The document discusses the author passing their FRCR final examination and sharing their exam cases. They provide a summary of their rapid reporting cases which included fractures and injuries. They also provide more details on several long cases they reported on involving tumors, infections and trauma. The author asks for feedback on any mistakes and says they will upload their viva cases in a separate post. They thank everyone and wish to improve.

1. Dear Friends,
I am pleased to share my happiness of passing FRCR final examination with god’s grace.
I sincerely thank Dr Girish Kukade for guiding me to do better in RR module. Needless to say, it
was great support from my wife during entire phase of exam preparations.
I am uploading my cases. If there are spelling mistakes or sentence errors, please forgive me.
Rapid reporting:
I got 15 positive in rapid reporting.
1. Slipped capital femoral epiphysis
2. # proximal phalynx of the ring finger
3. Hamate #
4. Avulsion # of the talus
5. # distal fibula
6. # inferior pubic ramus
7. Coracoclavicular ligamnent disruption with ACJ dislocation
8. # angle of the mandible
9. Radial head # with positive posterior fat pad sign
10. Distal radial #
11. L1 # on a lateral lumbar spine
12. Pneumoperitoneum
13. # neck of right femur
Other two I am not able to recall.
It is important to mention the side, however I do not remember them.
One most useful principle in rapid reporting that is mentioned in the Northwick park rapid
reporting course.
Do not overcall. Apply the “Eureka! I have definitely found it!” principle.
Long cases
1. Young patient with proptosis: Pre and post contrast T1 axial and coronal section, single image
of each series: Enlarged enhancing cavernous sinus with enhancing soft tissue in the right orbital
apex- Tolosa hunt syndrome
2. CECT abdomen and MIBG scintigram: Right adrenal neroblastoma in a child with right
acetabular metastasis, both were hot on MIBG.
3. Axial CECT Abdomen in a patient with haematuria: Right RCC with renal vein and IVC
invasion. There was large left adrenal mass-metastasis. There was one small enhancing soft
tissue density mass in the left kidney, which also probably RCC.
4. Mammogram: Multicentric right breast carcinoma, one of them contained microcalcification.
5. CECT abdomen: Multiple small hypodense lesions in liver and spleen with few enlarged
peripherally enhancing lymph nodes, Focal destruction of L1 with left small paravertebral
abscess. There was also loculated collection anteriorly showing peripheral enhancement and one
of them contained air. Gave the possibility infection, likely tuberculosis / pyogenic.
6. Haemoptysis and H/O fall. CECT chest
Right Hydropneumothorax with complete collapse of the lung. Multiple air space opacities in the
left lung, possibly contusions. Although I gave diagnosis secondary to trauma with possible
bronchopleural fistula, there was no rib fractures, no soft tissue swelling. Thus I gave alternative
possibility of infective process. Funny case, I had no other clues.
I am uploading my viva cases as separate post
Dr. Rajagopal KV
Kasturba medical college, Manipal

2. dr.Manal's oral exam:
case 1 chest hilar mass cause left upper lobe collapse my diagnosis B carcinoma most lokily
inoperable due close to mediastinum .
> case 2 ct abdomen liver arterial mets mass in the mesentery carciniod octroscan.
> case 3 ped chest pa dysplesia premature with surfactant SDD .
> case 4 ct abdomen wilms tumor with IVC thrombus.
> case 5 dorsal spine two vertabral collapse for DD . lytic lesions on skull MM what next BJ
protein in urine & lelectrophoresis .
> case 6 chest cavitating lesion DD & ct peripheral lesions septic emboli for fungal infection.
> case 7 chest anterior or med mediastinum mass no radiological signs of malignancy CT
paraterical cyst bronchogenic .
> case 8 expansile lytic on c 6/7 on AP CVS dd ABC mri .
> case 9 ped chest lul consolidation dd
> case 10 ct ped brain enhanced lesion adjacent to pterous bone abscess or tumor for
diffusion mri.
