the first case of Caceres’ corner was published in September 23, 2011. Today, seven years later, we are proud to present case 200. It was not always easy, but it was always fun and worth it. Thank you for your continuous support.
Today’s case was diagnosed by my friend and co-worker Carles Vilá. The PA radiograph was taken as a pre-op exam for renal stones.
Do you see any abnormality?
More images will be shown on Wednesday
we saw a peripheral opacity in the lower left hemithorax and performed a CT, which showed unexpected findings.
What do you see?
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Findings: PA radiograph shows a faint opacity in the periphery of the left lower hemithorax (A, circle). A CT was recommended.
Axial CT shows an unexpected irregular basal opacity (B, arrow). Caudal slices show several parietal nodules (C-D, arrows).
Coronal CT shows the large basal opacity (D, arrow), as well as the small parietal nodules (D-E, red arrows).
The clue to the diagnosis lies in a negative finding: absent spleen in the left upper quadrant of the abdomen (D-E, asterisks), suggesting that the chest opacities may represent accessory spleens.
The patient was interrogated and stated a previous car accident with ruptured spleen and subsequent splenectomy. A test with labelled erythrocytes in another institution confirmed the accessory spleens.
Final diagnosis: thoracic splenosis
As I am writing this (12:00 PM Thursday), nobody has suggested the right diagnosis. I was expecting many correct answers, since I showed a similar case eight weeks ago (Diploma case 135).
Teaching point: remember the importance of negative findings (Diploma cases 135 and 136). In this particular patient, they were crucial to suggest the correct diagnosis.
Congratulations to MK, who made a last-minute diagnosis at 2:08 P.M. on Thursday!
17 thoughts on “Cáceres’ Corner Case 200 – SOLVED!”
Hello! Opacity at the middle third of the right hemithorax, with obtuse angles (parietal) and in the lower third of the left hemithorax.
Gross rotation present
Illdefined patchy opacity in left lower zone
PA chest x-ray – The space between the intimal calcification and outer border of cortex is more ( 8 -9 mm) – aortic dissection.
* outer border of aortic wall at the knuckle
I think that the right hilum is pathological (increased density). Perhaps the lateral view can help me!!!
Nice to meet you!!!!!!!!!!!!!!!!!!!
No lateral view taken. More images tomorrow.
Was nice meeting you too 🙂
Calcium sign of aortic dissection.
Can´t delineate left hilum, but no triangular shaped opacity as in LLL atelectasis. Increased density in left lower zone.
Need a lateral view
-Left hilum is lower than the right, suspected of left lower lobe collapse… endobronchial lesion should be excluded.
-Double density aortic arch… hilar mass or LN.
Double contour of aortic knob
Fractured left 8th rib
So far, Aloria, M Venkatesh and Krister A are ahead.
More images tomorrow
Mildly thickened pleura, subtle left lower lung zone opacity, could be extrapulmonary.
Left hilum is at the same level as the right, but no definite signs of atelectasis.
Left shoulder seems a bit weird and right hilum is more pronounced, likely due to asymmetrical positioning/rotation.
Well done! Look for more images today
Cannot see left main bronchus. Elevated left diaphram with a small Bochdalek hernia.
Small pleural density in lateral lower zone on the same side. Right bronchi seems ectatic.
? Left sequestration.
Hello? Any personal history of intertest? Traumatic perhaps?
It seems to be an splenosis… If no traumatic history-extramedullary hematopoiesis