SPACS Modules Rotation Student Cases

Below you will find interactive flash radiology modules created by medical students as part of our interactive radiology elective. As all of the other modules in this site, the latest Adobe flash plugin is required. If you are interested in participating the Online Radiology and Anatomy elective, please contact the RWJMS registrar's office at (732) 235-6300.

For each module there is a brief description and the descriptive radlex keywords. Additionally, under "clues", are image numbers on which the selectable findings can be found.


SPACS Modules Rotation Student Created Cases

May 1 2009

[16yo with Chest Pain] 16 year old with pleuritic chest pain.
Author: Christina Cheng, MS III
Resident Supervisor: Salil Soman, MD, MS
Editors: S.Soman, MD, MS, L. Chiu-Serodio, MD, S. Driscoll, MSIII
Radlex Terms: Pleuritic chest pain; Pneumothorax; Trachea deviation; Depressed diaphragm; Chest-tube placement; Chest radiograph; Chest CT without contrast.
Clues: Finding 1: Images 2-12; Finding 2: Image 24; Finding 3: Image 24.
Difficulty:Overall: Low

May 1 2009

[Abdominal Pain Ultrasound] 5 year old male with abdominal pain.
Author:Christina Cheng,MSIII
ResidentSupervisor:SalilSoman,MD,MS
Editors:S.Soman,MD,MS, L. Chiu-Serodio, MD, S. Driscoll, MSIII
Radlex Terms:Appendix; Appendicitis; Appendicolith; Free fluid; Abdominal ultrasound.
Clues:inding 1: Image 0; Finding 2: Images 8-11, 13-14; Finding 3: Images 10-12.
Difficulty:Overall: Low

May 1 2009

[Incidental CXR Finding] 83 year old female with incidental finding on chest x-ray.
Author:Christina Cheng,MSIII
ResidentSupervisor:SalilSoman,MD,MS
Editors:S.Soman,MD,MS, L. Chiu-Serodio, MD, S. Driscoll, MSIII
Radlex Terms:Pulmonary mass; Chest radiograph; Chest CT without contrast; Window levels lung, soft tissue, bone; CT guided biopsy.
Clues:Finding 1: Image 0; Finding 2: Images 3-15; Finding 3: Images 10-15.
Difficulty:Overall: Low

May 10 2009

[Shortness of breath] 61 year old male with shortness of breath.
Author:Christina Cheng,MSIII
ResidentSupervisor:SalilSoman,MD,MS
Editors:S.Soman,MD,MS, J.K. Amorosa, MD
Radlex Terms:Mediastinal mass; Thyromegaly; Tracheal deviation; Chest radiograph; Hepatic cyst; CT Chest/Abdomen without contrast.
Clues:Finding 1: Image 0; Finding 2: Images 1-8; Finding 3: Images 13-30; Finding 4: images 10-24.
Difficulty:Overall: Medium

April 10 2009

[Dyspnea and Cough] 68 year old male with dyspnea and cough.
Author:Christina Cheng,MSIII
ResidentSupervisor:SalilSoman,MD,MS
Editors:S.Soman,MD,MS,JKAmorosa,MD
Radlex Terms:Pleural effusion; Pulmonary mass; Structures in the mediastinum; Mediastinal mass; Tracheal deviation; Esophagus; Esophageal deviation; CT Chest/Abdomen without contrast
Clues:Finding 1: Images 0-18; Finding 2: Images 19-29; Finding 3: Images 2-17; Finding 4: images 1-12; Finding 5: Images 19-29
Difficulty:Overall: High

Feb 27 2009

[ Abdominal Pain and Weight Loss] 46 yo male with severe abdominal pain, nausea, vomiting, and unintentional weight loss.
Author: Kate Osusky, MS IV
Resident Supervisor: Salil Soman, MD, MS
Editors:S.Soman, MD, MS, MP Bramwit, MD, B. Huang, MSIII
RadlexTerms: Gastric carcinoma; Gastric antrum; Gastric cardia; Gastric fundus; Peptic ulcer; Greater omentum; Greater curvature of stomach; Lesser curvature of stomach; Supraclavicular lymph node; Axillary lymph node
Clues: Finding 1: images 3-8 and 11-12, Finding 2: images 0-8 and 10-15, Finding 3: images 11-29
Difficulty:Overall *Easy*, Findings: *Easy*, Questions: *Medium*

Feb 27 2009

[Leg Pain and Swelling in a Young Girl] 17 yo girl with pain and swelling of the left lower extremity and a radiograph that shows only mild soft tissue swelling.
Author: Kate Osusky, MS IV
Resident Supervisor: Salil Soman, MD, MS
Editors:S.Soman, MD, MS, MP Bramwit, MD, B. Huang, MSIII
RadlexTerms: Ewing Sarcoma; Sarcoma; osteosarcoma; T1 weighted; T1/T2 weighted; Metastasis; Soft tissue; Diagnostic tissue obtained on biopsy; MR tissue contrast; Tibia
Clues: Finding 1: images 4-5, 13-14, 23-24, Finding 2: images slices 10-30
Difficulty:Overall *Easy*, Findings: *Easy*, Questions: *Medium*

