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Title100 Cases in Radiology
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Total Pages321
Table of Contents
                            Cover
Book title
Contents
Acknowledgements
Case 1 Deteriorating shortness of breath in a smoker
Case 2 The breathless asthmatic
Case 3 An icy fall
Case 4 Difficulty swallowing
Case 5 A mechanical fall in an elderly patient
Case 6 Right upper abdominal pain
Case 7 Heartburn, epigastric pain and a cough
Case 8 Lines, catheters and tubes on a radiograph
Case 9 Weakness and slurring while out for a drink
Case 10 Back pain relieved only by aspirin
Case 11 A persistent cough in an ex-smoker
Case 12 A schoolmaster with progressive breathlessness
Case 13 Numb right arm
Case 14 Jaundice following cholecystectomy
Case 15 Infant with clicking hips
Case 16 Painful wrist after falling
Case 17 Constipation in woman with ovarian tumour
Case 18 Thirty-year-old man with headache
Case 19 Persistent cough
Case 20 Chest pain and dyspnoea
Case 21 Young man with neck swelling
Case 22 Collapse and possible seizure
Case 23 Premature neonate with abdominal distension
Case 24 Young child with painful arm
Case 25 Acute epigastric pain
Case 26 Man with atypical chest pain
Case 27 Young woman with shortness of breath and chest pain
Case 28 Chest discomfort and dyspnoea
Case 29 Skateboarder with a painful foot
Case 30 Left-sided loin pain
Case 31 Unable to bear weight after a cycling accident
Case 32 Strange bone appearance after falling
Case 33 Lower back pain
Case 34 Vomiting baby boy
Case 35 Painless haematuria
Case 36 Sudden onset weakness in an 80-year-old woman
Case 37 Young man with ankle pain
Case 38 Painful shoulder
Case 39 Chest pain after falling
Case 40 Swelling of the big toe
Case 41 A young man with progressive dyspnoea on exertion
Case 42 Pain on deep inspiration
Case 43 An elbow injury
Case 44 Pain in the hand following a punching injury
Case 45 A fall on the hand and pain in the wrist
Case 46 Shortness of breath and pleuritic chest pain
Case 47 A new arrival with cough and a fever
Case 48 A seatbelt injury
Case 49 A device in the pelvis
Case 50 A cardiac abnormality
Case 51 A mirror image
Case 52 A distended and painful abdomen
Case 53 Bloody sputum and weight loss
Case 54 A soft fluctuant lump
Case 55 Abdominal distension and shifting dullness
Case 56 A painful hand
Case 57 A retired construction worker with a cough
Case 58 Distended abdomen and unable to pass gas
Case 59 Torrential haematemesis
Case 60 An incidental finding on chest radiograph
Case 61 A worried nurse in intensive care
Case 62 Young man with abdominal pain
Case 63 Skin plaques and achy hands
Case 64 Teaching sport can be a headache at times
Case 65 A chesty infant
Case 66 Difficulty in swallowing
Case 67 Pregnant woman with vomiting
Case 68 Infant with a head injury
Case 69 Abdominal distension in a woman with ovarian cancer
Case 70 A woman with a breast lump
Case 71 A rising creatinine
Case 72 Neck pain after falling
Case 73 A young man with back pain
Case 74 A child with an injury
Case 75 A renal tract abnormality
Case 76 Shooting leg pain following lifting
Case 77 A chronic productive cough
Case 78 General fatigue and weakness
Case 79 A cervical spine injury following a horse riding accident
Case 80 Abdominal pain and diarrhoea in a 28-year-old woman
Case 81 Pain in the left wrist following a fall
Case 82 A known case of inflammatory bowel disease
Case 83 A tourist from New Zealand
Case 84 Spontaneous nose bleeds in a young person
Case 85 Abdominal weight gain and distension despite dieting
Case 86 Left mid zone crackles
Case 87 Traumatic injury to a farmer’s foot
Case 88 An accountant with abdominal pain
Case 89 Pain in a woman with breast cancer
Case 90 Headache and visual field defects
Case 91 A claudicant with worsening leg pain
Case 92 Normal variant on a chest radiograph
Case 93 Flank pain and haematuria
Case 94 Patient with an intractable headache
Case 95 An unwell patient with a rash
Case 96 Chest wall swelling and a pleural effusion
Case 97 Chest wall deformity in a pacemaker patient
Case 98 Sudden onset back pain in a 72-year-old woman
Case 99 Constipation and colicky abdominal pain
Case 100 An ankle injury
Index
	A
	B
	C
	D
	E
	F
	G
	H
	I
	J
	K
	L
	M
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Document Text Contents
Page 2

