Dr. Pepe’s Diploma Casebook 149 – All you need to know to interpret a chest radiograph – Third Session – SOLVED

Dear Friends,

I am showing today the leading image of the third webinar. If you haven’t seen them, you can see the first one here and the second one here:

Chest radiograph belongs to a 24-year-old man with occasional episodes of fainting, currently asymptomatic.

What do you see?

Come back on Friday and enjoy the recording of the third webinar with the answer to this case and more information!

Click here to see the answer

Findings: PA chest radiograph shows convexity of the right outline of the middle mediastinum (A, arrow), suggesting dilatation of the ascending aorta. Some of you have mentioned aortic coarctation, which is not a good option because rib notching is not visible, and the aortic knob is unremarkable.
Given the patient´s age, a good possibility is congenital aortic stenosis.

Enhanced sagittal CT reconstruction shows dilatation of the ascending aorta (B, asterisk) and heavy calcification of the aortic valve (B, arrow). Axial CT demonstrated a malformed and calcified aortic valve (C, circle).

Final diagnosis: congenital aortic valve stenosis with post-stenotic dilatation

Congratulations to Renga, who was the first to mention the ascending aorta dilatation.
 
Teaching point: the middle third of the mediastinum is occupied by the aorta and pulmonary artery. Any mediastinal abnormality in this area should be suspected to have a vascular origin.

You can see on our youtube channel the webinar Prof. Cáceres has prepared discussing this case and others.

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

Dear Friends,

Today I am presenting the leading case of the second webinar. The PA radiograph belongs to a 62-year-old man with hemoptysis.

Is the radiograph abnormal?
If so, what do you see?

Starting this week, I have decided to stop giving live webinars. They will be recorded and published at the end of the week, together with the answer to the case. You can see the first session here

Click here to see the answer

Findings: PA chest radiograph shows convexity of the aorto-pulmonary window (A, arrow) and an opacity in the upper left hilum (A, red arrow). The findings were not present in a film taken three years earlier (B, circle) and suggest a pulmonary process with mediastinal adenopathy.

Findings were overlooked and the chest was read as normal. Six months later the patient returned with acute right chest pain. PA chest shows two triangular pleural-based opacities (C, arrows) suggestive of Hampton’s humps. The convexity at the APW is larger (C, green arrow) and the hilar opacity has increased in size (C, red arrow).

Coronal CT shows the typical appearance of pulmonary infarcts at the right lung base (D, arrows). There is large adenopathy at the APW (D, green arrow) accompanied by a lung mass (D, red arrow).

Final diagnosis: carcinoma of the lung with mediastinal metastases and associated pulmonary infarcts.
 
Congratulations to S, who made a brilliant diagnosis.
 
Teaching point: Remember the importance of checklists. If a checklist had been used in the initial radiography, a CT would had been taken and the tumor would had been discovered earlier

If you would like to learn more about this subject, check the webinar Prof. Cáceres recorded explaining this cases and others! You can also check the first webinar here.

Dr. Pepe’s Diploma Casebook – All you need to know to interpret a chest radiograph – First Session – CASE 147 – SOLVED

There are some things which cannot be learned quickly, and time, which is all we have, must be paid heavily for their acquiring. They are the simplest things; and, because it takes a man’s life to know them, the little new that each man gets from life is very costly and the only heritage he has to leave

Dear friends, this quote from Ernest Hemingway serves as introduction to the next series of webinars. From October to March I intend to give a webinar every two weeks describing my basic approach to interpreting the chest radiograph. The subject is ample, and will continue with a second series in 2021.

To start, I am showing a preoperative PA chest radiograph for varices in a 60-year-old woman. The chest was read as normal, but there is an abnormality, difficult to detect.
Do you see it?

The answer was given during a webinar. You can watch the webinar here

Click here to see the answer

Findings: PA radiograph shows a small nodule overlapping the left cardiac border (A-B, arrows). The nodule was overlooked, and the chest was read as normal.

A chest radiograph taken four years later shows a marked increase in size of the nodule (C, arrow). Enhanced axial CT shows a non-enhancing low-density nodule (-30 H.U.)
(D, arrow). Needle biopsy confirmed the diagnosis of hamartoma.

Final diagnosis: Pulmonary hamartoma, overlooked in the initial film
 
Congratulations to Uve, who discovered the nodule with a little help.
 
Teaching point: Remember that overlooking visible findings accounts for 50% of our errors. Using checklists is an excellent way to change an error into a discovery.

Dr. Pepe Case 139 – Webinar

Dear Friends,

Presenting PA chest radiograph of a 57-year-old woman with dyspnea and  fever.

What would be your diagnosis?
1. Lobar collapse
2. Pneumonia
3. Unilateral pulmonary edema
4. Any of the above

You have one week to post your answers. The correct answer will be given during the webinar of Wednesday 3 at 12:30 P.M.
You can join the webinar here

Click here to see the image

New Webinar Prof. Cáceres! Tuesday 18 December – SOLVED

Dear Friends,

Today I am presenting chest radiographs of a 66-year-old man with cough and low-grade fever.
What would be your diagnosis?

1. Pleural effusion
2. Lobar collapse
3. Pneumonia
4. Any of the above

You have one week to post your answers. The correct answer will be given during the webinar of Tuesday 18 at 12:30 P.M.
You can join the webinar here

Continue reading “New Webinar Prof. Cáceres! Tuesday 18 December – SOLVED”

Dr. Pepe’s dedicated picture

Dear Friends,

It has been one week since we published the webinar and we would like to send you the pictures we promised. However, we made a big mistake: we didn’t provide for your adding your name and e-mail address to the answers, so I can’t know who’s right and who isn’t.

Since this is our fault, I will honor my word: once you have seen the webinar, you decide if you got three or more correct answers. If so, write a comment on this entry with your name and e-mail address and a dedicated picture of Dr. Pepe will be mailed to you.

Sorry about the inconvenience. I trust your honesty. Scout’s honor.