Cáceres’ Corner Case 223 – SOLVED

Today’s radiographs belong to a 77-year-old man with dyspnea.

Diagnosis:

1.  Allergic aspergillosis
2.  A-V malformations
3.  Chronic changes post-TB
4.  None of the above

What do you see? Come back on Friday to see the answer 🙂

Click here to see the answer

Findings: PA chest radiographs shows elongated opacities apparently arising from the hila (A, arrows). The lack of branching goes against mucous impactions. The clue to the diagnosis lies in the calcified pleural plaque in the right hemidiaphragm (A, red arrow), which is a sign that strongly suggests asbestos exposure.
This diagnosis is corroborated by the lateral view, which shows calcified pleural plaques in the anterior clear space (B, red arrow).

Previous AP and oblique rib radiographs after chest trauma show the undulated calcified plaque in the right hemithorax (C-D, arrows).

Unenhanced coronal CT confirms the plaque in the right hemidiaphragm (E, arrow). Axial CTs demonstrate the anterior plaques (F-G, red arrows), as well as the unaffected lung (F).

Final diagnosis: calcified pleural plaques simulating pulmonary disease.
 
Congratulations to Phi Pham, who was the first to make the correct diagnosis.
 
Teaching point: Remember that superimposed opacities may simulate intrapulmonary pathology.

9 thoughts on “Cáceres’ Corner Case 223 – SOLVED

  1. Pleural calcifications, signs of hilar lymphadenopathy with calcium collections
    finger-like hilifugal shadows
    Prominent Tr. pulmonalis
    Elongation/Kinking of the aorta
    😦 i can not really decide which answer is the right one

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  2. Good morning!!!

    There are bilateral calcified pleural plaques and in the lateral view I think there are hilar adenopathies.
    In the PA view there is a left paravertebral inferior lesion that in the lateral view it seems to be an elongated aorta.

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  3. Good morning Professor.
    Enlarged mediastinal LNS visible in the lateral XR.
    Calcified pleural plaques are seen mimicking parenchymal nodules .
    Significant tortuous descending aorta visible also more clearly in the lateral view .
    4 None of the above.

    Like

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