Abdominal and Pelvic Radiology — MCQs
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A 55-year-old male patient presents with hematuria and a mass in the left kidney on a CT scan, as shown below. What is the diagnosis?
Identify the investigation modality shown in the image.
Which of the following kidney stones best explains the findings in this X-ray KUB?
The following MRI image shows:
The following IVU shows:
The given IVU shows:
The radiographic findings are most consistent with:
What does the given CT abdomen show?
A 28-year-old male patient presents with colicky abdominal pain along with vomiting. X-ray abdomen shows:
This young patient presented with acute right lower abdominal pain. What is the possible diagnosis?
Abdominal and Pelvic Radiology Indian Medical PG Practice Questions and MCQs
Question 531: A 55-year-old male patient presents with hematuria and a mass in the left kidney on a CT scan, as shown below. What is the diagnosis?
- A. Renal cell carcinoma
- B. Renal oncocytoma
- C. Renal angiomyolipoma (Correct Answer)
- D. Renal cyst
Explanation: ***Renal angiomyolipoma*** - This is a benign renal tumor composed of three tissue types: blood vessels (**angio**), smooth muscle (**myo**), and fat (**lipoma**). The presence of macroscopic fat on a CT scan is a key diagnostic feature. - Patients can be asymptomatic or present with **hematuria** or flank pain, particularly if the tumor is large. There is a strong association with **tuberous sclerosis**. *Renal cell carcinoma* - This is the most common malignant kidney tumor in adults, often presenting with **hematuria**, flank pain, and a palpable mass (the classic triad). - On imaging, it typically appears as a heterogeneously enhancing solid mass and crucially, **lacks macroscopic fat**, which helps differentiate it from an angiomyolipoma. *Renal oncocytoma* - This is a benign epithelial tumor that can be difficult to distinguish from renal cell carcinoma on imaging alone. - It may show a characteristic **central stellate scar** on contrast-enhanced CT, but it does not contain significant fat tissue. *Renal cyst* - A simple renal cyst appears on CT as a well-defined, thin-walled, non-enhancing lesion filled with fluid of **water density**. - The image and description indicate a solid, **neovascular mass**, which is inconsistent with the avascular nature of a simple cyst.
Question 532: Identify the investigation modality shown in the image.
- A. X-ray defecogram (Correct Answer)
- B. Barium swallow
- C. MR defecogram
- D. X-ray barium enema
Explanation: ***X-ray defecogram*** - This is a dynamic fluoroscopic study, also known as **evacuation proctography**, which visualizes the rectum and anal canal during the act of defecation. - The images show contrast material within the rectum and its expulsion, allowing for the assessment of anorectal angle, pelvic floor descent, and identification of pathologies like **rectocele**, **enterocele**, or **intussusception**. *Barium swallow* - A barium swallow is a radiographic study used to examine the **upper gastrointestinal tract**, specifically the pharynx, esophagus, and stomach. - The image clearly depicts the pelvic anatomy and rectum, not the upper GI tract. *MR defecogram* - While also a dynamic study of defecation, an MR defecogram utilizes **magnetic resonance imaging (MRI)**, which provides superior soft-tissue contrast and does not use ionizing radiation. - The image shown is a plain radiograph (X-ray), which has a different appearance compared to an MRI scan. *X-ray barium enema* - A barium enema is used to visualize the anatomy of the **entire large intestine** to detect structural abnormalities like polyps, tumors, or diverticula. - It is typically a static study of the colon's morphology, whereas a defecogram is a functional study focused on the dynamics of evacuation.
Question 533: Which of the following kidney stones best explains the findings in this X-ray KUB?
- A. Xanthine
- B. Phosphate
- C. Uric acid (Correct Answer)
- D. Cystine
Explanation: ***Uric acid*** - The X-ray KUB image shows **radio-lucent stones** (stones that are not visible) within the kidneys, which is characteristic of **uric acid** stones. - Uric acid stones appear radio-lucent because they **do not contain calcium** and have a low atomic number, making them poorly visible on plain radiographs. *Xanthine* - **Xanthine stones** are also typically **radio-lucent** on X-ray, similar to uric acid stones. - However, they are much **rarer** than uric acid stones, often associated with genetic disorders of purine metabolism or allopurinol use. *Phosphate* - **Phosphate stones**, such as **calcium phosphate** and **magnesium ammonium phosphate (struvite)** stones, are typically **radio-opaque** and appear bright white on X-ray. - Struvite stones often grow large, forming **staghorn calculi**, which is not depicted as a radio-opaque lesion here. *Cystine* - **Cystine stones** are usually **faintly radio-opaque** or **semi-opaque** on X-ray, appearing less dense than calcium stones but more dense than uric acid stones. - They tend to form in acidic urine environments due to a genetic defect in amino acid transport.
