Caceres’ Corner Case 144 (Update: Solution)

esr_2016_blog-cacerescorner-144

Dear Friends,

Today we are showing another pre-op case, including a PA chest radiograph of a 62-year-old man with lumbar hernia. Check the image below, give us your thoughts in the comments, and come back on Friday for the answer.

Diagnosis:

1. TB
2. Carcinoma
3. Pulmonary hypertension
4. None of the above


pa-chest

Click here for the answer to case #144

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03
Oct 2016
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DISCUSSION 16 Comments

16 Responses to : Caceres’ Corner Case 144 (Update: Solution)

  1. Mauro says:

    Hello.
    I see enlargement of the pulmonary trunk and the left pulmonary artery, with some calcifications. Maybe an aneurism secondary to pulmonic stenotic valvar disease?

  2. UFTM radiogroup says:

    Dear professor, we see a dense and apparent enlarged left hilum, which may correspond a hilar mass or lymphadenopathy. Lateral view could help.
    2. carcinoma.

  3. Borsuk says:

    Hello,
    I think enlargement of left hilum is vascular etiology. Pulmonary hipertension is in my opinion resonable option – only I dont know why finding is only on left side.

  4. MK says:

    I think that he has a dilatation of the main and left pulmonary artery, and I supose that the patient is asymptomatic, so Congenital Pulmonary valve stenosis would be a good diagnosis.

  5. 19Medicus83 says:

    I am also of the opinon that the dense left hilum is of vascular etiology with a dilated pulmonary trunk in an otherwise normal cardiac silhouette. For chronic pulmonary hypertension you would expect a widened right hilum, too.
    A rare and in an asymptomatic patient rather unlikely diagnosis would be a intimal sarcoma of the left pulmonary artery and pulmonary trunk.

    • Jose Caceres says:

      I like your diagnosis of sarcoma. Is very imaginative. But, as you say, highly unlikely.
      In most of my cases, what you see is what you get 😉

  6. UFTM radiogroup says:

    We see also an enlargement of the aortopulmonar window, which may correspond lymphadenopathy secondary a hilar mass, which produces a dense hilum.

  7. Abu rahmeh zuhair says:

    Lt main pilmonary artery aneurysm

  8. Yvette says:

    Hello, Dear Professor.
    On the PA view there is enlagement of pulmonary trunk and left pulmonary artery. I think it is due to pulmonary valve stenosis, it is usually asymptomatic when it doesn’t coexist with VSD. And asymmetry in pulmonary artery is due to jet stream effect. Peripheral pulmonary vasculature is usually normal – as in this case.

  9. Mahmoud says:

    There is dilatation of main pulmonary artery and left pulmonary artery
    The right pulmonary artery is normal in calibre and heart is not enlarged.
    No peripheral oligemia
    Findings are suggestive of pulmonary valve stenosis. Echo is recommended for further evaluation.

  10. amir says:

    There is an opacity anterior to aortic or pulmonary trunk in anterior mediastinal

  11. genchi bari italia says:

    ….pregiatissimo professore….la lezione su questo caso è inerente ad un “segno” radiologico definito come “segno ilare” che serve alla DD tra pertinenza polmonare di una massa, una massa mediastinica ed infine una “massa”di natura “vascolare” della opacita°….in questo caso i vasi polmonari “convergono” verso l’opacità: non vengono oscurati nè dislocati…..INOLTRE il cono di efflusso del tronco della polmonare è dilATATO….i campi polmonari superiori sono più perfusi…..stenosi dell’arteria polmonare distalmente ai vasi per il lobo superiore….sempre da Bari con stima….

  12. genchi bari italia says:

    …professore, grandissima Spagna nel 1° tempo, ma nessuno goal….goal solo su papera di Buffon nel 2° tempo…..poi la Spagna è sparita…..calo fisico e fari “spenti” di Iniesta che non ha più orchestrato a centrocampo….pari giusto…..ma la Spagna non può fare solo possesso estenuante di palla senza concretizzare con tiri in porta…inoltre il “taka-Tika” è dispendioso fisicamente ed alla lunga stanca, sopratutto gli “anziani”(vedi Iniesta), ….occorre anche giocare con palle lunghe ed attaccanti bravi di testa per far salire la squadra….se il ritorno è a Barcellona ci vedremo….

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