This document summarizes 10 radiology cases: 1. A 75-year-old female with cough and fever was found to have encysted pleural fluid resulting in a pulmonary pseudotumor. 2. A 26-year-old male who fell from height showed signs of bilateral pneumothoraces, pulmonary contusions, and small amount of gas in the posterior mediastinum. 3. A 12-year-old female presented with bilateral forearm deformity was diagnosed with Madelung deformity based on radiographic findings of short radius bones. 4. A 89-year-old male with chronic cough was found to have a large retrosternal goiter extending into

1. Film Reading
Session
19/02/2015
By Dr. Bhanupriya Singh

2. CASE-1
symptoms-cough with fever
75year old female.

5. Chest x-ray (rotated to the right) demonstrates widespread airspace
opacity (possibly with early cavitation) in the right mid zone. A large
left sided pleural effusion is present with associated atelectasis.
Nasogastric tube and ECG leads noted.
In the left upper zone a well circumscribed opacity is visible.

6. Coronal reformats of a CT of the chest demonstrates that the
opacity in the left upper zone is due to encysted fluid in the
superior part of the oblique fissure.
typical appearance of encysted pleural fluidencysted pleural fluid, resulting in
a pulmonary pseudotumour. It also highlights the
usefulness and necessity of reviewing previous films.

7. Case-2
26year old male
Fall from height

12. Left pneumothorax with deep sulcus sign on the left, despite
ICC, consistent with a persistent pneumothorax.

13. Bilateral moderate pneumothoraces, with bilateral
intercostal catheters in situ.

14. Extensive bilateral pulmonary opacity, predominantly centred in the
right middle and bilateral lower lobes consistent with pulmonary
contusions.

15. There is a small amount of gas tracking within the posterior
mediastinum. Small right haemothorax.

16. • DEEP SULCUS SIGN:-In a supine film (common in the ICU), it
may be the only indication of a pneumothorax because air collects
anteriorly and basally, within the nondependent portions of the
pleural space, as opposed to the apex when the patient is upright.
The costophrenic angle is abnormally deepened when the pleural air
collects laterally, producing the deep sulcus sign.
• PULMONARY CONTUSION refers to an interstitial and/or
alveolar lung injury without any frank laceration. It usually occurs
secondary to non-penetrating trauma.
• Radiographic clearing of pulmonary contusion is relatively rapid,
and the signs of contusion have often resolved within 48
hours. Features often does not localize in a lobar or segmental
pattern.
• Commoner posteriorly and in lower lobes.

17. Case 3
12 YEAR OLD FEMALE.
Patient presented with chief complaints of
bilateral forearm deformity and difficulty in
hand gripping. The symptoms were
progressive since last 3-4 years

20. bilateral shortening of radius bones with dorsal and radial bowing.
Moreover, there was V-shaped proximal carpal row and positive
ulnar variance. The pisiform appears impacted, which can cause
ulnar impaction.

21. • Madelung deformity is caused by epiphyseal growth plate
disturbance at the ulnar side of distal radius, resulting in a short
radius compared with the ulna.
• characterised by dorsal and radial bowing of the radius with resultant
cosmetic effects and decreased grip strength. It can be bilateral in 50-
66% of patients. It often occurs as rare congenital deformity and does
not usually manifest until 10-14 years. It may also be seen as an
acquired consequence of trauma to the growth plate, e.g. Salter V
fracture.
• The growth plate injury may be vascular, infectious, traumatic or
muscular.
• Most non-traumatic cases of Madelung deformity present with
progressive deformity during late childhood or early adolescence.
• Syndromes like nail-patella, Turner, Leri-Weill, Madelung
dyschondrosteosis, and others maybe associated with the deformity.
• Treatment options are mainly surgical: radial/ulnar eiphysiodesis or
corrective osteotomies and vicker ligament release.

22. Case 4
89 YEAR OLD MALE
Presents with chronic Cough

25. Heart size is normal. Left basal subsegmental atelectasis. There is superior
mediastinal widening. Cardiac pacemaker in situ.

26. • large retrosternal goitre. This correlates with
the widened superior mediastinum on CXR. No
narrowing of the trachea
• goitre that requires mediastinal exploration and
dissection for complete removal or an intrathoracic
component extending more than 3 cm in
the thoracic inlet
• A potential pitfall in the assessment of retrosternal
extension is the apparent lower position
temporarily assumed by the gland when the arms
are raised in the case of imaging aimed at the chest.