100 CASES
in Radiology

Page 160

151

CASE 55: ABDOMINAL DISTENSION AND SHIFTING DULLNESS

History
A 61-year-old man presents to hospital with generalized abdominal distension and bloat-
ing over the previous 3 weeks. This has become increasingly uncomfortable. He also notes
feeling tired and lethargic.

Examination
Upon examination his observations are all within normal limits. His chest is clear but the
abdomen is markedly distended. Upon percussing the abdomen there is dullness which
moves depending on the position of the patient (shifting dullness). Bowel sounds are
present but reduced. Rectal examination reveals an empty rectum.

His haemoglobin is reduced at 9.6 g/dL with evidence of a microcytic anaemia. Otherwise
his blood biochemisty, liver function test and inflammatory markers are normal.

An ultrasound was performed in the first instance (Figure 55.1) and on the basis of this
a computed tomography (CT) was done (Figure 55.2).

Figure 55.1 Ultrasound. Figure 55.2 CT scan.

Questions
• What do the ultrasound image and the CT image demonstrate?
• What are the potential causes that could give rise to this?

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311



leg (shooting pain), following 76(213–14)
loin/flank see loin pain
shoulder 38(113–15)
wrist, following fall 16(47–8), 45(131–2), 81(229–31)

papilloedema 18(51–3)
para-oesophageal hernia 7(17–18)
parietal bone fracture 68(181–5)
pars interarticularis defect 33(103–4)
pelvis

apophyseal avulsion 3(5–7)
Paget’s disease 32(99–101)

percutaneous transhepatic cholangiogram 14(41–4)
pericardial cysts 26(83–4)
pericardial effusions 28(87–9)
peripheral vascular disease, atherosclerotic 91(269–71)
peritoneal cavity

fluid accumulation (ascites) 55(151–2)
gas in 25(79–81)

phalangeal fractures 3(5–7)
pharyngeal pouch 4(8–11)
phrenic nerve crush (in tuberculosis treatment) 97(291–3)
physeal fractures 74(205–7)
physical abuse, infant 68(181–5)
pineoblastoma 18(51–3)
pituitary adenoma 90(265–7)
pleural effusions 27(85–6)

chest wall swelling and 86(287–9)
pleural plaques 57(155–6)
pleuritic chest pain 46(133–4)
plombage (in tuberculosis treatment) 97(291–3)
pneumatosis coli 80(225–8)
pneumocystis pneumonia 41(121–2)
pneumolysis, internal (in tuberculosis treatment) 97(291–3)
pneumomediastinum

in pregnancy 67(177–80)
Rigler’s sign 80(225–8)

pneumonia, pneumocystis 41(121–2)
pneumonitis, interstitial 12(35–7)
pneumoperitoneum 25(79–81)
pneumothorax 42(123–5), 96(287–9)

therapeutic, in tuberculosis 97(291–3)
podagra 40(119–20)
polycystic kidney disease 30(93–5)

