Splenic, Peritoneal, Mesenteric, and Retroperitoneal Disorders — WACS Viva & Clinical Scenarios (Gastrointestinal and Abdominal Imaging)

Exam-style splenic, peritoneal, mesenteric, and retroperitoneal disorders viva scenarios with examiner probes and model answers for Radiology candidates.

Scenarios covered

• SCENARIO 1: A 24-year-old known sickle cell anaemia (HbSS) patient presents to the emergency unit with severe left upper quadrant pain, profound pallor, and hypotension. Describe the systematic ultrasound and contrast-enhanced computed tomography (CECT) imaging evaluation of acute and chronic splenic complications in haemoglobinopathies, detailing the features that differentiate acute splenic sequestration from acute infarction and splenic abscess.
• SCENARIO 2: A 38-year-old female presents with low-grade fever, progressive abdominal distension, weight loss, and diffuse abdominal tenderness. An abdominal CECT demonstrates high-attenuation ascites, diffuse peritoneal thickening, and omental thickening. Provide the imaging characteristics that differentiate tuberculous peritonitis from peritoneal carcinomatosis and pseudomyxoma peritonei on ultrasound, CT, and MRI.
• SCENARIO 3: A 62-year-old male presents with bilateral lower limb oedema, dull flank pain, and progressive renal impairment. Cross-sectional imaging reveals a plaque-like retroperitoneal soft-tissue mass enveloping the infrarenal abdominal aorta and inferior vena cava. Detail the diagnostic imaging features of idiopathic retroperitoneal fibrosis (Ormond disease), the typical pattern of ureteric displacement, and the specific imaging discriminators that rule out retroperitoneal lymphoma and retroperitoneal sarcoma.
• SCENARIO 4: A 45-year-old male presents with acute, sharp, non-migratory left lower quadrant abdominal pain mimicking acute diverticulitis, but without leukocytosis or fever. Contrast-enhanced CT demonstrates an oval, fat-attenuation lesion abutting the anterior wall of the sigmoid colon with hyperdense peripheral rim enhancement and central hyperdense dot. Describe the radiological differential diagnosis for focal intra-abdominal fat necrosis, contrasting epiploic appendagitis, omental infarction, and mesenteric panniculitis.
• SCENARIO 5: A 50-year-old patient presents with acute postprandial abdominal pain, metabolic acidosis, and abdominal distension. Formulate a structured diagnostic approach to cross-sectional multidetector CT evaluation of mesenteric vascular disease, detailing the direct and indirect signs of acute mesenteric arterial occlusion, superior mesenteric vein thrombosis, and non-occlusive mesenteric ischaemia.