Detailed X-Ray Analysis

Imaging Overview

1. IMG-0002 & IMG-0003: Skull AP + Lateral - Patient: Muntasir Musalman, 30Y Male (dated 05/03/2025)
2. IMG-0004: Skull Lateral only - separate patient (DRTG/DTRGDYG label, dated 10/12/2025)
3. IMG-0002 (third image): Cervical Spine AP + Lateral - Patient: Birendra Kumar Khadka, 80Y Male (dated 03/23/2025)

SET 1 - Skull X-Ray: Muntasir Musalman, 30-Year-Old Male

AP (Frontal) View

• The outer and inner tables are intact and well-defined
• No fracture lines, sutural diastasis, or lytic/sclerotic lesions visible
• Coronal and sagittal sutures appear fused (appropriate for a 30-year-old)
• No intracranial calcification (no abnormal opacities suggesting shifted pineal or calcified lesion)

• Orbital margins appear symmetric and intact
• No periorbital soft tissue swelling or "teardrop sign" to suggest orbital floor fracture
• Nasal bones appear aligned

• Frontal sinuses appear well-aerated bilaterally - no opacification
• Maxillary sinuses (ethmoidal region visible) appear clear
• No air-fluid levels

• Mandibular arch visible; dentition appears present; no obvious fracture

• Cervical vertebrae visible; alignment appears adequate on AP view
• C-spine lateral curvature appears within normal limits

Lateral View

• Calvarium contour is smooth and intact; inner and outer tables well-defined
• No linear or depressed skull fractures identified
• No lytic lesions ("pepper pot" skull changes absent)
• Cranial sutures not pathologically widened
• No "beaten silver" (copper beaten) pattern (which would suggest raised ICP in a child - not expected at 30)

• Sella appears normal in size and shape; floor intact
• No "double floor" sign or ballooning suggestive of pituitary pathology

• Frontal sinus visible and well-aerated
• Sphenoid sinus appears aerated
• No air-fluid level to suggest sinusitis or trauma

• Soft tissue shadow in the nasopharynx appears normal for a 30-year-old (no bulky adenoid mass)
• Prevertebral soft tissues are not thickened

• Normal cervical lordosis maintained
• Vertebral body heights and disc spaces appear preserved
• Dens (odontoid process) visible and appears intact
• No prevertebral soft tissue swelling

No acute fracture, no obvious intracranial pathology, no sinus opacification. Normal skull X-ray for a 30-year-old male.

SET 2 - Skull Lateral: Separate Patient (DRTG label, 2025)

• Vault contour is intact with well-defined diploic space
• No fracture lines traceable across the vault
• No focal lytic or sclerotic lesions
• Normal vascular markings (middle meningeal channels) visible - should not be mistaken for fracture lines

• Sella turcica appears of normal size; no obvious ballooning or erosion of the dorsum sellae

• Frontal bone and supraorbital ridges appear intact
• Nasal bones visible; no obvious deformity

• Frontal and sphenoid sinuses appear aerated
• No air-fluid level visible

• Mandible and maxilla visible with teeth present; no gross abnormality

• C1-C7 vertebral bodies visible
• Cervical lordosis appears slightly reduced (borderline straightening) - could be positioning or muscle spasm
• Disc spaces appear maintained in the upper cervical levels
• Prevertebral soft tissues appear normal in width

No acute fracture lines. Mildly reduced cervical lordosis (possibly positional). Otherwise normal lateral skull radiograph.

SET 3 - Cervical Spine AP + Lateral: Birendra Kumar Khadka, 80-Year-Old Male

AP (Frontal) Cervical Spine View

• Vertebral bodies aligned in the midline; no lateral listhesis
• Spinous processes appear midline

• Vertebral body heights appear reduced at multiple levels - consistent with age-related degenerative changes
• Endplate irregularities visible at several levels

• Disc spaces appear narrowed at multiple levels - most prominent in the mid-lower cervical region (C4-C7 levels)
• This is consistent with multilevel degenerative disc disease (cervical spondylosis)

• Uncovertebral (Luschka) joint osteophytes likely present - seen as lateral bony projections off the vertebral body margins

• C1-C2 region: odontoid (dens) visible through the open mouth region; appears intact; no obvious atlantoaxial instability on this view

• No abnormal soft tissue calcification

Lateral Cervical Spine View

• Cervical lordosis is significantly reduced / borderline kyphotic in the lower cervical spine - this is a notable finding
• No subluxation or listhesis on static lateral view
• The anterior vertebral line, posterior vertebral line, spinolaminar line, and posterior spinous line all appear grossly intact

• Osteophyte formation (spondylotic bars) visible anteriorly at multiple levels - prominent at C4-C5, C5-C6, C6-C7
• Vertebral body sclerosis at endplates suggestive of Modic-type degenerative changes
• No acute compression fracture (no acute wedging), though chronic height loss may be present

• Multilevel disc space narrowing most pronounced at C5-C6 and C6-C7
• Consistent with advanced cervical spondylosis expected in an 80-year-old

• Facet joints show degenerative changes - cortical irregularity and likely sclerosis

• Posterior osteophytes may encroach on the spinal canal - canal compromise cannot be fully assessed on plain film; MRI would be required to evaluate for cervical cord compression

• Width appears within normal limits (should be <7 mm at C2-C3, <22 mm at C6) - no prevertebral hematoma or abscess suggested

• Spinous processes visible; no fracture

Advanced multilevel cervical spondylosis with significant disc space narrowing (C5-C6, C6-C7 most severely affected), anterior osteophyte formation, and loss of cervical lordosis. No acute fracture or listhesis on static views. Given the patient's age (80 years) and degree of degenerative change, MRI cervical spine is strongly recommended to assess for cord compression (cervical myelopathy) or nerve root compression (radiculopathy).

Summary Table

Clinical Recommendations

1. Sets 1 & 2 (skull films): No immediate action needed radiologically. Correlate with clinical presentation (headache, trauma, neurological symptoms).
2. Set 3 (80Y male cervical spine): Refer for MRI cervical spine to evaluate canal stenosis and cord signal. If the patient has upper or lower limb weakness, hyperreflexia, or gait disturbance - treat as possible cervical myelopathy until proven otherwise.

Disclaimer: This analysis is AI-assisted and is intended to support - not replace - formal radiologist reporting. All findings should be verified by a licensed radiologist and interpreted in the context of the patient's full clinical history.