APRIL 2019

Case 1
Name: Suresh Kotwani
MRD number: 1535788
Age: 43 years
Sex: Male

History: 43 year old patient known case of diabetes presented with complaints of headache
since 2 days associated with slurring of speech and 3 episodes of GTCS.No history of
vomiting , no history of swaying to any sides,no limb weakness.

Investigations
MRI- T2 heterointense lesion noted in the left frontal lobe which shows diffusion restriction
in the periphery and central blooming on gradient sequences. Gyriform enhancement noted
in the post contrast study.
T2 hyperintensity noted involving the right high frontal subcortical white matter and
superior frontal gyrus which shows diffusion restriction. No blooming on gradient
sequences.
Effacement of the frontal horn of left ventricle and a midline shift of 9 mm to the right is
noted secondary to the edema.
Bilateral basal ganglia and thalami are normal.
Optic nerve and optic chiasma are normal.
Pituitary gland is normal.
Basal cisterns are normal.
Mid brain, pons and medulla are normal.
Cerebellum appears normal.
Absence of normal flow voids noted in the superior sagittal sinus.
MRA shows attenuated bilateral anterior cerebral artery -?due to vasospasm.
Bilateral middle cerebral artery and posterior cerebral artery appears normal.
MRV shows filling defect in the superior sagittal sinus.
Impression: Features suggestive of hemorrhagic venous infarct secondary to superior sagittal
sinus thrombosis.

Case 2
Name: Asokan
MRD number: 1543609
Age: 49 years
Sex: Male

History: Patient was apparently asymptomatic until 3 months back when he developed
fever, which was high grade, intermittent, more towards the evening, not associated with
chills and rigor.He also started experiencing a burning sensation in the epigastric region and
diffuse abdominal pain.The pain was not associated with vomiting, and had no change with
food intake or posture.For these complaints he consulted a local hospital where he was given
medications

Investigations
USG abdomen- Liver is mildly enlarged measuring about 16cm with mild fatty infiltration
and few ill defined hypoechoic areas predominantly in the right lobe largest 1.34x1cm in
segment VIII and 1.4x2cm in segment VI.
A short segment of distal ileal loop appears uniformly thickened and hypoechoic.
There is no evidence of bowel obstruction.
Multiple discrete round to oval enlarged hypo to isoehoic nodes are noted adjacent to this
bowel loop and in the mesentery , predominantly in right iliac region

CECT-Thickened and enhancing jejunal loops and proximal ileal loops with maximum
thickness of 18mm involving the distal jejunal loops. Extending for an approximate length of
10 to 15cm.
Multiple enlarged retroperitoneal and mesenteric lymphnodes as described.
1. Paraaortic- largest left 1.5 x 1.1cm.
2. Aortocaval- largest 2.4 x 1.1cm.
3. Periportal-2.3 x 1.6cm.
4. Splenic hilar-2.1 x 2.8cm.
5. Portocaval hilar-1.7 x 1cm.
Gross splenomegaly and mild hypertrophy.
Moderate ascites seen.
Liver showed a subtle tiny subcentimetric lesion in segment VII.
The pancreas shows normal size, shape and attenuation values. No duct dilatation or focal
lesion.
The kidneys show normal size, shape and contrast enhancement with no pelvicalyceal
dilatation or calculi. No hydroureter.
Visualized lung fields show mild bilateral pleural effusion. Consolidatory air space opacities
noted involving the medial segment of right middle lobe.
Vertebral bodies did not reveal any lytic lesions.
Impression: Thickened and mildly enhancing jejunal loops with multiple enlarged
mesenteric and retroperitoneal lymphnodes as described- ? small bowel lymphoma. Gross
splenomegaly. Moderate ascites. Tiny subtle enhancing lesion in segment VII of liver- ?
deposit

Follow up: Endoscopic jejunal biopsy histopathology report-

Chronic active inflammation. Possibility of Immunoproliferative small intestinal disease
considered. Immunohistochemical studies: The lymphoid cells shows CD20 and CD3
positivity, CD138 - focal positive. The immunoprofile is suggestive of reactive lymphoid
population. Proliferation index (Ki67) -2-3% .
 PROCEDURES PERFORMED UNDER SUPERVISION
Date MRD no. Procedure Indication Complication Follow up
20/3/15 1542556 CT guided ? Ca lung Nil Squamous cell
lung biopsy carcinoma

REPORTING RECORD

Plain Radiograph reported 130

SPECIAL INVESTIGATIONS

MODALITY No. of Cases

Barium studies 10

Urographic studies 8

Others -

ULTRASOUND

TYPE No. of Cases

General Ultrasound 76

Obstetric Ultrasound 3

Neurosonogram 1

Doppler studies 8

Small parts 2

CT scans reported 120

MRI reported 112

MAY 2019
Case 1
Name: SUNIL KUMAR K B
MRD number: 1527764
Age: 47 years
Sex: Male

History: 47 Year old K/C/O Type 2 DM, Systemic HTN was conscious and ambulatory 1
hour back while he was driving his car. He had a sudden onset breathlessness followed by
sweating and the patient became unresponsive. Patient was brought to the ER in cardiac
arrest.

Investigations
MRI stroke protocol-Diffusion restriction noted bilateral basal ganglia.CT scan Brain does
not show any focus of haemorrhage or mass effect.
Impression- Features may represent hypoxic ischemic injury
MRI brain follow up-T2 FLAIR hyperintensities noted in bilateral frontal, parietal temporal
cortex, bilateral basal ganglia, bilateral thalami, bilateral hippocampi and cerebellum with
diffusion restriction in the para falcine frontal cortex. T1 hyperintensities noted in the
bilateral parafalcine frontal cortex, bilateral insular cortex, bilateral temporal lobe, bilateral
parietal lobe with no blooming on gradient sequences - ? laminar necrosis. Bilateral caudate
nucleus also show T1 hypointensities. Optic nerves and chiasma appear normal. Midbrain,
pons and medulla appear normal. Bilateral ventricles appear normal. Basal cisterns appear
normal.Normal flow voids in the intracerebral vessels noted. No extra axial collection.
Impression -Features are suggestive of sequelae to HIE
Follow up: Poor prognosis was explained to the bystanders

Case 2
Name: Arul Raj
MRD number: 1501530
Age: 24 years
Sex: Male

History: Known case of congenital heart disease, was admitted for treatment of infective
endocarditis. During his stay he developed abdominal pain / palpitation and acute pulmonary
edema. MDCT was advised to rule out mesenteric ischemia

Investigations
CT abdomen-Descending thoracic aorta, abdominal aorta appears normal. However the
abdominal aortic branches, celiac trunk and its branches, superior mesenteric artery and its
branches, renal arteries, Inferior mesenteric artery appear patent but hypoattenuated and
narrow in caliber. Iliac vessels also appear hypo attenuated and narrow in caliber. Right
Kidney upper pole shows a hypodense area - suggestive of renal infarct. Left Kidney appears
normal. Superior mesenteric vein appear patent. Bowel loop appear collapsed. No mural
stratification. No evidence of pneumatosis. Liver shows no focal lesion / IHBRD. Spleen
shows no lesion. Gall bladder and pancreas appears normal. Bilateral adrenal appears
hyperdense.No significant intra abdominal lymphnodes. Mild ascites noted.IVC appears
prominent along and hepatic veins show early filling- probably due to cardiac
disease.Cardiomegaly noted with mild pericardial effusion. Right pleural effusion with
 collapse consolidation of right posterobasal lung fields noted. Few air space opacities also
noted in the right middle lobe. Consolidation of left posterobasal lung fields noted.
Impression:Hypoattenuated mesenteric, renal vessels with right renal infarct and hyperdense
adrenals -features are suggestive of hypo volume shock. No evidence of bowel gangrene in
the present study. Right pleural effusion.
Follow up: He was started on fluids following which his condition improved.

