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Plain film of the abdomen : 

Plain film of the abdomen BY Waleed M. Abdel Maksoud MD, MS, PhD, MRCS

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A 44-year-old woman presents with right upper quadrant pain

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What is the most likely diagnosis:    A. drenal calcification B. Calcified gallstones C. Kidney stone D. Milk-of-calcium bile in the gallbladder

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multiple faceted calcifications in the right upper quadrant, which are characteristic for gallstone.

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A 36-year-old woman presents with flank pain

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What is the most likely diagnosis in Case:  A. Adrenal calcification B. Calcified gallstones C. Kidney stones D. Medullary nephrocalcinosis

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Three separate deposits of calcified density confined to the right renal shadow. The largest one measures 2 cm in greatest diameter

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A 48-year-old man who is an alcoholic presents with epigastric pain

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What is the most likely diagnosis A. Adrenal calcification B. Calcified hepatic metastases C. Pancreatic calcification D. Primary calcified mucoproducing adenocarcinoma in the colon

Slide 10: 

shows multiple stippled calcifications in the upper abdomen adjacent to the lumbar spine. In a patient with a history of alcoholism, pancreatic calcification from chronic pancreatitis would be the most likely diagnosis.

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A 59-year-old woman is seen who underwent colectomy surgery for colon cancer 10 years ago

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What is the most likely diagnosis    A. Adrenal calcification B. Calcified hepatic metastases C. Pancreatic calcification D. Primary calcified mucoproducing adenocarcinoma in the colon

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stippled and discrete calcifications overlying the right 12th rib, just above the renal outline. When calcification in the lung base, skin, retroperitoneum, pancreas, kidney, and adrenal glands is excluded, hepatic calcification should be considered in a patient with a history of colon cancer

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A 15-year-old boy presents with right lower quadrant pain and fever

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What is the most likely diagnosis A. Appendicolith B. Ectopic gallstone C. Pelvic phlebolith D. Right ureteral calculus

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a boy with acute appendicitis. An oval calcification measuring 0.8 cm in diameter projects over the iliac bone and laterally to the right sacroiliac joint with a distended appendiceal lumen filled with gas. At surgery, gangrenous appendicitis with perforation and an obstructing appendicolith were found.

Slide 17: 

A 15-year-old boy presents with right lower quadrant pain and fever

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A. Appendicolith B. Multiple phleboliths C. Multiple ureteral calculi D. Prostatic calculi

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demonstrates a 5- x 5-m and a 4- x 4-mm calcified density (arrows) along the expected course of the right distal ureter. These densities were formerly identified in the right kidney and have migrated inferiorly to their current positions, indicating right ureteral calculi. With the history of hematuria, the most likely choice would be right ureteral calculi.

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A 48-year-old woman presents with lower abdominal fullness

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A. Bladder calculus B. Chondrosarcoma of the sacrum C. Cystadenoma of the ovary D. Uterine fibroid calcifications

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2-cm-diameter mottled calcification and curvilinear calcifications in the midpelvis. These calcifications overlie the sacrum and are consistent with calcification in uterine fibroids

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A 57-year-old man presents with history of hepatitis

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A. Ascites B. Cirrhosis C. Hepatomegaly D. Nephromegaly

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the right side of the abdomen shows increased density and is relatively free of gas. Displacement of the gas pattern in the duodenum and jejunum to the left side is indicative of hepatomegaly.

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A 40-year-old man presents with back pain

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A. A pseudotumor sign of small bowel obstruction B. Gastric outlet obstruction C. Hepatomegaly D. Horseshoe kidney

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a mass in the midabdomen delineates the lower poles of both kidneys, which are fused at the midline, consistent with horseshoe kidney.

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A 65-year-old woman presents with abdominal distention and a history of abdominal surgery

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A. Functional ileus of the bowel B. Gastric outlet obstruction C. Mechanical obstruction of the small intestine D. Pneumoperitoneum

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gaseous distention of the stomach, duodenum, and jejunum on the supine film, but no gas is seen in the colon, suggesting mechanical small bowel obstruction. Gastric outlet or duodenal obstruction is unlikely because many jejunal loops are dilated. At surgery, an obstructing jejunal adhesion was found.

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A 70-year-old man presents with abdominal distention

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A. Cecal volvulus B. Functional ileus of the bowel C. Pneumoperitoneum D. Sigmoid volv

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a huge distended and folded colonic loop in the midabdomen and pelvis (the "coffee bean" sign). The most likely consideration is a sigmoid volvulus.

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A 66-year-old woman presents with abdominal distention and constipation for 3 days

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A. Ascites B. Functional ileus of the bowel C. Mechanical obstruction at the colon D. Mechanical obstruction at the small bowel

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a distended transverse colon and descending colon and no gas in the sigmoid colon and rectum. The small bowel is not distended. Mechanical obstruction of the colon distal to the level of descending colon is likely.

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A 35-year-old man is seen who underwent laparotomy 2 days earlier

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A. Bullous emphysema B. Colon interposition C. Pneumoperitoneum D. Tension pneumothorax

Slide 40: 

crescent-shaped lucencies beneath both hemidiaphragms outlining the liver on the right and the spleen on the left in the PA chest film, suggesting pneumoperitoneum.

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