Packet 4 Case 1
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Packet 4 Case 2
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Packet 4 Case 3
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Packet 4 Case 4
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Packet 4 Case 5
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Packet 4 Case 6
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LONG CASE PACKET 4 MODEL ANSWERS
Case 1
Observation
MRI Pelvis: 54 mm x 67 mm heterogeneous right adnexa lesion. No intralesional fat. High signal on FAT SAT sequences. Fluid in pouch of Douglas
NEGATIVES: Normal left ovary and uterus.
CT chest abdomen and pelvis: Solid right adnexal mass. 5cm cystic appendix based lesion.
2mm nodule in right lower lobe.
Interpretation
Appendix lesion with right ovarian mass.
Principle Diagnosis
Appendix tumour with krukenberg metastasis
Differential Diagnosis
Ovarian cancer with incidental appendix lesion
Further Management
Gynae consultation. Tumour marker correlation.
Case 2
Observation
CXR: Wedge shaped consolidation right subpleural lower lobe
CTPA: Bilateral pulmonary artery filling defects.
Patchy ground-glass haziness in right lower lobe and middle lobe.
Incidental tiny renal calculi.
Negatives No other significant abnormalities. No bony lesions.
Interpretation
PE with lung changes.
Principle Diagnosis
PE with wedge infarct
Differential Diagnosis
PE with lung inflammation
Further Management
Treat PE
Follow up CT chest in 3 months to monitor
Case 3
Observation
X ray Pelvis: Lytic area right intertrochanteric region
MRI Pelvis: Right femoral neck marrow infiltration.
Negatives, no additional lesions. No pathological fracture
Interpretation
Neoplastic process
Principle Diagnosis
Bony metastasis
Differential Diagnosis
Primary neoplasm
Further Management
Staging CT chest, abdomen and pelvis
Tumour marker correlation
Case 4
Observation
8.6 x 4cm collection surrounding right hip prosthesis
Left basal consolidation. Cysts in liver and kidneys. Catheter in bladder.
Negatives, solid organs normal. No adenopathy.
Interpretation
Abnormality near right prosthesis
Principle Diagnosis
Periprosthetic infection
Differential Diagnosis
Prosthetic loosening.
Further Management
Urgent orthopaedic review
Consider MRI scan to assess further
Case 5
Observation
Calcification medially within the left temporal lobe.
Negatives: No hydrocephalus. No white matter oedema. No bony lesions.
Interpretation
Non neoplastic lesion
Principle Diagnosis
Calcified meningioma
Differential Diagnosis
Calcified vascular malformation
Further Management
Contrast enhanced MRI with MRA sequences.
Case 6
Observation
CXR: Pneumomediastinum and pneumothorax.
CT chest abdomen and pelvis: Extensive pneumomediastinum retro and intraperitoneal air, right large pneumothorax, left small pneumothorax and widespread surgical emphysema.
Concentric thickening of the mid oesophagus
Right lower lobe nodule.
Left inguinal hernia containing bowel loops. L5/S1 spondylolisthesis.
Interpretation
Mid oesophageal obstructing mass which has ruptured.
Principle Diagnosis
Oesophageal neoplasm which has ruptured
Differential Diagnosis
Iatrogenic injury to oesophagus.
Further Management
Urgent surgical review