Dr. Pepe’s Diploma Casebook 155 – SOLVED!

Dear Friends,

Today I am presenting the leading case of a new webinar entitled: “Sherlock Holmes and the curious finding in the chest radiograph”.

AP radiograph belongs to a newborn with respiratory distress.


1. Diaphragmatic hernia
2. Lung tumor
3. Pneumonia
4. None of the above

What do you see? Come back on Wednesday to see the answer and the webinar!

Click here to see the answer

Findings: at a first glance, the predominant abnormality is a large bump in the left hemidiaphragm (A, arrow), suggestive of localized eventration or hernia. However, there is and additional important finding: both humeri are not visible (A, circles).
This baby was born with a congenital absence of the arms (amelia).

I am showing this case to stress the importance of discovering so-called negative findings. Our training emphasizes the discovery of positive findings and forgets teaching us to detect structures that are absent, as this case proves.
My apologies for tricking you, but I was trying to prove my point. You can get more information about negative findings in today´s webinar.

8 thoughts on “Dr. Pepe’s Diploma Casebook 155 – SOLVED!

  1. Good morning!!

    There is a lesion proyected over the inferior left lobe. I dont know if the hemidiaphgram is elevated or if there is an extrapulmonary lesion that made sillhoutte sign (for example a pleuro-pulmonary blastoma). I hope air bubbles if I think in a diaphragmatic hernia…

  2. left retrocardiac rounded opacity, medial aspect of left hemidiaphram and paraspinal line are obscured…. suspected of posterior mediastinal location…. dx:diaphragmatic hernia
    ddx: lung sequestration, neurogenic tumor

  3. The left hemidiafragm is elevated and the paravertebral left line is interrrupted. It could be a Bochdalek hernia, they are much more common on the left side.

  4. (I don’t know if my previous comment was sent) The left paravertebral line is interrupted and the ipsilateral hemidiafragm is elevated. I think it could be a Bochdalek hernia

  5. None of the above. it might be a tumour close to the vertebra, which is shadowing the diaphragm on the left side.

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