Caceres’ Corner Case 184 (Update: Solution!)

Dear Friends,

Today we are presenting a pre-op chest radiograph for knee surgery of a 48-year-old woman. What do you see?

Check the image below and leave your thoughts in the comments section. More images will be shown on Wednesday, and the final answer on Friday.

 

Dear Friends, these additional images were taken five years ago after an episode of abdominal pain.

Do they help you?




Click here for the answer

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14
May 2018
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DISCUSSION 34 Comments

34 Responses to : Caceres’ Corner Case 184 (Update: Solution!)

  1. Katarzyna says:

    There is a pulmonary nodule in the left lower lobe with well-defined margins. Maybe an AVM?
    Marked scoliosis of the thoracic spine.

  2. John says:

    Pulmonary AVM

  3. Amel says:

    Thorax PA film
    -increased bronchovascular pattern (vascular: arterial origin)
    -1 nodule in upper right lobe, 2 nodules in the lower right lobe,1 in the left upper lobe, and 1 more at left lower lobe near the left costophrenic angle
    -Thoracic Scoliosis with left convexity

    Otherwise everything looks completely normal to my n00b eyes ^^

  4. Trinity says:

    Multiple -two in RLZ and three in LLZ- well defined lesions with smooth margins are seen in2 BLZ. No calcification or cavitation seen within these lesions. Being in periphery and basal lung fields, multiple pulm modules may represent,
    1. Mets.
    2. Rheumatoid Lung nodules.

  5. Anisha Garg says:

    Multiple well defined lesions with smooth margins are seen in Bilateral LZ with no calcification or cavitation .

    Levoscoliosis
    Aortic calcification is displaced medially. Aortic dissection needs to be ruled out.

    Dd
    Mets
    Rheumatoid nodules
    Neurofibomatosis

  6. Elsa says:

    Multiple bilateral well defined nodules..hamartomas?

  7. Amri says:

    Nothing on skin?

  8. Mohamed shahbour says:

    Multiple well defined nodules at both lungs
    Smooth regular margin for d.d
    Hamartoma
    Mets
    Rh lung nodules

  9. Stef says:

    Maybe multiple fibroadenomas of breast. Pkus escoliosis.

    • Jose Caceres says:

      In my experience, fibroadenomas of the breast are not seen in the chest radiographs unless they are calcified 🙂

  10. BigDee says:

    Bilateral multiple nodules, right border of the heart is not seen, is it a pectus excavatum associated?

    • Jose Caceres says:

      Pectus causes blurring of the right heart border and, sometimes, apparent cardiomegaly. It has no relationship to pulmonary nodules. And in this case I believe the right heart border is visible 🙂

  11. Deresh Natali says:

    I see 4 nodules in basal parts of lungs, with well-defined margins. Scoliosis. Of course, bilateral multiple nodules – “o, metastases” – shablon and first thought. But it can be granulomas. What is the cause of knee surgery?

  12. Sb says:

    Bilateral multiple nodules
    And left side 3 4 5 bifid rib anomalies

  13. genchi bari italia says:

    Neurofibromatosi tipo 1: neurofibromi cutanei e scoliosi.Saluti carissimi PROF.

  14. MK says:

    Well defined bilateral pulmonary nodules (are they slightly cavitated?) in a normal parenchimal.

    Autoinmune process? (Wegener, reumathoid…)

  15. Jose Caceres says:

    Now you have all the information. Let’s summarize the findings:
    Basal nodules discovered accidentally, slow-growing in an asymptomatic woman.
    Think!

  16. Katarzyna says:

    Pulmonary hamartoma fits the best.

  17. Marco S says:

    lymphangioleiomyomatosis
    Sarcoidosis

  18. Katarzyna says:

    What a very interesting case! Thank You Prof. Caceres

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