PROCEDURES PERFORMED UNDER SUPERVISION

Date MRD no. Procedure Indication Complication Follow up

REPORTING RECORD

Plain Radiograph reported 190

SPECIAL INVESTIGATIONS

MODALITY No. of Cases

Barium studies 15

Urographic studies 8

Others -

ULTRASOUND

TYPE No. of Cases

General Ultrasound 86

Obstetric Ultrasound 2

Neurosonogram 3

Doppler studies 10

Small parts 2

CT scans reported 109

MRI reported 123

 QUARTERLY EVALUATION

Date: April 2017

Sl. No. Points to be considered Score

1 Punctuality

2 Regularity of Attendance

3 Quality of ward work

4 Presentation of cases

5 Bedside manners

6 Rapport with patients

7 Rapport with colleagues

8 Undergraduate teaching (if applicable)

9 Others

Total Score

Guidance for scoring:

0– Poor, 1- Below average, 2 – Average,3- above average, 4- Very good

Date: HEAD OF THE DEPARTMENT

DEPARTMENT OF

RADIOLOGY

AMRITA INSTITUTE OF MEDICALSCIENCES

 SIX MONTHLY EVALUATION
FOR THE PERIOD November 2016 to April 2017
Date : April 2017

Sl.
Points to be considered Scoring
No.
1Presentations
2Whether all relevant points elicited
3Cogency of presentation
4Logical order
5Mentioned importance all positive and negative points of importance
6Whether any major signs missed or misintepreted
7Diagnostic whether it follows logically from history and findings
Investigations required
8Complete list Relevant order Interpretation of
investigations
Overall
1 Ability to react to questioning – whether answers relevant and
complete
2 Ability to defend diagnosis
3 Ability to justify differential diagnosis
4 Confidence
5 Others

Total Score

Guidance for scoring:

0– Poor, 1- Below average, 2 – Average,3- above average, 4- Very good

Date: HEAD OF THE DEPARTMENT

DEPARTMENT OF

RADIOLOGY

AMRITA INSTITUTE OF MEDICALSCIENCES

JUNE 2019

Case 1
Name: Denny Thomas
MRD number: 1368440
Age: 42 years
Sex: Male

History: 41 years old male, with no known co-morbidities, presented with history of
numbness since 4 months which he initially noted along the right side of his face mostly
along the jaw which gradually increased. It was not associated with pain, facial weakness or
asymmetry. He also noticed an occasional loss of balance while walking. no
visual/auditory/speech disturbances. No history of fever/loss of consciousness/ vomiting/
headache. No other complaints.

Investigations
MRI brain- A 2.5 x 2.1cm extra axial T1 hypointense, T2 hyperintense enhancing CP angle
lesion with mass effect on IV ventricle and pons noted with obliteration of right
perimesencephalic cistern.
Lesion is extending along right internal acoustic meatus in a coned pattern causing widening
of the same.
No evidence of bleed, calcification or diffusion restriction within the lesion.
VII and VIII cranial nerves are abutted on right side by the lesion.
Bilateral semicircular canals are normal.
Bilateral Vth cranial nerve appears normal.
Tiny areas of lacunar infarcts noted in bilateral internal capsule.
No evidence of hydrocephalus.
Rest of the neuroparenchyma appears normal.
Cerebellum is normal
Impression- Enhancing CP angle lesion with extension along right internal acoustic
meatus-Features are suggestive of vestibular schwannoma.
Follow up: Patient underwent excision of right vestibular schwannoma.
Histopathology- features consistent with vestibular schwannoma.

Case 2
Name: Biju Anthony
MRD number: 1514638
Age: 37 years
Sex: Male

History: 37 year male was brought to the casualty with alleged history of road traffic
accident near Varapuzha junction (lorry vs bike) around 12. 20. He was a bike rider. There
was history of loss of consciousness for few minutes. There was history of nasal bleeding.
There was no oral or ear bleed. There was no history of seizures, vomiting. He sustained
multiple multiple soft tissue injuries.

Investigations
CT abdomen- A rent in the left hemi diaphragm of about 9.5cm with herniation of stomach,
few small bowel loop and spleen into the thoracic cavity causing mediastinal shift and
passive segmental atelectasis of left mid and lower lobe. There is minimal free fluid in the
left hemithorax.
The GE junction and pylorus appear normal in position.
The pancreas shows normal size, shape and attenuation values. No duct dilatation or focal
lesion.
Right adrenal shows a well defined predominantly hypodense lesion measuring 3.4x2.3cm.
The kidneys show normal size, shape and contrast enhancement with no pelvicalyceal
dilatation or calculi. No hydroureter.
Free fluid noted in the posterior pararenal left sided fluid space bilaterally (more on left)
with tracking down upto the pelvis along the large bowel mesentry.
Fractures of the superior and inferior ischiopubic ramus and left sacral ala extending to s2
and S3 segments noted on the left side.
Impression: Rupture of hemi left diaphragm with herniation of stomach, small bowel and
spleen with free fluid and multiple fractures as described. Incidentally detected right adrenal
lesion - ?adenoma.

CT Head and Spine-Sulci and gyri appear normal. No effacement.

Lateral ventricles are normal, no midline shift. Basal cisterns, brainstem and infra temporal
fossa appears normal.
An undisplaced linear fracture noted along the right temporal bone adjacent to the mastoid
process. No orbital blow out or chip fractures noted. No evidence of any bulbar or
retrobulbar haemorrhage.
Soft tissue Hypodensity noted in the subcutaneous tissue over the lateral aspect of left orbit -
probably a hemorrhagic contusion.
Atlas, axis and dense show normal alignment and structure. No rotational or transtentorial
injuries in upper cervical spine. Rest of cervical and thoracicspine appear normal. A wedge
compression fracture with posterior tilt involving superior endplate noted on L2 vertebrae
with ? some compression of neural foramen (10mm) and associated fracture of lamina and
spinous process of the same.
Small compression fractures noted at the superior endplate of L3 and L4 vertebrae.
Narrowing of disc place of L5-S1 with mild anterolisthesis. Fractures of posterior 8th , 9th
and 10th posterior ribs on right side and 9th posterior rib on left side.
Fractures of the left superior and inferior ischiopubic ramus , left sacral ala extending to S2
and S3 segments on left side.
Impression: Multiple fractures involving ribs, vertebrae, sacrum as described in text.
Calvarial fracture as described
Follow up: Patient underwent exploratory lapratomy which showed a large defect of the
 diaphragm on the left side[ about 10 cm defect] with Herniation of stomach , colon and
spleen into the left side of chest. Haematoma noted along the lateral wall of the descending
colon and colonic mesentry.
PROCEDURES PERFORMED UNDER SUPERVISION
Date MRD no. Procedure Indication Complication Follow up
07/01/15 1514105 CT guided Cavitatory Nil Ca lung
lung biopsy lesion
? Ca lung

