Question 1

This image shows a patient who:

Accepted Answer

Note the extraluminal air between the dome of the liver and the right hemidiaphragm and between the splenic flexure of the colon and the left hemidiaphragm, indicating a probable surgical emergency.

Question 2

The patient in this image suffers from:

Accepted Answer

This is a pattern recognition issue directly addressed in the text. There are dilated small bowel loops with air-fluid levels at different heights (stepladder appearance), and there is no large bowel air. There is no air distended viscus that has haustral markings or exceeds criteria given in the book for colonic dilatation. Neither free intraperitoneal air nor appendicolith or other sign of appendicitis is shown.

Question 3

There is an obstruction in this patient's:

Accepted Answer

A rectal obstruction is indicated because of the dilated large bowel that goes all the way down to the rectal canal, projecting just above the pubis. Mid-small bowel (A) and ileocecal valve (D) are not appropriate responses because of the presence of a dilated colon, and the dilatation goes all the way to the rectum, ruling of the mid colon.

Question 4

There is a very small but important finding in this patient with acute abdominal pain: What is it?

Accepted Answer

This is a good case to reinforce the concept that one has to actively look for things on radiologic images. Just looking "at" this radiograph, a student might not notice the appendicolith finding. With a standard differential diagnosis for acute abdominal pain, including appendicitis (the pain of appendicitis is not always in the right lower quadrant, so it should always be the list even for generalized abdominal pain), and if the student remembers that a radiologic finding of acute appendicitis is an appendicolith, then it is much more likely that the student will see the abnormal calcification in the right lower quadrant of the abdomen. The calcification is too low for the gallbladder. There is no dilated colon or free intraperitoneal air shown.

Question 5

This ultrasound image shows that this patient has:

Accepted Answer

This is an easy pattern recognition case of a large shadowing structure with a bright, echogenic near edge that is within the lumen of a fluid-filled structure (the gallbladder) along the inferior edge of an organ that has homogeneous intermediate-level parenchymal echoes (the liver). Nothing else looks like this. This image is outside of the liver, and a liver cyst does not shadow.

Question 6

The FAST exam refers to:

Accepted Answer

FAST stands for Focused Assessment with Sonography for Trauma and is mainly used to look for intraperitoneal blood in abdominal trauma or pericardial blood in chest trauma.

Question 7

Which of the following is INCORRECT in the case of acute abdominal pain?

Accepted Answer

The lateral abdominal view is not often used. In the past it might have been done occasionally as a problem-solving radiographic projection, but elaborate radiography is difficult to justify when abdominal CT is now so widely available to solve diagnostic questions. The other options are the basic radiographs of an "acute abdominal series."

Question 8

In a pediatric patient with right lower quadrant pain, your initial imaging modality would likely be:

Accepted Answer

In the pediatric patient, the radiation dose from CT should be avoided when possible and because obesity is unusual in pediatric patients; sonography for appendicitis is highly sensitive and specific in this population group. Radiography uses radiation and is less sensitive a study for appendicitis than CT or ultrasound. HIDA scans expose a patient to ionizing radiation and are used for biliary disease, which does not usually cause right lower quadrant pain.

Question 9

Ultrasound is never useful for the diagnosis of which of the following conditions?

Accepted Answer

Bowel gas shadowing results in very little (or no) diagnostic information about the large and small bowel when examined with ultrasonography. As discussed in the text, the other options are indications for abdominal ultrasound exams.

Question 10

An abdominal CT scan for a clinically suspected abdominal mass is usually done:

Accepted Answer

Opacification of the GI tract and vascular and parenchymal enhancement make abdominal CT a far better exam than without oral and IV contrast agents. Some institutions may still use the protocol of oral contrast material without and with IV contrast enhancement, but except in situations where there is a specific indication for unenhanced scanning (such as suspected renal calcifications or hepatic steatosis), it is not necessary to routinely expose patients to a double dose of ionizing radiation.

Question 11

An abdominal CT scan done to evaluate a hepatic mass seen on ultrasonography:

Accepted Answer

In this case, the CT scan is being done to try to definitively characterize a known hepatic lesion; therefore, a multiphase hepatic protocol CT study is medically indicated. For parenchymal disease-whether hepatic, pancreatic, or renal-IV contrast injection is needed in most cases to improve contrast resolution between normal and abnormal tissue.

Question 12

The finding of diffuse increased liver echogenicity on ultrasound (compared to normal) and poor transmission of the ultrasound beam through the liver would suggest:

Accepted Answer

The characteristic description of the ultrasound finding of hepatic steatosis is diffuse increased liver echogenicity on ultrasound (compared to normal) and poor transmission of the ultrasound beam through the liver. Mild to moderate cirrhosis may have no visible changes perceptible with ultrasound. Choledocholithiasis usually does not affect liver parenchyma unless there is very long-standing biliary obstruction-an unlikely clinical scenario. It would be a very unusual case for a patient to have steatosis and portal hypertension.

Question 13

Which of the following statements is NOT true of appendicitis?

Accepted Answer

Any inflammatory disease in the abdomen is more likely to cause an increase in the CT density of adjacent fat because of edema, increased vascularity, lymphatic distention, and inflammatory cells.

Question 14

Which of the following statements IS NOT consistent with diverticulitis?

Accepted Answer

Ultrasound is not useful for small or large bowel abnormalities. The other options are all correct statements.

Question 15

Which of the following statements pertaining to mesenteric ischemia is INCORRECT?

Accepted Answer

Mesenteric ischemia is caused by arterial disease and is not associated with stenosis in the portal vein. The other options are true statements.

Question 16

Which statement is INCORRECT regarding using imaging for patients with suspected jaundice?

Accepted Answer

Whereas MRCP provides an excellent and sometimes necessary view of the contour of the biliary and pancreatic ducts and might even correctly reveal evidence of a tumor encasing and obstructing the common bile duct, it would not show the size of the tumor or whether the tumor is resectable. Therefore, MRCP by itself is not sufficient for diagnosis. The other options are true statements.

Question 17

Which of the following statements regarding GI bleeding is INCORRECT?

Accepted Answer

Ultrasonography would not show extravasation into the lumen of a part of the GI tract. The other options are true statements.

Question 18

"Virtual colonoscopy" refers to:

Accepted Answer

Virtual colonoscopy is a commonly used expression for CT colonography. Barium is not used for CT.

Question 19

Which of the following is NOT true of adrenal masses?

Accepted Answer

Benign adrenal adenomas are very common, so an enlargement of an adrenal gland on routine abdominal CT does not necessarily indicate malignancy. The other options are true statements.

Question 20

Following the identification of polyps on a virtual colonoscopy, the radiologist:

Accepted Answer

Polyps smaller than 5 mm are likely to be benign. Additionally, the growth rate of small polyps, even if destined to evolve into malignancies, is very slow. Removal of all polyps would be overkill for the many small benign hyperplastic polyps. A radiologist should be more concerned about polyps that are irregular in shape. No ACR criteria exist to determine with a rate of accuracy as high as 99% whether a polyp needs removal.

Quiz 8: Abdomen