European Diploma in Radiology (EDiR)

A 2-year-old suddenly coughs while eating nuts. An expiratory chest radiograph shows persistent right-lung hyperlucency and expansion while the left lung decreases in volume. Which diagnosis best explains the asymmetry?

• ARight lower-lobe pneumonia with alveolar filling
• BRight endobronchial foreign body causing air trapping
• CRight pleural effusion compressing the lung
• DComplete right main-bronchus obstruction with total atelectasis

During a voiding cystourethrogram in a child with recurrent febrile urinary infections, contrast passes retrogradely from the bladder into a ureter and the renal collecting system. What abnormality is directly demonstrated?

• AUreteropelvic junction obstruction
• BA noncommunicating parapelvic renal cyst
• CAcute renal cortical scarring
• DVesicoureteric reflux

MRI in an adult with unilateral sensorineural hearing loss shows an avidly enhancing mass centred on the internal auditory canal, extending into the cerebellopontine angle and widening the canal. Which diagnosis is most likely?

• AVestibular schwannoma
• BPetrous meningioma
• CArachnoid cyst
• DEpidermoid cyst

An ultrasound DICOM study is prepared for an approved de-identified teaching collection. The patient name has been removed from the standard DICOM header. Which additional check is essential before release?

• AConfirm only that the filename contains no patient name
• BInspect pixel data and other attributes for retained identifying information
• CKeep the accession number unchanged to prove that the study is original
• DAssume that deleting the Patient Name attribute removes every identifying detail

A young adult develops chest pain and raised troponin after a viral illness. Cardiac MRI shows inferolateral subepicardial late gadolinium enhancement with regional oedema and sparing of the subendocardium. Which diagnosis is most likely?

• AInfarction in a single coronary artery territory
• BIsolated constrictive pericarditis
• CAcute myocarditis
• DChronic ischaemic scar without active injury

A radiologist changes the window width and level while reviewing the same reconstructed CT series. What changes?

• AThe mapping of stored voxel attenuation values to displayed shades of grey
• BThe patient's radiation dose from the completed acquisition
• CThe original Hounsfield value stored for each voxel
• DThe reconstructed slice thickness of the existing series

An adult without a known extra-adrenal malignancy has a homogeneous 1.8 cm adrenal nodule measuring -5 HU on an unenhanced CT. Which diagnosis is most likely?

• AAdrenal metastasis with necrosis
• BAn aggressive adrenocortical carcinoma
• CA lipid-poor pheochromocytoma
• DA lipid-rich adrenal adenoma

On review of an overnight CT, a radiologist identifies an acute pulmonary embolus missed in the preliminary report. The patient has already left the emergency department. What is the best immediate professional action?

• AReplace the report silently and assume that the patient will read the portal
• BContact the responsible clinical team urgently, issue an addendum, and document receipt a…
• CWait for the next routine multidisciplinary meeting before changing the report
• DSend the finding only to an unmonitored general administrative mailbox

A 62-year-old smoker has progressive cough. Chest radiograph shows right upper lobe volume loss, elevation of the minor fissure, and a right hilar mass. Which diagnosis is most likely?

• AUncomplicated right upper lobe pneumonia without airway obstruction
• BCentral bronchogenic carcinoma causing right upper lobe collapse
• CPulmonary embolism with Hampton hump
• DRight upper lobe pulmonary sequestration

A 28-year-old woman presents with acute pleuritic chest pain and dyspnoea. CT pulmonary angiography shows a central filling defect surrounded by contrast in a segmental pulmonary artery. What is the key imaging diagnosis?

• APulmonary artery sarcoma
• BBronchiectasis with mucus plugging
• CChronic pulmonary venous hypertension
• DAcute pulmonary embolism

A febrile patient has chest CT showing dependent lower lobe consolidation with air bronchograms. There is no significant volume loss. Which interpretation is best?

