Acute airspace opacification with lymphadenopathy is a subset of the differential diagnosis for generalised airspace opacification and includes:
post-obstructive causes (usually chronic, but 'new' changes can occur)
primary lung cancer
Adrenal calcification is not a rare finding in healthy asymptomatic people and is usually the result of previous haemorrhage or tuberculosis. Addison disease patients only occasionally develop calcification.
sepsis: Waterhouse-Friderichsen syndrome
Cervical lymphadenopathy in an adult can result from a vast number of conditions. They include:
from head and neck tumours
other neoplastic lesions
The apple core sign, also known as the napkin ring sign (bowel), is most frequently associated with constriction of the lumen of the colon by a stenosing annular colorectal carcinoma.
The appearance of the apple-core lesion of the colon also can be caused by other diseas...
Asymmetries in mammography represents a spectrum of morphological descriptors for a unilateral fibroglandular-density finding seen on one or more mammographic projections that does not meet criteria for a mass. The term refers to a density finding and should not be confused with asymmetry in bre...
Bat wing or butterfly pulmonary opacities refer to a pattern of bilateral perihilar shadowing. It is classically described on a frontal chest radiograph but can also refer to appearances on chest CT 3,4.
Bat wing pulmonary opacities can be caused by:
pulmonary oedema (e...
Bilateral testicular lesions have a relatively limited differential diagnosis.
lymphoblastic leukaemia (acute or chronic)
primary testicular lymphoma is rare but the testes are often the site of lymphoma/leukaemia recurrence due t...
There are several bony lesions that can involve or produce a sequestrum.
Brodie abscess: osteomyelitis
certain soft tissue tumours (with bony extension)
malignant fibrous histiocytoma
metastasis (especially from breast c...
Bulging duodenal papilla is a conical or cylindrical protuberance at the medial aspect of the descending or horizontal duodenum at the site of the sphincter of Oddi. It is a finding on small bowel follow-though (and endoscopy) and has a relatively long differential. On cross-sectional imaging, ...
There are numerous causes of calcified mediastinal lymph nodes.
Common causes include:
infectious granulomatous diseases
Uncommon causes include:
Pneumocystis jiroveci (PCP) pneumonia
thyroid carcinoma: papi...
The cardiophrenic space is usually filled with fat. However, lesions originating above or lower to the diaphragm can present as cardiophrenic angle lesions.
The more common lesions encountered include:
pericardial fat pad
pericardial fat necrosis
The differential for peripheral or ring enhancing cerebral lesions includes:
demyelination (incomplete ring)
tumefactive demyelinating lesion (incomplete ring)
Unfortunately the paediatric population is susceptible to malignancies. The most common entities, in overall order of frequency, are 1-4:
leukaemia/lymphoma: ~35% *
acute lymphoblastic leukaemia: 23%
Hodgkin disease: 5%
acute myelogenous leukaemia: 4%
central nervous system malignancies: ~2...
Clavicle tumours may be malignant or benign.
osteoma: uncommon, sclerotic, hamartomatous surface lesion
enchondroma: rare, geographic, intramed...
The differential for cystic lesions of the pancreas includes:
intraductal papillary mucinous neoplasm (IPMN)
serous cystadenoma uncommonly uni/macrolocular
simple pancreatic cyst
pancreatic cysts occur in association with
von Hippel Lindau syndrome
Cystic or necrotic appearing lymph nodes can be caused by a number of infectious, inflammatory or malignant conditions:
squamous cell carcinoma metastases
plasmacytoid T-cell leukaemia
acute myeloid leukaemia
herpes simplex lymphade...
Cystic pulmonary metastases are atypical morphological form on pulmonary metastases where lesions manifest as distinct cystic lesions. It is slightly different from the term cavitating pulmonary metastases in that the lesions are extremely thin walled.
It has been reported with many ...
An anterosuperior mediastinal mass can be caused by neoplastic and non-neoplastic pathology. As their name suggests, they are confined to the anterior mediastinum, that portion of the mediastinum anterior to the pericardium and below the level of the clavicles.