Oct 9 2008

[ Bacteremia and abdominal pain ] 76 year old male with bacteremia and abdominal pain with history of clostridium difficile colitis.
Author: Lauren Kovacs, MS III
Resident Supervisor: Salil Soman, MD, MS
Editors: A. Masand, MS III, S.Soman, MD, MS, JK Amorosa, MD, B. Huang, MSIII
Radlex Terms: pneumatosis coli (air in the bowel wall), causes: bowel perforation, ischemic bowel disease, blunt abdominal trauma; clostridium difficile; pneumoperitoneum; upper GI barium study; CT Abdomen/Pelvis without contrast
Clues: Finding 1: images 1-5
Difficulty:Overall *Medium*, Findings: *Medium*, Questions: *Easy*

Oct 9 2008

[ Flank pain, UTI, and fever ] 43 year old female with flank pain, UTI, and fever; on noncontrast CT, perinephric stranding was seen on the right side.
Author: Lauren Kovacs, MS III
Resident Supervisor: Salil Soman, MD, MS
Editors: A. Masand, MS III, S.Soman, MD, MS, JK Amorosa, MD, B. Huang, MSIII
Radlex Terms: striated nephrogram; perinephric stranding; renal and perirenal abcess; acute pyelonephritis; Escherichia coli; chronic pyelonephritis; ureteral calculus; kidney; CT Abdomen/Pelvis with and without contrast
Clues: Finding 1: images 4-6; Finding 2: images 7-15; Finding 3: images 1-13
Difficulty:Overall *Medium*, Findings: *Medium*, Questions: *Easy*

Oct 9 2008

[ Liver Process ] 83 year old female with acute onset of fever and chills with abdominal discomfort.
Author: Lauren Kovacs, MS III
Resident Supervisor: Salil Soman, MD, MS
Editors: A. Masand, MS III, S.Soman, MD, MS, JK Amorosa, MD, B. Huang, MSIII
Radlex Terms: polycystic liver disease; autosomal dominant polycystic kidney disease; adult polycystic disease; nephrectomy; surgical changes; CT Abdomen/Pelvis with contrast
Clues:Finding 1: images 1-29; Finding 2: images 13-18; Finding 3: images 18-23
Difficulty:Overall *Medium*, Findings: *difficult*, Questions: *Easy*

Oct 9 2008

[ Chronic pancreatitis ] 67 year old female with abdominal pain and elevated liver function tests.
Author: Lauren Kovacs, MS III
Resident Supervisor: Salil Soman, MD, MS
Editors: A. Masand, MS III, S.Soman, MD, MS, JK Amorosa, MD, B. Huang, MSIII
Radlex Terms: pancreas; chronic pancreatitis; calcification; pancreatic secretin test; CT thorax without contrast
Clues:Finding 1: images 3-10; Finding 2: image 7
Difficulty:Overall *easy*, Findings: *easy*, Questions: *Easy*

Aug 27 2008

[Small Bowel Process ] 4 year-old Mexican female who recently moved to the US and now presents with a 2-month history of abdominal pain, a 2-day history of vomiting, and periumbilical mass since birth. Identify an abnormality in the small bowel..
Author:Gajan Sivananthan, MS IV
Resident Supervisor: Salil Soman, MD, MS
Editors:A. Masand, MS III, S.Soman, MD, MS, JK Amorosa, MD, B. Huang, MSIII
Radlex Terms:curvilinear objects in the small bowel; filling defect; parasites; Ancylostoma duodenale; Ascaris lumbricoides; Schistosoma; Taenia saginata; Taenia solium; Loffler syndrome; stool smear; urachal diverticulum; allantoic duct remnant; CT Abdomen/Pelvis with contrast
Clues:Finding 1: images 1-25; Finding 2: images 16-23
Difficulty:Overall *difficult*, Findings: *Medium*, Questions: *difficult*

Aug 272008

[Mycetoma ]51 year-old male with a 15 year history of bronchiectasis and allergic bronchopulmonary aspergillosis who presents with worsening shortness of breath. Identify a mycetoma in images 0-7..
Author:Gajan Sivananthan, MS IV
Resident Supervisor: Salil Soman, MD, MS
Editors:A. Masand, MS III, S. Driscoll, MS III, S.Soman, MD, MS, JK Amorosa, MD
Radlex Terms:mycetoma; bronchiectasis; allergic bronchopulmonary aspergillosis; aspergilloma; chronic necrotizing aspergillosis; invasive pulmonary aspergillosis; signet ring sign; central bronchiectasis; halo sign; finger in glove sign; tree in bud sign; pulmonary emboli; lung; CT Angiogram Chest with contrast
Clues:Finding 1: images 0-7; finding 2: images 2-12; Finding 3: images 13-14
Difficulty:Overall *Difficult*, Findings: *Medium*, Questions: *Difficult*

