Image processing is an important focus area within case-based reasoning. CBR systems have been developed both to support image-centric functionality such as segmentation, as well as domain-specific imagery applications. In particular, case-based medical applications employ significant imagery elements to support tasks such as diagnosis and treatment planning. Whereas previous surveys have focused either on imagery or on medicine, this chapter takes a look specifically at their conjunction, providing a novel perspective and overview of the main issues and research work in case-based reasoning involving medical imagery.