Case 1A (1 film)

History
9 year old male, x-ray following fall.

Findings
Elbow joint effusion/haematoma
Comment on alignment of radial head fracture
No radial epiphyseal involvement
Normal radial head alignment
Displacement of medial epicondyle

Diagnosis
Fracture radial neck
Avulsion medial epicondyle

Case 1B (1 film)

History
27 year old male following MVA

Findings
Skeletal
Multiple rib fractures
Right scapular fracture
Right sided flail segment

Abnormal alignment mid thoracic spine at T6/T7 level

Displaced left paraspinal line

Indistinct aortic knuckle/arch

Right mid zone alveolar infiltrate/contusion
Right effusion/haemothorax
Right subcutaneous emphysema
Comment on endotracheal tube position (acceptable)
Deep right costophrenic angle
Lucency adjacent left heart border

Diagnosis
Left (and probable right) pneumothorax
Thoracic spine injury (this was associated with paraplegia)
Possible Aortic injury (this was later confirmed)

Film Reporting – August 2008

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 Case 2A (1 film)

History
34 week premature infant at 7 days post delivery.

Findings
Metaphyseal corner fractures
Right distal femur
Proximal right tibia
Distal right tibia
Distal right fibula
Slight displacement distal right tibial fracture
No periosteal reaction
Comment regarding age of fractures (likely recent)

Diagnosis
Possibility of non-accidental injury is raised
Birth related trauma (should be considered in this clinical setting)

Case 2B (2 films)

History
72 year old male with shortness of breath

Findings
Right pleural calcification
Left pleural plaque
Small right effusion
Multiple pulmonary arterial filling defects

Left basal atelectasis

Emphysema
‘Mass’ apical segment right lower lobe
Curving bronchovascular bundles

Relevant negatives
No interstitial abnormality at lung bases (i.e. no definite asbestosis)
No enlarged lymph nodes/hilar mass

Diagnosis
Asbestos related pleural disease
Round atelectasis
PE

Film Reporting – April 2008

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 Case 3 (3 films)

History
63 year old female with right flank discomfort

Findings
Right renal mass
Mass is vascular
Presence of necrosis
Comment regarding mass dimension (approx. 8-9cms)
Upper pole location of mass

Comment on differential density of contrast in left and right renal veins

No renal vein invasion
Supply of mass partly by right portal vein
Right sided hepatic invasion (implied by portal vein supply)
Necrotic para-caval lymph nodes

Other observations
3 lung base lesions
No liver masses/metastases
No left renal mass
Cystic lesions both adnexae

Diagnosis
Renal cell carcinoma
AV fistula within renal cell carcinoma
Lung metastases
Possible ovarian cyst or neoplasm
Ultrasound recommended for further assessment of adnexal structures

Film Reporting – April 2008

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 Case 4A (1 film)

History
Term infant at 4 hours. Respiratory distress

Findings
Opacity left hemithorax
Tubular lucencies within left hemithorax

Heart displaced to right

Trachea displaced to right
Nasogastric tube displaced to right

Moderate expansion right lung or statement regarding absence of pulmonary

hypoplasia
PICC line/long line over right upper arm/shoulder

Nasogastric tube position acceptable

NG position suggests stomach not displaced superiorly
Endotracheal tube position acceptable
UVC at level of porta (acceptable)
UAC at T9 (acceptable)

Diagnosis
Left diaphragmatic hernia

Case 4B (2 films)

History
67 year old female with abdominal pain for 2 days

Findings
Fat containing mass
Mass located in mid transverse colon
Dilatation right or proximal colon
No dilatation distal colon
Mild small bowel dilatation

Renal cysts
No free fluid
No free gas

Diagnosis
Intussusception
Lipoma as lead point

Film Reporting – April 2008

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 Case 5 (4 films)

History
20 year old male with blood at right external auditory meatus following MVA

Findings
Intracranial pneumocephalus
Intraventricular pneumocephalus

Rotation of C1 with respect to C2

Step in anterior arch of C1
Involvement of lateral mass of C1
Disruption of ossicles on right side
TMJ subluxation/dislocation
Right mastoid opacity
Maxillary sinus fluid levels
Intubated with haematoma/secretions in nasopharynx

Description of fracture extent

- to posterior wall right TMJ
- to right posterior cranial fossa
- to sphenoid sinus
- to right carotid canal

Diagnosis
Fracture right petrous temporal bone
Fracture C1
Recommendation for further images of C1 (X-ray or CT)

Film Reporting – April 2008

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 Case 6A (1 film)

History
67 year old female with dry cough

Findings
Large left pleural effusion
Right mastectomy
Diffuse pulmonary nodular opacity
Opacity involves both lungs

Indistinct T8 and T9 pedicles (particularly on left)

Hypoplastic left first rib or left cervical rib

Limited mediastinal shift implies probable left lower lobe collapse/volume loss

Diagnosis
Pulmonary metastatic disease
Possible/probable origin from right breast carcinoma

Case 6B (2 films)

History
Routine morphology study

Findings
Posterior placental location
Placenta 4.7cms from os /clear of os
21-22 week gestation

Echogenic mass in chest

Mass posterior to heart at lung base
Mass on left side
4mm cyst in mass
No cardiac displacement
No hydrops

Diagnosis
Cystic adenomatoid malformation
Follow up scan at 26-28 weeks recommended

Film Reporting – April 2008

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 Case 7 (4 films)

History
57 year old female with acute onset of back pain and ? urinary retention

Findings
Hypointensity within L3 vertebra
Partial collapse L3 vertebra
Retropulsion of a portion of the L3 posterior cortex
Central canal narrowing at L3
Left L3 pedicle involved

Suggests neoplasia rather than osteopaenia as cause for L3 abnormality

Other observations
Right renal mass
Hypointense masses uterus
Distended urinary bladder

Diagnosis
Probable right renal cell carcinoma
Spinal metastatic disease
Cauda equina compression
Uterine fibroids
Recommendation for bone scan or MRI of remainder of spine

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 Case 8A (1 film)

History
2 month old female infant with documented UTI

Findings

Recognition that the study is a MCU

Right ureteric reflux
Left ureteric reflux
Left sided reflux is Grade III/IV
Right ureter crosses mid line

No residual volume
No Hutch diverticula
Ultrasound suggested

Diagnosis
Crossed fused ectopia

Case 8B (2 films)

History
65 year old male with chronic cough FI

Findings
Oesophageal dilatation
Oesophageal fluid level
Left sided effusion
Cardiomegaly
Implantable cardiac defibrillator

Interstitial pulmonary opacity

Subpleural distribution of interstitial opacity
Subpleural cysts
Traction bronchiectasis

Diagnosis
Scleroderma
Pulmonary fibrosis
Designation of fibrosis as UIP in type

Film Reporting – April 2008

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