Caceres’ Corner Case 109 (Update: Solution)


Dear Friends,

Muppet insists on showing the following case that he saw recently: preoperative chest radiographs of a 25-year-old male with seminoma. Check the images below, leave us your thoughts in the comments, and come back on Friday for the answer.


1. Tuberculosis
2. Metastases
3. Mucous impaction
4. None of the above

PA chest

lateral chest

Click here for the answer to case #109

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    Feb 2015
    DISCUSSION 19 Comments

    19 Responses to : Caceres’ Corner Case 109 (Update: Solution)

    1. David says:

      I think that is something extrathoracic, like tail hair. In lateral view is not visible and probably is localized at skin surface of the posterior region of the thorax.

      The answer 4: none of the above.

    2. Nicky says:

      Pleural based mets?

    3. Janani says:

      2. Metastases

      Neck mass extending posterior to the spine. ? Metastases from the seminoma or extragonadal seminoma.

    4. Nikos says:

      Opacity with ill defined borders at the upper part of the right lung in the PA view.
      In the lateral view it seems to be extrathoracic, with well defined borders posteriorly.
      Because of its size and location, I would suggest elastofibroma of the back.

      • Jose Caceres says:

        Elastofibroma is a chest wall lesion and it is not visible in the plain film. Sorry.

        • Nikos says:

          I am sorry, too! It looks like braided hair in the PA view, but why so well defined borders in the lateral?

          • Jose Caceres says:

            To me, the shadow in the lateral view looks like the scapula. But I am not infalible (working on it, though).

    5. Lola la piconera says:

      Agree with David. Seems like mine when I was young.

    6. Maria says:

      definitely extrathorasic -hair tail!

    7. Is it subcutaneous lipoma of the paravertebral area?

    8. gus says:

      This density is definitely extra thoracic, extending to the soft tissue of the neck.
      Alongside the density borders and some focal spots inside the density me can see encaged hyperlucent areas (Air?)
      i think is somethink like dermal( mole? ) or extra dermal artifact lesion ( hair? )
      plus Chilaiditi syndrome

    9. Eliseo De la Fuente says:

      metastasis pleural de osteosarcoma

    10. Viktors Linovs says:

      The opacity in the upper part of the right lung on the PA view is seen it extends upwards to the neck with well defined margins except the lower parts and the right margin cranially, opacity is inhomogenous with hiperlucent zones, I do not see the opacity on the lateral view. I suggest it is extrathoracic and artificial.
      Chilaiditi syndrome.

    11. Genchi Bari Italia says:

      …la prima cosa che farei è’ richiamare il paziente e farei un esame “ispettivo”…..ricordandomi che sono innanzitutto un…..clinico……all’esame ispettivo, farei seguito quello ‘palpatorio’….. Aiutandomi con la palpazione ” digitale” , vale a dire una ecografia………risposta finale 4. ….potrebbe essere una patologia dei tessuti molli del collo o il risultato di una FNAB….con stima da Bari …..

    12. Mariana says:

      4. None of the above

    13. Irena says:

      4. None of the above