SET T0047 -
Mixed non trauma -
2019

Answers:

(a) There is evidence of Perthes disease affecting the right hip - specifically: slight flattening and a slight increase in density of the capital epiphysis.

Unless the radiograph is scrutinised carefully, and - most importantly - the various clinical possibilities are born in mind, the abnormal appearance of the capital epiphysis is easily overlooked. The findings can be very subtle. Careful comparison with the non-symptomatic side is always important . . . and will invariably clinch the diagnosis.

(b) The correct terminology to describe this particular radiographic projection is: Frog leg lateral.

A large goitre is present. The displacement of the trachea is marked.

Otherwise the CXR appearances are within normal limits.

The appearances are normal.

a) The radiological appearances are unremarkable.

b) The second view that has been obtained in this patient is often termed a "Y view". To use the precisely correct terminology -  it is a "lateral scapular view".

c) The Rhomboid notch?? It is also referred to as the rhomboid fossa. There is just a hint of a shallow rhomboid notch (or fossa) in the inferior surface of the medial end of the clavicle on the AP projection in this patient.

Explanation: the clavicle is attached to the costal cartilage of the 1st rib by a ligament (the costoclavicular ligament) which arises from the inferomedial surface of the clavicle (ie from the rhomboid fossa or notch).

In some patients the normal notch (or fossa) can be very prominent (ie deep and sometimes irregular) on the AP radiograph - or, indeed, on a frontal CXR. This normal anatomical finding is fairly common and must not be regarded or registered as abnormal.

[To repeat - there is only a very slight hint of a normal Rhomboid notch in this patient].