REPORTING RECORD

Plain Radiograph reported 190

SPECIAL INVESTIGATIONS

MODALITY No. of Cases

Barium studies 15

Urographic studies 12

Others -

ULTRASOUND

TYPE No. of Cases

General Ultrasound 110

Obstetric Ultrasound 5

Neurosonogram 6

Doppler studies 16

Small parts 10

CT scans reported 138

MRI reported 125

 JULY 2019

Case 1
Name: Dhakrishnan MRD number: 1501278 Age: 44 years Sex: Male
History: Patient presented with fever of 8 days duration. Was tested as leptospirosis from
outside but no relief of symptoms.
Investigations
USG showed Few areas of dirty air shadowing/calcification within the liver parenchyma.
CECT abdomen-Large peripherally enhancing abscess noted involving right lobe of liver
segments VII and VI extending to VIII and V. Abscess has two large locules which are
communicating. Multiple air foci noted within the abscess. Abscess measures approximately
11x7.7x12.5 cm (AP x Tr x CC). Liver surrounding the abscess shows ill defined
hypodensity ?spreading inflammation.
Portal vein is patent. CBD is not dilated. Gall bladder is normal.
The pancreas shows normal size, shape and attenuation values. No duct dilatation or focal
lesion. Spleen is normal.
The kidneys show normal size, shape and contrast enhancement with no pelvicalyceal
dilatation or calculi. No hydroureter. Adrenals appear normal.
Urinary bladder and prostate is normal.
Bilateral mild pleural effusion with basal consolidation noted.
No lytic / sclerotic bony leisons.
Impression: Large biloculated irregular right lobe liver abscess with air foci.
Follow up: The liver abscess was drained.
Case 2
Name: RIFANA MRD:1499542 Age :5Y Sex:Female
History:5yr old 2nd child of NCM ,ANP uneventful, born at term no perinatal issues and
attained milestones with delay. History of recurrent seizures.
Investigations
MRI BRAIN – PLAIN- Agyria -pachy gyria complex (thickened cortex with shallow
scanty sulci) seen predominantly involving parietal, temporal and occipital lobes with frontal
lobes being relatively spaced. Paucity of white matter seen in these regions.
Well defined tiny grey matter intensity foci seen in bilateral periventricular white matter
around frontal horns suggestive of band heterotrophies .
Occipital horns of bilateral lateral are prominent.Corpus callosum, basal ganglia, thalami,
brain stem normal.
Impression: Agyria pachygyria with relative sparing of bilateral frontal lobes.
Periventricular band heterotropia.
Follow up: Started on antiepileptic drugs. Advised regarding the genetic evaluation

PROCEDURES PERFORMED UNDER SUPERVISION

Date MRD no. Procedure Indication Complication Follow up
01/12/14 1500436 Ct guided lung biopsy ? Ca lung Nil Squamous
carcinoma
 REPORTING RECORD

Plain Radiograph reported 110

SPECIAL INVESTIGATIONS

MODALITY No. of Cases

Barium studies 5

Urographic studies 6

Others -

ULTRASOUND

TYPE No. of Cases

General Ultrasound 112

Obstetric Ultrasound 1

Neurosonogram 3

Doppler studies 12

Small parts 2

CT scans reported 130

MRI reported 50

DATE: SIGNATURE OF HEAD OF DEPARTMENT

AUGUST 2019

Case 1
Name: Essaki Kumar
MRD number: 1494533
Age: 26 years
Sex: Male

History:26-year-old male from Tamil Nadu presented with history of exertional

breathlessness of 1 month. He was apparently normal until one month back. Problems
started as dyspnea on exertion. The patient gets breathless when he walks fast or climbs
stairs, which was relieved by rest. No history of associated chest pain or orthopnea. The
patient was evaluated elsewhere by cardiologist. Echocardiogram showed dilated aorta, LV
dysfunction, PAH and was referred here for further management. He was evaluated here,
TEE echocardiogram showed B/L coronary sinus diverticule.

Investigations
CT aortogram-Diverticulum noted on both right and left coronary sinuses.
A bilobed diverticulum from the left sinus with a maximum diameter of 5.4 x 5.7 cm noted.
It is directed inferiorly and to left side.
A 4.6 x 2.7 cm right diverticulum from the right sinus which is bulging into the inter
ventricular septum noted. It is directed anteroinferiorly.
Right coronary artery is seen arising on the side of the right diverticula. Left coronary artery
is seen arising from the roof of left diverticula. Aorta at aortic annulus measures 1.9 cm.
Proximal ascending aorta measures 2.1 cm. Distal ascending aorta measures 2.2 cm.　
Ascending, arch, descending thoracic aorta and abdominal aorta are normal in calibre. No
evidence of aneurysm. Celiac artery and branches, superior mesenteric artery, bilateral renal
arteries, inferior mesenteric arteries are normal. Aortic bifurcation into common iliac arteries
is normal. External, internal iliac arteries are normal.
No abnormality in the intra abdominal organs.
Bowel loops appear normal.
No free fluid.
Visualized bones and lung fields are normal.
Impression: Right and left coronary sinus diverticula
Follow up: He was taken up for Bentall Procedure with St Jude valve with conduit + CABG

Case 2
Name: Leela
Age: 64 yrs
Sex: Female
MRD: 1491485
History: Patient presented with dysphagia since past 4 months which has increased since the
last one month.
 Investigations
Barium Swallow: A circumferential; luminal narrowing with mucosal irregularity and
shouldering noted in mid third of oesophagus for length of approximately 3.5cm with
dilatation of proximal oesophagus. Delayed, however complete passage of contrast noted
through stricture segment.
Impression: Short segment circumferential narrowing of mid esophageal segment as
described likely to represent malignancy.
CECT Chest: Luminal narrowing noted involving the mid esophagus for a length of 3.2 cm
with maximum thickness of 2.3 cm. The fat plane between the aorta and the lesion is
maintained. However the fat plane between the lesion and the carina is lost. No evidence of
extension into the lower esophagus / stomach. Few subcentimetric prevascular, right upper
paratracheal and lower paratracheal lymphnodes are noted.
Impression: Luminal narrowing involving the mid esophagus with few subcentimetric
mediastinal lymphnodes as described.
FOLLOW UP: She underwent endoscopic biopsy which revealed moderately differentiated
squamous cell carcinoma. She was treated with neoadjuvant chemo-radiotherapy and later
underwent esophago-gastrectomy.
Histopathology- Squamous cell carcinoma

