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Phase 3 RadiologyLearning Outcomes ● Techniques ○ CXR ○ AXR ● Pathology ○ Gynae ○ Cardiac ○ Respiratory ○ MSK ○ Neuro ○ GI and Liver ● Disclaimer: We have based these on our own Phase 3 notes, lectures, and ILOs - if something seems completely new to you it might be because it has been removed from the course!! However, everything included should become relevant in your clinical years.Exam Tips ● The story behind an image is the key to getting the correct diagnosis. ○ Don’t panic if you see a radiological image in the exam and can’t make sense of it! ○ Often you will be able to reach the diagnosis based on the story given in the question stem alone. ○ Read the question stem thoroughly - look for keywords that might suggest a diagnosis. We have bolded and highlighted some keywords in white. ○ Often the stem will point out key imaging findings for you and the image is just a wee bonus. ● At your stage (and while a medical student) there are a few images where the diagnosis should be clear (even without the question stem). ○ E.g. pneumothorax. ○ We have included Spot the dog in our powerpoint to highlight the cases we think are Spot diagnoses.Chest X-RayAssessing Image Quality (RIPE) ● Rotation ○ Equal distance between medial aspects of clavicles and spinous processes. ○ Rotation can give the appearance of tracheal deviation, mediastinal widening, and asymmetric lung density. ● Inspiration ○ Count >7 anterior (slanty) or >9 posterior (straight) ribs ○ 1st anterior rib highlighted in blue ● Picture ○ AP vs PA ○ Supine vs erect ○ Can you see all of lung fields? ● Exposure ○ Vertebral bodies behind the heartPA vs AP ● Posterior - Anterior (PA) ○ X-rays enter the patient back to front. The detector is at their chest. ○ Most CXRs will be PA. ○ Patient hugs detector → this move scapulae out of the way. ● Anterior-Posterior (AP) ○ X-rays enter the patient front to back. The receiver is at their back. ○ Heart appears enlarged due to increased distance from heart to detector. (X-ray beams diverge). ○ AP CXRs are often performed if the patient cannot mobilise from their bed or chair. ○ Scapula border in lung fields → see red line.Erect vs Supine ● Erect vs supine ○ Erect ■ Performed standing. ■ Can be done PA or AP. ○ Supine (lying down) ■ Can be done using a mobile x-ray unit on the ward. This is useful for patients who cannot sit up. ■ Results in physiological widening of cardiomediastinal outline. The image on the right is a supine AP CXR, the patient’s CT chest was normal. ■ Appearance of fluid or gas in the pleural space will look different.Normal StructuresCXR: AnnotatedSilhouette Sign “cast or show (someone or something) as a dark shape and outline against a brighter background.”Silhouette Sign ● Four basic radiographic densities: gas, fat, soft tissue (water), metal (bone). ● When two adjacent anatomical structures in direct contact have different densities we see a sharp margin on XR. If the structures have the same density there is no margin and they cannot be differentiated from one another.Silhouette Sign ● Anterior box contains heart, posterior box contains aorta. Heart and aorta = soft tissue/water density. ● A: Heart adjacent to air, aorta adjacent to air = both borders seen ● B: Heart adjacent to water = heart border obscured ● C: Aorta adjacent to water = aorta border obscured.Silhouette Sign ● Left heart border: ○ Healthy lung = air density ○ Heart = soft tissue density ○ Differing densities = silhouette ● Right heart border: ○ Lung pathology = soft tissue density ○ Heart = soft tissue density ○ Same density = silhouette is lost - i.e. right heart border is no longer sharp and defined - this