Spotters 13

Slide 2
Small bowel lymphoma. There is focal, concentric thickening of a loop of small bowel (asterisk). There is excavation of the inner lumen of the mass, resulting in mild so-called aneurysmal dilatation, unlike adenocarcinoma, which typically results in an annular stricture.
Slide 3
MR sialography image showing gross dilatation of the main duct and some of the secondary ducts. Areas of low signal in the main duct are due to the presence of several large stones. The distal part of the duct is normal.
Slide 4
X-linked spondyloepiphyseal dysplasia tarda. Characteristic dense mounds of bone on the posterior two-thirds of the vertebral end plates are seen.

Slide 5
Angiomyolipoma. Axial CT demonstrates small areas of fat within the right kidney consistent with an angiomyolipoma.
Slide 6
Preterm baby with respiratory distress syndrome. (A) Day 1: mild ground-glass appearance within both lungs. (B) Day 3: worsening opacification with air bronchograms.
Slide 7
Calcified hepatic metastases in a patient with mucinous adenocarcinoma of the colon.
Slide 8
Fluid attenuation structure (asterisk) in the right anterior cardiophrenic angle represents a pericardial cyst.

Slide 9
Rhabdomyosarcoma. (A) Axial and (B) coronal CT images with contrast medium. There is a large mass in the superior right orbit which is difficult to separate from the extra-ocular muscles. There is deformity of the posterior wall of the globe and marked proptosis. The mass shows uniform contrast enhancement.
Slide 10
Foreign body in the left bronchus (not radio-opaque). Relative oligaemia and small blood vessels at the left lung are due to poor ventilation and reflex vasoconstriction on the left side.
Slide 9
Rhabdomyosarcoma. (A) Axial and (B) coronal CT images with contrast medium. There is a large mass in the superior right orbit which is difficult to separate from the extra-ocular muscles. There is deformity of the posterior wall of the globe and marked proptosis. The mass shows uniform contrast enhancement.
Slide 10
Foreign body in the left bronchus (not radio-opaque). Relative oligaemia and small blood vessels at the left lung are due to poor ventilation and reflex vasoconstriction on the left side.

Slide 11
Takayasu's disease. (A) Axial CT demonstrates the diffuse thickening of the wall of the aorta (arrow). (B) Curved multiplanar coronal reformats demonstrate the bilateral renal artery stenosis (arrows).
Slide 12
Retroperitoneal fibrosis (periaortitis). There is a concentric soft tissue abnormality surrounding the aorta with obstruction of the right ureter. Differential diagnosis includes lymphoma and retroperitoneal metastases
Slide 13
Juvenile angiofibroma in a teenager with epistaxis. (A) This axial CT was the first study performed in this patient. The critical finding is widening of the pterygopalatine fissure on the left side. This is virtually diagnostic of an angiofibroma. (B–E) Contrast-enhanced (gadolinium) T1-weighted MRIs. (B) Axial image revealing an enhancing, well-defined mass in the nose. Clinically this was visible from an anterior view through the nose and a posterior view with a mirror in the nasopharynx. (C) Axial image. Note the lateral extension of the tumour towards the infratemporal fossa. (D) Axial image. More superiorly the tumour is less well defined and more infiltrative. Note the extension into the pterygopalatine fissure is visible but more easily seen on CT. (E) Coronal image revealing the mass at the level of the posterior choana with its lateral extension. This is an essential observation for surgical planning. (F) Angiography. Lateral superselective injection into the maxillary artery shows the highly vascular nature of the tumour. This investigation was performed before therapeutic embolization and subsequent surgical resection.
Slide 14
Sacrococcygeal teratomas. (A) Plain abdominal radiograph showing a very large external component to a sacrococcygeal teratoma in a newborn. (B) Sagittal T2-weighted image in another infant showing a large intrapelvic component to the sacrococcygeal teratoma. Note the teratoma, posterior to the uniformly hyperintense bladder, is of intermediate heterogeneous signal, and is invading the sacrum. (C) Axial T1-weighted image in the same patient showing the heterogeneous mass in a presacral location.

Slide 15
Fibrolamellar hepatocellular carcinoma. Unenhanced CT image shows a large, slightly hypoattenuating left hepatic lobe mass with a calcified central scar (arrow).
Slide 16
Thyroid ophthalmopathy. (A) Axial and (B) coronal CT imaging. There is generalized enlargement of the bellies of all the extra-ocular muscles, proptosis and increased intraorbital fat.
Slide 17
Bilateral staghorn calculi are seen on the control image of an IVU series.
Slide 18
Asphyxiating thoracic dystrophy. (A) Narrow thorax and short ribs. (B) Horizontal acetabular roofs and pronounced medial spurs, less pronounced laterally (‘trident’ appearance).