Aug 272008

[Right Lower Quadrant Pain ]4 year-old male with RLQ abdominal pain for the past two days. Identify the appendix..
Author:Gajan Sivananthan, MS IV
Resident Supervisor: Salil Soman, MD, MS
Editors:A. Masand, MS III, S. Driscoll, MS III, S.Soman, MD, MS, JK Amorosa, MD
Radlex Terms:inflammation in the RLQ; appendicitis; appendicolith; periappendiceal inflammation; epiploic appendagitis; omental infarction; appendix; CT Abdomen/Pelvis with contrast
Clues:Finding 1: images 13-18; Finding 2: images 4-12
Difficulty:Overall *Medium*, Findings: *Medium*, Questions: *Difficult*

Aug 272008

[Pregnancy ]31 year-old female, 10 weeks 2 days GA by LMP, who presents to the ED for pelvic cramping. The physical exam shows a 20-week size uterus. Identify the uterus..
Author:Gajan Sivananthan, MS IV
Resident Supervisor: Salil Soman, MD, MS
Editors:A. Masand, MS III, S. Driscoll, MS III, S.Soman, MD, MS, JK Amorosa, MD
Radlex Terms:uterus; gestational sac; hyatidiform mole; hemorrhagic cyst; Ultrasound 1st trimester (0-12 weeks)
Clues:Finding 1: images 0-2, 4-5, 7-8; Finding 2: images 9-11
Difficulty:Overall *Medium*, Findings: *Easy*, Questions: *Medium*

Aug 272008

[Pancreatic Mass ]67 year-old male with history of pancreatic cancer who now presents with elevated CEA levels. The study was obtained during the venous stage. Identify the pancreas..
Author:Gajan Sivananthan, MS IV
Resident Supervisor: Salil Soman, MD, MS
Editors:A. Masand, MS III, S. Driscoll, MS III, S.Soman, MD, MS, JK Amorosa, MD
Radlex Terms:pancreatectomy; LUQ abdominal pain; CA 19-9; CEA; pancreatic adenocarcinoma; metastatic pancreatic cancer; metastases; pancreas; CT Abdomen/Pelvis with and without contrast
Clues:Finding 1: images 19-26; Finding 2: images 8-16
Difficulty:Overall *Medium*, Findings: *Easy*, Questions: *Difficult*

Aug 272008

[Intestinal Obstruction ]83-year-old male with a four-day history of vomiting, decreased bowel movement and severe abdominal pain. Identify the intrahepatic biliary tree in images 1-5..
Author:Gajan Sivananthan, MS IV
Resident Supervisor: Salil Soman, MD, MS
Editors:A. Masand, MS III, S. Driscoll, MS III, S.Soman, MD, MS, JK Amorosa, MD, K. Osusky, MS IV, D. Walor, MD.
Radlex Terms:air in biliary tree; cholecystoduodenal fistula; gallstone; cholecystitis; air in gallbladder; gallstone in duodenum; pancreatic calcification; CT Abdomen/Pelvis without contrast
Clues:Finding 1: images 1-6; Finding 2: images 13-15; Finding 3: images 15-17; Finding 4: images 16-18; Finding 5: images 17-22; Finding 6: images 10-12
Difficulty:Overall *Medium*, Findings: *Difficult*, Questions: *Medium*

Aug 272008

[Enlarging Abdominal Mass ]3-year-old female who presents with an enlarging abdominal mass. .
Author:Gajan Sivananthan, MS IV
Resident Supervisor: Salil Soman, MD, MS
Editors:A. Masand, MS III, S. Driscoll, MS III, S.Soman, MD, MS, JK Amorosa, MD
Radlex Terms:nephroblastoma; lymphoma; IVC; spleen; painless abdominal mass; kidney; CT Abdomen with contrast
Clues:Finding 1: images 15-22; Finding 2: images 4-18; Finding 3: images 1-33
Difficulty:Overall *Medium*, Findings: *Easy*, Questions: *Medium*

May 192008

[Decreased Hearing ]12 month old male who presented for a CT scan without contrast of the right temporal bone due to decreased hearing..
Author:Chowdhury Furhad Miah, MS III
Resident Supervisor: Salil Soman, MD, MS
Editors:A. Masand, MS III, S. Driscoll, MS III, S.Soman, MD, MS, JK Amorosa, MD
Radlex Terms:unilateral atresia of the external auditory canal; congenital aural dysplasia; thalidomide; malleoincudal articulation; oval window; cochlea; ossicles; CT Temporal Bone without contrast
Clues:Finding 1: images 12-15 and images 42-43; Finding 2: images 42-43
Difficulty:Overall *Medium*, Findings: *Medium*, Questions: *Difficult*

May 192008

[Breast Lesion ]66 y/o African American woman with a PMHx significant for HTN, CAD, and recent left breast lumpectomy at an outside institution for suspected carcinoma. Shortly after the surgery, patient developed bradycardia. Cardiac cath revealed multivessel disease requiring CABG so she was transferred to RWJUH. Four days post CABG, patient developed sudden onset of SOB and desaturation, with hypotension requiring transfer to the ICU. She was found to have hemorrhage into the pericardial sac requiring an emergent thoracotomy and about 700 ml of bloody fluid was removed. .
Author:Chowdhury Furhad Miah, MS III
Resident Supervisor: Salil Soman, MD, MS
Editors:A. Masand, MS III, S. Driscoll, MS III, S.Soman, MD, MS, JK Amorosa, MD
Radlex Terms:hematoma; seroma; abscess; lumpectomy; mammography; pleural effusion; CHF; pericardial effusion; cardiac tamponade; breast; heart; CT thorax without contrast
Clues:Finding 1: images 4-12; Finding 2: images 1-14; Finding 3: images 11-15
Difficulty:Overall *Difficult*, Findings: *Difficult*, Questions: *Medium*

