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