RADIOLOGY FROM KHMER PROF PART 2

Concernant l’œsophage cervical :

Concernant l’appareil urinaire :

72. Choisissez la proposition inexacte parmi les suivantes. Font partie de la deuxième (=distale) rangée des os du carpe les os suivants :

A propos des poumons :

Concernant la vascularisation de l’appareil digestif :

Parmi les composants du rein qui suivent, un seul appartient au cortex. Lequel ?

A propos des os longs on peut dire que :

A 70-year-old man recently underwent a laparoscopic prostatectomy. He now presents to the Emergency Department complaining of shortness of breath, pleuritic chest pain and haemoptysis. D-dimer levels were measured and found to be significantly elevated. A CXR is performed as part of the initial set of investigations. Which one of the following is the most likely CXR finding?

A 27-year-old, previously fit and well man presents to his GP with a short history of pyrexia, cough and haemoptysis. He has never previously been admitted to hospital. Sputum culture has grown Streptococcus

A 7-year-old girl, who has recently migrated migrated to this country from India, presents with a productive cough, fever, night sweats and weight loss. A CXR demonstrates marked consolidation in the right upper lobe. Sputum cytology reveals the presence of acid-fast bacilli. What additional radiological finding is most likely to suggest a diagnostic of current primary tuberculosis as opposed to post-primary tuberculosis?

A 30-year-old male engineer has recently returned from North America having inspected a number of construction sites. He develops flu-like symptoms and CXR reveals the presence of a solitary well-defined nodule. What additional finding would make a diagnosis of Histoplasmosis infection more likely, rather than Cryptococcus infection?

A 30-year-old man is HIV positive with a most recent CD4 count = 100 cells/L. He presents to the infectious diseases team with a cough, dyspnea and general malaise. A CXR demonstrates bilateral, diffuse, medium-sized reticular opacities. An air-filled parenchymal cavity (pneumatocoele) is seen, but there is an absence of either mediastinal lymphadenopathy or a pleural effusion. What is the most likely underlying opportunistic infection?

A 50-year-old lifelong male smoker has presented to his GP with increasing shortness of breath. A CXR shows that the right atrial border is a little indistinct. On thee lateral view there is a triangular density with its apex directed towards the lung hilum. Which one of the following is the most likely diagnosis?

A confused 70-year-old man with a history of cough and some shortness of breath attends your Radiology Department for a CXR. It is noted that there are multiple discrete, spherical and well-defined pulmonary nodules with a peripheral distribution. Some calcification is noted within some of these nodules but cavitation is not evident. The accompanying nurse from the care home tells you that he has a “growth” somewhere but is not sure what this is. What is the most likely primary tumour?

A 25-year-old male pedestrian has been hit by a car and is currently being resuscitated in the Emergency Department. He complaint of paraesthesia involving his left shoulder. Which one of the following radiological features is the most likely related cause?

A 27-year-old man has been involved in a high-speed road traffic accident. There is significant diagonal bruising over the abdomen, due to the wearing of a seat belt. He is heamodynamically stable, but complains of severe abdominal pain and a CT of the chest and abdomen is performed. Which one of the following radiographic sings on a CXR would be most likely to suggest a right-side diaphragmatic injury?

A 30-year-old warehouse employee has been admitted to the Emergency Department, having been crushed between a reversing lorry and a wall. A supine CXR demonstrates a pneumomediastinum and a right-side pneumothorax that has not responded to the insertion of an appropriately sited chest drain. The right lung is seen to sag towards the floor of the right hemithorax. Which one of the following is the most likely diagnosis?

A 41-year-old man has previously had a large anterior myocardial infarction. He now presents with increasing shortness of breath on exertion and it is suspected that he has a degree of pulmonary venous hypertension (PVH) due to left ventricular failure. Which one of the following is the most likely radiological finding?

A 56-year-old female smoker presents with increasing shortness of breath, fever and a productive cough. Her CXR demonstrates diffuse opacification at the right lung base and treatment is commenced for community-acquired pneumonia. Which additional radiological finding is most likely to suggest a diagnosis of Streptococcus pneumoniae rather than Staphylococcus aureus?

A 49-year-old man presents to his GP with increasing shortness of breath. A CXR demonstrates a “white out” of left hemithorax with displacement of mediastinum towards the left. What is the most likely explanation?

