Abdominal and Pelvic Radiology Practice Questions

Q: What are the bilateral radiopaque structures extending from the renal pelvis to the bladder seen in this abdominal X-ray?

Stent. ***Stent*** - The image shows **bilateral coiled structures** (pigtail curls) in the renal pelvis and bladder, connected by a thin tube. This morphology is characteristic of **double-J ureteral stents**, which are used to maintain patency of the ureters. - The stents are radiopaque, as commonly seen in their composition (e.g., silicone with a metallic core or specific polymers), making them visible on X-ray. *Surgical clips* - **Surgical clips** are typically small, metallic, and used to ligate vessels or mark surgical sites. They appear as tiny, dense, uniform structures and do not have the elongated, coiled appearance seen here. - While there may be clips elsewhere in the abdomen, the prominent tubular structures with coiled ends are not surgical clips. *Foley catheter* - A **Foley catheter** is a tube placed in the bladder, typically with an inflatable balloon to secure it, and is visible as a single tube. - It would not extend up into the renal pelvis bilaterally and does not have the double-coiled configuration seen in the image. *Intravesical wire* - An **intravesical wire** (e.g., a guide wire used during a procedure) would appear as a single, thin, metallic, flexible line, often without the distinct coils at both ends. - The structures present are more substantial and clearly designed to maintain luminal patency over time, unlike a temporary guide wire.

Q: Chain of lakes appearance is seen in?

Chronic pancreatitis. ***Chronic pancreatitis*** - The **"chain of lakes" appearance** refers to the characteristic imaging finding of **multiple dilated pancreatic ducts** with intervening strictures, indicative of chronic inflammation and fibrosis. - This morphology is a hallmark of advanced chronic pancreatitis on **ERCP or MRCP**, reflecting irreversible damage to the pancreatic ductal system. *Gallstone ileus* - Characterized by **mechanical obstruction of the small intestine** by a gallstone that has entered the bowel lumen through a cholecystoenteric fistula. - Imaging shows signs of small bowel obstruction, pneumobilia, and ectopic gallstone, not pancreatic ductal abnormalities. *Sub-acute intestinal obstruction* - Refers to partial or intermittent bowel obstruction with features like abdominal pain, distension, vomiting, and altered bowel habits. - Imaging findings relate to dilated bowel loops proximal to the obstruction, not pancreatic duct changes. *Acute pancreatitis* - While acute pancreatitis can involve ductal inflammation and occasionally transient dilation, it does not present with the **permanent "chain of lakes" morphology** seen in chronic disease. - Acute pancreatitis shows peripancreatic inflammation, fluid collections, or necrosis rather than chronic ductal strictures and dilatations.

Q: Which imaging modality is considered the best for staging rectal carcinoma?

MRI. ***MRI*** - **Magnetic Resonance Imaging (MRI)** provides excellent soft tissue contrast, allowing for detailed visualization of the rectal wall layers, mesorectal fascia, and adjacent structures. - This high resolution is crucial for accurate **T-staging (tumor depth of invasion)** and assessment of **nodal involvement**, guiding treatment decisions like neoadjuvant therapy. *CT Scan* - **CT scans** are better for detecting distant metastases (e.g., in the liver or lungs) and assessing vascular involvement, rather than local staging of the primary tumor. - Its soft tissue resolution is inferior to MRI for distinguishing between the different layers of the rectal wall and for precise mesorectal fascia involvement. *TRUS* - **Transrectal ultrasound (TRUS)** is effective for evaluating superficial tumors and their depth of invasion within the rectal wall. - However, it has a limited field of view and is less reliable for assessing mesorectal fascia involvement or metastatic lymph nodes far from the rectal wall. *None of the options* - This option is incorrect because MRI is indeed the preferred imaging modality for precise local staging of rectal carcinoma due to its superior soft tissue resolution. - Accurate staging is critical for determining the appropriate treatment strategy, including the need for neoadjuvant chemoradiotherapy.

Q: Percentage of renal stones which are radio-opaque:

80. ***80*** - Approximately **80%** of renal stones are radio-opaque, making them visible on X-rays and CT scans [1]. - This high percentage is primarily due to the composition of most stones, such as **calcium oxalate** and **calcium phosphate** [1]. *20* - Only **20%** of renal stones are typically radio-opaque, which is significantly lower than the actual statistic. - This option fails to account for the majority of stones that are indeed visible on radiographic imaging. *40* - A **40%** radio-opacity would indicate a much larger proportion of stones being less visible on imaging, which is inaccurate. - The range for radio-opaque stones is considerably higher, primarily due to common stone types. *60* - While **60%** might suggest a considerable portion of stones are radio-opaque, it still underestimates the actual prevalence. - The more accurate figure reflects that at least **80%** of stones show radio-opacity which aids in diagnosis. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Diseases Of The Urinary And Male Genital Tracts, pp. 491-492.

Q: Which of the following HSG findings is most suggestive of genital tuberculosis?

