Dr. Pepe’s Diploma Casebook: The art of interpretation: CASE 134

Dear Friends,

I would like to start 2019 with a new section, called “The art of interpretation”.

Interpreting the chest radiograph is becoming a lost art and I would like to help you improve your skills in this area. With this in mind, I plan to show radiographs with interesting findings and analyze the steps that will lead to a correct evaluation of these findings.

That said, here is the first case: the chest radiographs of a 50-year-old man with liver cirrhosis and bloody vomiting.

What do you see and what would your diagnosis be?

Check the images and come back on Friday to see the answer!

10 thoughts on “Dr. Pepe’s Diploma Casebook: The art of interpretation: CASE 134

  1. Good morning,
    Increased left lower lobe oppacity. In the PA film, there is a retrocardiac supradiaphragmatic paramediastinal well defined, ovalar opacit, as well as an interphase between the outer 1/3 that is seen only in the lower 2/3 of the left lung. In the lateral film, it seems like a partial lower lobe colaps. Probably increased size of the pulmonary artery, seen only in the lateral film.
    I would recomend a contrasted CT.

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  2. Hello again!
    My attempt of interpretation:
    PA – lowered left hilium, left major fissure displaced medially (both consistant with lower lobe collapse), retrocardiac opacity and a little bit of effusion. Maybe pleural thickening on lateral chest wall?
    lateral – collapse confirmed (I’d say partial since I think I see major fissure going upwards spine), some opacities in basal parts of lower lobe with blurring of diaphragm – could be effusion + atelectasis) and semioval/triangular mass in the back, over the spine.

    Now onto my doubts: I really can’t decide if there is cavitationin the mass or is it just neural foramen. I’m also confused about diaphragm – on lateral view I see right diaphragm (middle line), left one (lower, incomplete) and a third line which I can’t explain – I think I see both lungs through it(?).
    From PA I wanted to suggest round atelectasis, but bottom line is that I’m confused and I want a CT 😉

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  3. Hello professor!
    Lesion seen on both views located close to thoracic vertebrae on left – neurogenic tumor suspected.
    Strange vertically oriented line projected on left lung could be a skin fold.
    Best Greetings

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  4. Thickening the tracheoesophageal stripe on the lateral view- lesion in the esophagus. Opacity projecting over the cardiac silhouette on the left side-hiatal hernia ?

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