Pediatric Radiology — MCQs
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Identify the type of diaphragmatic hernia shown in the X-ray.
Identify the fracture:
A 24-hour-old baby with severe respiratory distress was admitted to the ICU. A chest X-ray of the neonate is given. What is the most probable diagnosis?
Identify the radiological investigation and finding shown in the image below:
The following image shows presence of:
The figure shows:
Infantogram shows presence of:
Identify the condition on the basis of infantogram shown in the image:
A newborn presents with bilious vomiting on the first day of life. X-ray abdomen shows:
The given image shows presence of:
Pediatric Radiology Indian Medical PG Practice Questions and MCQs
Question 51: Identify the type of diaphragmatic hernia shown in the X-ray.
- A. Morgagni hernia
- B. Bochdalek hernia (Correct Answer)
- C. Hiatal hernia
- D. Traumatic diaphragmatic hernia
Explanation: ***Bochdalek hernia*** - This is the most common type of congenital diaphragmatic hernia (CDH), accounting for over 80% of cases, and is characterized by a defect in the **posterolateral** aspect of the diaphragm. - The X-ray shows classic findings: multiple **gas-filled bowel loops** in the left hemithorax, causing **mediastinal shift** to the right and compression of the left lung, which is consistent with a left-sided Bochdalek hernia. *Morgagni hernia* - This is a rare, **anteromedial** diaphragmatic defect that occurs through the **foramen of Morgagni**, typically on the right side. - It is less common than Bochdalek hernia and often discovered incidentally in older children or adults, presenting with less severe respiratory symptoms. *Hiatal hernia* - This involves the protrusion of the upper part of the stomach through the **esophageal hiatus** into the chest. - It is a midline defect and typically presents with **gastroesophageal reflux disease (GERD)**, not the extensive herniation of multiple abdominal organs seen in this neonatal X-ray. *Traumatic diaphragmatic hernia* - This is an **acquired** condition resulting from severe blunt or penetrating trauma to the chest or abdomen, not a congenital defect. - While it can appear similar on imaging, the clinical context of a newborn (as suggested by the image) makes a congenital cause like Bochdalek hernia the most likely diagnosis.
Question 52: Identify the fracture:
- A. Gutter fracture
- B. Linear fracture
- C. Depressed fracture (Correct Answer)
- D. Hinge fracture
Explanation: ***Depressed fracture*** - This radiograph clearly shows an inward displacement of a segment of the skull, which is the defining characteristic of a **depressed fracture**. This type of fracture is often described as a "ping-pong" fracture in infants due to the pliability of their skulls. - These fractures are clinically significant as they can be associated with underlying **dural tears**, **cortical contusions**, or **intracranial hemorrhage**, often necessitating surgical evaluation and intervention. *Linear fracture* - A linear fracture would appear as a sharp, lucent line on the radiograph without any displacement or depression of the bone fragments. - This is the most common type of skull fracture, but it does not match the visible **indentation** of the cranial vault seen in the image. *Hinge fracture* - A hinge fracture is a type of **basilar skull fracture** that runs across the floor of the middle cranial fossa, effectively separating the skull base into two halves. - This is a severe injury, not depicted in the image, which shows a fracture of the **parietal bone** in the cranial vault, not the base. *Gutter fracture* - A gutter fracture is a specific subtype of depressed fracture, typically caused by a tangential impact (e.g., a bullet grazing the skull), which carves out a trough or "gutter" in the bone. - While it involves depression, the term is more specific. The fracture shown is better classified by the general term **depressed fracture**, which accurately describes the inward buckling of the bone.
Question 53: A 24-hour-old baby with severe respiratory distress was admitted to the ICU. A chest X-ray of the neonate is given. What is the most probable diagnosis?
- A. Congenital lobar emphysema
- B. Congenital Pulmonary Airway Malformation (CPAM)
- C. Neonatal pneumonia
- D. Congenital Diaphragmatic Hernia (CDH) (Correct Answer)
Explanation: ***Congenital Diaphragmatic Hernia (CDH)*** - The image shows loops of **gas-filled bowel** (multiple curvilinear lucencies) in the left hemithorax, confirming the presence of abdominal contents in the chest cavity, which is pathognomonic for **CDH** (most commonly through the **Bochdalek defect**). - There is significant **mediastinal shift** to the right, leading to compression of the right lung (pulmonary hypoplasia) and severe respiratory distress in the neonate. *Congenital Pulmonary Airway Malformation (CPAM)* - CPAM (previously CCAM) usually presents as a **mass of cysts** (Type 1 is large cysts, Type 2 is small cysts) within the lung parenchyma, which are not typically associated with gas-filled loops of bowel extending from the abdomen. - While CPAM can cause mediastinal shift, the defining feature in CDH is the presence of **abdominal viscera** above the diaphragm, which is clearly visible. *Congenital lobar emphysema* - This condition involves **hyperinflation** of one or more lobes (most commonly the upper lobes) due to air trapping, resulting in an abnormally large, radiolucent lobe on X-ray. - It would show a large area of hyperlucency and possible collapse of adjacent lung tissue but would **not show intestinal loops** in the chest cavity. *Neonatal pneumonia* - Neonatal pneumonia typically presents with generalized or focal **opacification/consolidation** (white patches) rather than distinct, gas-filled cystic appearances resembling bowel loops. - While pneumonia causes respiratory distress, it does **not cause the mediastinal shift** or the visualization of abdominal organs in the chest seen here.
