Caceres’ Corner Case 141 (Update: Solution)

ESR_2016_Blog-CaceresCorner-141

Dear Friends,

Showing today pre-op radiographs for a hip prosthesis in a 62-year-old man.
What do you see?

Check 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 #141

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    06
    Jun 2016
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    DISCUSSION 24 Comments

    24 Responses to : Caceres’ Corner Case 141 (Update: Solution)

    1. Kazi says:

      I noticed a thick walled cavity at the posterior LLL which is more obvious on the profile X-ray. Additionally, there is a fracture/ lytic lesion on the Rt posterior 8th rib. Finally, there is some hyperinflation..

    2. Anna says:

      Some pneumosclerosis, such as age-related

    3. Jose Caceres says:

      First day, no answers. Are you getting cold feet?

    4. tekwani says:

      right hilar rounded opacity

    5. Mauro says:

      There seems to be increased radiodensity of the posterior elements of two middle thoracic vertebrae. Maybe metastatic lesions?

    6. zafir says:

      Subpulmonic effusion on the left?

    7. Diogo says:

      Cavitary lesion best seen posteriorly on lateral view. Apparently overshadowed by the right hilum on frontal view.

      Looks thick-walled, worrisome for neoplasm (bronchogenic carcinoma, metastatic). Ddx includes infeccion (tuberculosis, fungal), vasculitis and rheumatoid nodule.

      I think an extrapulmonary posterior mediastinal cavitary mass would unsual.

      • Jose Caceres says:

        Do you see it in the PA view?

        • Diogo says:

          Maybe I’m seeing too much. I thought it was projected over the R hilum at level of the 8th posterior rib.

          And maybe what I thought was a central cavity on the lateral view is just the neural foramen.

    8. ZHW says:

      Two opacities seen on lateral- one projected over upper thoracic vertebra and one over lower thoracic vertebra. Neither are cavitating. Only one is seen on PA view projected over upper right hilum.
      They look quite dense but are not obviously calcified
      Given that there are two metastases would be the most common diagnosis.
      CT would be next step.

    9. zafir says:

      rt. thoracic spinal neurofibroma?

    10. genchi bari italia says:

      ….professore stimatissimo…..ci sono 2 elementi da considerare, tutto a dx, a livello di D8: esiti di rimaneggiamento costale posteriore dx ed opacità a livello del corrispettivo forame di coniugazione intervertebrale….esiti di neurinoma ?….

    11. ZHW says:

      SAPHO syndrome – a long shot and probably wrong!

    12. ZHW says:

      Some form of benign hyperostosis of the vertebra. Doesn’t look typical for DISH. I am at the limits of my MSK knowledge.

      • Jose Caceres says:

        Close enough. You get full credit for the answer, although it is too late to include your name in today’s answer.

    13. Diogo says:

      Well, if this is really a vertebral sclerotic lesion I’d put melorheostosis in ddx list.

    14. UFTM radiogroup says:

      wait for the next case!!!

    15. Jorge says:

      Is there any litic lesion or old fracture in the 8th right rib?

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