Caceres’ Corner: Case No.2 (Update: Solution)

Caceres Corner Case 02 Clinical history: asymptomatic 75 year-old man, operated on ten years ago for carcinoma of the larynx. Current chest radiographs were obtained during the yearly routine control.

Most likely diagnosis:

1. Radiation pneumonitis

2. Tuberculosis

3. Carcinoma of the lung

4. Pulmonary hypertension

Asymptomatic 75 year old man, PA chest

Asymptomatic 75 year old man, PA chest

Asymptomatic 75 year old man, lateral chest

Asymptomatic 75 year old man, lateral chest

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10
Oct 2011
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DISCUSSION 34 Comments

34 Responses to : Caceres’ Corner: Case No.2 (Update: Solution)

  1. Karolina says:

    radiation pneumonitis

  2. Mohammed Noeman says:

    Tuberculosis

  3. Laszlo Toth says:

    Tbc

  4. Livia says:

    Carcinoma of the lung

  5. Luis Rios says:

    I think it looks like post radiation therapy

  6. mememe says:

    pulmonary hypertension

  7. Dragos says:

    Radiation pneumonitis & Carcinoma of the lung.
    On PA chest: opacity- post rib6 right,and between 8-9 left.

  8. girish kulkarni says:

    pulmonary hypertension

  9. Radiation pneumonitis?

  10. girish kulkarni says:

    left sided hyperlucency with peribronchial thickening in the lower lobe. prominent left hilum -?mass/lymph node.

    old fibrotic changes right apex.

  11. nashwan says:

    pulmonary hypertension

  12. sanil says:

    the given case of the gentle man probably indicates a tuberculosis feature based on a dense oval lesion on rt upper lobe and the lateral view indicates signs of pneumonitis and sclerotic changes on base and lower lobe of lungs
    final diagnosis : tuberculosis ,radiation pneumonitis

    • dr vibhu sharma says:

      the case is about a 75 year old man who has been operated 10 years ago for carcinoma larynx. he is asymptomatic and for routine chest xray done

      i think the most appropriate answer is radiation pneumonitis as changes in his lungs are generally confined to the field of irradiation.

      observe that there is a diffuse haze in the irradiated region with obscuring of vascular outlines.Patchy consolidations appear in RUZ and then coalesce to form a relatively sharp edge that conforms to the treatment portals rather than to anatomic boundaries.

      fibrous change in RLZ and overlying left hemidiphragm seen as tenting
      small amount of effusion is seen as there is blunting of anterior CP angles in lat chest view which could be reactionary to the radiation changes in this patient

      active infection is not seen in this case and ca lung doesnt fit in as changes are not there
      no e/o pulmonary hypertension

      i put my money on radiation pneumonitis
      kindly u throw light and inform us abt the right choice and reason it out please

  13. Eduardo Hornia says:

    Radiation pneumonitis

  14. whisper in the wind says:

    I’m stuck in these details: translucent contour of lower left arch of heart, vertical opaque band trough the shadow of heart+mediastinum – left contour better defined (no correspondence in lateral seen by my eyes 🙂 ).
    What I see: thickening of pleura in left costophrenic angle (anterior mostly), ill-defined contour of upper mediastinum+lost of translucency in upper pre-mediastinum compartment – lateral view (=radiation pneumonitis following larynx Ca. treatment??), ovoid opacity in left hilum well defined only on left side (AP view)=belonging to mediastinum, calcified round lesions (middle area of right lung and right hilum) (=scars of TB?), tracheostomy (following larynx Ca.), osteoporosis (vertebrae mostly).
    If seems like a too long comm, I apologize but I need (expect from readers) clear directions for my “radiological” thinking.
    Thanks in advance! AE

    • Jose Caceres says:

      Dear Wisper in the wind, I think you describe very well the findings. All you have to do now is to put two and two together.
      Sorry, I cannot keep on because I do not want to give away the diagnosis.
      Keep up the good work

  15. Dada says:

    Tuberculosis!

  16. aca says:

    yeah,agree with the whisper in the wind…stigmata TBC,but that sharp and continuity contour of the left hemidiaphragm,and paravertebral sharp line maybe suspicious from litlle bit of pneumomediastinum(tracheostomy),or postradiation fibrosis…scolyosis of the vertebra too.
    right heart ventricle dominated,because of COPD…no Neo signs 4 me

    • Jose Caceres says:

      Are you sure?

      • aca says:

        well,translucency on the left was due to colaps of the left upper lobe,but i’m proud of seeing that signs…TBC lymph nodes was detail which made a dilema,and that sign of major incisura,i think it was a pleural athesia 🙂
        anyway,thank you mr. profesor for nice presentation and replying comment

  17. Jose Caceres says:

    Dear friends, i am very pleased with your answers. Some are right and others are not.
    Perhaps is too early to post the final diagnosis. Do not want to spoil the chances of the late comers.
    Anyhow, i would exclude the diagnosis of pulmonary hypertension. Basic findings in PH are prominent hila, enlarged main pulmonary arteries and cut off of peripheral arteries. In the present case only the left hilum is prominent and there is a pulmonary infiltrate. These findings make PH unlikely.
    So, now you have three choices.
    Final diagnosis by the end of the week

  18. Nidhi Gambhir Bhatia says:

    Tuberculosis.
    Pleural calcification, tenting of left dome of diaphragm with fibrotic band in left lower zone, calcific opacity in right middle zone, ?left hilar lymph nodes.

    But in a 70 year old asymptomatic patient, having a left hilar mass..i think he would need a CT to rule out a central tumour.

  19. Madi says:

    Radiation pneumonitis

  20. Anna says:

    Thank you Professor, simultaneously challenging and educative.

  21. Dr. Saleem says:

    A Really Good Case !!!

  22. Adela Montelongo Martín says:

    Radiation pneumonitis + TBC

  23. Amutha says:

    Luftsichal sign and juxtaphrenic peak sign & left hilar mass suggest left upper lobe collapse following lung carcinoma

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