is silhouette sign.Silhouette Sign “An intrathoracic lesion touching a border of the heart, aorta, or diaphragm will obliterate that border. An intrathoracic lesion not anatomically contiguous with a border of one of these structures will not obliterate that border.” - term Silhouette Sign)ho coined theSilhouette Sign ● Silhouette sign refers to the loss of a silhouette. It is indicative of pathology. ● The area of silhouette lost depends on the site of the pathology. ○ Right paratracheal stripe (blue): right upper lobe ○ Right heart border: right middle lobe or medial right lower lobe ○ Right hemidiaphragm: right lower lobe ○ Aortic knuckle (green): left upper lobe ○ Left heart border: lingula ○ Left hemidiaphragm: Left lower lobeSilhouette sign ● This X-ray is an example of silhouette sign. ● Which anatomical area is affected? ○ A: Right middle lobe ○ B: Lingula ○ C: Right lower lobe ○ D: Left upper lobe ○ E: Left lower lobeSilhouette sign ● This X-ray is an example of silhouette sign. ● Which anatomical area is affected? ○ A: Right middle lobe ○ B: Lingula ○ C: Right lower lobe ○ D: Left upper lobe ○ E: Left lower lobe ● B: There is pathology in the lingula.CardiorespiratoryHeart Failure ● A patient is admitted with decompensated heart failure. ● Look at this erect PA CXR, what signs of heart failure are present? ○ A: Alveolar oedema ○ B: Kerley B lines ○ C: Cardiomegaly ○ D: Cephalization of vessels ○ E: All of the above!Heart Failure ● The answer is all of the above! (+ pleural effusions) ● ABCDE ○ A: alveolar oedema ■ Bat wing opacities ○ B: Kerley B lines ■ Horizontal lines in periphery of lower lung fields ○ C: Cardiomegaly ■ Cardiothoracic ratio >0.5 ○ D: Dilated upper lobe vessels ■ Staghorn sign ○ E: Pleural Effusion ■ Blunting of costophrenic angles ● Findings Heart Failure ○ Cephalization of vessels → interstitial oedema Progression (Kerley B lines) → alveolar oedema and pleural effusions ● Pathophysiology ○ Increased pressure in left side of the heart → increased pulmonary venous pressure → increased capillary pressure in lungs → fluid leaks out into interstitial spaces → further increase in pressure → fluid leaks out from interstitial to alveolar spaces.Heart Failure: Cardiomegaly ● Horizontal width of heart / widest internal diameter of the thorax. ○ Normal <0.5 ○ Enlarged >0.5 ○ Increase in heart size compared to previous films of similar quality can also be significant. ○ Remember! The heart appears enlarged on AP CXR so measurement is unreliable.. (However, if the ratio is normal on AP then cardiomegaly is unlikely to be present).Heart Failure: Dilated Upper Lobe Vessels ● Normally in an erect patient, gravity causes most of the blood in pulmonary vessels to flow to the base. ○ Lower vessels should be wider than upper. ● Heart disease can cause cephalization or vascular redistribution. ○ Due to increase in LA pressure ■ Causes include left heart failure and mitral valve stenosis. ○ Upper vessels are of same or higher diameter of lower vessels. ○ Resembles stag antlers.Heart Failure - Kerley B Lines ● Lines perpendicular to pleural surface. ● Fluid in interlobular septa. Indicator of interstitial oedema. ● Some are outlined in blue, can you spot some more? ● Sir Peter James Kerley (1900-1979) was an Irish Radiologist who named 3 lines - A, B, & C - the most useful of which are Kerley B lines.Heart Failure: Alveolar Oedema ● Fluid leaks out of interstitial spaces and into alveoli. ● Bat wing opacities: bilateral perihilar lung shadowing.CR: Pathology ● 40F presenting with shortness of breath and haemoptysis. She has then collapsed. Her D-dimer is raised. ● What is the diagnosis? ○ A: Myocardial infarction ○ B: Pneumonia ○ C: Trauma ○ D: Pulmonary embolismCR: Saddle Pulmonary Embolism (PE) ● PE which extends into both pulmonary arteries. ○ Blue: Pulmonary trunk ○ Red: PE ○ Green: Aorta ■ Ascending and descending ○ Yellow: Superior Vena CavaCR: Pathology ● 20M presents to A&E with sudden onset pleuritic chest pain and shortness of breath. He has no known lung disease. ● What is the diagnosis? ○ A: Asthma ○ B: Pneumonia ○ C: COPD ○ D: Pneumothorax ○ E: Myocardial infarctionPneumothorax ● Presence of gas in the pleural space. ○ If gas enlarges and compresses mediastinal structures → tension pneumothorax. May present with tracheal deviation (away from pneumothorax), cardiac arrest, and death. ● Primary/spontaneous vs secondary (underlying lung disease) vs iatrogenic/traumatic. ● Findings ○ Visceral pleural edge looks like a thin white line (blue). ○ No lung markings peripheral to this line. ○ Mediastinal shift = tension (see image)CR: Pathology ● This CXR shows a lobar collapse. Which lobe has collapsed? ○ A: RUL ○ B: RML ○ C: RLL ○ D: LUL ○ E: LLL ● Tip: compare both lungs carefully.Lobar Collapse - Left Upper Lobe ● Veil-like opacity over left hemithoraxLobar Collapse - LLL (sail sign)Lobar Collapse - Right Upper Lobe ● Elevation of horizontal fissure (red). ● Elevation of right hilum. ● Elevation of right hemidiaphragm. ● Increased density in upper medial right hemithorax.Lobar Collapse: Right Middle Lobe ● Silhouette sign: loss of right heart border. (blue line) ● Best seen on lateral projection.Lobar Collapse: Right Lower Lobe ● Silhouette sign: Loss of right hemidiaphragm border. ● Triangular opacity in posterior medial right hemithorax.CR: Pathology ● 60M, acute onset abdominal pain with guarding. ● Look at the diaphragm, what does this abnormality suggest? ○ A. Pneumoperitoneum ○ B. Pneumonia ○ C. Hepatitis ○ D. Normal anatomical variantCR: Pneumoperitoneum ● Air in the abdominal cavity ● Findings include free air under the diaphragm. ○ Note how thin the diaphragm is! ● Can be caused by bowel perforation. ● Can be a normal finding following recent abdominal surgery.Pneumonia ● 70M is admitted to hospital with a 7/7 history of coughing up green and brown sputum. He has a fever, is confused, and is hypotensive. ● What is the most likely treatment for this man’s condition? ○ A: Lobectomy ○ B: Antibiotics ○ C: Steroids ○ D: Drainage ○ E: ImmunosuppressantsPneumonia ● Infection within the lung. ○ Material fills alveoli → consolidation on the CXR. ○ Often infectious cause - can be due to bacterial, viruses, mycobacteria, fungi. ● CURB65 scoring system for pneumonia severity - guides outpatient or inpatient management ○ Confusion ○ Urea >7mmol/L ○ Resp rate >30 ○ SBP <90 DBP <60 ○ >65MSKBone Tumours ● 15M with worsening pain below his knee. ● X-ray shows a lesion in his proximal fibula with sunburst periosteal reaction. ● What is the most likely diagnosis? ○ A: Fracture ○ B: Osteoid osteoma ○ C: Osteosarcoma ○ D: Bone mets ○ E: Paget’s disease Bone Tumours - Malignant ● Osteosarcoma ○ Most common primary malignant bone tumour ○ Children and adolescents ○ Typically femur and tibia ○ Sunburst (top image) periosteal reaction ■ Indicates aggressive disease ○ Codman triangle ■ Bone lesion lifts periosteum off bone ● Ewing’s sarcoma ○ Common in children ○ Onion skin reaction (bottom image) ■ Intermittent or discontinuous growth. Bone laid down between growth periods. ● Chondrosarcoma ○ More common middle-age ○ Malignant tumour of cartilage ○ Typically axial skeletonBone Tumours - Benign ● Osteoid osteoma ○ Benign, bone-forming neoplasm ○ Children and young adults. ● Osteochondroma ○ Most common benign bone tumour ○ Benign protuberance surrounded by a layer of cartilage ○ Adolescents ● Giant cell tumour of bone (image) ○ Soap bubble appearance ○ Benign ○ Peak age 20-40Knee: Pathology ● 70M presenting with 4/12 of worsening knee stiffness and pain. He is now housebound due to his symptoms. ● What is the definitive management for this condition? ○ A. Steroids ○ B. Knee replacement ○ C. Immunosuppression ○ D. Rest Knee: Osteoarthritis ● Findings (LOSS) ○ Loss of joint space ○ Osteophytes ○ Subchondral sclerosis ○ Subchondral cysts ● Management: ○ Total knee replacementHand: Pathology ● 70F with chronic pain and stiffness in fingers. ● What’s the diagnosis? ○ A: Osteoporosis ○ B: Osteoarthritis ○ C: Gout ○ D: Fracture Osteoarthritis ● Findings (LOSS) ○ Loss of joint space ■ I.e. loss of cartilage ○ Osteophytes ■ Bony lumps/spurs ○ Subchondral sclerosis ■ Whitening of bone beneath cartilage ○ Subchondral cysts ■ Look like black holes in bonePaget’s Disease (bone) ● Chronic bone disorder. ● Excessive abnormal bone remodelling. ● Often affects skull, spine, pelvis, and lower extremity long bones ● Left femur: ○ Coarse trabeculations (see lines a lot more clearly) ○ Expanded femoral head ● Skull: ○ Thickened vault ○ Osteoporosis circumscripta ■ Well-defined lucency often in frontal bone (arrows)Ankylosing Spondylitis ● Seronegative spondyloarthropathy ○ Rheumatoid factor negative (seronegative) ○ HLA B27 associated ● Fusion (ankylosis) of spine and sacroiliac joints ● Findings ○ Sacroilitis ○ Vertebral body squaring ○ Dagger spine ■ Interspinous ligament ossification ○ Bamboo spine (images) ■ Syndesmophytic ankylosisAS: Dagger Spine ● Calcification of supraspinous (SSL) and interspinous (ISL) ligaments. ● Normal x-ray is on the left.Hand: Pathology ● 20M with hand pain following fall onto outstretched hand. Tender in anatomical snuffbox. ● What bone has been fractured? ○ A. Scaphoid ○ B. Lunate ○ C. 4th Metacarpal ○ D. TrapezoidHand: Scaphoid Fracture ● Important not to miss! ○ Blood supply for the scaphoid comes in one direction. ■ Risk of avascular necrosis due to disrupted blood supply in fracture. ○ Not always seen on X-ray, MRI is the gold standard. Waist and proximal scaphoid fractures disrupt the blood supply to prox. scaphoid!NeurologyNeuro: Case ● 55F presents with a thunderclap headache and neck-stiffness. ● A non-contrast CT head is performed. ● What is the diagnosis? ○ A: Subarachnoid haemorrhage ○ B: Epidural haematoma ○ C: Subdural haematoma ○ D: Brain tumour ○ E: Multiple sclerosisSubarachnoid Haemorrhage ● Cause ○ 85% due to ruptured aneurysm ○ Trauma ○ Vascular malformation ● S+S ○ Thunderclap headache - like being hit with a bat. Reaches maximum intensity in <1 minute. ● Investigate with CT head, if negative LP >12 hours after onset (to look for xanthochromia). ● Findings ○ Acute blood looks bright on CT. There is blood in the basal cisterns and sulci. ○ Consider CT angiogram to look for aneurysm.Haematomas ● Epi/extradural haematoma ○ Between skull and dura mater ○ Limited by suture lines ○ Lens/convex shaped ○ Middle meningeal artery ○ Presents with lucid interval (temporary improvement before deterioration) ● Subdural haematoma ○ Concave/crescent shaped ○ Bridging veins ○ Seen in elderly (brain atrophy is common in older age and makes bridging veins more vulnerable) and excessive alcohol use.Neuro: Case ● A 70F presents with a 1/24 history of hemiparesis and facial droop. It is suspected she has had a stroke. ● A non-contrast CT head is performed - no acute abnormality is detected. ● Does this mean stroke is ruled out? ○ A: Yes ○ B: NoStroke: CT ● CT is a quick and accessible test that can be performed in stroke presentations. ● However, it takes time for changes due to ischaemic stroke to show up on CT. ○ 