Dr. Pepe’s Summer cases: CASE 1 – SOLVED

Dear Friends,

As I am on vacation in Menorca, my plan is to start the Diploma cases in October. To whet your appetite,  I will show in September two unusual cases that I saw this summer.

The first case is the scout film of a CT done in 52-year-old man without significant symptoms.
What do you see?

Check the images below, leave your thoughts in the comments section, and come back on Friday for the answer.

Click here for the answer

The AP scout radiograph shows several interesting findings: there is an obvious rounded paratracheal opacity (A, white arrow). Displaced right and left paraspinal lines are seen (A, red arrows). In the abdomen, the transverse colon is inverted, with the splenic flexure on the right and the hepatic flexure on the left (A, yellow arrows). Finally, the shadow of the liver occupies the left upper quadrant of the abdomen.

This case is identical to case 178 of the blog, shown a few months ago and the diagnosis is also the same: levocardia with abdominal situs inversus. It is highly unusual to discover two cases in a short period of time but in this patient I have CT proof.

Enhanced coronal CT shows that the displacement of paraspinal lines is due to enlarged azygos / hemiazygos veins (B, arrows).

Another view shows polysplenia in the right upper quadrant of the abdomen (C, circle) as well as the liver in the left upper quadrant (C, arrow).
 
I apologize for presenting such a difficult case, but I thought it was interesting having two of them in a short period of time. In addition, the diagnosis can be suggested in the plain film if we pay attention to the findings.

5 thoughts on “Dr. Pepe’s Summer cases: CASE 1 – SOLVED

  1. There is discrete loss of volumen of the right hemithorax with diaphragmatic elevation. The cardiac is on the left hemithorax so I am thinking about a congenital malformation like pulmonary hypoplasia or pericardium agenesia. There are lucendy mediastinal lines.

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