. Radiology Case Scenariosssssssssssssss
- 1. Radiology Case Scenarios Lecturer: Huda Nasser Biophysics II Course Washington University of Health and Science Summer 2025
- 2. Case 1 A 9-year-old boy fell on his left wrist. There’s pain and swelling. What imaging modality would you choose and why? Plain X-ray (Left wrist) Best for initial evaluation of bone injury after trauma. Fast, accessible, and diagnostic in most pediatric wrist injuries. 2 Bone - > X-ray or CT (if not clear in X-ray & off tissue - > MRI or US Arteries-> > <T wi contrast (CTA = 1 angiography
- 3. Case 2 A patient presents with localized pain at the plantar aspect of the heel, worsened by walking, consistent with a heel spur. What imaging modality would you choose and why? Plain X-ray (Heel, lateral foot) Clearly shows bony spurs projecting from the calcaneus. Quick, inexpensive, and widely available. 3 * DoneSuching ot a
- 4. Case 3 A 35-year-old woman twisted her ankle. X-ray appears normal but pain persists. What imaging modality would you choose and why? MRI (Ankle) X-ray normal, but pain persists → suspect soft tissue injury or occult (non- visible) fracture. MRI is excellent for evaluating ligament and tendon injuries, bone marrow edema, cartilage damage, and joint effusion. 4
- 5. Case 4 A 12-year-old has a painful swollen knee. Suspected bone infection. What imaging modality would you choose and why? MRI (Knee) Early, accurate detection of bone and soft tissue infection to guide treatment. Sometimes, X-ray is done first to rule out fractures or chronic changes but often normal early in infection. 5
- 6. Case 5 A 25-year-old male presents to the emergency department (ED) unconscious following a motor vehicle accident. What imaging modality would you choose and why? Non-contrast CT (Head) Fast and widely available → ideal for emergencies. Best initial test for detecting intracranial hemorrhage, skull fractures, and swelling. 6
- 7. Case 6 A 28-year-old woman at 24 weeks of gestation presents with back pain following a motor vehicle accident, raising concern for vertebral injury. What imaging modality would you choose and why? MRI (Spine) Safe in pregnancy (no ionizing radiation). Can detect bone marrow edema, fracture lines, and associated spinal cord or nerve root involvement. 7 If not preg its CT -
- 8. Case 7 A 35-year-old female presents to the clinic with fever and cough. What imaging modality would you choose and why? Chest X-ray (CXR) Fever and cough suggest possible respiratory infection. Best initial tool to assess lung pathology causing fever and cough. For more detailed evaluation → chest CT scan. 8
- 9. Case 8 A 60-year-old patient presents to the clinic with persistent cough and unintentional weight loss. What imaging modality would you choose and why? CT Scan (Chest) Persistent cough + weight loss → raises suspicion for a lung mass. A chest X-ray is often done first but may miss small or central lesions. CT provides far superior detail and is essential for diagnosis and staging. 9 - > usually turner -
- 10. Case 9 A 55-year-old male presents to the emergency department with chest pain and shortness of breath. What imaging modality would you choose and why? Based on clinical suspicion: If acute coronary syndrome (heart attack) suspected: ECG, echocardiography, and coronary CT angiography. If pulmonary embolism (PE) suspected: CT pulmonary angiography (CTPA) is the gold standard for diagnosis. If aortic dissection suspected: CT angiography of chest (aorta) is preferred. 10
- 11. Case 10 A newborn is suspected to have congenital heart disease based on clinical findings. What imaging modality would you choose and why? Echocardiography Non-invasive and radiation-free. Provides real-time visualization of heart structures and blood flow. Can detect structural defects. 11
- 12. Case 11 A newborn presents with limited hip abduction and asymmetry of the thigh folds, raising suspicion for developmental dysplasia of the hip (DDH). What imaging modality would you choose and why? Ultrasound (Hip) The gold standard for early diagnosis of DDH in infants under 6 months (bones are not yet ossified). Radiation-free and safe for newborns. 12 - > after 6 months its X-ray
- 13. Case 12 A 3-year-old child presents to the ED after swallowing a coin. What imaging modality would you choose and why? X-ray (Neck, Chest, and Abdomen) A coin is radiopaque → visible on X-ray. Helps locate the coin and determine orientation and risk of airway obstruction. 13
- 14. Case 13 A 5-year-old child presents to the pediatric clinic with nasal congestion, and snoring, consistent with enlarged adenoids. What imaging modality would you choose and why? X-ray (Lateral neck) Simple, quick, and widely available. Effective in assessing adenoid size and airway obstruction. 14
- 15. Case 14 A young adult presents with pain in the right lower quadrant of the abdomen and fever. What imaging modality would you choose and why? Ultrasound (Abdomen) Suspected acute appendicitis based on the symptoms. Easily detect enlarged, non-compressible appendix, free fluid, and others. 15
- 16. Case 15 A 30-year-old woman presents to the gynecology clinic with irregular menstrual cycles. What imaging modality would you choose and why? Ultrasound (Pelvis) Best for evaluating reproductive organs with high resolution and no radiation. 16
- 17. Case 16 A 25-year-old male patient presents with sudden onset of severe flank pain and hematuria, raising suspicion for a kidney stone. What imaging modality would you choose and why? Non-Contrast CT (Abdomen and pelvis) Detects stones of all compositions (radiopaque and radiolucent). Precisely locates stones in the urinary tract. Assesses stone size and number. 17 bone indow
