RADIOLOGY

MUST-SEE

IMAGES

SEMMELWEIS UNIVERSITY

Dr. Pál Novák Kaposi

Dr. Dávid László Tárnoki, PhD

Aim of this section

To display the typical features of the most important diagnoses in radiology

To summarize the common applications of the main imaging modalities

Important to recognize

Imaging modality/technique

Examined region

Main anatomical structures

Radiologic signs suggesting disease

Diagnoses of clinical significance

1.

1.

Modality: Non-enhanced CT, axial view

Region: Brain

Radiologic sign: Cortical-subcortical border disappeared/blurred

due to oedema, (Gács’) hyperdense media sign (arrows)

Diagnosis: Subacute ischaemia in territory of right middle

cerebral artery

2.

Modality: Non-enhanced CT, brain window setting (window center: 40

HU; window width: 80 HU); Region: Brain

Radiologic sign: Hypodense brain parenchyma

Diagnosis: Ischaemic lesion in chronic phase in territory of right MCA

2.

3.

3.

Modality: Non-enhanced CT

Region: Brain

Radiologic sign: Large hyperdense

hemorrhage extending into the ventricles,

midline shift to the right

Diagnosis: Acute cerebral apoplexy

4.

4.

Modality: Non-enhanced CT, Region: Brain

Radiologic sign: Hyperdense bleeding in

basal cisterns and sulci

Diagnosis: Acute subarachnoid hemorrhage

5.

5.

Modality: Non-ehnanced CT, Region: Brain

Radiologic sign: Crescent-shaped hyperdense

blood Diagnosis: Acute subdural hematoma

(bilateral)

6.

6.

Modality: Non-enhanced CT

left – brain window, right – bone window

Region: Brain

Radiologic sign: Lens-shaped hyperdense bleeding

and skull vault fracture

Diagnosis: Right-sided epidural hematoma

7.

7.

Modality: right – Non-enhanced CT, left – CE T1WI MRI

upper – Sagittal view, lower – Axial view

Region: Brain

Radiologic sign: Parenchymal lesion showing rim

enhancement

Diagnosis: Glioblastoma multiforme (GBM)

8.

8.

Modality: Non-enhanced MRI

left: T1WI sagittal, center: T2WI sagittal, right: T2WI axial

Region: Lumbar spine

Radiologic sign: Hypointense discus protruding into the spinal canal

Diagnosis: Disc herniation between L2 and L3 level

9.

9.Modality: Contrast-enhanced CT

Region: Upper abdomen; Radiologic sign:

Hypoenhancing lesions, normal spleen

Diagnosis: Multiple liver metastases

Modality : Liver ultrasound with convex

probe (3.5-5 MHz), B-mode; Region: Liver

Radiologic sign: Hypoechoic lesions

Diagnosis: Multiple liver metastases

10.

Modality: left – Non-enhanced CT, right – Contast-

enhanced CT

Region: Upper abdomen

Radiologic sign: Enlarged pancreas with indistinct margins

green arrow: Enhancing head – living tissue

red arrow : Non-enhancing body – necrosis

Diagnosis: Acute necrotizing pancreatitis

10.

11.

Modality: Ultrasound of gallbladder with convex probe (3.5–5 MHz)

Region: Gallbladder

Radiologic sign: Hyperdense structure in the lumen of the gallbladder

with acoustic shadowing

Diagnosis: Gallstone

11.

12.

Modality: Ultrasound of gallbladder with convex

probe (3.5–5 MHz), B-mode; lower left – Color

Doppler of the gallbladder

Region: Gallbladder

Radiologic sign: Stone in the lumen (green arrow),

Thick, stratified, oedematous wall (red arrow),

hypervasculatisation in the wall (white arrow)

Diagnosis: Acute cholecystitis

12.

13.

Modality: Sonogram of the appendix with linear probe (7.5–10 MHz), B-mode

upper right: Color Doppler of the appendix

Region: Appendix

Radiologic sign: left image – Normal, compressible appendix; right image – Non-compressible

tubular structure with thickened wall showing signs oedema (red arrow) and hypervascularisation

(white arrow). Free abdominal fluid is also present (green arrow). Diagnosis: Acute appendicitis

13.

14.

Modality: Chest radiograph, frontal projection (in upright position)

Region: Chest, upper abdomen

Radiologic sign: Crescents of radiolucency under both hemidiaphragms (red

arrows) Diagnosis: Free abdominal air (due to perforation of luminal

abdominal organ)

14.

15.

Modality: left image – Abdominal plain radiograph, standing

posture; right image – Contrast-enhanced CT scan

Region: Abdomen and pelvis

Radiologic sign: Distended colon (green arrows) with air–fluid

levels (red arrows). In the sigmoid colon an obstructing

contrast-enhancing mass is shown (white arrows).

