Cáceres’ Corner Case 197 – SOLVED!

Dear Friends;

Today I am showing a preoperative PA chest radiograph for knee surgery in a 50-year-old woman. More images will be shown on Wednesday.

What do you see?

Click here to see the images published on Monday


Dear Friends,

showing today axial CTs and a cone down view of lesion. Hope they clarify your thoughts.

Click here to see the new images

Click here to see the see the answer

Findings: PA chest radiograph shows a well-defined opacity in the apex of the right lung. There is pleural thickening in the periphery of the opacity (A, arrow) that suggests an extrapulmonary location. There is a chain-like line in the periphery, better seen in the cone down view (A-B, red arrows), which looks like metallic surgical sutures. In addition, an irregular mass is visible in the right upper mediastinum (A-B, yellow arrows).


Discovering metallic sutures raises the possibility of post-surgical changes. It was found that the patient had been treated five years earlier with bullectomy and talc pleurodesis for persistent pneumothorax (C-D, arrows).

Enhanced axial CT at the present time shows a cystic pleural collection surrounded by talc (E, arrow). A caudal paramediastinal clump of talc (F, arrow) explains the right mediastinal mass seen in the plain film.

Final diagnosis: post-operative changes after bullectomy and talc pleurodesis for persistent pneumothorax.
 
Congratulations to Ner, who gave an excellent discussion and discovered the metallic sutures in the plain film.
 
Teaching point: Remember to look carefully at the radiographs. A simple finding, such as discovering metallic sutures, may lead to the correct diagnosis before CT.

Dr. Pepe’s Diploma Casebook: The art of interpretation: CASE 134 – SOLVED

Dear Friends,

I would like to start 2019 with a new section, called “The art of interpretation”.

Interpreting the chest radiograph is becoming a lost art and I would like to help you improve your skills in this area. With this in mind, I plan to show radiographs with interesting findings and analyze the steps that will lead to a correct evaluation of these findings.

That said, here is the first case: the chest radiographs of a 50-year-old man with liver cirrhosis and bloody vomiting.

What do you see and what would your diagnosis be?

Check the images and come back on Friday to see the answer!

Continue reading “Dr. Pepe’s Diploma Casebook: The art of interpretation: CASE 134 – SOLVED”

Cáceres’ Corner Case 196 – SOLUTIONS


Dear Friends,

Welcome to 2019! I will start the year with preoperative chest radiographs for meningioma in a 78-year-old woman.
More images will be shown on Wednesday.

What do you see?

Click here to see the images showed on Monday

Dear Friends,

Presenting CT images of the chest. Do they help?

Click here to see more images

Click here to see the solution

Findings: PA radiograph shows a bilobed lesion in the LLL (A, arrow) with ill-defined margins, which makes it intrapulmonary. It is rounded in the lateral view, with ill-defined inferior border (B, arrow).

Enhanced axial CT shows a pulmonary mass with little enhancement (C, arrow). Coronal and sagittal views show distal pulmonary impactions (D-E, arrows), suggesting an intrabronchial location.

Bronchoscopy confirmed an intrabronchial mass in the L10 segmental bronchus. Biopsy returned as atypical carcinoid.
 
Final diagnosis: atypical carcinoid with distal bronchial impaction
 
Congratulations to Ner, who made a good interpretation of the plain film and CT. And saw a finding that I overlooked: increased posterior lucency in the lateral view. I reviewed the original CT and the lucency was not evident, although an expiratory CT was not done.
 
Teaching point: this case complements nicely my recent webinar on endobronchial lesions. Remember that bronchial mucous impaction is an important sign to suspect malignant endobronchial tumors.

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”