Image Challenge
Image Challenge
Sessió de formació continuada SCC Juny-2011 What is the diagnosis?
1. Gastric outlet obstruction 2. Hirschsprung disease 3. Ileal intussusception 4. Ulcerative colitis 5. Zollinger-Ellison syndrome Answer:
The abdominal radiograph shows a severely dilated transverse colon and free air. The findings are typical of fulminant ulcerative colitis. The patient recovered after a total abdominal colectomy with end ileostomy. What is the diagnosis?
1. Amebic liver abscess 2. Diffuse bilioma 3. Echinococcosis 4. Hepatocellular carcinoma 5. Polycystic liver disease What is the diagnosis?
Answer:
3. Echinococcosis
Serologic testing for hydatid disease confirmed that the cystic mass was a result of echinococcosis. The patient recovered after treatment with albendazole. What is the diagnosis?
1. Bowel infarction 2. Crohn's disease 3. Cystic fibrosis 4. Echinococcosis 5. Lead poisoning What is the diagnosis?
Answer:
1. Bowel infarction
The image shows gas in the wall of the bowel, in the portal venous system, and in the superior mesenteric vein. These findings are most consistent with extensive bowel infarction. This appearance was noticed during routine colonoscopy. What is the diagnosis?
1. Addison's disease 2. Hemochromatosis 3. Laxative use 4. Metastatic melanoma 5. von Hippel-Lindau disease This appearance was noticed during routine colonoscopy. What is the diagnosis?
Answer:
3. Laxative use
Melanosis coli is dark brown pigmentation of the colon that occurs with the use of laxatives containing anthraquinone, such as senna. It can develop within a few months of use, and it can disappear in a few months if the use of the laxative is discontinued. What is the diagnosis?
1. Diverticular abscess 2. Hirschsprung's disease 3. Sigmoid volvulus 4. Small-bowel obstruction 5. Trichobezoar What is the diagnosis?
Answer:
3. Sigmoid volvulus
The coronal view of the computed tomogram reveals dilated loops of colon with a central whirl sign that is most consistent with a sigmoid volvulus. What is the diagnosis?
1. Diverticulosis 2. Familial adenomatous polyposis 3. Foreign object ingestion 4. Pneumatosis cystoides coli 5. Trichinosis What is the diagnosis?
Answer:
4. Pneumatosis cystoides coli
Submucosal cysts are most consistent with the diagnosis of pneumatosis cystoides coli. These characteristic cysts can be focal or diffuse and occur mainly in adults. The disease is usually asymptomatic, but can cause obstruction, pain, or pneumoperitoneum.
Richard H. Marshak E Lindner, Daniel Maklansky and Fran Espin What underlying disease is most likely to have been present in this patient?
1. Atrial fibrillation 2. Chronic constipation 3. Chronic renal insufficiency 4. Diabetes mellitus 5. Thalassemia What underlying disease is most likely to have been present in this patient?
Answer:
4. Diabetes mellitus
The abdominal radiograph shows air throughout the urinary tract. Patients with diabetes mellitus have a particular predisposition for complicated urinary tract infections such as emphysematous cystitis, which is thought to be caused by fermentation of glucose by bacterial and fungal pathogens. What is the diagnosis in this 56-year-old man with abdominal pain?
1. Acute pancreatitis 2. Colonic volvulus 3. Colonic carcinoma 4. Mesenteric ischemia 5. Pneumoperitoneum What is the diagnosis in this 56-year-old man with abdominal pain?
Answer:
5. Pneumoperitoneum
Careful inspection of this supine plain radiograph of the abdomen reveals a small triangular pocket of air outlined by three adjacent bowel loops. This finding is consistent with the presence of free intraperitoneal air and is known as the telltale triangle sign. Abdominal computed tomography confirmed the presence of pneumoperitoneum and also showed a subdiaphragmatic abscess with an air-fluid level. During surgery, a perforated gastric ulcer and two intraabdominal abscesses were found. This patient presented following a high-speed motor vehicle crash. Which structure has been disrupted?
1. Aorta 2. Diaphragm 3. Esophagus 4. Myocardium 5. Trachea This patient presented following a high-speed motor vehicle crash. Which structure has been disrupted?
Answer:
2. Diaphragm
The elevated right hemidiaphragm suggests traumatic diaphragmatic rupture. The other listed structures appear to be intact. A computed tomographic scan confirmed the diaphragmatic rupture and showed that the dome of the liver had herniated into the right hemithorax. What is the diagnosis?
1. Anaplastic thyroid carcinoma 2. Graves' disease 3. Hashimoto's thyroiditis 4. Medullary thyroid carcinoma 5. Thyroid lymphoma What is the diagnosis?