60% seen in 3-6 hours, virtually all in 24h. ○ Ischaemic cytotoxic cerebral oedema looks hypodense (dark) ● CT in the acute setting is used to ○ Exclude intracranial haemorrhage (white blood) → thrombolysis would be contraindicated if haemorrhage is present ○ Look for early features of ischaemia ○ Exclude other intracranial pathology e.g. tumour.Stroke: CT ● Hyperdense middle cerebral artery sign ○ Artery appears bright ○ Due to thromboembolic material in arterial lumen. ■ Thrombus formed in heart or carotids → embolism → occlusion of MCA. ○ First visible sign of MCA infarction - visible within 90 minutes.Stroke: MRI ● MRI is more sensitive and specific in the diagnosis of acute ischaemic stroke in the first few hours after onset. ● However, it is more time-consuming and may not always be available (e.g. remote and rural hospitals). ● Diffusion weighted imaging (DWI) is often used to look for ischaemic changes. ○ The ischaemic changes on the CT (left) are very hard to spot but very noticeable on the DWI images. Stroke: Additional Imaging ● Carotid imaging ○ ?carotid disease and carotid dissection ○ Consider carotid endarterectomy if significant stenosis present and patient has had stroke or TIA in carotid territory. ● CT or MR angiography ○ ?thrombectomy ■ Location of thrombus is important when considering thrombectomy. ● Perfusion imaging (CT) ○ Can be used to determine if there is salvageable tissue and if patient would benefit from treatment. ■ DWI MRI is also used for this purpose. For in-depth criteria for what imaging to use and when to thrombolyse see the NICE guidelines: https://www.nice.org.uk/guidance/ng128/chapter/Recommendations#imaging-for-people-who-have-had-a-suspected-tia-or-acute-non-disabling-stroke Gynaecology Note: We think you are unlikely to be asked to interpret gynae imaging in your exams but you could receive a question stem that describes imaging findings and be asked for a diagnosis based on that.Ovarian Pathology ● 30F, transvaginal ultrasound scan of the left ovary. ● The patient has no symptoms. ● The scan shows a left ovarian lesion (large black circle). It is thinned walled and has no solid component. Doppler scan (bottom right image) shows no flow within the lesion. ● This lesion is most likely: ○ A: Teratoma ○ B: Ovarian follicular cyst ○ C: PCOS ○ E: Ovarian cancerBenign Ovarian Cysts ● Ovarian follicle (<3cm) ○ ~10 ovarian follicles grow and develop during a normal menstrual cycle. ○ Usually one will become a dominant ovarian follicle. ● Ovarian follicular cyst (>3cm) ○ Dominant ovarian follicle enlarges to become an ovarian follicular cyst. ○ Asymptomatic, commonly seen on pelvic USS. ○ Does not occur post-menopause. ○ Findings: ■ Looks like a cyst - empty and dark inside. ■ Thin walled and unilocular. ■ No colour flow on doppler, no solid component. ○ Management ■ Most require no follow-up. ■ May require more imaging/follow-up if large.Benign Ovarian Cysts ● Corpus luteum ○ Remnants of follicle after ovulation ○ Produces oestrogen and progesterone ○ If fertilisation does not occur → involutes → corpus albicans ○ If fertilisation occurs → enlarges and secretes hormones → involutes 16-20 weeks ● Corpus luteum cyst ○ Failure of corpus luteum to regress after ovum release. ○ Most common pelvic mass in 1st trimester. Most will involute by end of 2nd trimester. ○ Has “ring of fire” appearance on doppler.Ovarian Pathology ● 25F presents with sudden-onset pelvic pain. ● Pelvic USS shows a left ovarian cyst. Doppler shows no flow within cyst. ● What complication has occurred? ○ A: Ovarian torsion ○ B: Rupture of cyst ○ C: Haemorrhage into cyst ○ D: Normal appearance ○ E: Malignant transformation of cystBenign Ovarian