adult/autosomal dominant 30(93–5), 94(279–81)
portal hypertension 59(159–60)
positron emission tomography (PET), lung cancer 11(31–4)
pregnant woman, vomiting 67(177–80)
premature neonate with abdominal distension 23(71–3)
prostate cancer metastases 89(261–3)
pseudodiverticula, oesophageal 4(8–11)
pseudomembranous colitis 80(225–8)
psoriatic arthropathy 63(167–9)
pulmonary embolism 20(59–61), 46(133–4), 50(141–2)
pulmonary non-vascular lesions see lung
pyloric stenosis 34(105–6)
pyrexia see fever

radial fracture
distal 81(229–31)
proximal head 43(127–8)

radiation exposure (safety concerns) 86(249–52)
pregnancy 67(177–80)
in various imaging modalities 86(249–52)

radiofrequency ablation 41(41–4)
radionuclide scan see scintigraphy
rash, unwell patient 95(283–5)
reflex (regional) sympathetic dystrophy 56(153–4)
regional sympathetic dystrophy syndrome 56(153–4)
renal lesions see kidney
respiratory crackles, left mid zone 86(249–52)
respiratory problems, infant with 65( 173–4)

see also breathlessness
rheumatoid arthritis 63(167–9)
ribs

cervical 13(39–40)
fracture

elderly fall 39(117–18)

infant, non-accidental 68(181–5)
Rigler’s sign 80(225–8)
road traffic accident

cyclist with knee injury 31(97–8)
seatbelt injury 48(137–8)

rolling hiatus hernia 7(17–18)

safety considerations
contrast media 91(269–71)
ionizing radiation see radiation exposure

sail sign 2(3–4)
Salter–Harris fractures 74(205–7)
sarcoidosis, thoracic 95(283–5)
sarcomatous chain/transformation

exostosis 16(47–8)
in Paget’s disease 32(99–101)

scintigraphy (radionuclide scan)
bone, metastases 89(261–3), 98(295–7)
lung, pulmonary embolism 50(141–2)
nephrolithiasis 93(275–8)

scottie dog sign 33(103–4)
seatbelt injury 48(137–8)
sebaceous cyst 54(149–50)
seizure, possible 22(67–9)
shoulder pain 38(113–15)
sigmoid colon volvulus 99(299–301)
silhouette sign 26(83–4), 86(249–52)
situs inversus 51(143–4)
skin

plaques, and achy hands 63(167–9)
rash in unwell patient 95(283–5)

skull fracture
cricket ball 64(171–2)
infant 68(181–5)

sliding hiatus hernia 7(17–18)
small bowel obstruction 58(157–8)
Smith fracture 81(229–31)
smoker

breathlessness 1(1–2)
cough (persisting) in ex-smoker 11(31–4), 19(55–7)

sonography see ultrasound
speech slurring and weakness 9(23–6)
spine

discs see intervertebral discs
Paget’s disease 32(99–101)
soft swelling over 54(149–50)
trauma

fall 72(197–9), 79(21–3)
seatbelt-related injury 48(137–8)
wedge compression fractures, systemic cause 39(117–

18)
tumour 10(27–30)

spondylolisthesis 33(103–4)
spondylolysis 33(103–4)
sputum, bloody, and weight loss 53(147–8)
stenting 14(41–4)

colonic 69(187–9)
femoral artery 91(269–71)
ureteric 71(193–6), 93(275–8)

sternoclavicular dislocation 38(113–15)
stomach (gastric…)

variceal bleeding 59(159–60)
volvulus 99(299–301)

stones (calculi)
biliary (gallstones) 6(15–16)
renal 93(275–8), 93(275–8)

stress fractures, foot 29(91–2)
stroke 9(23–6)
stromal tumour, gastrointestinal 55(151–2)
subarachnoid haemorrhage 94(279–81)
subclavian vessels

angiography 13(39–40)
right aortic arch with isolated left subclavian vein

92(273–4)
right aortic arch with left subclavian artery 92(273–4)

subcutaneous emphysema 96(287–9)
subcutaneous lump over lumbar spine 54(149–50)

