The answer
None of the above MCQ's are correct.
The PFA shows an unusual density in the patients right loin region.
What the student may say
This is the PFA of a gentleman. I cannot see the patients name, date of birth or when the X-ray was taken. The marker `R` would indicate that the film is orientated correctly.
The most striking feature is an unusual density in the right loin. Without a lateral view it is not possible to be sure that this is in fact inside the abdomen, it could be lying on the patients skin, or it could be between the patient and the X-ray plate.
If it is in the abdomen, the unusual density is too far lateral for a stone in the kidney or ureter. It is too lateral for a calcified lymph node (and it appears the wrong consistency). It appears too low for a gall stone.
A differential diagnosis should include, a peritoneal stone, a faecolith, and a foreign body.
Small print
Constipation is a diagnosis that is difficult to make based upon an X-ray
alone. You could say the patient has faecal loading. Be careful about feeling
that the patients symptoms are due to faecal loading as you may miss something
more serious.
A left renal caculus has to be wrong, because the opacity is on the
right side of the abdomen.
Gallstones, are possible, but very unlikely. Most gallstones are not
radioopaque and when they are they are not as dense as this.
A right renal caclus is highly unlikely as the density is below and
lateral to the right kidney on the film. The density is also too lateral for a
ureteric calculus.
