25-year-old female:
Presented with RIGHT-SIDED ILIAC FOSSA PAIN
Appendicitis
Infracecal epiploic appendigitis
Appendicular mucocele
Cecal diverticulitis
45-year-old female patient:
* Generally unwell with abdominal pain and palpable cervical lymph nodes
– Newly diagnosed HIV infection with a very low CD4 count of 30 cells/uL
– Generally unwell
– Presents at the emergency department with abdominal pain and palpable cervical lymph nodes
Most likely pulmonary and extrapulmonary tuberculosis in an immunocompromised patient with miliary pulmonary lesions, tuberculous colitis and ileitis, and necrotic extrapulmonary adenopathy (cervical and abdominal adenitis)
Microbiological analysis of an excised abdominal node confirmed the presence of Mycobacterium tuberculosis
Ileocaecal resection, tuberculostatic medication, and HAART
– Be aware of TB in immunocompromised patients
– Cervical nodes are the #1 site of extrapulmonary TB adenopathy and the most common cause of adenopathy worldwide
– Intestinal tuberculosis can mimic inflammatory bowel disease
86-year-old patient:
– With sudden collapse
– Patient known with infrarenal aortic aneurysm
– Sudden collapse at home
– Transfer to the hospital with ambulance
Axial and coronal slices of an abdominal CT in 2019 show a tortuous abdominal aorta with aneurysmal dilatations and eccentric thrombus. There is a thrombosed saccular component at the level of the aortic bifurcation (arrow)
CT at presentation:
– Ruptured aortic aneurysm
* known infrarenal aortic aneurysm
* massive retroperitoneal hematoma extending into the posterior pararenal and perirenal compartments
* active contrast extravasation
– Point of weakness: saccular aneurysmal component
– This case did not show a classic sign of pending rupture; however, a clear point of weakness was retrospectively identified (the saccular aneurysmal component at the aortic bifurcation)
– Radiological signs of pending rupture:
* !! High attenuating crescent (= acute haematoma within the mural thrombus or aneurysmal wall)
* Focal discontinuity of intimal calcification and ‘tangential calcium sign’
* ‘Draped aorta sign’, present when
* The posterior aortic wall is unidentifiable as a distinct line
* The posterior aorta follows the contour of the spine on one or both sides
– Reference: CT signs of pending aortic aneurysm rupture, J.P. Heiken, radiologyassistant.nl
https://radiologyassistant.nl/abdomen/aorta/aneurysm-rupture
61-year-old female:
– With elevated ALT, AST, and bilirubin
Wall thickening and enhancement of the gallbladder wall
Mild common bile and intrahepatic duct dilatation
Filling defect within the distal common bile duct
Choledocholithiasis
53-year-old male:
– Persistent right shoulder pain, no movement limitations.
– No previous trauma.
– Shoulder MRI is performed
What do you see?
Quadrangular/Quadrilateral space syndrome
– Posteroinferior paralabral cyst (arrow) extending into the quadrangular space
– Teres minor mild fatty infiltration – atrophy (circle)
– Neurovascular compression syndrome of the posterior humeral circumflex artery (PHCA) and/or the axillary nerve or one of its major branches in the quadrangular space
– Multiple causes of compression: fibrotic bands, ganglion/cysts, aneurysms, tumours
– MRI may demonstrate atrophy and/or denervation edema of the teres minor and/or deltoid muscles
– Differential diagnosis: Parsonage-Turner sd, disuse atrophy
75-year-old female:
– Day 4 post Whipple procedure
– Ongoing abdominal pain with increased inflammatory markers and slightly increased lactate levels
– Post-operative changes following partial pancreatectomy and duodenojejunostomy (partially shown)
– Prominent mesenteric nodes
– Partially occlusive thrombus of the superior mesenteric vein (best seen on axial slice) extending to a large jejunal branch (seen on coronal slice)
Partial SMV occlusion as a complication to recent Whipple procedure
8-year-old patient:
– With a chronically painful right knee and ankle
– Patient with no relevant clinical history
– Parents mention a difficulty when running, the patient trips very easily and sometimes struggles to use the right leg. The right leg is often painful
Showing the X-ray right knee and the pelvis
Eccentric, lytic bone lesions with sharp margins
No periosteal reaction
Ground-glass matrix of the lesion in the right tibial diaphysis
Soap-bubbly appearance of the lesion in the femoral diaphysis
Expansile bone lesion with ground glass matrix in the right femoral neck, extending into the proximal diaphysis
Slight varus deformity of the femoral neck
Similar lesion in the right iliac wing/acetabular region
A CT was performed:
Showing X-ray of both feet.
Expansile bone lesion with ground glass matrix involving the 1st metatarsal and proximal and distal phalanges of the left foot
Soap-bubbly lesions of the talus and 5th metatarsal
– Multiple bone lesions with benign appearance
– Expansile lesion with ground-glass matrix in the femoral neck virtually pathognomonic for fibrous dysplasia
– Genetic testing could not reveal mutations of the GNAS gene: no syndromic association in this patient
Benign bone lesions
– Usually central in bone
– Varying degrees of expansion
– Ground-glass matrix (mildly sclerotic)
– Lack of aggressive features (no periosteal reaction, no cortical breakthrough or soft tissue mass)
Aetiology: developmental dysplasia
Fibrous dysplasia is polyostotic in 15–20%, often in syndromic association (mutations of the GNAS gene)
– McCune-Albright syndrome (in combination with endocrine dysfunctions)
– Mazabraud syndrome
Known patient with recently diagnosed poorly differentiated vaginal carcinoma with staging FDG PET/CT study. What is the study showing?
– A hypermetabolic lower vaginal lesion representing the known vaginal neoplasm associated with a larger hypermetabolic uterine body neoplastic lesion suggesting synchronous malignant process
– Multiple hypermetabolic enumerable bilateral lung deposits associated with a single right lower para-tracheal nodal deposit
Ossification of the membranous labyrinth, high-density bone deposition involving all the cochlear turns.
This usually occurs as a complication of suppurative labyrinthitis, either due to otomastoiditis or meningitis. Other causes include trauma, autoimmune diseases, and surgery.
What do you see on the following images?
TB cervical lymphadenitis
Mild progression in size of multiple necrotic lymph nodes in bilateral supraclavicular, axillary regions, at all anterior and posterior cervical chain (more prominent at right side lower anterior cervical chain)