Slide 19
Scleroderma. A: Oral contrast material delineates abnormal jejunum, which is mildly dilated. There is apparent mural thickening (arrow), which actually represents the very closely spaced folds collapsed on one another. B: This was confirmed on a small-bowel study, which reveals abnormally close folds, which are not thickened or nodular.
Slide 20
Hydatid disease of the kidney. There is a cystic mass in the left kidney with a multiloculated internal appearance from the presence of many daughter cysts. The mass is causing marked pelvicalyceal dilatation.
Slide 21
Raised intracranial pressure. Axial T2 MRI. There is dilatation of the optic nerve sheath in a patient with raised intracranial pressure secondary to right transverse sinus occlusion
Slide 22
Neuroblastoma with midline extension. Contrast-enhanced computed tomography scan demonstrates extension of tumor, with calcifications anterior to the vertebral body and with encasement of the left renal artery (arrow) and aorta (A). There is mild left hydronephrosis.

Slide 23
Hypertropic pyloric stenosis. (A) Longitudinal ultrasound shows the thickened hypo-echoic muscle. The margins of the pyloric canal appear as parallel, curvilinear echogenic lines. (B) Transverse ultrasound of the pylorus with central echogenic mucosa and surrounding hypo-echoic muscle Barium meal showing the narrow pyloric canal with a double track of barium. The hypertrophied pylorus indents the base of the duodenal cap.
Slide 24
(A) Part of a panoramic radiograph showing a corticated radiolucency between the inferior alveolar canal and the lower border of the mandible due to the presence of a Stafne bone cavity. The 3D CT (B) shows the depression on the lingual aspect of the mandible.
Slide 25
Blount's disease. (A) Plain radiograph, (B) coronal CT and (C) 3D CT reconstruction (posterior view).
Slide 26
Osteopoikilosis. Multiple discrete islands of sclerosis, especially affecting the carpus, metaphyses, and epiphyses.

Slide 27
Necrotizing enterocolitis. Supine radiograph demonstrates multiple dilated loops of bowel, extensive submucosal and subserosal pneumatosis, and portal vein gas.
Slide 28
Congenital abnormalities. (A) Neonate with multiple congenital abnormalities. Note the duodenal atresia with ‘double bubble’ sign, the dextrocardia, the nasogastric tube arrested at the T3 level suggestive of oesophageal atresia, and because of the gas in the stomach it therefore represents a tracheo-oesophageal fistula. (B) This child was found to have an absent portal vein with the superior mesenteric vein draining into the inferior vena cava as seen on the longitudinal ultrasound view.
Slide 29
Cystadenoma. A and B: Axial contrast-enhanced computed tomography images show a large fluid density cystic mass with multiple predominantly thin septations (arrows) and no associated ascites.
Slide 30
Neurofibromatosis Type 1. AP radiograph of the skull showing ‘empty’ left orbit.

Slide 31
Nephroblastomatosis, 12-month-old girl. Computed tomography demonstrates an enlarged right kidney with a rind of soft tissue in the subcapsular space compressing the enhancing renal cortex.
Slide 32
Collection of calculi at hilum of parotid gland. There is minor sialectasis (irregularity of calibre of some intraglandular ducts).
Slide 33
Le Fort II fracture. The fractures of the inferior margins of the orbits and of the lateral walls of the maxillary sinuses have been arrowed. The fracture of the nasal bone is not visible on this projection.
Slide 34
Recto-urethral fistula. Augmented pressure colostogram in a male infant with a high anorectal malformation

Slide 32
Collection of calculi at hilum of parotid gland. There is minor sialectasis (irregularity of calibre of some intraglandular ducts).
Slide 33
Le Fort II fracture. The fractures of the inferior margins of the orbits and of the lateral walls of the maxillary sinuses have been arrowed. The fracture of the nasal bone is not visible on this projection.
Slide 34
Recto-urethral fistula. Augmented pressure colostogram in a male infant with a high anorectal malformation
Slide 35
Wilms' tumour. (A) Axial CT of the abdomen after intravenous contrast medium enhancement in a 2˝ year old boy showing a large mass arising from the right kidney which is of heterogeneous attenuation. The mass is seen to displace the normal enhancing renal parenchyma to the left. (B) Thoracic CT tumour thrombus was seen to extend from the inferior vena cava into the right atrium, causing a filling defect within the heart (thin arrow). Note the enlarged azygos vein (wide arrow) adjacent to the aorta and the large right pleural effusion.

Slide 36
Malrotation and volvulus. Upper GI contrast medium study demonstrates the classical ‘corkscrew’ pattern of the duodenum and jejunum spiralling around the mesenteric vessels
Slide 37
Pyknodysostosis. (A) The mandibular angle is obtuse (straight). (B) Generalized osteosclerosis. The terminal phalanges show varying degrees of hypoplasia and tapering.
Slide 38
Intussusception. Air outlines the intussusception in the transverse colon during an air enema.
Slide 39
Acute appendicitis. Ultrasound shows an enlarged appendix with a fluid-filled lumen.

Slide 40
Ovarian teratomas. (A) Pelvic US in an 8 year old girl showing a mainly anechoic cystic mass, over 10 cm in diameter, with a more solid component posteriorly. (B) Coronal CT reformatted image in a 10 year old girl showing a cystic mass lesion superior to the bladder with (possibly tooth-like) calcification seen peripherally on the right side of the mass.
Slide 41
Metaphyseal chondrodysplasia, Type Jansen. Femora are short with marked expansion, irregular ossification and some sclerosis of the metaphyses. Epiphyses are large and rounded.