CHEST & CVS

KEY
STUDY: Contrast enhanced CT chest & abdomen
• axial section chest mediastinal window
• coronal section abdomen
• sagittal section abdomen
FINDINGS:
Well defined cystic lesions in left ventricle, left lung lower lobe, liver
and peritoneum
DIAGNOSIS:
Multiple hydatid cysts
NEXT:
Serological test for hydatid disease
 KEY
STUDY:
CXR frontal projection
Contrast enhanced CT chest axial section chest mediastinal window
T2W FS chest axial section
FINDINGS:
Chest radiography showed a large opacity in the middle and lower zones of
the right hemithorax
Contrast-enhanced CT demonstrated a large expansile multiloculated cystic
lesion in the right hemithorax originating from the posterior arch of rib.
MRI T2 weighted images confirmed a multiloculated cystic structure with
fluid-fluid level as well
DIFFERENTIAL DIAGNOSIS:
Anuerysmal bone cyst
Giant cell tumor
 KEY
STUDY:
CXR frontal projection
Contrast enhanced CT chest axial and coronal section chest mediastinal
window
FINDINGS:
Chest radiography showed bilateral enlarged hila
Contrast-enhanced CT revealed bilateral pulmonary aneurysms which were
partially thrombosed
DIFFERENTIAL DIAGNOSIS:
Pulmonary aneurysms with thrombosis in Behçet disease
Mycotic pseudoaneurysm
Traumatic pseudoaneurysm
Tumoural pseudoaneurysm
NEXT:
SEROLOGY FOR BEHCET’s
 KEY
STUDY:
Plain CT chest axial lung & mediatinal window
Contrast enhanced CT chest axial and coronal section mediastinal
window
FINDINGS:
Nonenhanced axial CT image shows pneumomediastinum, left pleural
effusion, and small amount of fluid surrounding the distal oesophagus
Contrast-enhanced CT image shows pneumomediastinum and peri-
oesophageal fluid collection. After administration of oral contrast,
mediastinal extravasation was noted
DIFFERENTIAL DIAGNOSIS:
Boerhaave's syndrome
NEXT:
Surgical consult
 KEY
STUDY:
Contrast enhanced CT chest axial and coronal section mediastinal
window
FINDINGS:
Contrast-enhanced CT image shows loculated left pleural effusion
with surrounding thick, enhancing and partially calcified pleural
surfaces
This is communicating with an organized, subcutaneous chest-wall
fluid collection which also showed peripheral enhancement
DIAGNOSIS:
Empyema necessitans
NEXT:
Surgical consult
GIT
 KEY
STUDY:
CXR frontal & lateral projection
CT chest abdomen axial and sagittal section
FINDINGS:
CXR showed pneumoperitoneum with laminar atelectasis right middle
& lower lobes
CT image shows multiple rounded air-filled lesions occupying the
anterior part of the mesentery
DIAGNOSIS:
Pneumatosis cystoides intestinalis
NEXT:
Conservative management
SUPINE PRONE
 KEY
STUDY:
Barium meal & follow through
CT abdomen 3 D recon sagittal section
CECT abdomen axial section at level of SMA
FINDINGS:
Barium meal & follow through showed a compression at the third part
of the duodenum that regained its usual diameter in prone position. A
light distension of the second part of the duodenum could also be
seen.CT image shows multiple rounded air-filled lesions occupying the
anterior part of the mesentery
DIAGNOSIS:
Pneumatosis cystoides intestinalis
NEXT:
Conservative management
 KEY
STUDY:
XRAY abdomen
CECT abdomen sagittal, coronal and axial sections
FINDINGS:
Plain radiographs----distended central small bowel loops.
CT image sagittal----anterior sausage or kidney-shaped mass at the
level of the umbilicus.
CT image coronal---- bowel-in-bowel appearance
CT image axial---- a well-defined anterior solid mass with bowel-in-
bowel appearance representing the intussuscipiens and intussuceptum
DIAGNOSIS:
Intussusception
USG abdomen right iliac
fossa
 KEY

STUDY:
USG abdomen
CECT abdomen sagittal, coronal and axial sections
FINDINGS:
Plain radiographs----Anechoic mass with hyperechoic wall and
posterior shadow
CT image ----fluid over distension of the appendix, small gas bubbles
inside, wall thickening and parietal calcifications.
DIAGNOSIS:
Appendiceal mucocele
 KEY

STUDY:
CECT abdomen sagittal, coronal and axial sections at the level of
pancreas
FINDINGS:
Tortuous tubular structures with marked enhancement in and around
the pancreatic head, uncinate process and tail
The gastroduodenal and splenic arteries are the main feeders of this
structure
Non-enhancing pancreatic body and tail several fluid collections in
pancreatic tail, gastrosplenic ligament and anterior pararenal space
DIAGNOSIS:
Acute pancreatitis due to pancreatic arteriovenous malformation
GUT
 KEY

