Examkin

Question

Difficulty: HardInterpreting Imaging Results

For each patient presentation and associated radiological imaging description below, select the most accurate diagnosis.

  • A 54-year-old man with sudden-onset tearing abdominal pain. Non-contrast CT shows a hyperdense crescent within the aortic wall without a visible intimal flap or luminal contrast enhancement.Acute aortic intramural hematoma
  • A 68-year-old man with acute severe periumbilical pain out of proportion to physical exam findings. Contrast-enhanced CT shows pneumatosis intestinalis and lack of focal bowel wall enhancement.Acute mesenteric ischemia
  • A 32-year-old woman with chronic right lower quadrant abdominal pain and diarrhea. CT enterography reveals a thickened terminal ileum, engorgement of the vasa recta ('comb sign'), and adjacent fibrofatty proliferation.Crohn disease
  • A 45-year-old man with a history of ulcerative colitis presenting with progressive fatigue. MRCP shows alternating strictures and dilatations ('beaded' appearance) of the intrahepatic and extrahepatic biliary tree.Primary sclerosing cholangitis
  • A 60-year-old man with cirrhosis presenting for routine surveillance. Multiphasic CT shows a 3-cm focal liver lesion with avid arterial phase hyperenhancement and rapid washout during the portal venous phase.Hepatocellular carcinoma

Answer

The accurate pairs connect pathognomonic imaging findings to their distinct pathologies: the hyperdense crescent corresponds to intramural hematoma, pneumatosis to mesenteric ischemia, the comb sign to Crohn disease, the beaded biliary tree to primary sclerosing cholangitis, and arterial hyperenhancement with venous washout to hepatocellular carcinoma.
Each description highlights a classically tested radiological pattern that solidifies the diagnosis: the crescent sign definitively indicates intramural hematoma, pneumatosis points to necrotic bowel from ischemia, the comb sign is specific to active Crohn disease, ductal stricturing/dilatations reflect sclerosing cholangitis, and classic enhancement/washout kinetics diagnose hepatocellular carcinoma without biopsy.

Step-by-Step Solution

1
Analyze the vascular imaging presentations.
Identified the hyperdense aortic crescent without a flap as an intramural hematoma, and pneumatosis intestinalis with lack of bowel enhancement as advanced mesenteric ischemia.
Vascular emergencies present with highly specific signs; distinguishing an intramural hematoma from a classic dissection requires noting the absence of an intimal flap.
2
Evaluate the gastrointestinal inflammatory imaging descriptions.
Correlated the 'comb sign' and fibrofatty proliferation in the terminal ileum with Crohn disease.
These findings represent engorged vasa recta supplying an inflamed segment of bowel, characteristic of transmural inflammation.
3
Assess the hepatobiliary imaging descriptions.
Linked the 'beaded' MRCP appearance to primary sclerosing cholangitis and the arterial enhancement with venous washout in a cirrhotic liver to hepatocellular carcinoma.
These are standardized criteria and pathognomonic markers used for definitive non-invasive diagnosis in hepatology.

Key Concept

Identifying pathognomonic radiological signs in gastrointestinal, hepatobiliary, and vascular emergencies
Rate this question

Topics

Interpreting Imaging Results

More questions from this topic