Cáceres’ Corner Case 220 – SOLVED

Dear Friends,

I am showing today a case seen last week. Radiographs belong to a 35-year-old man with fever. 

What do you see?

The answer will be published on Friday.

Click here to see the answer

Findings: PA chest radiograph shows widening of the superior mediastinum (A, arrows). There is moderate prominence of both hila (A, red arrows) and two rounded opacities in the inferior aspect of the right hilum (A, yellow arrows). The lateral view shows convex bumps in the left hilum (B, red arrows).
Findings in both views are practically pathognomonic of mediastinal and hilar lymphadenopathies.

Changes in the PA radiograph are more evident when comparing with a previous film taken two years earlier.

In this case, lymphoma is the best possibility. For the sake of the patient I hoped it was infectious mononucleosis. Analysis discovered immature cells in the bloodstream. Further workup confirmed the diagnosis of acute lymphoblastic leukemia.
Final diagnosis: acute lymphoblastic leukemia with enlarged hilar and mediastinal lymph nodes.
Many of you discovered the enlarged lymph nodes, which makes me very proud.
Kudos for Amal Mahran, who was the first to give a detailed description.
Teaching point: I believe this case emphasizes the importance of comparing with previous studies. If I had shown the previous PA chest, I am sure the percentage of correct answers would had been close to one hundred percent.

14 thoughts on “Cáceres’ Corner Case 220 – SOLVED

  1. Hello. I think the right heart border is ill defined in the PA view and there seems to be a wedge shaped opacity anteriorly in the lateral view, suggestive of middle lobe consolidation.

  2. Partially defined opacity noted at the right lower lung zone not silhautting the right heart border and seen posterior to the heart in lateral view indicate right lower lobe location
    Left hilar enlarged lymph node

  3. Enlarged bilateral hila with increased vascular markings.
    Increased opacity in the retrosternal space- lateral view.

  4. RIght paratracheal stripe appears widened
    Both hila appear enlarged
    Opacity noted inferior to right hila, adjacent to the right paraspinal border
    Duoghnut sign on lateral CXR suggests adenopathy

  5. Right para cardiac soft tissue density area seems to be separated from right hilar shadow which could be a mass lesion wi thin right middle lobe or vascular structure CT chest is advisable

  6. Bilateral hilar enlargement (lymphadenopthy? Vascular?)
    Thickening of the right paratracheal line.
    Doubtful consolidation in the right lower lobe.

  7. Good morning Professor

    Opacity of upper and mid zone on right side

    Right hilum increased opacity

    —- provisional diagnosis: pneumonia, with consolidation in middle lobe and hilar adenopathy

    Upper lobe collapse

  8. Thickened rt paratracheal stripe, enlarged bilateral hilum: lymphadenopaty, doughnut sign in lateral view. Right peribroncivascular tickening/mass.

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