GI imaging: Rigler sign: 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 · GI imaging: Rigler sign

Sample item

A supine abdominal radiograph shows both the inner and outer walls of bowel loops clearly outlined by gas as a thin line. What is this sign?

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

The answer and the reasoning

C. Rigler (double wall) sign of pneumoperitoneum

When gas lies both inside and outside the bowel, the wall is seen as a thin line, the Rigler sign. Massive pneumoperitoneum may also show the football sign and the falciform ligament sign. These supine signs are useful when an erect film cannot be taken.

Option by option

  • A. String of beads sign

    String of beads indicates small bowel obstruction with trapped gas bubbles in fluid.

  • B. Coffee-bean sign

    Coffee-bean sign indicates sigmoid volvulus.

  • C. Rigler (double wall) sign of pneumoperitoneum (correct)

    Correct. Gas on both sides of the wall is Rigler sign.

  • D. Football sign of fluid

    The football sign refers to a large oval gas collection of massive pneumoperitoneum, not the bowel wall outline.

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.

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Questions about this Radiology question

What is the answer to this Radiology question?

The best answer is C, Rigler (double wall) sign of pneumoperitoneum. When gas lies both inside and outside the bowel, the wall is seen as a thin line, the Rigler sign.

Why is "String of beads sign" not the answer?

String of beads indicates small bowel obstruction with trapped gas bubbles in fluid.

Why is "Coffee-bean sign" not the answer?

Coffee-bean sign indicates sigmoid volvulus.

Why is "Football sign of fluid" not the answer?

The football sign refers to a large oval gas collection of massive pneumoperitoneum, not the bowel wall outline.

What concept does this question test?

It tests GI imaging: Rigler sign in Radiology. Massive pneumoperitoneum may also show the football sign and the falciform ligament sign. These supine signs are useful when an erect film cannot be taken.

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 GI imaging: Rigler sign?

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.