May 192008

[Head Trauma ]28 year-old man with past a medical history significant for substance abuse is brought to the ER s/p 35 feet fall from a roof. He is taken for emergent CT scan of the head..
Author:Chowdhury Furhad Miah, MS III
Resident Supervisor: Salil Soman, MD, MS
Editors:A. Masand, MS III, S. Driscoll, MS III, S.Soman, MD, MS, JK Amorosa, MD
Radlex Terms:hemorrhage; maxillary sinus; acute intracranial hemorrhage; skull fractures; subdural hemorrhage; posterior falx cerebri; tentorium cerebelli; epidural hematoma; cerebral contusion; subarachnoid hemorrhage; frontal bone; orbital rood; sphenoid bone; tripod fracture; Le Fort’s type fracture; cavum septum pellucidum; brain; CT Head without contrast
Clues:Finding 1: images 1-6; Finding 2: images 8-23; Finding 3: images 12-23; Finding 4: images 21-23; Finding 5: images 36-41; Finding 6: images 15-17
Difficulty:Overall *Medium*, Findings: *Difficult*, Questions: *Medium*

May 192008

[Hepatic Mass ]51 year old man who presented with abdominal pain, SOB, and mild abdominal distension. He was found to have hepatitis and an abdominal U/S showed a nonspecific hepatic mass. He presents for a follow-up MRI..
Author:Chowdhury Furhad Miah, MS III
Resident Supervisor: Salil Soman, MD, MS
Editors:A. Masand, MS III, S. Driscoll, MS III, S.Soman, MD, MS, JK Amorosa, MD
Radlex Terms:liver; abscess; necrosis; jaundice; ascites; pleural effusion; retroperitoneal space; simple renal cyst; kidney; abdominal MRI
Clues:Finding 1: images 9-14 and 32-38; Finding 2: images 6-17; Finding 3: 21-23; Finding 4: images 27-29
Difficulty:Overall *Medium*, Findings: *Medium*, Questions: *Medium*

May 192008

[Tuberculosis ]46 year-old female who was sent by her PCP for a CT scan of the thorax without contrast due to chest pain. She has a history of advanced pulmonary Tb involving the left lung many years ago..
Author:Chowdhury Furhad Miah, MS III
Resident Supervisor: Salil Soman, MD, MS
Editors:A. Masand, MS III, S. Driscoll, MS III, S.Soman, MD, MS, JK Amorosa, MD
Radlex Terms:tuberculosis; atelectasis; bronchiectasis; Ghon focus; Ranke complex; mediastinal shift; compensatory overexpansion; trachea; lung; CT thorax without contrast
Clues:Finding 1: images 1-17; Finding 2: images 6-13; Finding 3: images 0-20; Finding 4: images 0-4
Difficulty:Overall *Medium*, Findings: *Medium*, Questions: *Easy*

May 192008

[Scoliosis ]17 year-old male with a past medical history of congenital scoliosis who presented for follow-up radiologic studies including a CT scan of the thoracic spine without contrast..
Author:Chowdhury Furhad Miah, MS III
Resident Supervisor: Salil Soman, MD, MS
Editors:A. Masand, MS III, S. Driscoll, MS III, S.Soman, MD, MS, JK Amorosa, MD
Radlex Terms:scoliosis; dextroscoliosis; congenital scoliosis; Cobb technique; hemivertebra; supernumerary vertebral body; rib hypoplasia; spine; CT thoracic spine without contrast
Clues:Finding 1: images 15-26, images 30-36, and images 42-47; Finding 2: images 15-21, image 30, Images 39-47; Finding 3: images 0-11, images 30-31, and images 35-47
Difficulty:Overall *Medium*, Findings: *Medium*, Questions: *Difficult*

May 72008

[Appendicitis ]13 year-old male complains of RUQ pain. CT with contrast is ordered..
Author:Rory Ulloque, MS III
Resident Supervisor: Salil Soman, MD, MS
Editors:A. Masand, MS III, S. Driscoll, MS III, S.Soman, MD, MS, JK Amorosa, MD
Radlex Terms:appendicitis; appendicolith; appendix; CT Abdomen/Pelvis with contrast
Clues:Finding 1: images 19-30; Finding 2: images 26-32
Difficulty:Overall *Medium*, Findings: *Easy*, Questions: *Medium*

May 72008

[Dyspnea and pleuritic chest pain ]14 year-old female complains of dyspnea, pleuritic chest pain, and abdominal bloating over a period of a week prior to examination. CT of chest-abdomen-pelvis with contrast is ordered..
Author:Rory Ulloque, MS III
Resident Supervisor: Salil Soman, MD, MS
Editors:A. Masand, MS III, S. Driscoll, MS III, S.Soman, MD, MS, JK Amorosa, MD
Radlex Terms:pulmonary embolism; Westermark sign; Hampton hump; infarct; hemorrhage; venous thromboembolism; lung; pulmonary artery; CT Chest/Abdomen/Pelvis with contrast
Clues:Finding 1: images 16-20; Finding 2: images 26-32
Difficulty:Overall *Easy*, Findings: *Medium*, Questions: *Easy*

