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Observations: hyperdensity at the SSS, straight sinus and transverse sinuses bilaterally Diagnosis: cerebral venous thrombosis Differential Diagnosis: arachnoid granulations Management: urgent referral to paediatrics MRV/MRI with contrast according to local policy, for confirmation

Observations: bilateral posterior nasal membrane, narrowing the airway hypodensity at the posterior parietal lobes bilaterally, left temporal lobe and the periventricular deep white matter bilaterally caudate nuclei and left basal ganglia Interpretation: congenital Diagnosis: choanal atresia, HIE Management: urgent referral to ENT MRI for confirmation

Observations: The bilateral temporomandibular joints appears unremarkable without evidence of joint subluxation/dislocation, erosion or destruction. The articular disc are intact on both sides. Incidental; a collection is noted at the left sphenoidal sinus which is hyperintense on T1 and iso- to slightly hyperintense on T2- most proteineous fluid collection Interpretation: The findings are suggestive of normal bilateral temporomandibular joints Diagnosis: TMJ Management: Inform the referring physician about the findings

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Observations: MRI of the pelvis and scrotum revealed intraparenchymal air that was hypointense on all sequences in the testis, epididymis and scrotal wall along with the hyperintense septa in Left testis, peritesticular collection and thickened scrotal wall Interpretation: Left emphysematous epididymo-orchitis with cellulitis of scrotal wall Diagnosis: emphysematous epididymo orchitis Differential Diagnosis: Fournier's gangrene Management: urgent call to the referral doctor and Discuss findings . Referral to surgical team. orchiectomy with surgical debridement and antibiotic cover

Observations: Branch of superior cerebellar artery is noted to indent the left trigeminal nerve. Interpretation: Neurovascular compression syndromes Diagnosis: 5th NV conflict Management: refer to neurosurgical team

Observations: extraaxial lobulated outline focal lesion at the left cerebellum posteriorly. this is avidly enhancing and is causing significant mass effect on the ipsilateral cerebellum and brainstem, and associated ventricular dilation, with periventricular CSF seepage. Interpretation: Benign neoplasm Diagnosis: meningioma Differential Diagnosis: metastases other extraaxial focal lesions, like epidermoid cyst, and others Management: urgent referral to neurosurgical team

Observations: There is a hypointense irregular lesion on TI FS in the ampullary region of the pancreas. This lesion is causing obstruction and marked dilatation of the CBD, right & left hepatic ducts. Dilatation of the intrahepatic ducts also seen. Stent is seen in CBD with mild pneumobilia. Gall bladder is showing thickened and edematous walls. Cystic duct is dilated and tortuous along with dilatation of the pancreatic duct. There is marked peripheral fat stranding . Interpretation: Malignant lesion of the amullary region of the pancreas causing obstruction and dilatation of the of the CBD, cystic duct, pancreatic duct and cystic duct. Thick walled GB Diagnosis: pancreatic neoplasm Differential Diagnosis: CBD distal calculus. CBD Stricture Acute on chronic pancreatitis Management: discuss the findings with the referral doctor. refer to gastro surgeon. failure of the stunt and complicated by acute cholecystitis. Advise endoscopic brushing CT staging. Compare with previous images CA125 correlation

Observations: Right concha bullosa appears enlarged with FLAIR and Fat suppressed hyperintense signal within. Noted to also extend into the right ethmoid air cells Interpretation: Infective etiology Diagnosis: sof lesion, concha infection Differential Diagnosis: Concha mucocele Management: Refer ENT team for antibiotics and FESS

Observations: Mild dural thickening noted in the Brain Absence of spine process and posterior elements noted in lower lumbar spine with e/o subcutaneous sac like structure with fibrous tract extending from the spinal canal to the sac like subcutaneous structure. Corpus callosum is within normal limits No tonsillar descent noted Interpretation: Opinal spinal dysraphism Diagnosis: Open spinal dysraphism with meningocele with dural thickening - ?hypotension Differential Diagnosis: Myelomeningocele Chiari II malformation Management: Refer to spine surgical team