The differential diagnosis for a...
A diffuse homogeneous bone marrow FDG uptake usually reflects hyperplastic bone marrow which can be seen in the following conditions:
granulocyte colony-stimulating factor (G-CSF)
Endosteal scalloping refers to the focal resorption of the inner layer of the cortex (i.e. the endosteum) of bones, most typically long bones, due to slow-growing medullary lesions.
It is important to note that although it is evidence of a slow non-infiltrative lesion, it does not equate to ben...
Fetal cardiac tumours refer to primary cardiac tumours that can present in the in utero population.
Fetal cardiac tumours are rare; the prevalence, reported from autopsy studies of patients of all ages, varies from 0.0017-0.28 % 2.
Known cardiac tumour types that pres...
Focal gas collection in right upper quadrant on plain radiographs can occur from a number of pathologies. Things to consider are:
enterobiliary fistula: common types include cholecystoduodenal fistula and cholecystocolic fistula. It may occur with:
gallstone ileus (being most common) 3
Generalised osteopenia refers to osteopenia diffusely affecting the bones.
The differential diagnosis is wide and includes:
osteoporosis: decreased osteoid production
osteomalacia: undermineralisation of osteoid
Hepatosplenomegaly is simply the simultaneous presence of a pathologically-enlarged liver (hepatomegaly) and spleen (splenomegaly).
Many, many infections can produce a mild concurrent enlargement of the liver and spleen. This list is by no means exhaustive!
HIV-associated neoplasms are numerous and can be broadly divided into two groups:
associated but not AIDS defining malignancies
The development of these malignancies in HIV affected individuals generally implies progression to AIDS 4:
Hypertrophic osteoarthropathy (HPOA) is a syndrome characterised by periosteal reaction of the long bones without underlying bone lesion. There are a broad range of manifestations, although typically there is symmetrical involvement of the appendicular skeleton. Accompanying abnormal soft tissue...
There are several tumours which are noted to cause hypervascular metastases. The list of differential diagnoses includes:
renal cell carcinoma (RCC)
breast cancer: homogeneously hypervascular liver metastases from breast are considered rare 3
Hypothalamic lesions are numerous representing some entities that are unique to the hypothalamus, as well as many lesions that can be seen elsewhere within the brain. Additionally, due to its proximity to the optic chiasm, third ventricle and pituitary region, many lesions of these locations can...
A variety of intracranial tumours exhibit different forms of calcification. Some lesions commonly show calcification while in some tumours, calcification is seen only in few number of cases. In this article these tumours are classified on the basis of frequency of calcification.
Intraventricular neoplasms are rare and arise from periventricular structures such as the walls of the ventricular system, the septum pellucidum and the choroid plexus. Many tumour types arise from or can bulge into the ventricular system, although there are certain lesions that are relatively r...
Leptomeningeal enhancement refers to a diffuse or focal gyriform or serpentine enhancement that can be seen in the following conditions:
tuberculous meningitis (can also be focal)
CNS cryptococcal infection
coccidioidal meningitis (c...
Mandibular lesions are myriad and common. The presence of teeth results in lesions that are specific to the mandible (and maxilla) and a useful classification that defines them as odontogenic or non-odontogenic. While it may often not be possible to make a diagnosis on imaging alone, this classi...
Mediastinal lymph node enlargement can occur from a wide range of pathologies. It may occur on its own or in association with other lung pathology.
Although mediastinal lymphadenopathy is used interchangeably - by some - with "mediastinal lymph node enlargement", they are not synon...
Mixed lytic and sclerotic bone metastases are seen in a number of malignancies:
breast carcinoma: typically sclerotic but 25% are mixed
lung carcinoma: typically lytic but 15% are mixed
carcinoma of the cervix
prostate carcinoma: typically sclerotic but 15% are mixed
The differential diagnosis for multiple cystic neck lesions is different to that for a solitary cystic neck mass.
Cystic neck lesions are seen in:
metastatic squamous cell carcinoma: older patient, M>F
metastatic papillary thyroid carcinoma: usually a younger patient, ...