May 72008

[Abdominal Trauma ]19 year-old male who was involved in a MVA is seen in the emergency department. The trauma team orders CT chest-abdomen-pelvis with contrast..
Author:Rory Ulloque, MS III
Resident Supervisor: Salil Soman, MD, MS
Editors:A. Masand, MS III, S. Driscoll, MS III, S.Soman, MD, MS, JK Amorosa, MD
Radlex Terms:hepatic laceration; blunt abdominal trauma; liver; CT Chest/Abdomen/Pelvis with contrast
Clues:Finding 1: images 6-28
Difficulty:Overall *Easy*, Findings: *Easy*, Questions: *Easy*

May 72008

[Abdominal Mass ]14 year-old female complains of dyspnea, pleuritic chest pain, and abdominal bloating over a period of a week prior to examination. CT of chest-abdomen-pelvis with contrast is ordered..
Author:Rory Ulloque, MS III
Resident Supervisor: Salil Soman, MD, MS
Editors:A. Masand, MS III, S. Driscoll, MS III, S.Soman, MD, MS, JK Amorosa, MD
Radlex Terms:neoplasm; tumor emboli; thrombosis; transverse colon; rhabdomyosarcoma; sarcoma; CT Chest/Abdomen/Pelvis with contrast
Clues:Finding 1: images 6-15; Finding 2: images 6-10
Difficulty:Overall *Medium*, Findings: *Medium*, Questions: *Medium*

May 72008

[Neck Trauma ]33 year-old male is seen in the emergency department after suffering a stab wound to the neck. Contrast-enhanced CT of the neck is ordered..
Author:Rory Ulloque, MS III
Resident Supervisor: Salil Soman, MD, MS
Editors:A. Masand, MS III, S. Driscoll, MS III, S.Soman, MD, MS, JK Amorosa, MD
Radlex Terms:internal carotid artery; hematoma; pseudoaneurysm; sternocleidomastoid incision; neck; vascular injury; CT Angiogram Neck with contrast
Clues:Finding 1: images 1-18
Difficulty:Overall *Medium*, Findings: *Medium*, Questions: *Difficult*

May 72008

[Left upper quadrant abdominal pain ]72 year-old status post motor vehicle accident is seen in the emergency department with a complaint of left upper quadrant abdominal pain. CT-chest-abdomen-pelvis with contrast is ordered..
Author:Rory Ulloque, MS III
Resident Supervisor: Salil Soman, MD, MS
Editors:A. Masand, MS III, S. Driscoll, MS III, S.Soman, MD, MS, JK Amorosa, MD
Radlex Terms:pleural effusion; hemorrhage; esophagus; esophageal perforation; CT Chest/Abdomen/Pelvis with contrast
Clues:Finding 1: images 12-35; Finding 2: images 6-18
Difficulty:Overall *Easy*, Findings: *Medium*, Questions: *Easy*

Mar 112008

[Abdominal pain, nausea, and vomiting ]84 year-old female with history of nausea and vomiting..
Author:Chun Ho, MS III
Resident Supervisor: Salil Soman, MD, MS
Editors:A. Masand, MS III, S. Driscoll, MS III, S.Soman, MD, MS, JK Amorosa, MD
Radlex Terms:aorta; calcification; atherosclerosis; intussusception; bowel obstruction; barium enema; CT Abdomen/Pelvis without contrast
Clues:Finding 1: images 10-13; Finding 2: images 3-12
Difficulty:Overall *Medium*, Findings: *Meduim*, Questions: *Medium*

Mar 112008

[Headache and Facial Pain ]54 year-old male with history of headache and facial pain. .
Author:Chun Ho, MS III
Resident Supervisor: Salil Soman, MD, MS
Editors:A. Masand, MS III, S. Driscoll, MS III, S.Soman, MD, MS, JK Amorosa, MD
Radlex Terms:occipital lobe; vasogenic edema; Anton-Babinski syndrome; Anton's blindness; brain; CT Head without contrast
Clues:Finding 1: images 15-19;
Difficulty:Overall *Easy*, Findings: *Easy*, Questions: *Easy*

Mar 112008

[Facial trauma ]Patient history is withheld..
Author:Chun Ho, MS III
Resident Supervisor: Salil Soman, MD, MS
Editors:A. Masand, MS III, S. Driscoll, MS III, S.Soman, MD, MS, JK Amorosa, MD
Radlex Terms:orbital floor fracture; periorbital fat; inferior oblique muscle; inferior rectus muscle; orbital edema; brain; eye; orbit; CT Head
Clues:Finding 1: images 2-9 and 26-38
Difficulty:Overall *Easy*, Findings: *Easy*, Questions: *Medium*

