Caceres’ Corner Case 148 (Update: Solution)

esr_2016_blog-cacerescorner-148

Dear Friends,

Today we are presenting a pre-op chest radiograph of a 70-year-old man with carcinoma of the bladder.
What do you see?

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


pa-chest

Click here for the answer to case #148






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21
Nov 2016
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DISCUSSION 21 Comments

21 Responses to : Caceres’ Corner Case 148 (Update: Solution)

  1. MK says:

    There is a loss of volume of the left hemithorax.
    I see a cavitate lesion in the LLL and an increased diffuse density in this hemithorax, with an obliterated costophrenic sinus. Also, there is a left pleural thickening and a partially calcified left diaphragm.

    I think that there is a flattened of both hemidiaphragm.

    Granulomatous or occupational dissease would be a good option.

    Any interesting personal medical history?

  2. Rv says:

    Cavitating masses in left lower lobe with minimal left pleural effusion. Prominent vascular markings in left upper lobe and peri hilar region with .? Bulla in left lower lobe

  3. MK says:

    Asbestosis?

  4. Masi says:

    Same like MK and calcarea pleurae because of status post Tbc pleuritis.

  5. Genchi Bari Italia says:

    ….professore stimatissimo……l’anamnesi lavorativa potrebbe essere la chiave interpretativa tra le lesioni “pleuriche” nell’emitoace S ed il cancro della vescica….il cancro vescicale è’ secondo per incidenza tra i tumori professionali dopo quelli per esposizione ad. Amianto…..l’esposizione ad amine aromatiche, prodotti in vari tipi occupazionali, può avere determinato gli esiti pleurici ed il successivo cancro della vescica….il Bari ha finalmente vinto una partita….per il Barca senza Messi è’ dura…..per ora il Real è’ in testa….

  6. MK says:

    I am doubting about cavitary lesion va pleural plaques that are more typical in abestosis

  7. sht says:

    cavity left mid zone.
    pleural thickening + suspected effusion left CP angle and base.
    foci of pleural calcification including above dome of diaphragm.
    cannot exclude rib lesion.
    any history of asbestos exposure, please?

  8. MK says:

    Perhaps, hystory of “talcodesis”?

  9. Mahmoud says:

    Thick calcified left pleual plaque + cavitary lesion in in left lung with left pleural thickening at left costriohrenic angle + no history of asbestos exposure—–raise possibility of TB.

  10. Nacer says:

    Sequellar lesions of left pulmonary and pleural tuberculosis

  11. ZHW says:

    bladder cancer with calcified pleural mets on the left (chondrosarcomatous component). Rare but recognized.

    I googled bladder cancer and calcified pleura!

  12. sht says:

    Just the chest x ray – 1st ddx would be granulomatous dis like TB.
    Trying to correlate with bladder ca – the only thing i can think of schistosomiasis

  13. ZHW says:

    one other possible link – bladder cancer treated with BCG gets TB from the cancer treatment due to being immunocompromised and then has pleural calcification secondary to the TB.

  14. ZHW says:

    Sorry what is the KISS method?

    • Jose Caceres says:

      KISS is an acronym for “Keep it simple, stupid”. It emphasizes that simple explanations are better to interpret the findings than convoluted ones. It is similar to “Occam’s razor”: when there are two explanations for an occurrence, the simple one is the best.

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