08FRCR.doc

1) CXR - bilateral upper lobe bronchiectasis with finger-in-glove mucous plug. Dx - ABPA. Ddx - cystic fibrosis


2) CXR + Bilateral hands XR - Acro-osteolysis + soft tissue Ca + chest wall calcification. Dx - Scleroderma.

3) CT brain - frontal midline extra-axial hyperdense mass (which simulate a butterfly tumor). Dx - meningioma. (We have a similar film in our museum - Case 7xx)

4) Ba enema 70s male- apple core lesion in sigmoid colon, another long segment of narrowing is seen along the descending colon which is separated from the tumor stricture. Mucosal thickening and ulcerations are seen. Incidental findings of cecal mucosal irregularity. No terminal ileal lesion is detected. I and stephen were not sure about the answers, but definitely there is a tumor in sigmoid colon, on top of that, may be Crohn'sor ischemic colitis.

5)AP Lt shoulder + Bone scan + CT shoulder - aggressive lytic lesion at left scapular with laminated periosteal reaction. Posterior cortical break is seen. Dx - Ewing sarcoma. Ddx - eosinophilic granuloma. I and Stephen think this is an Ewing, due to the aggressive appearance. Other candidates think that is an EG. Anyway you need to Bx the lesion, and you will still pass if you mention both.

6) IVU + US + MR (T1W axial abdomen only) middle age patient with uremia- Most difficult question - Non-excretory left kidney in IVU. USG Doppler left interpolar renal artery showed dampened waveform with reverse diastolic flow, left kidney is swollen. MR showed lack of flow void in left renal artery and IVC. Dx - Left renal vein thrombosis with extension into IVC due to uremia.


LONDON long cases questions:
1st set:
23F dysuria
Dx: Desmoid tumour
IVU showing pelvic calcification and mass effect on distal ureter

28F hip pain
Dx: Aggressive bone primary
Pelvic x-ray showing lucent lesion at medial aspect of femoral head with destroyed cortex and periosteal reaction

IVDU
Dx: Septic emboli
CT chest lung windows showing multiple cavitating lesions throughout
CT pelvis showing gas in the left femoral vein
80F in AF
Dx: Haemorrhage 2° to warfarin
CT abdo – rectus sheath haematoma
CT head – acute on chronic subdurals
80F recent contrast study, malaise for 2/52
Dx: Pre-sacral collection
Contrast enema – extravasation of contrast around rectum
2y child
Dx: Neuroblastoma
AXR – RUQ mass with soft tissue calcification
CT – Large adrenal mass with calcification crossing midline and encasing major vessels

2nd set:
Vascular calcification and multiple bone lucencies of different appearances in the forearm and leg - browns tumours in hyperparathyroidism.

CXR of 4 year old - paucity of gas in RUQ, paraspinal mass, lucency in humerus - metastatic neuroblastoma.

Ba enema - I think two areas of narrowing - descending and caecum, and perforation on descending colon = abscess on CT - I think Crohns rather than UC (also sacro-ileitis)

MRI brain post contrast- posterior fossa mass with serpiginous flow voids, further lesion in thoracic cord, and angio showing vascular tumour with large draining vein = haemangioma in someone with von Hippel Lindau (given history of father having nephrectomy)

IVU - medial deviation of ureters- CT contrast showed retroperitoneal fibrosis

CXR - mid zone consolidation and CT with ring enhancing lesion in high frontal lobe - ?TB with tuberculoma.


3rd set:

1. L spine plain film and L spine MRI Sag and axial.Child with pain
Paediatric sclerotic T11 with partial collapse
DD infection vs E Granuloma vs Osteid osteoma unlikely mets

2. CXR and CT thorax Middle age female
Massive Left mediastinal mass.
Aggressive cystic solid huge mass. eroding chest wall, invading ribs Not from abdomen. Not from breast.
DD Aggressive tumour Liposarcoma vs rhabdomyosarcoma.

3.SBFT and CT Male 35
Nodular filling defects multiple ++ on FT
CT thickened sb loops. No RP nodes, no other lymphadenopathy. Soft tissue nodules in right chest wall.
DD Melanoma with mets to SB, not enough nodes for lymphoma, other mucosal abnormality

4. CXR x2 elderly male
Interstitial changes Rt paratracheal mass subtle on the first CXR. 2nd more obvious plus Rt apical mass.
DD background changes and right apical bronchogenic carcinoma.

5 MRI Paediatric brain yr child increasingly irritable.
Mass in posterior fossa. ! Cetred on cerebellar vermis
Further extension into basal cistern. Enhances post contrast. Calcification.
DD Cerebellar medulloblastoma, neuroblastoma, ependymoma.

6. CT Abdomen male adult with recurrent pain.
Pancreatic duct dilatation No intrahepatic dilatation mass in head of pancreas splenic artery involvement Stranding of fat. no calcification. no lymphadenopathy.No other pseudocysts.
DD Pancreatitis and pseudotumour eroding/invading vessel.
Pancreatic tumour with vascular involvement.

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