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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: 4. Ulcerative colitis 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: 2. Enteric duplication cyst 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
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