RADIOLOGY MUST-SEE IMAGES SEMMELWEIS UNIVERSITY Dr. Pál Novák Kaposi Dr. Dávid László Tárnoki, PhD
RADIOLOGY
MUST-SEE
IMAGES
SEMMELWEIS UNIVERSITY
Dr. Pál Novák Kaposi
Dr. Dávid László Tárnoki, PhD
Aim of this section
To display the typical features of the most important diagnoses in radiology
To summarize the common applications of the main imaging modalities
Important to recognize
Imaging modality/technique
Examined region
Main anatomical structures
Radiologic signs suggesting disease
Diagnoses of clinical significance
1.
1.
Modality: Non-enhanced CT, axial view
Region: Brain
Radiologic sign: Cortical-subcortical border disappeared/blurred
due to oedema, (Gács’) hyperdense media sign (arrows)
Diagnosis: Subacute ischaemia in territory of right middle
cerebral artery
2.
Modality: Non-enhanced CT, brain window setting (window center: 40
HU; window width: 80 HU); Region: Brain
Radiologic sign: Hypodense brain parenchyma
Diagnosis: Ischaemic lesion in chronic phase in territory of right MCA
2.
3.
3.
Modality: Non-enhanced CT
Region: Brain
Radiologic sign: Large hyperdense
hemorrhage extending into the ventricles,
midline shift to the right
Diagnosis: Acute cerebral apoplexy
4.
4.
Modality: Non-enhanced CT, Region: Brain
Radiologic sign: Hyperdense bleeding in
basal cisterns and sulci
Diagnosis: Acute subarachnoid hemorrhage
5.
5.
Modality: Non-ehnanced CT, Region: Brain
Radiologic sign: Crescent-shaped hyperdense
blood Diagnosis: Acute subdural hematoma
(bilateral)
6.
6.
Modality: Non-enhanced CT
left – brain window, right – bone window
Region: Brain
Radiologic sign: Lens-shaped hyperdense bleeding
and skull vault fracture
Diagnosis: Right-sided epidural hematoma
7.
7.
Modality: right – Non-enhanced CT, left – CE T1WI MRI
upper – Sagittal view, lower – Axial view
Region: Brain
Radiologic sign: Parenchymal lesion showing rim
enhancement
Diagnosis: Glioblastoma multiforme (GBM)
8.
8.
Modality: Non-enhanced MRI
left: T1WI sagittal, center: T2WI sagittal, right: T2WI axial
Region: Lumbar spine
Radiologic sign: Hypointense discus protruding into the spinal canal
Diagnosis: Disc herniation between L2 and L3 level
9.
9.Modality: Contrast-enhanced CT
Region: Upper abdomen; Radiologic sign:
Hypoenhancing lesions, normal spleen
Diagnosis: Multiple liver metastases
Modality : Liver ultrasound with convex
probe (3.5-5 MHz), B-mode; Region: Liver
Radiologic sign: Hypoechoic lesions
Diagnosis: Multiple liver metastases
10.
Modality: left – Non-enhanced CT, right – Contast-
enhanced CT
Region: Upper abdomen
Radiologic sign: Enlarged pancreas with indistinct margins
green arrow: Enhancing head – living tissue
red arrow : Non-enhancing body – necrosis
Diagnosis: Acute necrotizing pancreatitis
10.
11.
Modality: Ultrasound of gallbladder with convex probe (3.5–5 MHz)
Region: Gallbladder
Radiologic sign: Hyperdense structure in the lumen of the gallbladder
with acoustic shadowing
Diagnosis: Gallstone
11.
12.
Modality: Ultrasound of gallbladder with convex
probe (3.5–5 MHz), B-mode; lower left – Color
Doppler of the gallbladder
Region: Gallbladder
Radiologic sign: Stone in the lumen (green arrow),
Thick, stratified, oedematous wall (red arrow),
hypervasculatisation in the wall (white arrow)
Diagnosis: Acute cholecystitis
12.
13.
Modality: Sonogram of the appendix with linear probe (7.5–10 MHz), B-mode
upper right: Color Doppler of the appendix
Region: Appendix
Radiologic sign: left image – Normal, compressible appendix; right image – Non-compressible
tubular structure with thickened wall showing signs oedema (red arrow) and hypervascularisation
(white arrow). Free abdominal fluid is also present (green arrow). Diagnosis: Acute appendicitis
13.
14.
Modality: Chest radiograph, frontal projection (in upright position)
Region: Chest, upper abdomen
Radiologic sign: Crescents of radiolucency under both hemidiaphragms (red
arrows) Diagnosis: Free abdominal air (due to perforation of luminal
abdominal organ)
14.
15.