Non-seminomatous germ cell tumours (NSGCT) are one of the main groups of germ cell tumours (the other being seminoma). Although they are made up of distinct histological entities, in general, they have similar radiographic appearances. They can, however, be found widely in the body, with variabl...
Non-small-cell lung cancer represents a heterogeneous group of lung cancers that do not have "small cells" on histology. They are thus separated, as small cell carcinoma of the lung has distinctive management implications. The major histological types include:
adenocarcinoma of lung
Ocular pathology covers a wide range of conditions and therefore represents the cause of a wide range of symptoms, signs and radiographic features.
Ocular metastases account for over 80% of all ocular pathology. With regard to the remainder of ocular lesions, the primary differentiating factor ...
Oligometastases refers to distant disease that is limited in number and distribution, Niibe et al. defined this as ≤5 metastatic/recurrent lesions with control of the primary lesion 1,2. These metastases can be treated with local measures (surgery, radiation therapy, etc.) with the aim of increa...
Omental cake refers to infiltration of the omental fat by material of soft-tissue density. The appearances refer to the contiguous omental mass simulating the top of a cake. Masses on the peritoneal surfaces and malignant ascites may also be present.
The most common cause is metasta...
Enlargement of the optic nerves is uncommon and has a surprisingly broad differential:
optic nerve glioma
optic nerve meningioma
Paediatric renal tumours and masses are another group of diseases (just like cystic renal diseases in both the adult and child) that are bewildering in their number, nomenclature and overlapping findings.
Wilms tumour: common in older children 1-8 years old
Pancreatic calcifications can arise from many aetiologies.
Punctate intraductal calcifications
alcoholic pancreatitis (20-40%) 2
intraductal, numerous, small, irregular
preponderant cause of diffuse pancreatic intraductal calcification
gallstone pancreatitis (2%) 2
There are numerous primary pancreatic neoplasms, in part due to the mixed endocrine and exocrine components.
Classification based on function
exocrine: ~99% of all primary pancreatic neoplasms
pancreatic ductal adenocarcinoma ~90-95%
intraductal papillary muc...
Parotid enlargement (also known as parotidomegaly) has a wide differential given the significant breadth of pathology that can affect the parotid gland. These can be separated by the standard surgical sieve approach into infective, inflammatory, immune, neoplastic, infiltrative, and congenital c...
Patellar tumours are extremely rare. They can be either benign or malignant primary bone tumours, or metastases.
Patellar tumours represent just 0.1% of all primary bone tumours 1.
Patients may present with anterior knee pain and/or a palpable mass 1,3.
A pedunculated intratracheal mass has a variety of differential diagnoses:
benign tumour, e.g. hamartoma, chrondroma, lipoma
metastasis to tracheal mucosa, e.g. renal cell carcinoma, melanoma
polyp, e.g. inflammatory, antrochoanal
Pelvic masses in females carry a broad differential diagnosis:
benign adnexal cyst: 34%
pelvic malignancy: 14%
pelvic inflammatory disease: 8%
Extra-gynaecological masses, e.g. colorectal carcino...
Periosteal reaction, also known as periostitis or periosteitis, is a non specific radiographic finding that occurs with periosteal irritation. Periosteal reactions may be broadly characterised as benign or aggressive, or more specifically broken down by pattern.
Benign versus ag...
Peritoneal calcification is seen in a limited number of conditions that result in calcification of peritoneal structures. Therefore, the differential diagnosis is small:
psammoma bodies in malignancy (most frequently cystadenocarcinoma of the ovary): fine sand-like calcification
PET-CT is a combination of cross-sectional anatomic information provided by CT and the metabolic information provided by positron emission tomography (PET).
PET is most commonly performed with 2-[F-18]fluoro-2-deoxy-D-glucose (FDG). Fluorine-18 (F-18) is an unstable radioisotope and has a half-...
