Caceres’ Corner Case 114 (Update: Solution)


Dear Friends,

As Dr. Rusty mentioned in the most recent Diploma case, it is amazing how old school radiologists survived without CT. I recently saw one such case, diagnosed because I am one of this old breed. Image belongs to a 67-year-old woman who had a preoperative chest before lumbar spine surgery.

What do you see?

Check the image below, leave your thoughts in the comments section and come back for the answer on Friday.

PA chest

Click here for the answer to case #114

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    Apr 2015
    DISCUSSION 35 Comments

    35 Responses to : Caceres’ Corner Case 114 (Update: Solution)

    1. Rusty says:

      I’m famous now 😀

    2. Ryan Tee says:

      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.

    3. Dot says:

      extension of the third right rib? (the anterior part)

    4. tekwani parmanand says:

      fibrous dysplasia of anterior end of right 3rd rib with elevated right dome of diaphragm

    5. Lola la Piconera says:

      Is the bone density normal? Or is there some increse in density mainly in both humeral heads?

    6. J.D. says:

      Elevated right hemidiaphragm, lateral shift of the “diaphragm” peak => Subpulmonic effusion. ??

    7. Borsuk says:

      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.

    8. Dot says:


    9. hector says:

      Retrocardiac mass

    10. gus says:

      i agree with Borsuk (multiple myeloma?)
      i like to see first a lateral skull film

    11. Akram says:

      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 ?

    12. Katerina says:

      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

    13. SP says:

      Possible partial right diaphragmatic eventration. Bifid Rt 3rd rib.

    14. Maria S. says:

      I see increased radioopacity of TH8 vertebra.
      Perhaps there is also minor elevation of the right hemidiaphragm.

    15. Genchi Bari italia says:

      …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….

    16. Gyan M. says:

      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

      • Jose Caceres says:

        Really wild guess 🙂 !
        I don’t see any signs of RML disease. Answer tomorrow.

    17. Dr khaled says:

      bilateral high scapula, springle shoulder

    18. Sameh Khodair says:

      I just see subluxation of the left acromio-clavicular joint , ….I will be angry from myeself if a positive findings missed from me 🙂

    19. ays says:

      “Bone within bone” both clavicles

    20. sheetal says:

      Anterior end of right 3rd rib expanded,few lytic lesions involving left ribs.will go for metastatic lesions

    21. DrPedro says:


    22. samar says:

      Lytic lesions left 1st and 6th ribs,mets/
      Multiple myeloma

    23. genchi bari italia says:

      …prof…… ma il seno è vero ?….dei tre mali non saprei scegliere il minore( Coppa Champion)!!!!

    24. gus says:


    25. Alaa says:

      Renal osteodystropy.

    26. genchi bari italia says:

      …grazie professore cosmico…..aspettando il BARCA !!!!!