Joseph Dalby Sinnott

A woman with abdominal distension and pain

A 40 year old woman presented to the surgical assessment unit with a 12 hour history of abdominal distension and tenderness. She had not opened her bowels or passed wind since her symptoms started. An abdominal radiograph was requested—what does it show (fig 1)? The abdominal radiograph shows a caecal volvulus. ### Discussion Caecal volvulus is much less common …

Comparison of the number of thyroid nodule FNAs one year before and after recommendations to report radiological incidentalomas

Aim To determine the number of FNAs performed one year before and one year after recommendations. Determine the number incidentalomas and the originally modality where they were detected. Determine whether there was a significant increase in the number of concerning lesions found, whether more operations were performed and whether there was any benefit for patients. Also, to study the relationship between the Thy3 lesions and number of follicular carcinomas..

Severe abdominal pain in an 85 year old woman

An 85 year old woman was admitted to hospital with a rigid, mildly distended, severely painful abdomen and absent bowel sounds. She was in atrial fibrillation and was hypotensive. A computed tomography (CT) scan was performed. What does it show (fig 1⇓)? Fig 1 The CT scan shows widespread peripheral branching gas within the liver. This is consistent with a diagnosis of portal venous gas, and in this case was secondary to small bowel ischaemia. ### Discussion The non-contrast CT scan (fig 2⇓) shows widespread branching gas that is …

Mild cough and decreased breath sounds in an 82 year old woman

An 82 year old woman presented to her general practitioner with a tickling cough and symptoms of an upper respiratory tract infection. Her blood gas saturations were normal and she was otherwise well. However, she had a history of tuberculosis and had undergone an unknown operation many years ago. The GP thought that she had decreased breath sounds at …

Dyspnoea in an older woman.

An 80 year old woman presented to the emergency department with increasing shortness of breath on exertion and “noisy breathing.” She was easily able to complete full sentences, but on examination there was a faint biphasic stridor. The patient stated that she had been breathing like this for months but that it was slowly worsening. She had no polyphonic expiratory wheeze and on …

Computed tomography findings in a confused patient

A 75 year old woman was referred to the emergency department from her nursing home because of increasing confusion. She had a history of falls and was taking warfarin for atrial fibrillation (international normalised ratio 2.6). On examination the patient appeared confused but had no focal neurological deficit. She underwent cranial computed tomography (CT) (fig 1⇓). What does this show? Fig 1 The CT scan shows two subdural haematomas: one on the right (fig 2 …

Cough and haemoptysis in an older woman.

A 72 year old woman was referred to the respiratory clinic with a recent history of cough and haemoptysis. She had no history of smoking or weight loss. What does this plain chest radiograph show (fig 1)? Fig 1 A pulmonary fungal ball within the …

Urinary frequency and dysuria in an older woman

A 66 year old woman with diabetes was admitted to the medical assessment unit with lower abdominal pain and dysuria. The patient was pyrexial (38.8°C) and had a white cell count of 17.1×109/L. A urine dipstick test was positive for leucocytes, nitrites, and blood. Computed tomography (fig 1⇓) was performed because of the severity of the lower abdominal pain. What is …

Plain radiography of the skull after investigation for raised calcium

A 63 year old man was being investigated for raised serum calcium and alkaline phosphatase. Plain radiography of the head was performed after a bone scan showed increased uptake in the patient’s skull. What does the radiograph show (fig 1)? Fig 1 The radiographic findings are consistent with a diagnosis of Paget’s disease of the bone. ### Discussion The lateral skull radiograph shows marked calvarial thickening, with …

A man with severe abdominal pain.

A 38 year old man presented to the emergency department with a 12 hour history of central and right sided severe abdominal pain. The pain had been getting gradually worse, he had vomited, and he was finding it difficult to walk. On examination he looked unwell, his temperature was …