ROSH Gastrointestinal Practice Exam

For a child with abdominal pain and a sausage-shaped mass upon examination, what is the most appropriate diagnostic test?

1. Computed tomography

2. KUB radiograph

3. Magnetic resonance imaging

4. Ultrasonography

The correct answer is: Ultrasonography

In a pediatric case involving abdominal pain accompanied by a palpable sausage-shaped mass, the most appropriate diagnostic test is ultrasonography. This imaging technique is particularly useful for evaluating pediatric abdominal conditions due to its non-invasive nature, absence of ionizing radiation, and ability to provide real-time images. Ultrasonography is particularly effective in identifying conditions such as intussusception, which is often characterized by the presence of a sausage-shaped mass on physical examination due to the telescoping of one part of the intestine into another. It allows clinicians to assess blood flow to the affected area and visualize the intestines directly, making it an excellent first-line diagnostic tool in children presenting with these symptoms. Other imaging modalities, such as computed tomography and magnetic resonance imaging, while potentially providing more detailed images, are less favorable in children due to higher radiation exposure with CT scans and the need for sedation or longer imaging times with MRI. KUB (kidney, ureter, bladder) radiographs may assist in evaluating abdominal issues but are not as effective as ultrasound in diagnosing conditions like intussusception, where soft tissue evaluation is crucial. Thus, ultrasonography stands out as the optimal initial diagnostic approach in this clinical scenario.