STUDY:
CECT abdomen sagittal, coronal sections
CT chest axial section mediastinal window
Ct scan head bone window
FINDINGS:
CT abdomen----a large heterogeneously enhancing mass seen in upper pole
and interpolar region of right kidney with a rim of compressed residual renal
parenchyma (claw sign)
CT chest----Lytic rib lesion with a large soft tissue
Ct head----Lytic lesion in left mandibular ramus with periosteal reaction and
lytic lesion in right frontal bone with soft tissue component
DIAGNOSIS:
Wilms tumour with bony-mandibular, rib and calvarial metastases
 KEY

STUDY:
CT pyelography---axial plane, corticomedullary phase axial &
excretory phase coronal
FINDINGS:
Plain axial---the calculi in upper pole left kidney
Corticomedullary phase axial --- blunted renal papilla in right kidney
Excretory phase ---- lobster clawing in right kidney & signet ring sign
along with filling defect in the distal left ureter
DIAGNOSIS:
Renal papillary necrosis
 KEY

STUDY:
X-ray abdomen
CT cystography
FINDINGS:
X-ray abdomen----curvilinear area of radiolucency delineating the
bladder wall
CT cystography--- air-fluid level, wall thickening with air attenuation
areas in bladder wall and no presence of contrast medium in tissues
around bladder.
DIAGNOSIS:
Emphysematous cystitis
 KEY

STUDY:
CE CT abdomen
FINDINGS:
Bilateral renal medullary enhancement and lack of cortical
enhancement
Peripheral rim enhancement of subcapsular area in bilateral renal
cortex
Hepatic and splenic contusions
DIAGNOSIS:
Acute renal cortical necrosis
 KEY

STUDY:
CE CT abdomen axial and coronal sections
FINDINGS:
Left well defined renal mass bulging outside renal margins but not
breaching perinephric fasciae
Filling defect in left renal vein with cephalad extension into IVC &
right atrium
Left paraaortic lymph nodes
Left side pleural effusion
DIAGNOSIS:
Mass left kidney with thrombus left renal vein extending into IVC and
right atrium
CNS
 KEY

STUDY:
MRI T2W axial, FLAIR axial and coronal, T1W coronal
FINDINGS:
A large well defined lobulated T2W heterogenously hyperintense cystic
lesion arising from the right frontal sinus with gross expansion of the
sinus. The entire lesion showed T1W hyperintense signal. Mild
extraconal extension of the lesion was seen along the superomedial
aspect of the right orbit. A large intracranial extra axial extension of
the lesion was seen compressing the right frontal lobe with perifocal
edema.
DIAGNOSIS:
Right Frontal sinus mucocele with intracranial and intraorbital
extension
 KEY

STUDY:
MRI T2W axial, T1W axial, FLAIR coronal, DWI/ADC axial and T1W CE axial
FINDINGS:
Well defined abnormal signal intensity lesion in the posterior cranial fossa
with extension between the cerebellar hemispheres, predominantly on
the left side causing effacement of fourth ventricle.
Showing CSF signals on all pulse sequences giving "dirty CSF" appearance
on FLAIR
Restricted diffusion on DWI /ADC
No enhancement is seen after Gadolinium administration
DIAGNOSIS:
Epidermoid cyst
 KEY

