This 63 year old man presented with a long history of dysphagia, regurgitation of undigested food and a nocturnal cough. This film is from a barium swallow and show the typical smooth, 'rat tail'
appearance of achalasia. Oesophageal manometry showed absent primary peristaltic waves and non-propulsive tertiary waves. Endoscopy showed a large volume of food residue within the oesophagus. The mucosa appeared normal.
The diagnosis is one of achalasia. This can be managed with either endoscopic balloon dilatation or surgical cardiomyotomy. In this patient symptomatic improvement followed balloon dilatation. The three vertical dots on the
x-ray are skin markers used to locate the position for the balloon.
This 50 year old man presented with left loin pain and macroscopic haematuria. This film is from an intravenous contrast enhanced abdominal CT scan. It shows a large partially necrotic mass replacing much
of the left kidney. The features are those of a renal cell carcinoma. In renal cell carcinoma, contrasted enhanced CT allows assessment of metastatic spread and tumour invasion of the renal vein and inferior vena cava
This 35 year old lady presented with a breast lump. Clinically it was smooth, with a lobulated surface and was not fixed to either the skin or chest wall. Fine needle aspiration cytology showed benign
cohesive cells. This mammographic image shows a well circumscribed mass with the features typical of a fibroadenoma.
This 6 month old boy presented with a short history of colicky abdominal pain and vomiting. The initial clinical impression was that he had gastroenteritis. Soon after admission he passed altered blood
per rectum. He had a palpable abdominal mass on the right side of his abdomen suggesting that he hand an Intussusception. As he was well with no features of sepsis or peritonitis he underwent a water soluble contrast enema to both confirm the
diagnosis and attempt reduction. This was unsuccessful and the Intussusception required surgical reduction.
This 40 year old man presented with sudden onset of severe epigastric pain. The clinical picture was that of a visceral perforation. An erect chest X-ray showed free gas under the diaphragm. This is his
plain abdominal X-ray which showed another feature of a pneumoperitoneum - 'Riggler's sign' with both the luminal and external border of the bowel are visible.