Answer:
2. Graves' disease
The patient has a large nodular goiter, eyelid retraction, diaphoresis, and jugular venous distension. Together these are most consistent with Graves' hyperthyroidism. What diagnosis is suggested by this barium swallow?
1. Ingested foreign body 2. Esophageal diverticula 3. Diffuse esophageal spasm 4. Gastric linitis plastica 5. Esophageal carcinoma What diagnosis is suggested by this barium swallow?
Answer:
3. Diffuse esophageal spasm
Radiographs of the esophagus that were performed with the use of barium contrast material showed a spiral formation of the barium column up to the cervical esophagus, most consistent with diffuse esophageal spasm. This 8-year-old girl had a 2-year history of abdominal pain. What is the diagnosis?
1. Crohn's disease 2. Enteric duplication cyst 3. Pancreatic pseudocyst 4. Intestinal malrotation 5. Wilms' tumor This 8-year-old girl had a 2-year history of abdominal pain. What is the diagnosis?
Answer:
The patient had an infected enteric duplication cyst, a rare lesion that usually involves the ileum and may contain ectopic gastric mucosa. Crohn's disease does not cause large abscesses, and the chronicity would not suggest a pancreatic pseudocyst. Malrotation would not explain the multicystic mass. The mass does not have the appearance of Wilms' tumor.
http://www.radiologyassistant.nl/en/4a6c7bba1ef26
What is the diagnosis?
1. Asbestosis 2. Colonic interposition surgery 3. Suppurative mediastinitis 4. Pneumopericardium 5. Thoracic aortic aneurysm What is the diagnosis?
Answer:
4. Pneumopericardium
The chest radiograph shows pneumopericardium without evidence of pneumothorax or pneumomediastinum. This patient had a perforating esophageal ulcer. The radiograph is not consistent with the other listed diagnoses.
What is the diagnosis?
1. Bezoar 2. Pericardial effusion 3. Pneumatosis coli 4. Gastric carcinoma 5. Pheochromocytoma What is the diagnosis?
Answer:
1. Bezoar
The computed tomography shows a large gastric mass that is separate from the gastric wall. Endoscopy revealed a large trichobezoar occluding nearly the entire stomach.
Read More: N Engl J Med 2007;357:e23 Which one of the following organs is enlarged?
1. Colon 2. Ovary 3. Stomach 4. Spleen 5. Gall bladder Which one of the following organs is enlarged?
Answer:
3. Stomach
Massive dilation of the stomach with distal gas is most consistent with gastric outlet obstruction.
Read More: N Engl J Med 2007;356:942 What is the diagnosis?
1. Cholangiocarcinoma 2. Cirrhosis 3. Echinococcosis 4. Hepatocellular carcinoma 5. Tuberculosis What is the diagnosis?
Answer:
2. Cirrhosis
The magnetic resonance image shows a connection between the umbilical vein and the left portal vein, as well as esophageal varices. Together these features suggest a diagnosis of portal hypertension and cirrhosis.
Read More: N Engl J Med 2007;357:e17 What is the diagnosis?
1. Subcutaneous metastases 2. Filariasis 3. Caput Medusae 4. Neurofibromatosis 5. Hepatocellular carcinoma What is the diagnosis?
Answer:
3. Caput Medusae
These enlarged veins on his abdomen are consistent with caput medusae.
Read More: N Engl J Med 1999;341:419 What is the diagnosis?
1. Pancreatic pseudocyst 2. Duodenal torsion 3. Cholangiocarcinoma 4. Gallbladder lipomatosis 5. Emphysematous cholecystitis What is the diagnosis?
Answer:
5. Emphysematous cholecystitis
The computed tomogram shows an air-fluid level in the lumen of a dilated gallbladder and gas within the gallbladder wall. These findings suggest emphysematous cholecystitis.
Read More: N Engl J Med 2003;348:2329 An elderly woman presented with abdominal pain and vomiting for three days. A computed tomogram of the abdomen was obtained. What is the diagnosis?
1. Cecal volvulus 2. Intussusception 3. Mesenteric ischemia 4. Obturator hernia 5. Ovarian cancer An elderly woman presented with abdominal pain and vomiting for three days. A computed tomogram of the abdomen was obtained. What is the diagnosis?
Answer:
4. Obturator hernia
An obturator hernia was diagnosed.
Read More: N Engl J Med 2006;355:1714 Image Challenge
Q What is the diagnosis? : 1. Small-bowel obstruction 2. Echinococcosis 3. Mesenteric ischemia 4. Pancreatic pseudocysts 5. Cecal volvulus Image Challenge
Q What is the diagnosis? :
Answer:
1. Small-bowel obstruction
The computed tomogram reveals small-bowel obstruction by a left-sided luminal mass. The mass has a hyperdense periphery and an aerated core.
Read More: N Engl J Med 2008;358:1381 Image Challenge
What is the diagnosis?