Mar 112008

[Neck Mass ]45 year-old female with history of a neck mass..
Author:Chun Ho, MS III
Resident Supervisor: Salil Soman, MD, MS
Editors:A. Masand, MS III, S. Driscoll, MS III, S.Soman, MD, MS, JK Amorosa, MD
Radlex Terms:thyroid; vocal cord paralysis; tumor; vagus nerve; recurrent laryngeal nerve; CT Neck with contrast
Clues:Finding 1: images 10-15; Finding 2: images 5-10
Difficulty:Overall *Difficult*, Findings: *Difficult*, Questions: *Medium*

Mar 112008

[Abdominal Distension ]27 year-old male with history of abdominal distension.
Author:Chun Ho, MS III
Resident Supervisor: Salil Soman, MD, MS
Editors:A. Masand, MS III, S. Driscoll, MS III, S.Soman, MD, MS, JK Amorosa, MD
Radlex Terms:colitis; infectious colitis; cecum; rectum; pseudomembranous colitis; clostridium difficile; hepatic cyst; colon; liver; CT Abdomen/Pelvis with contrast
Clues:Finding 1: images 13-54; Finding 2: images 6-11
Difficulty:Overall *Medium*, Findings: *Medium*, Questions:*Easy *

Mar 11 2008

[Abdominal Pain ]45 year-old male with history of abdominal pain..
Author:Chun Ho, MS III
Resident Supervisor: Salil Soman, MD, MS
Editors:S. Saad, MS III, A. Masand, MS III, S. Driscoll, MS III, S.Soman, MD, J. K. Amorosa, MD
Radlex Terms:small bowel obstruction; stent; superior mesenteric artery; CT Abdomen/Pelvis without contrast
Clues:Finding 1: images 29-40; Finding 2: images 25-28; Finding 3: images 33-35
Difficulty:Overall *Medium*, Findings: *Difficulty*, Questions: *Medium*

Nov 12007

[Neck Injury ]26 year-old man suffered a recent back injury. He presents to the ER with vague back and neck pain. CT of the neck is performed in evaluation..
Author:Janine Collinge, MS IV
Resident Supervisor: Salil Soman, MD, MS
Editors:S. Saad, MS III, A. Masand, MS III, S. Driscoll, MS III, S.Soman, MD, J. K. Amorosa, MD
Radlex Terms:occipital condyle fracture; dens process; os odontoideum; odontoid process; atlantoaxial joint; CT Neck
Clues:Finding 1: images 7-12; Finding 2: images: 13-23
Difficulty:Overall *Medium*, Findings: *Medium*, Questions: *Medium*

Nov 12007

[Foot Pain ]50 year-old man with history of diabetes and a wound on his right foot presents with foot pain, redness, and swelling in the area over the great toe. .
Author:Janine Collinge, MS IV
Resident Supervisor: Salil Soman, MD, MS
Editors:S. Saad, MS III, A. Masand, MS III, S. Driscoll, MS III, S.Soman, MD, J. K. Amorosa, MD
Radlex Terms:osteomyelitis; staph aureus; cuneiform bone; tarsometatarsal joint; Lisfranc joint; Lisfranc fracture; foot; MRI, T1 weighted
Clues:Finding 1: images 6-11; Finding 2: images 8-18; Finding 3: images 8-19
Difficulty:Overall *Difficult*, Findings: *Difficult*, Questions: *Medium*

Nov 12007

[GI Bleeding and Back Pain ]66 year-old woman with past medical history of afib and chronic anti-coagulation therapy presents to the ER with GI bleeding and back pain. CT of the abdomen is performed..
Author:Janine Collinge, MS IV
Resident Supervisor: Salil Soman, MD, MS
Editors:A. Masand, MS III, S. Driscoll, MS III, S.Soman, MD, K. Osusky, MS IV., D. Walor, MD.
Radlex Terms:retroperitoneal hematoma; psoas muscle; abdominal aorta; renal vein; renal vein thrombosis; CT Abdomen
Clues:Finding 1: images 17-45; Finding 2: images 9-33; Finding 3: images 21-23
Difficulty:Overall *Medium*, Findings: *Medium*, Questions: *Difficult*

Nov 12007

[Headache ]35 year-old woman G1P1 at 32 weeks presents with headache. CT scan of the head is performed..
Author:Janine Collinge, MS IV
Resident Supervisor: Salil Soman, MD, MS
Editors:S. Saad, MS III, A. Masand, MS III, S. Driscoll, MS III, S.Soman, MD, J. K. Amorosa, MD
Radlex Terms:subarachnoid hemorrhage; hydrocephalus; pregnancy; aneurysm; brain; CT Head
Clues:Finding 1: images 6-27; Finding 2: 5-21
Difficulty:Overall *Difficult*, Findings: *Difficult*, Questions: *Medium*

Nov 12007

[Left-sided back pain ]69 year-old woman presents with long-standing left-sided back pain. CT of the abdomen was performed during evaluation..
Author:Janine Collinge, MS IV
Resident Supervisor: Salil Soman, MD, MS
Editors:S. Saad, MS III, A. Masand, MS III, S. Driscoll, MS III, S.Soman, MD, J. K. Amorosa, MD
Radlex Terms:renal calculus; staghorn calculus; calcium oxalate; calcium phosphate; triple phosphate; struvite; urease; cortical thinning; liver granuloma; ventral hernia; linea alba; omentum; kidney; CT Abdomen
Clues:Finding 1: images 18-23; Finding 2: images 35-47
Difficulty:Overall *Easy*, Findings: *Easy*, Questions: *Easy*

