Dear Friends,
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!
REMEMBER
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).