Caceres’ Corner Case 145 (Update: Solution)

esr_2016_blog-cacerescorner-145

Dear Friends,

Today we are presenting a recent case. The PA radiograph was made for routine check up of a 49-year-old male.

Check the image below, leave your thoughts in the comments and come back on Friday for the answer.

Diagnosis:

1. McLeod syndrome
2. Changes post-TB
3. Congenital lung hypoplasia
4. None of the above


pa-chest

Click here for the answer to case #145

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17
Oct 2016
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DISCUSSION 12 Comments

12 Responses to : Caceres’ Corner Case 145 (Update: Solution)

  1. Mahmoud says:

    Answer : Non of the above.
    McLeod syndrome: unlikely as the smaller left lung is not hyperlucent
    Changes post TB: unlikely as there is no fibrotic scary changes
    Congenital lung hypoplasia: unlikely as it is usually opaque

    Possible cause is interrupted left pulmonary artery , CECT is recommended.

  2. MK says:

    There is a lost volume of the left hemithorax, and we can see mediastinal and tracheal shift toward the left affected side. I can´t delineate the left hemidiagphram.

    We can see some tracts, so I thinK that MacLeod syndrome will be a good option (1), but a left pulmonary artery atresia (4) it´s too a nice option.

  3. Mauro says:

    Hello professor.
    Is there the “figure of 3” sign? If there is aortic coarctation, maybe there could be an associated anomaly of the pulmonary vasculature, as mentioned by above.

  4. Yvette says:

    Small volume of left lung (but it is not hyperlucent so it is not Swyer James syndrom) mediastinal shift to the left, I can not see any vascular structures of the left hilum so I would say that it could be LLL colaps or hypoplastic left pulmonary artery. I think lateral approach would bring some additional information.

  5. MK says:

    Ok, perhaps McLeod syndrome is not a good option (too much loss of volume and no hyperlucent).
    There is a loss of left hemithorax volume with mediastinal and tracheal shift toward the left side. Agenesis of the left pulmonary artery with pulmonary hypoplasia is the best option.

    • Jose Caceres says:

      In my opinion, McLeod is always accompanied by air trapping.Therefore, you cannot make the diagnosis without expiratory films.
      I agree with your second opinion

  6. MK says:

    Hyperexpanded compensatory right hemithorax.

  7. Genchi Bari italy says:

    ….pregiatissimo prof. Il polmone sx è’ ipoespanso, con compenso funzionale del controlaterale, con shiit di tutto l mediastino…..non si vede l’arteria polmonare sx e le sue diramazioni, mentre la vascolarizzazione polmonare appare disordinata…..il seno costo frenico è libero e non ci sono calcificazioni adenopatiche e/ o polmonari quali esiti di pregressi eventi flogistici(d’altronde basterebbe questo ad escludere una tbc),,,MC leod si esclude perché’ non c’è’ air trappista anzi il polmone sembra opaco….l’ ipotesi di una ipogenesia polmonare da anomalia vascolare sia la più’ probabile…..prima di eseguire una angiotc…….NB il Bari, un disastro !!!!!!

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