Nov 12007

[Pelvic Trauma ]45 year-old woman, a passenger in a vehicle manned by a drunk driver, is brought to the ER. She is complaining of lower abdominal pain. CT of the abdomen and pelvis revealed several abnormalities..
Author:Janine Collinge, MS IV
Resident Supervisor: Salil Soman, MD, MS
Editors:S. Saad, MS III, A. Masand, MS III, S. Driscoll, MS III, S.Soman, MD, J. K. Amorosa, MD
Radlex Terms:pelvic fracture; iliac crest; superior pubic ramus; femur; inferior pubic ramus; pelvis; CT Abdomen/Pelvis without contrast
Clues:Finding 1: images 0-4; Finding 2: images 22-26; Finding 3: images 25-49; Finding 4: images 32-35; Finding 5: images 31-34
Difficulty:Overall *Difficult*, Findings: *Difficult*, Questions: *Medium*

Oct 182007

[Headache and mental status change ]58 year old man with HTN presents with one hour of 8/10 headache. His wife notes that he has become more lethargic indicating a change in mental status. She denies observing any direct trauma. In the ER he is found to have slight nuchal rigidity. Lumbar tap shows some blood after the 3rd tube. What abnormality is seen on the angiogram?.
Author:John Yoon, MS IV
Resident Supervisor: Salil Soman, MD, MS
Editors:S. Saad, MS III, A. Masand, MS III, S. Driscoll, MS III, S.Soman, MD, D. Walor, MD
Radlex Terms:aneurysm; anterior cerebral artery; anterior communicating artery; subarachnoid hemorrhage; internal carotid artery; cavernous sinus; dilator pupillae; carotid plexus; circle of Willis; ophthalmic artery; superior sagittal sinus; arteriovenous malformation; transverse sinus; sigmoid sinus; internal jugular vein; brain; Angiogram
Clues:Finding 1: images 1-9; Finding 2: images 0-9; Finding 3: images 11-14; Finding 4: images 11-14
Difficulty:Overall *Medium*, Findings: *Difficult*, Questions: *Medium*

Oct 182007

[Headache ]54 year-old female smoker with a history of migraines presents with what she describes as a much stronger headache than normal. The headache has been increasing in severity with no improvement with medication. In the ED, she is oriented to person, place, and time but appears tired and weak. .
Author:John Yoon , MS IV
Resident Supervisor: Salil Soman, MD, MS
Editors:S. Saad, MS III, A. Masand, MS III, S. Driscoll, MS III, S.Soman, MD, J. K. Amorosa, MD.
Radlex Terms:aneurysm; middle cerebral artery; hypertension; sacular; berry; fusiform; brain; Angiogram
Clues:Finding 1: images 0-7
Difficulty:Overall *Easy*, Findings: *Easy*, Questions: *Medium*

Oct 182007

[New Onset Seizures ]24 year-old male with no prior history of epilepsy presents with his first episode of tonic-clonic seizure for two minutes. His history is pertinent for many trips to India. In the ED he is oriented to person, place, and time. There are no focal deficits on the neurological exam..
Author:John Yoon, MS IV
Resident Supervisor: Salil Soman, MD, MS
Editors:S. Saad, MS III, A. Masand, MS III, S. Driscoll, MS III, S.Soman, MD, J. K. Amorosa, MD
Radlex Terms:Taenia solium; neurocysticercosis; ring enhancing lesion; epilepsy; lateral ventricle; hydrocephalus; fourth ventricle; thalamus; cerebellum; tonsillar herniation; brain; CT Head
Clues:Finding 1: images 7-8; Finding 2: images 12-16; Finding 3: images 5-8; Finding 4: images 12-1; Finding 5: images 3-8
Difficulty:Overall *Easy*, Findings: *Easy*, Questions: *Easy*

Oct 182007

[Urination Difficulty ]65 year-old male presents with difficulty urinating for two months. There is no pain on urination but he complains of difficulty starting urination. At the PMD, a urine dipstick shows positive blood. Digital rectal exam is abnormal..
Author:John Yoon , MS IV
Resident Supervisor: Salil Soman, MD, MS
Editors:S. Saad, MS III, A. Masand, MS III, S. Driscoll, MS III, S.Soman, MD, D. Walor, MD, J.K. Amorosa, MD
Radlex Terms:prostate; prostatic carcinoma; PSA; bladder; ilium; kidney; cyst; simple renal cyst; CT Abdomen/Pelvis with contrast
Clues:Finding 1: images 41-53; Finding 2: images 32-44; Finding 3: images 26-34; Finding 4: images 8-17
Difficulty:Overall *Medium*, Findings: *Medium*, Questions: *Medium*

