Caceres’ Corner Case 89 (Update: Solution)

ESR_2012_Blog-CaceresCorner-590-CASE89

Dear Friends,

Muppet is concerned about the few responses in the last case. He wants to show an easy case to stimulate participation. Showing pre-op radiographs of a 41-year-old woman with rectal prolapse. The opacity in the right lung was not seen in the CT. What do you think?

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


PA chest

PA chest

lateral chest

lateral chest

coronal CT

coronal CT

Click here for the answer to case #89

Be Sociable, Share!
    24
    Mar 2014
    POSTED BY
    POSTED IN
    DISCUSSION 18 Comments

    18 Responses to : Caceres’ Corner Case 89 (Update: Solution)

    1. genchi bari italia says:

      ….la lesione è , per ragioni di semeiotica radiografica, extra-polmonare ed extra-plerica….orginadal margine superiore della 3 costa( assottigliata), ha margini regolari non aggressivi ed opacità omgenea….essa allarga lo spazio tra 2 e 3 costa e si dimostra convessa verso l’esterno…..potrebbe trattarsi di una complicanza di una costotomia.Data la sede superficiale, io avrei fatto per prima cosa una ecografia , per stabilirne la natura solida o liquida….. NB: bene il Barca contro il Real e Messi 3 goals….il Bari è fallito ma si salva in serie B.

      • Jose Caceres says:

        Can you explain why the lesion is visible in the radiograph and not in the CT?

        • genchi bari italia says:

          ….cosmico Professore, hai fatto una domanda ma non mi hai risposto perchè hai fatto una TAC e non una semplice ecografia, come esame iniziale…se la massa fosse “vera”, gli US avrebbero già chiarito le cose, penso…c’è un nesso con la relaxatio diaframmatica? il torace è fatto in ortostasi….la TAC supina….

          • Jose Caceres says:

            TAC was ordered by her doctor. How would you prove the “relaxatio diaframmatica?

            • genchi bari italia says:

              ….Galactico…”pitfaill”diagnostico?…Nella mia prima diagnosi ho parlato di esiti di costotomia della 3 costa, che tu hai confermato,”aggiungendo” resezione parziale dei muscoli….ora nella “stessa” sede si trova una formazione rx-opaca , “vista” con l’Rx e”scomparsa” in TAC(!)…l’esito chirurgico muscolo-cutaneo deve aver lasciato un “vuoto cicatriziale” con fibrosi, il che spiegherebbe l’opacità all’rx( da fibrosi) con mancata visualizzazione alla TAC….và meglio come diagnosi?….

    2. Ibrahim says:

      An extra joint is seen in the anterior part of the right first rib at the point where the bone meets the calcified cartilageneous part.This may simulate a lung mass on PA-CXR but the lung is normal in chest CT.

    3. gus says:

      I say the same thinks with my colleagues. But i think the mass is visible in CT indirectly as a more translucent area in the mass borders with mass effect in thoracic wall.
      i think these mass is chronic (benign)that’s why the hypoplastic rib.

    4. Murzin says:

      Rib hypoplasia probably caused a wider intercostal space that is filled with chest wall soft tissue fold. No volume averaging on ct so no visibility of lesion.
      The other thing about ct: is there a intercostal (2-3) muslce absence?
      Perhaps it is a mild form of Poland Syndrome?

    5. Jose Caceres says:

      The absence of muscle and rib hypoplasia are due to chest surgery in childhood.
      How would you prove your theory?

    6. gus says:

      Intercostal uncomplicated hernia on inspiration and expiretion?

    7. Bibi says:

      1- 3th right ribbon rib
      2-extrathoracic tumor soft tissue not seen well
      3-bronchiectasis
      Diag: NFibromatosis

    8. Stathis Detorakis says:

      Intercostal lung hernia

    Leave a Reply

    Your email address will not be published. Required fields are marked *