• ALobar pneumonia
• BObstructive atelectasis
• CPulmonary oedema only
• DLymphangitic carcinomatosis

A 70-year-old man with asbestos exposure has unilateral pleural effusion and nodular circumferential pleural thickening extending into the fissures on contrast-enhanced CT. Which diagnosis should be most strongly suspected?

• ASimple parapneumonic effusion
• BPulmonary alveolar proteinosis
• CMalignant pleural mesothelioma
• DAcute hypersensitivity pneumonitis

A patient with chronic productive cough has high-resolution CT showing dilated bronchi larger than the accompanying pulmonary artery, lack of normal bronchial tapering, and visible bronchi near the pleural surface. What is the diagnosis?

• ACentrilobular emphysema
• BUsual interstitial pneumonia
• CBronchiectasis
• DMiliary tuberculosis

An older patient with progressive exertional dyspnoea has HRCT showing basal and subpleural reticulation, traction bronchiectasis, and honeycombing without extensive ground-glass opacity. Which pattern is most likely?

• AUsual interstitial pneumonia pattern
• BOrganising pneumonia pattern
• CAcute pulmonary oedema pattern
• DLangerhans cell histiocytosis pattern

A chest radiograph shows a hyperlucent left hemithorax with absent peripheral lung markings and a visible pleural line. The trachea is central and the patient is stable. What is the most likely diagnosis?

• ALeft pleural effusion
• BLeft lower lobe pneumonia
• CLeft diaphragmatic paralysis
• DLeft pneumothorax

A 68-year-old man with tearing chest pain has CT angiography showing an intimal flap in the ascending aorta extending into the arch. What is the most appropriate classification?

• AStanford type B aortic dissection
• BStanford type A aortic dissection
• CIsolated infrarenal aortic aneurysm
• DPenetrating ulcer limited to the descending thoracic aorta

A patient after blunt deceleration trauma has CT angiography showing focal contour abnormality and pseudoaneurysm at the aortic isthmus just distal to the left subclavian artery. Which diagnosis is most likely?

• ATakayasu arteritis
• BTraumatic thoracic aortic injury
• CCongenital right aortic arch
• DChronic uncomplicated aortic coarctation

A 76-year-old man with syncope has echocardiography showing heavily calcified aortic valve cusps and reduced systolic opening. Which additional imaging finding on CT most supports severe degenerative aortic stenosis?

• AIsolated calcification of the mitral annulus with a normal aortic valve
• BAir in the pulmonary artery
• CDiffuse pericardial fat without valve abnormality
• DDense aortic valve calcification at the valve plane

A contrast-enhanced CT in a patient with leg swelling shows a non-opacified expanded left common femoral vein with surrounding soft tissue oedema. Which diagnosis best explains the finding?

• AAcute deep vein thrombosis
• BFemoral artery aneurysm
• CArteriovenous malformation
• DPopliteal cyst rupture only

A trauma patient has CT showing fractures through the anterior and posterior walls of the left maxillary sinus, the orbital floor, and the zygomatic arch. What is the most likely facial fracture pattern?

• AIsolated nasal bone fracture
• BLe Fort III craniofacial dissociation
• CZygomaticomaxillary complex fracture
• DTemporal bone transverse fracture

A patient with fever, sore throat, muffled voice, and trismus has contrast-enhanced CT showing a rim-enhancing collection in the peritonsillar space with surrounding inflammatory change. What is the most likely diagnosis?

• ABranchial cleft cyst without infection
• BThyroglossal duct cyst
• CPeritonsillar abscess
• DUncomplicated reactive lymph node

A 45-year-old woman has a painless parotid tail mass. MRI shows a well-circumscribed lesion that is markedly T2 hyperintense with avid enhancement. Which benign salivary tumour is most likely?

• APleomorphic adenoma
• BSquamous cell carcinoma
• CLymphoma of Waldeyer ring
• DSubmandibular sialolithiasis

A child with minor head injury has a normal neurological examination and no clinical red flags. Before deciding whether any CT should be performed, which radiation-protection principle is being applied?