Pleural involvement with lymphoma can occur in two situations:
primary pleural lymphoma
primary effusion lymphoma
secondary involvement of the pleura with lymphoma
Post surgical breast scar is a benign complication that usually occurs following surgical intervention to breast tissue. It can however be a strong and potentially very confusing mimicker of breast malignancy.
Review of the patient's past history and previous mammography...
Primary benign cardiac tumours are much less common than secondary metastatic deposits. However they are more likely when a cardiac mass is seen outside of the setting of terminal metastatic disease. Tumours include 1-2:
most common in adults
accounts for ~50% of all primary be...
There are a number of primary malignancies of the nasopharynx:
nasopharyngeal carcinoma (squamous cell carcinoma): 70%
lymphoma (sinonasal lymphoma): 20%
nasopharyngeal papillary adenocarcinoma
adenoid cystic carcinoma
Pseudocirrhosis is a radiological term used to recapitulate imaging findings of cirrhosis, but occurring in the setting of hepatic metastases. It is most commonly reported following chemotherapeutic treatment of breast cancer metastases, although has also been reported before treatment, and with...
Pulmonary metastases are common and the result of metastatic spread from a variety of primary tumours via blood or lymphatics.
This article describes haematogenous pulmonary metastases with lymphangitis carcinomatosis discussed separately.
The epidemiology will match that of the ...
Pure ground glass lung nodules are a subtype of ground glass lung nodules where there is no associated solid component.
They have been shown to represent various pathologies such as 1,3
adenocarcinoma in situ of lung
minimally-invasive adenocarcinoma of lung
invasive adenocarcinoma of lung
RASopathies are a class of developmental disorders caused by germline mutations in genes that encode for components or regulators of the Ras/mitogen-activated protein kinase (MAPK) pathway.
As a group, RASopathies represent one of the most common malformation syndromes, with an in...
Response evaluation criteria in solid tumours or RECIST refers to a set of published rules used to assess tumour burden in order to provide an objective assessment of response to therapy. They were initially introduced in 2000 and have undergone subsequent revision in 2009 (RECIST 1.1). For the ...
Salivary gland tumours are variable in location, origin and malignant potential.
In general, the ratio of benign to malignant tumours is proportional to the gland size; i.e. the parotid gland tends to have benign neoplasms, the submandibular gland 50:50, and the sublingual glands an...
Secondary organising pneumonia (SOP) refers to organising pneumonia that can be attributed to a specific cause, in contrast to cryptogenic organising pneumonia (COP).
SOP can be attributed to the following causes 1:
atypical pneumonias (e.g. Leg...
Skeletal metastases are common and result in significant morbidity in patients with metastatic disease. Although the diagnosis is often straightforward, especially as in many cases there is a well-documented history of metastatic malignancy, sometimes they may mimic benign disease or other prima...
Soft-tissue sarcomas are a heterogeneous group of malignant tumours of mesenchymal origin (sarcoma) that originate from the soft tissues rather than bone. They are classified on the basis of tissue seen on histology. The commoner sarcomas in the adult and paediatric population are listed below.
Solid lesions with enhancement are by far the most commonly encountered appearance of pituitary region masses.
by far the most common entity
typically enhances less vividly than other entities
elevates the dura of the diaphragma sella (as the origin is wi...
Solid periosteal pattern is thought to evolve from single layer and multilayered periosteal reactions, forming a solid layer of new bone adjacent to the cortex.
It can be seen in:
The differential diagnosis of a solitary sclerotic bone lesion is heavily influenced by the age of the patient, and includes:
solitary either because no others are present or no others have been imaged
enostosis (bone island)
Spinal metastases is a vague term which can be variably taken to refer to metastatic disease to any of the following:
vertebral metastases (94%)
may have epidural extension
intradural extramedullary metastases (5%)
intramedullary metastases (1%)
Each of these are discussed separately. Below...
Splenomegaly refers to enlargement of the spleen. The upper limit of normal adult splenic length is traditionally cited at 12 cm, but lengths upwards of 14 cm can be seen in normal, taller males 7.
Massive splenomegaly is variably defined, including when the spleen is 5 standard deviations abov...