Sept 282007

[Chest Pain ]60 year-old man presents to the ER with sudden onset of severe, tearing chest pain. A chest x-ray reveals a widened mediastinum. .
Author:Sam Shahpar, MS IV
Resident Supervisor: Salil Soman, MD, MS
Editors:S. Saad, MS III, A. Masand, MS III, S. Driscoll, MS III, S.Soman, MD, M. Censullo, MD.
Radlex Terms:aortic dissection; aorta; iliac arteries; renal artery; aneurysm; kidney; CT Chest with contrast
Clues:Finding 1: images 1-41; Finding 2: images 29-30
Difficulty:Overall *Easy*, Findings: *Easy*, Questions: *Easy*

Sept 282007

[LLQ Abdominal Pain ]44 year-old female presents with lower left abdominal pain for the past two days. She has not been able to eat or drink anything since the pain began secondary to nausea/vomiting. .
Author:Sam Shahpar, MS IV
Resident Supervisor: Salil Soman, MD, MS
Editors:S. Saad, MS III, A. Masand, MS III, S. Driscoll, MS III, S.Soman, MD, M. Censullo, MD
Radlex Terms:diverticulitis; gallstone; cholelithiasis; cholecystitis; gallbladder; colon; large bowel; CT Abdomen/Pelvis with contrast
Clues:Finding 1: images 37-48; Finding 2: images 2-7
Difficulty:Overall *Medium*, Findings: *Easy*, Questions: *Medium*

Sept 282007

[Posterior Communicating Artery Aneurysm ]82 year-old female is s/p endovascular coiling of posterior communicating artery aneurysm. A noncontrast CT scan of the brain was done postoperatively. Identify the coil..
Author:Sam Shahpar, MS IV
Resident Supervisor: Salil Soman, MD, MS
Editors:S. Saad, MS III, A. Masand, MS III, S. Driscoll, MS III, S.Soman, MD, M. Censullo, MD
Radlex Terms:posterior communicating artery aneurysm; intracranial aneurysm; oculomotor nerve palsy; subarachnoid hemorrhage; intracranial bleed; intraventricular hemorrhage; hydrocephalus; brain; CT Head without contrast
Clues:Finding 1: images 9-10; Finding 2: images 16-17
Difficulty:Overall *Medium*, Findings: *Easy*, Questions: *Difficult*

Sept 282007

[Jaw Trauma ]42 year-old male presents to the ER complaining of jaw pain. He states that he had gotten into a fight at the local bar, and he believes that he was struck in the face with a beer bottle. Identify any possible sources of the patient's pain on the CT scan..
Author:Sam Shahpar, MS IV
Resident Supervisor: Salil Soman, MD, MS
Editors:S. Saad, MS III, A. Masand, MS III, S. Driscoll, MS III, S.Soman, MD, M. Censullo, MD
Radlex Terms:mandible; fracture; CT Maxilla/Mandible without contrast
Clues:Finding 1: images 19-25
Difficulty:Overall *Difficult*, Findings: *Difficult*, Questions: *Medium*

Sept 282007

[Syncope/Headache ]80 year-old male presents to the ER via ambulance after experiencing an episode of syncope and hitting his head on a dresser. The patient is oriented to time, person, and place but he complains of a headache..
Author:Sam Shahpar, MS IV
Resident Supervisor: Salil Soman, MD, MS
Editors:S. Saad, MS III, A. Masand, MS III, S. Driscoll, MS III, S.Soman, MD, M. Censullo, MD
Radlex Terms:ambient cisterns; cistern of the great cerebral vein; midbrain; subarachnoid hemorrhage; sylvian fissure; brain; CT Head without contrast
Clues:Finding 1: images 10-11; Finding 2: images 12-15
Difficulty:Overall *Difficult*, Findings: *Medium*, Questions: *Difficult*

Sept 282007

[Shoulder Pain ]60 year-old male presents with severe left shoulder pain following a fall. X-rays reveal several fractures. Identify the fractures on this follow-up CT..
Author:Sam Shahpar, MS IV
Resident Supervisor: Salil Soman, MD, MS
Editors:S. Saad, MS III, A. Masand, MS III, S. Driscoll, MS III, S.Soman, MD, M. Censullo, MD
Radlex Terms:humerus; proximal humerus fracture; rib; pneumothorax; scapula; CT Left Shoulder
Clues:Finding 1: images 0-20; Finding 2: images 12-19; Finding 3: images 0-10
Difficulty:Overall *Medium*, Findings: *Difficult*, Questions: *Medium*

Sept 282007

[Back Pain ]60 year-old female presents with pain localized in the middle of her back for the past 4 days. She denies having suffered any significant trauma or falls recently, but she states that the pain started the day that she was caring for her 4 year-old grandson. Look through the axial, coronal, and sagittal views of the CT scan to determine if there are any abnormalities..
Author:Sam Shahpar, MS IV
Resident Supervisor: Salil Soman, MD, MS
Editors:S. Saad, MS III, A. Masand, MS III, S. Driscoll, MS III, S.Soman, MD, M. Censullo, MD
Radlex Terms:vertebral body fracture; T8; wedge fracture; compression fracture; thoracolumbar spine; osteoporosis; CT thoracic spine without contrast
Clues:Finding 1: images; 14-15, 29-24, and 46-52
Difficulty:Overall *Medium*, Findings: *Easy*, Questions: *Medium*