• AOptimisation of an already justified CT exposure
• BApplication of occupational annual dose limits to the child
• CRetrospective audit of the department's dose-reference levels
• DJustification of the proposed imaging examination

A patient develops urticaria, wheeze, and hypotension minutes after iodinated contrast injection. Which is the immediate treatment priority?

• AIntravenous antihistamine alone as definitive treatment
• BEmergency ABC support and intramuscular adrenaline according to the anaphylaxis protocol
• CIntravenous corticosteroid alone before any adrenaline
• DIntravenous fluid alone while deferring adrenaline until the rash resolves

A patient with chronic kidney disease is referred for contrast-enhanced CT. Which practice best reflects safe contrast decision-making?

• AWithhold intravascular iodinated contrast media strictly in every patient whose estimated…
• BAssess renal function and clinical indication, use contrast only when justified, optimise…
• CAdminister a double volume of high-osmolar iodinated contrast medium to overcome reduced…
• DDisregard baseline renal function and hydration status entirely whenever the patient deni…

A 54-year-old woman presents with right upper quadrant pain, fever, leukocytosis, and focal tenderness during ultrasound probe compression over the gallbladder. Ultrasound shows gallstones, gallbladder wall thickening, and a small amount of pericholecystic fluid. What is the most appropriate interpretation?

• AUncomplicated biliary colic, discharge with elective follow-up only
• BChronic cholecystitis, because stones are present
• CPrimary sclerosing cholangitis, because the gallbladder wall is thickened
• DAcute calculous cholecystitis requiring urgent clinical management

A patient has jaundice, abnormal cholestatic liver tests, and ultrasound demonstrates intrahepatic duct dilatation and a 10 mm common bile duct, but no definite duct stone. The patient is clinically stable and has no sepsis. Which imaging test is the best non-invasive next step to confirm choledocholithiasis?

• AMR cholangiopancreatography
• BHepatobiliary scintigraphy
• CNon-contrast CT of the abdomen
• DPlain abdominal radiography

A 63-year-old patient with cirrhosis undergoes dynamic liver MRI for a 2.4 cm nodule. The lesion shows non-rim arterial phase hyperenhancement, portal venous washout, and an enhancing capsule. What is the most likely diagnosis?

• ASimple hepatic cyst
• BFocal nodular hyperplasia
• CHepatocellular carcinoma
• DPyogenic liver abscess

A 68-year-old man has painless jaundice and ultrasound shows a double-duct sign with suspected pancreatic head malignancy. Which examination is most appropriate for initial staging and surgical planning?

• ASingle-phase unenhanced abdominal CT with oral barium opacification
• BDouble-contrast upper gastrointestinal barium meal fluoroscopy
• CPancreatic protocol multiphasic contrast-enhanced CT
• DPlanar technetium-99m HIDA hepatobiliary cholescintigraphy

A 45-year-old patient has epigastric pain radiating to the back and serum lipase greater than three times normal. He is stable and improves with treatment during the first 24 hours. What is the best imaging approach?

• ANo immediate CT is required if the diagnosis is clear and the course is mild
• BImmediate multiphasic contrast-enhanced CT within 4 hours of onset to grade necrosis in a…
• CEmergency ERCP with sphincterotomy within 12 hours in every case of mild interstitial pan…
• DRoutine secretin-enhanced MRCP within 6 hours of admission to exclude late walled-off nec…

A non-pregnant adult presents with right iliac fossa pain and raised inflammatory markers. CT shows a blind-ending tubular structure arising from the caecum measuring 11 mm in diameter, periappendiceal fat stranding, and a small appendicolith. What is the key diagnosis?

