Question 1

History A 28 year old male presents with pain in his shin for
the last 6 months.

Imaging An X-ray was performed on 28 May 2014.

A Bone Scan was performed on 9 July 2014.
An MRI was performed on 8 August 2014.
Findings 28/5/2014 X-ray
 Focal cortical thickening medial aspect tibia.
 Narrow zone of transition, and no soft tissue
component or periosteal reaction

9/7/2014 Bone Scan

 Increased uptake. No other lesion

4/8/2014 MRI
 Nidus
 Sclerosis (low signal)
 Enhancement of nidus
Likely Diagnosis Osteoid Osteoma

Differential
Further Consider for RFA
Investigation or
Management

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© The Royal Australian and New Zealand College of Radiologists® 2015
Series 2, September 2015
Question 2
History A 52 year old perimenopausal female presents with increasing
abdominal girth.
Imaging A CT was performed on 24 April 2013.
Findings CT
 Large heterogeneous mass in uterus
 Posterior intramural, displacing endometrium
anterosuperiorly
 Confined within myometrium
 Both ovaries seen and appear normal, contain follicles
 Bilateral hydronephrosis
 No lymphadenopathy
 No evidence metastatic disease
Likely Diagnosis Uterine Fibroid
(Leiomyoma, myoma)
Differential Uterine leiomyosarcoma
Further Investigation or Gynaecology referral
Management Consider MRI

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Question 3
History An 80 year old male, presents with painless obstructive jaundice.

Imaging A CT of the abdomen was performed on 27 Feb 2013.

An ERCP was performed on 7 Mar 2013.

Findings CT
 Dilated intra and extra-hepatic bile ducts
 Dilated pancreatic duct with no pancreatic mass seen.
Small focus of calcification in the tail
 Gallstones
 No abnormal lymph nodes or metastatic disease seen
ERCP
 Irregular stricture distal common bile duct
 Filling defects pancreatic duct
Likely Diagnosis IMPN – main branch type
Malignant change, causing biliary obstruction
Differential Mucinous pancreatic neoplasm
Further Investigation or Palliation - stent
Management

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© The Royal Australian and New Zealand College of Radiologists® 2015
Series 2, September 2015
Question 4
History A 5 year old male presents with an acute headache, bilateral
papilloedema and an intermittent convergent squint. He also
suffered varicella 5 weeks ago.
Imaging A CT of the brain was performed on 9 January 2015.
An MRI of the brain was performed on 9 January 2015.
Findings CT
 Opacified sclerotic simplified ME cleft & mastoids
Hyperdense – Lt TS/SS/IJV
MRI
 Signal & CE left mastoid
 Loss of flow void – Lt TS/SS/IJV
 Bilateral Papilloedema
 Gyrus rectus damage – incidental
 Normal MRA
 No intracranial indicators of infection
Likely Diagnosis Primary diagnosis: Lt acute or chronic oto-mastoiditis with
osteomyelitis & Lt TS/SS/IJV thrombosis
Associated diagnosis: Raised ICP & previous HI
Differential
Further Investigation or Emergency call to ENT/Neurology/Neurosurgery
Management Dedicated temporal bone imaging

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© The Royal Australian and New Zealand College of Radiologists® 2015
Series 2, September 2015
Question 5
History A 32 year old female presents with haematuria.
Imaging A CT of the Abdomen and Pelvis was performed on 20 April
2011.
Findings CT
 28x21x12cm mass left side
 Fat content
 Pseudoaneurysm
 Right kidney removed
 No other abnormality in the abdomen and pelvis

Likely Diagnosis AML

TS
Differential Retroperitoneal lipoma/liposarcoma
Further Investigation or MRI Brain
Management Consider embolisation

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© The Royal Australian and New Zealand College of Radiologists® 2015
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Question 6
History An 80 year old presents with increasing confusion.
Imaging An MRI was performed on 7 Aug 2014.
Findings  Extra-axial mass – 43x35x33mm
 Peripheral cystic component
 Heterogeneous superior T2 more focal signal –
calcification
 Adjacent vasogenic oedema
 Mild local mass effect
 Increased signal DWI and low signal ADC

Likely Diagnosis Meningioma – atypical (WHO Grade 2)

Differential Epidermoid (doesn’t enhance)
Further Investigation or Neurosurgical referral
Management

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© The Royal Australian and New Zealand College of Radiologists® 2015
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Question 7
History A 26 year old male presents with back pain and confusion.

Imaging A Chest X-ray was performed on 10 October 2014.

A CT of the chest was performed on 10 October 2014.
An MRI of the brain was performed on 10 October 2014.

Findings CXR
 Miliary nodules
CT chest
 Miliary nodules
 No lymphadenopathy
 Destructed L1 with paravertebral abscesses
MRI brain
 Enhancing and thickened leptomeninges around
brainstem and superior cerebellar cistern.
 Recent superior cerebellar and right corona radiate
infarcts
Likely Diagnosis Miliary TB
Associated with - osteomyelitis of L1
- Leptomeningitis
Differential
Further Investigation or Clinical review
Management

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© The Royal Australian and New Zealand College of Radiologists® 2015
Series 2, September 2015
Question 8
History 61 Year old male presents with sudden chest pain, radiating to
back and jaw. D-dimer positive.
Imaging A CTA of the chest was performed on 28 May 2011.

Findings  High density ring on non-contrast scans

 Dissection of descending thoracic aorta
 Involves the left subclavian and both iliac arteries, which
remain patent
 True lumen supplies the coeliac trunk, SMA, IMA and
both renal arteries
 No PE is seen.

Likely Diagnosis IMH

Type B dissection
Differential
Further Investigation or Urgent Cardiothoracic review
Management

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© The Royal Australian and New Zealand College of Radiologists® 2015
Series 2, September 2015