Abdominal and Pelvic Radiology Practice Questions

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

Q: Christmas tree appearance of urinary bladder is seen in

Neurogenic bladder dysfunction. ***Neurogenic bladder dysfunction*** - The "Christmas tree appearance" refers to the **trabeculated and irregular bladder wall** with associated **bladder diverticula** seen on a voiding cystourethrogram (VCUG). - This appearance is characteristic of chronic, high-pressure bladder emptying due to **neurological impairment**, leading to hypertrophy of the detrusor muscle. *Autonomous bladder function* - An autonomous bladder (or isolated detrusor contraction) typically results from **complete spinal cord lesions** above the sacral micturition center after spinal shock. - While it is a type of neurogenic bladder, it doesn't specifically correlate with the "Christmas tree appearance," which is broader and signifies any form of chronic bladder outlet obstruction or spasticity. *Nocturnal enuresis* - This refers to **involuntary urination during sleep** and is primarily a functional disorder, especially in children, without structural bladder changes. - It is not associated with the characteristic radiological findings of bladder wall hypertrophy or diverticula. *Urinary stress incontinence* - Characterized by **involuntary leakage of urine** during physical activity that increases intra-abdominal pressure. - This condition is typically due to **urethral hypermobility** or **intrinsic sphincter deficiency** and does not involve structural changes to the bladder wall itself that would cause a "Christmas tree appearance."

Q: A delayed intravenous urogram of a patient is given below. What is the likely diagnosis?

Pelviureteric junction obstruction. ***Pelviureteric junction obstruction*** - The image shows marked **dilatation of the renal pelvis and calyces** on the right side, with a relatively abrupt narrowing at the junction of the pelvis and ureter. - The delayed nature of the urogram suggests **impaired drainage** of contrast from the renal pelvis, accumulating proximal to the obstruction. *Putty kidney* - A "putty kidney" (or **autonecrotic kidney**) refers to a chronic, severely diseased kidney, often seen in end-stage **renal tuberculosis**, that has become calcified and non-functional. - This image demonstrates active contrast excretion and pelvicalyceal dilatation, not a calcified, non-functional organ. *Staghorn calculus* - A staghorn calculus is a **large, branched kidney stone** that occupies a significant portion of the renal collecting system. - While it can cause hydronephrosis, the image does not show a dense, radiopaque calculus filling the collecting system. *Cystic kidney* - **Cystic kidneys**, such as in polycystic kidney disease, are characterized by multiple fluid-filled sacs within the kidney parenchyma. - The image depicts dilatation of the collecting system, not diffuse cystic changes throughout the renal parenchyma.

Q: A female patient presented with recurrent urinary tract infections. Imaging shows the following picture. What can be the most probable diagnosis based on the imaging findings?

Ureterocele. ***Ureterocele (Correct Answer)*** - The image shows a **cystic dilation of the distal ureter** (red arrow) that protrudes into the bladder, which is characteristic of a ureterocele. - Ureteroceles can cause **obstruction and recurrent UTIs** due to stasis and impaired emptying. *Ureteral duplication (Incorrect)* - Ureteral duplication would present as two distinct ureters draining from the same kidney, typically with separate insertions into the bladder or urethra. This is not observed in the image, as there is only one ureter visible from each kidney down to the bladder. - While complete ureteral duplication often features an *ectopic* and *obstructed* upper pole ureter, the imaging here primarily shows a bladder abnormality. *Congenital megaureter (Incorrect)* - A congenital megaureter involves a **diffusely dilated ureter** along its length, without the focal, cystic protrusion into the bladder seen here. - While it can cause UTIs due to stasis, the specific localized dilation inside the bladder strongly points away from this diagnosis. *Urinary calculi (Incorrect)* - Urinary calculi (stones) would appear as **hyperdense opacities within the collecting system** or ureter, which could cause obstruction and UTIs. - The image distinctly shows a **fluid-filled, balloon-like structure** at the ureterovesical junction, not a calcified stone.

Q: Which radiological finding is shown in the image?

Intussusception. ***Intussusception*** - The image clearly displays the classic "coiled spring" appearance, which is pathognomonic for **intussusception** on a barium enema study. This pattern is created by barium trapped between the intussusceptum and intussuscipiens. - The arrow specifically points to the leading edge of the intussusception, where the bowel telescopes into an adjacent segment. *Colon carcinoma* - Colon carcinoma typically presents as an **irregular narrowing** or an **apple-core lesion** on barium studies, a sign of luminal stricture due to a mass. - The radiological appearance for carcinoma would not show the distinct layered or coiled pattern seen in the provided image. *Sigmoid volvulus* - Sigmoid volvulus is characterized by a **"coffee bean" sign** on plain radiographs due to the massively dilated, inverted U-shaped loop of colon, or a **"bird's beak" appearance** on contrast studies at the twisted obstruction point. - This contrasts significantly with the concentric rings and linear striations indicative of intussusception. *Ileus* - Ileus, or paralytic ileus, involves generalized **bowel dilation** without a clear point of mechanical obstruction, often with gas present throughout the large and small bowel. - The image shows a very specific, localized abnormality with a characteristic pattern, not generalized bowel distension associated with ileus.