PROCEDURES PERFORMED UNDER SUPERVISION

Date MRD no. Procedure Indication Complication Follow up
10/11/14 1462035 Ultrasound ? Ca prostate Nil Prostatic
guided TRUS adenocarcinoma
biopsy of
prostate

REPORTING RECORD

Plain Radiograph reported 220

SPECIAL INVESTIGATIONS

MODALITY No. of Cases

Barium studies 9

Urographic studies 10

Others -
 ULTRASOUND

TYPE No. of Cases

General Ultrasound 75

Obstetric Ultrasound 1

Neurosonogram 0

Doppler studies 6

Small parts 1

CT scans reported 105

MRI reported 40

DATE: SIGNATURE OF HEAD OF DEPARTMENT

 QUARTERLY EVALUATION

Date: July 2017

Sl. No. Points to be considered Score

1 Punctuality

2 Regularity of Attendance

3 Quality of ward work

4 Presentation of cases

5 Bedside manners

6 Rapport with patients

7 Rapport with colleagues

8 Undergraduate teaching (if applicable)

9 Others

Total Score

Guidance for scoring:

0– Poor, 1- Below average, 2 – Average,3- above average, 4- Very good

Date: HEAD OF THE DEPARTMENT

DEPARTMENT OF

RADIOLOGY

AMRITA INSTITUTE OF MEDICALSCIENCES

SEPTEMBER 2019

Case 1
Name: ASWATHI V. MOHAN
MRD number: 1487935
Age: 18 years
Sex: Female

History:History of pain in abdomen

Investigations
CECT abdomen-Well defined multi loculated cystic lesion measuring 7.4x6.7x7cm noted
arising from the body of pancreas. The lesion shows enhancing walls and septa. Speck of
calcification measuring 4mm noted along the septa. The lesion is seen compressing the
splenic vein.
Head and uncinate process of pancreas is normal. Tail is atrophic. Pancreatic duct is not
dilated.
Superior mesenteric artery and superior mesenteric vein is normal.
Liver shows arterially enhancing lesion measuring 1.5x1.2cm in segment 7 which is partially
homogenising in the venous phase likely to be haemangioma. No IHBRD.
Portal vein and hepatic veins are normal. Spleen is normal.
Stomach is normal. Fat plane is maintained with the pancreatic body lesion.
The liver shows normal parenchymal attenuation, normal enhancement pattern, normal
shape and size. No focal lesions are seen. No IHBR dilatation. Portal vein is normal.
The GB is normal. The CBD is normal.
The kidneys show normal size, shape and contrast enhancement with no pelvicalyceal
dilatation or calculi. No hydroureter.
Adrenals are normal. Urinary bladder appears normal.
No pelvic mass lesion.
Bones are normal. Basal ling fields are normal.

Impression: Well defined multi loculated cystic lesion involving the body of pancreas with
internal enhancing septation and septal calcification. Features likely to represent
1. Mucinous cystadenoma.
2. Solid and papillary epithelial neoplasm. Haemangioma in segment 7 of liver.

Follow up: Patient underwent open distal pancreatectomy. Histopathology report-

Suggestive of solid pseudopapillary neoplasm (SPN)

Case 2
Name: Baby of Neethu
MRD number: 1473955
Age: 21 days
Sex: Female
 History:
This full term female neonate born by normal delivery, birth weight 3.35kg, was antenatally
detected to have CCAM on right side. Post delivery, the child was stable on room air. She
was admitted for further management.

Investigations
CT chest-Large cystic lesion measuring approximately 4.7 x 3.2cm noted almost involving
the entire right lung lower lobe. Few other small cysts seen in the basal segments of the
lower lobe and in the anterior and posterior segments of the right upper lobe. Compensatory
hypertrophy of the middle lobe of right lung seen. Few surrounding consolidatory air space
opacities noted in the right upper lobe apicoposterior segments.
The lesion is displacing the mediastinum to the opposite side. The tracheobronchial tree is
patent.
Left lung fields are normal.
No evidence of any diaphragmatic discontinuity/ diaphragmatic herniation.
No evidence of any pleural effusion/ pleural thickening.
Vertebral bodies are normal.
Visualized upper abdominal organs are normal
Impression-
Features are in favour of right sided congenital cystic adenoid malformation-Type I.

Follow up: She was transferred to Pediatric Surgery and underwent right upper lobectomy
under GA. Post-operatively, the child developed superficial surgical site infection which was
managed with daily dressing. Recovery was otherwise uneventful.
HISTOPATHOLOGY-Right upper lobe lobectomy:- Suggestive of Congenital cystic
adenomatoid malformation -type 1.

PROCEDURES PERFORMED UNDER SUPERVISION

Date MRD no. Procedure Indication Complication Follow up
11/10/14 1476470 Ultrasound ? lymphoma Nil Lymphoma
guided
axillary soft
tissue mass
biopsy
REPORTING RECORD

Plain Radiograph reported 125

SPECIAL INVESTIGATIONS

MODALITY No. of Cases

Barium studies 6

Urographic studies 5

Others -

ULTRASOUND

TYPE No. of Cases

General Ultrasound 110

Obstetric Ultrasound 5

Neurosonogram 5

Doppler studies 8

Small parts 6

CT scans reported 110

MRI reported -

DATE: SIGNATURE OF HEAD OF DEPARTMENT

OCTOBER 2019

Case 1
Name: EDENA SHIJU
MRD number: 1468910
Age: 10 months
Sex: Female

History: Presented with noisy breathing and stridor since birth. Was diagnosed as GERD
from outside and was started on omeprazole, domstal. Stopped domstal before 2 weeks
Child persist to be symptomatic.

Investigations
Barium swallow-Plain film was taken.
Serial images were taken under fluoroscopic guidance after administration of barium
Persistent posterior indentation of esophagus noted at the level of carina. Free flow of
contrast was noted across the indentation. No evidence of hold up of contrast.
Aspiration of contrast was noted in to the trachea during swallowing after which study was
abandoned.
Impression: Persistent posterior indentation of the esophagus at the level of carina as
described. Aspiration of contrast noted in to the trachea.

CECT
Situs solitus. Levo cardia.
Right sided aortic arch with aberrant left subclavian artery causing minimal tracheobronchio
malacia at the level of carina and origin of left main bronchus.
Rest of the tracheobronchial tree is normal. Other mediastinal structures appear normal.
Abberent left subclavian shows minimal narrowing at abve1.1cm from origin. No post site
stenotic dilatation.
Sub segmental collapse with consolidatory change in superior segment of right lower lobe.
Rest of the lung fields appear normal.
A 1.1x0.8cm hypodense foci in spleen.
Impression: Right sided aortic arch with mildly stenotic left aberrant subclavian artery.
Minimal tracheobronchiomalacia as described. Sub segmental collapse of right lower lobe.

Follow up: Child was treated symptomatically

Case 2
Name: Sasidharan
MRD number: 1407514
Age: 47years
Sex: Male
 History: He is a known diabetic ,was initially evaluated at EMS hospital for chest pain and
he was evaluated with CT which showed SOL liver and mass head of pancreas. No h/o
nausea, vomiting, pruritis or fever. He was referred to here for further evaluation and
management.