- 18. Case 17 A patient presents to the emergency department with acute flank pain, elevated blood pressure, and hematuria, suggestive of renal artery infarction (renal artery stroke). What imaging modality would you choose and why? CT Angiography (Abdomen) Detailed visualization of renal arteries to detect occlusion, stenosis, or infarction. Quick and widely available imaging in emergency settings. 18
- 19. Case 18 A 20-year-old female patient presents to the clinic with symptoms of sinusitis, including facial pressure, headache, and nasal discharge. What imaging modality would you choose and why? Non-contrast CT (Sinuses) Provides detailed anatomy of the sinuses, and nasal cavity. Detects mucosal thickening, air-fluid levels, and obstruction. 19
- 20. Case 19 A 68-year-old male presents to the ED with sudden onset of right-sided weakness. What imaging modality would you choose and why? Non-contrast CT (Head) Fast and widely available → ideal for emergencies. CT is the first-line imaging to differentiate between ischemic stroke and hemorrhagic stroke (bleeding), and detect early signs of ischemia (though subtle in first hours). 20
- 21. Case 20 A 50-year-old female presents with sudden loss of consciousness without any history of trauma. What imaging modality would you choose and why? Non-contrast CT (Head) Sudden loss of consciousness without trauma raises concerns for: intracranial hemorrhage, stroke, brain mass, or other acute brain pathology. Rapidly rules out acute hemorrhage or other urgent brain pathology causing sudden unconsciousness. 21
- 22. Case 21 A young woman presents to the neurology clinic with vision problems, numbness in the limbs, and fatigue. What imaging modality would you choose and why? MRI with contrast (brain and spinal cord) Symptoms suggest a neurological demyelinating disorder, such as multiple sclerosis (MS). MRI is the gold standard for evaluating lesions in the brain and spinal cord, optic nerve involvement, plaques typical of MS, and active lesions using gadolinium contrast. 22
- 23. Case 22 A 25-year-old patient presents with recurrent, unprovoked seizures, consistent with a diagnosis of epilepsy. What imaging modality would you choose and why? MRI (brain) & EEG MRI identifies the underlying structural cause of seizures. EEG assesses the functional brain activity to confirm epilepsy and characterize and locate the sites of seizures. 23
- 24. Case 23 A 15-year-old male presents to the clinic with tilting of the body to one side, asymmetry of the shoulders, and a visible spinal curvature, suggestive of scoliosis. What imaging modality would you choose and why? X-ray (Whole spine- standing) Assess the degree and location of spinal curvature, and monitor progression over time. 24
- 25. Case 24 A 40-year-old patient presents with lower back pain that radiates to the right leg, raising concern for nerve root compression, possibly due to a herniated disc. What imaging modality would you choose and why? MRI (Lumbar spine) Provides excellent visualization of intervertebral discs, nerve roots, spinal canal, and soft tissues. Can detect herniated discs and nerve root compression causing radicular symptoms. 25 disc is always MRI -
- 26. Case 25 A 50-year-old female presents with visible, tortuous veins and aching pain in her lower legs, consistent with varicose veins. What imaging modality would you choose and why? Doppler Ultrasound Best non-invasive method to evaluate venous reflux and anatomy in varicose veins. 26
- 27. Case 26 A 45-year-old male presents with right leg swelling, pain, and warmth suggestive of deep vein thrombosis (DVT). What imaging modality would you choose and why? Doppler Ultrasound (Right leg) Non-invasive, and highly accurate test to visualize the deep veins of the leg and evaluate blood flow changes. If ultrasound is inconclusive and clinical suspicion remains high, CT or MRI venography is recommended. 27
- 28. Case 27 A 32-year-old woman presents with a lump in her right breast. What imaging modality would you choose and why? Ultrasound (Right breast) In women under 40, breast tissue is usually dense, making mammography less sensitive. Ultrasound is useful to assess size, shape, margins, and vascularity of the lump. 28
- 29. Case 28 A 60-year-old patient with newly diagnosed lung cancer requires further imaging for accurate staging and assessment of metastatic disease. What imaging modality would you choose and why? PET-CT (Whole-body imaging) Highly sensitive for detecting metabolically active metastatic disease in lymph nodes and distant organs. Helps identify occult metastases (invisible on CT alone). Essential for accurate staging and treatment planning. 29
- 30. Case 29 A 25-year-old patient presents to the dental clinic with lower jaw pain and swelling. What imaging modality would you choose and why? Panoramic X-ray Provides a broad view of the entire mandible, teeth, and jaw joints. Quick, low-radiation, and widely available. 30
- 31. Case 30 A 28-year-old patient presents with a soft, painless, and slowly growing lump on the upper back. What imaging modality would you choose and why? Ultrasound Excellent for differentiating solid and cystic lesions. Helps assess the size, vascularity, and relationship to surrounding structures. 31
- 32. Case 31 A patient diagnosed with a condition requiring surgery under general anesthesia is being evaluated. What imaging investigations are appropriate for preoperative assessment? Chest X-ray, ECG, and Echocardiography They all assesses the patient’s cardiopulmonary status since anesthesia affects both the heart and lungs, and any pre-existing cardiopulmonary issues can increase risks during surgery. 32