Findings and interpretation:

• There are ill defined ground-glass centrilobular nodules in both lungs with a generalised distribution.
• There are a few mildly enlarged mediastinal lymph nodes.
• There is mild nodular pleural thickening in the left hemithorax.

Pertinent negative findings:

• No areas of consolidation in the lungs.
• No pleural effusions.

The findings represent acute inflammation of the lungs at the bronchiolar level.

Principal diagnosis:

Sub-acute hypersensitivity pneumonitis

Differential diagnosis:

• Respiratory bronchiolitis – interstitial lung disease (this typically shows sparing of the lower lungs and bases)
• Infectious bronchiolitis

Management:

Review clinical notes for history of possible exposure to organic allergen/ history of smoking.

Refer to respiratory physician for further management.

Findings and interpretation:

• The thalami are hypo-attenuating and enlarged in size bilaterally indicating parenchymal infarction, with compression of the third ventricle by mass effect and causing obstructive hydrocephalus at that level with dilatation of the lateral ventricles.
• Generalised sulcal effacement indicating brain edema.
• Hyper-attenuation of the deep cerebral veins, vein of Galen and straight sinus, indicating venous sinus thrombosis.

The findings indicate venous infarction of the thalami caused by thrombosis of the deep cerebral veins.

Principal Diagnosis:

Deep cerebral venous thrombosis with bilateral thalamic infarction

Differential diagnosis:

None

Management:

Urgently alert referring medical team and inform of diagnosis.

Immediate administration of intravenous thrombolytic agents should be performed.

Findings and interpretation:

• There is an amorphous lesion in the body and trigone of the right lateral ventricle, appearing hyperintense on both T1 and T2 weighted images, and showing suppression on the T1 fat saturated images. These characteristics indicate that it contains material of a fatty nature.
• Foci showing the same signal characteristics are seen in the lateral ventricles, aqueduct of Sylvius and 4^th ventricle, within the subarachnoid space and insinuating into the cerebral and cerebellar sulci, and in the CSF cisterns including the pre-pontine cistern.
• There is dilatation of the lateral ventricles, most likely due to obstruction of the foramen of Monro by the material, leading to obstructive hydrocephaly and consequent T2 hyperintensity of the peri-ventricular white matter.
• There is midline shift to the left caused by disproportionate dilatation of the right lateral ventricle.

Pertinent negative findings:

• The lesion shows no enhancement on the post contrast images.
• There is no meningeal enhancement to suggest meningitis.

The lesion in the right lateral ventricle containing fatty material is a dermoid cyst, which appears to have ruptured causing dissemination of the fatty material throughout the CSF spaces; this has caused blockage of CSF flow, leading to obstructive hydrocephalus with consequent periventricular white matter gliosis and midline shift by mass effect of the dilated right lateral ventricle.

Principal diagnosis:

Ruptured intracranial dermoid cyst causing obstructive hydrocephalus.

Differential diagnosis:

• Intracranial lipoma; may contain calcifications; rupture is extremely rare.
• Teratoma; rupture is extremely rare.

Management:

Alert referring physician of findings.

Recommend urgent neurosurgery referral for CSF shunting.

Findings and interpretation:

Knee radiograph:

• There is a well defined, eccentric bony lesion in the proximal tibial metaphysis with a narrow zone of transition and a sclerotic border. However, there is ill-defined sclerosis at the superior margin of the lesion.
• Pertinent negative findings: There is no periosteal reaction adjacent to the lesion. No bony destruction.

MRI:

• The well defined bony lesion is surrounded by dense cortical bone with T2 hyperintensity in the central component.
• Immediately superior to this lesion there is thickening of the cortex with periosteal reaction. There is a central, small, well defined round lesion in the thickened cortex, which is hyperintense on T2. In the surrounding bone there is significant STIR hyperintense signal.

Pertinent negative findings:

• No soft tissue mass. No cortical/bony destruction.

The findings represent two bone lesions, both of which are non-malignant. One of these lesions is causing inflammation and edema in the bone.

Principal diagnosis:

Non-ossifying fibroma and osteoid osteoma

Differential diagnosis:

• Stress fracture (however, the finding of a nidus is strongly suggestive of osteoid osteoma)

Management:

Alert referring physician of findings.

Recommend radiofrequency ablation of osteoid osteoma.

No management is required for the non-ossifying fibroma.

Findings and interpretation:

• There is concentric, irregular aortic wall thickening at the ascending aorta and aortic arch, as well as the proximal descending aorta.
• There are multiple small atherosclerotic ulcers along the aortic arch and descending thoracic aorta.
• There is a moderate sized mediastinal haematoma.
• There is a mild left haemothorax.
• There is basal interlobular septal thickening and ground glass opacification, more on the left side, as well as thickening of the fissures. This is caused by fluid retention, indicating interstitial pulmonary oedema.

Pertinent negative findings:

• No intimo-medial dissection flap.
• No aortic pseudo-aneurysm.  

The findings indicate haemorrhage into the aortic media, likely from atherosclerotic ulcers.

Principal Diagnosis:

Aortic intramural haematoma.

Differential diagnosis:

Aortic dissection (however, there is no intimal flap).

Management:

Urgently contact the referring physician and inform of findings, as this constitutes a surgical emergency (this is part of the acute aortic syndrome spectrum, and can rapidly progress to dissection and rupture).

Urgent cardiothoracic surgery referral is indicated.

Findings and interpretation:

• The gastric pylorus is thickened, and has a target appearance in transverse section.
• The muscular layer of the wall is hypoechoic. The walls are thickened, measuring 4mm circumferentially.
• The length of the pylorus is 19mm, and the transverse thickness is approximately 13mm.

The findings represent congenital thickening of the pyloric muscle.

Diagnosis:

Congenital hypertrophic pyloric stenosis

Differential diagnosis:

None

Management:

Urgently contact referring physician and inform of findings.

Recommend referral to paediatric surgery for surgical management.