Abdominal and Pelvic Radiology — MCQs

Abdominal and Pelvic Radiology Indian Medical PG Practice Questions and MCQs

Question 631: Double bubble sign is seen in -

A. Duodenal atresia
B. Annular pancreas
C. Ladd's band
D. All of the options (Correct Answer)

Explanation: ***All of the options*** - The **"double bubble sign"** on an X-ray indicates **duodenal obstruction**, which can be caused by intrinsic factors like **duodenal atresia** or extrinsic compressions such as an **annular pancreas** or **Ladd's bands** associated with malrotation. - While differing in etiology, all these conditions lead to fluid and air accumulation in the stomach and proximal duodenum, creating the characteristic two dilated loops. *Duodenal atresia* - This is an **intrinsic congenital obstruction** of the duodenum, preventing the passage of gastric and duodenal contents. - On imaging, it shows **two distinct air-filled bubbles** (one for the stomach, one for the proximal duodenum) separated by the pylorus. *Ladd's band* - **Ladd's bands** are peritoneal fibrous bands that can compress the duodenum in cases of **intestinal malrotation**, leading to extrinsic obstruction. - The resulting proximal duodenal dilation, along with gastric distension, presents as the **double bubble sign**. *Annular pancreas* - An **annular pancreas** is a congenital anomaly where pancreatic tissue completely encircles and obstructs the second part of the duodenum. - This extrinsic compression causes significant dilation of the stomach and proximal duodenum, mimicking the appearance of the **double bubble sign**.

Question 632: Which of the following is NOT a radiological sign of urogenital tuberculosis?

A. Enlarged Bladder (Correct Answer)
B. Saw tooth Ureter
C. Putty Kidney
D. "Smudged Papillae" and "Moth eaten Calyx"

Explanation: ***Enlarged Bladder*** - An **enlarged bladder** is not a typical radiological sign of urogenital tuberculosis. Instead, bladder involvement often leads to a **contracted**, **fibrotic**, and **small bladder**, known as a **thimble bladder**, due to chronic inflammation and scarring. - The progressive fibrosis and inflammation characteristic of urogenital tuberculosis cause a decrease in bladder capacity, leading to a small and non-compliant bladder rather than an enlarged one. *"Smudged Papillae" and "Moth eaten Calyx"* - **Smudged papillae** and a **moth-eaten calyx** are classic radiological findings in renal tuberculosis, indicating destruction and ulceration of the renal papillae and calyces. - These terms describe the characteristic erosive changes in the kidney parenchyma caused by granulomatous inflammation. *Putty Kidney* - A **putty kidney** (also known as a **cement kidney** or **autonephrectomy**) refers to a chronically diseased, calcified, and non-functional kidney, which is a late-stage manifestation of renal tuberculosis. - This indicates diffuse caseous necrosis and calcification, leading to a shrunken and non-functioning organ. *Saw tooth Ureter* - The **sawtooth ureter** is a characteristic appearance on imaging studies due to **ureteral strictures** and inflammation in tuberculosis, resulting in an irregular, notched outline. - This irregular contour is caused by granulomatous inflammation and fibrosis along the ureteral wall, leading to areas of narrowing and dilatation.

Question 633: What is the best diagnostic procedure for identifying complications in acute pancreatitis?

A. CT scan (Correct Answer)
B. Ultrasound
C. PIPIDA scan
D. MRI

Explanation: ***CT scan*** - **CT scans** are excellent for visualizing the pancreas and surrounding structures, allowing for detailed assessment of complications like **necrosis**, **collections/pseudocysts**, and **vascular involvement**. - Contrast-enhanced CT (CECT) is particularly useful for differentiating viable from non-viable pancreatic tissue and assessing the extent of disease. *Ultrasound* - While useful for initial diagnosis by identifying **gallstones** (a common cause of pancreatitis), ultrasound is generally **poor for visualizing the pancreas** in the acute setting due to overlying bowel gas. - It has limited ability to detect and characterize **pancreatic necrosis** or other intra-abdominal complications. *MRI* - **MRI** is an excellent imaging modality for soft tissue characterization and can be used to assess pancreatic complications, including **fluid collections** and **necrosis**. - However, it is often less readily available and takes longer than CT, making it less practical for initial evaluation in acutely ill patients. *Pipida scan* - A **PIPIDA scan** (hepatobiliary iminodiacetic acid scan) is primarily used to evaluate **gallbladder function** and diagnose **acute cholecystitis** or **biliary obstruction**. - It provides no direct information about the pancreas or its complications in acute pancreatitis.

Question 634: A 50-year-old man suffering from left colon carcinoma. Which of the following is the MOST CHARACTERISTIC finding?

