Rosh Emergency Medicine Practice Test

What finding on imaging would be consistent with suspected bowel obstruction?

1. Free air

2. Mass lesion

3. Air fluid levels

4. Enlarged thoracic veins

The correct answer is: Air fluid levels

In cases of suspected bowel obstruction, the presence of air-fluid levels on imaging is a classic finding. When there is an obstruction in the gastrointestinal tract, the normal passage of contents is hindered, leading to the accumulation of gas and fluids in the bowel proximal to the obstruction. This can be visualized on an upright or decubitus abdominal X-ray, where the differing densities of air (which rises) and fluid create the characteristic air-fluid levels. This finding indicates that the obstruction is causing fluid to collect and is a significant diagnostic clue in identifying bowel obstructions. While free air might indicate perforation of the bowel, mass lesions can signify tumors or other growths, and enlarged thoracic veins typically relate to cardiovascular issues rather than gastrointestinal problems. Each of these findings can provide important diagnostic information, but they are not characteristic of bowel obstruction in the same way that air-fluid levels are.