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© 2019 Radiology Bits

 This PDF book is a collection of our Twitter account cases
number 71 to 80. Shown here are quiz cases and their
related 'Radiology Wisdom' in an organized manner. This
book would be useful if you missed on any of our Twitter
cases, want to refresh your memory regarding prior posted
information or just want to have a good number of cases
collected in one document that is easy to carry around on a
mobile device. The difficulty of the presented quiz cases
spans various levels. The content is never meant to be
comprehensive, but rather gives bits and pieces of easy to
grasp information on various imaging-related topics. This
Book is ideal for radiology residents, as well as interns and
students who are interested in the topic. I hope you find
this helpful and enjoyable at the same time!︎

Amr Ajlan ︎

Case Contributors:︎
Amr Ajlan, MD︎
Khalid Khashoggi, MD ︎

All rights reserved © 2019 Radiology Bits

 FIND
T HE
CODE

J
 X-ray:
Right-sided aortic
arch

Upper GI study:
Posterior esophageal
indentation by an
aberrant left
subclavian artery
 Unenhanced CT IV-enhanced CT

The spleen appears low on unenhanced CT and

appears dense after IV enhancement (asterisks).
Perisplenic blood is hyperdense on the unenhanced
CT and appears relatively hypodense on post-IV
study.

Radiology Wisdom
CT density of structures is relative to its
surroundings and may appear of different
attenuation on unenhanced vs. enhanced phases
There is resorption of the distal clavicle (arrow).

Main Differential diagnoses include:
Hyperparathyroidism, traumatic acroosteolysis,
rheumatoid arthritis, and septic joint.
 This image is supposed to be an
external rotation view on which
the humeral head should show the
bump of the greater trochanter.
However, this is not the case, since
The humerus is fixed in internal
rotation and the humeral head
looks more smoothly rounded
(i.e., lightbulb sign’).

This scapular Y view confirms the

posterior location of the humeral head.

This axillary view confirms the

posterior location of the humeral
head.
 Lateral neck
radiograph showing
marked prevertebral
soft tissue swelling
(arrow) that
compromises the
airway.

CT with IV contrast
showing a ring
enhancing abscess
(arrow).
This axillary view confirms the
posterior location of the humeral
head.
 Lateral view

Frontal view

Much more dramatic on frontal view!

Radiology Wisdom
To ensure fracture detection, always obtain at least
2 different radiographic views of the region
 Nodular liber border (cirrhosis) + Infiltrative liver lesion (HCC)

Radiology Wisdom
Cirrhosis is a risk factor for HCC, so always check
for liver lesions in such cases
RBTB3
Lytic proximal humerus lytic lesion with internal chondroid matrix in
the form of rings and arcs and an associated pathological fracture
 Note the bilateral scattered lucent areas without
walls, consistent with the centrilobular emphysema
type (typically in smokers)
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