Whilst reporting plain radiographs from a respiratory outpatient clinic, you view a CXR that demonstrates bilateral hypertransradiant hemithoraces. The lung volumes are normal and, unfortunately, there is no clinical history accompanying the request card. Which diagnosis would best explain these finding?

A CXR is performed on a 62-year-old man with a chronic cough. This demonstrates multiple tiny nodules throughout both lungs, measuring up to 2 mm in size. These micronodules appear to be of greater density than soft tissue. Which one of the following is the most likely diagnosis?

You are asked by the Emergency Department clinicians to review a trauma series of plain radiographs of a young man involved in a road traffic accident. The clinicians suspect that the patient has multiple right-sided rib fractures. Which one of the following is the correct radiological consideration as you review these films?

A 27-year-old woman has severe asthma. She is admitted to ITU with a severe, life-threatening exacerbation requiring mechanical ventilation. Two days later, a supine CXR is performed. This demonstrates a lucent line around the left heart border and aortic arch with surgical emphysema at the root of the neck. The lungs are hyperinflated but appear clear. Which complication is likely to have occurred?

A 43-year-old man is investigated for pain related to his left arm. Plain radiography demonstrates a well-defined, lytic lesion in the proximal humerus, with chondroid matrix mineralisation and a narrow zone of transition. There is deep endosteal cortical scalloping and the suggestion of bone expansion. What is the most likely diagnosis?

A 32-yea-old man attends hospital following a fall onto his flexed left arm. He is referred to the duty orthopaedic team with a “Monteggia injury”. What are the most likely radiological findings?

A 27-year-old man is referred by his GP with progressively painful swelling of his left knee following a minor football injury some weeks ago. The radiograph shows a 5-cm ill-defined lytic lesion within the left distal femoral metaphysis, with a permeative pattern of bone loss and areas of cloud-like ossification. There is an extensive periosteal reaction, predominantly orientated perpendicular to the cortex. What is the most likely diagnosis?

An 80-year-old woman is admitted to hospital following a fall. The patient had a right mastectomy and axillary dissection 5 years ago to treat an invasive ductal carcinoma. The pelvic radiograph reveals a left hip fracture. Which fracture site would be most suggestive of a pathological fracture?

A 19-year-old student returns to the UK following 4 months’ travelling around the world. Radiographs reveal multiple oval areas of calcification, up to 1 cm in long axis, aligned in the direction of muscle fibres. What is the most likely diagnosis?

A previously well 80-year-old woman sustains a subcapital fracture of the right neck of femur following a fall onto hard ground. The plain film reveals multiple lytic lesions within the pelvic bones and proximal femora, which are highly suspicious for bone metastases. What is the most likely occult primary lesion?

A 34-year-old man with chronic back pain is referred by his GP for thoracic and lumbar spine radiographs. The GP is concerned about the possibility of ankylosing spondylitis. Which radiological feature is atypical for ankylosing spondylitis, and might suggest an alternative diagnosis?

A 50-year-old woman complains of painful swelling of the joints of the hands and wrists. Radiographs show evidence of an erosive arthropathy. Which radiological feature would favour a diagnosis of rheumatoid rather than psoriatic arthritis?

An 18-year-old man attends his general practitioner with a painful right knee. His radiograph shows a well-defined, lobular, lytic lesion within the proximal tibial epiphysis, extending into the metaphysis. There is a faintly sclerotic margin and no matrix calcification. What is the most likely diagnosis?

A young girl is brought to the Emergency Department with a painful right elbow following a fall. The radiograph reveals that the radial head is ossified. Which other structure should be visible?

A radiograph of the left knee of a 35-year-old man reveals a 3-cm lytic lesion sited eccentrically in the proximal tibia. It has a well-defined non-sclerotic margin, and extends to the tibial articular surface. What is the most likely diagnosis?

A 35-year-old woman is referred to thee Radiology Department following the birth of her first child. The baby was delivered 8 days post-term and was a vaginal delivery following a prolonged labour and episiotomy. Two months later, the patient continues to experience faecal incontinence and an anal sphincter tear is suspected. Which investigation would be most useful to demonstrate anal sphincter damage?

A 37-year-old man presents to his GP with increasing right upper quadrant pain. On examination, he is afebrile with right upper quadrant tenderness and fullness. An abdominal ultrasound is performed and demonstrates a 5-cm diameter cystic lesion in the right lobe of liver. The mass contains multiple septations with a large cyst centrally and multiple small cystic spaces peripherally. Echogenic debris is seen within the cystic lesion and alters in position when the patient lies on his side. From the clinical an sonographic details, what is the most likely diagnosis?

