Case 1A (2 films)

History
65 year old female pre and post treatment films following a fall.

Findings
Film obtained shortly post trauma
Dislocation of radius
Dislocation of ulna
Direction of Dislocation
Posterior
Lateral
Right side noted
Intact proximal radioulnar joint
Small bony fragment
Fracture (presumably osteochondral)

Later film (in plaster)

Right radio-capitellar joint widened
Position of humero-ulnar joint improved
Intraarticular fragment

Diagnosis
Posterolateral dislocation right elbow with osteochondral fracture and intraarticular fragment

Case 1B (2 films)

History
63 year old male with chest pain post procedure.

Findings
Gas fluid level
Right side noted
Right hydropneumothorax
Lobulated right pleural thickening
th
Destruction posterior aspect left 7 rib
th
Associated soft tissue mass at site of 7 rib destruction

Left PICC line

PICC line projected over SVC
Left lung clear
Probable thickening right paratracheal stripe

Diagnoses
Pleural metastatic disease
th
Metastasis to left 7 rib

Other less relevant observations include presence of a press stud over the clavicle, the
presence of rotator cuff disease and also the presence of right upper quadrant surgical clips.

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 Case 2A (3 films)

History
67 year old male with headache.

Findings
Mass in/adjacent to trigone of left lateral ventricle
Mass hyperdense pre contrast
Adjacent vasogenic oedema
Dilated left temporal horn
Pronounced enhancement post contrast
Mild mass effect

Mucous retention cyst right maxillary antrum

Hyperdensity left frontal sinus
Ivory osteoma left frontal sinus

Diagnosis
This case has a differential diagnosis in descending order of preference:
1. Meningioma
2. Metastatic disease (eg melanoma, thyroid, renal or chorio-carcinoma)
3. Glioma
4. Lymphoma
5. Choroid plexus papilloma (if mentioned better if done in order to dismiss)

Recommendation that MRI be performed

In addition to the above several additional observations include:

• Right concha bullosa

• Minor ethmoid opacity bilaterally
• Small left maxillary mucous retention cyst
• Possible left frontal pacchionian granulation

Case 2B (2 films)

History
82 year old female with history of falls six months ago. Increasing right hip pain over past three
days.

Findings
Eccentric position of femoral component
Right side noted
Acetabular cup expanded
Lucency across acetabular component
Wire disruption

Lower lumbar degenerative change

Normal left hip

Diagnosis
Fracture acetabular component

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 Case 3A (1 film)

History
66 year old male with recurrent abdominal pain.

Findings
Contrast enema
Rectosigmoid narrowing
Twisted folds

Diagnosis
Sigmoid volvulus

Case 3B (1 film)

History
28 week premature female now 9 days old. Routine scans

Findings
Ventricular dilatation
Casting clot within ventricles
Bilateral intraventricular haemorrhage
Bilateral Grade III haemorrhage
Possible right sided Grade IV haemorrhage
(The latter is associated with significantly worse prognosis)

Case 3C (1 film)

History
60 year old female with cough and weight loss.

Findings
Diffuse pulmonary nodularity
Left sided pleural thickening

Left T10 pedicle missing

Probable T6 wedge fracture
Spinal rods

Diagnosis
Multiple pulmonary metastases
Bony metastatic disease

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 Case 4 (2 films)

History
24 year old female with large PV bleed. ? viability.

Findings
Left adnexal mass
Size 9x12x11.7cms
Echogenic material in nondependent position
Left ovarian dermoid

Anterior placenta
Viable intrauterine gestation
Mention that dates, BPD and head circumference suggest approximately 15 weeks 3 days

Unusual appearance of ventricle

Dilated left renal pelvis
Cleft lip/palate
No definite retroplacental haemorrhage/clot
(in relation to PV loss)

Diagnosis
Suggestion of holoprosencephaly
Aneuploidy

Other observations that may be raised include the presence of a small thorax and discussion of
the possibility of Trisomy 13.

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 Case 5A (2 films)

History
70 year old female with headaches and general deterioration

Findings
Pre contrast hyperdensity in subependymal region
Lobular contour of subependymal hyperdensity
Intense subependymal enhancement (lateral ventricles,
rd
3 ventricle/pituitary recess, pituitary stalk)
Ventriculomegaly
Sulcal effacement

Differential Diagnosis
Lymphoma
Ependymytis/atypical infection

Recommendation for staging or body CT

Case 5B (1 film)

History
22 year old male with recent onset left flank pain.

Findings
Omental abnormality
Site in left flank
Close to descending colon
Central fatty attenuation within lesion or abnormal region
No diverticular disease detected
Adjacent normal small bowel

Diagnosis
Epiploic appendagitis

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 Case 6 (5 films)

History
50 year old patient referred for MRI. ? MS

Findings
Conus medullaris abnormal on pre contrast T1 & T2 images
Enhancement of conus mass

Lesion posterior aspect T6 vertebra

Left sided foraminal extent
Left epidural extent
Left pleural effusion
Left lower lobe mass

Multiple liver lesions

Right adrenal mass

L5/S1 disc protrusion

Cervical spondylosis

Diagnosis
Bronchogenic carcinoma
T6 lesion described as probable metastasis
Right adrenal mass described as likely metastatic

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 Case 7 (2 films)

History
80 year old male with pyrexia of unknown origin

Findings
Surgical clip posterior to aorta
Aorto-bifemoral graft
Gas in aortic graft
Occluded right limb of aorto-bifemoral graft
Soft tissue surrounding graft at bifurcation and
extending along right limb of graft to right groin
Fistula to skin

Bilateral renal calculi

Small left renal cyst
No renal obstruction
Pleural calcification

Diagnoses
Aortic graft infection
Extension to right groin

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 Case 8 (3 films)

History
Acute on chronic left flank pain

Findings
Large left upper quadrant mass
Mass contains dystrophic calcification
Infiltration of retroperitoneum and left paraspinal musculature
Epidural extent
Direct extent into vertebral bodies with bone destruction
Foraminal involvement

Epicardiophrenic nodal metastasis

Serosal metastatic disease
Left retrocrural involvement
Transverse process fracture

Bowel dilatation/obstruction
Multiple lung base nodules
Subcutaneous nodule right lateral chest wall
Subcutaneous fatty tissue/lipoma adjacent subcutaneous nodule
(Variably differentiated liposarcoma metastasis also acceptable)

Diagnosis
Neoplasm, probable sarcoma/liposarcoma

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