Today’s radiographs belong to a 46-year-old man.
Preoperative for knee surgery.
What do you see?
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Findings: PA chest radiograph show increased size of both hila (A, arrows), more evident in the right side. There is also convexity of the aorto-pulmonary window (A, red arrow). The findings are highly suspicious of widespread lymphadenopathy, confirmed in the lateral view (B, arrow). There is also anterior bowing of the posterior tracheal wall by a rounded opacity in Raider´s triangle (B, red arrows).
Enhanced axial CT confirms enlarged hilar lymph nodes (C, arrows) as well as an adenopathy in the A-P window (D-E, red arrows).
The retrotracheal opacity was due to an aberrant subclavian artery arising from a Kommerel diverticulum (F-H, red arrows).
The patient had been diagnosed of sarcoidosis in 2015. Follow-up CTs in 2017 and 2019 did not show any change.
Final diagnosis: Sarcoidosis with an incidental aberrant right subclavian artery.
Congratulations to Manal Gebril, who was the first to make the diagnosis and to Gaborini, who described the aberrant right subclavian artery.
Teaching point: remember satisfaction of search. Some of you missed the occupation of Raider´s triangle and nobody mentioned the convex A-P window.
17 thoughts on “Cáceres’ Corner Case 213 – SOLVED”
Bilateral hilar lymphadenopathy. No lung infiltrations are shown. No fibrosis.
demonstrates stage 1 sarcoidosis
Prominent hilar shadows more on the right side and on lateral view showing lobulated outline ? Hilar lymphadenopathy
CT chest is advisable to rule out other possibility of vascular pathology
Can you rule out vascular pathology with the present images?
Hilar enlargement, right side more evident, in AP and LL
Right paratracheal enlargement
Prominent bilateral hilum that in the lateral x-ray apperance to be adenopathies that modify the trajectory of the trachea .
Medial displacement of gastric bubble.
I think that sarcoidosis is a good option.
Bilateral prominent hilum with diffuse increased vascular markings.
There is opacity at the right cardiophrenic angle could represent partial atelectasis.
Bilateral lymphadenopathy…sarcoidosis stage II.
Thickened rt paratracheal stripe…LNs
opacity in the region of right hilum and infrahilar region, hilar vessels seen through it . Right descending pulmonary artery is also seen separately ,maybe little faint.
on lateral 2 lobulated opacities seen anterior to trachea ,nothing seen posterior or inferior to trachea. Opacities have convex and angulated margins , with few areas of spiculations.
I suspect that there is a lung mass with lymph nodes in right hilum .
Don´t agree with your comment about “nothing seen posterior to trachea”. Look again
we had so many nice lectures in ecr online 2019 and 2018 ,which I used to watch and now they are no longer available and replaced by ecr connect which has only limited content. Is there a way those lectures could still be available for viewing .
I understand your concern. I do not have any executive responsibility in ECR but I will transmit your plea to people in charge.
aberrant right subclavian artery crossing behind the trachea
LEFT PARATRACHEAL STRIPE IS PROMINENT – SOFT TISSUE SHADOW ABOVE AORTIC KNOB – ABERRANT RIGHT SUBCLAVIAN ARTERY (LATERAL VIEW ANTERIOR DISPLACEMENT OF TRACHEA)
BILATERAL HILA PROMINENT