Beaded tubes. ***Beaded tubes*** - **Beading** of the fallopian tubes on hysterosalpingography (HSG) is **the most characteristic finding** of **genital tuberculosis (GTB)**, representing multiple strictures and dilatations. - This appearance is due to the characteristic **granulomatous inflammation** and subsequent fibrosis that occur with tuberculous salpingitis, creating a **"rosary bead" or "string of pearls"** pattern. - This is considered the **most specific HSG sign** for genital TB. *Honeycomb uterus* - A **honeycomb uterus** appearance on HSG shows multiple small filling defects in the endometrial cavity. - This is more commonly associated with **synechiae (Asherman's syndrome)** or advanced **endometrial tuberculosis**, but is not the most suggestive finding. *Golf club tube* - A **golf club tube** appearance refers to a **dilated fallopian tube with a rounded, blunt end** that has lost its fimbrial integrity, seen in **hydrosalpinx**. - While hydrosalpinx can occur due to GTB, this finding is **non-specific** and can result from any chronic salpingitis (PID, post-infectious). *Pipe stem tubes* - **Pipe stem** or **rigid tubes** show straightened, non-dilated fallopian tubes due to fibrosis. - While this can be seen in genital TB, it is **less specific** than the beaded appearance and can occur in other chronic inflammatory conditions.

Q: Investigation of choice for detecting hepatic metastasis from stomach cancer is

CECT. ***CECT*** - **Contrast-Enhanced Computed Tomography (CECT)** is the **primary investigation of choice** for detecting **hepatic metastases from gastric cancer** due to its widespread availability, speed, and high spatial resolution. - Multi-phase CECT (arterial, portal venous, and delayed phases) effectively visualizes liver parenchyma and identifies most metastatic lesions with high sensitivity. - It provides excellent anatomical detail for **surgical planning** and **treatment decisions**. *Magnetic Resonance Imaging (MRI)* - While **MRI** with liver-specific contrast agents (e.g., gadoxetate disodium) offers superior **soft tissue contrast** and can be more sensitive for smaller or atypical lesions. - It is typically reserved as a **second-line investigation** when CECT findings are equivocal, for characterization of indeterminate lesions, or for detailed surgical planning, rather than the initial investigation of choice. *PET-CT* - **Positron Emission Tomography-Computed Tomography (PET-CT)** is highly effective for detecting metabolically active lesions and is useful for **whole-body staging and identifying distant metastases** beyond the liver. - However, it's not the primary investigation solely for **hepatic metastasis** due to lower spatial resolution compared to CECT, higher cost, limited availability, and greater radiation exposure. *Ultrasound (USG)* - **Ultrasound** is often used as an initial screening tool for abdominal pathologies due to its accessibility, low cost, and lack of radiation. - Its sensitivity for detecting small or deeply located **hepatic metastases** is limited compared to CECT, making it unsuitable as the definitive investigation of choice for staging gastric cancer.

Q: Which of the following is a direct (primary) sign of obstruction of the urinary tract on a CT scan?

Hydroureter. ***Hydroureter*** - **Hydroureter** (dilation of the ureter) is a **direct/primary sign** of urinary tract obstruction on CT scan. - It represents the physical consequence of upstream blockage and is a **direct visualization** of the obstructed collecting system. - On CT, a dilated ureter proximal to the point of obstruction is the most specific radiological evidence of ureteral obstruction. *Perinephric stranding* - **Perinephric stranding** represents edema in the perinephric fat and is a **secondary/indirect sign** of obstruction. - While commonly seen with acute ureteral obstruction (as part of renal inflammatory response), it is **not a direct sign** of the obstruction itself. - It can also occur with pyelonephritis, trauma, or other inflammatory processes, making it less specific. *Thickening of the lateroconal fascia* - **Lateroconal fascia thickening** is another **secondary/indirect sign** that can accompany urinary tract obstruction. - It reflects inflammatory changes in the retroperitoneal fascial planes adjacent to an obstructed kidney. - Like perinephric stranding, it is a non-specific finding that can occur with various retroperitoneal inflammatory processes. *None of the options* - This option is incorrect because **hydroureter** is a well-established direct sign of urinary tract obstruction on CT scan.

Q: Which of the following is a radiological sign of acute pancreatitis on plain radiography?

Sentinel loop sign. ***Sentinel loop sign*** - The **sentinel loop sign** refers to a focally dilated segment of small bowel (usually proximal jejunum) adjacent to an inflamed pancreas due to localized ileus. - This sign is often visible on **plain abdominal radiographs** in cases of acute pancreatitis. *Murphy's sign* - **Murphy's sign** is a clinical finding, not a radiological sign, characterized by inspiratory arrest upon deep palpation of the right upper quadrant. - It is classically associated with **acute cholecystitis**, not acute pancreatitis. *Renal halo sign* - The **renal halo sign** is a radiological finding (typically on CT) describing perinephric fat stranding that can be seen in various renal pathologies, not acute pancreatitis. - It is not a characteristic sign of pancreatic inflammation on plain radiography. *Grey Turner's sign* - **Grey Turner's sign** is a clinical sign characterized by ecchymosis or discoloration of the flanks. - It indicates **retroperitoneal hemorrhage**, which can be a severe complication of acute pancreatitis but is not a radiological sign itself and is not specific to acute pancreatitis on plain X-ray.