Observations: Polymicrogyria noted in bilateral frontal lobes and cerebellar hemispheres. Cystic changes noted in the cerebellum. T2 hyperintense white matter changes noted in bifronto=parietal lobes Interpretation: congenital muscular dystrophy Diagnosis: fukayamas congenital muscular dystrophy Differential Diagnosis: Walker-Warburg syndrome Management: Refer to pediatric neurologist team

Observations: low signal focal lesion at the posterior UB wall, in close proximity to the adjacent uterus Diagnosis: Bladder endometriosis Differential Diagnosis: bladder tumour Management: refer to gynaecology/urology

Observations: large lobulated outline focal lesion at the tail of pancreas, infiltrating the adjacent stomach. multiple enlarged lymph nodes seen. multiple omental focal lesions also noted at the upper abdomen bilaterally, more at the hypocondrium bilaterally. multiple hypodense enhancing focal liver lesions seen. filling defect at the portal vein confluence, SV and IMV no evidence of perforation or bowel ischaemia Diagnosis: ca tail pancreas Differential Diagnosis: stomach tumour with metastases Management: urgent referral to GI/vascular team staging refer to oncology/relevant MDT

Observations: Right cerberopontile angle lesion Interpretation: The lesion has a similar signal intensity to CSF on both T1 and T2 weighted sequences but is 'dirty' on FLAIR. The diagnosis is confirmed on DWI which demonstrates very bright signal with intermediate ADC values similar to brain parenchyma Diagnosis: cp angle epidermoid post op Differential Diagnosis: CP angle dermoid Management: comparison to previous scan. Call to referral doctor and referral to neurosurgeon

Observations: looped linear signal void sturcture at the right CPA extending to the IAC Diagnosis: rt cp angle vascular loop type II Management: refer to ENT

Observations: Heterogeneous areas of high intensity signal in distal femur in T2W and STIR which are hypo intense in T1W indicating marrow oedema. No focal collections within the marrow. No cortical breaching.. No subperisoteal collections. Minimal Amount of effusion in supra patella pouch. Moderate soft tissue oedema on popliteal region. Popliteat vascular bundle is intact. Cruciate ligaments, other knee ligaments and menisci are normal Interpretation: Marrow oedema of distal femur with soft tissue oedema on poplitieal fossa Diagnosis: osteomyelitis of distal femur Differential Diagnosis: Aggressive bone neoplasm like osteosarcoma Management: Perform contrast MR of femur and knee. Correlate with radiograph and CT scan of the knee joint. Inform orthopedic team and arrange MDT

Observations: cystic fluid signal collection at the right mastoid air cells, extending to the petrous apex Diagnosis: gradenigo syndrome Management: refer to ENT. management mostly conservative, rarely surgery

Observations: fluid density and signal at the right mastoid air cells, with rarefication of temporal bone and extension through the inner table of the skull at temporal bone to extend slightly intracranially Interpretation: Infective Diagnosis: right mastoid abscess Differential Diagnosis: nasopharyngeal mass causing mastoiditis Management: referral to ENT

Observations: Bony fragment in the superior lateral quadrant of the patella separated by articular cartilage with bone marrow oedema in accessory fragment and in intercondylar notch. The fragment is of similar size to the bony defect Interpretation: a patella fragment in superolateral corner the most common location for bipartite patella, appears i equal size of the defect Diagnosis: bipartite patella with edema Differential Diagnosis: Patella fracture Management: Inform the findings to the orthopedic surgeon. Further imaging with CT scan to exclude associated osteochondral injury/ Follow up imaging can be arranged if symptomatic treatment fails and surgery is required

