Question

Diagnosis of following Plain Xray of abdomen.

• A. Enterolith in jejunum
• B. Calcific mediastinal lymph nodes
• C. Horse shoe kidney with calculi
• D. Chronic calcific pancreatitis

Hint:

Multiple coarse calcifications scattered transversely across the upper abdomen along the line of the pancreas = chronic calcific pancreatitis.

Answer 1

The Correct Option is D

Step 1: Define the modality and the abnormality. A plain (KUB) abdominal radiograph detects calcified structures as white densities. The film shows multiple coarse calcifications clustered transversely across the upper-mid abdomen.

Step 2: Localise the calcifications. The calcific specks lie in the epigastric/upper abdominal region, spread across the midline along the expected course of the pancreas (which runs transversely from the duodenal C-loop to the splenic hilum at roughly the L1-L2 level).

Step 3: Why option D (Chronic calcific pancreatitis) is correct. Chronic pancreatitis causes intraductal protein plugs that calcify, producing multiple scattered parenchymal/ductal calcifications distributed transversely across the upper abdomen along the gland - the pathognomonic plain-film finding. The commonest cause is chronic alcohol use; in India, tropical (fibrocalculous) pancreatitis is also classic.

Step 4: Why the distractors are wrong. (A) An enterolith in the jejunum would be a single rounded calcified body within a bowel loop, not a transverse band of multiple calcifications. (B) Calcific mediastinal lymph nodes are intra-thoracic (above the diaphragm) and would not appear in an abdominal KUB film. (C) Horseshoe kidney with calculi would show calcific densities in the renal/paraspinal regions bilaterally low across the midline (fused lower poles), with stones overlying the kidneys, not the pancreatic transverse distribution shown.

Final Answer: Option D - Chronic calcific pancreatitis.