Dr. Pepe’s Diploma Casebook 151 – All you need to know to interpret a chest radiograph – Fifth Session – SOLVED!

Dear Friends,

Showing today the leading case of the next webinar. PA radiograph belongs to an 86-year-old woman with chest pain.
What do you see?

More images will be shown on Wednesday. You can refresh your memory viewing the older webinars on our youtube channel.

Dear Friends, showing today a lateral film of the case. Hope it helps.

Click here to see the lateral film

Click here to see the answer

Findings: PA radiograph shows a faint opacity in the left mid-lung field (A, arrow), better seen in the cone down view (B, arrow). The opacity is ill-defined, and my first impression would be an intrapulmonary lesion.

The lateral view shows that the opacity is located in the posterior chest wall. It has a typical pregnancy sign (C, arrow), indicating an extrapulmonary origin.
Enhanced axial CT confirms a low-density chest wall mass (D, arrow). Note the anterior displacement of the intercostal vessel (D, red arrow).

Final diagnosis: lymphoma of chest wall
 
Congratulations to all of you who diagnosed a chest wall lesion. Special mention to MK, who was the first to give the answer.
 
Teaching point: This case documents the importance of the lateral chest to clarify indeterminate findings in the PA radiograph.

Check the full webinar here

17 thoughts on “Dr. Pepe’s Diploma Casebook 151 – All you need to know to interpret a chest radiograph – Fifth Session – SOLVED!

  1. Frontal chest radiograph showing

    Unfolding of thoracic aorta which is expected in this age group
    Widening of the right para cardiac and right mediastinal border by soft tissue density area which could be a vascular Cause
    No hilar lymphadenopathy
    No pulmonary perenchymal consolidation
    No pleural effusion
    CT chest is advisable for further evaluation

  2. Good morning!!

    Right tracheal displacement because of an elongated aorta and prominent aortic arc.
    There is an increased left hiliar density so we need a CT scan.
    Bibasal laminar tracts.

    1. Imagine that an evil mind has created a virus that destroyed all the CT machines in the world.
      What would you do?

  3. Ufffff, I would like to see the lateral view and if I don´t find a solution I´ll ask to the teacher Dr. Cáceres!!!!

    1. The evil mind was Dr Pepe, trying to convince radiologists to look at the lateral view 🙂

  4. Good evening Professor
    Chest xray PA VIEW:
    1. Prominent aorto-pulmonary window and left and right paratracheal region.
    d/d
    1. Paratracheal lymphadenopathy
    2. Vascular cause – aortic dissection less likely

  5. Enlarged left hilus with descreased vascular markins left lung, bibasilar atlectasis, enlarged heart summary Pulmonal embolism

  6. Good morning professor
    – prominent aortic knuckle due to aortic unfolding
    -left parahilar opacity
    -cardiomegaly

  7. Hello!!!

    Lateral view!!! There is an extrapulmonary lesion.
    The most common pleural tumor is fibrous tumor.
    Perhaphs the patient has had an accident and it´s a haematoma?.
    Has the patient been exposed to amianto to think in mesotelioma?
    Other common pathology are pleural metastases

    1. See? The lateral view can be very useful.
      No previous accident, no asbestos exposure. Answer on Friday

  8. Posterior mediastinal mass. Sharp, obtuse margins. May be a peripheral nerve sheath tumor, which can present with pain. No bone remodeling noted.

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