Long Case

Case 1
Hx: dizziness
MRI T1, T2, T1+C
Tumour in right middle ear with extension to mastoid air cells and CPA
Dx: Glomus tumour (probably tympanicum type)

Case 2
Hx: abdominal pain
Contrast CT A+P
Filling defect in the SMV
Small bowel wall thickening
Dx: SMV thrombosis

Case 3
Hx: haematuria
Contrast CT T+A+P
Multiple lung nodules
Horseshoe kidney
Left kidney tumour (features more of TCC appearance) with hydronephrosis, renal nodal metastasis
Dx: Aggressive left renal tumour (no need to DDx TCC or RCC) with renal nodal metastasis and lung
metastasis.

Case 4
Hx: chest pain
Contrast CT aortogram
T8/9 spondylodiscitis
Saccular aneurysms at the corresponding level and also just above the aortic bifurcation
Suspicious right lower pole renal infarct
Dx: T8/9 spondylodiscitis (no need to DDx pyogenic or TB) with mycotic aneurysms

Case 5
Hx: skiiing related injury
MRI knee
High grade PCL and LCL tear
Reverse segond fracture
Dx: PCL injury with reverse segond fracture and LCL tear

Case 6
Hx: 19yo patient with knee pain
X-ray knee, contrast MRI knee, whole body bone scan
Aggressive distal femoral metaphyseal lesion (with features more suggestive of osteosarcoma)
MRI shows suspicious neurovascular bundle involvement, no definite intraarticular extension, another
lesion over the proximal femur but with different signal characteristics as the index lesion
Bone scan only shows increased uptake in the index lesion
Dx: Osteosarcoma of distal femur, not sure if the answer really includes a skip lesion
Viva

****************************************************************************************************************************
Brown
Skull
Large lytic lesion with scalp swelling
Not sure
DDx: osteoporosis circumscripta, myeloma, met

XR thoracic and LS spine

Rugger jersey spine
? Increased bone density
Small kidney with ? Cortical cal + medullary cal
I said TB autonephrectomy he said no
? Chronic renal failure with renal osteodystrophy
? Oxalosis

IVU excretory phase

No opacification of right collecting system
Irregular mass at bladder dome
Left ilium bone met with pathological fracture
Dx: met TCC

Enema (water soluble contrast, hx is abd pain)

Sigmoid diverticulitis
Extraluminal contrast
Perforated sigmoid diverticulitis

PCP?

Ruchi
LUL collapse
Lateral- asked to delineate the collapsed LUL

CXR
Well defined lentiform shaped opacity at right middle zone. Veil like opacity at right lower zone
Cardiomegaly
Ask for lateral --> loculated pleural effusion at oblique and horizontal fissure

Babygram
Hyaline membrane disease
Wrong UVC - tip in left atrium
Ask why UVC at left atrium
Wrong feeding tube in mediastinal
MMG
Breast implant
DCIS in lateral breast, not seen on MLO
USG:Small mass at lateral left breast
Microlobulated, taller than wider - suspicious
Biopsy
Asked if there is any precaution? Rupture of implant
Any way to prevent ?

CT abd pelvis. Septic shock

Sigmoid diverticulitis fistulation to bladder

Sherwin Lo
Wrist and knee XR
Diaphyseal aclasia
Psuedomadelung
Ask for other cause of pseudomadelung
Asked for malignant features
Asked what is the best modality to assess for malignant change: MRI
Cartilage cap

CXR
Reduced right lung volume, right pleural effusion
Rib defect
lymphangitis carcinomatosis
What can cause the rib defect
What other findings do u see: pleural met???

CT
Crohn
Long segment bowel wall thickening at terminal ileum
What complications to look for: perforation fistulation, gallstones, sacroiliitis

CXR
Preterm
RDS but one side more lucent?
What are the complications of RDS?

CT brain
Left temporal lobe hypodensity
Basal ganglion hypodensity
Asymmetrical
MRI T1 bright ? Forget if it is contrast or not
Multiple bright rim lesions at basal ganglion, right corona radiata
Given hx: Immunocompromised, confusion
Dx:? Toxoplasmosis

****************************************************************************************************************************
Brown
LUL collapse

CT perinephric hematoma -> selective renal a DSA: vasculitis (wegener/pan)

AXR Cecal volvulus (quite atypical)

CXR: bulge at aortopulmonary window -> traumatic aortic pseudoaneurysm

Ruchi (asked about basis despite quite straightforward film: won't let go until explain all the
radiological signs)
Coartation of aorta

