PCE intro to CXR & AXR & CT interpretation, these cards to be viewed alongside the powerpoint

Question 1

Structure of a head CT PCE
Shape and size of pathology
Attenuation/opacity
Location
Effacement/mass effect
Any soft tissue or bone abnormalities
Name the pathology if you are sure (not needed for full marks)
Beware: if you get this wrong, you lose all marks.

slide 10 image

Answer 1

“A large bi-convex (lemon) shaped high attenuation (bright white, meaning fresh blood) opacity on the left parieto-temporal region with effacement of the left lateral ventricle and midline shift (mass effect) to the right. Left sided acute extra dural haematoma (epidural also accepted)

Question 2

Slide 13
Abdo pain radiating to back ?cause.

Answer 2

There is a curved area of calcification to the left of the lumbar spine in keeping with a calcified abdominal aortic aneurysm.

Question 3

Slide 15
Smoker. Cough and chest pain.
?infection

Answer 3

There is a homogenous triangle density behind the left heart border with features of volume loss (midline shift to the left; absent left diaphragm) in keeping with a left lower lobe collapse.
Would need to note triangular opacity/density and volume loss to gain mark. LLL collapse not needed for mark but could be stated.

Other points of note: Gas/fluid level under left diaphragm is stomach gas. Scoliosis and degenerative changes of thoracic spine noted. Some calcification of the aortic arch.

Question 4

Slide 17
SOBOE. Pedal oedema. Non-productive cough.
?cause

Pedal oedema – oedema of the feet

Answer 4

There is cardiomegaly (the heart is enlarged) and minor blunting of the costophrenic angles (small pleural effusions) – this is needed to gain marks. ½ mark for only noting cardiomegaly.
Features are in keeping with congestive cardiac failure – this is not needed for the marks

Points to note: there is also prominence of the hilar vessels. There is upper lobe blood diversion (increased upper hilar regions).

Question 5

Slide 19
Abdo pain and tenderness. Some distention. No flatus for 24 hours.
?obstruction

Answer 5

There are multiple loops of gas-filled dilated loops of small bowel in the left upper quadrant.
There are branching linear lucencies in the right upper quadrant in keeping with pneumobilia (air in the biliary tree). Together, features suggest a gallstone ileus.
NB. You only need to identify the dilated small bowel and suggest a small bowel obstruction for the mark.

Question 6

Slide 21
Smoker for 35 years. Cough persisting despite abx.
?mass

Answer 6

There is a small rounded focal opacity in the right upper zone – this is needed to gain the mark
Suspicious for a lung mass – not needed for mark

Question 7

Slide 23
Follow up post right frontotemporal craniotomy for an orbital tumour.

Answer 7

Crescent shaped high attenuation (bright) opacity surrounding a hypodense collection of air (this is too dark to be blood) in the right fronto-parietal region, with no evidence of midline shift/mass effect (required for mark). Subdural collection/haematoma (not needed for mark)
Evidence of craniotomy and subgaleal (scalp) swelling as expected following surgery (not needed for mark)

Question 8

Slide 25
Chest pain. SOB.
?infection

Answer 8

Normal cardiac and mediastinal outline. Normal lungs and pleura. No fractures of the bones.

Question 9

Slide 27
Right sided chest pain and increasing SOB. No trauma.
?infection

Answer 9

There is a lack of lung markings with a lung edge visible in the right upper zone (required for full marks). Features in keeping with a right pneumothorax (not required for full mark).

Question 10

Slide 29
Abdo pain and distension. No bowel movements. PR exam empty.
?obstruction

Answer 10

There are multiple dilated loops of gas filled small bowel in the right upper quadrant. Minimal gas in the large bowel (similar required for full mark). Features in keeping with a small bowel obstruction (not required for full mark).

Question 11

Slide 31
RTC. GCS 6 ?head injury

GCS = Glasgow coma scale
Scale of 3-15.
6 implies significant neurological deficit.

Answer 11

Biconvex (lemon) shaped hyperdense (high attenuation) opacity overlying right front-parietal-temporal lobes with significant contralateral midline shift. (Similar needed for full mark)
In keeping with an acute epidural/extradural haematoma (not needed for full mark)

There is also small hyperdense acute cortical contusion with mild surrounding oedema and a few small patchy areas of acute subarachnoid haemorrhage in cortical sulci overlying the left parietal-temporal lobes. – you definitely do not need to note this for marks.
Bone windows noted a linear minimally displaced fracture of the right temporal bone, extending into the ipsilateral parietal bone – this can be seen on this image, though not in detail. Again, not needed for marks.

Question 12

Slide 33
Gross abdominal distension and pain. Tympanic abdomen. Fever and unwell. Vomiting ++
?obstruction

Tympanic = drum like sound on palpation = dilated under pressure

Answer 12

There is a massive, dilated loop of sigmoid in the pelvis, extending throughout the abdomen with dilated loops of large bowel throughout. (required for full mark)

Features are in keeping with a sigmoid volvulus. There is also free air (Rigler’s sign) suggesting perforation. (not required for full mark)

The Rigler sign, also known as the double-wall sign, is a sign of pneumoperitoneum seen on an abdominal radiograph when gas is outlining both sides of the bowel wall, i.e. gas within the bowel’s lumen and gas within the peritoneal cavity. It is seen with large amounts of pneumoperitoneum (>1000 mL). Rigler sign (bowel) | Radiology Reference Article | Radiopaedia.org

Question 13

Slide 35
Persistent cough and chest pain. Lifelong smoker. Some haemoptysis.
?infection

Answer 13

There is a veil like shadowing throughout the left hemithorax with traction of the hilum superiorly and traction of the mediastinum to the left. (need to note change in opacity to left lung and midline shift to gain full mark)

Features are in keeping with a left upper lobe collapse. A large density is visible at the left hilum likely a mass causing the collapse (this part not required for the mark).

Question 14

Slide 37
Large palpable swelling to abdomen. ?cause

Answer 14

There is a large soft tissue mass extending from the lower abdomen displacing the bowel superiorly.

Question 15

Slide 39
Vomiting with abdo pain and distension. No bowel motions. ?Obstruction.

Answer 15

The transverse colon is gas filled and dilated with minimal gas seen in the distal large bowel. (required for full mark)

Features suggest a large bowel obstruction. (not required for full mark)

Question 16

Slide 41
Epigastric pain and tenderness.

Answer 16

There is free air beneath both hemidiaphragms in keeping with a pneumoperitoneum (this could be due to perforation).

A difficult one to interpret due to the poor inspiratory effort – if you had taken this image you need to justify why you haven’t repeated