CASE 1: 60-year-old female with shortness of breath and intermittent chest pain. Axial CTPA demonstrated faint peripheral areas of non-opacification of the right middle lobe segmental pulmonary artery thought to be secondary to pulmonary embolism on the preliminary report. This is favoured to be secondary to cardiac motion artifacts with partial volume of the adjacent pulmonary parenchyma mimicking a filling defect. The differential diagnosis of chronic thromboembolic pulmonary hypertension (CTEPH) was raised and would be best demonstrated on modalities such as VQ scan or MR pulmonary perfusion/MRA. Final diagnosis – No pulmonary embolism. No features of CTEPH. False positive CTPA study.
CASE 2: An 87-year-old female with chest pain, hypertension who was diaphoretic. History of sternotomy, ascending aortic aneurysm and aortic valve repair 6 months prior. Preliminary report recognises the presence of surgical material at the proximal arch with dense coronary arterial calcifications. A moderate volume pericardial effusion was present overlying the left ventricle and was thought to be stable post-operative changes. The preliminary reports concluded with no aortic dissection and moderate volume pericardial effusion. The presumed 98 X 30 mm posterior pericardial effusion is hyperdense (46 HU), with a small focus of contrast extravasation (no corresponding calcification on pre-contrast CT) detected arising from a small OM branch overlying the basal inferolateral left ventricle. The pericardial effusion is loculated, causing mass effect by effacing the left ventricular apex, which was concerning for haemopericardium and cardiac tamponade.
CASE 3: A 53-year-old male with a fall 2 weeks ago presented with a constant headache. Non-contrast CT head coronal and axial images demonstrates a left cerebral convexity isodense subdural haematoma and non-displaced fracture of the left temporal bone which were not seen by the reporting registrar and was subsequently identified by the radiologist the next morning.
CASE 4: CT thoracic spine on an elderly nursing home resident presented with mid thoracic spine tenderness following a fall. Multilevel fractures involving C7, T1, T2 and multilevel insufficiency fractures of the thoracic vertebra were identified. Failure to compare with available prior studies resulted in the lack of appreciation of the new C7/T1 fractures. Old sternal fractures in two places are also noted.
CASE 5: Elderly patient with unwitnessed fall and delirium. Non-contrast CT head. Small focus of hyperdensity overlying the left frontal lobe middle gyrus was not identified by the registrar in keeping with traumatic subarachnoid haemorrhage. Note is made of subtle thin bifrontal isodense subdural hygromas. Careful windowing to demonstrate subtle density differences between the CSF and extra-axial collection is suggested.
CASE 6: History: acute confusion. Possible recent fall. Lump on left forehead. Exclude bleed. The preliminary report concluded there was no acute intracranial haemorrhage or fracture. A small left frontal scalp haematoma was identified. A partial effusion of the right mastoid air cell was missed. A non-displaced longitudinal fracture of the right temporal bone without otic capsule involvement was identified subsequently. Small gas locules within the sigmoid sinus with suspicion of sigmoid venous sinus thrombosis prompt subsequent MR evaluation. The fracture is better appreciated on MIP images. Subsequent MR brain of the same patient demonstrated a small subdural haematoma indenting the transverse sinus. No Dural venous sinus thrombosis.
CASE 7: Portal venous CT abdomen and pelvis of a 74-year-old male with 1 day history of left sided abdominal pain. The registrar correctly identified an epiploic appendagitis of the mid distal descending colon (coronal image). However, a left lower lobe segmental pulmonary embolism was not seen at the edge of the scanned volume. This was recognised by the radiologist and confirmed on subsequent CTPA.
CASE 8: History provided: 60-year-old female with vertigo. Peripheral vs. central. Non-contrast CT demonstrated no intracranial bleeding was concluded in the preliminary report. Dehiscence of the right superior semicircular canal was subsequently identified, raising suspicion of superior semicircular canal dehiscence syndrome.
CASE 9: GCS 8 post neck of femur fracture surgery. Reduced movements on right upper and lower limb and equivocal right plantar reflex. CT head to exclude haemorrhage or stroke. The registrar did not identify the small wedge-shaped hypodense area of the superior aspect of the left parietal lobe along the intraparietal sulcus. Loss of grey-white matter differentiation at the cortex with effacement of the adjacent sulcal spaces are demonstrated, correlating to the clinical history, consistent with an acute infarct.
CASE 10: Right occiput fracture and underlying extradural haemorrhage. Exclude transverse sinus thrombus. CT head venogram demonstrated a right occipital epidural haematoma which is stable in size compared to the initial trauma CT head. The registrar did not identify a venous sinus thrombosis. Subsequently, the radiologist identified a partial filling defect within the right transverse sinus which was not appreciated on previous CT and MR images 1 year prior, along with non-displaced fracture at the site in keeping with a non-obstructive transverse sinus.