Q: The 'coffee bean sign' is typically seen in which condition?

Sigmoid volvulus. ***Sigmoid volvulus*** - The **coffee bean sign** is a classic radiographic finding in **sigmoid volvulus**, representing the hugely distended, gas-filled loop of bowel twisting on its mesentery. - This sign is due to the **two limbs of the distended sigmoid colon** converging towards the pelvis, creating a peculiar shape on an abdominal X-ray. *Gastric volvulus* - **Gastric volvulus** involves torsion of the stomach, which can appear as a massively dilated stomach with an air-fluid level or a "double bubble" sign if there is also duodenal obstruction. - It does not typically produce the **coffee bean appearance**, which is characteristic of colonic volvulus. *Hypertrophic pyloric stenosis* - **Hypertrophic pyloric stenosis** is a condition in infants characterized by a thickened pylorus, often leading to non-bilious projectile vomiting. - Imaging typically shows an elongated, narrowed pyloric channel (the "string sign") and a thickened pyloric muscle ("target sign" or "doughnut sign") on ultrasound, not a coffee bean sign. *Achalasia* - **Achalasia** is an esophageal motility disorder where the lower esophageal sphincter fails to relax, leading to food accumulation. - Radiographic findings include a dilated esophagus with a "bird's beak" appearance at the gastroesophageal junction, distinct from the coffee bean sign.

Q: Mercedes Benz sign is seen in:

Gallstone. ***Correct Option: Gallstone*** The **Mercedes Benz sign** is a classic radiologic finding specifically associated with **gallstones**, particularly cholesterol stones. - Appears as a **triradiate or stellate lucency** within the gallstone on plain radiographs, CT scans, or ultrasound - Named for its resemblance to the **Mercedes-Benz three-pointed star logo** - Caused by **nitrogen gas trapped within fissures or clefts** in the stone - Highly specific for gallstones when present *Incorrect Option: Bladder stone* - Bladder stones are calcifications in the **urinary bladder**, typically associated with urinary stasis, infection, or outlet obstruction - Appear as calcifications on imaging but **do not exhibit the Mercedes Benz sign** - This sign is unique to gallstones *Incorrect Option: Renal stones* - Renal stones (kidney stones) are found in the **kidneys or ureters** and are composed of various salts (calcium oxalate, uric acid, struvite, etc.) - Visible on imaging as calcifications or filling defects, but **do not show the Mercedes Benz sign** - This characteristic appearance is specific to certain types of gallstones *Incorrect Option: Foreign body in bronchus* - A foreign body in the bronchus presents as an **opaque or radiolucent object within the airway** on chest imaging - May cause complications like atelectasis, air trapping, or pneumonia - **No association** with the Mercedes Benz sign, which is specific to gallstones

Question 1

What are the bilateral radiopaque structures extending from the renal pelvis to the bladder seen in this abdominal X-ray?

Accepted Answer

Stent

Answer

Surgical clips

Answer

Foley catheter

Answer

Intravesical wire

Question 2

Chain of lakes appearance is seen in?

Accepted Answer

Chronic pancreatitis

Answer

Gallstone ileus

Answer

Sub-acute intestinal obstruction

Answer

Acute pancreatitis

Question 3

Which imaging modality is considered the best for staging rectal carcinoma?

Accepted Answer

MRI

Answer

CT Scan

Answer

TRUS

Answer

None of the options

Question 4

Percentage of renal stones which are radio-opaque:

Accepted Answer

80

Answer

20

Answer

60

Answer

40

Question 5

Which of the following HSG findings is most suggestive of genital tuberculosis?

Accepted Answer

Beaded tubes

Answer

Honeycomb uterus

Answer

Golf club tube

Answer

Pipe stem tubes

Question 6

Investigation of choice for detecting hepatic metastasis from stomach cancer is

Accepted Answer

CECT

Answer

Magnetic Resonance Imaging (MRI)

Answer

PET-CT

Answer

Ultrasound (USG)

Question 7

Which of the following is a direct (primary) sign of obstruction of the urinary tract on a CT scan?

Accepted Answer

Hydroureter

Answer

None of the options

Answer

Perinephric stranding

Answer

Thickening of the lateroconal fascia

Question 8

Which of the following is a radiological sign of acute pancreatitis on plain radiography?

Accepted Answer

Sentinel loop sign

Answer

Grey Turner's sign

Answer

Renal halo sign

Answer

Murphy's sign

Question 9

The 'coffee bean sign' is typically seen in which condition?

Accepted Answer

Sigmoid volvulus

Answer

Achalasia

Answer

Gastric volvulus

Answer

Hypertrophic pyloric stenosis

Question 10

Mercedes Benz sign is seen in:

Accepted Answer

Gallstone

Answer

Foreign body in bronchus

Answer

Bladder stone

Answer

Renal stones

Abdominal and Pelvic Radiology — MCQs

Abdominal and Pelvic Radiology — MCQs

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