Caceres’ Corner Case 129 (Update: Solution)

ESR_2015_Blog-CaceresCorner-129

Dear Friends,

Today we are presenting chest images of a 47-year-old woman with a cough. What do you see?
Check the images below, leave your thoughts in the comments section and come back on Friday for the answer.


lateral chest

PA chest

Click here for the answer to case #129

Be Sociable, Share!
    25
    Jan 2016
    POSTED BY
    POSTED IN
    DISCUSSION 23 Comments

    23 Responses to : Caceres’ Corner Case 129 (Update: Solution)

    1. Suman says:

      pleural plaques

    2. Yvette says:

      Abnormal vessel close to the right border of the heart. Anomalous pulmonary vein draining to right heart. Right to left shunt cause volume overloading of pulmonary arteries, that are very well visible and quite wide to the distal parts of the lungs. Although congenital , partialy anomalous pulmonary vein return could be diagnosed in adult.

    3. khan says:

      inferior rib notching 6,7,8. coarctation of aorta.
      few granulomas right lung field

    4. Pasquale says:

      Scimitar syndrome

    5. dashurie says:

      pulmonal pletora?

    6. Jose Caceres says:

      As Sherlock Holmes said to Watson: “You see, but you don’t observe”

    7. rezi says:

      Tracheomalacia

    8. Khan says:

      Right sided tracheal shift– right upper love segmental collapse.

    9. Olena says:

      On frontal view: 1. Following airways there are trachea and carina deformation 2. Aortic contour deviation to the right in descending part of aorta 3. In the lungs: symmetrically intensified the shadows of pulmonary vessel system in hilar and prehilar zones – increased width of the vessels (increaseed/slowed blood supply/flight). In the right lung on the level of anterior parts of 5 – 7 ribs – diffuse single shadows, probably pleural plagues (ask for patients’ anamnesis morbi, working anamnesis); Blunt right costophrenic angle 4. There is no evidence of the surrounding soft tissue and the chest bone tissue pathology, but there is an S-like scoliosis deformation of thorasic spine – probably of II grade – which affects on the location of the mediastinum – there is not normal mediastinum contours, edges and shape; mentioned trachea deformation.
      On lateral view: 1. Increased kyphosis 2. There is evidence of both increased left and right heart ventricles 3. It is noticed the “second” trachea behind the main radiograph trachea visualisation – it looks like tracheal trifurcation 4. There doubt about top of superior part – the additional horizontal wide shadow in the middle and inhomogeneous shadow of the first visible thorasic vertebrae – suspicion fracture (which could be denied because of no trauma and complains of back pain)

      It could be scimitar syndrome (because of increaseed/slowed blood supply/flight, and the suppose of tracheal trifurcation (as an additional finding)), cough could be a symptom of recurrent pulmonary infection, but there is no visible evidence of small right lung and hemithorax, mediastinal shift to the right (dextroposition of the heart), indistinct right cardiac border, increased right lung opacity or precise shadow of vertically oriented curved tubular opacity (anomalous draining vein) in right inferior hemithorax coursing toward right cardiophrenic angle (it could be obscured by the heart in cases of pronounced cardiac dextroposition, but not in this case) or diminished right pulmonary vascularity.
      It is recommended to persue CT angiography/Echocardiography to look for other associated congenital heart diseases in symptomatic patients

      • Jose Caceres says:

        Wow!Nice discussion, although you missed some findings. See the answer tomorrow.

        • Olena says:

          Maybe I miss the not normal right hila – maybe because of error of bronchial and vessels branching. And also I didn’t mentioned the more evident shadow of superior vena cava….Oh! I see! – The absence of bronchus lobaris superior dexter!

    10. genchi bari italia says:

      ….micronodulia alle basi,bilateralmente….lieve sbandamento a dx della colonna d’aria tracheale, con sottile ispessimento del profilo mediastinico, da questo lato….leggermente sollevata la cupola diaframmatica….la TAC chiarirà il tutto…..sospetto per k polmonare con atelettasia e metastasi….

    11. Hellene says:

      Scimitar syndrome

    12. sht says:

      Scattered nodular opacities in the right mid and lower zones.
      Small right sided pleural effusion.

      Trachea deviated to the right.
      Ascending aorta not well visualised in PA view.
      Descending aorta is shifted to the right.

      The linear opacity lateral to the right heart border may be due to scimitar, but how does that explain right volume loss or right shifts?

    13. Doyin says:

      A curvilinear vessel seen in the right lower zone adjacent to the right cardiac border. There is hypoplasia of the right lung with associated deviation of the trachea and mediastinum to the right.
      The pulmonary vessels are prominent and rapidly taper, suggestive of pulmonary arterial hypertension. The heart is normal in size and contour.
      Inferior notching is seen of the 6th-8th anterior ribs on the right.
      Appearances are those of pulmonary venolobar syndrome with associated pulmonary arterial hypertension.

    14. Lola la Piconera says:

      1. Left lung is small. There are abnormal tubular structures on the left hemithorax. Therefore pulmonary hypoplasia with anomalous venous retirn
      2. The hila are abnormal in the lateral view: there is almost a donut but with a cleft and there could be a noch in the anterior portion of the trachea. Could it be a pulmonary ring?
      3. There are calcified nodules in both lower zones: chicken pox pneumonia? Hemosiderosis related to valvular disease?
      4. The anterior portion of the right hemidiphragm is blurred. Diaphragmatic duplication?

    15. Lola la Piconera says:

      Corrigendum
      1. Right lung is small. There are abnormal tubular structures on the left hemithorax. Therefore pulmonary hypoplasia with anomalous venous return?
      2. The hila are abnormal in the lateral view: there is almost a donut but with a cleft and there could be a noch in the anterior portion of the trachea. Could it be a pulmonary ring?
      3. There are calcified nodules in both lower zones: chicken pox pneumonia? Hemosiderosis related to valvular or associated cardiac disease?
      4. The anterior portion of the right hemidiphragm is blurred. Diaphragmatic duplication?

    16. ahmed says:

      exaggerated bronchovascular markings on both sides.
      right pleural effusion .

    17. saira says:

      dilated oesophagus with few basal reticular shadowing most likely systemic sclerosis

    Leave a Reply

    Your email address will not be published. Required fields are marked *