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SET T0050 -
Mixed 2019 CASES

CASE 1

HISTORY	HISTORY 31 year old female. Fell down the steps at a railway station. Injured the right shoulder. On examination: generalised tenderness.
QUESTION	QUESTION 1). Normal or abnormal? 2). The AP view of an injured shoulder is standard, but - how is this second view obtained? 3). Name two other "second views" that are commonly obtained as an alternative to this particular projection.
RADIOGRAPHS	RADIOGRAPHS
ANSWER	ANSWER VIEW 1). No abnormality shown on these two views. Normal appearances. 2). The second view that has been obtained in this patient is an axial (or cephalo-caudal) radiograph. Sometimes referred to as the "Armpit" view. The patient's arm is abducted and positioned above and close to the surface of the X-ray cassette; the X-ray tube is positioned above the shoulder joint and a vertical beam utilised. The problem with this particular second view? If there is a subluxation or dislocation (or, indeed, a fracture) present then the abduction can be very painful. In addition, and as a consequence, the resulting radiographic image can be very poor. 3.1). A common alternative to the axial view is the so called "Y View". The "Y View" is essentially a Lateral view of the scapula. Positioning is relatively easy - and, importantly, will not cause any pain. In general, it is a good view to confirm or exclude a dislocation of the head of the humerus. It is poor at revealing fractures involving the glenoid or the head of the humerus. 3.2). Arguably, the best second view is the "Apical Oblique view". Not a painful projection. It readily confirms (or excludes) a dislocation - whether anterior or posterior. Brilliant at showing fractures. A 10 out of 10 view! *See : Accident & Emergency Radiology : A Survival Guide (3rd edition) : Pages 76-79*

CASE 2

HISTORY	HISTORY Male. Age 36 years. Facial swelling and pain. But, difficult to obtain a history.
QUESTION	QUESTION Is there any evidence of a dental abscess? Alternatively, given that the hisory is difficult to obtain - is there any evidence of trauma?
RADIOGRAPHS	RADIOGRAPHS
ANSWER	ANSWER VIEW The appearnces are normal. No evidence of an abscess. No evidence of a fracture. The TM joints are unremakable.

CASE 3

HISTORY	HISTORY 41 year old male Shortness of breath on exertion. Chest tightness.
QUESTION	QUESTION Normal or abnormal?
RADIOGRAPHS	RADIOGRAPHS
ANSWER	ANSWER VIEW Observations: * Symetrical shadowing is projected over the upper zones of both lungs. The lateral margins of the shadowing are straight and well defined and extend inferiorly to cross both hila. * There is an indentation on the left side of the trachea. An important finding. * The heart and lungs appear normal. Specifically, the hilar shadows and position(s) are entirely normal. Impression: An anterior mediastinal mass. The tracheal indentation confirms the position of the mass. Given the close relationship of the thyroid gland to the trachea . . . the tracheal indentation suggests that the mass is possibly an enlarged thyroid gland (ie common things occur commonly), but the configuration of this mass is not typical. Indeed, it is very atypical. Alternative possibilities include a thymoma or a lymphoma. Subsequent follow up: Proven lymphoma - Hodgkin's disease.

CASE 4

HISTORY	HISTORY 27 year old male. Fell playing football following a hard tackle. Opponent was shown a red card. Painful and tender all over the foot and the ankle.
QUESTION	QUESTION Foot radiographs: normal or abnormal?
RADIOGRAPHS	RADIOGRAPHS
ANSWER	ANSWER VIEW Findings: * Fracture of the cuboid bone. This is best shown on the AP radiograph. Minimal displacement of the fragments. * All of the other bones and joints are unremarkable.

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