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Observations: High signal lesions in the T2W, and PD weighted sequences which are low in T1W the posterior and medial aspect of the knee. The lesions arsing from the posterior horn of the medial meniscus. Associated horizontal tear and a longitudinal tear in the medial meniscus which appears to be communicating with the cysts. Mild scalloping of the posterior tibial plateau. Interpretation: para-meniscal cysts communicating with meniscal tears Diagnosis: pm cyst Differential Diagnosis: Intra articular ganglion cysts Management: communicating meniscal tear - arthroscopy. Non communicating meniscal tear - Surgery

Observations: There is linear high signal across the non displaced antero inferior glenoid labrum at 3-6 O'clock position indicating a tear, associated with complete tearing of the anterior scapular periosteum. It extends superiorly. Rest of the labrum appear normal. There is no ossesous fragments. Associated Hill Sachs defect is present in the humeral head. The glenohumeral ligaments appear normal. No associated bone marrow oedema in both the scapula and humeral head. Rotator cuff muscles and tendons appear normal. Mild joint effusion noted. subacrmial subdeltoid bursa distended with fluid. Interpretation: Tear of the antero inferior glenoid labrum with associated Hil Sachs defect Diagnosis: Bankart lesion with Hill Sachs defect Management: Inform the orthopedic team about the findings

Observations: Two ill defined mass lesions in the brain; one on left frontal lobe anteriorly and the other on right periventricular region adjacent to the anterior horn. Both the lesions are located in the grey white interface, demonstrating heterogeneously high signal in T2W and mixed Intensity signal in T1W to the grey matter. Heterogeneous enhancement following gadolinuim contrast. No significant diffusion restriction. Single focus of blooming in the lesion on right peri ventricular region. No other foci of blooming artifacts in the SWI sequences. Marked surrounding perliesional vasogenic oedema. Compression oft the anterior horn of the right lateral ventricle and minimal left ward bowing of the septum pellucidum. No obstructive hydrocephalus. Sclerotic area with bone defect in the frontal bone on right side suspicious for previous surgical defect. Interpretation: Two mass lesions with avid enhancement in the grey white interface with marked perilesional vasogenic oedema 'likely malignant neoplastic Diagnosis: Brain metastases Differential Diagnosis: primary Multicentric glioblastomas Management: Further carry our MR spectrospopy to see NAA peaks or choline peaks/lipid peaks. to rule out gliomas.

Observations: The MRI study of the ankle shows a small bone adjacent to the posteromedial tuberosity of the navicular tuberosity suggestive of accessory navicular bone/Os naviculare. The accessory navicular bone and adjacent navicular bone both shows marrow edema suggestive accessory navicular syndrome Diagnosis: Os naviculare/Accessory navicular bone with accessory navicular syndrome Differential Diagnosis: Trauma Management: Conservative management(rest, NSAIDS and corticosteroid injection). - For refractory cases; surgery

Observations: The MRI study of the brain shows multiple ring enhancing lesions in bilateral cerebrum, cerebellum and brainstem. Some of the rim-enhancing lesions at the right frontal lobe shows perilesional edema. No fluid restriction is exhibited by any of the lesion Diagnosis: Tuberculoma Neurocysticercosis Differential Diagnosis: 1. Metastases 2. Other infection (toxoplasmosis, cryptococcosis). 3. Neurosarcoidosis Management: Review previous images if available to see the progression - CXR to rule out pulmonary TB - Referral to infectious disease specialist

Observations: Lumber vertebral angiomas Interpretation: MRI LUMBER SPINE MULTIPLE PLANNER AND MULTI SEQUENCE. There is abnormal signal intensity noted in L2 vetrbera mixed intensities on T1 and high signal intenisty on T2 . No associated soft tissue componenet is seen, Modiac changes 3 seen in L4 and L5 along anterior corners of the superior endplate , high on T1 anf T2 . L3 vertebral body is showing a curved lesion along the lower end plate of the with central low signal and outer high signal on T1 , and reverse signal intenisty on T2 suggetsive andersson lesion There is also evidence a well defined rounded lesion in L4 verterbal body with high signal on T1 and T2 suggetsive of an hemangioma Diffuse disc bulge noted at the L4 and L5 level causing bilateral lateral recess narrowing Diagnosis: Lumber vertebral angiomas. Modiac 3 changes Andersson lesion Differential Diagnosis: Plasmacytoma. Mets Management: Benign incidental lesions no follow up needed until causing any pain

