Findings and interpretation:

Non-contrast CT:

• There is high density fluid within the lower abdomen and pelvis, extending into the pouch of Douglass. There is also free fluid around the liver and spleen. The density of the fluid indicates acute haemorrhage.

Contrast enhanced CT:

• There is a poorly defined right adnexal mass within the haematoma.
• There are foci of contrast density within the adnexal mass on the portal venous phase images. This indicates extravasation of intravenous contrast media.

The findings represent haemoperitoneum, due to acute, active haemorrhage from a right adnexal mass.

Principal diagnosis:

Acute haemorrhage from a ruptured ectopic tubal pregnancy.

Differential diagnosis:

Bleeding from a ruptured corpus luteum cyst.

Management:

Urgently contact referring physician and inform of findings.

Consider serum beta-HCG testing to confirm ectopic pregnancy.

Findings and interpretation:

• There is an ill-defined, hypodense lesion in the head and uncinate process of the pancreas, with a focus of punctate calcification.
• The lesion is causing extra and intra-hepatic bile duct as well as main pancreatic duct dilatation.

Pertinent negative findings:

• There are no enlarged local / abdominal lymph nodes.
• There are no hepatic parenchymal / pulmonary / bony metastases.

The findings represent a likely malignant mass in the head of the pancreas / ampulla causing pancreatic and biliary ductal obstruction and resultant dilatation.

Principal diagnosis:

Pancreatic head / ampullary carcinoma

Differential diagnosis:

• Neuroendocrine pancreatic tumour (these are typically hyper-enhancing and well-defined)

Management:

Alert referring physician of findings.

Recommend endoscopic ultrasound with biopsy for tissue diagnosis.

Refer for discussion at hepatobiliary MDT regarding further management / amenability for resection.

Findings and interpretation:

• There is generalised effacement of the cerebral sulci and loss of grey/white matter differentiation.
• There is global hypodensity of the cerebral hemispheres, with more pronounced hypodensity of the basal ganglia. The cerebellum appears hyperdense in comparison.
• There is an air-fluid level in the right maxillary sinus. There are nasal bone fractures.

Pertinent negative findings:

• No intra/extra axial intracranial haemorrhage.
• No fractures of the skull / skull base.

The findings represent global hypoxia of the brain with evidence of traumatic injury, as indicated by maxillary haemosinus and facial bone fractures.

Principal diagnosis:

Hypoxic ischaemic encephalopathy

Differential diagnosis:

None

Management:

Urgently inform referring physician of findings.

Obtain bony reconstructions, as well as further imaging of the facial bones and cervical spine to assess for traumatic injury in those regions.  

Findings and interpretation:

• The non-contrast images show high density material in the stomach lumen, with a rim of non-dependent air surrounding it.
• There is thickening of the second part of the duodenum, with ill defined relative hyperdensity in the lumen on the non-contrast images.
• The post contrast images confirm mural thickening in the 2^nd part of the duodenum and ill definition of the walls due to surrounding peri-duodenal and pancreatico-duodenal groove fat stranding, with relative hyper-enhancement of the mucosa in this segment.
• On the arterial phase images, the gastroduodenal artery shows short segment attenuation / stenosis as it courses adjacent to the involved segment of the 2^nd part of the duodenum.
• Fat stranding in the peri-nephric spaces and retroperitoneum is secondary to the retroperitoneal inflammatory process centred on the 2^nd part of the duodenum.

Incidental findings:

• Rounded, well defined mass showing popcorn calcifications and areas of low density in the left lung base, representing a hamartoma.

The findings represent blood in the stomach lumen, and a haematoma in the second part of the duodenum caused by a bleeding ulcer, complicated by duodenitis and inflammatory involvement of the gastroduodenal artery.

Principal diagnosis:

Bleeding duodenal ulcer causing duodenitis.

Differential diagnosis:

Duodenal adenocarcinoma; however, this would show more irregular, mass-like thickening.

Management:

Urgently contact referring physician and inform of findings.

Recommend interventional radiology opinion regarding embolisation of the gastroduodenal artery.

Inflammatory breast carcinoma

Findings and interpretation:

Mammograms:

• There are clustered micro-calcifications in the outer-upper / central quadrant of the right breast.
• There is thickening of the skin of the breast anteriorly.
• There are a few irregular lymph nodes in the right axillary region.
• The left breast is normal.

US:

• There is a large, heterogeneously hypoechoic mass in an area that corresponds to the region where the micro-calcifications were found on the mammogram.
• The mass is ill-defined, and shows prominent posterior acoustic shadowing.
• Skin thickening is also demonstrated on ultrasound.
• The axillary lymph nodes are abnormal in appearance, showing loss of the fatty hilum.

CT:

• There are innumerable hypodense lesions spread throughout the liver parenchyma.
• There are sclerotic bony lesions diffusely spread throughout the bony skeleton.
• Bilateral pleural effusions.

Pertinent negative findings:

• No pulmonary metastases.

The findings represent metastatic breast carcinoma. The skin changes indicate inflammatory breast carcinoma.

Principal diagnosis:

Inflammatory breast carcinoma with disseminated metastases

Differential diagnosis:

None

Management:

Ultrasound guided core biopsy of breast mass for tissue diagnosis.

Refer for breast MDT after obtaining biopsy result to discuss further management.

Findings and interpretation:

• There is high T2 signal in the cervical spinal cord, extending over a long segment of the cord from C2 level to C6 level. The signal is located centrally in the cord involving the central gray matter.
• There is high FLAIR signal intensity extending over almost the entire length of the left optic nerve.
• There are also a few foci of high FLAIR SI in the left peri-ependymal region at the lateral ventricle, corona radiata and left external capsule.

Negative findings:

• No post contrast enhancement in the cervical spinal cord.

Incidental findings:

• Mild spondylo-degenerative disc changes in the cervical spine.

The findings represent oedema and inflammation in the cervical spinal cord, indicating longitudinally extensive transverse myelitis (LETM); they also denote inflammation in the left optic nerve, indicating optic neuritis.

Principal diagnosis:

Neuro-myelitis Optica Spectrum Disorder (NMSOD)

Differential diagnosis:

Multiple sclerosis- however the cord lesions are typically shorter over fewer vertebral body levels, and peripherally placed involving the white matter.

Management:

Contact referring physician and inform of findings.

Recommend discussion at neurology MDT.