **double decidual sac sign** itself is an indicator of the presence of any single normal gestational sac within the uterus, regardless of the number of fetuses. - The sign confirms the intrauterine location and viability of a pregnancy, but additional features are needed to diagnose a multiple gestation.

Q: In which of the following conditions is air under both sides of diaphragm visualized -

Perforation of duodenal ulcer. ***Perforation of duodenal ulcer*** - A perforated duodenal ulcer is the **most classic and common cause** of pneumoperitoneum (free air under the diaphragm). - Perforation creates a communication between the gastrointestinal tract and the peritoneal cavity, allowing **free air to escape into the abdomen**. - This free air, being less dense than surrounding tissues, rises and collects **bilaterally under the diaphragm**, creating the classic **"football sign"** or crescents of air on upright chest X-ray. - Duodenal ulcer perforation is the **most frequently tested** cause of this radiological finding in medical examinations. *Perforated Meckel's diverticulum* - A perforated Meckel's diverticulum would also allow **intraluminal gas to escape into the peritoneal cavity**, causing pneumoperitoneum. - However, this is a **much rarer condition** compared to duodenal ulcer perforation. - Meckel's diverticulum perforation occurs in only 10-30% of symptomatic cases, making it less common than duodenal ulcer perforation. - While technically correct that it would show free air, duodenal ulcer perforation is the **primary answer** due to its higher frequency. *Uterine rupture following illegal abortion* - Uterine rupture would primarily involve **blood and uterine contents** spilling into the peritoneal cavity, rather than free air. - While instrumentation during illegal abortion could potentially introduce air, significant **bilateral subdiaphragmatic free air** is not a typical or diagnostically significant finding. - The hallmark findings would be **hemoperitoneum and pelvic fluid collections**, not pneumoperitoneum. *All of the options* - This option is incorrect because uterine rupture (as explained above) typically does not cause diagnostically significant pneumoperitoneum. - While both GI perforations can cause free air, only duodenal ulcer perforation is the **classic and most common** cause being tested here.

Q: Claw sign seen in?

Intussusception. ***Intussusception*** - The **claw sign** is a characteristic radiological finding in **intussusception**, seen on barium enema or ultrasound - It represents the **intussusceptum** (the invaginated bowel segment) within the **intussuscipiens** (the receiving bowel segment), creating a claw-like appearance at the margins - The claw-like projections are formed by the opposing walls of the intussusception *Malrotation* - Malrotation presents with **midgut volvulus** and shows the **whirl sign** (twisted mesentery) on imaging - May show **duodenal obstruction** with double bubble sign, not claw sign - The claw sign is not a feature of malrotation *Volvulus* - **Volvulus** typically presents with a **"coffee bean sign"** (sigmoid volvulus) or **"whirl sign"** (cecal/midgut volvulus) on imaging - These signs indicate twisted bowel loops around the mesentery - The **claw sign** is not associated with volvulus; it is specific to the telescoping of bowel segments seen in intussusception *Both* - This option is incorrect as the **claw sign** is specific to **intussusception** only - While intussusception, malrotation, and volvulus can all cause bowel obstruction, their radiographic signs are distinct and diagnostically important

Q: USG findings of focal anechoic lesion with floating membranes indicate which liver pathology?

Hydatid cyst. ***Hydatid cyst*** - A **hydatid cyst** often presents on ultrasound as a **focal anechoic lesion** with characteristic **floating membranes** (water lily sign) due to detachment of the endocyst. - These cysts are caused by tapeworm larvae (*Echinococcus granulosus*) and can have daughter cysts within the main cyst. *Pyogenic abscess* - A **pyogenic abscess** typically appears as an **ill-defined, hypoechoic liver lesion** with internal debris, sometimes showing gas. - While it can be anechoic, the presence of **floating membranes** is not a characteristic feature. *Hemangioma* - A **hemangioma** is usually a **well-defined, hyperechoic lesion** on ultrasound, without any internal fluid or floating membranes. - Its appearance is distinct from cystic lesions and it often shows characteristic peripheral nodular enhancement on contrast-enhanced imaging. *Amoebic abscess* - An **amoebic abscess** typically presents as a **hypoechoic, often round or oval lesion** with fine internal echoes and poorly defined walls, usually without floating membranes. - It is frequently located in the right lobe of the liver and can be difficult to differentiate from a pyogenic abscess based on imaging alone.

