Long Case Practice Packet 2

LONG CASE PACKET 2 MODEL ANSWERS

Case 1

Observation and Interpretation

CT abdomen and pelvis with contrast: Thickening of the terminal ileum with mucosal enhancement.

Left adrenal nodule

Negatives No small bowel obstruction. No colonic lesions. Solid organs normal. No adenopathy or lung lesions. No destructive bony changes. Normal SI joints.

Interpretation small bowel abnormality

Indeterminate adrenal lesion

Principle Diagnosis

Inflammatory bowel disease

Differential Diagnosis

Neoplasia

Infection

Further Management

Gastro consult and consideration for colonoscopy

Adrenal protocol mri scan for assessment.

Case 2

Observation

MRI Knee: Large bucket handle tear of the medial meniscus with meniscal fragment flipped into the intercondylar notch.

High signal near collateral ligaments suggestive of mild strain.

Negatives Remainder of menisci normal and tendons normal. No bony injury.

Interpretation

Ruptured menisci

Principle Diagnosis

Bucket Handle tear of menisci

Differential Diagnosis

None

Further Management

Emergency orthopaedic Consultation

Case 3

Observation

CT cervical spine:Fracture of the left body of C2

No other bony injury

MRI cervical spine: Fracture of the odontoid PEG within the body.

High signal areas within the visualised cervical and thoracic level cord.

Negatives, no additional bony injury. No additional cord lesions.

Interpretation

Spine fracture with cord lesions.

Principle diagnosis

C2 fracture. Multiple sclerosis in cord.

Differential Diagnosis

C2 fracture. Cord metastasis.

Further Management

Orthoapedic consult

Contrast enhanced scan of whole spine.

Neurology referral

Case 4

Observation

7 X 6 mm mass in the left internal auditory meatus

Negatives Normal 7^th and 8^th cranial nerves. No intracranial lesions.

Interpretation

lesion in left IAM.

Principle Diagnosis

Acoustic Neuroma

Differential Diagnosis

Epidermoid

Further Management

Contrast enhanced MRI

ENT Consult

Case 5

Observation

X Ray Cervical Spine :Abnormal cortical erosions involving C5 and C7
MRI cervical spine: C5 and C7 bone marrow infiltration

Negatives, no cord lesions.

Interpretation

Neoplastic process involving spine

Principle Diagnosis

Bony metastasis

Differential Diagnosis

Myeloma

Further Management

Work up and assessment for primary

Staging CT chest, abdomen and pelvis

Case 6

Observation

CT abdomen pelvis with contrast: Ileocolic intussusception in the right iliac fossa with thickened and dilated small bowel.

Multiple enhancing large mucosal polyps are seen in the small bowel loops.

Enlarged mesenteric nodes.

Negatives, no free air or fluid.

Interpretation

Small bowel tumours causing obstruction.

Principle Diagnosis

Small bowel cancer with obstruction.

Differential Diagnosis

Small bowel metastasis with obstruction.

Further Management

Emergency surgical consultation

CT chest