> case 11 chest non cardiogenic pul oedema for DD.
> case 12 ct brain no contrast SAH what next what complicaton. what are causes most commens
sites of brain ANU .
> case 13 skull ped NAI why type of fractures multiple , dirctions & wide due to HG . CT braion &
sk survey .
Dear Friends, i am uploading my cases.
Rapid reporting:
I alot of positive in rapid reporting.
1. Slipped capital femoral epiphysis
2. # proximal phalynx of the ring finger
3. Hamate #
4. Avulsion # of the talus
5. # distal fibula
6. # inferior pubic ramus
7. Coracoclavicular ligamnent disruption with ACJ dislocation
8. # angle of the mandible
9. Radial head # with positive posterior fat pad sign
10. Distal radial #
11. L1 # on a lateral lumbar spine
12. Pneumoperitoneum
13. # neck of right femur
14 metaphseal fx
15 skull fx
16 fx raduis i think that was wrong
Other two I am not able to recall.
Long cases
1. Young patient with proptosis: Pre and post contrast T1 axial and coronal section, single image
of each series: Enlarged enhancing cavernous sinus with enhancing soft tissue in the right orbital
apex- i said caverenous sinus thrombosis
2. CECT abdomen and MIBG scintigram: Right adrenal neroblastoma in a child with right
acetabular metastasis, both were hot on MIBG.
3. Axial CECT Abdomen in a patient with haematuria: bilateral RCC with renal vein and IVC
invasion. There was large left adrenal mass-metastasis. i said bilateral RCC or VHL.
Mammogram: Multicentric right breast carcinoma, one of them contained microcalcification.
5. CECT abdomen: Multiple small hypodense lesions in liver and spleen with few enlarged
peripherally enhancing lymph nodes, Focal destruction of L1 with left small paravertebral
abscess. There was also loculated collection anteriorly showing peripheral enhancement and one
of them contained air. Gave the possibility infection, likely tuberculosis / pyogenic AND I
MENTIONED FIRST LYMPHOMA

3. 6. Haemoptysis and H/O fall. CECT chest
Right Hydropneumothorax with complete collapse of the lung. Multiple air space opacities in the
left lung, possibly contusions. PATIENT WAS OLD AND FALL SO I GAVE DIAGNOSIS O
OESOPHGEAL TEAR
I am uploading my viva cases as separate post
DEAR FRIENDS I'M SENDING VIVA COS I THINK I DID WHAT I CAN TO PASS BUT THEY
GAVE ME E IN VIVA AND F IN RAPID REPORTS I DON'T KNOW WHERE MY MISTAKE
i hope anyonE tell what is my mistakes i'll try to send all it but you know i'm old and no memory
viva A
2 exprienced drs and they where too too nice and encouraging
first film plain x-ray and was scerlotic head of the right hip and described and said avascular
necrosis said why i asked about or operation he said there was trama and i saw serotic line as fx
and i pointed so relaease allahmdoullah
second case was also chest x-ray i saw longtuidinal lines along the mediastium and trachea and i
described well i felt that the dr pleased really i'm not sure however he asked about the reason and
i concentrated on abdomen i saw opaque shadow i told him that i saw that may barium i was
surprised he told me that is barium and i saw also as stent he mentoned that to me of course of i
lost degree for that told me he was ca oes-phagus and i told him in hurry that i didn't see that
before and i think for sick of patient to eat
third case was pelvic x-ray bilateral sclerotic SIJ WITH WELL-DEINED sclerotic egde lesion and
he point for symphsis pubis joint and i told him same as SIJ and i told him it is seondary
hyperparathyroidism asked about what we can do i told him go for isotope and then told we don't
have i asked for U/S
FOURTH CASE BRAIN WITH LEVELING SUB-DURAL AND OF COUSRE COS OF THE EXAM
I TOLD ONE SUB-DURAL AND SUB-ARACHNOID AND HE TOLD ME WHICH ONE I SAID
SORRY FOR DISTRIBUENCE AND I SAID SUB-DURAL
fifth case chest x-ray i saw left lung field longuidinal structures then afetr time i said it is more
vascularity than right and said it is right hypoplasia of pulmonary artery he asked about syndrome
as he was young and he wasn't suffer anything i told hypo-plasia i can't recall syndrome and said
