Dr. Pepe’s Diploma Casebook: Case 103 – To err is human: how to avoid slipping up (Chapter 2) – SOLVED!

Dear Friends,

Today I am presenting radiographs of a 30-year-old man. They were taken because an abnormal ECG was found in a routine check-up. What do you see?

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

Read more…

Dr. Pepe’s Diploma Casebook: Case 102 – To err is human: how to avoid slipping up (Chapter 1) – SOLVED!

Dear Friends,

Today we’ll start the second part of The Beauty of Basic Knowledge series, titled ‘To err is human: how to avoid slipping up’. In the next six chapters I intend to analyse the most common causes of errors in chest imaging and how to avoid them. As Cicero said: All men can err, but only the ignorant persevere in the error.

This week I am presenting two cases. Case 1 shows the PA radiograph of a 57-year-old man with a cough. Would you say the chest is normal?
1.Yes
2.No
3.Need a lateral view
4.Need a CT

Case 2 presents PA and lateral radiographs of the yearly check-up of a 70-year-old man. CT done in another institution was reported as chronic post-TB changes. Do you agree?

Check the images below, leave your thoughts in the comments section and come back on Friday for the full solution!

Read more…

Dr. Pepe’s Diploma Casebook: Case 101 – A painless approach to interpretation (Chapter 8) – SOLVED!

Dear Friends,

Today I am presenting the last chapter of the Painless Approach to Interpretation. Showing chest radiographs taken during an annual check-up of a 70-year-old man.

What do you see? Check the images below, leave your thoughts in the comments section and come back on Friday for the answer.

Read more…

Dr. Pepe’s Diploma Casebook: Case 100 – A painless approach to interpretation (Chapter 7) – SOLVED!

diploma_casebook_case100

Dear Friends,

Today I present the seventh chapter of the Painless Approach to Interpretation, which also happens to be case number 100 of Dr. Pepe’s Diploma Casebook. It makes me very proud to have shared with you one hundred cases and hope they have been useful.

Showing chest radiographs of a 47-year-old woman with mild fever and chest pain.

What do you see? Check the images below, leave me your thoughts in the comments section and come back on Friday for the answer.

Read more…

Dr. Pepe’s Diploma Casebook: Case 99 – A painless approach to interpretation (Chapter 6) – SOLVED!

diploma_casebook_case99

Dear Friends,

We’re moving on to a new chapter of the Painless Approach to Interpretation, and this week I’m showing the routine control radiographs of a 48-year-old woman, surgically treated for carcinoma of the breast ten years ago.
What do you see?

Check the image below, leave your thoughts in the comments section, and come back for the answer on Friday.

Read more…

Dr. Pepe’s Diploma Casebook: Case 98 – A painless approach to interpretation (Chapter 5) – SOLVED!

diploma_casebook_case98

Dear Friends,

Today we are moving to a new chapter in the Painless Approach to Interpretation, addressing what to do when the chest radiograph does not show an obvious abnormality.

For this purpose I am presenting the PA and lateral radiographs of a 57-year-old man with a chronic cough. What do you see?

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

Read more…

Dr. Pepe’s Diploma Casebook: Case 97 – A painless approach to interpretation (Chapter 4) – SOLVED!

diploma_casebook_case97-bobk

Dear Friends,

Now that we’ve looked at the three key questions to ask when facing a chest radiograph (chapters 1, 2 and 3), we move on to the interpretation of pulmonary lesions.

Today I am showing chest radiographs of a 31-year-old woman with marked dyspnoea for the last three days.

What would you call the predominant pattern?

1. Reticulonodular
2. Septal
3. Air-space disease
4. None of the above

Check the images below, leave your thoughts in the comments and come back on Friday for the answer.

Read more…

Dr. Pepe’s Diploma Casebook: Case 96 – A painless approach to interpretation (Chapter 3) – SOLVED!

diploma_casebook_case96

Dear Friends,

I hope you remember the three questions to ask when facing a chest radiograph:

a) Is there any visible abnormality? (Chapter 1)
b) Is it intra or extrapulmonary? (Chapter 2)
c) What does it look like?

To discuss the third question, I’m showing chest radiographs of a 36-year-old woman with chest pain.

What does the lesion look like?

1. Pericardial fat pad
2. Thymic tumour
3. Pericardial cyst
4. Any of the above

Check the two images below, leave your thoughts in the comments section and come back on Friday for the solution.

Read more…

Dr. Pepe’s Diploma Casebook: Case 95 – A painless approach to interpretation (Chapter 2) – SOLVED!

diploma_casebook_case95

Dear Friends,

As you may remember from Diploma Case 94, when I’m facing a chest radiograph I start by asking three questions:

a) Is there any visible abnormality?
b) It is intra- or extrapulmonary?
c) What does it look like?

Today we will discuss the second question, showing chest radiographs in two different patients. Is the abnormality intra- or extrapulmonary? Check the images below, leave your thoughts in the comments and come back for the answer and discussion on Friday.

Read more…

Dr. Pepe’s Diploma Casebook: Case 94 – A painless approach to interpretation (Chapter 1) – SOLVED!

Diploma_casebook_case94

Dear Friends,

This year I intend to discuss the basic principles of interpreting chest radiographs, under the heading, “The Beauty of Basic Knowledge”.

I plan to structure the discussion into three main parts, which will take us through the whole academic year:

Part 1. A painless approach to interpretation
Part 2. To err is human: how to avoid slipping up
Part 3. The wisdom of Dr. Pepe

This week’s case is the first chapter of my ‘painless approach to interpretation’. Interpreting chest radiographs is not difficult if we follow Confucius’ saying: “ A journey of a thousand miles begins with a single step”. As a clinical radiologist, my first step is to ask myself three questions:

a) Is there any visible abnormality?
b) It is intra or extrapulmonary?
c) What does it look like?

Today I’ll discuss the first question. Below you can see the chest radiographs of three different patients. Do you see any visible abnormality in any of them? Let me know in the comments section and come back on Friday for my answer.

Read more…