Caceres’ Corner Case 131 (Update: Solution)

ESR_2016_Blog-CaceresCorner-131

Dear Friends,

This week’s images belong to a 16-year-old boy with a cough and fever for the last two weeks.
Check the images below, leave your thoughts in the comments section, and come back on Friday for the answer.

Diagnosis:
1. Lobar pneumonia
2. Tuberculosis
3. Foreign body
4. None of the above


PA chest

lateral chest

Click here for the answer to case #131

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    Feb 2016
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    DISCUSSION 17 Comments

    17 Responses to : Caceres’ Corner Case 131 (Update: Solution)

    1. leila says:

      There is consolidation and nodules in the right upper lobe, and on lateral view cavity in the posterior segment of right upper lobe. I would think about tuberculosis.

    2. Hellene says:

      Pneumonia

    3. sht says:

      (Seeing too many ifs and buts so cant really decide!!)

      There are infiltrates in the rt upper lobe.
      There is also segmental consolidation (air bronchogram?) and collapse and Goldens S.
      A cystic focus (better seen in lat view overlying vert) – no fluid level. ?Pneumatocele / ?cavity

    4. D. Pinheiro says:

      RUL consolidation with a cavity at the posterior segment. Confluent acinar nodules at the margins of the consolidation. There’s a little of volume loss of RUL (horizontal fissure and right hilum dislocated superiorly).

      I´d consider granulomatous infection (tuberculosis, fungal) and necrotizing bacterial infection as the main hypotheses.

    5. Amira NCI Egypt says:

      right upper lobe pneumonia
      right upper lobe patchy consolidation with air bronchogram obscuring right upper heart border with loss of volume ( elevated right hilum and transverse fissure ) .

    6. Olena says:

      there is increased inhomogeneous lung attenuation in right upper lobe, with well-defined lower margin due to horizontal fissure, mostly in hila and prehilar zone and less on the periphery, right apex is not involved (it is known as contra to tuberculosis), but there are shadows of multiple nodules seen through this lung consolidation and on the lateral view it seems that there are lung parenchyma destruction zone (in S2)
      the right hila and trachea are shifted to the right because of mainly suggesting inflamation process but not atelectasis – there is no shift of horizontal fissure cranialy.

      if suggesting this young patient have cough and fever the last two weeks, with such symptoms he should be healed as pneumonia, but with no positive progression, it looks like it is

      2. tuberculosis

    7. gus says:

      2. Tuberculosis

    8. bvsk says:

      Lobar pneumonia, with small pneumatocele formation. TB is less likely; however interval follow up would be recommended after a course of empirical antibiotics; following which further evaluation for TB could be indicated, if there is no resolution.

    9. sht says:

      TB without weight loss is very unlikely.
      Am unsure whether I can see the Rt bronchus in the lateral view.
      Along with Golden S, am leaning towards obstruction.
      The pneumatocele/cavity is confusing.

    10. genchi bari italia says:

      …gentile Professore, ho aspettato a rispondere perchè con le tue opzioni diagnostiche mi hai messo” of-side”( il calcio è la mia pelle!)…come potrebbe una ragazza di 16 inalare un corpo estraneo? non è una bambina !…però una risposta stravagante ci sarebbe….abbiamo una opacità con perdita di volume, come indicato dalla risalita dell’ilo e della piccola scissura, indicativi per una sub-atelettasia, da corpo estraneo e magari broncopolmonite post-ostruttiva e piccolo pneumatocele…l’anamnesi cosa dice per eventuale inalazione, magari di un dente(estrazione), una nocella etc….

    11. dr meza says:

      neumonia lobar derecha

    12. Enam says:

      picture goes with TB

    13. Enam says:

      consolidation with air bronchogram in posterior segment of rihgt upper lobe suggest TB

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