Cysts ● This is an example of a hemorrhagic ovarian cyst. ○ These are usually formed due to haemorrhage into a corpus luteum. ○ Most common cause of acute pelvic pain in afebrile, premenopausal females. ● Findings ○ Cyst no longer looks dark and empty. ■ Typically, a lace-like pattern within cyst. ○ No internal blood flow on doppler. ○ Thin walled. ● Management ○ Usually completely resolve within 8 weeks. ■ Follow-up with a repeat USS. ○ If post-menopausal → further investigation. Benign Ovarian Cysts ● Endometrioma (AKA chocolate cyst) ○ Localised form of endometriosis, forms cysts containing dark degenerated blood products following repeated haemorrhage. ○ Usually found in ovary. ○ Patients may present with S+S of endometriosis (dysmenorrhoea, dyspareunia, infertility). ○ Findings ■ Classically unilocular cyst, “ground-glass” internally. ■ No flow on doppler. ○ Management ■ 1% chance of malignant transformation, often excised or followed-up annually. Benign Ovarian Cysts ● Endometrioma (AKA chocolate cyst) ○ Localised form of endometriosis, forms cysts containing dark degenerated blood products following repeated haemorrhage. ○ Usually found in ovary. ○ Patients may present with S+S of endometriosis (dysmenorrhoea, dyspareunia, infertility). ○ Findings ■ Classically unilocular cyst, “ground-glass” internally. ■ No flow on doppler. ○ Management ■ 1% chance of malignant transformation, often excised or followed-up annually.Ovarian Pathology ● 30F with incidental finding on AXR (arrow). ● Surgical excision revealed the benign lesion on the right. ● What is the diagnosis? ○ A: Endometrioma ○ B: Immature teratoma ○ C: Ovarian cancer ○ D: Mature teratoma ○ E: Normal findingBenign Ovarian Cysts ● This is a mature teratoma aka a dermoid cyst. ○ “Monstrous tumour” ○ Common benign neoplasm. Contains elements from multiple germ cell layers. ○ Typically young females. Can be asymptomatic or present with ovarian torsion. ○ Findings ■ Can contain calcification (including teeth!) which are seen on XR ■ USS usually shows a heterogeneous cystic mass with no blood flow on doppler. ○ Management ■ Usually slow growing and can be monitored for growth. Large lesions are excised. ● Immature teratomas are a lot less common and are malignant.Benign Ovarian Cysts ● 25F presenting with S+S of hyperandrogenism (hirsutism, acne, androgenic alopecia) and infertility. ● Pelvic USS shows the following. ● What is the diagnosis? ○ A: Normal finding ○ B: Ovarian malignancy ○ C: PCOS ○ D: Endometrioma ○ E: TeratomaPolycystic Ovarian Syndrome (PCOS) ● Most common endocrinopathy in reproductive age females. Leading cause of infertility. ● Often presents with irregular menstruation, infertility, hyperandrogenism (hirsutism, acne), obesity. ● Findings ○ Multiple small follicles with no dominant follicle. ○ Increased ovarian volume ● Management ○ Depends on symptoms ■ Infertility - clomifene, metformin, gonadotrophins ■ Hirsuitism and acne: combined pill, topical eflornithineCase ● 25F with known ovarian teratoma presents to A&E with acute severe abdominal pain, nausea, and vomiting. ● An USS shows a very large ovary with no venous blood flow on doppler. ● The most likely diagnosis is: ○ A: Cystic haemorrhage ○ B: Appendicitis ○ C: Gastroenteritis ○ D: Endometriosis ○ E: Ovarian torsionOvarian Torsion ● Cause ○ Commonly due to an ovarian mass e.g. teratoma. ● Presentation ○ Typically young or postmenopausal ○ Severe abdominal pain, can be constant or intermittent. ○ N+V common. ● Findings ○ USS investigation of choice ■ Enlarged ovary, poor blood flow on doppler, ovarian oedema ■ Free pelvic fluid commonly seen.Ovarian Malignancy ● Risk of Malignancy Index = U x M x Ca 125 ○ U = Ultrasound features suggesting malignancy ■ irregular solid or multiloculated cystic mass ■ solid components on cyst wall ■ high Doppler flow in solid components ■ ascites, peritoneal nodules, or other evidence of metastases ○ M = pre or post menopausal ○ Ca 125 = tumour marker ● Results ○ >200: high risk, referral and CT recommended ○ 25-200: intermediate risk, MRI for further characterisation of lesion ○ <25: low risk, consider USS or MRI if borderlineAXRAbdominal X-Rays ● Indications ○ Emergency presentations ■ Toxic megacolon ■ Bowel obstruction ■ Ingestion of foreign body ○ Monitoring radiopaque renal calculi ○ Colonic transit studies ■ Radiopaque markers ingested, time to exit bowel is monitored by AXR. ● Negatives ○ Ionising radiation ■ Pregnancy ○ Limited use ■ Less sensitive and specific than abdominal CT ○ Huge radiation dose - up to 35x that of CXR! ● Positives ○ Rapid, accessibleAXRAXR Annotated ● Large bowel in red ○ Large diameter ○ More peripheral ○ Sections ■ Ascending (pink arrow) ■ Transverse (orange arrow) ■ Descending (yellow arrow) ■ Sigmoid (blue arrow) ○ Flexures ■ Hepatic (green arrow) ■ Splenic (purple arrow) ● Small bowel (not annotated) ○ Central ○ Smaller diameterGI and Liver GI: Case ● 30F presenting with chronic epigastric abdominal pain. ● Where is the abnormality? ○ A: Stomach ○ B: Liver ○ C: Pancreas ○ D: KidneyGI: Chronic Pancreatitis ● Chronic pancreatitis can lead to calcification of the pancreas. ○ Often due to chronic alcohol use. ● Pancreas looks like a sausage on CT (in my opinion).GI: Case ● 40F with 3/12 RUQ pain after eating. ● Where is the abnormality? ○ A: Gallbladder ○ B: Liver ○ C: Small bowel ○ D: Stomach RUQ: Right Upper QuadrantGI: Gallstones ● Cholelithiasis: ○ Gallstones in the gallbladder ○ Can be multiple (like the AXR) or single and large (like the CT) ● Choledocholithiasis ○ Gallstones within common bile duct.Renal Pathology ● 30M with left sided back pain and intermittent haematuria. ● What is the diagnosis? ○ A: renal cancer ○ B: UTI ○ C: Renal calculus ○ D: Bladder tumourRenal: Staghorn Calculus ● Branching kidney stone.GI: Case ● 80M presents with acute abdominal bloating and nausea. He has not moved his bowels or passed flatus for 24 hours. ● He is diagnosed with large bowel obstruction. ● The AXR shows ‘coffee bean sign’, what does this suggest? ● A: Malignancy ● B: Caecal volvulus ● C: Medication induced ● D: Sigmoid volvulus ● E: GastroparesisSigmoid Volvulus ● SIgmoid volvulus = Coffee bean sign ● Caecal volvulus also presents with S+S of large bowel obstruction. The AXR does not show a coffee bean, some say it looks fetus shaped.Conclusion ● Imaging is hard - that’s why we have radiologists ○ Make sure you know the basics and can recognise ‘spot’ diagnoses. Have a good systematic process for going through CXR, AXRs, head CT, pelvic x-rays (you will learn more of this in your senior years and for OSCEs) ● Remember to read the question stem carefully!! The story is the key to understanding imaging. ● Exposure to imaging will help a lot ○ Radiology masterclass (beginner interpretation), MRI master (scrollable scans with labelled anatomy), Radiopedia (more advanced) ○ Use PACS on placement/ask Drs to show you scansResources for Extra Learning ● Radiopaedia ● Learning radiology.com ● The Student Radiologist - by our very own Dr Cindy Chew!! ● Felson’s Principles of Chest Roentgenology ○ Very good book for principles of CXR and chest CT. All relevant for students and future clinical practice. Should be accessible through UofG login. ○ https://www-sciencedirect-com.ezproxy.lib.gla.ac.uk/book/9781416029236/felsons-principles-o f-chest-roentgenologyFeedback ● Help us make our events better!!