Breast hamartoma

XR tibia: Ollier's - ask for hand to confirm -> pathological fracture

AXR: thumbprinting

KT
CXR - RUL consolidation - Background tb changes , unilateral left lung intubation because of right
hemoptysis -> DSA for BAE 1 : right upper lobe tortuous bronchial a + extravasation -- > DSA 2 ectopic
bronchial a (asked about procedure and embolization agents)

8yo CT brain : typical HIE

AXR multiple calicifed LN + spondylidiscitis - TB -> confirmed with CT

USG + MRI : median n nerve sheath tumor

Lui
Posterior shoulder dislocation

Cystogram of woman: urethral divericulum

USG thyroid: Ca papillary with LN mets - not sure if it is medullary ca actually

MRI knee: bucket handle tear of medial meniscus

****************************************************************************************************************************
Stephen Cheung
Miliary met CXR surgical clips at neck
Asked if any possible source of met from the film
Then Iodine 131 scan
Uptake in bilateral lungs
Asked what subtype of thyroid met compatible with the whole picture
Ultrasound testes
Left testes rupture
Multiple well defined hypoechoic lesions in upper pole ? Lacerations ? Intratesticular hematoma
A isoechoic lesion at lower pole with disrupted tunica albuginea ? --> ruptured testis
Plain CT, female patient, abdominal pain
Hemoperitoneum
Given contrast Scan
Hyooenhancing lesion at left adnexa
? Extravasation from left ovarian vessel
Asked what is the diagnosis: ruptured ectopic
But PT negative....
A rim enhancing cystic lesion at left adnexa?
Diagnosis: ruptured corpus luteal cyst?

Brain MRI 6yo, confusion and encephalopathy

Thalami hyperintensity

XR whole leg (AP + Lat)

Metaphyseal transverse lucent line at distal tibia (young adult, already fused growth plate)
Said ? Stress fracture
Give pelvis XR
Lucent line at acetabulum perpendicular to cortex ? Generalized reduced bone density
--> looser's zone fracture
****************************************************************************************************************************

Ruchi
CXR of 20yo:
several bilateral lung nodules, the largest one at left lung -> ill-defined, others smaller one -> well defined
I say DDX: infection, neoplasm, inflammatory
FU CXR 2 month later: the largest one become a thin walled cavity, other smaller nodule no change
Dx: ? Wegener granulomatosis

AXR of 1 day old:

Dilated bowel loops -> low GI obstruction
CXR: ? A small retrocardiac lucency
Dx: ?? Diaphragmatic hernia causing mechanical IO

CXR:
Opacity at RMZ, with well defined sharp upper border
Then times up
I said: loculated pleural effusion

Sherwin Lo
CXR:
RUZ opacity
Reticulonodular shadowing at RLZ
Say: Ca lung with lymphangitis carcinomatosa
HRCT shown: confirm the Dx
Bilateral Hand X-Ray:
Bilateral asymmetrical arthropathy
Carpal erosion
Pencil in cup
Dx: Psoriatic arthropathy

MRI C+T spine:

Spine normal
Tortuous T1 intermediate T2 hyper pre-vertebral lesion ?rim enhancing
Say: aorta, mediastinal cystic lesion
Being told patient complained dysphagia
Dx: dilated esophagus
CXR shown: confirm achalasia

LS-spine X-ray:
Cannot find any abnormality, then times up

Stephen Cheung
CXR:
diffuse cystic changes
Say: LAM
Shown a single slide of contrast CT abdomen: enhancing soft tissue around aortic bifurcation
Say: ?? Retroperitoneal fibrosis or lymphoma
Shown HRCT: confirm LAM
Being asked to link the finding together, I failed
Final Dx: should be LAM and retroperitoneal lymphangioleiomyoma

Plain CT brain:
Extra-axial hyperdensity at R Sylvian fissure, falx cerebri and vertex
Say: extra-axial hematoma
Being told no Hx of injuryand shown contrast CT: enhancement +ve
Say leptomeningeal met

Forgot. sorry

Brown
CXR
triangular opacity at medial RLZ
But heart border and diaphragm still seen
Say: ? RLL collapse
? R descending PA Missing
Dx: ???
AXR
Soft tissue mass at left side abdomen
L hip AVN
-> splenomegaly + AVN
Shown bilateral knee X-ray: Erlenmeyer flask deformity + bone infarct
Dx: Gaucher

Descending aortogram
Stenosis at proximal R renal artery
?? Missing SMA
IMA dilated
Then discussion: Atherosclerosis VS FMD VS vasculitis

CT abdomen
Pancreatic cyst
Renal cyst + RCC
Dx: VHL
****************************************************************************************************************************

Lui
CT brain plain
Right ACA infarct
Which part of body being affected

IVU release phase

Left upper ureter goblet sign
Pre contrast no hyperdense stone
What is goblet sign
Dx: ureteric TCC

Barium enema
Double contrast
Collar button ulcer of descending transverse colon
UC
Said no complications including toxic megacolon, tumour, gallstone, renal oxalate stones, sacroiliitis
Then ask if sigmoid colon is normal or not???