27. Case 5
 Non specific knee pain in 9 year old
female.

30. Cortical bone shows well circumscribed lucency without
destruction/soft-tissue mass.

31. • Fibrous cortical defect
• Cortical fibrous defect also known as "non-ossifying fibroma" is
the most frequent bone lesion in children, occurring in up to 30-40%
of children.
• Most commonly seen in adolescents. No histologic difference exists
between non-ossifyinf fibromas and cortical fibrous defects.
• Most large lesions called nonossifying fibromas (NOF), smaller ones
- cortical fibrous defects,
• basicly the terms FCD and NOF are interchangeable. Most authors
believe these to be the same entity.
• These lesions are developmental abnormalities opposed to tumours.
They are usually incidental findings on x-rays, small ones have no
clinical significance, large ones may result in fracture, considered
pathological.
CFDs may be multiple.
• In this case FCD is for sure an incidental finding having
pathognomonic visual features. Biopsy, intervention and surgery in
such lesions should be avoided as well as followup imaging.

32. Case 6
 4 year old male
 child presented with fever and weight loss

34.  Lobulated hilar mass with widening of right
paratracheal stripe suggests hilar and
mediastinal lymphadenopathy most likely
tubercular.
 Occasionally these nodes may be large
enough to compress adjacent airways
resulting in distal atelectasis
 In most cases the infection becomes
localised and a caseating granuloma forms
(tuberculoma) which usually eventually
calcifies, and is then known as a Ghon
lesion
 When a calcified node and a Ghon lesion
are present, the combination is known as
a Ranke complex.

35. Case 7
20 year old male with recurrent left pneumothorax

39. Left sided pneumothorax with small apical air-filled blebs on the
second examination (arrows). Given the repeated episodes, surgical
excision was undertaken with a line of surgical staples
(arrows) traversing the left apex at the site of the previous blebs
Recurrent (non-traumatic) pneumothorax in young people is often due
to apical blebs that rupture spontaneously
Pulmonary blebs are small subpleural thin walled air containing
spaces, not larger than 1-2 cm in diameter. Their walls are less than 1
mm thick. If they rupture, they allow air to escape into pleural space
resulting in a spontaneous pneumothorax.

40. CASE 8
 30 year old male came to emergency
with
 Vomiting and chest pain

42. • Boerhaave's Syndrome
• due to a forceful ejection of gastric contents in an unrelaxed
oesophagus against a closed glottis.
• The tears are vertically oriented, 1-4 cm in length.
Approximately 90% occur along the left posterolateral wall
(left diapgragmatic crus) of the distal oesophagus.
• Naclerio V sign is a sign described on the plain film in patients
with a pneumomediastinum occurring often secondary to an
oesophageal rupture.
• It is seen as a V-shaped air collection. One limb of the V is produced by
mediastinal air outlining the left lower lateral mediastinal border.
• The other limb is produced by air between the parietal pleura and medial left
hemidiaphragm.
• Although Naclerio V sign was originally described in patients with
oesophageal rupture, it is not entirely specific to that condition.

43. CASE 9
 50 year old ICU pt with sudden and
violent onset of bloody emesis

45. Emphysematous gastritis
Rare and severe gastritis secondary to mucosal disruption and gas-forming
bacterial invasion
Characterized by air in the wall of the stomach
Causes:
Ingestion of toxic material such as corrosives
Alcohol ingestion
Trauma
Gastric infarction
Ulcer disease
Submucosa is invaded by gas-forming organisms which include:
Hemolytic strep
Clostridia Welchi
E. Coli
Staph aureus
X-ray:
Linear small gas bubbles in gastric wall
Gas in portal vein

46. CASE 10
5 month old child with vomiting,
abdominal distention, bloody
diarrhoea

50. Anteroposterior radiograph shows dilated bowel loops in the left upper
quadrant and soft tissue density in the right abdomen. The clinicial
presentation and appearance is highly suspicious for intussusception.

51. Ileocolic intussusception
90% of ileocolic intussusceptions are idiopathic
it is the most common cause of paediatric small bowel
obstruction
most common between 5-9 months of age, but ranges from 3-36
months
if patient >3 years, question pathologic lead point
•target signs/ doughnut sign: is generated by concentric
alternating echogenic and hypoechogenic bands. The
echogenic bands are formed by mucosa and muscularis
whereas the submucosa is responsible fo the hypoechoic
bands.
•Pseudokidney: of intussusception refers to the longitudinal
ultrasound appearance of the intussuscepted segment of bowel.
The fat containing mesentary which is dragged into the
intussusception, containing vessels, is reminiscent of the renal
hilum, with the renal parenchyma formed by the oedematous
bowel.