Caceres’ Corner Case 107 (Update: Solution)

ESR_2015_Blog-CaceresCorner-case107

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.

Diagnosis:

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


Q1

Q2

Click here for the answer to case #107

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    19
    Jan 2015
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    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 ?

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