Findings and interpretation:

• There are multiple, T1 hypointense and T2 hyperintense thin walled cysts in the liver. These follow the distribution of the bile ducts.
• Some of the cysts have central, linear hypointense structures running through them.
• On MRCP, the cysts appear to communicate with the biliary system.

Pertinent negative findings:

• There are no stones in the biliary system.
• The cyst walls do not enhance.
• There are no bile duct strictures.

The findings represent saccular dilatation of the intrahepatic bile ducts. Some of these have portal radicles running through them.

Principal diagnosis:

Caroli’s disease

Differential diagnosis:

• Biliary hamartomas
• Primary sclerosing cholangitis

Management:

Review previous imaging (Caroli’s disease is congenital, and would be present on previous imaging).

Recommend discussion at hepatobiliary MDT with regards to further management.

Findings and interpretation:

• There is loss of T2 signal in the L4/L5 and L5/S1 intervertebral discs, which also show reduced height and posterior bulge.
• There is posterior central protrusion of L4/L5 intervertebral disc, which is herniating into the spinal canal at that level and causing complete CSF effacement of the thecal sac.
• There is significant narrowing of the spinal canal at that level.
• The cauda equina nerves cannot be separately identified at that level.

The findings represent significant compression of the cauda equina nerves by herniated intervertebral disc material.

Principal diagnosis:

Cauda equina syndrome

Differential diagnosis:

None

Management:

Urgently contact the referring physician / neurosurgeon to perform decompression surgery.

Findings and interpretation:

• There is widespread cylindrical and varicoid bronchiectasis, predominantly in the upper lobes bilaterally and right middle lobe.
• Some of the bronchi show mucus plugging, with adjacent centrilobular nodules, giving a tree-in-bud appearance.
• There are some patchy, subsegmental areas of consolidation in the right middle lobe and apex.

Pertinent negative findings:

• There are no pleural effusions.
• No obvious liver cirrhosis.

The findings represent upper lobe predominant bronchiectasis with active pneumonia.

Principal diagnosis:

Cystic fibrosis with endobronchial infection

Differential diagnosis:

• Allergic broncho-pulmonary aspergillosis

Management:

Alert referring physician of findings.

Infective exacerbations of cystic fibrosis are treated by intravenous antibiotic regimens. 

Findings and interpretation:

Chest radiograph:

• There is a large, peripheral mass in the left lower lobe.

Brain MRI:

• There are two small cystic lesions in the left fronto-parietal region, located at the grey/white matter junction, with marked surrounding vasogenic oedema.
• The lesions have thick, nodular walls. They show marked post-contrast enhancement.

Pertinent negative findings:

• The lesions do not show diffusion restriction.
• There is no significant intracranial mass effect.

The findings represent aggressive brain lesions, as well as a likely neoplastic mass in the left lung.

Principal diagnosis:

Lung carcinoma with brain metastases

Differential diagnosis:

• Multi-system infection with consolidation in the lung and brain abscesses

Management:

Alert referring physician of findings.

Recommend staging CT thorax/abdomen/pelvis.

Refer for oncology MDT discussion with regards to image guided tissue biopsy from appropriate source following further radiological examinations.

Findings and interpretation:

• There is a well circumscribed, homogeneous lesion in the right thalamus, appearing hyperintense on the T2 and FLAIR images.
• There is minimal enhancement on the post-contrast images.
• MR spectroscopy shows elevated choline and creatinine. However, the NAA peak is preserved. The Choline/Creatinine ratio is not raised much above 1.

Pertinent negative findings:

• There is no surrounding vasogenic oedema or haemorrhage.
• The lesion does not show diffusion restriction.

High FLAIR signal and spectroscopy findings indicate a solid, cellular lesion. Lack of surrounding oedema indicate a non-aggressive nature of the lesion. The findings are typical of a low grade neoplasm in the thalamus.

Principal diagnosis:

Low grade thalamic astrocytoma

Differential diagnosis:

• Other low grade brain glioma

Management:

Alert referring physician of findings.

Recommend discussion at neurosurgery MDT with regards to follow up imaging / further management.

Findings and interpretation:

• The appendix is distended, enlarged and fluid filled with rim-like calcification at the tip.
• There are large, conglomerate multi-cystic masses in the pelvis with thick, enhancing septations and walls. The ovaries cannot be separately identified from these masses.
• There is peritoneal free fluid in the left paracolic gutter and left upper quadrant, as well as perihepatic fluid and bilateral pleural effusions. The peritoneal lining around the free fluid is thick and enhancing. There is scalloping of the liver margins representing pseudomyxoma peritonei.
• There are multiple enlarged mesenteric lymph nodes, as well as soft tissue infiltration in the mesentery.
• There is right sided hydronephrosis and hydroureter of the proximal third of the right ureter; at the middle third, the ureter becomes inseparable from the cystic pelvic mass.
• There are large, bilateral pleural effusions.
• There is an ascitic drain in situ with the loop in adequate position.

Pertinent negative findings:

• There are no hepatic parenchymal metastases / suspicious bony lesions.

The findings represent a mucinous, cystic malignancy involving the appendix and ovaries. The peritoneal findings represent peritoneal carcinomatosis. The pelvic mass is obstructing the right ureter with resultant right sided hydronephrosis.

Principal diagnosis:

Mucinous adenocarcinoma of the appendix with peritoneal metastatic spread and metastases to the ovaries resulting in Krukenberg tumours

Differential diagnosis:

Ovarian carcinoma with unrelated mucocele of the appendix / appendiceal spread

Management:

Alert referring physician of findings.

Refer for oncology / general surgery MDT discussion to discuss further imaging (staging CT thorax), as well as image guided biopsy of pelvic cystic mass / sampling of peritoneal fluid for cytology.