Caceres’ Corner: Case No. 22 (Update: Solution)

Dear Friends,

Muppet strives to give satisfaction (like Jeeves) and presents you with an easy case:

Fifty-one-year-old male smoker with moderate cough, no fever.

Diagnosis:

1. Metastases
2. Carcinoma of the lung
3. Allergic aspergillosis
4. None of the above

51-year-old male smoker, PA chest

51-year-old male smoker, PA chest

51-year-old male smoker, lateral chest

51-year-old male smoker, lateral chest

51-year-old male smoker, coronal CT

51-year-old male smoker, coronal CT

51-year-old male smoker, axial CT

51-year-old male smoker, axial CT

Click here for the answer to case #22

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23
May 2012
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DISCUSSION 27 Comments

27 Responses to : Caceres’ Corner: Case No. 22 (Update: Solution)

  1. Alice says:

    Allergic Aspergillosis

  2. maja says:

    none of above

  3. AHMED EID says:

    Allergic Aspergillosis

  4. GENCHI BARI ITALIA says:

    Se la mia diagnosi è corretta, il caso presentato dall’illustre collega è veramente bello! si tratta di infarcimento mucoide endo-bronchiale di bronchi dilatati come nell’aspergillosi allergica: infatti l’ipodensità parailare sx è tortuosa e si accompagna ad un vaso satellite; non è allora una troboembolia polmonare, mancandone peraltro gli altri segni TC di una trombo-embolia. La risposta è pertanto la 3. nb non vedo la milza ed il colon sx è alto ( trappola di Muppet?).

  5. Kristina says:

    Allergic Aspergillosis

  6. Endobronchial adenoma with bronchocele.

  7. lakshman says:

    allergic bronchopulmonary aspergillosis, Because aspergillus spores are ubiquitous in soil and are commonly found in the sputum of healthy individuals, Aspergillosis causes airway inflammation which can ultimately be complicated by sacs of the airways (bronchiectasis). The disease may cause airway constriction (bronchospasm). we can see in X-ray and CT above.
    Please if it wrong correct me sir. Thank You

  8. Albert says:

    Central bronchiectasies with dense mucoid impactions (sometimes can even calcify).
    Findings clasically related to ABPA (allergic bronchopulmonary aspergillosis).

  9. san says:

    Carcinoma lung

  10. lakshman says:

    allergic bronchopulmonary aspergillosis.Aspergillus spores are commonly found in the sputum of healthy individuals.Aspergillosis causes airway inflammation which can ultimately be complicated by sacs of the airways (bronchiectasis). The disease may cause airway constriction (bronchospasm).
    Thank you

  11. vinay says:

    ABPA

  12. Albert says:

    I have to correct my initial diagnostic: you can see two pulmonary nodules and multiple hepatic solid nodules. Also exophitic mass in the gallbladder.

    Maybe metastasic hepatopulmonary disease with endobronchial mets?

    The mass in the gallbladder could also be a metastasis.

    If my hypothesis are true, the endobronchial and gallbladder mets are unusual and one possible primary tumor is melanoma.

    Sorry for the first failed attemp, too fast.

  13. Vilma says:

    I agree with Albert, it could be melanoma metastases

  14. Nafisa Shakir Batta says:

    Apspergillosis
    The gloved finger sign of mucous impaction

  15. Marius says:

    Central neoplasm of lingula with hepatic hypervascular metastasis in segment V (that should sugest the possibility of carcinoid). The left Nelson bronchia is also filled (carcinoid can be multicentric). There also seems to be a metastasis on the gallbladder (coronal section is oblique to catch all lesions)- lung and melanoma have the most freq mts here. No apparent ADP in mediastinum.

  16. ravi heer says:

    ABPA

  17. Allan francisco says:

    allergic bronchopulmonary aspergillosis (ABPA)

  18. rajat mohanty says:

    allergic bronchopulmonary aspergillosis

  19. Laura says:

    lung carcinoma

  20. Alice says:

    The hyperdense material in the gallbladder is most likely sludge, and the liver lesion is hyperdense in a portalvenous phase – therefore it is most likely benign (hemangioma in a discrete fatty liver?).
    I could be terribly wrong, though 😉 – looking forward to the solution!

  21. JESUS ORTIZ MD RADIOLOGIST says:

    I am pretty sure it is a case of Allergic Bronchopulmonary Aspergillosis. In my hospital I´ve seen similar cases… Am I correct?

  22. GENCHI BARI ITALIA says:

    Se il ” suggerimento” dell’illustre collega è stato ben interpretato, allora per spiegare un solo impatto endobronchiale mucoide dovremmo pensare ad un a atresia bronchiale, con broncocele impattato.ma la milza dov’è ? c’è polisplenia? Un altro piccolo aiuto illustre collega!!!!

  23. Htwe says:

    Allergic Aspergillosis

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