Question 54: Identify the radiological investigation and finding shown in the image below:
- A. Barium enema ulcerative colitis
- B. Hysterosalpingogram suggestive of PID
- C. Micturition cystourethrogram suggestive of VUR
- D. IVP showing horseshoe kidney (Correct Answer)
Explanation: ***IVP showing horse shoe kidney*** - The image displays features consistent with an **Intravenous Pyelogram (IVP)**, a radiological study of the urinary tract using contrast. The large, fused renal structures at the inferior poles, forming a "U" or "horseshoe" shape, are characteristic of a **horseshoe kidney**. - In a horseshoe kidney, the **lower poles of both kidneys are fused**, typically anterior to the great vessels, which is visible here through the opacified collecting systems. *Barium enema ulcerative colitis* - A **barium enema** visualizes the colon, and typical findings in **ulcerative colitis** include loss of haustra, narrowing, and mucosal irregularities, which are not seen in this image. - The structures shown here are clearly **intravenous contrast-filled renal collecting systems**, not intestinal loops. *Hysterosalpingogram suggestive of PID* - A **hysterosalpingogram (HSG)** is an imaging test for the uterus and fallopian tubes, visualized after contrast injection. - While **pelvic inflammatory disease (PID)** can cause tubal abnormalities (e.g., hydrosalpinx), the image clearly shows structures resembling kidneys and ureters, not female reproductive organs. *Micturition cystourethrogram suggestive of VUR* - A **micturating cystourethrogram (MCUG)** assesses the bladder and urethra, primarily for **vesicoureteral reflux (VUR)**, where urine flows backward into the ureters and kidneys from the bladder. - This image shows contrast in the renal collecting systems and ureters, but it's consistent with an **IVP and an anatomical variant** (horseshoe kidney), not reflux from the bladder as would be observed during active micturition in an MCUG.
Question 55: The following image shows presence of:
- A. Vesico-ureteric reflux (Correct Answer)
- B. Posterior urethral valves
- C. Bladder stone
- D. Bladder rupture
Explanation: ***Vesico-ureteric reflux*** - The image, likely a **voiding cystourethrogram (VCUG)**, shows **contrast material filling the bladder and extending upwards into both ureters and renal pelves**. This **retrograde flow of urine** from the bladder into the upper urinary tract is diagnostic of **vesicoureteral reflux (VUR)**. - VUR can lead to **recurrent urinary tract infections** and potential **kidney damage** due to pressure and infection. *Posterior urethral valves* - Posterior urethral valves typically cause an obstruction to urine flow from the bladder, leading to marked bladder distension and often significant bilateral hydronephrosis and hydroureter. - While VUR can coexist with PUV, the primary finding in this image is the reflux itself rather than signs of distal urethral obstruction. *Bladder stone* - A bladder stone would appear as a filling defect or a high-density area within the bladder, which is not depicted in this image. - The image shows the bladder uniformly filled with contrast, with no obvious intraluminal masses or calcifications. *Bladder rupture* - Bladder rupture would demonstrate extravasation of contrast material outside the confines of the bladder into the surrounding peritoneum or retroperitoneum, which is not seen here. - The contrast remains contained within the bladder and refluxes only into the collecting systems.
Question 56: The figure shows:
- A. Right upper lobe consolidation
- B. Sail sign (Correct Answer)
- C. Gas under diaphragm
- D. Box shaped heart
Explanation: ***Sail sign*** - The image displays a prominent triangular shadow in the right upper mediastinum, consistent with the **thymus gland** in a pediatric chest X-ray. - This characteristic appearance, resembling a **sailboat's sail**, is a normal finding in infants and young children and is known as the sail sign. *Right upper lobe consolidation* - **Consolidation** would appear as an area of increased opacity in the lung parenchyma, which is not clearly visible in the right upper lobe. - The opacity present is specifically located in the mediastinal region and has the typical shape and borders of the normal thymus. *Gas under diaphragm* - **Gas under the diaphragm** is typically seen as a crescent-shaped lucency beneath the diaphragm, usually indicative of a **pneumoperitoneum**. - No such free air is visible below either hemidiaphragm in this image. *Box shaped heart* - A **box-shaped heart** is a classic finding in **Ebstein's anomaly**, where the heart appears enlarged and more square due to atrialization of the right ventricle. - The cardiac silhouette in this image does not exhibit this specific morphology and appears within normal limits for a pediatric patient.