Modality: left image – Abdominal plain radiograph, standing
posture; right image – Contrast-enhanced CT scan
Region: Abdomen and pelvis
Radiologic sign: Distended colon (green arrows) with air–fluid
levels (red arrows). In the sigmoid colon an obstructing
contrast-enhancing mass is shown (white arrows).
Diagnosis: Large-bowel obstruction caused by sigmoid cancer
15.
16.
Modality: Barium enema study,
double-contrast method
Region: Abdomen
Radiologic sign: Annular irregular
stenosis (apple-core sign)
Diagnosis: Colon cancer
16.
17.
Modality: Barium swallow test, fluoroscopy
Region: Esophagus
Radiologic sign: Outpouching (green arrows) filled with
contrast material near the pharyngoesophageal junction
(white arrow). An air-fluid level is also seen (red arrow).
Diagnosis: Zenker diverticulum
17.
18.
Modality: Non-enhanced CT scan (low-dose)
Region: Kidney
Radiologic sign: Hyperdensity in the right kidney
Diagnosis: Stone in the right kidney
18.
19.
Modality: Contrast-enhanced CT
Region: Abdomen
Radiologic sign: Enlarged right kidney
demonstrates patchy hypoenhancement
Diagnosis: Acute pyelonephritis
Modality: Kidney ultrasound with convex probe (3.5–5 MHz), B mode &
color Doppler Region: Abdomen
Radiologic sign: Enlarged right kidney shows ill-marginated central echo
group and parenchymal hypovascularisation
Diagnosis: Acute pyelonephritis (right side)
19.
20.
Modality: upper left: Non-enhanced CT, lower left and
right: Multiphase contrast-enhanced CT
Region: Abdomen, retroperitoneum
Radiologic sign: Aortic aneurysm with wall
calcifications (green arrow), hyperdense
retroperitoneal fluid collection (red arrow), aortic
aneurysm leakage (white arrow)
Diagnosis: Aortic aneurysm rupture
20.
21.
Modality: Posteroanterior chest radiograph (upright); hard-beam technique (120– 140 keV) Region: chest,
pleura
Radiologic sign: left image – normal morphology; right image – Decreased transparency at lung bases showing
a meniscus-shaped contour on the right side. Diaphragm and lateral sinuses cannot be differentiated (arrows).
Diagnosis: Bilateral pleural effusion
21.
22.
Modality: Expiratory chest radiograph in frontal
projection
Region: Chest, pleura
Radiologic sign: Peripheral space is radiolucent
with no lung markings (arrow), visible visceral
pleural line (white line), collapsed right lung
Diagnosis: Right-sided pneumothorax (PTX)
22.
23.
Modality: Bedside chest radiograph (anteroposterior)
Region: Chest, lung
Radiologic sign: Decreased tranparency
(consolidation) in the right upper lobe (white line), left-
sided central venous catheter
Diagnosis: Right-sided lobar pneumonia
23.
24.
Modality: left – Posteroanterior chest radiograph
upper right – Chest CT, lung window
lower right – Contrast-enhanced chest CT,
mediastinal window
Region: Chest, lung
Radiologic sign: Air-containing fluid collection with thick
enhancing rim (arrows)
Diagnosis: Left-sided lung abscess
24.
25.
25.
Modality: Non-enhanced chest CT; bone
window; core biopsy
Region: Chest, lung
Radiologic sign: CT-guided biopsy from the
right apical mass
Diagnosis: Thoracic core biopsy
Modality: PET-CT; 18-fluorodeoxyglucose (18F-FDG)
radiotracer; fused image. Region: Chest, lung
Radiologic sign: Increased 18F-FDG uptake in the
right apical mass
Diagnosis: Right apical lung cancer (Pancoast tumor)
26.
Modality: left image – Posteroanterior chest radiograph
(upright); right image – chest CT; lung window;
Region: Chest, lung
Radiologic sign: Multiple rounded lesions (red arrows);
Multiple soft tissue lesions showing different size and
rounded shape (green arrows). History: Kidney cancer.
Diagnosis: Multiple lung metastases
26.
27.
27.Modality: HRCT of the lung, lung window, axial view. Region: Chest, lung
Radiologic sign: Bilateral dorsobasal honeycombing pattern (red arrow), traction
bronchiectasis (green arrow)
Diagnosis: Pulmonary fibrosis
28.
28.
Modality: Pulmonary CT-angiography (contrast-enhanced series in pulmonary arterial phase, CTA)
Region: Chest, pulmonary arteries
Radiologic sign: Large hypodense filling defects in the left main pulmonary artery. History: Lower extremity
deep vein thrombosis
Diagnosis: Pulmonary embolism
29.
29.
