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