Caceres’ Corner Case 97 (Update: Solution)

ESR_2012_Blog-CaceresCorner-590-CASE597

 

Dear Friends,

Muppet wants to start the new season with a warm-up case, provided by my good friend and former resident Carles Vilá. Images belong to a 62-year-old woman who has had a dry cough for the last six months. Chest radiograph was normal and a CT was taken.

Diagnosis:

1. Coin
2. Chicken bone
3. Pencil lead
4. None of the above


CT

CT

scout view

scout view

Click here for the answer to case #97

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01
Sep 2014
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DISCUSSION 22 Comments

22 Responses to : Caceres’ Corner Case 97 (Update: Solution)

  1. gus says:

    welcome back professor
    my answer ia :a coin

  2. Mila says:

    This is not a coin or pencil lead, as it would be seen in the chaest radiogram. It doesn`t look like chicken bone as well, so answer is 4- none of above. I suggest performing a bronchoscopy:)

    • Jose Caceres says:

      Your suggestion was carried out and bronchoscopy performed. Afraid you have to wait for the answer till Friday!

  3. Essam says:

    welcome back sir
    i think its bronchial wall lesion

  4. Eugenio says:

    It does not produce beam hardening artifact nor does appear clearly in the chest radiograph, so I asume that is calcium density, and not too much of it.

    With that morphology I could be a broncolith. The positions looks good to me too.

    So my answer is 4. Broncolith maybe.

    Welcome back professor!!!

  5. mohammad alshafie says:

    I think it’s a calcified plaque in the bronchial wall,as there are calcified foci on the opposite (ventral) bronchial wall.

  6. Andrei says:

    On the topogram I can’t see any metal intensity projections in that area. So it might be a pencil lead aspirated and stuck into the wall of the right bronchai, so option 2 for me.
    Inwards calcifications of the bronchial wall is rather seldom.

  7. Gyan Mishra says:

    1. History of foreign body aspiration is absent!
    2. Bronchial wall calcification is seen i.e it seems to be a chronic process.Since bronchial wall calcification is seen in both bronchi, a local foreign body reaction may be ruled out since they will be unilateral.
    3. Answer seems to be option 4.
    4. Bronchoscopy will help.

    • Jose Caceres says:

      Although foreign bodies in adults are not frequent, a history of previous aspiration is not always elicited.

  8. Hanna says:

    It has the same density as patient’s bones (ribs and vertebres). So why not chicken bone? It’s interesting to know bronchoscopy results=)

  9. Eric Strong says:

    4. It’s location and its regular shape with sharp borders all suggest an aspirated foreign object. It’s shape is too regular for a bone; too thick for a conventional coin, which would also show up on X-ray; I also assume pencil lead would show up on X-ray.

    It would obviously help to see the object’s profile on other CT axes, but with the combination of its size, radiodensity on CT, and lack of visibility on plain film, it seems most consistent with a chewable tab of calcium carbonate (if profile was round on coronal view), or potassium chloride (if coronal profile was identical to axial profile). It’s too big to be any other med. Only problem, it seems highly improbable that either would have survived 6 months without being dissolved – unless the symptom duration is a red herring.

    • Jose Caceres says:

      Excellent discussion. Duration of symptoms is correct (according to patient), although I am sure that you have seen a patient with a large breast mass, that states that the mass appeared two weeks earlier.

  10. devjani says:

    #4. No metal in axial or scout. No collapse or other effects of obstruction

  11. Pietro says:

    I think it’s a coin: even if it has not clear hardening artifact in the ct-scan (copper? zinc?), it is leaning down into the bronchus and in the scout-view it has a clear round shape!

  12. Carlos says:

    High-densitiy aspirated foreing body in the right main bronchus without beam hardening and not clearly visible in the CT topogram. I think it could be a medical tablet.

    A MPR would be of help for selecting the right answer 😉

  13. genchi bari italia says:

    ….scusa MITICO…..sono arrivato in ritardo dalle vacanze!!!!Non ti dimentico e sarò in “campo” dalla prossima partita!!!!

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