Packet 5 Case 1
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Packet 5 Case 2
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Packet 5 Case 3
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Packet 5 Case 4
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Packet 5 Case 5
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Packet 5 Case 6
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LONG CASE PACKET 5 MODEL ANSWER
Case 1
Observation
MRI sacroiliac joints: Bone marrow oedema around both sacroiliac joints.
28 mm cystic structure in the right iliac fossa
MRI whole spine
Minor image degradation but no significant abnormalities.
Interpretation
SI joint disease. Right iliac fossa lesion
Principle Diagnosis
Bilateral sacroiliitis. Right ovarian cyst.
Differential Diagnosis
Bilateral sacroiliitis. Right appendix mass.
Further Management
CT abdomen and pelvis is advised for further evaluation.
Case 2
Observation
X ray Knee: No acute bony injury. Joint space chondrocalcinosis. Joint space preserved.
MRI Knee: Joint effusion. Florid marrow oedema in the medial tibial plateau. Small subcortical trabecula fracture.
Medial meniscus extruded from the joint line. Meniscal fragment in medial recess.
Medial condyle articular cartilage shows full thickness fissuring.
Negatives. No other ligamentous injuries identified.
Interpretation
Injury to meniscus and fracture of tibial cortex.
Principle Diagnosis
Medial meniscus tear. Fracture tibia
Differential Diagnosis
None.
Further Management
Urgent orthopaedic Consultation
Case 3
Observation
CT Abdomen and pelvis: Gastric mucosal lesion measuring 2cm.
Several lesions, show progressive contrast filling in portal venous phase.
Negatives, solid organs normal. No bowel lesions. No bony lesions.
Interpretation
Gastric lesion.
Principle Diagnosis
Gastric polyp, hemangioma in liver
Differential Diagnosis
Gastric neoplasm, hemangioma in liver.
Future Management
Gastroenterology consultation with consideration for endoscopy
Case 4
Observation
CT head: Cystic lesion in left occipital lobe with small foci of calcification.
MRI Head with contrast: Heterogenous cystic lesion in left occipital lobe, involving posterior fossa. High signal on precontrast T1. No enhancement. Significant restricted diffusion is shown. Mass effect on left cerebellum.
T2 high signal in white matter on FLAIR imaging.
Interpretation
Mass lesion in the brain
Principle Diagnosis
Intradiploic epidermoid.
Differential Diagnosis
Cystic metastasis
Further Management
Neurology Consult
Case 5
Observation
CT Chest, abdomen and pelvis: Right portal vein thrombosis. Several perihepatic collections demonstrated
Dilated biliary tree with periportal fluid.
No radiopaque gallstones.
Incidental splenomegaly.
Solid organs otherwise normal.
Lung base atelectasis
MRCP: Gallbladder distended with large calculi near hilum.
Dilated biliary tree with periportal fluid.
Interpretation
Lesion resulting in obstruction of biliary system.
Principle Diagnosis
Mirizzi Syndrome
Differential Diagnosis
Hilar neoplasm
Future Management
Surgical Consultation
Antibiotic therapy.
Case 6.
Observation
CXR 1 (CXR DATED 7/9/2018): Cardiac apex on the right.
No focal active lung lesions.
No bony lesions
CXR 2 (CXR DATED 17/9/2018) :Normal position of cardiac apex.
Interpretation
Technique acquisition error
Principle Diagnosis
Rotated CXR simulating dextrocardia
Differential Diagnosis
X ray labelled in correctly.
Future Management
Nil