Sunburst appearance is a type of periosteal reaction giving the appearance of a sunburst secondary to an aggressive periostitis. It should not be confused with the sunburst sign of meningioma vascularity.
The sunburst appearance occurs when the lesion grows too fast and the periosteum does not...
Superscan is intense symmetric activity in the bones with diminished renal and soft tissue activity on a Tc99m diphosphonate bone scan.
This appearance can result from a range of aetiological factors:
diffuse metastatic disease
transitional cell ...
The differential diagnosis for a terminal ileitis is quite extensive, and includes:
inflammatory bowel disease
Crohn disease (most common)
backwash ileitis due to ulcerative colitis
Testicular cancers are the most common neoplasm in men between the ages of 20 and 34 years.
Testicular cancer is uncommon, accounting for less than 1% of all internal organ malignancies 2.
The demographics of affected individuals depends on the age of the histology of the tumour....
Thyroid malignancies are most commonly primary thyroid cancers but can rarely be metastatic deposits.
Thyroid malignancies can be categorised into the following key subtypes:
primary thyroid cancers
papillary thyroid carcinoma: 60-80% of carcinomas
The differential for tracheal masses can be rather wide.
For a single mass consider:
direct invasion from adjacent organ (lung, thyroid, oesophagus and larynx)
distant metastasis (e.g. melanoma, breast, renal and colon cancer)
squamous cell carcinoma: common...
Tuberculosis of the central nervous system can result from either haematogenous spread from distant systemic infection (e.g. pulmonary tuberculosis) or direct extension from local infection (e.g. tuberculous otomastoiditis).
Intracranial manifestations of tuberculosis are protean and can affect...
Tumour ablation, or image-guided tumour ablation, is the direct application of chemical or energy-based (i.e. thermal and nonthermal) treatments to cause local tumour destruction. Techniques include:
radiofrequency ablation (RFA)
microwave ablation (M...
Tumours of the male urethra are uncommon. They can be categorised both on the grounds of histology and location.
squamous cell carcinoma of the urethra: 80%
urothelial/transitional cell carcinoma of the urethra: 15% (predominantly posterior urethra)
adenocarcinoma of the urethra: 5...
Ultrasound appearance of liver metastases can have bewildering variation, and the presence of hepatic steatosis can affect the sonographic appearance of liver lesions.
Patterns do exist between ultrasound appearance of the liver metastases and the likely prima...
Unilateral axillary lymphadenopathy while being more concerning than bilateral axillary lymphadenopathy can still arise from a variety of benign, as well as malignant, causes.
other regional infective causes
ipsilateral arm infection, e.g. cellulitis
The differential diagnosis for unilateral testicular lesions is wide-ranging.
seminoma (40-50% of testicular malignancies)
non-seminomatous germ cell tumours:
testicular epidermoid (teratoma with ectodermal elements only)
Vertebra plana (pleural: vertebrae planae), also known as the pancake or silver dollar or coin-on-edge vertebra, is the term given when a vertebral body has lost almost its entire height anteriorly and posteriorly, representing a very advanced compression fracture.
It can occur in a ...
Vulval neoplasms are rare and mostly seen in elderly female patients. Squamous cell carcinoma (SCC) is the most common malignancy of the vulva and only 30% of them are associated with oncogenic human papillomaviruses (HPVs).
Squamous neoplastic lesions
A clinical presentation of weight loss is extremely common and often a source of marked anxiety for the patient. The commonest cause of unintentional weight loss (UWI) is gastrointestinal tract disease, and not malignancy.
The published literature lacks a consistent definition of w...
Certain well-defined breast cancers tend to lack the characteristic spiculation and can give false reassurance of more benign entities on both ultrasound and mammography. These include:
certain high grade invasive ductal carcinomas: not enough time for a desmoplastic reaction to form spiculatio...
The World Health Organisation (WHO) classification of soft tissue tumours is the most widely used pathologic classification system for such disorders. The current revision, part of the 4th edition of the WHO series, was published in 2013 and is reflected in the article below 1.