sorry
sixth case was x-ray thumb i saw irregul in distal phalaynx and i told me nothing than i asked aout
base metacarpal and really i didn't see anything except small fissure in the base asked in the ap
postion i said i can't see it
seventh case shows x-ray knees i saw as radiolucent lesion in the right knee told me may be
osteochondrtitis dissecans both stooped speaking and i think wrong and then told me look at
femur i didn't see anything so pass
eigth case right para-vertbral mass as in which part and told it is pra-vetebral mass with sclloping
of the right vetebrae and give me the CT and time finished without diagnosis but seems it is
benign i hope some one give me diagnoiss
before there was small chest for child air broncho-gram lesion i said consilationd due to
penuomina and mentioned the organism
viva B
first film x-ray chest with right apical pan-cost and left pneumonic changes
second case abdomen x-ray shows thickend small bowel and he told look more i saw radiolucent
leosn symmetrical in pelvic bone i told may it hperparathyoidism and he said what to do i said
again isotope or U/S he gave me isotope and i said it is hyperparathyroidism lesiosn all over the
body

4. third case parotis U/S i saw right and he point for left to i said it is bilateral benign lesion i can't
recall the name and he said it is urgent for maligncny i said it is not and confirm with FNAC
FIFTH CASE u/s TESTIS OF microlithasis and i told it transfare to seminoma some follow up
some do orchiecomy i said twice that aggrressive
another case sixth benign with isotope and shows low position kidney with nephrostomy and alot
of isotope in abdomen, right kidney not seen i asked about removed right kidney he said no i
mentioned i can' read more of isotope and i tried to give some diagnosis and he said you told you
don't read much of iostop and took the film away
seventh follow through barium and multiple polyps no colon with pouch in the front of the film i
thought first it is fisulla and crohn's but she shows me stoamch with multipel polyps and i told
colonectomy with ileal pouch cos of FAMILIAL POYPOLYSYS
ABDOMEN X-RAY WITH bilateral renal stones air in the kidney i told emphysmatous
pyleoephritis and she asked to see more i saw urinary bladder and uerter air she asked why i told
her infection from operations or post-partum in young female
eight case sagittal cervical with cord cyst i forget the name
ninth case right anterior opacity she have me lateral and the end after long time i gave here
diagnosis of rt atrium and pectus exacvatum
10th case chest x-ray with oxygen tube i did't know name and i said it is aspirations pneumonia
after he told me he is ill
11th case plevic ankylosing spondolitis of end stage
I DON'T KNEW WHY I GOT E IN THESE EXAM PLEASE INFORM ME TO IMPROVE MY SELF
THANK YOU TOO MUCH
Hello everyone,
Here are few fundas that i learnt during my april preparation and attempt (which i mercifully
cleared).This input is based on my experience and also of candidates who were answering with
me.
-I question the utility of discussing viva and long cases put up in the past as the pathology and
presentation is so variable, tht grinding up the old cases doesnt help. One of my vivas was solely
on a single enema film with some mucosal crinkling. I doubt if any anyone mentioned a similar
case throughout the srt archives. so a piece of advice; use the past cases only to judge the
degree of difficulty of the exam n nothing else. Hanging on to hope that cases will be repeated
would be short-sighted.
-The key to a good viva performance is recognizing the abnormality on the very first film, usually
a radio graph. Hence a sizable proportion of ur prep shud be devoted towards plain films, usually
chest and abdomen.Ur score will fly thru the roof if u manage to detect the abnormality on the
xray itself. The examiners will guide u to it in case u miss it. Their doin so doesnt mean ur flunking
out. If u latch on to their hints and get the diagnosis, u ll be fine.
