Normal Anatomical Variants, Pseudolesions, and Developmental Landmarks — WACS Viva & Clinical Scenarios (Radiological Anatomy and Normal Imaging Variants)

Exam-style normal anatomical variants, pseudolesions, and developmental landmarks viva scenarios with examiner probes and model answers for Radiology…

Scenarios covered

• SCENARIO 1: A lateral radiograph of the ankle in a 24-year-old athlete following an inversion injury demonstrates a well-corticated ossicle posterior to the lateral tubercle of the talus. Detail the differentiating radiological features between an os trigonum, a fractured Stieda process (fracture of the posterolateral talar tubercle), and Shepherd fracture on plain films and MRI. State the clinical significance and imaging findings of os trigonum syndrome.
• SCENARIO 2: A contrast-enhanced abdominal CT in an asymptomatic 48-year-old patient reveals a focal area of geographic low attenuation anterior to the porta hepatis and adjacent to the gallbladder fossa, without mass effect or vascular displacement. Explain the pathophysiological and vascular basis of focal fatty sparing versus focal fatty infiltration of the liver. Describe the specific MRI pulse sequence findings required to definitively confirm this normal pseudolesion.
• SCENARIO 3: A routine posteroanterior chest radiograph demonstrates a fine, convex-outward curvilinear line traversing the right upper pulmonary zone, terminating inferiorly at the level of the second posterior intercostal space in a teardrop-shaped soft tissue density. Identify the anatomical structure, describe its embryological origin, and detail its cross-sectional CT anatomy, including the number of pleural layers forming its septum.
• SCENARIO 4: A renal ultrasound demonstrates an apparent solid, isoechoic soft tissue mass indenting the renal sinus in the interpolar region of the left kidney. Describe the criteria used on ultrasound, contrast-enhanced CT, and MRI to confirm a hypertrophied column of Bertin (pseudotumor) and definitively exclude renal cell carcinoma.
• SCENARIO 5: An axial T2-weighted brain MRI of a neonate reveals a fluid-filled cavity situated between the frontal horns of the lateral ventricles extending posteriorly beyond the columns of the fornix to the splenium of the corpus callosum. Differentiate between cavum septum pellucidum, cavum vergae, and cavum veli interpositi on multiplanar MRI, detailing their boundaries, communication with the ventricular system, and clinical significance.