Station 1

ELEMENT FEATURE

History 59 year old female, complains of loss of sense of smell and headaches

Imaging CT Scan Brain (noncontrast, 1 sheet)

MRI Brain (composite, 1 sheet)

Findings  CT Brain
 Rounded mass midline frontal region
 2cm diameter, slightly hyperdense
 Surrounding mass effect and vasogenic edema both frontal lobes
 MR Brain
 T1 & T2 axial: rounded isointense extracerebral mass midline
frontal, displacing olfactory cortex
 Post-Gd sagittal and coronal: mass shows rim and heterogeneous
internal enhancement. Visible dural tail on sagittal
 No definite nasal cavity invasion

Likely Diagnosis Olfactory groove meningioma

Differential Nil

Further Imaging
& Approach

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 Station 2

ELEMENT FEATURE

History 60 year old female with unexplained dyspnea. HRCT for investigation

Imaging HRCT scan chest (supine, inspiratory, 1 sheet)

HRCT scan chest (composite expiratory, prone, 1 sheet)

Findings Inspiratory Supine HRCT

 Widespread patchy bilateral mosaic pattern
 No septal lines, septal thickening, interstitial nodules
 No bronchiectasis, bronchial wall thickening
Expiratory Supine HRCT
 Lucent areas unchanged, increased density of normally ventilated
lung
 Consistent with air trapping
Inspiratory prone HRCT
 No dependent changes or interstitial fibrosis

Likely Diagnosis Bronchiolitis obliterans

Differential Pulmonary embolism (no air trapping)

Hypersensitivity pneumonitis (often interstitial changes)
Sarcoidosis (usually normal on inspiration)

Approach Lung biopsy if clinical history is unrevealing

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 Station 3

ELEMENT FEATURE

History 74 year old woman with right abdominal pain, fever, distension and loss of
appetite for 2 days. Ultrasound diagnosis of cholecystitis and cholelithiasis

Imaging CT scan of abdomen and pelvis (3 sheets)

Findings Gallbladder distended

 Contains numerous dense stones
 Thin layer of surrounding fluid
 Slightly prominent intrahepatic ducts

Retrocecal enlarged appendix > 10mm diameter

 Surrounding fat stranding
 Adjacent retrocecal, subhepatic fluid collection
 Gas-filled distended right colon (ileus)

No free gas or free fluid

Right basal pleural effusion and atelectasis
Likely Diagnosis Retrocecal appendicitis with rupture and loculated retrocecal abscess
Possible calculous cholecystitis

Differential

Further Tests Surgery!

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 Station 4

ELEMENT FEATURE

History 5 year old male. Incidental opacity found on routine CXR for viral infection

Imaging Chest X-ray & Chest ultrasound composite (1 sheet)

Chest CT with reformats composite (1 sheet)

Findings CXR:
 Rounded large mass right upper chest
 Displacing trachea and right main bronchus
US:
 Solid mass, penetrating vessels
CT Chest:
 Right apical extrapulmonary mass
 No involvement of spine, ribs
 Displacing but not encasing adjacent vessels

Likely Diagnosis Ganglioneuroma

Differential Neuroblastoma
Ganglioneuroblastoma
Sarcoma

Approach MIBG nuclear scan

Urinary catecholamines
Image-guided biopsy

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 Station 5

ELEMENT FEATURE

History 27 year old female, threatened preterm labour. Abnormal CTG

Imaging US pregnancy (2 sheets)

Findings Severe intrauterine growth restriction (IUGR)

Retroplacental haemorrhage, probably abruption
Abnormal umbilical artery Doppler, with diastolic flow reversal
Reduced amniotic fluid volume
Abnormal ductus venosus Doppler trace with deep A wave and increased
SA ratio
Abnormal MCA Doppler with reduced RI due to cerebral redistribution

Likely Diagnosis Severe IUGR

Placental abruption

Differential Severe IUGR from other causes

Approach Immediate/urgently contact obstetrician

Urgent delivery within 24 hours

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 Station 6

ELEMENT FEATURE

History 65 year old male with right maxillary sinus pain and fullness over right
cheek. Prior history of lymphoma.

Imaging CT scan paranasal sinuses (4 sheets)

Findings Right maxillary antral mass

 ≈2.5 cm ovoid, fills most of sinus
 Heterogeneous with hyperdense centre
 Bony erosion of lateral wall, floor and inferomedial wall of antrum,
right alveolar ridge
 Mass extends into retromaxillary and buccal spaces
No lymphadenopathy
Sphenoid sinus opacification without erosion
Soft tissue thickening beneath left middle concha

Likely Diagnosis Invasive aspergillosis of maxillary antrum

Differential SCC of maxillary sinus (no high density)

Chronic mucocoele of right antrum (usually bowing rather than erosion of
antral walls)

Approach

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 Station 7

ELEMENT FEATURE

History 57 year old male. Right shoulder pain, persistent weakness of elevation 3
months after a fall.

Imaging MRI right shoulder (4 sheets)

Findings Complete tear and retraction of supraspinatus tendon

 Atrophic supraspinatus belly
 Hyperintense distal SST tendon insertion (chronic tendinosis)
Complete tear and retraction of infraspinatus tendon
Moderate joint effusion
Hyperintense biceps tendon in shoulder joint (tendinosis)
Biceps anchor intact (no SLAP tear)
Glenoid labrum intact
Teres minor and subscapularis intact

Likely Diagnosis Extensive tear of rotator cuff

Differential

Approach

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 Station 8A

ELEMENT FEATURE

History 89 year old male. Sudden onset severe abdominal pain radiating to back.
Suspected renal colic

Imaging AXR (1 sheet)

Findings Aortic stent graft in situ

 Disruption/displacement of proximal graft stent element
 Remainder of graft intact
Central fusiform soft tissue mass around stent/aorta
 Displacement of calcified aortic wall
 Extends beyond native calcified aorta

Likely Diagnosis Failure/disruption of aortic stent graft

Major leak into aortic aneurysm
Probable retroperitoneal hematoma

Differential

Approach Emergency – immediately contact vascular surgeons

CT angiogram to define extent and severity of hemorrhage/leak

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 Station 8B

ELEMENT FEATURE

History 65 year old female. Recalled for asymmetric density right breast on
screening mammography

Imaging Right screening mammograms (2 sheets)

Right spot view (1 sheet)
Right lump ultrasound (1 sheet)

Findings Screening Mammogram

 Small rounded isodense mass right lower inner quadrant
 Poorly defined margins
 No associated distortion, calcifications
Spot view
 BB marker on skin over lesion
 Tangential view shows lesion is subcutaneous
Ultrasound
 Mass is sharply defined, hypoechoic, solid
 Subcutaneous, intradermal

Likely Diagnosis Sebaceous cyst

Differential

Approach Benign lesion, requires no intervention or followup

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