Caceres’ Corner: Case No.14 (Update: Solution)

Dear Friends,

Sorry about the delay in posting a new case, but Muppet was invited to the ECR, got drunk every night and did not cooperate at all. By the way, he sends his warmest regards to Marina, a very smart resident.

Our new patient is a 36 year-old lady with lupus, admitted with mild dyspnea.

Diagnosis:

1. Myocardiopathy
2. Pericarditis
3. Hilar adenopathy
4. None of the above

36 year-old woman. PA chest

36 year-old woman. PA chest

36 year-old woman, lateral chest

36 year-old woman, lateral chest

Click here for the answer to case #14

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    09
    Mar 2012
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    DISCUSSION 38 Comments

    38 Responses to : Caceres’ Corner: Case No.14 (Update: Solution)

    1. merle says:

      proeminent pulmonary hilum
      enlarged pulmonary artery (middle left cardiac arch)
      perriferic olighemia
      dyspnea

      => pulmonary hypertension

      • osama alnuaimi says:

        im thinking about pulmonary embolism …there is large right hilum …large pulmonary arch and right pulmonary artery ..Westermark sign, (combination of:

        1.the dilation of the pulmonary arteries proximal to the embolus and
        2.the collapse of the distal vasculature creating the appearance of a sharp cut off ).
        small hump on the right diafragm (may be Hampton’s hump?) ..,,,

    2. Marius says:

      Signs of pulmonary hypertension and RV hypertrophy – large right hillum, pruning, concave left middle arch, ascending of the apex. Left pulmonary hillum is too small by comparison to the right; it could be a large PTE on the left (especially with lupus), but since the dyspnea is mild -Swyer James Mcleod syndrome?

      • Marius says:

        sorry convex

      • Jose Caceres says:

        Look at the lateral film. Do you still believe that the left hilum is small?

        • Marius says:

          i first thought that the enlarged artery on the profile was the right one. But i see now that it might as well be a left pulmonary artery aneurysm, and it also fits better the pulmonary hypertension. Pulmonary hypertension is a serious complication that occurs less frequently in lupus, it seems (after some reading…)

    3. Albert says:

      Pulmonary hypertension (probably related with her collagen vascular disease).

    4. Lola la Piconera says:

      4. None of the above
      Both pulmonary arteries are big as it can be seen at the lateral view.
      A pulmonary hypertension is a good posibility for me.
      It seems to me the vessels of the left upper lobe are smaller than the right ones. Lupus can be associated with antiphospholipid syndrome that is acause of PE. PE can be the cause of the pulmonary hipertension in this patient.

    5. gennares says:

      4. None of the above.
      I agree with Lola: pulmonary hypertension

    6. burak says:

      Hiler adenopathy I think

      • Jose Caceres says:

        With hilar adenopathy, you see the “donut sign” in the lateral view. It is not visible in this patient

    7. burak ozkan says:

      when it will be explained ?

    8. Genchi Bari Italia says:

      Ipersione polmonare da Lupus .
      Ipertensione polmonare associata a Lupus.

    9. Genchi Bari Italia says:

      Ipertensione polmonare associata a Lupus.

    10. maria says:

      none of the above
      maybe aortic aneurysm

    11. FARES says:

      4. None of the above

      I suppose to be Pulmonary Thromboembolism or hypertension

      • FARES says:

        Pulmonary Arterial Hypertension because:

        1- Central pulmonary arterial enlargement

        2- Decreased peripheral lung vascular markings

        3- Right ventricle hypertrophy and dilatation (on lateral radiograph)
        4- History of mild dyspnea
        5- Female patient with SLE

        • Jose Caceres says:

          Excellent. Muppet very happy about the significant amount of correct diagnosis.
          Beware of the next case, though…

    12. Marina says:

      Thank you for a nice complement, Mr.Muppet)

      My husband said that I have a halo over my radioactive head))))

      Looking forward to seeing a new clinical case)

    13. Marcela says:

      I missed the case..I will be waiting for the netx one!!

    14. Maria says:

      Pulmonary hypertension

    15. girish kulkarni says:

      -prominent main and branch pulmonary arteries with perpheral pruning consistent with pulmonary arterial hypertension.

    16. Evgeny says:

      answer is 4
      may be it is pulminary artery aneurysm due to vasculitis? it is a rare condition often associated with Behcet’s disease.

    17. Evgeny says:

      answer is 4
      it seems like pulmonary artery aneurysm which developed as a result of vasculitis

    18. answer is 4
      it seems like pulmonary artery aneurysm which developed as a result of vasculitis

    19. Jolga says:

      answer is 4
      pulmonary artery aneurysm

    20. Adela Montelongo Martín says:

      Pulmonary Hypertension, probably due to Lupus

    21. Maria Claudia Pulido says:

      I agree with the rest of the people in pulmonary hypertension. I didn´t have the opportunity to thank you and Mr Muppet for your kind answer to my reply in the previous case. It was very helpful! thanks a lot!

    22. clergola says:

      must look at this fake chanel bags for more

    23. Laurens says:

      My shunt propositions ended in total failure.
      I was thinking of a new idea: it could be vasculitis,
      for instance Behçet’s disease.

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