Cáceres’ Corner Case 214 – SOLVED

Dear Friends,

Presenting today radiographs of an 89-year-old woman with dyspnea and moderate fever.

Diagnosis:

1. Empyema
2. Mediastinal tumor
3. Pneumonia
4. None of the above

What do you see? Come back on Friday to see the answer!

Click here to see the answer

Findings: PA chest radiograph shows an opacity occupying the middle and lower right lung It is located anteriorly in the lateral view and has a well-defined posterior border.
The clue to the diagnosis lies with the bubbles of air within the opacity (A, red arrows) which resemble bowel loops in the lateral view (B, circle). The heart is displaced towards the left, but this finding cannot be evaluated because of the moderate scoliosis. In addition, a hiatus hernia is present (A-B, arrows).

Enhanced axial CT (C-D) demonstrates that the opacity consists mainly of fat containing some bowel loops.

Coronal and sagittal reconstructions show a large gap in the anterior right hemidiaphragm (E-F, circles), with herniation of bowel and abdominal fat into the hemithorax.

Final diagnosis: large Morgagni´s hernia simulating pulmonary disease.
 
Congratulations to xristoby, who was the only one who mentioned anterior diaphragmatic hernia.
 
Teaching point: Remember that any lower lung lesion adjacent to the diaphragm may arise from the abdomen, as demonstrated with the present case.

20 thoughts on “Cáceres’ Corner Case 214 – SOLVED

  1. Features of achalazia

    Opacification of the right hemithorax involving the bus and lower zones giving wedge shape like area on lateral chest view
    Which could be collapse / consolidation

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  2. Good morning!!!

    There is an increased density projected over the medium lobe with aereal opacities. Cardiac is displaced to the left and I can´t see its right border probable because of the hiatal hernia. I suggested pneumonia

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  3. The opacity in right hemitorax has c fluid-air levels . It can be in association with neumonía, pulmonary sequestration, congenital pulmonary airway malformation, anterior diafragmatic hernia

    Like

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