Q: X-Ray appearance of CBD stone on cholangiography is:

Meniscus appearance. ***Meniscus appearance*** - A **meniscus appearance** on cholangiography is characteristic of a **filling defect** caused by a common bile duct (CBD) stone. The contrast material outlines the stone, creating a curved, crescent-shaped border. - This image clearly demonstrates the classic **meniscus sign** where the contrast agent partially outlines the stone, showing its superior surface as a curved line, with dilated CBD just proximal to it. *Sudden cut off* - A **sudden cut off** might suggest a complete obstruction, but it typically implies **malignancy** or extrinsic compression that completely obliterates the lumen, rather than an intraluminal stone. - While a large stone can cause severe obstruction, it rarely presents as a perfectly abrupt, sharp block on cholangiography without some outlining. *Eccentric occlusion* - **Eccentric occlusion** usually means partial blockage from one side, which could be due to a stone, but it often implies the stone is **not completely obstructing** the lumen or is adherent to one wall. - While stones can cause eccentric occlusion, "meniscus appearance" more specifically describes the classic imaging finding of a stone within the lumen. *Smooth tapering* - **Smooth tapering** is usually indicative of a **benign stricture** or inflammatory process, where the duct gradually narrows. - It does not suggest an intraluminal filling defect like a stone; rather, it implies a gradual constriction of the duct wall.

Q: Gas absent from intestine (gasless abdomen) on x-ray is seen in which condition?

Acute pancreatitis. ***Acute pancreatitis*** - In **severe acute pancreatitis**, a **gasless or relatively gasless abdomen** may be seen due to profound **ileus** with fluid accumulation displacing intestinal gas. - The marked inflammatory process can lead to complete loss of intestinal motility and fluid sequestration (third-spacing), resulting in minimal visible bowel gas on X-ray. - **Note**: Classic signs include **sentinel loop sign** (dilated jejunal loop) or **colon cut-off sign**, but in severe cases with massive ascites or fluid collections, a gasless pattern may occur. *Ulcerative colitis* - Typically presents with **dilated loops of large bowel** with visible gas and **toxic megacolon** in severe cases. - Inflammatory changes cause bowel wall thickening, but gas is usually **present and often increased**. *Intussusception* - May show a **target sign** or **meniscus sign** on imaging, with bowel loops dilated proximal to the obstruction. - Gas is typically **present** within the bowel or proximal to the invagination, not absent from the entire abdomen. *Necrotizing enterocolitis* - Characterized by **pneumatosis intestinalis** (gas in the bowel wall) and **portal venous gas**, features directly contradicting a gasless abdomen. - Shows dilated loops with gas and evidence of bowel wall necrosis - **gas is prominently present**.

Q: Causes of thickened gallbladder wall on ultrasound examination are all except:

Kawasaki disease. ***Kawasaki disease*** (Correct - NOT a typical cause of gallbladder wall thickening) * Although **Kawasaki disease** can cause systemic inflammation and **gallbladder hydrops** (distension) in children, it typically does NOT present with primary gallbladder wall thickening as a diagnostic finding. * The gallbladder manifestation in Kawasaki disease is **hydrops** (distension without stones), which is distinct from wall thickening. * Other hallmark features include **coronary artery aneurysms**, mucocutaneous manifestations, rash, and lymphadenopathy. * Gallbladder wall thickening is **not a recognized criterion** or common ultrasound finding in Kawasaki disease. --- *Congestive cardiac failure* (Incorrect - DOES cause thickening) * **Right-sided heart failure** leads to systemic venous congestion, causing **edema** in the gallbladder wall and subsequent thickening on ultrasound. * The thickening results from increased **hydrostatic pressure** and fluid accumulation in the wall. * This is a well-recognized cause of gallbladder wall thickening in the setting of hepatic congestion and ascites. *Postprandial state* (Incorrect - DOES cause thickening) * After a meal, especially one rich in fats, the gallbladder **contracts physiologically** to expel bile into the duodenum. * The contracted gallbladder wall appears **thickened** due to muscular contraction and reduced luminal volume. * This is a **normal physiological response**, not pathology; the thickening is *transient*, *symmetric*, and resolves on follow-up imaging after fasting. *Cholecystitis* (Incorrect - DOES cause thickening) * **Acute cholecystitis** involves inflammation of the gallbladder, directly causing **edema** and cellular infiltration of the gallbladder wall. * Wall thickening (>3 mm) is a **primary ultrasound diagnostic criterion** for acute cholecystitis. * Often accompanied by *pericholecystic fluid*, gallstones, and positive **sonographic Murphy's sign**.