-Another not so well documented issue in previous blog posts is extra-radiological manifestation
and management of a case. I was questioned on lab parameters in TB and sarcoid in 2 separate

5. vivas. More importantly, after reaching every diagnosis, U will be asked-'What will you do for this
patient?'Your answer shud either involve a further meaningful radiological investigation and/or a
referral to an appropriate clinician. Do not forget stating this esp in an emergency case. Make
saying this a habit wen u practice presenting cases with ur study partners.
-Avoid rattling out crammed DDs once u recognize a disease pattern (eg: miliation). Ur D.Ds shud
be relavant to age and clinical presentation. Easier said than done tho. Nevertheless, do not
hesitate to ask for those details. The examiners will be happy with 2 or 3 diagnoses as long as
they are applicable to that film. The best last minute cramming book is eisenberg, simply coz it
also contains images.
-Cram the contraindications of radiological procedures (eg biopsy in a pheochromocytoma or high
osmolar contrast medium for a pediatric upper UI study). These are blunders which cannot be
forgiven no matter how well u do in other components of the exam. The prime goal of RCR is to
assess the safety of ur practice rather than brilliance.
Lastly the pass score of each of the 3 components is 8. Now, while i do not know wat the
maximium score is or how this number is arrived at, wat i am sure about is that u dont need to
pass each module separately. U can score an 7 in RR and hit a 9 in long cases n still clear as
long as u hit the magic no of 24. However, if ur score is too low in one of the components ( say a
4), it then becomes very difficult to dig urself out.
Hope this helps.........good luck
Thats a very important point you have brought out Dr Dinesh.In my viva also i was asked about
pathology of gall stone formation in case of hemolytic anemias and management in every case.
I did not clear the exam this time but i thought it will be helpful to share my experience here.
I felt that the exam cases were not too difficult,so just reaching the diagnosis is not what they
want. But i feel that probably what they are looking for is that you pick up 100% findings on the
radiograph, impeccable description, only relevant differentials, most probable diagnosis, and
management. and for every statement we need to reason it or justify it.
I feel what is required is :
continuous practice by either reading out films to a friend or to yourself rather than just reading
books.
read a bit about clinical aspects and management of commonly encountered cases in the exam.
and go through the list of previous cases posted on this site they are good to know about the
commonly asked cases.
finally luck is also important in this exam as any other exam, at least it is one thing we can always
blame to reassure ourselves
Best of luck to me and others who are appearing exam the next time.
Its truly tragic that capable rads like Rania or Mateen dont get through. I was around them in one
of the courses n they both were extremely sound conceptually and appeared yards ahead of the
rest. it just proves the luck factor of these exams.
Mateen is also right about reading out films to others.I was very lucky to have found a study
partner 10 days b4 the exam. She was a sharp torpedo who also cleared. But at tht time, both of
us were horribly under prepared. all we did was go thru the images in texts n presented them to

6. each other as one would in the exam. Tht got us into the habit of spontaneous description which
is critical to set the ball rolling in the vivas.
If possible, try to get a study partner who has trained in a different institution coz frankly we all
receive variable skills. I am good with HRCT but suck at interventions while my study partner was
exactly the opposite. Hence thru out the time we both coached one another on basics the above
topics. This served to build our knowledge bank.
A peculiar thing happened to several of the candidates in vivas.Most of us performed very well on
the first table and crashed in the 2nd. Its an odd feeling coming out of 1st viva feeling like a
heavyweight champ only to undergo a body cavity examination in the next. So be prepared for
this quirk.