A 33-year-old woman presents to her GP with a one year history of intermittent rectal bleeding. She experiences regular episodes of fresh blood per rectum with associated lower abdominal pain, lasting several days at a time. A flexible sigmoidoscopy is normal. A double contrast barium enema is performed and demonstrates an irregular appearance of the anterior wall of the sigmoid colon with mild extrinsic mass effect. What is the most likely diagnosis?

A 56-year-old woman presents with a 4-day history of right upper quadrant pain and vomiting. She describes a previous episode one year ago that resolved after a few day. On examination, she is very tender in the right upper quadrant with guarding on deep palpation during inspiration. Laboratory investigations reveal elevated white cell count and CRP but normal liver function tests and an abdominal ultrasound is performed. What are the most likely ultrasound findings?

An 82-year-old woman is referred to the on-call surgical team as an emergency admission. The patient lives in a residential care home and has a 48-hour history of generalised abdominal pain and vomiting. On examination, she is dehydrated and tachycardic and an abdominal radiograph demonstrates multiple dilated small bowel loops measuring up to 4.8 cm in diameter. A linear gas-filled structure is present in the right upper quadrant with short branches extending from it. What is the most likely diagnosis?

A 72-year-old man is referred to hospital as an emergency admission by his GP. He has experienced vomiting and abdominal pain for 24 hours following a takeaway meal. There is a past medical history of ischaemic heart disease, chronic obstructive pulmonary disease and hypertension. An abdominal radiograph is performed and demonstrates several gas-filled loops of small bowel centrally measuring up to 2.5 cm diameter. In the left side of the abdomen, multiple round foci of gas are projected over the wall of a loop of large bowel. No free gas or mucosal thickening is identified, what is the most likely explanation for the clinical and radiographic findings?

A 50 year-old man has a CT head after sustaining a head injury during a mechanical fall. The only positive finding is a large low attenuation lesion in the left middle cranial fossa, which is well defined, and of the same attenuation as cerebrospinal fluid (CSF). There is some thinning of the overlying temporal bone. Which one of the following is the most likely diagnosis?

A 37-yeao-old woman is involved in a road traffic accident and sustains a severe head injury. Her CT head shows acute blood within the extradural, subdural and subarachnoid spaces. Which one of the following statements is true regarding extradural haematomas?

A 19-year-old HIV-positive man is admitted with headache, confusion and disorientation. He is mildly pyrexial. A CT brain reveals multiple hypodensities, particularly in the brainstem and in the periventricular white matter. There is some ependymal enhancement postcontrast. What is the most likely cause for these findings?

A GP requests your advice regarding an 18-month-old girl whose mother has noticed that her left pupil appears white. The GP has performed ophthalmoscopy and is suspicious that there is a retinal mass. Which one of the following is the investigation of choice?

A 33-year-old HIV-positive woman presents with increasing headache and confusion. On examination she is pyrexial and has left leg and right facial weakness. A CT head demonstrates multiple lesions measuring between 2 and 4 cm, which are predominantly situated at the corticomedullary junction. These lesions have a thin enhancing rim as well as associated oedema and local mass effect. Which one of the following is the most likely diagnosis?

A 2-year-old child presents to Emergency Department with a greenstick fracture of the ulna. On the radiograph, there is evidence of an old fracture to the same limb and the history given by the parents is inconsistent. Non-accidental injury (NAI) is clinically suspected and a skeletal survey is performed. Which of the following fractures have a high specificity for NAI?

A 2-week-old septic neonate shows worsening renal function and proteinuria. He is currently being monitored on the pediatric ITU. Seven days after his initial illness, an ultrasound is performed which reveals a unilateral enlarged kidney, with loss of corticomedullary differentiation and reversal of end diastolic arterial flow. Associated adrenal haemorrhage is noted. What is the most likely diagnosis?

On a 20-weeks antenatal ultrasound, unilateral fetal hydronephrosis is detected. Which one of the following findings would confirm the diagnosis of renal pelvic dilatation (RPD)?

A 2-year-old has an elbow radiograph performed following a fall. Which one of the following epiphyses should be visible?

A 6-year-old boy presents with a right-sided limp of a few weeks’ duration. He is apyrexial. Which one of the following is the earliest radiographic sign that would support a diagnosis of Perthers’ disease of the hip?

A 5-year-old boy who had a coarctation of his aorta repaired 12 months ago requires follow-up. Which of the following imaging modalities is the gold standard?