Modality: Lower extremity venous ultrasound,
linear probe, B-mode
Region: Crural, posterior tibial vein
Radiologic sign: Posterior tibial vein is filled with
hypoechoic thrombus, the lumen is non-
compressible. Left image – longitudinal section,
right image – transverse section
Diagnosis: Deep vein thrombosis (DVT)
30.
30.
Modality: Digital subtraction angiography (DSA), Catheter angiography
Region: Neck, carotid bifurcation
Radiologic sign: left image – Significant internal carotid artery stenosis (green arrow), center
image – balloon dilatation and stenting (red arrow), right image – Control angiography
Diagnosis: Carotid angioplasty and stenting
31.
31.
Modality: Digital subtraction angiography (DSA), Catheter angiography
Region: Lower extremity, popliteal artery
Radiologic sign: left image – Significant right popliteal artery stenosis (red
arrow), collateral circulation (green arrows); right image – Control angiography
after percutaneous transluminal angioplasty (PTA), balloon dilatation.
Diagnosis: Chronic popliteal artery stenosis, balloon angioplasty (PTA)
32.
32.
Modality: Foot X-ray – Anteroposterior (left image), oblique view (right image)
Region: Left foot
Radiologic sign: Oblique fracture of the left 2nd metatarsus with minimal
dislocation (red arrow). Patient fell from height.
Diagnosis: Fracture of the 2nd metatarsus
33.
33.Modality: X-ray of the left knee in two projections
Region: Left knee
Radiologic sign: Inhomogeneous destructive
metaphyseal lesion of the left femur. Periosteal
reaction, Codman triangle and invasion to the
sorrounding soft tissue is also present.
Diagnosis: Osteosarcoma of the femur
34.
34.
Modality: Radiograph of the left hallux in two
projections
Region: Left foot, hallux
Radiologic sign: Marked ill-defined bone resorption in
distal tuberosity (= ungual process). Ulcerous lesion is
also shown.
Diagnosis: Acute osteomyelitis
35.
35.
Modality: left image – X-ray of the sinuses; right image –
CT of the sinuses, low-dose, bone window
Region: Maxillary region, paranasal sinuses
Radiologic sign: Right maxillary sinus shows homogenous
decreased transparency, the left one has rounded mucous
thickening
Diagnosis: Bilateral sinusitis
36.
36.
Modality: Contrast-enhanced head-and-neck CT, left image – axial view; right image – coronal view
Region: Head and neck
Radiologic sign: Right-sided submandibular fluid collection with thick enhancing wall.
Patient had wisdom tooth extraction before.
Diagnosis: Neck abscess
37.
37.
Modality: Thyroid ultrasound, linear probe (7.5–10 MHz), B-mode
Region: Thyroid
Radiologic sign: Isoechoic spongiform nodule with hypoechoic halo (white line)
Diagnosis: Benign thyroid nodule
38.
38.
Modality: Thyroid gland scintigram, Technetium-99m (99m Tc)-pertechnetate scintigraphy
Region: Thyroid
Radiologic sign: Enlarged right lobe with focal lesion showing decreased tracer activity (white
arrow)
Diagnosis: Cold nodule
39.
39.
Modality: PET-CT, 18-fluorodeoxyglucose (18F-FDG) radiotracer
Hybrid imaging method: PET – Metabolic activity, CT – Morphology
Region: Whole-body
Radiologic sign: Increased fluorodeoxyglucose (18F-FDG) uptake in liver and pubic bone,
normal physiologic activity is shown in the bladder; known underlying malignancy
Diagnosis: Multiple metastases
40.
Modality: Mammography of the right breast, mediolateral oblique
view, soft-beam technique (30 keV); Region: Right breast
Radiologic sign: Soft tissue mass with spiculated contour
Diagnosis: Breast cancer
40.
41.
Modality: Breast sonography with linear probe (7.5–10 MHz), B-mode
Region: Breast, axilla
Radiologic sign: left image – well-defined anechoic lesion with
posterior acoustic enhancement; right image – ill-defined
hypoechogenic lesion with partial
acoustic shadowing: solid structure, suspicious of cancer
Diagnosis: cyst and malignancy
41.
42.
42.
Modality: Babygram
Region: Neonate
Radiologic sign: „White lung”, wide air-bronchograms
running to the peripheries. The contours of the heart
blurred, complete loss of transparency is shown.
Diagnosis: IRDS (Idiopathic respiratory distress syndrome)
43.
43.liver
right kidney
spleen
left kidney
bowels
bladder
uterus
Modality: FAST (Focused Assessment with Sonography for Trauma) scan
Region: Abdomen, pleural sinuses, pericardium, aorta
Radiologic sign: Free abdominal fluid in the hepatorenal fossa, around the spleen,
among the bowel loops and in Douglas pouch. Patient sustained blunt trauma.
Diagnosis: Free abdominal fluid suspicious for hemorrhage