Lastly a word about some of the courses i attended:
Newham (held 3rd n 4th april): They have a huge archive of RR cases which are a bit too easy
and often repetitive, but yield good practice. The long cases are good too, but it involves self
assessment. ur long cases arent marked by anyone n all u get is an answer sheet to compare ur
performance with-not good enuf, but then u are paying less for the course too. The Vivas were a
let down. Two of the examiners were awesome while the rest werent. so for those who were lucky
to land up on an 'awesome' table, the course seemed worthwhile. Also the vivas are held in
groups rather than in a stand alone fashion, altho only one candidate gets grilled at a time. This
splits the assessment time u have with examiner by a factor of 1/2 to 1/4, so please be aware of
that. Now compare all this with the Leeds course. It is more expensive, lasts 3 days, is held a
month b4 exam, u get two examiners per candidate (just the way it is in the exam)and individual
scores for all modules including long cases.
last minute revision course at stanmore: No long cases here. RR was the pits. most cases were
too difficult with odd views used for subtle fractures (this doesnt happen in the exam) and several
abnormal ones were wrongly labeled as normal. Also the results for RR are discussed at the end
of the day on a bad quality projection system and we were not allowed to review the cases on the
reporting consoles.like i said..its the pits. The main focus remains on the Vivas. i was lucky to get
a a very senior ex-frcr examiner who was phenomenal (a good examiner trains u in the technique
of answering rather than the content n she did tht very well). But other candidates did not have
great things to say about their viva teachers be it the assessment or feedback.
For those who are attending preparatory courses, pay strong attention to the answering tips
provided by the examiners but take their final assessment of ur performance with a pinch of salt.
They wont tell u after a bad performance, tht u are headed for flunkland. Instead they are more
likely to belt out a 'you will be fine'. so dont be falsely reassured with a positive feedback. Keep
working hard to erase the deficiencies in ur viva technique.However, the tips they provide are
useful. For example, i was coached to ask for a control film every time i am given a 5 min
urogram. I did tht in the exam n picked up paravertebral calcifications with a hydronephrotic
kidney. Diagnosis-TB kidney. Retrospectively the calcifications were just not visible on the 1st
film. Another tip-if u see a topogram/scanogram on a ct fim, look at it b4 anything else. Its been
put there for a reason and may reveal an enlarged pituitary in a case of sheehans syndrome, or a
vertebral changes of sickle cell disease...........
cheers
my VIVA CASES WHERE :
1- WHITE LINE PARALLEL THE CARDIAC BORDER AND EXTEND ABOVE CLAVICLE
DIAGNOISS : PNEMOMEDISTINUM DD: LUNG TEAR , ESOPHAGEAL TEAR , BRONCHEAL
TEAR , ASTHMA , VALSALVA MANUVERE .
MANAGMNET : REFER TO CARDIOTHORACIC SURGEN
2- UPPER GI CONTRAST STUDY : PART OF SMALL BOWEL SEEN AS WELL AS PART OF

7. LARGE BOWEL ASK FOR OTHER VIEWS DIAGNOSIS WAS FISTULA DUE TO CHRON
3- ivu BILATERAL MEDULARY CALCIFICATION DIAGNOSIS MEDULLARY SPONGE KIDNEY
ASK ABOUT RENAL FUNCTIION TEST IS IT NORMAL OR ABNORMAL
4- ct BRAIN :HYPERDENSITY IN SULCI DIAGNOSIS SUBARCHANOID HEMORRHAGE
MANAGMENT CT ANGIO AND REFFER TO NEUROLOGIST
5- LOWER GI contrast study descrption: granuler and leed pipe of decending colon diagnsosis
:ulcerative colitis he ask me pt develop pain after procedure are you going to discharge him i said
i will do abdomin radiograph to check for pnemopertonum and the n i saw the pnemopertonum in
the same film he showed me but it was decubitus so it was on the side of spleen
6- chest x ray : right upper lobe caivitary lesion in child it was abscess managmnet drainage
under ultrasound guidence
7- right shoulder x ray in 70 yrs old women : sclerotic lesion seen in the rib i ask for full view of
chest it was breast mestastais
8- chest x ray with medistinitis due to radiation and right lower lobe opacity it was breast implant
9- lower tibia x ray : paget with secondary osteosarcoma
10-upper GI study of stomach : irrguler narrowing of stomach diagnsosi linitis plastica due to
gastric carcinoma
11-MRI cardic : interventriculer septal thickening diagnsosis hyperatrophic cardiomyopathy
12-posterior medistinal mass DD NEUROGENIC TUMOUR OR ESOPHAGEAL PATHOLOGY
ASK FOR LATERAL CONFIRM POSTERIOR AND THERE WAS POSTERIOR SCALLOPING
SO IT WAS NEUROFIBROMATOSIS
13-LUMBER SPINE AND HAND X RAY PSORAISIS
14- XRAY ABDOMEN : DILATED SMALL BOWEL AND STONE :GALLDTONE ILEUS ASK FOR
ABDOEMN ct CONFIRM DIAGNSOSIS.