A 22-year-old woman presents to her GP with irregular menstrual periods. She is overweight with a body mass index of 32 and has excess body hair. Her LH/FSH ratio is elevated and her GP refers her for a pelvic ultrasound. Which one of the following findings are most likely to be present on ultrasound?

A 24-year-old man presents to his GP with increased urinary frequency. Physical examination is normal and he is referred for ultrasound. Transabdominal ultrasound demonstrates a cystic structure posterior to the urinary bladder and a TRUS is performed for further evaluation. TRUS reveals a midline anechoic structure in the posterior portion of the prostate gland, superior to the verumontanum. It does not communicate with either the bladder or the seminal vesicles. Which of the following is the most likely diagnosis?

A 53-year-old woman is invited to attend a mobile breast-screening unit for routine screening mammograms. Which one of the following statements is correct regarding the standard mammographic projections (the mediolateral oblique (MLO) and craniocaudal (CC) views)?

Which of the following best describes the radiological findings of urinary tract malakoplakia?

An immunosuppressed 24-year-old man presents with left renal colic. He is referred for an IVU. The control film shows a gas containing, round lamellated mass within the urinary bladder. Postcontrast, there are multiple filling defects within the urinary bladder. What is the most likely cause of these appearances?

Which one of the following statements best describes the course of the normal ureter within the pelvis?

A 35-year-old woman presents with a painless lump in the outer upper quadrant of her left breast. She is referred for an ultrasound examination of the left breast. Which of the following ultrasound findings would suggest a malignant rather than a benign breast mass?

A 29-year-old man presents with a 4-hour history of sudden onset right loin pain, radiating to the right groin. The clinicians request an emergency IVU for suspected acute urinary obstruction. Which one of the following IVU features would be most consistent with acute urinary obstruction?

A 42-year-old man with known Wegener’s granulomatosis develops haematuria. He has an abdominal ultrasound which reveals small, smooth kidneys with diffuse thinning of the renal parenchyma. The pelvicalyceal systems appear normal but there is an increased amount of renal sinus fat. What is the most likely diagnosis?

A 56-year-old woman is found to have a screen-detected breast cancer on her second screening mammogram. Two breast radiologists both agree that there is no evidence of malignancy on the previous mammograms, even in retrospect. Which one of the following statement best describes this interval cancer?

A 68-year-old woman presents with a 2month history of generalized abdominal bloating and two episodes of vaginal bleeding. On examination, the abdomen is distended with clinical evidence of ascites. Tumour makers are performed; CA 15-3 is normal, CA 125 and CEA are slightly elevated and CA 19-9 is markedly elevated. An abdominopelvic ultrasound demonstrates a moderate volume of ascites, multiple liver metastases and bilateral mixed solid/cystic adnexal masses. What is the most likely underlying primary tumour?

A 27-year-old man is referred to the hepatology outpatient clinic with a 3-week history of malaise, lethargy and mild upper abdominal pain. Liver function tests performed by his GP are significantly abnormal. The results of hepatitis serology performed in the clinic are consistent with an acute hepatitis B infection. An abdominal ultrasound is performed. What is the most likely finding on ultrasound?

A 32-year-old man presents to his GP with increasing pain on swallowing solids and liquids. He has lost 15 kg in weight over the preceding 2 months. After a full history and examination, he is found to be HIV positive with a very low CD4 count. The GP refers him for a barium swallow examination and this demonstrates a single ulcer in the mid-oesophagus. The ulcer has a smooth margin, measures 4 cm in length and is oval in shape. There is no stricture identified. Which diagnosis is most likely?

A 49-year-old woman has experienced increasing difficulty swallowing over the past 6 months, with associated retrosternal discomfort. A barium swallow is performed and demonstrates virtually no peristaltic activity within a dilated oesophagus. The gastro-oesophageal junction appears widened and there is marked reflux of barium when the patient lies supine. An upper GI endoscopy shows moderate reflux oesophagitis. Given these findings, what is the most likely underlying diagnosis?

115. A 30-year-old man attends the Emergency Department with a 2-day history of abdominal pain and vomiting. On examination, he is afebrile with a firm mass palpable in the right lower quadrant of the abdomen. A supine abdominal radiograph is performed and demonstrates dilated loops of small bowel with a large soft tissue mass in the right lower quadrant. On ultrasound, the mass has a “pseudotumour” appearance. What is the most likely diagnosis?