1. Duodenal perforation 2. Emphysematous pyelonephritis 3. Perinephric cyst 4. Situs inversus 5. Ureterocele Image Challenge
Q What is the diagnosis? :
Answer:
1. Duodenal perforation
The computed tomography shows air surrounding the right kidney and extending to the retroperitoneum. A duodenal ulcer with retroperitoneal perforation was diagnosed. The normal appearance of the kidney excludes emphysematous pyelonephritis.
Read More: N Engl J Med 2006;354:e9 Image Challenge
Q What is the diagnosis? : 1. Ankylosing spondylitis 2. Ascending cholangitis 3. Intestinal obstruction 4. Pancreatitis 5. Perforation of a viscus Image Challenge
Q What is the diagnosis? :
Answer:
5. Perforation of a viscus
The plain-film radiograph of the abdomen shows several signs of free intraperitoneal gas. These include air accumulation in the right upper quadrant; the falciform-ligament sign, visible as a longitudinal linear density on the ventral surface of the liver; the ligamentum teres sign, visible as a linear density running along the inferior edge of the falciform ligament; and the visualization of air on both sides of the bowel wall. The patient had a perforated cecum. Image Challenge
This patient had hypertension. What is the diagnosis?
1. Coarctation of the aorta 2. Pheochromocytoma 3. Primary hyperaldosteronism 4. Renal artery stenosis 5. Systemic sclerosis Image Challenge
This patient had hypertension. What is the diagnosis?
Answer:
2. Pheochromocytoma
There is a heterogeneous (vascular), contrast-enhanced, right adrenal mass, 4.5 cm in diameter. This is most consistent with a pheochromocytoma.
Read More: N Engl J Med 2007;356:601
This 10-year-old presented with abdominal pain. What is the diagnosis?
1. Hirschsprung's disease 2. Meckel's diverticulum 3. Peptic ulceration 4. Pyloric outlet obstruction 5. Situs inversus Image Challenge
This 10-year-old presented with abdominal pain. What is the diagnosis?
Answer:
2. Meckel's diverticulum
Intussusception was diagnosed. Results of imaging suggested the presence of a Meckel s diverticulum. Intussusception that presents after infancy should raise suspicion regarding a pathologic lead point, including a Meckel s diverticulum. The child s symptoms resolved after surgical resection.
Read More: N Engl J Med 2010;363:2045
This patient had a history of breast-cancer surgery. Which one of the following rib abnormalities is present on her follow-up imaging?
1. Absent rib 2. Inferior rib notching 3. Rib metastases 4. Sternocostal anomaly 5. Supernumerary rib Image Challenge
This patient had a history of breast-cancer surgery. Which one of the following rib abnormalities is present on her follow-up imaging?
Answer:
5. Supernumerary rib
A vertically oriented structure similar in density to adjacent bone within the right hemithorax is visible. This finding was consistent with a supernumerary intrathoracic rib. There are right axillary surgical clips from the previous breast-cancer surgery. Supernumerary intrathoracic ribs are most common on the right side and do not warrant further evaluation or intervention. What is the diagnosis?
1. Coarctation of the aorta 2. Lung cancer 3. Pneumothorax 4. Rib fracture 5. Substernal goiter What is the diagnosis?
Answer:
5. Substernal goiter
The chest radiograph demonstrates tracheal deviation. Ultrasonography of the neck revealed a large goiter with the right lobe extending into the anterior superior mediastinum. Where is the abnormality on this chest radiograph?
1. Left lower lobe 2. Left upper lobe 3. Right lower lobe 4. Right upper lobe 5. Superior mediastinum Where is the abnormality on this chest radiograph?
Answer:
2. Left upper lobe
A pulmonary mass is visible in the left upper lung. What is the diagnosis?
1. Aspiration pneumonia 2. Sarcoidosis 3. Silicosis 4. Idiopathic pulmonary fibrosis 5. Lymphangioleiomyomatosis What is the diagnosis?
Answer:
4. Idiopathic pulmonary fibrosis
The chest radiograph reveals bilateral reticular infiltrates. There is subpleural and lower- lobe predominance, consistent with idiopathic pulmonary fibrosis.
Read More: N Engl J Med 2001;345:517 This patient developed jaundice and an enlarging neck mass. What is the diagnosis?
1. Medullary carcinoma of the thyroid 2. Peripancreatic malignancy 3. Scrofula 4. Hodgkin's lymphoma 5. Pancoast tumor This patient developed jaundice and an enlarging neck mass. What is the diagnosis?
Answer:
2. Peripancreatic malignancy
The patient had a fungating mass around the Vater's ampulla. Abdominal cancers can metastasize through the thoracic duct to the left supraclavicular fossa.
Read More: N Engl J Med 2007;357:282