Q: What does the sign depicted in the image represent?

Mickey mouse sign. ***Mickey mouse sign*** - The **Mickey Mouse sign** is a radiological finding seen on **cross-sectional imaging (CT/ultrasound)** of the porta hepatis. - It represents the appearance of the **portal vein** (forming the "face") with the **hepatic artery and common bile duct** on either side (forming the "ears"). - This anatomical configuration in transverse sections resembles Mickey Mouse's face and ears. - It is a normal anatomical landmark used for orientation in hepatobiliary imaging. *String sign* - The **string sign** is a radiological finding where a segment of bowel lumen is narrowed to a thin string-like appearance. - Commonly seen in **Crohn's disease** due to chronic inflammation and stricture formation, typically affecting the terminal ileum. - Can also refer to a severely stenotic mitral valve on cardiac angiography. *Tillaux sign* - The **Tillaux fracture** is a **Salter-Harris type III fracture** of the anterolateral distal tibial epiphysis. - This is a **radiological fracture pattern** seen in adolescents during skeletal maturation. - The fracture line extends from the articular surface through the epiphysis and out through the lateral physis. - Not to be confused with a clinical examination finding. *Stemmer's sign* - **Stemmer's sign** is a **clinical examination finding**, not a radiological sign. - Used to diagnose **lymphedema** - positive if the skin on the dorsal aspect of the second toe cannot be lifted or tented. - Indicates tissue thickening due to chronic lymphatic fluid accumulation.

Q: The Barium Swallow examination shows a mass in the esophagus. What can be the most probable diagnosis?

Esophageal Cancer. ***Esophageal Cancer*** - A **mass** identified in the esophagus on **Barium Swallow** is highly suggestive of esophageal cancer, typically presenting as a **solitary lesion**. - Other associated features may include **dysphagia**, weight loss, and potentially lymphadenopathy on imaging. *Esophageal Ring (Stricture)* - Usually presents as a **narrowing of the esophagus** rather than a distinct mass on imaging, often causing intermittent **dysphagia**. - The appearance is more likely to cause **functional obstruction** rather than present as a **solid mass** in the esophagus. *Esophageal Perforation* - This condition would not present as a **mass**; instead, symptoms include **severe chest pain**, and may show mediastinal air on imaging. - Perforation leads to **acute symptoms** and signs of **infection**, differentiating it from a neoplastic process. *Achalasia* - Characterized by **dilated esophagus** with a **bird-beak appearance** on imaging rather than a discrete mass. - It commonly results in **dysphagia** for solids and liquids, not presenting as a mass lesion on Barium Swallow.

Question 1

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

Accepted Answer

Sigmoid volvulus

Answer

Achalasia

Answer

Gastric volvulus

Answer

Hypertrophic pyloric stenosis

Question 2

Mercedes Benz sign is seen in:

Accepted Answer

Gallstone

Answer

Foreign body in bronchus

Answer

Bladder stone

Answer

Renal stones

Question 3

Christmas tree appearance of urinary bladder is seen in

Accepted Answer

Neurogenic bladder dysfunction

Answer

Autonomous bladder function

Answer

Nocturnal enuresis

Answer

Urinary stress incontinence

Question 4

A delayed intravenous urogram of a patient is given below. What is the likely diagnosis?

Accepted Answer

Pelviureteric junction obstruction

Answer

Putty kidney

Answer

Staghorn calculus

Answer

Cystic kidney

Question 5

A patient presents with severe epigastric pain, markedly elevated serum lipase, and imaging showing substantial ascites. In this clinical setting, which diagnosis best explains the gasless abdominal radiograph?

Accepted Answer

Acute pancreatitis

Answer

Intussusception

Answer

Necrotising enterocolitis

Answer

Ulcerative colitis

Question 6

A female patient presented with recurrent urinary tract infections. Imaging shows the following picture. What can be the most probable diagnosis based on the imaging findings?

Accepted Answer

Ureterocele

Answer

Ureteral duplication

Answer

Congenital megaureter

Answer

Urinary calculi

Question 7

Which radiological finding is shown in the image?

Accepted Answer

Intussusception

Answer

Colon carcinoma

Answer

Sigmoid volvulus

Answer

Ileus

Question 8

What does the sign depicted in the image represent?

Accepted Answer

Mickey mouse sign

Answer

String sign

Answer

Tillaux sign

Answer

Stemmer's sign

Question 9

The Barium Swallow examination shows a mass in the esophagus. What can be the most probable diagnosis?

Accepted Answer

Esophageal Cancer

Answer

Esophageal Ring (Stricture)

Answer

Esophageal Perforation

Answer

Achalasia

Question 10

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

Accepted Answer

Uterine Leiomyoma

Answer

Bladder rupture

Answer

Bladder stone

Answer

Transitional Cell Carcinoma of the Bladder

Abdominal and Pelvic Radiology — MCQs

Abdominal and Pelvic Radiology — MCQs

On this page

Practice by Chapter

Want unlimited practice?