A premature neonate at 28 weeks gestation develops abdominal distension and blood in stool. Abdominal X-ray shows pneumatosis intestinalis and portal venous gas. The initial imaging of choice to assess viability and guide management in necrotizing enterocolitis (NEC) is:

• A CT abdomen with contrast
• B MRI abdomen
• C Upper GI contrast study
• D Serial abdominal X-rays (supine and left lateral decubitus) ✓

Explanation

In NEC, serial abdominal X-rays (supine AP and left lateral decubitus) are the primary imaging investigation. They identify pneumatosis intestinalis (intramural gas — earliest sign), portal venous gas, pneumoperitoneum (indicating perforation), and fixed bowel loops (indicating necrosis). CT is avoided in neonates due to radiation risk and the need for transport. Contrast studies are contraindicated in suspected NEC due to perforation risk.

Reference: Grainger & Allison's Diagnostic Radiology, 7th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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