15- CONGENITAL LOBER EMPHYSEMA MANAGMENT IMMEDUATE REFFEREAL TO
PEDIATRIC SURGEN
16- HAND X RAY 2ND METACARPAL SUNBURST PERIOSTEAL REACTION :
OSTEOSARCOMA
17 :
CHEST XRAY : OPACITY WITH SOLITARY NODULE ? BRONCHOGENIC CARCINOMA WITH
METS
I DONT REMEMBER THE REST
lONG CASES :
1- NEUROBLASTOMA ( MIBG :INCREASE UPTAKE ) , 2-MAMMOGRAM : BREAST ca WITH
MICROCALCIFICATION , 3- TB ( LIVER HYPODENSITY + PSOAS ABSCESS ) 4-RENAL CELL
CARCINOMA WITH LEFT ADRENAL METASTAISS AND IVC THROMBUS 6- ESOPHAGEAL
RUPTURE OR TEAR
RAPID REPORT ALL STRAIGHT FORWARD EXCEPT 4 :
RIGHT MASTECTOMY , OSTEOCHONDRITIS DISSECANS IN KNEE JOINT , RIGHT
FEMORAL NECK FRACTURE , ODONTOID FRACTURE
Here are my cases, hope it will be helpful to u all.
Sameer’S FRCR 2B April 2010
Rapid Reporting Positive Cases:
1. # 4th MC neck
2. Pelvic mass displacing bowel on AXR
3. Rt paratracheal L/N
4. Rt suprahilar mass on CXR
5. Rt Pneumothorax ( subtle apical)
6. # Scaphoid

8. 7. # OsCalcis
8. # Triqueteral on lat
9. Impacted distal radial fracture (subtle)
10. Greenstick # distal radius
11. # Lt NOF on pelvis
12. Ant dislocation shoulder (looked post on AP-lightbulb but clear on Y-view)
13. # Greater tuberosity humerus
14. Lt inferior orbital wall fracture
15. Lipohaemarthrosis on lat knee
16. Ext avulsion # distal phalynx (subtle but obvious on zooming)
17. Pars defect L5/S1
Long cases:
1. Trauma CT Brain:
• Bifrontal EDH + mass effect, splayed ant horns, uncal and sub-falcine herniation
• Subdural extension
• Bn window: # frontal bone
2. IVU: Control, 15min and 1hr. DTPA renogram with a postvoid image showing full bladder. %fn
Rt-46 and Lt 54
Dx: Lt hydronephrosis + Lt VUJ calc
DDX: calc, clot or tumour
3. MRI Spine: Thoraco-lumbar TB discitis with paraspinal abscess and extradural spinal
extension
4. 11yo Haematuria:
CT RK- heterogenous lx, almost in renal pelvis and not cortex. Retrocrural L/N. No renal v / IVC
invasion. Pulm and Bony mets on windowing.
MR spine: bone marrow mets and spinal extension
5. CXR: RLL – lymphangitis carcinomatosa
CT: lt eye-prosthesis (? Malg melanoma), enhancing mass in the floor of 4th ventrical
6. CT abdo:
Acute on chronic pancreatitis( pancreatic calcifications), pseudopancreatic cyst with contrast
gushing in the centre of cyst. Significant peripancreatic fat stranding and fluid tracking along
gastro-splenic and gastro-colic ligaments
Lt Gastric aneurysm rupture as a complication of acute pancreatitis. (Clinical history:
haematemesis, on and off pain abdomen for 6 months)
VIVA Cases
1. CXR: foreign student; B/L upper lobe patchy consolidation with 2 cavitating lxs: TB
? next, said will call GP and asked to do contact tracing and segregate the pt.