Investigations
CT abdomen was done which showed a large brilliantly enhancing lesion measuring 6.8 x
10.3 cm noted in the head and body of pancreas. Tail of pancreas is not visualized, probably
atrophic. Area of necrotic degeneration noted within the lesion. The lesion is showing
washout in delayed phases.
Multiple enhancing lesions noted in liver which are showing washout in delayed phases.
Multiple para aortic enlarged lymph nodes noted.
Spleen is bulky and enlarged and shows multiple gastro splenic collaterals.
No evidence of thrombosis of portal vein. However portal vein appears impinged at the head
region of pancreas.
Cholelithiasis present in the gall bladder.
Impression: A large enhancing lesion in head and body of pancreas with multiple enhancing
liver lesions and enlarged para aortic lymph nodes -to consider the possibility of neuro
endocrine tumor of pancreas.

Follow up: Liver biopsy - Shows a Neoplasm with rossettoid pattern ?Neuro endocrine
tumour.
Immuno histo chemistry - Cells are positive for synaptophysin,CD56,Shows paranuclear
positivity for CK, negative for CD10. Ki 67-5-8% Neuroendocrine tumour
The patient was started on long acting octreotide.

PROCEDURES PERFORMED UNDER SUPERVISION

Date MRD no. Procedure Indication Complication Follow up
1165436 1165436 USG guided ?intramuscular Nil Started on
aspiration abscess in the antibiotics based
thigh on the
sensitivity
report.
 REPORTING RECORD

Plain Radiograph reported 190

SPECIAL INVESTIGATIONS

MODALITY No. of Cases

Barium studies 25

Urographic studies 18

Others -

ULTRASOUND

TYPE No. of Cases

General Ultrasound 100

Obstetric Ultrasound 3

Neurosonogram 6

Doppler studies 13

Small parts 6

CT scans reported 135

MRI reported -

DATE: SIGNATURE OF HEAD OF DEPARTMENT

NOVEMBER 2019

CASE NO :1

Name: SHAHUSHAN AGE:19 Y/Female MRD NO:1892057

HISTORY:

19 year old female with no known comorbidities, presented with: post prandial
severe epigastric pain ,malena: 6-10 days before onset of pain and once during
admission .No fresh bleed .No vomiting OGD Scopy : Gastric fundal diverticula, blood
in stomach - ? source, small antral ulcer.

CECT ABDOMEN

Pancreas is completely replaced by multiple cysts of varying sizes, some of

which are communicating with each other. Pancreatic duct not visualised separately.
Some of the cysts show peripheral wall calcifications. Largest cyst measuring
9x5x11.5cm (APxTRxCC) at the tail region, displacing the adjacent bowel loops and
closely abutting the psoas muscle. The liver shows normal parenchymal attenuation,
normal enhancement pattern, normal shape and size. No focal lesions are seen. No
IHBR dilatation. Portal vein is normal. The GB is normal. The CBD is normal.Spleen is
normal. The kidneys show normal size, shape and contrast enhancement with no
pelvicalyceal dilatation or calculi. No hydroureter. No pelvic mass lesion. Contrast
filled bowel loops are normal. No free fluid. Visualized basal lung fields are normal.
Impression:Multiple cysts of varying sizes, replacing the pancreas completely as
described . Pancreatic duct not seen seperately.

FOLLOW UP

ENDOSCOPIC ULTRASOUND

The entire pancreatic parenchyma has been replaced by cysts of multiple sizes
ranging from a few millimeters to 7 x 10 cm in the pancreatic tail. A single mural
nodule noted in one of the cysts. The cyst fluid contained no debris. Very minimal
pancreatic parenchyma could be visualised and the main pancreatic duct could not be
seen at all. The CBD and surrounding vasculature were not clearly visualised

MRI BRAIN

A 2.4 x 1.6 x 32. cm ( AP x TRX CC) cystic lesion with a prominent mural
nodule which is isointense to grey matter is noted arising from the inferior vermis of
cerebellum. Prominent flow voids noted in the periphery of the cystic lesion. The mural
nodule is showing homogenous intense post contrast enhancement. The cyst is
compressing the inferior 4th ventricle and causing mild obstruction with mild
 prominence of bilateral lateral ventricles. Brain stem appear normal. Flow voids
corresponding to normal cerebral vessels seen. No extra axial lesion.No other abnormal
post contrast enhancement noted.
Impression: Cystic lesion with enhancing mural nodule involving inferior cerebellar
vermis compressing inferior 4th ventricle causing early obstructive hydrocephalus. -
Hemangioblastoma.

CECT ABDOMEN:

Multiple simple cysts replacing pancreatic parenchyma with largest cyst showing mild
increase in size. Small area of airspace opacity with adjacent ground glassing in left
lung basal segment probably infective. Rest of the findings remain status quo.

MANAGEMENT

Midline subocciptial craniotomy Telovelar approach and gross total excision

under MEP monitoring under GA on 16/11/2017. She was shifted to ICU on ventilator.
Post op MRI brain with contrast showed post changes with gross total excision.

HISTOPATHOLOGY

Cerebellar lesion biopsy: Vascular neoplasm- hemangioblastoma

FINAL DIAGNOSIS

VON HIPPEL LINDAU SYNDROME

Case 2
Name: Kalyani
MRD number:1546729
Age: 67 years
Sex: Female

History: A 67 years old housewife , having 4 children, resident of Thrissur, right handed
presented to AIMS with history of Headache from 4 months with watery discharge from left
ear, Discharge from right ear since 1 month.

Investigations
MRI brain-Diffuse ill defined enhancing lesion noted in the skull base involving the walls
of nasopharyx, prevertebral space with lesions extending in to both carotid space and mildly
into right parapharyngeal space. Lesion erodes the clivus occipital condyles and petrous
apex. Obliteration of jugular foramen and bilateral hypoglossal canal and foramen ovale
with minimal dural enhancement of floor of orbit noted .
Laterally it is seen extending till the condyle of TM joint .
Temporalis and pterygoid muscles are normal.
Enhancing lesion seen involving the right orbit apex .
 Minimal enhancement seen involving along the rotundum .
Central non enhancing areas noted likely to represent collection /abscess.
Serous effusion of both mastoid noted - likely to be due to block of eustachian tube. No
evidence of any brain parenchymal involvement noted .
Neuroparenchyma appears normal.
Impression: Diffuse infiltrative enhancing skull base lesion as described with
abscess/collection likely to be represent osteomyelitis (?fungal in view of diabetes).

Follow up: CSF cytology was negative for atypical/ malignant cells. She was started with
Inj. Amphotericin B with regular monitoring of required blood parameters and discontinued
with antibiotic. Nasal discharge aerobic culture isolated candida albicans. She was added
with Fluconazole. Patient improved over the course.

