Caceres’ Corner Case 143 (Update: Solution)

esr_2016_blog-cacerescorner-143

Dear Friends,

Today we are presenting pre-op radiographs for inguinal hernia in a 37-year-old-man. Check the images below, leave your thoughts in the comments section, and come back on Friday for the answer.

Diagnosis:

1. Pulmonary arterial hypertension
2. Thymoma
3. Pericardial cyst
4. None of the above


lateral-chest

pa-chest

Click here for the answer to case #143

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    Sep 2016
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    DISCUSSION 11 Comments

    11 Responses to : Caceres’ Corner Case 143 (Update: Solution)

    1. Olena says:

      PA: The mediastinum is enlarged and shifted to the left with the following shadowing of the middle and inferior lung fields; has clear and smooth outer upper, middle contours but the outer inferior contour is connected with lateral chest wall and obscures the view of diaphragm and left lateral sinus – the sign of lifted and enlarged right ventricle, which is confirmed on lateral view: the retrosternal airspace and the right ventricle seems to be in contact with more than one-third of the distance from the sternodiaphragmatic angle to the point where the trachea meets the sternum.
      The right central and peripheral pulmonary vessels are enlarged as the same peripheral pulmonary vessels on the left due to high blood pressure. The central left pulmonary vessels are not clear visible due mentioned mediastinum enlargement.
      Laterally on the right on the level of 1-2 ribs subpleurally the small consolidation is seen – healing/ healed pulmonary infarction.

      1. Pulmonary arterial hypertension

    2. Olena says:

      … the retrosternal airspace is filled…

    3. Diogo says:

      There´s levoposition of the heart with abnormal left cardiac contour. The aortic knob seems normal in position. Maybe there is interposition of some lung parenchyma between the aorta and pulmonary artery. Since this is an asymptomatic patient I think partial absence of the pericardium would be a good hyppothesis.

    4. UFTM radiogroup says:

      Dear professor, in PA x ray we see a left mass and we can outline de heart and left hilum, suggesting a retrocardiac mass. In perfil we see this mass shows an round contour and has a apparent contact with heart shadow. Our opinion: mediastinal mass, probably pericardial cyst. Timoma, we think it`s not the typical mediastinal position.

    5. Dr Pepe says:

      Three responses and three different diagnosis.
      Waiting for a brave radiologist to break the tie!

    6. MK says:

      The cardiac silhouette is missing. I can´t delimitate its right and left border. In the lateral view there is an increased density proyected over de anterior-medium mediastinum, son I think a pericardial cyst would be a good option. The retroesternal space is partially obliterated.

      There is a flattened/inversed right hemidiagphram, and I am doubting about LLL collapse but the lateral view is unremarkable in this aspect.

    7. Maria O says:

      I vote for Option 4 (none of the above) . my answer is left pulmonary atelectasis, probably lingular bronchus.

    8. Mohsen says:

      as we can see normal pulmonary arteries through the opacity, so we can exclude pulmonary hypertension, the opacity silhouetting the adjacent cardiac border, considering the fact that the lesion is incidentally discovered, with no eleventh patient compliant, most proper diagnosis is pericardial cyst.

    9. UFTM radiogroup says:

      Analysing the case with care, there is levoposition of the heart with loss of the right heart border and producing a round image on lateral view, that seems to be displaced upward from the left hemidiaphragm. Congenital defect of the pericardium (agenesis) would be a great diagnosis.

    10. vesna says:

      Pericardial cyst

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