Diagnosis: Large-bowel obstruction caused by sigmoid cancer

15.

16.

Modality: Barium enema study,

double-contrast method

Region: Abdomen

Radiologic sign: Annular irregular

stenosis (apple-core sign)

Diagnosis: Colon cancer

16.

17.

Modality: Barium swallow test, fluoroscopy

Region: Esophagus

Radiologic sign: Outpouching (green arrows) filled with

contrast material near the pharyngoesophageal junction

(white arrow). An air-fluid level is also seen (red arrow).

Diagnosis: Zenker diverticulum

17.

18.

Modality: Non-enhanced CT scan (low-dose)

Region: Kidney

Radiologic sign: Hyperdensity in the right kidney

Diagnosis: Stone in the right kidney

18.

19.

Modality: Contrast-enhanced CT

Region: Abdomen

Radiologic sign: Enlarged right kidney

demonstrates patchy hypoenhancement

Diagnosis: Acute pyelonephritis

Modality: Kidney ultrasound with convex probe (3.5–5 MHz), B mode &

color Doppler Region: Abdomen

Radiologic sign: Enlarged right kidney shows ill-marginated central echo

group and parenchymal hypovascularisation

Diagnosis: Acute pyelonephritis (right side)

19.

20.

Modality: upper left: Non-enhanced CT, lower left and

right: Multiphase contrast-enhanced CT

Region: Abdomen, retroperitoneum

Radiologic sign: Aortic aneurysm with wall

calcifications (green arrow), hyperdense

retroperitoneal fluid collection (red arrow), aortic

aneurysm leakage (white arrow)

Diagnosis: Aortic aneurysm rupture

20.

21.

Modality: Posteroanterior chest radiograph (upright); hard-beam technique (120– 140 keV) Region: chest,

pleura

Radiologic sign: left image – normal morphology; right image – Decreased transparency at lung bases showing

a meniscus-shaped contour on the right side. Diaphragm and lateral sinuses cannot be differentiated (arrows).

Diagnosis: Bilateral pleural effusion

21.

22.

Modality: Expiratory chest radiograph in frontal

projection

Region: Chest, pleura

Radiologic sign: Peripheral space is radiolucent

with no lung markings (arrow), visible visceral

pleural line (white line), collapsed right lung

Diagnosis: Right-sided pneumothorax (PTX)

22.

23.

Modality: Bedside chest radiograph (anteroposterior)

Region: Chest, lung

Radiologic sign: Decreased tranparency

(consolidation) in the right upper lobe (white line), left-

sided central venous catheter

Diagnosis: Right-sided lobar pneumonia

23.

24.

Modality: left – Posteroanterior chest radiograph

upper right – Chest CT, lung window

lower right – Contrast-enhanced chest CT,

mediastinal window

Region: Chest, lung

Radiologic sign: Air-containing fluid collection with thick

enhancing rim (arrows)

Diagnosis: Left-sided lung abscess

24.

25.

25.

Modality: Non-enhanced chest CT; bone

window; core biopsy

Region: Chest, lung

Radiologic sign: CT-guided biopsy from the

right apical mass

Diagnosis: Thoracic core biopsy

Modality: PET-CT; 18-fluorodeoxyglucose (18F-FDG)

radiotracer; fused image. Region: Chest, lung

Radiologic sign: Increased 18F-FDG uptake in the

right apical mass

Diagnosis: Right apical lung cancer (Pancoast tumor)

26.

Modality: left image – Posteroanterior chest radiograph

(upright); right image – chest CT; lung window;

Region: Chest, lung

Radiologic sign: Multiple rounded lesions (red arrows);

Multiple soft tissue lesions showing different size and

rounded shape (green arrows). History: Kidney cancer.

Diagnosis: Multiple lung metastases

26.

27.

27.Modality: HRCT of the lung, lung window, axial view. Region: Chest, lung

Radiologic sign: Bilateral dorsobasal honeycombing pattern (red arrow), traction

bronchiectasis (green arrow)

Diagnosis: Pulmonary fibrosis

28.

28.

Modality: Pulmonary CT-angiography (contrast-enhanced series in pulmonary arterial phase, CTA)

Region: Chest, pulmonary arteries

Radiologic sign: Large hypodense filling defects in the left main pulmonary artery. History: Lower extremity

deep vein thrombosis

Diagnosis: Pulmonary embolism

29.

29.

Modality: Lower extremity venous ultrasound,

linear probe, B-mode

Region: Crural, posterior tibial vein

Radiologic sign: Posterior tibial vein is filled with

hypoechoic thrombus, the lumen is non-

compressible. Left image – longitudinal section,

right image – transverse section

Diagnosis: Deep vein thrombosis (DVT)

30.