Question 57: Infantogram shows presence of:
- A. Hemangioma
- B. Sacrococcygeal teratoma (Correct Answer)
- C. Myelomeningocele
- D. Arnold-Chiari malformation
Explanation: ***Sacrococcygeal teratoma*** - The image shows a large, well-defined mass extending from the **sacrococcygeal region** of the infant. The presence of both soft tissue and calcifications within the mass (suggesting varying tissue types) is characteristic of a **teratoma**. - **Sacrococcygeal teratomas (SCTs)** are the most common germ cell tumors of childhood, typically presenting as external masses projecting from the lower back/buttocks. *Hemangioma* - A hemangioma is a **benign vascular tumor** that would typically appear as a soft tissue mass without the presence of internal calcifications or complex structures visible on plain radiography. - While they can be large, their radiological appearance would be primarily of **soft tissue density**, and they don't commonly arise with such distinct bony involvement or complex internal architecture. *Myelomeningocele* - A myelomeningocele is a form of **spina bifida** where the spinal cord and meninges protrude through a defect in the vertebral column, often presenting as a fluid-filled sac. - While it occurs in the same anatomical region, the image depicts a **solid, heterogeneous mass** with calcifications rather than a herniated neural tissue with cerebrospinal fluid. *Arnold-Chiari malformation* - Arnold-Chiari malformation is a structural defect in the **cerebellum**. - It involves the downward displacement of the cerebellar tonsils through the foramen magnum and would not present as an external mass in the sacrococcygeal region.
Question 58: Identify the condition on the basis of infantogram shown in the image:
- A. Congenital diaphragmatic hernia (Correct Answer)
- B. Cystic adenomatoid malformation
- C. Pneumomediastinum
- D. Congenital lobar emphysema
Explanation: ***Congenital diaphragmatic hernia*** - The infantogram shows loops of **bowel within the thoracic cavity**, displacing the heart and mediastinum. - This classic appearance, with visible **gas-filled loops** in the chest, is characteristic of a congenital diaphragmatic hernia, typically on the left side (Bochdalek hernia). *Cystic adenomatoid malformation* - This condition involves an abnormal growth of lung tissue forming **cysts**; these cysts typically appear as discrete radiolucencies or a solid mass within the lung. - Unlike in the image, it does not typically show distinct **bowel loops in the chest cavity**. *Pneumomediastinum* - This condition is characterized by air in the **mediastinum**, which would appear as lucency outlining the mediastinal structures, such as the heart and great vessels. - It does not involve the presence of **abdominal contents** within the chest cavity. *Congenital lobar emphysema* - This condition presents with **hyperinflation of a single lobe** (usually left upper lobe) causing mass effect and mediastinal shift. - It appears as a hyperlucent, overexpanded lobe, but does not show **bowel gas pattern** or abdominal contents in the thorax.
Question 59: A newborn presents with bilious vomiting on the first day of life. X-ray abdomen shows:
- A. Duodenal atresia (Correct Answer)
- B. Jejunal atresia
- C. Pneumatosis intestinalis
- D. Hirschsprung's disease
Explanation: ***Duodenal atresia*** - The X-ray image shows a classic "double bubble" sign, which is pathognomonic for **duodenal atresia**, caused by air trapped in the stomach and the proximal dilated duodenum. - There is an absence of distal bowel gas, indicating a complete obstruction beyond the duodenum. *Jejunal atresia* - While jejunal atresia also presents with intestinal obstruction, it typically shows **multiple dilated loops of small bowel** proximal to the obstruction, not just two distinct air-filled structures. - The "double bubble" sign is not characteristic of jejunal atresia, as the obstruction occurs further down the small intestine. *Pneumatosis intestinalis* - **Pneumatosis intestinalis** is characterized by the presence of gas within the bowel wall, often appearing as linear lucencies or bubbly patterns on X-ray. - This finding is typically associated with **necrotizing enterocolitis** and is not seen in the provided image. *Hirschsprung's disease* - **Hirschsprung's disease** is characterized by the absence of ganglion cells in the distal colon, leading to a functional obstruction. - X-rays typically show a **dilated colon proximal to the aganglionic segment** and often a paucity of gas in the rectum, but not the specific "double bubble" sign seen here.
Question 60: The given image shows presence of:
- A. Hamman crunch sign
- B. Schamroth's window (Correct Answer)
- C. Pemberton sign
- D. Oliver sign
Explanation: ***Schamroth's window*** - The image illustrates the physical exam maneuver used to assess for **Schamroth's window test**, where the distal phalanges of two opposing fingers are pressed together. - The presence of a **diamond-shaped space (window)** in the center, as shown, indicates a negative test, meaning clubbing is absent. Its absence signifies positive clubbing. *Hamman crunch sign* - This refers to a **crunching sound** heard over the precordium synchronous with the heartbeat, indicating **mediastinal emphysema** or pneumomediastinum. - It is an **auditory sign**, not a visual one involving the digits as depicted in the image. *Pemberton sign* - This sign is observed in patients with a **retrosternal goiter**, where facial plethora, distended neck veins, and respiratory distress occur upon raising both arms above the head. - It is a test for **superior vena cava obstruction** and has no relation to finger examination. *Oliver sign* - The Oliver sign is a **tracheal tugging** sensation felt upon palpation of the cricoid cartilage while the patient extends their neck, indicative of **aortic aneurysm**. - This sign is related to the great vessels and is not a digital examination.
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