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.
Diagnosis:
1. Tuberculosis
2. Metastases
3. Mucous impaction
4. None of the above
Click here for the answer to case #109
Findings: PA chest radiograph shows a triangular opacity in the right upper lung (A, arrows). The appearance is unspecific. The clue to the diagnosis lies in discovering that the opacity extends into the soft tissues of the neck (A, red arrow), indicating that it is not located in the lung and originates outside the chest.
Examination of the patient showed a long ponytail. A new radiograph after lifting the ponytail (B) confirms it as the cause of the opacity.
Final diagnosis: ponytail simulating lung disease.
Congratulations to David who was the first to answer and to give the correct diagnosis.
Teaching point: always remember that long hair may simulate apical lung disease.