PROCEDURES PERFORMED UNDER SUPERVISION

Date MRD no. Procedure Indication Complication Follow up
27/04/2015 161223 CT guided Paraspinal Nil Possibility of
biopsy mass lymphoproliferative
neoplasm
 REPORTING RECORD

Plain Radiograph reported 56

SPECIAL INVESTIGATIONS

MODALITY NO. OF CASES

Barium studies 2
Urographic studies 4
Others -

ULTRASOUND

TYPE NO. OF CASES

General Ultrasound 56
Obstetric Ultrasound 8
Neurosonogram 1
Doppler studies 20
Small parts 7

CT scans reported 100

MRI reported 70

DATE: SIGNATURE OF HEAD OF DEPARTMENT

 QUARTERLY EVALUATION

Date: October 2017

Sl. No. Points to be considered Score

1 Punctuality

2 Regularity of Attendance

3 Quality of ward work

4 Presentation of cases

5 Bedside manners

6 Rapport with patients

7 Rapport with colleagues

8 Undergraduate teaching (if applicable)

9 Others

Total Score

Guidance for scoring:

0– Poor, 1- Below average, 2 – Average,3- above average, 4- Very good

Date: HEAD OF THE DEPARTMENT

DEPARTMENT OF

RADIOLOGY

AMRITA INSTITUTE OF MEDICALSCIENCES

 SIX MONTHLY EVALUATION
FOR THE PERIOD May 2017 to October 2017
Date : October 2017

Sl.
Points to be considered Scoring
No.
1Presentations
2Whether all relevant points elicited
3Cogency of presentation
4Logical order
5Mentioned importance all positive and negative points of importance
6Whether any major signs missed or misintepreted
7Diagnostic whether it follows logically from history and findings
Investigations required
8Complete list Relevant order Interpretation of
investigations
Overall
1 Ability to react to questioning – whether answers relevant and
complete
2 Ability to defend diagnosis
3 Ability to justify differential diagnosis
4 Confidence
5 Others

Total Score

Guidance for scoring:

0– Poor, 1- Below average, 2 – Average,3- above average, 4- Very good

Date: HEAD OF THE DEPARTMENT

DEPARTMENT OF

RADIOLOGY

AMRITA INSTITUTE OF MEDICALSCIENCES

DECEMBER 2019

Case 1

Name: George Thomas MRD number: 1562498 Age:67 years Sex: Male

History: Patient presented with left sided back pain.

MRI LUMBAR SPINE

A dorsal dermal sinus track at S1 level with spinabifida of S1.The sinus track is seen
extending upto the dura.No definite extension into the subarachnoid space is
appreciated.A 4 mm x 11 mm cystic lesion is seen within the conus in relation to the
central canal.This is consistent with persistent terminal ventricle.A well defined
rounded lesion measuring 7mm x 6mm dark in T1 and T2 is seen within the cauda
equina roots attached to the tip of the conus likely to be an epidermoid.Conus is ending
at L3-L4 level.Filum terminale is normal.Vertebral bodies and discs are normal in
signal intensities.
Impression: Closed Spinal Dysraphism. Dorsal Dermal sinus likely to be terminating at
Dura with spinabifida of S1.No definite extension into the subarachnoid space.
Persistent terminal ventricle A well defined rounded lesion measuring 7 mm x 6mm
within the cauda equina roots attached to the conus ? epidermoid.

FOLLOW UP

Dermal tract excision, excision of the L3-L4 dermoid cyst and detethering of the cord
was performed.

HISTOPATHOLOGY

Biopsy Dermal Patch +Capsule of the Swelling :Features are Suggestive of Dermoid
Cyst. No evidence of any Malignancy seen.

FINAL DIAGNOSIS

CLOSED SPINAL DYSRAPHISM

Dermal sinus tract with Tethered spinal cord and L3-L4 dermoid cyst.
 Case 2
Name: Kalyani
MRD number:1546729
Age: 67 years
Sex: Female

History: A 67 years old housewife , having 4 children, resident of Thrissur, right handed
presented to AIMS with history of Headache from 4 months with watery discharge from left
ear, Discharge from right ear since 1 month.

Investigations
MRI brain-Diffuse ill defined enhancing lesion noted in the skull base involving the walls
of nasopharyx, prevertebral space with lesions extending in to both carotid space and mildly
into right parapharyngeal space. Lesion erodes the clivus occipital condyles and petrous
apex. Obliteration of jugular foramen and bilateral hypoglossal canal and foramen ovale
with minimal dural enhancement of floor of orbit noted .
Laterally it is seen extending till the condyle of TM joint .
Temporalis and pterygoid muscles are normal.
Enhancing lesion seen involving the right orbit apex .
Minimal enhancement seen involving along the rotundum .
Central non enhancing areas noted likely to represent collection /abscess.
Serous effusion of both mastoid noted - likely to be due to block of eustachian tube. No
evidence of any brain parenchymal involvement noted .
Neuroparenchyma appears normal.
Impression: Diffuse infiltrative enhancing skull base lesion as described with
abscess/collection likely to be represent osteomyelitis (?fungal in view of diabetes).

Follow up: CSF cytology was negative for atypical/ malignant cells. She was started with
Inj. Amphotericin B with regular monitoring of required blood parameters and discontinued
with antibiotic. Nasal discharge aerobic culture isolated candida albicans. She was added
with Fluconazole. Patient improved over the course.

PROCEDURES PERFORMED UNDER SUPERVISION

Date MRD no. Procedure Indication Complication Follow up
27/04/2015 161223 CT guided Paraspinal Nil Possibility of
biopsy mass lymphoproliferative
neoplasm
 REPORTING RECORD

Plain Radiograph reported 56

SPECIAL INVESTIGATIONS

MODALITY NO. OF CASES

Barium studies 4
Urographic studies 3
Others -

ULTRASOUND

TYPE NO. OF CASES

General Ultrasound 40
Obstetric Ultrasound 6
Neurosonogram 2
Doppler studies 12
Small parts 2

CT scans reported 75

MRI reported 56

DATE: SIGNATURE OF HEAD OF DEPARTMENT

 JANUARY 2020

Case 1
Name: Renisha N M RD number:1873395 Age: 37 years Sex: Female

History:
Mrs. Renisha N M , 30 year old female with no comorbidities , hypothyroidism during
pregnancy, Last child birth - 6 years ago, FTNVD Had a missed abortion in Feb 2017, D &
C done, no HPR. Has been on contraceptive since then. She had irregular bleeding for the
last 5 months, h/o spotting + Increased over the last 2 weeks. She was evaluated in an out
side hospital. USG abdomen: suggestive of Large echogenic mass in the lower uterine
segment measuring 8.1x7.4x7.5 cm in lower uterine segment and cervix with tortuous
vessels. She was admitted here for further evaluation and treatment.

MRI ABDOMEN & PELVIS CONTRAST

Axial T1 & T2 weighted images show a heterogeneous hyperintense mass in the left lateral
lower uterine myometrium extending into the left lip of cervix with parametrial extension.
The endometrial cavity is preserved. The cervical canal is displaced to the right. The lesion
measures approximately 12.4 x 9.5 x 8.8 cm. The T1 hyperintensity in the lesion indicates
hemorrhage. Multiple large tortuous flow voids noted within and around the lesion.
Anteriorly the lesion is seen infiltrating the posterior wall of the bladder which shows
hyperintense signal. Posterior the rectum is not involved. No free fluid in the pelvis.
The lesion shows non enhancing cystic areas predominantly on post contrast study.
Feeding arteries are seen from bilateral internal iliac artery.
Drainage is into the left gonadal vein and internal iliac vein. Left common iliac vein shows a
T2 hyperintense thrombus within.
Bilateral ovaries are normal.
Abdominal screening showed left hydroureteronephrosis secondary to entrapment of the left
distal ureter.
No significant pelvic nodes.
No significant intraabdominal nodes.

