Packet 3 Case 1
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Packet 3 Case 2
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Packet 3 Case 3
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Packet 3 Case 6
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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