LONG CASES
1)CT abdo - Horseshoe kidney with enhancing/nodular mass (+?calculus in region of pelvis) with pulmonary nodules ?RCC with pulmonary mets
2)Young patient (~30yrs) CT brain – SAH with intraventricular extension. Early hydrocephalus + ?early coning. Recon CTA – several small aneurysms + larger basilar tip aneurysm, impression of vessel irregularity. Dx FMD? DDx berry aneurysms with ADPCKD. Urgent neurosurgical management for hydrocephalus/coning then neuro IR/neurosurgery for further Mx/possible renal US
3)CT angiogram from apex to pelvis, 70 year old pt – posterior saccular aortic aneurysm at level of T8/9 disc. T8/9 shows irregularity/loss of disc height/sclerosis. Dx discitis induced mycotic aneurysm? Also infrarenal aortic aneurysm, possible localised dissection – said would need to see pre-contrast, urgent referral to vascular if pt symptomatic/unstable
4)MR lumbar spine (T1 sag, T2 sag, T2 ax) – loss of posterior elements, partially bony diastematomyelia, conus not clearly seen but low lying split cords around bony bar. No dermoid/sinus tract/lipoma etc - Dx spinal dysraphism. Also some high signal in a lumbar disc and Modic type 2 change, doubt these were relevant and unsure if there was more to the case
5)Newborn babyogram, previous intrauterine polyhydramnios – bilateral pneumothoraces with intercostals drains. Possible underlying granular lungs ?meconium asp ?HMD or just secondary to collapse. Abdo – central bowel loops, non-dilated, no distal gas or peripheral. Unsure what going on, suggested may need further bowel Ix or at least examination. Also compare with previous XR for ?improvement in Ptx/evaluation of underlying lung disease. Should have probably suggested US abdo ?enlarged kidneys. Unsure what they were really looking for here
6)CT abdomen, arterial/portal venous. Patient with haematemesis and melaena. Probably more to this case [IN FACT – SINCE SPOKEN TO TT WHO SAYS THIS WAS THE HARDEST CASE, DIDN’T GIVE THE GAME AWAY THOUGH] but ran out of time and didn’t get time to fully evaluate. Thick walled GB with calculus and pericholecystic fluid. Also fluid round the head of the pancreas. Intra- and extra-hepatic biliary dilatation. Possible contrast blush in art phase near porta hepatis. ?Pancreatitis with vascular involvement ?cholecystitis. Need urgent IR/GI surgeon input.
RAPID REPORTING
-No point trying to recall a case by case breakdown as it was as fairly standard bag in terms of range of films (CXRs, shoulder views, facial views, C spines, hands/scaphoid views, wrists, feet, elbows etc) – nothing too esoteric
-There were 17-18 abnormalities
-Quite a few subtle (but definite) fractures of e.g. metacarpals, metatarsals, phalanges (hands and feet) – TRACE ROUND EVERY OUTLINE OF EVERY BONE!!! Or you will miss these
-There was a posterior shoulder dislocation with a Y view – get used to looking at Y views if you haven’t before (I thought about this one for a while)
-There was also an anterior shoulder dislocation
-There was a lung nodule, fairly subtle – not many CXRs in this bag
-There were no pneumothoraces (some people say there’s always one – do look carefully!)
-Definite radial head fracture
-Supracondylar fracture (relatively undisplaced, no effusion) but definite break
-There was a ?Lisfranc – I didn’t call, I reckon some did (to give 18th abnormality) – make sure you know which lines you’re looking at, I spent a while before deciding the apparent malalignment was probably due to rotation (i.e. could follow one line from metatarsal to cuneiform superior surface of cuneiform , but the superior and inferior surface of the cuneiform were both seen – if you see what you mean) – in real life I’d probably get a second opinion on this one but excluded it as an abnormality on the basis of it being too subtle and not definite
-There was a fairly obvious scaphoid fracture
-There was a paeds buckle fracture – these often crop up, look at lat view!
-Facial views - normal
-Couple of C spines – seem to recall both being normal (remember – look at skull and sphenoid sinus too)