Impression:
Large heterogeneous mass in the lateral lower uterine myometrium extending into the left
cervical lip with parametrial and posterior bladder wall involvement and prominent vessels.
In view of elevated beta-HCG levels, the lesion is most likely to represent gestational
trophablastic disease - invasive mole / choriocarcinoma.

Follow up: She was transferred under Medical Oncology Department for further
management. She was planned for chemotherapy with EMACO regimen.
 CASE NO :2

Name: Gopalakrishnan MRD number: 1841870 Age: 60 years Sex:Male

HISTORY:

A 60 year old man known case of Type II DM, admitted for evaluation of Pyrexia of
Unknown origin.

CECT Abdomen
Well defined heterogeneously enhancing lesions with fluid density areas within noted seen
involving both limbs of right adrenal, medial limb and body of left adrenal gland, largest on
right measuring 3x2.6cm and that on left measuring 1.4x2cm. No areas of fat density,
hemorrhage or calcification seen.
Liver is normal in size and enhancement. No focal lesions. No IHBRD.
Gall bladder and CBD are normal.
Pancreas is normal in size and enhancement. No focal lesion. No pancreatic duct dilatation.
Spleen is normal.
Bilateral kidneys are normal in size and enhancement. No focal lesion. No pelvicalyceal
dilatation or hydroureter. Few simple cysts seen, largest measuring 9x8mm in interpolar
region of right kidney and 8x8mm in interpolar region of left kidney.
Urinary bladder is minimally distended. Prostate is normal.
Visualized bowel loops are normal in enhancement and wall thickness.
Few subcentimetric paraaortic lymphnodes seen, largest measuring 7x9mm.
No ascites noted.
Visualized bones are normal.
Bilateral lung parenchyma are normal. No areas of consolidation or ground glassing.
No areas of traction bronchiectasis or honey combing.
No pleural effusion.
Tracheobronchial tree is normal.
Mediastinal vasculature is normal.

Impression-
Well defined heterogeneously enhancing lesions with fluid density areas within
involving bilateral adrenal glands as described - in view of the history, granulomatous
disease like tuberculosis is likely. However in view of age, the possibility of metastasis
to be considered.

PET CT-

FDG AVID ENLARGED HETEROGENEOUSLY ENHANCING BILATERAL

ADRENAL GLANDS WITH LOBULATED SURFACE. - METABOLICALLY ACTIVE
INFECTIVE (TUBERCULOSIS / HISTOPLASMOSIS) OR NEOPLASTIC ETIOLOGY.
SUGGESTED HISTOPATHOLOGICAL CORRELATION.

CT DETECTED TINY MULTIPLE PARA-AORTIC, AORTOCAVAL LYMPH NODES

ARE FDG NON AVID.

NO FDG AVID POSSIBLE SITE OF ANY OTHER NEOPLASM/ INFECTION/

INFLAMMATION COULD BE DETECTED IN CURRENT PET CT SURVEY.

Histopathology -
CT guided biopsy: Shows liver tissue with kupffer cell granulomas and large granuloma
with necrosis containing yeast forms s/o fungal infection .

Final diagnosis- Adrenal fungal infection -? histoplasmosis

PROCEDURES PERFORMED UNDER SUPERVISION

Date MRD no. Procedure Indication Complication Follow up

No
CT guided
inflammator
biopsy Paraspinal
12/01/2019 1744583 Nil y infiltrate
paraspinal mass
or atypical
soft tissue
cells seen.
 REPORTING RECORD

Plain Radiograph reported 89

SPECIAL INVESTIGATIONS

MODALITY NO. OF CASES

Barium studies 5
Urographic studies 0
Others -

ULTRASOUND

TYPE NO. OF CASES

General Ultrasound 56
Obstetric Ultrasound 4
Neurosonogram 1
Doppler studies 14
Small parts 2

CT scans reported 78

MRI reported 57

DATE: SIGNATURE OF HEAD OF DEPARTMENT

FEBRUARY 2019

CASE NO :1

Name: JAYALEKSHMI AGE:61 Y / Female MRD NO:502709

HISTORY:

61 years old female with presented with complaints of backache, bodyache and
generalized weakness since 2-3 weeks. Now pain has increased since 2 days. She also
complaints of chest pain and difficulty in breathing. She has decreased hearing from left
ear. No complaints of bowel or bladder disturbances. No history of trauma or fall. No
complaints of limb pain or numbness. She has difficulty in walking due to back pain.

MRI SPINE WITH CONTRAST

Cervical intradural extramedullary neurofibroma predominently cystic mass
seen displacing the cord anteriorly compressing cervical cord and at C5 to C7
level.Large dumbbell shaped mass seen at D4 level , predominently extradural with
large paraspinal component seen extending through Right D4-D5 neural foramen into
the spinal canal and compressing cord at D4 level.Small well defined enhancing
intradural lesions noted at D12(7mm) and L1-L2( 13mm) and at S3 (11mm)
levels,Diffuse disc bulge noted at L3-L4,L4-L5 and L5-S1 level causing mild narrowing
of bilateral lateral recess and neural formina. Anterolisthesis of L5 over S1 vertebrae.D7
vertebral hemangioma. Screening MRI of chest region showing similar multiple
enhancing lesions in chest wall
Impression: Neurofibromatosis I with intradural extramedullary lesion compressing
cord at C5 to C7 level. Large dumbbell neurofibroma at D4- D5 level.

MRI BRAIN

T2 hyperintense right cerebellopontine angle lesion with multiple thin

septations measuring 3x2.1cms compressing the right side of pons and right middle
cerebellar peduncle partially effacing the fourth ventricle . T2 hyperintense lesions also
noted in bilateral meckel's cave measuring 2.2x1.9cms on the right side and 1.5x0.5cms
on the left side. Bilateral lateral ventricles are dilated with periventricular CSF seepage.
Impression: Altered signal intensity lesion in the right cerebellopontine angle with mass
effect on the brainstem, fourth ventricle and causing mild proximal hydrocephalus with
similar lesions in bilateral meckel's cave as described- ? Schwannomas

FOLLOW UP

She was advised for surgical excision but bystanders were not willing for the same.

FINAL DIAGNOSIS

NEUROFIBROMATOSIS TYPE 2
CASE NO :2

NAME: INDIRA BALAKRISHNAN AGE: 49Y / Female MRD NO:1922814

HISTORY

49 years old lady, known case of hypothyroidism, presented with the complaints
of abdominal pain for the past one week duration. The pain more over the right upper
abdomen which was non radiating to the back. No history of fever, vomiting, jaundice
or altered bowel or bladder habits. Initially she was admitted elsewhere and was found
altered liver parameters. Her ultrasound abdomen was done which showed acute
acalculous cholecystitis with mild intrahepatic biliary radical dilatation . Magnetic
resonance cholangeopancreatography was done which showed well defined soft tissue
mass lesion at hilar confluence with diffuse bilateral intrahepatic biliary radical
dilatation and collapsed common hepatic duct and common bileduct.. She came here for
further evaluation and management.

