Caceres’ Corner Case 106 (Update: Solution)


Dear Friends,

The first case of 2015 is intended to wake you up after the holidays. The patient is a 68-year-old man who came to our institution last October with pain in the chest and skin lesions. Is the chest normal?

If not, where is the abnormality? Check the images below, leave your thoughts in the comments section and come back on Friday for the answer.

PA chest

lateral chest

Click here for the answer to case #106

Be Sociable, Share!
    Jan 2015
    DISCUSSION 22 Comments

    22 Responses to : Caceres’ Corner Case 106 (Update: Solution)

    1. murzin says:


      Happy N. Year Professor..
      Here’s what I think:
      In upper pulmonary zones We can see some mild fironodular opacification and the a-p tracheal diameter is quite big inadequately to the sd diameter- maybe the patient has COPD?
      The other thing is, what seems to be enlarged/ swollen costal cartilages of the first ribs.. To make better ddx would be good to know, what type of pain and skin lesions this patient has.
      Plus the degeneration of thoracic spine is quite obvious

    2. gus says:

      Rheumatoid arthritis ?

    3. salwan aljamil says:

      Picture of granuloma. RH A granuloma

    4. Tedi says:

      I would go with pustular psoriasis with hypertrophy and sclerosis of the manubrium.

    5. Ivan says:

      SAPHO syndrome

    6. Sonali says:

      I agree with SAPHO..

    7. PATO says:

      Bronchial involvement in RUL and tracheomalacia in psoriasis disease.
      Alternative diagnosis: right fifth rib may show signs of osteitis , in this case, SAPHO syndrome should be suspected even though it is typical of pediatric patients.

      HNY drs pepes 😉

    8. andrei says:

      This patient is on a cronical steroid treatment, which can explain the thoracic modifications: ginecomasty,bone mass loss with aberrant exostosis of the 1st ribs, posibly modifications in the lumbar spine as well. Psoriasis maybe the cause of steroid treatment.

    9. genchi bari italia says:

      ….la patologia è a carico della parete toracica… osserva iperostosi dell’arco anteriore della 1 costa di dx e di sx, con rarefazione osteitica della 4 costa di dx….stessa disomogeneità strutturale a carico dei corpi vertebrali e dell’arco anteriore della 2 costa sx….l’associazione con acne e pustole, coincide con eventuale SAPHO sindrome, come giustamente suggerito…..

      • Jose Caceres says:

        Better late than never…

        • genchi bari italia says:

          ….sono appena tornato da S.Domingo…..Prospero ano nuevo y prosperidad, magico Professore…..ero in dubbio con la S.di Giano( iper-IGE), che si manifesta con pustole diffuse….all’areooprto di Madrid non ho trovato magliette “blu-grana” x il mio nipotino ed ho optato x quella della Nazionale spagnola….hasta la victoria siempre !!!!

    10. Pal R D says: