LONG CASE PACKET 3 MODEL ANSWERS

Case 1

Observation 

X ray spine: L2 wedge fracture.

MRI Lumbar spine: L2 wedge fracture

Large right sided effusion

Right renal based mass

Negatives, no bony metastasis.

Interpretation

Acute fracture with incidental renal lesion

Principle Diagnosis

Renal mass with non pathological L2 old fracture

Differential Diagnosis

Lymphoma

Further Management

Staging CT chest, abdomen and pelvis

 

Case 2

Observation 

Abdominal Radiograph: Calcified density projected over the right kidney.

Density behind the heart border-could be hiatus hernia or lung lesion

CT KUB: 10mm gallstone

Large 5cm pericardial lesion

Negatives, no renal tract stones. No bony lesions. No large colonic lesions.

Interpretation

Pericardial lesion.

Principle Diagnosis

5cm pericardial cyst

Differential Diagnosis

5cm Lung mass

Further Management

Further assessment with CT chest with contrast

 

Case 3

Observation 

CT Head: CT intermediate attenuation area in parietal occipital region

MRI Head: Restricted diffusion in the occipital pole of the right cerebral hemisphere and parietal region

T2 FSE showed low signal within the right occipital pole

Low intensity changes in the periventricular spaces.

Interpretation

Ischaemia and haemorrhage

Principle Diagnosis

Acute right cerebral infarction with haemorrhage.

Differential Diagnosis

Bleeding AVM.

Further Management

Stroke Consultation.

 

Case 4

Observation 

AXR: Nil acute

CT abdomen and pelvis: Normal spleen not visualised. Multiple soft tissue densities identified.

NEGATIVES no other abnormalities identified.

Interpretation

Soft tissue based lesion.

Principle Diagnosis

Congenital splenosis

Differential Diagnosis

Polysplenia

Peritoneal metastasis

Further Management

Consider TC-99m sulfur colloid scan.

 

Case 5

Observation and Interpretation

CXR: Left lower lobe collapse

CT chest abdomen with contrast: Left lower lobe collapse

Right sided pulmonary artery filling defects

Calcified left chest wall plaque, right lower lobe bronchiectasis

NEGATIVES, no lung nodules or destructive bony change. No solid organ metastasis

Interpretation.

Lung lesion with emboli.

Principle Diagnosis

Lung cancer with pulmonary emboli

Differential Diagnosis

Nil

Further Management

Chest Consultation

 

Case 6

Observation 

MRCP: Gallstones. Thick walled gallbladder

Dilated Intrahepatic ducts with beaded stricture at the liver hilum

Partially solid/ partially cystic nodule measuring about 12 mm behind the IVC

NEGATIVE, no other solid organ pathology appreciated. No lung base lesions. No biliary tree stones.

Interpretation

Shrunken kidney. Biliary tree pathology.

Principle Diagnosis

Acute cholecystitis. Sclerosing cholangitis.

Differential Diagnosis

Acute cholecystitis. Cholangiocarcinoma

Further Management

Treat cholecystitis with antibiotics.

Follow up ERCP/EUS to assess liver hilum