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subdural haemorrhage 5(13–14)
submucosal uterine fibroids 85(245–8)
subserosal uterine fibroids 85(245–8)
surgical emphysema 96(287–9)
swallowing difficulty 4(8–11), 66(175–6)

teardrop fracture, C7 79(221–3)
temporal bone fracture 64(171–2)
thoracic outlet syndrome 13(39–40)
thoracoplasty (previous) 97(291–3)
thromboembolic stroke 9(23–6)
thrombolysis, NICE guidelines 9(23–6)
thrombosis, deep vein 83(237–40)
thumb injury, child 74(205–7)
thymoma 78(219–20)
tibial plateau fracture 31(97–8)
toe, big, swelling 40(119–20)
toxic megacolon 80(225–8)
tracheal tubes 8(19–20)
tracheotomy tube 8(19–20)
transient ischaemic attack 9(23–6)
transitional cell carcinoma, bladder 71(193–6)
trauma see fractures; injuries
traveller, returning

fever and cough 47(135–6)
leg pain 83(237–40)

triquetral fractures 45(131–2)(car/tri)
tube(s) 8(19–20)

nasogastric, misplaced 61(163–4)
tuberculosis

discitis in 73(200–2)
miliary 47(135–6)
pulmonary, collapse therapy 97(231–3)

tumours
gastrointestinal stromal 55(151–2)
intracranial see intracranial tumours
malignant see malignant tumours
ovarian see ovarian cancer
pineal 18(51–3)
pituitary 90(265–7)
spinal 10(27–30)
thymic 78(219–20)

ulcerative colitis 80(225–8)
ultrasound

abdominal
jaundice following cholecystectomy 14(41–4)
pain 6(15–16)

appendicitis 62(165–6)
ascites 55(151–2)
deep vein thrombosis 83(237–40)
hip, infants 15(45–6)
image guidance

biopsy 14(41–4)
drainage of pleural effusions 27(85–6)

pyloric stenosis 34(105–6)
subcutaneous lipoma 54(149–50)

urinary tract
bilateral hydronephrosis 75(209–11)
obstruction 71(193–6)
renal stones 93(275–8)

uterine fibroids 85(245–8)
ureter

distension with urine (hydroureter) 75(209–11)
obstruction 71(193–6)

stents 71(193–6), 93(275–8)
urinary tract disorders 71(193–6), 75(209–11)

in Crohn’s disease 82(235–7)
see also kidney

urogram, intravenous, loin/flank pain 30(93–5), 93(275–8)
uterine fibroids 85(245–8)

varices, bleeding gastric 59(159–60)
vascular disease, peripheral, atherosclerotic 91(269–71)
venous lines, central 8(19–20)
venous thrombosis, deep 83(237–40)
ventilation–perfusion (V/Q) scanning, pulmonary embolism

50(141–2)
vertebrae

collapse 98(295–7)
Paget’s disease 32(99–101)
seatbelt-related injury 48(137–8)
slip of L5 on S1 33(103–4)
tumour 10(27–30)
wedge compression fractures, systemic cause 39(117–

18)
vertebroplasty 41(41–4)
visual field defects and headache 90(265–7)
volvulus 99(299–301)

midgut 88(257–9), 99(299–301)
vomiting (emesis)

abdominal pain and 62(165–6)
epigastric 25(79–81)

baby boy 34(105–6)
oesophageal rupture secondary to 67(177–80)
pregnant woman 67(177–80)
see also haematemesis

weakness
elderly see elderly
fatigue and see fatigue
slurring and 9(23–6)

web, oesophageal 66(175–6)
Weber classification of ankle fractures 100(303–5)
weight gain, abdominal, and distension despite dieting

85(245–8)
weight loss and bloody sputum 53(147–8)
wrist pain following fall 16(47–8), 45(131–2), 81(229–31)

X-rays
exposure risk see radiation exposure
physics 3(5–7)

Zenker’s diverticulum 4(8–11)

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