Cáceres’ Corner Case 220 – SOLVED


Dear Friends,

I am showing today a case seen last week. Radiographs belong to a 35-year-old man with fever. 

What do you see?

The answer will be published on Friday.

Click here to see the answer

Findings: PA chest radiograph shows widening of the superior mediastinum (A, arrows). There is moderate prominence of both hila (A, red arrows) and two rounded opacities in the inferior aspect of the right hilum (A, yellow arrows). The lateral view shows convex bumps in the left hilum (B, red arrows).
Findings in both views are practically pathognomonic of mediastinal and hilar lymphadenopathies.

Changes in the PA radiograph are more evident when comparing with a previous film taken two years earlier.

In this case, lymphoma is the best possibility. For the sake of the patient I hoped it was infectious mononucleosis. Analysis discovered immature cells in the bloodstream. Further workup confirmed the diagnosis of acute lymphoblastic leukemia.
 
Final diagnosis: acute lymphoblastic leukemia with enlarged hilar and mediastinal lymph nodes.
 
Many of you discovered the enlarged lymph nodes, which makes me very proud.
Kudos for Amal Mahran, who was the first to give a detailed description.
 
Teaching point: I believe this case emphasizes the importance of comparing with previous studies. If I had shown the previous PA chest, I am sure the percentage of correct answers would had been close to one hundred percent.