• ACrohn terminal ileitis without appendicitis
• BRight-sided diverticulosis without inflammation
• CEpiploic appendagitis
• DAcute appendicitis

A patient with prior abdominal surgery has small bowel obstruction on CT. There are two adjacent transition points, a C-shaped fluid-filled bowel loop, converging mesenteric vessels, mesenteric edema, and reduced mural enhancement. What is the most important management implication?

• AUncomplicated low-grade adhesive obstruction suitable for outpatient gastrografin follow-…
• BClosed-loop obstruction with possible strangulation requiring urgent surgical review
• CPostoperative paralytic ileus best managed conservatively with oral prokinetic laxatives
• DChronic partial distal ileal stricture suitable for elective outpatient colonoscopy in fo…

An elderly patient with atrial fibrillation develops sudden severe abdominal pain out of proportion to examination findings. Lactate is elevated. Which imaging examination is most appropriate to assess suspected acute mesenteric ischemia?

• ABedside duplex colour Doppler ultrasound of the proximal celiac axis and portal vein alone
• BCT angiography of the abdomen and pelvis with arterial and portal venous phase assessment
• CSingle-contrast small-bowel barium follow-through study with serial overhead radiographs
• DUnenhanced T1/T2 abdominal MRI with respiratory-triggered MRCP as the first-line emergenc…

CT in a patient with left iliac fossa pain shows sigmoid diverticulitis with a 5 cm rim-enhancing pericolic abscess, but no diffuse pneumoperitoneum. What is the most appropriate radiological management consideration?

• ADischarge without antibiotics because uncomplicated colonic diverticulosis is an incident…
• BPerform an immediate high-pressure barium enema to delineate the pericolic abscess cavity
• CSchedule a routine ultrasound in 12 months while withholding antibiotics to avoid colitis
• DPercutaneous drainage should be considered in addition to antibiotics if safely accessible

A patient has acute generalized abdominal pain and guarding. CT demonstrates free intraperitoneal gas, focal discontinuity of the anterior duodenal bulb wall, and adjacent inflammatory fluid. What is the most likely diagnosis?

• APerforated peptic ulcer
• BUncomplicated gastritis
• CGallbladder adenomyomatosis
• DChronic pancreatitis

A 36-year-old non-pregnant patient presents with acute flank pain radiating to the groin and microscopic hematuria. Ultrasound is inconclusive. Which imaging test is most sensitive for ureteric calculus in the emergency setting?

• AECG-gated contrast-enhanced CT pulmonary angiography of the thorax
• BConventional intravenous urography with serial abdominal radiographs as the routine first…
• CLow-dose non-contrast CT of the kidneys, ureters, and bladder
• DDelayed hepatobiliary phase gadoxetic acid-enhanced MRI of the upper abdomen

A diabetic patient with febrile urinary tract infection remains septic after 72 hours of antibiotics. Contrast-enhanced CT shows an enlarged kidney with a striated nephrogram and a 4 cm low-attenuation rim-enhancing collection. What is the key diagnosis?

• AUncomplicated Bosniak I simple cortical renal cyst requiring no intervention
• BBland embolic renal cortical infarction without urinary tract infection
• CAcute pyelonephritis complicated by renal abscess
• DCongenital medullary sponge kidney with benign papillary tubule ectasia

A multiphasic renal CT identifies a 3.2 cm solid cortical renal mass that increases from 34 HU pre-contrast to 82 HU in the corticomedullary phase. No macroscopic fat is seen. What is the most appropriate interpretation?

• AEnhancing renal neoplasm until proven otherwise
• BSimple Bosniak I cyst
• CClassic angiomyolipoma because all cortical masses are fat-containing
• DNon-obstructing renal calculus

An adult patient has painless macroscopic hematuria after urinary tract infection has been excluded. Which imaging examination best evaluates the kidneys, collecting systems, and ureters for urothelial or renal causes of hematuria?