CT ABDOMEN WITH CONTRAST

Heterogenously enhancing mass is seen in contiguity to the body of the gall

bladder in the lateral aspect measuring 4.7x2.2x2.9cm (TRXAPxCC) extending in to
segment V and IV of the liver . The mass is seen infiltrating into the porta hepatis,
encasing the main portal vein and proper hepatic artery, causing mild pinching of the
portal vein and biliary obstruction at common hepatic duct and common bileduct level
with associated intrahepatic biliary radical dilatation. The infiltrating mass at the porta
mass is also seen indenting on the retrohepatic inferior vena cava with loss of fat plane.
There is minimal sub hepatic extension of the mass with probable infiltration into the
wall of hepatic flexure of the colon. A lymph node is seen anterior to the head of the
pancreas , measuring 8x14mm. Gall bladder shows multiple calculi with wall thickening
(4.5 mm). The pancreas shows normal size, shape and attenuation values. No duct
dilatation or focal lesion.Spleen is normal. The kidneys show normal size, shape and
contrast enhancement with no pelvicalyceal dilatation or calculi. No hydroureter. No
ascites. Bones are normal. Few air space opacities are seen in the right basal lung
segments.
Impression: Heterogenously enhancing mass in contiguity to the body of the gall
bladder in the lateral aspect, extending into the segment V and IV ,infiltrating into the
porta hepatis, encasing the main portal vein and proper hepatic artery, and causing
biliary obstruction at CHD/CBD level with associted IHBR dilatation. -likely to
represent Carcinoma gall bladder with infiltration into the porta as described.

FOLLOW UP

Diagnostic laparoscopy followed by extended left hepaectomy was performed.

HISTOPATHOLOGY

Poorly differentiated adenocarcinoma arising from gall bladder extending into the
adventitia of common hepatic artery, wall of main portal vein, right portal vein,
perimuscular tissue, liver and muscularis propria of small intestine.
TUMOUR BOARD:

Following histopathology report,the patient is planned to be managed with adjuvant

chemotherapy.

FINAL DIAGNOSIS

POORLY DIFFERENTIATED ADENOCARCINOMA GALL BLADDER

PROCEDURES PERFORMED UNDER SUPERVISION

Date MRD no. Procedure Indication Complication Follow up

Post
Acute
USG guided transplant
09/02/2018 1762269 Nil cellular
liver biopsy for ALD
rejection
cirrhosis
 REPORTING RECORD

Plain Radiograph reported 78

SPECIAL INVESTIGATIONS

MODALITY NO. OF CASES

Barium studies 4
Urographic studies 2
Others -

ULTRASOUND

TYPE NO. OF CASES

General Ultrasound 56
Obstetric Ultrasound 4
Neurosonogram 1
Doppler studies 20
Small parts 1

CT scans reported 76

MRI reported 45

DATE: SIGNATURE OF HEAD OF DEPARTMENT

 QUARTERLY EVALUATION

Date: January 2017

Sl. No. Points to be considered Score

1 Punctuality

2 Regularity of Attendance

3 Quality of ward work

4 Presentation of cases

5 Bedside manners

6 Rapport with patients

7 Rapport with colleagues

8 Undergraduate teaching (if applicable)

9 Others

Total Score

Guidance for scoring:

0– Poor, 1- Below average, 2 – Average,3- above average, 4- Very good

Date: HEAD OF THE DEPARTMENT

DEPARTMENT OF

RADIOLOGY

AMRITA INSTITUTE OF MEDICALSCIENCES

MARCH 2019

CASE NO :1

NAME:INDIRA KUMAR AGE: 58Y / Female MRD NO:1794165

HISTORY

58 years old female came with complaints of fever, breathlessness and fatique for the
past 2 days.

CHEST RADIOGRAPH

Lobulated mass noted in the mediastinum on both sides obscuring the right heart border
suggestive of bilateral hilar adenopathy.

CT CHEST WITH CONTRAST

Thyroid gland is normal. Multiple discrete enlarged mediastinal nodes noted in

the paraaortic(1.2 x 1.3 cms), right upper paratracheal(1x 1 cms),right hilar(1.3 x 1.2
cms) and left hilar region(1.6 x 1.6 cms).Few subcentimetric nodes are also noted in
subcarinal and bilateral interlobar regions. Multiple scattered tiny centrilobular nodules
noted in right upper lobe, posterior segment, right middle lobe, lateral segment, left
lower lobe, anterobasal segment, left lower lobe posterobasal segment. Few fissural
basal nodules noted along the left lower lobe.No evidence of centrilobular fissural
thickening / peribronchovascular thickening. No evidence of pleural effusion /
thickening.Mediastinal structures are normal.Liver is enlarged.Spleen is normal.Rest of
visualized Upper abdomen is normal. Vertebrae shows degenerative changes.
Impression: Multiple enlarged mediastinal nodes with scattered centrilobular nodules
and few fissural based nodules as described - consistent with sarcoidosis.

FOLLOW UP

Mantoux test was done and was negative.The patient was started on DMARD’s
and corticosteroids.

FINAL DIAGNOSIS

SARCOIDOSIS
CASE NO: 2

NAME: HAMEED MOHAMMED AGE: 58Y/Male MRD

NO:1928993

HISTORY

58 yr old male presented with complaints of right shoulder pain for past 1 1/2
years.He had h/o fall from bike ,after that his symptoms started.The pain was dull
and progressive in nature radiating to his right arm.He had restriction of
movement and difficulty in doing day to day activities .No h/o swelling /fever or
any other systemic illness .

MRI SHOULDER

Degenerative intrasubstance tear of supraspinatus withperitendinous

fluid.Infraspinatus tendon and muscle are normal.Subscapular tendon shows
intrasubstance tear with peritendinous fluid.Teres minor is normal. Peritendinous
fluid around biceps tendon , suggestive of tendinosis.Osteoarthritic changes seen
in acromioclavicular joint impinging on the supraspinatus tendon /
muscle.Superior and inferior glenoid labrum are normal.Glenohumeral joint
spaces are normal.
Impression: Degenerative intrasubstance tear of supraspinatus with peritendinous
fluid.Infraspinatus tendon and muscle is normal.Peritendinous fluid around
biceps tendon , suggestive of tendinosis. Osteoarthritic changes seen in
acromioclavicular joint impinging on the supraspinatus tendon / muscle.

FOLLOW UP

Arthroscopic rotator cuff repair right shoulder was performed.

FINAL DIAGNOSIS

Rotator cuff tear involving supraspinatus. Subacromial bursitis Adhesive capsulitis

PROCEDURES PERFORMED UNDER SUPERVISION

Date MRD no. Procedure Indication Complication Follow up

USG guided Suspected

02/03/2019 1716380 Post LDLT Nil
liver biopsy rejection