Observations: The MRI images of the brain show FLAIR hyperintensities at the left frontal and left parieto-occipital lobe with cytotoxic edema at the left parieto-occipital lobe. These corresponding areas of abnormal signal intensity at left frontal and left parieto-occipital lobe shows fluid restriction, seen as hyperintense on DWI and hypointense on ADC indicating acute infarction. However, it is not corresponding with the arterial territory. These regions also show areas of blooming artifact on GRE sequence suggestive of hemorrhage. The MRA brain shows non-visualization of A1 segment of right anterior cerebral artery and right posterior communicating artery suggestive of either hypoplastic artery or stenosis/occlusion. However, these MRA findings does not correspond with abnormal findings noted in the MRI brain. Interpretation: The area of abnormal signal intensity described at left frontal and parieto-occipital lobe which does not correspond to the arterial territory is highly suggestive of venous infarct with hemorrhage, most probably secondary to the cortical venous thrombosis. Diagnosis: Venous Infarcts, CVT Differential Diagnosis: Encephalitis CNS vasculitis Management: Look at the other MRI sequences

Observations: The axial CT study of the ankle shows two well-defined round cystic lesions with partial intraosseous component at the lateral aspect of the calcaneum without bony destruction suggestive of intraosseous ganglion cyst. Another similar well-defined round cystic lesion is seen in close association and posterior to peroneus tendon suggestive of ganglion cysts. The MRI ankle confirms ganglion cysts and cystic nature of the lesion seen as well-defined round lesion that is hypointense on T1 and hyperintense on T2 and STIR Interpretation: The imaging findings are highly suggestive of ganglion cysts (intraosseous and intratendinous). Diagnosis: Ganglion cyst Differential Diagnosis: Degenerative subchondral cyst Synovial cyst Management: Orthopedic or surgical referral

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Observations: abnormal signal seen as high T2 and FLAIR at the superior and inferior colliculi similar abnormal signal at the spinal cord at the level of C4 normal optic nerves Diagnosis: ms Differential Diagnosis: ADEM vasculitis transverse myelitis Management: referral to neurology

Observations: gastric and proximal small intestine wall thickening and submucosal oedema Diagnosis: eosinophilic gastritis Differential Diagnosis: hypertrophic gastritis, Ménétrier's disease, Zollinger-Ellison syndrome, lymphoma Management: refer to GI

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Observations: No abnormal decent noted. No cystocele / rectocele. No pelvic organ prolapse noted Diagnosis: defecogram Management: Inform the findings to referring physician

Observations: PD FS / T1 Hyperintense multicystic/ multilobulated cystic lesion noted in 1st web space, in the intramuscular plane in the dorsal aspect of the hand, abutting the 2nd metacarpal with marrow edema noted. Interpretation: PD FS / T1 Hyperintense multicystic/ multilobulated cystic lesion noted in 1st web space, in the intramuscular plane in the dorsal aspect of the hand, abutting the 2nd metacarpal with marrow edema noted. Diagnosis: hemangioma web space Differential Diagnosis: Soft tissue sarcoma Management: Refer to IR team / Vascular surgeon USG correlation

Observations: CT - A lobulated midline soft tissue mass centered at sacrum and coccyx associated with bony destruction and internal calcifications. - The mass is seen extending to presacral space anteriorly and to the sacral spinal canal posteriorly. - No significant pelvic lymphadenopathy. - No evidence of lung metastases. MRI - Well-defined lobulated midline homogeneous mass centered at the sacrum and coccyx that is hypointense on T1 and avidly hyperintese on T2. The is seen extending anteriorly to presacral space abutting the rectum. Posteriorly it seen extending to and effacing the sacral spinal canal and right paravertebral muscle. - Rest of the spine shows no mass. - The brain is unremarkable. Interpretaton: The findings are suggestive of locally aggressive neoplasm of the sacrum Diagnosis: Chordoma (sacrococcygeal) Differential Diagnosis: Chondrosarcoma Metastases Management: Give IV contrast to further characterize the lesion. - Inform the referring physician about the findings. - Refer to oncology MDT to discuss further management including image guided biopsy and treatment like surgery, radiotherapy and so on

