Caceres’ Corner Case 187 (Update: Solution!)

Dear Friends,

Today I am presenting the last case of the season. These images belong to a 47-year-old woman with a chronic cough and mild fever. The pulmonary infiltrate has not changed significantly in the last six months.

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

Diagnosis:
1. Adenocarcinoma
2. TB
3. Fungal infection
4. Any of the above

 

Click here for the answer

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25
Jun 2018
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DISCUSSION 20 Comments

20 Responses to : Caceres’ Corner Case 187 (Update: Solution!)

  1. MK says:

    Good morning!!

    Alveolar consolidation at lingula with air bronchogram. Also in the lateral view there is an increased density in the LLL.
    Abdominal surgical staples.

    In CT there is a left paramediastinal solid hyperdense mass with bronchogram and peripheral tree in bud and nodules.

    We have to rule out malignancy but perhaphs it could be superinfected.

  2. Coffee says:

    There is patchy opacity at LUL zone and LLL zone. Surgical clips are also noted.
    On CT, there is focal consolidation, surrounding with GGO, centrilobular nodules, possibly with TIB pattern, and some small nodules in left lung, some mediastinal nodes, also suspected some GGO in right lung
    Differential diagnosis are chronic infection, and malignancy

  3. Billy R says:

    Hello! The chest xray shows alveolar infiltrations in the left upper and lower lung field. On ct there is consolidation with air-bronchogram and many surrounding nodules, which could be suggesting a granulomatous disease. There may also be some left hilar lymph nodes with calcification. Given that the findings did not change in the last 6 months, the malignancy may be less likely. So this could be tubeculosis or a fungal infection, especially if there is immunosuppresion?

    Wish you a nice summer vacation!

    • Jose Caceres says:

      Have to disagree with you about the lack of change. Adenocarcinomas may be very indolent. In this particular case, the leafless tree appearance of the bronchogram is a strong indication of malignancy and trumps all the other findings.

  4. Amjad Ramzanali says:

    Invasive Mucinous Adenocarcinoma

  5. Sb says:

    İt could be post primer tbc
    There is no obvious adenophaty at pa and lateral view
    Nodal engalarhment can’t seen 2/3 of postprimer tbc
    BAL Must be done rule olur for malignancy

  6. Angel says:

    Answer: any of the above.
    Air bronchogram sign 🙂

  7. Sonetavanh says:

    There is a consolidation in the left upper lung. Ddx: TB

  8. Trinity says:

    Good afternoon sir. Cxr pa view shows increased left perihilar non homogenous opacity with air bronchogram within. No cavitation or calcification seen.aortic knuckle silhouette also not lost. Patchy opacity seen along left paracardiac border with no loss of silhouette suggestive of posterior basal segment involvement seen

    • Trinity says:

      On ct scan there is well defined perihilar opacity abutting the mediastinum with consolidation of apical segment of LLL and associated opacities with halo sign , suggestive of :
      1. Fungal angioinvasive aspergilloma .
      2.central bronchoalveolar carcinoma with lung consolidation.

  9. Trinity says:

    On ct scan there is well defined perihilar opacity abutting the mediastinum with consolidation of apical segment of LLL and associated opacities with halo sign , suggestive of :
    1. Fungal angioinvasive aspergilloma .
    2.central bronchoalveolar carcinoma with lung consolidation.

  10. Rageh says:

    radiograph show left upper zone consolidation
    CT show non-segmental consolidation with GGO suggestive of associated haemorrhage, infiltration of the mediastinal fat and left pulmonary veins

    multiple nodules alonge the left oblique feutrues

    features strongly suggestive of Adenocarcinoma

  11. Jose Caceres says:

    I believe you all can refine your diagnosis by looking at Diploma case 62 🙂

  12. FranciscoST says:

    Adenocarcinoma. Lepid growth pattern. Un abrazo

  13. Dijana Bojić says:

    I believe this is fungal infection.

  14. bujar says:

    On CT scan, according to thin stretched bronchi within LUL consolidation, suggest lung malignancy.

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