Question 534: The following MRI image shows:
- A. RCC
- B. Nephronophthisis
- C. Hydronephrosis (Correct Answer)
- D. Polycystic kidney
Explanation: ***Hydronephrosis*** - The MRI image clearly shows **dilatation of the renal pelvis and calyces** in the left kidney, indicated by the arrow. This uniform distension is characteristic of hydronephrosis secondary to obstruction. - This condition results from an **obstruction of urine outflow**, leading to urine accumulation and subsequent swelling of the kidney's collecting system. *RCC* - **Renal cell carcinoma (RCC)** typically presents as a solid mass or lesion within the kidney parenchyma, which is not depicted in this image. - While an RCC could cause obstruction leading to hydronephrosis, the primary finding here is fluid distension, not a solid tumor. *Nephronophthisis* - **Nephronophthisis** is a genetic disorder characterized by **cysts primarily in the renal medulla** and progressive renal failure. It typically causes small, shrunken kidneys with numerous small cysts, not widespread pelvicalyceal dilation. - It usually manifests in childhood or adolescence with symptoms related to chronic kidney disease, which doesn't directly correspond to the imaging finding of marked collecting system dilation. *Polycystic kidney* - **Polycystic kidney disease** is characterized by the presence of **multiple cysts of varying sizes throughout the renal parenchyma**, leading to enlarged, distorted kidneys. - The image shows a single, dilated collecting system rather than numerous discrete cysts distributed throughout the kidney.
Question 535: The following IVU shows:
- A. Hydronephrosis
- B. Horseshoe kidney (Correct Answer)
- C. Polycystic kidney
- D. Duplication of collecting system
Explanation: ***Horseshoe kidney*** - The image shows both kidneys are **fused at their lower poles** across the midline, forming a "horseshoe" shape, which is a classic radiographic finding for this condition. - The **calyces and renal pelves are seen medially oriented**, supporting the diagnosis of a horseshoe kidney. *Hydronephrosis* - **Hydronephrosis** would appear as a dilation of the renal pelvis and calyces due to obstruction, which is not the primary finding here. - While a horseshoe kidney can be associated with hydronephrosis due to an abnormal ureteral course, the image clearly depicts the **fused renal parenchyma** rather than just dilation. *Polycystic kidney* - **Polycystic kidneys** are characterized by numerous cysts of varying sizes replacing normal renal parenchyma, which would present as enlarged, multi-cystic kidneys on imaging. - The image does not show multiple cysts replacing the renal tissue but rather a **fused, single-mass structure** in the lower abdomen. *Duplication of collecting system* - **Duplication of the collecting system** involves two ureters draining a single kidney, or a bifid renal pelvis, which would appear as double ureters or collecting systems on an IVU. - This condition does not present with the characteristic **fusion of the renal poles** across the midline as seen in the image.
Question 536: The given IVU shows:
- A. Hydronephrosis
- B. Horseshoe kidney (Correct Answer)
- C. Polycystic kidney
- D. Duplication of collecting system
Explanation: ***Horse shoe kidney*** - The IVU image clearly shows both kidneys are **fused at their lower poles**, forming a 'U' shape across the midline, characteristic of a **horseshoe kidney**. - This fusion often results in the kidneys lying lower in the abdomen and can cause anatomical variations in the **collecting system and vasculature**, as hinted by the lower position and altered calyces. *Hydronephrosis* - **Hydronephrosis** would manifest as **dilatation of the renal pelvis and calyces** due to urine outflow obstruction. - While horseshoe kidneys can be prone to hydronephrosis due to their abnormal anatomy, the primary finding here is the fusion, not significant dilatation. *Polycystic kidney* - **Polycystic kidney disease** would present with multiple **cysts replacing normal kidney parenchyma**, leading to enlarged, typically non-functioning kidneys. - The image does not show multiple fluid-filled sacs or significant renal enlargement typical of polycystic disease. *Duplication of collecting system* - A **duplication of the collecting system** (e.g., duplicate ureters) would show two distinct collecting systems draining from a single kidney. - The image shows a single collecting system for each kidney, albeit abnormally shaped due to the fusion, but not duplicated.
Question 537: The radiographic findings are most consistent with:
- A. Paralytic ileus (Correct Answer)
- B. Hyperkalemia
- C. Burst abdomen
- D. Malnutrition
Explanation: ***Paralytic ileus*** - The image shows a **plain abdominal radiograph** revealing **diffusely dilated bowel loops** throughout the small and large intestines, with air-fluid levels, consistent with **paralytic ileus** (also known as adynamic ileus). - Paralytic ileus is a common cause of bowel dilation post-surgery, inflammation, or electrolyte disturbances, where **peristalsis ceases temporarily** without a mechanical obstruction. *Hyperkalemia* - **Hyperkalemia** is an electrolyte imbalance that can lead to significant cardiac dysfunction and muscle weakness, but it **does not directly cause generalized bowel dilation** visible on an X-ray. - While severe electrolyte imbalances can sometimes contribute to ileus, hyperkalemia itself is a metabolic derangement, not a radiographic finding. *Burst abdomen* - A **burst abdomen** (or wound dehiscence) refers to the **separation of abdominal wound edges**, typically after surgery, and is a clinical finding, often with evisceration. - It describes a **surgical complication of the abdominal wall** and is not reflected by the dilated bowel loops seen internally on this radiograph. *Malnutrition* - **Malnutrition** is a state of nutrient deficiency and can lead to various systemic problems, including muscle wasting and immune compromise. - While severe malnutrition can subtly affect bowel function over time, it is **not directly demonstrable as acute, diffuse bowel dilation** on a plain abdominal X-ray.
