FRCR Mindset Cases

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These are not my cases. They have been kindly donated by doctors who wish to support FRCR preparation. The cases are from people who have done the exam previously and reflect the types of questions they encountered. 


CASE 1

Case 1

 

Model Answer

  • XRAY- Frontal radiograph of pelvis of a skeletally immature patient shows a mildly expansile lucent lesion in the left ilium with sclerotic margins and narrow zone of transition. The articular margins appear intact. No evidence of internal calcifications/ pathological fracture/ soft tissue component. No periosteal reaction noted. Interpretation- f/s/o benign non aggressive lesion. d/d- sbc, abc, (? Enchondroma),eosinophilic granuloma (but no periosteal reaction

Case1.1

  • CT- limited axial sections of pelvis in bone window confirms an expansile lucent lesion with well defined margins and cortical thinning. Multiple thin internal septae noted. No evidence of cortical break. Diagnosis is ABC.

Case 2

Case 2

  • Frontal radiograph of a skeletally mature patient shows faint soft tissue opacity projected over central abdomen and pelvis with superior margin reaching up to L2 Vertebral body. No e/o calcification. Visualised bowel/ bones unremarkable.
  • d/d- overdistended urinary bladder (male patient- sec to ca prostate/ BHP)
  • Ovarian tumour / large fibroid
  • - history of acute pain – possibility of torsion to be ruled out
  • - suggest usg as next investigation

ULTRASOUND

Case 2.3

  • USG WITH DOPPLER
  • Large cystic lesion with internal echoes and multiple internal septations noted in midline. No e/o calcification/ soft tissue component.
  • Vascularity is reduced and whirlpool sign noted in right adenexa due to twisting of pedicle.
  • Minimal free fluid in pelvis. DIAGNOSIS, TORSION OF OVARIAN PEDICLE.

Case 3

Case 3

  • Frontal radiograph of chest of a skeletally mature patient shows air density overlying the mediastinum. The cardiac margins and medial aspect of domes of diaphragm are not visualised. b/l hila visualised through the lucency. Descending aorta visulalised.
  • Lucency in anterior mediastinum
  • - diaphragmatic hernia( ask for h/o trauma)
  • -correlate with lateral xray
  • Look for bowel markings/ valulae coniventes

Case3b

  • Lateral xray shows- bowel loops with valvulae coniventes reaching in thorax along the anterior aspect of diaphragm.
  • -f/s/o morgagni hernia
  • - suggest ct to look for the defect size

Case3c

 

Case 4

Case4

  • Frontal radiograph of chest shows enlarged cardiothorasic ratio and prominent pulmonary trunk. Bilateral central pulmonary arteries are dilated with pruning of peripheral arteries.
  • Lungs appear unremarkable
  • Diagnosis-Pulmonary arterial hypertension
  • Correlate with previous reports
  • Echo to look for any septal defect
  • Ct pulmonary angio

Case 5

5

  • CC and MLO views of both breasts show evidence of a spiculated lesion in upper outer quadrant of right breast. No evidence of clustered/ suspicious calcifications
  • - suggest triple assesment
  • Usg
  • Compare with previous reports

5b

  • Usg shows- irregular hypoechoic leison with posterior acoustic shadowing and mild internal vascularity.
  • Birads- 5 (malignancy)
  • Suggest HPE
  • Biopsy negative/ unchanged on previous mammograms
  • Answer- radial scar

Case 6

7

  • Frontal radiograph of a skeletally mature patient shows- absence of left breast shadow.
  • Underlying lung and bones appear unremarkable.

-Rule out h/o mastectomy

-Examiner told young patient – so they asked for dd

-Poland syndrome (not sure of the answer)

 

Case 7

8

  • h/o trauma-
  • Physeal widening noted in distal phalanx of index finger- suggestive of grade 1 salter haris injury. Metaphysis and epiphysis appear normal.
  • Ask for lateral view to see volar or dorsal angulation
  • Specific name- seymour fracture
  • Associations- mallet finger

Case 8

9

  • Young patient (40y) with h/o trauma-
  • Multiple sclerotic lesions noted in tibia and talus, mainly around the ankle joint
  • s./o Osteopoikilosis
  • Patient father had ca prostate, patient worried about sclerotic metastasis
  • Reassure the patient, or do serum PSA/ USG

Case 9

12

  • Frontal radiograph of chest of a skeltally mature patient shows- triangular opacity on right side with obscuration of right dome of diaphragm.
  • Diagnosis- rll collapse
  • Suggest ct to look for cause
  • Causes- mucous, foreign body in children, carcinoid, endobronchial metastasis

Case 10

6

  • DMSA- posterior view shows non excreting left kidney.
  • Right kidney appears normal.
  • Correlate with previous reports
  • Suggest usg as next investigation

6b

6c

  • Left pelvicalyceal system appears dilated with internal echoes and cortical thinning. Perinephric fat stranding. No perinephric collection
  • Diag- Chronic non functioning obstructed kidney due to staghorn
  • - convey to referring urologist
  • Nephrostomy for urgent decompression

 


Case 1: