Caceres’ Corner Case 107 (Update: Solution)


Dear Friends,

Today I am showing a recent case seen by my good friend Dr. Josep Mata. Radiographs belong to a 48-year-old man with haemoptysis and history of previous TB. Have a look at the images below, leave your thoughts and diagnosis in the comments section, and come back on Friday for the answer.


1. Infected bulla
2. Reactivation TB
3. Carcinoma in previous cavity
4. None of the above



Click here for the answer to case #107

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    Jan 2015
    DISCUSSION 26 Comments

    26 Responses to : Caceres’ Corner Case 107 (Update: Solution)

    1. murzin says:

      Crucial qustions: Is the pateint febrile? Does he have night sweats? Did he loose any weight?

    2. Eliseo de la Fuente says:

      Reactivación de TB.

    3. Sally says:

      Infected bulla

    4. Sally Emad says:

      It is infected with newly depicted fluid level

    5. delin says:

      Dilated azygos vein, enlarged central pulmonary arteries, the right upper costal and mediastinal pleural thickening. Pulmonary hypertension and fibrosing mediastinitis?

    6. merv says:

      non of above

    7. Nicky says:

      None of the above. Fungal ball in cavity

    8. Nataliya Litvakovskaya says:

      Lobula v. azygos with apical carcinoma (Pancoast?)

    9. Nataliya Litvakovskaya says:

      Apical carcinoma of lobe of v. azygos

    10. gus says:

      I think is not cancer why?
      – The pulmonary nodes on both lungs is stable in a long time (without chemiotherapy).
      – no other change on both images except thickening on the right apical cup.
      – no rib involvement.
      – the thickening is growth in azygos lobe und in oblique fissure too.
      I think is pleural fat in chronic tb

    11. gus says:

      sorry no azygos lobe. is a catheter on june film

    12. asdf says:

      Given onlt chest x-ray I cant exlude anything.
      I’m waiting for CT.

      • Jose Caceres says:

        This is the easy way out. The plain fim findings give you grounds for especulation. Of course, you need CT to confirm your suspicions.

    13. Ash says:

      None of the above

    14. Lola la Piconera says:

      There is pleural thickening in the right apical area and that happened in a year and a half more or less. There is also thickening of an oblicque line probably an azygous lobe fissure.

      Before this I would think about
      1.- Pancoast tumour
      2.- Occult aspergilloma where you only see the pleural reaction

      Between both I would choose tho second one regarding no pain and no significant weight loss is reported. Haemoptysis is a complication of aspergilloma and history of TB is also suggesting.

      Nice to see Dr Mata in white coat.

    15. David Coll says:

      There is an air-crescent sign and its suggestive of aspergylloma in chronic cavity TB.

    16. tayyiba says:

      Reactivation T.B

    17. Serife says:

      It can be infected bulla

    18. Ruben N says:

      There is an azygos lobe with cisuritis an and an air-fluid level, so it seems inflammatory or infectious proccess. I choose option 1, infected bulla.

    19. UJWALA JADHAV says:

      In view of h/o Koch’s it can be thick walled cavity with fluid level limited by the azygous fissure due to reactivation TB

    20. genchi bari italia says:

      …radiogramma 2013: esiti di scissurite lobo accessorio v.azygos e presenza di immagine bollosa in apice( pareti sottili della bolla)….radiogramma 2014….iperplasia delle ombre ilari di natura adenopatica….ispessimento pleura corticale e versamento interscissurale del lobo v.azygos….presenza di piccolo livello idroaereo nella bolla, senza che di riesca a vedere(all’Rx) eventuali masse da “ospiti” indesiderati…..ipotesi diagnostica….Ripresa di attività TBC….Saluti da Bari alla eccellente coppia !

    21. Fares says:

      infected bulla

    22. Carlo says:

      2014 Upper lobe volume loss with dislocation and thickening of minor fissure (and obstruction of the upper lobe bronchus/ subatelectasis ).
      In 2013, there seems to be a port A Cath ( cancer treatment ?) . Lung cancer ?