LONG CASE PACKET 1 MODEL ANSWERS
AXR: Dilated loops of small bowel. Normal calibre large bowel
CT Abdomen and Pelvis: Dilated proximal loops of small bowel with thickened small bowel in the right side and calibre change at the level of a small bowel mass in the ileum.
Incidental gallstones and diverticula disease.
No free air or free fluid. No soft tissue disease.
No solid organ or bony metastasis.
Appearances likely represent bowel obstruction.
Mechanical small bowel obstruction from obstructing tumour
Mechanical small bowel obstruction from metastasis or lymphoma
Emergency surgical referral
CT chest to complete staging assessment.
CT Head and MRI Head Observation
Downward descent of cerebellar tonsils by approximately 5mm
Crowding of foramen magnum;;
Grey-white matter differentiation preserved
Abnormal position of cerebellar tonsils
Arnold chiari malformation type I
Incidental tonsillar ectopia
Will need a full spine MRI scan to assess for syrinx and other anomalies.
MRCP: Moderately dilated biliary tree with calibre change in the CBD.
Liver solid lesions and retroperitoneal upper abdomen adenopathy.
Incidental findings, gallstones and liver cysts.
Significant negatives no biliary tree stones.
CBD obstruction with liver solid lesions.
CBD cholangiocarcinoma with retroperitoneal and liver metastases
Passed stone causing CBD stricture and cholangitis with liver abscess and adenopathy.
Upper GI surgery consultation
Staging CT chest, abdomen and pelvis
Blood tests including inflammatory markers.
CT abdomen and pelvis: Dilated small bowel with calibre change in the right side.
Liver metastasis. Pancreatic body mass. Retroperitoneal lymphadenopathy
Incidental left kidney calculus and sigmoid diverticular disease.
No free air or fluid. Remainder of solid organs normal. No bony metastasis
Bowel obstruction with metastatic disease
Metastatic pancreatic cancer with serosal disease causing bowel obstruction
Neuroendocrine tumour with metastasis
Referral to surgery for management of obstruction
Staging CT chest
HPB MDT referral
CT Head: Abnormal high attenuation in the right carotid artery
No intracranial abnormality appreciated
MRA Head: Filling defects in the carotid artery
Narrowing of the right carotid artery
Dissection of right carotid artery
Urgent neurology review for management
Needs MRI Head
AXR: Radio-opaque material in right lower abdomen
CT Abdomen and pelvis: Cystic lesion in the right side of the abdomen measuring 8 x 12cm with wires and calcification inside
Previous liver resection
Negatives: Normal uterus, solid organs. No free air or fluid.
Ovarian lesion or retained material from previous surgery
Retained material from previous surgery. Development of an ovarian lesion.
Tumour marker correlation