Observations: Increased posterior epidural space on flexion with cord hyperintense signal noted. adjacent to C3-C5 levels Interpretaton: benign motor neuron disorder Diagnosis: hirayama Management: Refer to spine surgery team and neuro team

Observations: large exophytic solid mass noted at the greater curvature of the stomach. this is compressing rather than infiltrating the adjacent organs Diagnosis: Gist Differential Diagnosis: Ca stomach Management: staging refer to GI/relevant MDT

Observations: There is a well circumscribed round cystic mass with an eccentric solid mural nodule which is hypointense in T1 and hyperintense in FLAIR at medulla oblongata. Post-contrast, the mural nodule shows intense homogeneous enhancement without enhancement of the cystic wall. Perilesional edema with expansion of the medulla is observed. Rest of the brain and whole spine are unremarkable without evidence of space occupying lesion Interpretation: benign brainstem neoplasm Diagnosis: Hemangioblastoma Differential Diagnosis: Pilocytic astrocytoma (unlikely as there is no enhancement of cystic wall) Metastases Management: Inform the referring physician about the findings. - Refer to the neurosurgeon for further management. - Work up for VHL / Genetic counselling

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Observations: smaller right cerebrum compared to the left counterpart cystic encephalomalacia of the right parietotemporal lobe with atrophy of the ipsilateral basal ganglia and brainstem right calvarial thickening with hyperpneumatization of the ipsilateral mastoid air cells no obvious vascular malformation identified Interpretation: Congenital disorder Diagnosis: dyke-davidoff-masson syndrome Differential Diagnosis: hemimegalencephaly Sturge-Weber syndrome rasmussen encephalitis Management: refer to neurology

Observations: The MRI study of both legs show periosteal edema seen as hyperintense signal on STIR along anteromedial aspect of the right femur with bone marrow edema at proximal half of the right femur. No fracture is noted. Interpretation: The imaging findings are suggestive of medial tibial stress syndrome. Diagnosis: Medial tibial stress syndrome Management: Alert the referring physician about the findings. - Correlate with the patient's clinical history. - Recommend referral to the orthopedic surgeon for further management

Observations: The MRI study shows diffuse cerebral atrophy with enlarged subarachnoid space. An extra-axial cystic lesion is seen along the left frontal lobe with mild mass effect over the underlying left frontal lobe. The lesion almost follows the CSF intensity, high in T2, low in T1 and FLAIR, no restriction on DWI and no blooming artefact on GRE sequence. However, a round focal area of T2 signal loss and FLAIR increased signal is noted within cystic lesion suggestive of CSF flow artefact. Multiple T2/FLAIR hyperintense lesions are seen at bilateral centrum semiovale and periventricular region suggestive small vessel disease. Interpretation: The imaging findings are highly suggestive of arachnoid cyst along the left frontal lobe with CSF flow artefact within the arachnoid cyst. Diagnosis: Arachnoid cyst with CSF flow artefact Differential Diagnosis: epidermoid cyst Management: Refer to neurosurgeon

Observations: gestational sac noted at the lower segment caesarian section scar Diagnosis: scar ectopic Management: urgent referral to gynaecology

Observations: parallel parafalcine stripe in the subcortical white matter at the vertex on the right side the right ICA shows no flow, and the right MCA and ACA are reconsititued via the circle of Willis Interpretation: Ischemic Diagnosis: RT watertshed infarcts Differential Diagnosis: Small vessel ischemic disease Management: urgent referral to vascular team inform IR