Caceres’ Corner: Case No.1 (Update: Solution)

Meet Professor Jose Caceres and his Muppet

Meet Professor Jose Caceres and his Muppet

Dear friends, welcome to Caceres’ Corner. The objective of this post is to remember basic principles of chest imaging, with the emphasis on conventional radiography. Interpreting a chest radiograph is becoming a lost art and I would like to slow this tendency by reviewing the current approach to chest x-ray.

Nowadays, the initial question when facing a chest radiograph should be: “is there any abnormality present? And, if so, should we do any additional examination?” (CT in the great majority of cases).

With this approach in mind, let’s start with a sample case:  62 year old male with liver cirrhosis and upper gastrointestinal bleeding. No other symptoms. History of pulmonary tuberculosis 20 years ago.

62 year old male with liver cirrhosis and upper gastrointestinal bleeding (PA view)

62 year old male with liver cirrhosis and upper gastrointestinal bleeding (PA view)

62 year old male with liver cirrhosis and upper gastrointestinal bleeding (lateral view)

62 year old male (lateral view)

The most likely diagnosis would be:

  1. Blood aspiration
  2. Loculated pleural fluid
  3. Carcinoma of the lung
  4. None of the above

I will be back with the solution in 1-2 weeks depending upon the number of answers posted. My muppet and I will be delighted to answer all your questions and comments (muppet will be in charge of the difficult ones).

Muppet guides Prof. Caceres through the options

Muppet guides Prof. Caceres through the options


Click here for the answer to Case #1!
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23
Sep 2011
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DISCUSSION 26 Comments

26 Responses to : Caceres’ Corner: Case No.1 (Update: Solution)

  1. Mohammed Noeman says:

    “Lobulated Pleural Effusion”

  2. Karolina Markiet says:

    Loculated pleural fluid

  3. Claudia Bonnet says:

    Loculated pleural fluid

  4. Fares says:

    Loculated pleural fluid

  5. Adela Montelongo Martín says:

    Carcinoma of the lung

  6. Muthiah says:

    Loculated pleural collection

  7. yasir jamil says:

    aspirated blood

  8. Josep Garcia Bennett says:

    Carcinoma of the lung.
    Sent from my Iphone……

  9. Marianne Hodoul says:

    carcinoma of the lung

  10. OSAMA ALNUAIMI says:

    posterior left loculated pleural fluid ( it is retrocardiac in the PA film )

  11. Carmelo says:

    Loculated pleural fluid!

  12. Antonio Chiaravalloti says:

    None of the above (tuberculous cavern)

  13. Muriel says:

    none of the above

  14. Lola la piconera says:

    Non of the above. Is there a lost of volume of the left lower lobe? Is there some incurvation of the vessels on lateral view?

  15. Jose Caceres says:

    Dear friends, the muppet and I want to thank you all for participating in the blog and answering the queries.
    Remember that knowledge is in the books, but we have to learn to interpret the signs. It is important to scrutinize the films, put all the findings together and, with the help of the clinical information, arrive to the most likely diagnosis.
    In a few days we will post case #2 (muppet selected it. Beware!)

    Jose Caceres

  16. GIUSEPPINA COZZA says:

    None of the above. There is a consolidation in left lower lobe.

  17. Dinesh Singh says:

    Loculated Pleural Effusion

  18. Calin Bolosiu says:

    nice case. an alternative name for that situation (Satisfaction Of Search) would be the SOS syndrome !

  19. Dada says:

    Carcinoma of the lung!

  20. Dr. Saleem says:

    Nice one Professor !!!

  21. salma says:

    I haven’t diagnose but I saw left large membranous shadow beside the cardiac shadow (( without absent of vascular marking ))
    If we said it is cavitory lesion ,what is the nature of contents
    …not pleural fluid
    …not carcinoma
    It looked like pneumomediastinum …..???

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