A 49-year-old man is involved in a road traffic accident and sustains serious head and chest injuries. He is ventilated on the intensive care unit and his injuries are managed conservatively. Ten days later, he develops a temperature of 39.5°c, becomes tachycardic and requires inotropic support to maintain his blood pressure. An abdominal ultrasound is performed and shows a cystic structure in the right upper quadrant measuring 12 x 8 cm in size. The mass has a 6-mm thick wall, contains a layer of echogenic material and is surrounded by a rim of fluid. What is the most likely diagnosis?

A 40-year-old male diabetic patient has an intravenous urogram (IVU) for left-sided renal colic. On the IVU, the left kidney shows papillary and calyceal abnormalities that give an “egg in a cup” appearance at some calyces and “tracks and horns” at other calyces. The affected left kidney has preserved renal cortical thickness despite the calyceal/papillary abnormalities. The contralateral kidney appears normal. What is the most likely diagnosis?

A 40-year-old female diabetic patient has right loin pain, vomiting and a fever. An ultrasound examination is requested to exclude urinary obstruction. This demonstrates no evidence of upper tract dilatation, but features of acute pyelonephritis are present. What are the most likely sonographic findings within the right kidney?

A 55-yea-old HIV-positive man presents with macroscopic haematuria and right-sided renal colic. An IVU does not demonstrate any renal tract calcification, but there is a dense right nephrogram with no excretion of contrast on a delayed film. The urologist performs a retrograde ureteroscopy and retrieves a 9-mm right ureteric calculus. What is the likely composition of the calculus?

A 29-year-old man has an IVU performed following an episode of haematuria. This demonstrates complete right-sided ureteric duplication. Which one of the following statements is true?

A 27-year-old man with membranous glomerulonephritis presents with a 1-day history of right-sided flank pain and haematuria. An abdominal radiograph did not reveal any renal calcification but his renal function has significantly deteriorated over the past 24 hours. On ultrasound there is a large, oedematous right kidney with loss of the corticomedullary differentiation. On a subsequent IVU, there is a faint nephrogram with absent pelvicalyceal filling after 15 minutes. What is the most likely diagnosis?

A 24-year-old motorcyclist involved in a traffic accident presents to the Emergency Department with a broken leg and bruising over his left flank. He is found to have microscopic haematuria and fractures of the left 8th and 9th ribs. The patient is haemodynamically stable and clinicians suspect a left renal injury. Which one of the following imaging investigations is the most appropriate?

A 68-year-old man is involved in a traffic accident and sustains a pelvic fracture, head and limb injuries. Attempted urethral catheterisation in the Emergency Department is unsuccessful and a cystourethrogram is requested to exclude urethral injuries. Regarding urethral injuries, which one of the following statements is correct?

Which one of the following statements best describes the radiological appearances of parapelvic renal cyst?

A 42-year-old man is referred for investigation of painless microscopic haematuria. An IVU is performed and demonstrates bilateral small areas of calcification within the kidneys on the control image. On the 5-min postcontrast IVU film, the calcification appears to lie within the collecting system. On ultrasound, there are numerous small hyperechoic rounded areas within the medullary pyramids, many of which cast an acoustic shadow. What is the most likely diagnosis

A 32-year-old man involved in a high-speed traffic accident is found to have blood at the urethral meatus and a high riding prostate during the secondary clinical survey. The examining doctor suspects a urethral injury. Which part of the urethra is most likely to be involved?

You are the radiologist reviewing the mammograms of a 56-year-old woman. When compared with her previous mammograms, areas of calcification previously seen within the left upper outer quadrant have now disappeared. Which of the following is not a possible explanation?

A transvaginal ultrasound is performed on a 36-year-old woman with dysfunctional uterine bleeding. This demonstrates an enlarged globular uterus with a heterogeneous appearance of the myometrium. The myometrium contains diffuse echogenic nodules, subendometrial echogenic linear striations and 2- to 6-mm subendometrial cysts. Color Doppler demonstrates a speckled pattern of increased vascularity within the heterogeneous area of myometrium. What is the most likely diagnosis?

A 52-year-old postmenopausal woman presents for her first screening mammogram. Within the right upper outer quadrant, there is a 2-cm well-defined, oval mass that has dense “popcorn” calcification within it and is surrounded by a thin radiolucent rim. On ultrasound, the mass is well defined and hyperechoic with areas of acoustic shadowing due to contained calcification. What is the most likely diagnosis?