Questions and Answers
A 65-year-old male presents to the emergency department with acute onset of abdominal pain, distension, and obstipation. Physical examination reveals a distended, tympanic abdomen with hyperactive bowel sounds. A plain abdominal radiograph is performed and reveals a markedly distended sigmoid colon with an inverted U-shape and air-fluid levels. Given the clinical picture and imaging findings, what is the next best imaging modality to confirm the diagnosis and assess for complications such as bowel ischemia or perforation?
According to the radiologic approach to volvulus discussed in the diagnostic imaging of colorectal disorders, what is the most common site of volvulus in the large intestine, often identified by a “coffee bean” sign on plain abdominal radiograph?
In diagnosing sigmoid volvulus, what classic radiologic sign is seen on a contrast enema study, characterized by a narrowing of the contrast column at the site of the twist?
A 30-year-old female with a history of ulcerative colitis presents with abdominal distention, fever, and absent bowel sounds. A plain radiograph shows significant colonic distention without haustral markings, and the transverse colon is dilated over 6 cm. Which of the following imaging studies is contraindicated in the management of this patient?
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A 32-year-old female with a history of ulcerative colitis presents with severe abdominal pain, fever, and abdominal distention. A plain abdominal X-ray reveals a dilated colon, with the transverse colon measuring 7 cm in diameter. Given this clinical presentation, you suspect toxic megacolon. After confirming the diagnosis with a plain radiograph, what is the most appropriate next imaging study to evaluate for potential complications?
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A 60-year-old male presents with intermittent lower abdominal pain and a recent history of constipation. A CT scan reveals multiple small outpouchings along the sigmoid colon, consistent with diverticulosis. Which of the following radiologic findings would best help differentiate uncomplicated diverticulosis from diverticulitis?
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A 55-year-old male with a history of chronic constipation presents with mild lower abdominal discomfort. A CT scan of the abdomen shows multiple air-filled sacculations in the sigmoid colon. Which imaging modality would be most appropriate to confirm the diagnosis of diverticulosis and provide detailed visualization of the colonic mucosa?
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A 42-year-old male presents with a painful perianal swelling. Clinically, you suspect a deep-seated abscess with possible spread to the supralevator space. Which imaging modality would be most appropriate to delineate the exact location, extent, and possible fistulous connections of the abscess?
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A 45-year-old male presents with severe right-sided perianal pain and swelling. On physical examination, there is a tender, indurated mass without obvious drainage. Given the concern for a deep ischioanal abscess with potential extension into adjacent spaces, which imaging modality will best delineate the abscess boundaries and guide surgical drainage?
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A 39-year-old male presents with recurrent perianal discharge and pain. He was treated for an abscess a year ago, and now you suspect an anal fistula. Which imaging modality would be most appropriate to accurately map the fistulous tract and identify any secondary extensions before surgical intervention?
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