Question 538: What does the given CT abdomen show?
- A. Hydatid cyst (Correct Answer)
- B. Liver abscess
- C. Hepatic adenoma
- D. Hepatocellular carcinoma
Explanation: ***Hydatid cyst*** - The image shows a large, **multiloculated cystic lesion** within the liver, typical of a hydatid cyst with **daughter cysts** (indicated by arrows). - The presence of **internal septations** and **daughter cysts** strongly suggests **Echinococcus granulosus infection**. - Classic imaging features include the "**water lily sign**" (floating membranes) and **wheel-spoke pattern** of septations. *Liver abscess* - A liver abscess typically appears as a **single or multiple fluid-filled cavities** with **rim enhancement** on contrast CT. - Usually associated with **fever, leukocytosis**, and may show **gas bubbles** if pyogenic. - Lacks the characteristic **daughter cyst** appearance and organized septations seen in hydatid disease. *Hepatic adenoma* - Hepatic adenomas are **solid, well-circumscribed lesions** that may contain **fat** and show **arterial phase enhancement**. - They can undergo **hemorrhage** but do not present as **multiloculated cysts** with daughter cysts. - Typically occur in women on **oral contraceptives**. *Hepatocellular carcinoma* - HCC is typically a **solid mass** with characteristic **arterial phase hyperenhancement** and **venous/delayed phase washout**. - May show **capsule appearance** and can invade vessels. - While large HCCs can have **necrotic areas**, they lack the classic "**daughter cyst**" appearance pathognomonic of hydatid disease.
Question 539: A 28-year-old male patient presents with colicky abdominal pain along with vomiting. X-ray abdomen shows:
- A. Pseudo-obstruction
- B. Cancer colon
- C. Small bowel obstruction (Correct Answer)
- D. Paralytic ileus
Explanation: ***Small bowel obstruction*** - The X-ray image shows multiple **dilated loops of small bowel** with **air-fluid levels** and prominent **valvulae conniventes** (herringbone pattern), which are classic signs of small bowel obstruction. - The clinical presentation of **colicky abdominal pain** and **vomiting** is highly consistent with a small bowel obstruction. *Pseudo-obstruction* - Pseudo-obstruction, or Ogilvie's syndrome, primarily affects the **large bowel**, leading to colonic dilation without a mechanical obstruction. - While it can cause abdominal pain and vomiting, the X-ray findings would typically show marked dilation of the colon rather than predominantly small bowel loops. *Cancer colon* - Colon cancer, if it causes obstruction, typically presents as a **large bowel obstruction**, with colonic dilation proximal to the tumor. - While severe cases could lead to cecal dilation and subsequent small bowel obstruction, the primary radiographic findings would focus on the colon. *Paralytic ileus* - Paralytic ileus, or adynamic ileus, involves generalized bowel dilation (both small and large bowel) due to **impaired peristalsis**, without mechanical obstruction. - Although it causes abdominal pain and vomiting, it usually presents with more continuous, less colicky pain, and the X-ray often shows gas in the colon, which is typically absent or minimal in a complete small bowel obstruction.
Question 540: This young patient presented with acute right lower abdominal pain. What is the possible diagnosis?
- A. Acute appendicitis (Correct Answer)
- B. Acute salpingo-oophoritis
- C. Ruptured ectopic pregnancy
- D. Intestinal obstruction due to Meckel's diverticulum
Explanation: ***Acute appendicitis*** - The CT scan shows a dilated, **thickened appendix** measuring 17 mm in diameter, which is a classic finding for acute appendicitis. - The patient's presentation with acute right lower abdominal pain is highly consistent with this diagnosis. *Acute salpingo-oophoritis* - This condition involves inflammation of the **fallopian tubes and ovaries** due to infection, typically causing bilateral lower abdominal pain and fever. - The image does not show findings specific to salpingo-oophoritis, such as **tubo-ovarian abscess** or significant adnexal inflammation. *Ruptured ectopic pregnancy* - A ruptured ectopic pregnancy would typically present with severe lower abdominal pain, **vaginal bleeding**, and hemodynamic instability in a female patient, none of which are described. - Imaging would typically show **pelvic free fluid** and an adnexal mass, rather than an inflamed appendix. *Intestinal obstruction due to Meckel's diverticulum* - Intestinal obstruction would present with **abdominal distension**, vomiting, and changes in bowel habits, which are not mentioned in the patient's presentation. - While Meckel's diverticulum can cause obstruction, the primary finding on this CT is a **dilated appendix**, not bowel obstruction.
Practice by Chapter
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Gastrointestinal Tract Imaging
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Renal and Urinary Tract Imaging
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Adrenal Imaging
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Male Pelvic Imaging
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Abdominal Trauma Imaging
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Acute Abdomen Imaging
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Imaging of Peritoneal Cavity and Retroperitoneum
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