Dr. Pepe’s Diploma Casebook 153 – All you need to know to interpret a chest radiograph – Seventh Session

Dear Friends,

Today I am presenting the leading images of the seventh webinar. They belong to a 66-year-old man with vague chest complaints. Chest was read as normal, but there is a visible abnormality, difficult to see.
Can you see it?

Remember, you can see the previous sessions of the webinar in our youtube channel. We will published the answer to this question (and the webinar) on Friday.

Click here to see the answer

Findings: PA radiograph (A) is unremarkable. In the lateral view there is a nodule projected over the mid-thoracic spine (B, arrow). The nodule was overlooked, and the examination was read as normal.

One year later the nodule has increased in size (C, arrow) and has become visible behind the heart in the PA view (D, arrow). It was diagnosed as adenocarcinoma and liver metastases were found.

Two years later, CT and PET-CT show marked progression of the liver metastases.

Final diagnosis: lung adenocarcinoma missed in the first chest radiographs, with widespread metastases two years later
 
Congratulations to Spat, who discovered the initial nodule.
 
Teaching point: remember to look at the dorsal spine in the lateral view. By doing so, you may discover early disease, with great benefit for the patient.

7 thoughts on “Dr. Pepe’s Diploma Casebook 153 – All you need to know to interpret a chest radiograph – Seventh Session

  1. There’s enlargement of both superior paratracheal bands in PA view, due to anterior-middle mediastinum lesion in lateral view.

  2. Aortic elongation on PA and lateral view.
    On lateral view: increased wedge-shaped density anterior and posterior to the trachea: vascular abnormality?

  3. Good Morning Professor

    1. Prominent pericardial fat – radioopaque density over the anterior cardiophrenic angle in lateral view.
    2. Lucency noted below the bilateral hemidiaphragm on PA view.

  4. Oval big soft lesion in posterior mediastinum, paravertebral on lateral image ddg primary tumor. Widened uper mediastinum with thick traheal stripe pbb lymphadenopaty

  5. The anterior cortex of the manubrium sterni is barely discernible. A lytic lesion maybe?
    Also the serrati anteriores seem somehow hypertrophic on both sides.

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