• ASupine plain abdominal radiograph (KUB) alone without cross-sectional evaluation
• BSingle-phase portal venous CT without unenhanced or excretory urographic phases
• CPlanar technetium-99m MAG3 diuretic renography without cross-sectional imaging
• DCT urography

A 15-year-old boy has sudden severe testicular pain and nausea. Doppler ultrasound shows an enlarged hypoechoic testis with absent intratesticular arterial flow and a twisted spermatic cord. What is the correct implication?

• ASimple epididymal head cyst requiring only reassurance and routine ultrasound follow-up
• BTesticular torsion requiring immediate urological surgery
• CPrimary left varicocele requiring multiphase abdominal CT to exclude a retroperitoneal ma…
• DUncomplicated reactive hydrocele managed conservatively with oral analgesia and scrotal s…

A pregnant patient with placenta previa and prior caesarean section has ultrasound findings of placental lacunae, loss of the retroplacental clear zone, and bridging vessels. What is the main concern?

• AComplete molar pregnancy
• BPlacenta accreta spectrum
• COvarian torsion
• DFetal renal agenesis

A patient in early pregnancy has pelvic pain, a positive pregnancy test, and no intrauterine gestational sac on transvaginal ultrasound. There is an adnexal tubal ring and moderate echogenic free pelvic fluid. What is the most likely diagnosis?

• ANormal early intrauterine pregnancy before visualisation of the double decidual sac
• BPostmenopausal endometrial carcinoma invading more than half of the myometrium
• CUncomplicated pedunculated subserosal uterine fibroid with trace physiological fluid
• DEctopic pregnancy with possible hemoperitoneum

A reproductive-age patient presents with sudden unilateral pelvic pain and vomiting. Ultrasound shows an enlarged ovary with peripheral follicles, stromal edema, and a twisted vascular pedicle. Some venous and arterial Doppler flow is still detectable. What is the best interpretation?

• AOvarian torsion remains likely and urgent gynecologic review is required
• BOvarian torsion is excluded because persistent arterial and venous Doppler flow confirms…
• CThe ultrasound appearance is diagnostic of primary mucinous cervical adenocarcinoma
• DNo acute gynaecological review is required because unilateral stromal oedema is physiolog…

A patient with biopsy-proven endometrial carcinoma is referred for preoperative imaging. Which MRI feature is most important for local staging and surgical planning?

• APresence of benign Nabothian cysts along the endocervical canal
• BMeasurement of uterine fundus-to-cervix length ratio and subserosal fibroid size
• CDepth of myometrial invasion and cervical stromal involvement
• DDegree of renal corticomedullary differentiation on coronal localiser images

A 32-year-old patient has fever, pelvic pain, raised inflammatory markers, and cervical motion tenderness. Ultrasound shows a complex thick-walled multiloculated adnexal mass with internal debris and adjacent hyperemia. What is the most likely diagnosis?

• ASimple follicular cyst
• BPlacenta accreta spectrum
• CTubo-ovarian abscess
• DUncomplicated uterine fibroid degeneration in all cases

A septic patient has an obstructing proximal ureteric stone with hydronephrosis. Retrograde ureteric stenting is not technically possible. What is the most appropriate image-guided intervention?

• APercutaneous nephrostomy for urgent decompression
• BElective extracorporeal shock wave lithotripsy in several weeks without drainage
• CRenal biopsy of the obstructed kidney
• DObservation until the fever resolves spontaneously

A patient with malignant distal biliary obstruction has fever, jaundice, and dilated intrahepatic ducts. ERCP fails because the papilla cannot be accessed, and EUS-guided biliary drainage is not feasible locally. Which image-guided procedure can provide urgent biliary decompression?

• AElective planar HIDA hepatobiliary scintigraphy without biliary drainage
• BUnenhanced low-dose CT KUB to exclude concomitant renal calculi
• CDiagnostic secretin-stimulated MRCP alone while deferring biliary decompression
• DPercutaneous transhepatic biliary drainage