9. 2. CXR: apical Pneumothorax and Pancoast Tx with 1st rib erosion (apicogram for confirmation!
Surprised I picked it on the CXR)
3. Bone scan: multiple mets and a left tibial longitudinal thick uptake; asked for plain film
correlation; Paget’s with multiple mets.
4. US: AML in kidneys followed with a CT confirming the same alongwith hepatic low density
lesions; suggested Tub Sclerosis and said would also do CT Chest; examiner put up a CT which
showed LAM. Discussed all features of TS
5. CXR: morgagni hernia (confirmed on lateral; asked me to show how would I systematically
evaluate a Lat CXR)
6. Babygram with dilated bowel loops ( said larger than the heights of vertebral bodies) no
pneumoperitoneum/ intramural gas – but asked how would u confirm said a lat decubitus and was
given the same which had free gas ! discussed management of NEC and how often would you x
ray babies?
7. CT brain: Plain – sup sag sinus thrombosis on higher slices, no haem infarcts. Said will do a
venogram, got a 3D MIP which confirmed SSST. Asked to show venous anatomy and asked how
would you manage clinically- said urgent neuro referral and thrombolysis -? Intraarterial said
clinicians would decide on the local protocol and expertice ( in a way said don’t know !!! but
examiner happy and told me that they wuld do in their centre)
8. CT Brain: low density lesion in left thalamus, rest normal. Suggested neoplasm or granuloma
and unlikely to be infarct as whole thalamus involved and neither ACA or PCA territories show
other signs of infarcts. Would do a CE MRI…Bell rang ooooops
9. Foot XR - AP: lacy trab pattern with granumolas – sarcoid asked for CXR which showed B/L
hilar L/N ------hurray my best case
10. AXR: gallstone ileus with pneumobilia: CT confirmed the same
11. AXR with 2 transplant kidneys; both calcified and another line of surgical clips suggesting a
fresh transplant. Looked at native kidneys, looked big with large low density lesions; suggested
ADPCKD and an ultrasound to confirm, which was seen on the CT. Also patient had rugger
jersey spine – renal osteodystrophy.
12. CT Brain: Acute Rt MCA infarct with dense MCA; discussed stroke imaging use of DWI/ADC
mri and perfusion CT principles.
13. AXR: paed: intususception: with US showing interloop fluid; discussed contra-indications for
air reduction
14. Hand XR: enchondroma with fracture
15. 4th/5th MC base dislocation
16. Lumb Sp AP: GP with c/o back pain; irregular pedicle, asked for lat which showed soft tissue
mass displacing aorta anteriorly, suggested lymphoma, CT confirmed nodes. Asked how would u
further proceed, said biopsy, asked me to show my approach, said do pre-procedure checks n bx
with prone position and showed a spot, said that’s where they biopsied !!! some days u seem to
have goodluck going your way !!!
17. CXR: Convex bulge to left hemi-diaph, suggested sub-pulmonic effusion, subphrenic abscess

10. asked for a CT got us confirming an abscess.
18. CXR: rt mastectomy + military nodules, said breast cancer with military mets; asked for all
differentials
19. CXR and HRCT Sarcoid
20. Small bowel Followthrough: Coin stack appce; said scleroderma and lymphoma as
differential, said would do an upper GI study in the same sitting, then got a dilated esophagus
image! Said scleroderma, will look for patients hands and all available imaging in routine practice.
21. CXR: Lt hilar mass: GP film discussed on further Mx-routine story !
22. CT Brain: subtle subdural ( isodense bifrontal), further management.
Goodness me, finished atlast !!!!!!!!!!!