Caceres’ Corner Case 139 (Update: Solution)

ESR_2016_Blog-CaceresCorner-139

Dear Friends,

Dr. Pepe is back and he refuses to show easy cases. He has forced me to present the following images which belong to a 38-year-old woman with right chest pain. Check the three images below, leave us your thoughts in the comments section and come back on Friday for the answer.

Diagnosis:
1. Carcinoma
2. TB granuloma
3. Hamartoma
4. None of the above


PA chest

lateral chest

AP ribs

Click here for the answer to case #139

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    09
    May 2016
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    DISCUSSION 33 Comments

    33 Responses to : Caceres’ Corner Case 139 (Update: Solution)

    1. alaa elgamel says:

      Hamartoma

    2. Mohamed Mourad says:

      rather well defined opacity involving the posterior aspect of the right lower lung lobe and shows multiple calcifications at its upper portion, mostly hamartoma

    3. Borsuk says:

      Hello,
      lesion in right lower lobe connected by broad base to posterior pleura. If is it hard case I suppose round atelectasis – CT confirmation needed.

      • Jose Caceres says:

        I hope you do not consider rounded atelectasis a hard case! And there is an element missing: pleural thickening.
        Take a second shot 😉

    4. Michał says:

      I may be over the line here…
      It seems like two lesions overlapping:
      1. Background smaller hamartoma
      2. More apparent nodular opacity with peripheral atelectasis which could indicate lung cancer

    5. Nafisa says:

      Hamartoma

    6. Olena says:

      Two opacities in the right lower lobes draining together not homogeneous with slightly ill-defined contours
      There is pleural thickening well seen on PA view on the level of middle clavicula line. And on lateral view there is pleural thickening in great fissure.
      On PA view there multiple small nodules on the level of the III rib, III intercostal space, IV rib and IV intercostal space, small nodules are also seen on the upper part of opacity more laterally. Some of that nodules looks “old” – they have slight increased attenuation.
      The differential diagnosis should be done between relapse of tuberculosis and neoplasm with MTS dissemination in the right lung
      But mostly suggesting tuberculosis

    7. Rusudan says:

      He didn’t lost weight?

    8. Patricia Rodriguez says:

      Tubercolusis Granuloma

    9. Svetlana says:

      sequestration of the lung

    10. polys pilavas says:

      hamartoma

    11. M. A. Fahmy says:

      oval shaped opacity is seen at the apical segment of the right lower lobe.
      There is linear vascular structure extending from the hilum to the lesion.
      There is no evidence of bone erosion.
      There is serpiginous density seen within the lesion.
      Hamartoma is highly suspicious, CT is needed to look for any fat component.

    12. Lola la Piconera says:

      There are two lung dnodules that coalesce in the RLL one of them with a serpiginous calcification. The key point for me is the calcification.
      Serpiginous calcifications like this can be seen in some parasit disease such as filariasis in the breast. I was wondering if this could be a possibility in this case. Lung filariasis.
      A gossibipoma can also show serpiginous calcifications but there are no features suggesting previous thoracic surgery. If this had been the case a foreign body would be a possibility
      Lung cancer is infrequent ammong young adults and does not show this calcifications.
      Hammartoma and tuberculous granuloma calcify but not this way
      So I would go for none of the above

      • Jose Caceres says:

        Intelligent discussion. Patient was a Spaniard, no foreign travel. I agree with your opinion (none of the above). So what is it?

    13. sht says:

      Soft opacity right lower lobe with serpiginous calfifications and a small round lucent area inside.

      Hamartoma.

      Ddx – vascular malformation
      – TB

      • Jose Caceres says:

        See answer to M A Fahmy, above.

        • sht says:

          “None of the above”

          The only differentials for that calcification I can think of:

          – parasite (but that’s usually in the skin)
          – vascular malformation
          – occupational lung disease (but she is only 38y)

    14. genchi bari italia says:

      …magico Professore…..Bari risponde: probabile cisti idatidea con calcificazione degli scolici e/o della membrana, rotta ed accartocciata….minute altre piccoli esiti calcifici nodulari omolaterali…..

      • Jose Caceres says:

        Dear friend, in my opinion, calcification goes against hydatid cyst. Analysis of the abnormality:
        1. Calcification goes against malignancy and suggests a chonic process
        2. Minimal symptoms. Non-specific pain
        3. Definitely an ill-defined pulmonary process This information narrows down the differential diagnosis before biopsy

        • genchi bari italia says:

          …sempre grazie magico Prof., perchè ci aiuti a riflettere con i bei casi che ci proponi….

    15. Uli says:

      Granulomatous disease secondary to inflammatory process or infectious disease, maybe vasculitides? Tuberculosis or fungal disease?

    16. Uli says:

      Calcified hydatid cyst in a lung?

    17. sht says:

      “None of the above”

      The only differentials for that calcification I can think of:

      – parasite (but that’s usually in the skin)
      – vascular malformation
      – occupational lung disease (but she is only 38y)

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