A. Apple core sign on imaging (Correct Answer)
B. Bleeding can occur
C. Stools may be liquid
D. Mass may be present

Explanation: ***Apple core sign on imaging*** - The **"apple core"** or **"napkin ring" sign** is a classic radiologic finding in **left-sided colon carcinoma** on barium enema or CT, indicating circumferential narrowing of the bowel lumen due to tumor growth. - This characteristic appearance results from the tumor encircling and constricting the colon, resembling an apple core after the core has been removed. *Bleeding can occur* - While bleeding is a common symptom of **colorectal cancer** (both left and right-sided), it is a **non-specific finding** and not the *most characteristic* for left colon carcinoma. - **Occult blood** in stool is more common with right-sided lesions, whereas visible **hematochezia** can occur with left-sided lesions. *Stools may be liquid* - **Liquid stools** are not a characteristic finding of left colon carcinoma; rather, **obstruction** can lead to **tenesmus** and **pencil-thin stools** or **constipation** due to tumor narrowing the lumen. - Diarrhea can sometimes be observed in more proximal colon tumors, but it's not specific to left colon cancer. *Mass may be present* - A **mass** often develops in **colorectal cancer**, but it is a **general feature** of many cancers and is not the *most characteristic* finding specifically for left colon carcinoma. - A palpable mass is more common in **right-sided tumors**, which can grow larger before causing obstructive symptoms.

Question 635: The coffee bean appearance on imaging is specifically associated with which condition?

A. Testicular torsion
B. Meconium ileus
C. Ileal atresia
D. Sigmoid volvulus (Correct Answer)

Explanation: ***Sigmoid volvulus*** - The **coffee bean sign** on an abdominal X-ray is a classic finding in **sigmoid volvulus**, representing the hugely dilated, gas-filled loop of bowel. - This characteristic appearance is due to the **mesentery twisting** on itself, creating a closed-loop obstruction. *Testicular torsion* - This condition involves the **twisting of the spermatic cord**, leading to interrupted blood supply to the testis. - Imaging focuses on the **scrotum** (e.g., ultrasound) and does not produce a "coffee bean" sign on abdominal films. *Meconium ileus* - This is a form of **small bowel obstruction** in newborns caused by abnormally thick and sticky meconium. - Imaging typically shows **dilated loops of small bowel** and a **"soap bubble" appearance** due to trapped gas in meconium, not a coffee bean shape. *Ileal atresia* - This condition involves a **congenital blockage of the ileum**, leading to proximal bowel dilation. - While it causes bowel obstruction, the characteristic imaging features are **dilated bowel loops** with **air-fluid levels**, not the specific coffee bean shape seen in sigmoid volvulus.

Question 636: Which pancreatic lesion is characterized by a spongy appearance with central sunburst calcification?

A. Pancreatic adenocarcinoma
B. Mucinous cystadenocarcinoma
C. Somatostatinoma
D. Serous cystadenoma (Correct Answer)

Explanation: ***Serous cystadenoma*** - **Serous cystadenomas** are characterized by a **spongy or honeycomb appearance** due to multiple small cysts filled with thin, watery fluid. - A **central stellate scar with "sunburst" calcification** is a classic radiological finding, though not always present. *Pancreatic adenocarcinoma* - Pancreatic adenocarcinoma typically presents as a **solid, infiltrative mass** on imaging, often causing ductal obstruction. - It rarely features a **cystic, spongy appearance** or central calcification; calcifications, if present, are usually amorphous and diffuse. *Mucinous cystadenocarcinoma* - **Mucinous cystadenocarcinomas** are usually macroscopic, **multilocular cysts** filled with viscous mucin, often with mural nodules indicating malignancy. - While they can present with calcification, it is typically **peripheral or curvilinear** rather than a central sunburst pattern. *Somatostatinoma* - **Somatostatinomas** are neuroendocrine tumors that manifest as solid masses, often in the head of the pancreas or duodenum. - They do not typically exhibit the **spongy architecture** or **central sunburst calcification** described for serous cystadenomas.

Question 637: String sign of Kantor is seen in:

A. Crohn's disease (Correct Answer)
B. Ulcerative colitis
C. Typhoid colitis
D. Colorectal cancer

Explanation: ***Crohn's disease*** - The **string sign of Kantor** is a classic radiographic finding in advanced Crohn's disease, particularly affecting the **terminal ileum**. - It refers to the appearance of a thin, continuous linear shadow of barium representing a severely narrowed, rigid, and stenosed lumen due to chronic inflammation and fibrosis. *Ulcerative colitis* - Ulcerative colitis primarily affects the **colon** and rectum, causing diffuse mucosal inflammation. - Common radiographic findings include **loss of haustrations** (lead pipe appearance) and **pseudopolyps**, not the string sign. *Typhoid colitis* - Typhoid colitis is a rare manifestation of **typhoid fever** (caused by *Salmonella Typhi*) that involves inflammation of the colon. - This condition presents with features of acute colitis, but not the chronic inflammatory changes or strictures leading to a string sign. *Colorectal cancer* - Colorectal cancer typically presents as a **mass lesion** or an **apple-core stricture** on barium studies, representing an obstructing tumor. - While it can cause luminal narrowing, it does not typically produce the diffuse, long-segment "string sign" characteristic of Crohn's disease.

