Caceres’ Corner Case 136 (Update: Solution)

ESR_2016_Blog-CaceresCorner-136

Dear Friends,

Today I am presenting the third case of the “five easy pieces”. Images belong to a 63-year-old man operated on for carcinoma of the colon five years ago. Previous annual CTs were read as normal. What do you see?

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


PA chest

lateral chest

Click here for the answer to case #136

Be Sociable, Share!
    11
    Apr 2016
    POSTED BY
    POSTED IN
    DISCUSSION 24 Comments

    24 Responses to : Caceres’ Corner Case 136 (Update: Solution)

    1. Olena says:

      There is homogeneous shadow of pleura thickening on the right which is mostly on the anterior part of thorax wall and also in the middle part above of diaphragm in great fissure, suggesting pleural effusion (on lateral view).
      On PA on the level of VI intercostal space there is a round nodular opacity, the similar nodular opacity is seen on lateral view on the level of heart shadow mostly anteriorly in lingula.

      Regarding to anamnesis of carcinoma of the colon five years ago DDx is needed – nodulal mts with mts pleural effusion

      • Olena says:

        Besides, pulmonary structure shows increased and intenceed due to peribronchovascular infiltration mostly in right lung and there is suggestion of multiple micro nodules on the right on the level of IV – VI ribs

    2. Bujar says:

      I agree with Olen only adding pleural apical thickening of the lung and some nodular ill-defined opacities in the anterior recessus. DDg secondary meta lesion.

      • Olena says:

        “apical thickening of the lung” – where? left ? right?
        because I thought about one on the left but was not sure – it seems like it is sum of shadows

        • Olena says:

          yes, and I agree about multiple nodular opacities anteriorly – I do not detailed

          • Olena says:

            but where is that pleural apical thickening of the lung on lateral view? on the anterior part of superior mediastinum? close to sternum?

            • Jose Caceres says:

              I believe the apical thickening is minimal. It is not seen in the lateral view, usually

    3. magda says:

      Opacity in the upper field of the left lung?

    4. Borsuk says:

      Hello,
      on ap it looks like pleural effusion on the right but on lateral view there istn’t any fluid in posterior right costophrenic angle. I suppose opacity on ap view is caused by change in pleura (as mentioned pleural thickening) or chest wall. Taking into account previous colonic carcinoma pleural mets is most probable diagnosis.

    5. Eugeny says:

      There are metastases in the upper lobe of the left lung, and hilar lymph nodes. There is more rounded opacities in the middle lobe (mets). Right frontal sinus obliterated, it can not be excluded encysted fluid.

    6. Ryan says:

      Right pleural effusion. I feel like in lateral film the anterior mediastinal space is obliterated. on PA film the heart doesnt look that enlarge to me.

    7. genchi bari italia says:

      ….grande maestro….la clinica…..storia di CR colico 5 anni prima…..versamento pleurico unilaterale con ombra cardiaca nella norma….piccola opacità nodulare in LL contro l’ombra cardiaca… sospetto di opacità nodulare pleurica alla base posteriormente…..l’ipotesi è versamento da metastasizzazione pleurica…conferma diagnostica , oltre che con l’esame citologico del versamento,….con la PET-TC ….Il Bari supera la crisi e viene acquistato da un Tycoon Malese…..diventeremo grandi….tifo blaugrana stasera….

      • Jose Caceres says:

        Great game today! Hope Barça will pass.
        The appearance of the pleura suggests scarring, supported by the normal costophrenic sinus in the lateral view.

    8. Maria Sarwar says:

      Right sided pleural effusion along with a metastatic radioopaque density/module in right mid mum zone

    9. sht says:

      Right sided pleural thickening/effusion with multiple nodules seen through it both in PA and lateral.
      Another nodule seen in lateral view overlying the heart/ ascending aorta.
      Is there any erosion with soft tissue opacity in the posterior elements of the last visible thoracic vertebra?

      • Jose Caceres says:

        No vertebral problems. There is only one nodule, well seen in he lateral view.
        Regarding the pleura, see answer to Genchi Bari above.

    10. emano says:

      Rt sided pleural effusion and diffuse pleural thickning with lung nodule…metes?

    11. Right sided pleural thickening/effusion with multiple nodules seen through it both in PA and lateral.
      Another nodule seen in lateral view overlying the heart/ ascending aorta.
      Is there any erosion with soft tissue opacity in the posterior elements of the last visible thoracic vertebra?

    12. stanko says:

      Right lower lobe collapse due to endobronchal metastasis. Another nodular shadow is seen on lateral image.

    13. M. A. Fahmy says:

      I can see multiple scattered fine nodules of tree in bud appearance at both lung fields.
      There is opacity of the right lower lung zone sillhuotting the diaphragm, at the lateral view there is associated cystic like dilatation of the right lung base.
      Picture may suggest fine pulmonary nodular metastases with suspected right basal pleural nodular thickening and underlying lung tissue changes.

    14. sht says:

      An opacity is seen through the right effusion in PA and multiple round structures are present at the anteroinferior aspect on lateral.
      If they are not mets then ?cystic bronchiectasis.

    Leave a Reply

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