Check the image below, leave your thoughts in the comments section and come back for the answer on Friday.
Findings: notice the uniform density of the abdominal left upper quadrant with medial displacement of the gastric air (Fig 1, red arrow), suggesting an enlarged spleen.
Fig. 1
In addition there is increased density of both humeral heads with lack of trabeculation (compare with normal appearance, Fig 2, arrows). When adding splenomegaly to bone sclerosis, the first diagnosis that comes to mind is myelofibrosis.
Fig. 2
The patient’s physician was contacted and it turned out that he already knew the diagnosis, which had been made a few years earlier. Images of lumbar spine after surgery confirm the sclerotic bone changes (Fig 3) and the large spleen compressing the left kidney (Fig 4, arrows).
Fig. 3
Fig. 4
The enlarged anterior right rib is a normal variant.
Final diagnosis: myelofibrosis
Congratulations to Lola la Piconera and Genchi Bari, who detected the bone changes. However, they missed the splenomegaly, which qualifies them as part-time old timers.
Comment: being an old timer has its advantages; occasionally you can make discoveries such as this and see (again) the gleam of reverence in the eyes of underlings!
I’m famous now 😀
Sorry, you are only real famous when you get your picture taken with Dr. Pepe
It looks completely normal for me. If i really want to find something, i may say there seems to be a faint mass hiding behind clavicle in the right apical lobe.
This confirms that you are not an old timer!
extension of the third right rib? (the anterior part)
fibrous dysplasia of anterior end of right 3rd rib with elevated right dome of diaphragm
Is the bone density normal? Or is there some increse in density mainly in both humeral heads?
Are you asking me? I am the one supposed to ask the questions
Elevated right hemidiaphragm, lateral shift of the “diaphragm” peak => Subpulmonic effusion. ??
Hello,
I’m not so sure about these findings but there are some lytic changes in ribs with sclerotic boundaries: in anterior part of left 1st rib and posterior part of left 6st rib.
If it’s not only superposion of vessels I suppose multiple myeloma or metastases.
Both DDx could be connected with lumbar pain as a reason for lumbar surgery.
Plasmocytoma
Retrocardiac mass
i agree with Borsuk (multiple myeloma?)
i like to see first a lateral skull film
I am not a radiologist but I can seen an obvious deformity of the anterior part of the right 3rd rib. some sort of tumor ?
You see right. Is a congenital deformity, without significance
Hello,
I’ll give it a try too …
Enlargement of the right paratracheal line
Slight depression of the minor fissure (RLL atelectasis?)
Enlargement of the anterior part of the right 3rd rib
Possible partial right diaphragmatic eventration. Bifid Rt 3rd rib.
Hello!!
I see increased radioopacity of TH8 vertebra.
Perhaps there is also minor elevation of the right hemidiaphragm.
…mitico professore, non mi sembra di vedere nulla a livello del torace….quello che mi insospettisce e’ un aumento in densità’ delle ossa e l’aspetto dismorfico della testa omerale dx… reperto di nessun significato il dismorfismo ad y della 3 costa dx….
1. Bifid right 3rd rib
2. Elevated right hemidiaphragm
3. Hilar calcification
4. ? probably right m/l atelectasis / bronchiectasis
I would like to know her occupation/ any previous history of infection / any chest complaints in the past
A wild guess : Lady Windermere syndrome
Really wild guess 🙂 !
I don’t see any signs of RML disease. Answer tomorrow.
bilateral high scapula, springle shoulder
I just see subluxation of the left acromio-clavicular joint , ….I will be angry from myeself if a positive findings missed from me 🙂
You missed two! OK to be angry.
“Bone within bone” both clavicles
Anterior end of right 3rd rib expanded,few lytic lesions involving left ribs.will go for metastatic lesions
Osteopetrosis
Close.
Lytic lesions left 1st and 6th ribs,mets/
Multiple myeloma
…prof…… ma il seno è vero ?….dei tre mali non saprei scegliere il minore( Coppa Champion)!!!!
….mielofibrosi…
Myelofibrosis
Renal osteodystropy.
…grazie professore cosmico…..aspettando il BARCA !!!!!
Actually, we are waiting for the Bayern!