30.

Modality: Digital subtraction angiography (DSA), Catheter angiography

Region: Neck, carotid bifurcation

Radiologic sign: left image – Significant internal carotid artery stenosis (green arrow), center

image – balloon dilatation and stenting (red arrow), right image – Control angiography

Diagnosis: Carotid angioplasty and stenting

31.

31.

Modality: Digital subtraction angiography (DSA), Catheter angiography

Region: Lower extremity, popliteal artery

Radiologic sign: left image – Significant right popliteal artery stenosis (red

arrow), collateral circulation (green arrows); right image – Control angiography

after percutaneous transluminal angioplasty (PTA), balloon dilatation.

Diagnosis: Chronic popliteal artery stenosis, balloon angioplasty (PTA)

32.

32.

Modality: Foot X-ray – Anteroposterior (left image), oblique view (right image)

Region: Left foot

Radiologic sign: Oblique fracture of the left 2nd metatarsus with minimal

dislocation (red arrow). Patient fell from height.

Diagnosis: Fracture of the 2nd metatarsus

33.

33.Modality: X-ray of the left knee in two projections

Region: Left knee

Radiologic sign: Inhomogeneous destructive

metaphyseal lesion of the left femur. Periosteal

reaction, Codman triangle and invasion to the

sorrounding soft tissue is also present.

Diagnosis: Osteosarcoma of the femur

34.

34.

Modality: Radiograph of the left hallux in two

projections

Region: Left foot, hallux

Radiologic sign: Marked ill-defined bone resorption in

distal tuberosity (= ungual process). Ulcerous lesion is

also shown.

Diagnosis: Acute osteomyelitis

35.

35.

Modality: left image – X-ray of the sinuses; right image –

CT of the sinuses, low-dose, bone window

Region: Maxillary region, paranasal sinuses

Radiologic sign: Right maxillary sinus shows homogenous

decreased transparency, the left one has rounded mucous

thickening

Diagnosis: Bilateral sinusitis

36.

36.

Modality: Contrast-enhanced head-and-neck CT, left image – axial view; right image – coronal view

Region: Head and neck

Radiologic sign: Right-sided submandibular fluid collection with thick enhancing wall.

Patient had wisdom tooth extraction before.

Diagnosis: Neck abscess

37.

37.

Modality: Thyroid ultrasound, linear probe (7.5–10 MHz), B-mode

Region: Thyroid

Radiologic sign: Isoechoic spongiform nodule with hypoechoic halo (white line)

Diagnosis: Benign thyroid nodule

38.

38.

Modality: Thyroid gland scintigram, Technetium-99m (99m Tc)-pertechnetate scintigraphy

Region: Thyroid

Radiologic sign: Enlarged right lobe with focal lesion showing decreased tracer activity (white

arrow)

Diagnosis: Cold nodule

39.

39.

Modality: PET-CT, 18-fluorodeoxyglucose (18F-FDG) radiotracer

Hybrid imaging method: PET – Metabolic activity, CT – Morphology

Region: Whole-body

Radiologic sign: Increased fluorodeoxyglucose (18F-FDG) uptake in liver and pubic bone,

normal physiologic activity is shown in the bladder; known underlying malignancy

Diagnosis: Multiple metastases

40.

Modality: Mammography of the right breast, mediolateral oblique

view, soft-beam technique (30 keV); Region: Right breast

Radiologic sign: Soft tissue mass with spiculated contour

Diagnosis: Breast cancer

40.

41.

Modality: Breast sonography with linear probe (7.5–10 MHz), B-mode

Region: Breast, axilla

Radiologic sign: left image – well-defined anechoic lesion with

posterior acoustic enhancement; right image – ill-defined

hypoechogenic lesion with partial

acoustic shadowing: solid structure, suspicious of cancer

Diagnosis: cyst and malignancy

41.

42.

42.

Modality: Babygram

Region: Neonate

Radiologic sign: „White lung”, wide air-bronchograms

running to the peripheries. The contours of the heart

blurred, complete loss of transparency is shown.

Diagnosis: IRDS (Idiopathic respiratory distress syndrome)

43.

43.liver

right kidney

spleen

left kidney

bowels

bladder

uterus

Modality: FAST (Focused Assessment with Sonography for Trauma) scan

Region: Abdomen, pleural sinuses, pericardium, aorta

Radiologic sign: Free abdominal fluid in the hepatorenal fossa, around the spleen,

among the bowel loops and in Douglas pouch. Patient sustained blunt trauma.

Diagnosis: Free abdominal fluid suspicious for hemorrhage