Questions and Answers
A 60-year-old male presents with severe abdominal pain and vomiting. A supine abdominal X-ray reveals dilated loops of bowel with visible valvulae conniventes across the entire width, resembling a "stack of coins." An upright X-ray shows multiple air-fluid levels in a step-ladder arrangement. Which of the following findings on CT would be most indicative of a complete small bowel obstruction requiring surgical intervention?
A 45-year-old female presents with crampy abdominal pain and distension. A supine abdominal X-ray shows dilated small bowel loops with a 'stack of coins' appearance. The patient undergoes a CT scan, which shows dilated small bowel loops, a transition point, and minimal mesenteric fat stranding. Which of the following CT findings would most likely suggest a superimposed ischemia complicating the small bowel obstruction?
A 35-year-old male presents with abdominal pain, distension, and vomiting. An upright abdominal X-ray reveals multiple air-fluid levels in the small bowel with a step-ladder appearance. A CT scan is ordered for further evaluation. Which of the following CT findings is most characteristic of this disease?
A 65-year-old patient presents with abdominal pain and vomiting. An upright abdominal X-ray is performed, which reveals multiple air-fluid levels arranged in a "stepladder" pattern. What is the most likely diagnosis based on these radiologic findings?
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A 30-year-old female presents with recurrent abdominal pain and diarrhea. She undergoes an MRI enterography, which reveals bowel wall hyperenhancement, bowel wall thickening, and a 'string sign' in the terminal ileum. What is the most likely pathological process indicated by these findings?
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A 28-year-old male with a history of Crohn’s disease presents with worsening abdominal pain and weight loss. A CT enterography reveals thickened loops of bowel with increased vascularity in the mesentery, described as the 'comb sign.' Additionally, there is significant fat stranding and the presence of a fistula between the small bowel and bladder. Which of the following is the next best step in management?
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A 40-year-old patient with Crohn’s disease undergoes an MRI enterography, which reveals bowel wall thickening, luminal narrowing, and fat stranding adjacent to the terminal ileum. The imaging also demonstrates hypervascular mesenteric changes, described as the "comb sign." Which of the following best explains the significance of the "comb sign" in Crohn’s disease?
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A 28-year-old male presents with right lower quadrant pain, nausea, and fever. A CT scan shows a tubular, non-compressible structure in the right lower quadrant with periappendiceal fat stranding. Which of the following additional findings would most strongly suggest acute appendicitis?
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A 30-year-old male presents with right lower quadrant pain and fever. A CT scan with IV contrast reveals a dilated appendix with a diameter of 10 mm, periappendiceal fat stranding, and an appendicolith. Which of the following additional findings on CT would suggest a complication of appendicitis?
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A 28-year-old male presents with right lower quadrant pain, nausea, and fever. A CT scan with IV contrast is performed, and the findings include a distended appendix measuring 11 mm in diameter, wall thickening, and periappendiceal fat stranding. Which of the following radiologic findings would best support the diagnosis of perforated appendicitis?
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A 35-year-old male presents with right lower quadrant pain, fever, and vomiting. A CT scan with IV contrast shows an enlarged appendix measuring 10 mm in diameter, with periappendiceal fat stranding and an appendicolith. Based on the CT findings, what additional radiologic sign would confirm a complicated case of appendicitis (e.g., perforation or abscess)?
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A 32-year-old male presents with right lower quadrant pain and tenderness. An abdominal ultrasound reveals a non-compressible, tubular structure with a diameter of 8 mm and periappendiceal fat prominence. No significant free fluid is noted. Based on these findings, which imaging modality should be considered next to confirm the diagnosis of acute appendicitis and assess for possible complications?
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