Abdominal imaging: gallstones: practice question

A Radiology question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Radiology · Abdominal imaging: gallstones

Sample item

Ultrasound in a patient with biliary colic shows a contracted gallbladder with a curved echogenic line, a thin rim of bile around it and a dense posterior acoustic shadow. Which sign is this, and what does it show?

AEmphysematous cholecystitis, showing gas in the wallBA polyp, showing a fixed echogenic lesion without shadowCThe wall-echo-shadow (WES) triad, showing a gallbladder filled with stonesDA porcelain gallbladder, showing a calcified wall

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

C. The wall-echo-shadow (WES) triad, showing a gallbladder filled with stones

In the wall-echo-shadow sign, the gallbladder wall, the echogenic stone surface and the acoustic shadow are seen in sequence, because the lumen is packed with stones. A contracted gallbladder full of stones can be difficult to recognise. Porcelain gallbladder shows a curvilinear calcified wall and carries a risk of carcinoma.

Option by option

A. Emphysematous cholecystitis, showing gas in the wall
Emphysematous cholecystitis shows gas with dirty shadowing and acute illness.
B. A polyp, showing a fixed echogenic lesion without shadow
A polyp is a non-shadowing, non-mobile lesion projecting from the wall.
C. The wall-echo-shadow (WES) triad, showing a gallbladder filled with stones (correct)
Correct. A bile rim, an echogenic stone surface and a shadow are the WES triad.
D. A porcelain gallbladder, showing a calcified wall
Porcelain gallbladder shows wall calcification and no bile rim.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

Questions about this Radiology question

What is the answer to this Radiology question?

The best answer is C, The wall-echo-shadow (WES) triad, showing a gallbladder filled with stones. In the wall-echo-shadow sign, the gallbladder wall, the echogenic stone surface and the acoustic shadow are seen in sequence, because the lumen is packed with stones.

Why is "Emphysematous cholecystitis, showing gas in the wall" not the answer?

Emphysematous cholecystitis shows gas with dirty shadowing and acute illness.

Why is "A polyp, showing a fixed echogenic lesion without shadow" not the answer?

A polyp is a non-shadowing, non-mobile lesion projecting from the wall.

Why is "A porcelain gallbladder, showing a calcified wall" not the answer?

Porcelain gallbladder shows wall calcification and no bile rim.

What concept does this question test?

It tests Abdominal imaging: gallstones in Radiology. A contracted gallbladder full of stones can be difficult to recognise. Porcelain gallbladder shows a curvilinear calcified wall and carries a risk of carcinoma.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Abdominal imaging: gallstones?

Learn signs with the image, and the disease they point to. Then use the flashcards and the other Radiology questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.