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Case 1


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.

Principle Diagnosis:

Mechanical small bowel obstruction from obstructing tumour

Differential Diagnosis

Mechanical small bowel obstruction from metastasis or lymphoma


Emergency surgical referral

CT chest to complete staging assessment.


Case 2


CT Head and MRI Head Observation

Downward descent of cerebellar tonsils by approximately 5mm

Crowding of foramen magnum;;

Grey-white matter differentiation preserved

Normal ventricles


Abnormal position of cerebellar tonsils

Principle Diagnosis

Arnold chiari malformation type I

Differential Diagnosis

Incidental tonsillar ectopia

Further Management

Will need a full spine MRI scan to assess for syrinx and other anomalies.

Neurology Consultation


Case 3


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.

Principle Diagnosis

CBD cholangiocarcinoma with retroperitoneal and liver metastases

Differential Diagnosis

Passed stone causing CBD stricture and cholangitis with liver abscess and adenopathy.

Further Management

Upper GI surgery consultation

Staging CT chest, abdomen and pelvis

Blood tests including inflammatory markers.


Case 4


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.

Significant negatives

No free air or fluid. Remainder of solid organs normal. No bony metastasis


Bowel obstruction with metastatic disease

Principle Diagnosis

Metastatic pancreatic cancer with serosal disease causing bowel obstruction

Differential Diagnosis

Neuroendocrine tumour with metastasis

Further Management

Referral to surgery for management of obstruction

Staging CT chest

HPB MDT referral


Case 5


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

Principle Diagnosis

Dissection of right carotid artery

Differential Diagnosis


Further Management

Urgent neurology review for management

Needs MRI Head


Case 6


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

Principle Diagnosis

Retained material from previous surgery. Development of an ovarian lesion.

Differential Diagnosis


Further Management

Tumour marker correlation

Gynaecology consult