T tube cholangiogram
Intrahepatic ducts not dilated
Common bile duct slightly dilated
No filling defect
Then adjust the window a bit and right upper quadrant radiolucency
? Pneumoretroperitoneum
Ruchi
CXR
Left upper zone post irradiation pneumonitis and left mastectomy
How can u mean so sure it is post irradiation changes??

CXR and AXR neonate

RDS
AXR shows pneumoperitoneum
NEC

Mammo
Left lower outer quadrant mass obscured margin with fibrous strands
High density
? Malignant
Usg shows non specific

CXR
Pneumomediastinum
Right supra hilar mass
Not enough of time to complete this case

KT
Pelvis XR elderly
Post irradiation osteonecrosis
Same 3 years ago

KUB
Right irregular calcifications
Right retroperitoneal God knows what tumour
Probably aggressive

CXR
T spine collapse and loss of disc space
Infection vs tumour
Mri given
Put the wage on tb spondylodiscitis

Brown
XR tibia showing Brodie abscess

IVU
Medullary nephrocalcinosis
Left hydronephrosis??

USG transplant kidney

Doppler USG
? Reversed diastolicflow in renal transplant
****************************************************************************************************************************
Ruchi
LUL collapse
Lateral- asked to delineate the collapsed LUL

Babygram
Hyaline membrane disease
Wrong UVC - tip in left atrium
Wrong feeding tube in mediastinal

MMG
Breast implant
DCIS in lateral breast, not seen on MLO
USG:Small mass at lateral left breast
Microlobulated, taller than wider - suspicious
Biopsy
Asked if there is any precaution? Rupture of implant
Any way to prevent ?

CT abd pelvis. Septic shock

Sigmoid diverticulitis fistulation to bladder

Stephen Cheung
Miliary met CXR
Asked if any possible source of met from the film
Then Iodine 131 scan
Uptake in bilateral lungs
Asked what subtype of thyroid met compatibke with the whole picture

Ultrasound testes
Left testes rupture
hypoechoic lesions in upper pole ? Lacerations

Plain CT, female patient, abdominal pain

Hemoperitoneum
Given contrast Scan
Hyooenhancing lesion at left adnexa
? Extravasation from left ovarian vessel
Asked what is the diagnosis: ruptured ectopic
But PT negative....
? Diagnosis

Brain MRI 6yo, confusion and encephalopathy

Thalami hyperintensity

Metaphyseal lucent line

Sherwin Lo
Wrist and knee
Diaphyseal aclasia
Asked for malignant features
Asked what is the best modality to assess for malignant change: MRI
Cartilage cap

CXR
Reduced right lung column, right pleural effusion
Rib defect
Lymphangitis carcinomatosis
What can cause the rib defect
What other findings do u see: pleural met???

CT
Crohn
What complications to look for: perforation fistulation, gallstones, sacroiliitis

CXR
Preterm
RDS but one side more lucent?
What are the complications of RDS?

CT brain
Left temporal lobe hypodensity
Basal ganglion hypodensity
Asymmetrical
MRI T1 bright ? Forget if it is contrast or not
Multiple bright rim lesions at basal ganglion, right corona radiata
Given hx: Immunocompromised, confusion
Dx:? Toxoplasmosis

Brown
Skull
Large lytic lesion with scalp swelling
Not sure
Ddx: osteoporosis circumscripta, myeloma, met

Rugger jersey spine

Small kidney- renal osteodystrophy ?

IVU excretory phase

No opacification of right collecting system
Irregular mass at bladder dome
Left ilium bone met with pathological fracture
Dx: met TCC
Enema (water soluble contrast, hx is abd pain)
Sigmoid diverticulitis
Extraluminal contrast
Perforated sigmoid diverticulitis

PCP?

Rapid (should have 15-16 abnormal)

1. Hamate fracture
2. Fracture NOF
3. Pathological fracture at PP of little finger
4. 2nd MT stress fracture
5. Calcaneal fracture
6. 4th toe PP fracture
7. Right suprahilar mass
8. Sacral fracture
9. Colitis
10. Parietal fracture
11. Proximal tibial fracture