Question 638: Which of the following may be detected on the plain abdominal film and is a premalignant condition?

A. Porcelain gallbladder (Correct Answer)
B. Limy bile
C. Adenomyosis of gallbladder
D. Cholesterosis

Explanation: ***Porcelain gallbladder*** - This condition is characterized by **calcification of the gallbladder wall**, appearing as a curvilinear or speckled calcification on a plain abdominal film. - It is considered a **premalignant condition** due to an increased risk of developing gallbladder carcinoma. *Limy bile* - **Limy bile** (or milk of calcium bile) is a thick, pasty, calcium-containing bile that can be seen within the gallbladder lumen on imaging but does not represent calcification of the gallbladder wall itself. - While it indicates chronic inflammation and potential biliary stasis, it is **not considered a premalignant condition** like porcelain gallbladder. *Adenomyosis of gallbladder* - This is a benign condition involving **hyperplasia of the muscularis propria** and **outpouchings of the mucosa** (Rokitansky-Aschoff sinuses) into the muscular layer. - It is typically diagnosed with ultrasound or MRI and is **not reliably detected on a plain abdominal film**, nor is it premalignant. *Cholesterosis* - Also known as **"strawberry gallbladder,"** cholesterosis is a benign condition where **cholesterol esters accumulate in the gallbladder mucosa**. - It is usually **not detectable on plain abdominal films** and is not considered a premalignant condition.

Question 639: Which X-ray finding is more suggestive of ulcerative colitis than Crohn's disease?

A. Rectal sparing
B. Tracking of contrast within the bowel wall
C. Discontinuous lesions
D. Loss of haustrations (Correct Answer)

Explanation: ***Loss of haustrations*** - **Loss of haustrations**, also known as "lead pipe" appearance, is a classic X-ray finding in **ulcerative colitis**. - This indicates chronic inflammation leading to fibrosis and shortening of the colon, which obliterates the normal haustral markings. *Rectal sparing* - **Rectal sparing** is more characteristic of **Crohn's disease**, as ulcerative colitis typically involves the rectum and extends proximally. - While rare, some cases of ulcerative colitis can spare the rectum, but it is not the typical presentation seen on imaging. *Tracking of contrast within the bowel wall* - **Tracking of contrast within the bowel wall** (e.g., fistulas, sinus tracts) is a hallmark feature of **Crohn's disease**. - This indicates **transmural inflammation**, which is characteristic of Crohn's disease but not usually seen in ulcerative colitis. *Discontinuous lesions* - **Discontinuous lesions**, also known as "skip lesions," are a classic feature of **Crohn's disease**. - **Ulcerative colitis** is characterized by **continuous inflammation** that starts in the rectum and extends proximally without skipped areas.

Question 640: Investigation of choice in small renal calculi is:

A. Low dose non enhanced CT (Correct Answer)
B. High dose non enhanced CT
C. Low dose enhanced CT
D. High dose enhanced CT

Explanation: ***Low dose non enhanced CT*** - **Low dose non-enhanced CT (LD-NCCT)** is the investigation of choice for suspected renal calculi, including **small stones as small as 1-2 mm**, due to its **high sensitivity (95-100%) and specificity (94-96%)** for detecting stones. - **Non-contrast** is preferred because contrast material can obscure small stones, and stones themselves are intrinsically dense enough to be visualized without it. - Low-dose protocols reduce radiation exposure by **50-75%** compared to standard CT while maintaining excellent diagnostic accuracy for stone detection. *High dose non enhanced CT* - A **high dose non-enhanced CT** is unnecessary as the diagnostic accuracy for renal calculi is already excellent with a low-dose protocol. - Using a high dose would lead to **increased radiation exposure** to the patient without providing additional diagnostic benefits for stone detection. - Modern low-dose protocols achieve similar image quality for stone identification. *Low dose enhanced CT* - **Enhanced CT** involves the administration of intravenous contrast, which is generally not required for the detection of renal calculi. - Contrast can potentially **obscure small stones** by making them less conspicuous against the enhanced renal parenchyma and collecting system. - It adds risks associated with contrast administration, such as allergic reactions or contrast-induced nephropathy, without improving stone detection. *High dose enhanced CT* - **High dose enhanced CT** combines the disadvantages of both high radiation exposure and contrast material. - This approach is not indicated for renal calculi and would expose the patient to **unnecessary risks and radiation** without improving diagnostic yield for stones. - Contrast is reserved for evaluating complications or alternative diagnoses, not primary stone detection.

Practice by Chapter

Imaging of Liver

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Biliary Tract Imaging

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Pancreatic Imaging

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Spleen and Lymphatic System

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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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Female Pelvic 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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