José Vilar and Friends Case 4 (Update: Solution!)


Dear friends,

This case goes to basics and it should not be difficult to interpret.
28-year-old. Incidental finding.

What finding is there and what do you think?

Check the images below!


 

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    18
    Feb 2019
    POSTED BY
    DISCUSSION 8 Comments

    8 Responses to : José Vilar and Friends Case 4 (Update: Solution!)

    1. Trinity says:

      Good evening sir,
      Chest X ray PA view shows a well defined oval shaped opacity in the left retrocardiac region.I am not sure about it’s calcification…but it does not show any cavitation or underlying bone erosion.No air fluid level seen within. Rest of the lungs are clear. Cardiac silhouette is normal. Bones and soft tissues also appear normal.
      D/D is 1. SPN
      2. Pulmonary Sequestration
      3. Hamartoma if it’s calcification…
      Regards.

      • Pannonique says:

        Hi!
        I agree with your differential diagnosis, I would like to add a pulmonary arteriovenous malformation, because I think that may exist a vascular dilated structure on top of the nodule that run to the hilium.

        Regards!

    2. Pedro Perpiñán says:

      Calcificaciones superpuestas mediastino, área retrocardiaca y hemidiafragma izquierdo (lineal). Signos de hiperinsuflación pulmonar. Enfermedad por exposición al asbesto.

    3. ELM says:

      There’s a tubular opacity in left lower lobe (retrocardiac). This structure seems to belong to pulmonary vessels. This finding is in a young assymptomatic patient, so I’d expect to find a pulmonary arteriovenous malformation (+/- congenital pulmonary airway malformation, due to the association).

    4. José Vilar says:

      OK, some of you are very good.! Sorry but we did not include the lateral in the first images. Here it comes and I am adding a lung window CT image and expect to see your comments..

    5. Trinity says:

      Good afternoon sir.
      The lateral chest radiograph shows some postero-inferior displacement of the oblique fissure and tubular oval opacity in retrocardiac region.
      CT chest shoes obliteration of the brochure with distal hyperlucent lung,
      Findings are suggestive of Bronchial atresia involving the LLL.
      Regards.

    6. Fingers crossed says:

      Tubular shadow in lll projection. Ct shows mucocele within hypoatenuating lung segment. Bronchial atresia, probabaly subsegmental bronchi of left lower lobe.
      Had a case recently in a 45 year old, also asymptomatic, my seniors disagreed with me. But i stood my ground! 🙂

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