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