STUDY:
MRI T2W axial, T1W axial, T1W axial CE
FINDINGS:
Nodule appearing hyperintense on both T1WS & T2WS in the right
cerebellar hemisphere with hypointense halo
On post contrast images nodule shows no enhancement , however
contrast outlined multiple small vessels are seen draining into right
petrosal vein
DIAGNOSIS:
Cavernoma with developmental venous anomaly
 KEY
STUDY:
CT scan and CECT scan brain
MRI T2W axial and T1W CE coronal
FINDINGS:
•Non Enhanced Brain CT: Intra-axial infratentorial lesion in the right
cerebellum consisting of a large cystic component (density similar to CSF) with
a mural isodense nodule (compared to the brain tissue) arising from the
posterior wall.
•Enhanced Brain CT: the nodule shows a uniform and intense enhancement
while there is no enhancement of the cystic wall.
•Non-enhanced T2w : the nodule has similar density to the brain tissues while
the cystic component is isointense (compared to CSF).
•Enhanced T1w: the nodule shows a homogenous enhancement.
DIAGNOSIS:
Hemangioblastoma
 KEY
STUDY:
MRI T1 & T2W axial and T1W CE axial
FINDINGS:
•Large heterogeneous mass located in frontal horn of right lateral
ventricle at the foramen of Monro, with an intense inhomogeneous
enhancement in T1W CE
•T2-FLAIR axial MRI image: Irregular hyperintense areas in the
subcortical white matter suggestive of subcortical tubers.
•Small subependymal nodule appearing iso to hyperintense on T1WS &
hyperintense on T2WS and showing ring enhancement in T1W 
DIAGNOSIS:
Tuberous sclerosis with subependymal giant cell astrocytoma
MUSCULOSKELETAL
SYSTEM
 KEY
STUDY:
XRAY both femurs, hand & lateral view face
CT head bone window coronal section
FINDINGS:
•Femurs X-ray - distal expansion and slight deformity.
•Hands X-ray - bone cortical thickening.
•Lateral face X-ray - Expansion and increased density of mandibular
and maxillary bones.
•Coronal face CT- expansion, increased density and marked
thickening of mandibular, maxillary and frontal bones.
DIAGNOSIS:
Polyostotic fibrous dysplasia 
 KEY
STUDY:
XRAY femur
MRI Coronal FS T1 image
MRI Coronal STIR image
FINDINGS:
•Femur X-ray - calcifications in the quadriceps muscle bellies
•Coronal FS T1 image - inhomogeneous area with hypointense zones,
corresponding to calcifications at vastus intermedius belly.
•Coronal STIR image -presence of oedema in the lesion.
DIFFERENTIAL DIAGNOSIS:
Myositis Ossificans 
Extraosseous osteosarcoma
 KEY
STUDY:
XRAY knee joint AP view
Chest X ray frontal projection
FINDINGS:
•Knee X-ray –  Multiple calcified lesions within the soft tissues around
the joint.
•Chest X-ray- Calcified serpentine lesion in the soft tissues overlying
the lateral aspect of the right side of the chest.
DIAGNOSIS:
Dracunculus medinesis infection
 KEY
STUDY:
XRAY both knee joint AP view
X-ray of the legs in standing position
XRAY both hands AP view
FINDINGS:
•Knee X-ray –  Metaphyseal fraying and irregularity along the physeal
margin. Looser zone fracture in the proximal tibia left side.
•X-rayof the legs in standing position - Windswept deformity, with valgus
deformity of the right leg and varus deformity of the left.
•Hands X-ray- Demonstrate cupping and fraying of the metaphyseal region
of radius and ulna.

DIAGNOSIS:
Rickets
 KEY
STUDY:
Coronal T1-weighted image
Sagittal PD-weighted and T2-weighted images
FINDINGS:
•Coronal T1-weighted image - a large meniscal fragment displaced
into the intercondylar notch.
•Sagittal PD-weighted and T2-weighted images - anterior horn
appears large in height and width
•Sagittal PD-weighted and T2-weighted images - a meniscal fragment
lying anterior and parallel to the PCL, making it like a double
ligament.
DIAGNOSIS:
Bucket handle tear ACL
MISCELLANEOUS
 KEY
STUDY:
Sagittal and axial T2-weighted images
Sagittal and axial T1-weighted images
FINDINGS:
•Large heterogeneous signal intensity mass lesion in the presacral
region. The lesion showed internal fat, calcification, cysts,
hemorrhage and soft tissue elements.
•The lesion causing compression and displacement of the bladder,
uterus and rectum anteriorly without any definite evidence of
invasion.
 DIAGNOSIS:
Sacrococcygeal teratoma (Type IV)
 KEY
STUDY:
CT scan brain axial section
FINDINGS:
•The overlying calvaria on the right side shows asymmetric thickening
as compared to the contralateral side.
•Right hemicerebral atrophy with sulcal and ventricular enlargement
is well visualised.

 DIAGNOSIS:
Dyke-Davidoff-Masson syndrome
 KEY
STUDY:
MCUG—AP & Oblique projection
FINDINGS:
•AP view: Dilated and elongated posterior urethra, trabeculated
urinary bladder and grade 5 reflux of contrast into the right sided
dilated collecting system.
•Oblique View: A crescent shaped filling defect near the
verumontanum consistent with 
 DIAGNOSIS:
Posterior urethral valve with complications
 KEY
STUDY:
Ultrasound pelvis

FINDINGS:
•TVS showing a 10 week intrauterine gestation.
•TVS colour Doppler showing adnexal mass with colour flow in the
trophoblastic tissue.

 DIAGNOSIS:
Heterotopic pregnancy
USG PELVIS
 KEY
STUDY:
Ultrasound pelvis
CECT Pelvis

FINDINGS:
•Ultrasound pelvis: Lesion of varying echogenicity with fat-fluid level
and a highly echogenic nodule with posterior shadowing. There is no
blood-flow.
•CT SCAN:Bilocular cystic lesion with fat-fluid levels. The two round
soft tissue masses in one plane.

 DIAGNOSIS:
Dermoid cyst