I am showing today PA chest radiographs in two asymptomatic patients They have subtle findings that can be discovered if you paid attention to the previous webinars.
What do you see?
Prof. Cáceres will take some well-deserved holidays and will come back on January 6th with new cases!
Click here to see the answer
Case 1 findings: PA radiograph shows a well-defined opacity behind the cardiac shadow (A, arrow), better seen in the cone-down view (B, arrow). It has an extrapulmonary appearance and the best option is diaphragmatic hernia.
Coronal and sagittal CT demonstrate herniated abdominal fat through a rent in the posterior diaphragm (C-D, arrows).
Final diagnosis:Bochdaleck hernia
Case 1 has been diagnosed by most of you. Congratulations to Archanareddyt,
who was the first. Hope my recommendations in Webinar 4 were helpful!
In the cardiac area look for:
* Opacities behind the left heart
* Double contour on the right
Case 2 findings: This patient has a faint but visible right infraclavicular nodule (A-B, arrows).
The nodule was overlooked and one year later had grown markedly (D, arrow). At surgery, a melanoma was found.
Final diagnosis: melanoma of the lung, missed in the initial examination
Teaching point: This is a difficult case, but easily diagnosed if you remember my oft-repeated mantra: “Search for pulmonary nodules in the pulmonary apices” (Webinar 1). Nobody saw the nodule and I feel useless (sniff).
15 thoughts on “Cáceres’ Corner Case 217 – SOLVED”
Good afternoon professor
Left focal eventration of the left hemidiaphragm
There is a well defined round lesion at the level of left hemidiaphragm, could be in left lung lower lobe, needs lateral CXR to define it’s location.
Retrocardiac left lesion, with well defined superior borders except the inferior one. Extrapulmonary origin but I miss the lateral view.
Where is the other case??
The second case has been posted. Look at it.
Left basal retrocardiac mass, but hard to say more from AP view.
The abnormality on the first image at least, could be a posteriorly located one, since the anterior portion of the hemidiaphragm is not obscured. Maybe a Bochdalek hernia.
Good afternoon Professor
Second chest xray
There is bowel loop between right hemidiaphragm and liver shadow – chilaiditi
Keep looking 🙂
Good morning professor
First radiograph- irregular opacity in right infrahilar region,
Another opacity with convex border in left lower zone, medial aspect- likely extra parenchymal pathology
Second radiograph-abnormal opacity in aortopulmonary window
Second case: the A-P window looks normal to me. Keep looking.
Is there blunting of right cardiophrenic angle, professor ??
I don’t think so. Keep looking 🙂
…una ernia diaframmatica , a sede anteriore, Morgagni …una altra a sede posteriore , Bokdalek….auguri per le festività’ e grande Barca!
Barca needs Klopp badly!
1. There is a partly well-defined radioopacity at the right cardiac border at cardiophrenic angle – mediastinal lesion to be ruled out – lateral view of xray needed.
2. Tracheal diameter increased – age related.