Q: A dense persistent nephrogram may be seen in all of the following except:

Systemic hypertension. ***Systemic hypertension*** - **Systemic hypertension** is not typically associated with a dense, persistent nephrogram on imaging. While chronic hypertension can cause renal damage, it does not directly lead to the characteristic prolonged parenchymal enhancement. - A dense, persistent nephrogram suggests impaired contrast excretion or increased reabsorption, neither of which is a primary manifestation of systemic hypertension itself. *Severe hydronephrosis* - **Severe hydronephrosis** leads to impaired urine flow and delayed transit of contrast medium through the renal tubules, resulting in a persistent nephrogram. - The dilated collecting system and compressed parenchyma can retain contrast for an extended period due to reduced glomerular filtration rate (GFR) in the affected kidney. *Dehydration* - In cases of **dehydration**, the kidneys attempt to conserve water, leading to increased reabsorption of water from the renal tubules. - This process can concentrate the contrast medium within the tubules, resulting in a denser and more persistent nephrogram as it slowly transits through the kidney. *Acute ureteral obstruction* - **Acute ureteral obstruction** causes a build-up of pressure within the renal collecting system, impairing glomerular filtration and slowing the passage of contrast. - The contrast medium remains within the renal parenchyma for a prolonged period due to the blockage, leading to a dense and persistent nephrogram and delayed excretion.

Q: A patient with right lower quadrant pain shows target sign on ultrasound. Diagnosis?

Intussusception. ***Intussusception*** - The **target sign** on ultrasound is a classic radiological finding in **intussusception**, indicating a segment of bowel telescoping into an adjacent segment. - This condition is a common cause of **acute abdominal pain** and bowel obstruction, particularly in young children, though it can occur in adults. *Diverticulitis* - Diverticulitis presents with **inflammation of diverticula**, often in the left lower quadrant, but can occur in the right. - Ultrasound findings typically include **thickened bowel wall**, pericolic fat stranding, and sometimes abscesses, not a target sign. *Mesenteric cyst* - A mesenteric cyst is a **fluid-filled mass** located within the mesentery and would appear as a well-defined, anechoic (fluid-filled) structure on ultrasound. - It would not exhibit the characteristic concentric layers of the target sign. *Appendicitis* - Acute appendicitis is characterized by a **dilated, non-compressible appendix** with a thickened wall and surrounding inflammation on ultrasound. - While it causes right lower quadrant pain, the specific **target sign** is not typical for appendicitis.

Question 1

The "Target sign" ultrasonographically means:

Accepted Answer

Intussusception

Answer

Liver metastasis

Answer

Ectopic kidney

Answer

Ovarian carcinoma

Question 2

Double decidual sac sign is indicative of?

Accepted Answer

Intrauterine pregnancy

Answer

Ectopic pregnancy

Answer

H. mole

Answer

Twin pregnancy

Question 3

In which of the following conditions is air under both sides of diaphragm visualized -

Accepted Answer

Perforation of duodenal ulcer

Answer

Uterine rupture following illegal abortion

Answer

All of the options

Answer

Perforated Meckel's diverticulum

Question 4

Claw sign seen in?

Accepted Answer

Intussusception

Answer

Malrotation

Answer

Volvulus

Answer

Both

Question 5

USG findings of focal anechoic lesion with floating membranes indicate which liver pathology?

Accepted Answer

Hydatid cyst

Answer

Pyogenic abscess

Answer

Hemangioma

Answer

Amoebic abscess

Question 6

X-Ray appearance of CBD stone on cholangiography is:

Accepted Answer

Meniscus appearance

Answer

Sudden cut off

Answer

Eccentric occlusion

Answer

Smooth tapering

Question 7

Gas absent from intestine (gasless abdomen) on x-ray is seen in which condition?

Accepted Answer

Acute pancreatitis

Answer

Ulcerative colitis

Answer

Intussusception

Answer

Necrotizing enterocolitis

Question 8

Causes of thickened gallbladder wall on ultrasound examination are all except:

Accepted Answer

Kawasaki disease

Answer

Congestive cardiac failure

Answer

Postprandial state

Answer

Cholecystitis

Question 9

A dense persistent nephrogram may be seen in all of the following except:

Accepted Answer

Systemic hypertension

Answer

Severe hydronephrosis

Answer

Dehydration

Answer

Acute ureteral obstruction

Question 10

A patient with right lower quadrant pain shows target sign on ultrasound. Diagnosis?

Accepted Answer

Intussusception

Answer

Diverticulitis

Answer

Mesenteric cyst

Answer

Appendicitis

Abdominal and Pelvic Radiology — MCQs

Abdominal and Pelvic Radiology — MCQs

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