Cáceres’ Corner Case 211 – SOLVED

Dear Friends,

Today I’m showing chest radiographs of a 50-year-old woman with cough and sputum production.

What do you see?

You will have more images on Wednesday.

Dear Friends,

showing today CT images of the patient. What do you see?

Click here to see the CT images

Click here to see the answer

Findings: PA chest shows a small right lung, with a triangular opacity occupying the lower lung (A, arrow). The right heart border is not seen. The trachea and mediastinum are displaced to the right. In the lateral view the lower opacity occupies the lower lung from front to back (B, arrows).
This appearance is typical of combined RLL and RML collapse (obliteration of right heart border) and the most likely diagnosis is an obstructing lesion in the intermediary bronchus.

Enhanced axial CT shows marked narrowing of the intermediary bronchus (C, arrow). A caudal image shows marked dilatation of mucous-filled bronchi (D, arrows). This appearance indicates a long-standing obstruction and goes against a malignant process

Comparison with a previous radiograph (F) shows that the chest has not changed in comparison with the recent one (E). Bronchoscopy performed three years earlier demonstrated chronic stenosis of intermediate bronchus secondary to previous TB

Final diagnosis: Chronic TB changes of intermediary bronchus causing collapse of RML and RLL.
 
Congratulations to Maged Shaban and Yelgha who made the correct diagnosis of RLL and RML collapse
 
Teaching point: remember that central lobar collapse with bronchiectasis is rarely caused by malignancy.

7 thoughts on “Cáceres’ Corner Case 211 – SOLVED

  1. Good morning!
    There is an evident loss of volume of the right hemithorax with an obliteration of the main bronchus an atelectasi of the Inferior lobe.
    Thera is an incresed density over the atelectasia so I think that the patient has an hiliar mass.

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  2. Loss of volume at right hemi thorax, evident by:
    – Mediastinal shift.
    – elevated right hemi diaphragm.

    Right sided lung opacity is seen obscuring right heart border (middle lobe) and right diaphragmatic copula (right lower lobe)
    Consisting with middle and right lower lobe collapses

    Cut off of bronchus intermedius (after bifurcation of upper lobe bronchus) with soft tissue tumefaction there (?? central lung mass/mediastinal mass)

    Compensatory hyperinflation of right ULL is also seen

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  3. – Atelectasis of the middle and inferior right lobes causing right hemithorax volume loss, mediastinal shift and diaphragmatic elevation.
    -Obliteration of the right bronchus on PA view and hilar mass on lateral view.

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  4. CT, reveals:
    – loss of volume of right lung, evident by:
    + mediastinal shift to the right side.
    + retro-sternal lung herniation to the right side.

    – well defined (bounded by fissures) opacification is seen at site of collapsed middle and lower lobes of the right lung, which are occupied by multiple dilated tortuous mucoid impacted bronchi (finger in gloves.. bronchoceles).
    – at level of carina:
    Homogeneously enhanced triangular /elongated shaped endo-bronchial soft tissue lesion within bronchus intermidus

    Provisional diagnosis:
    Right sided endo-bronchial mass lesion, with subsequent obstructive collapse of right middle and lower lobes

    D.D:
    – Endo-bronchial carcinoid.
    – Endo-bronchial metastasis.
    – other Endo-bronchial masses: hamartoma, papilloma or lipoma.

    Recommendations:
    Bronchoscopy and histopathological correlation.

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  5. Loss of rt. Lung volume, increased opacity, mediastinal shift.. rt middle and lower lung collapse.
    Lateral view hilar mass.. LNs or central mass

    Like

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