Today I am showing the PA radiograph of an 82-year-old woman. Preoperatory for cataracts.
What do you think about the right hilum?
1. Calcified TB nodes
4. None of the above
More images will be shown on Wednesday.
Dear friends, showing today PA and lateral radiographs taken two years earlier. Hope they help.
Click here to see the answer
Findings: Initial PA radiograph shows opacities in the right hilum (A, circle), unchanged in comparison with a previous film taken two years earlier (B, circle).
The clue to the diagnosis lies in the density and appearance of the opacities. They are denser than the typical lymph node calcifications, suggesting that they are metallic. In addition, some of them look tubular or branching (C, red arrows). A lateral view taken two years earlier confirms dense lineal and branching opacities in right lung (D, arrows).
The combination of linear and branching metallic opacities suggests that they are either in the bronchi (previous bronchography) or within the pulmonary vessels (embolism after vertebroplasty o treatment of AV malformation). See Diploma # 44.
Lateral view of the lumbar spine shows surgical changes with vertebroplasty of L3 to L5 and leakage of the cement into the epidural veins (E, arrows), better seen in the sagittal CT (F, arrows).
Unenhanced CT confirms multiple cement emboli in the pulmonary arteries (G-J, circles)
Final diagnosis: cement embolization of the lung after vertebroplasty
I must mention Olena and Ayudi who suggested amyloid and broncholithiasis but failed to notice the metallic opacity of the findings.
Teaching point: Consider previous vertebroplasty when you see metallic opacities in the lungs. It is a common complication.