Caceres’ Corner Case 149 (Update: Solution)


Dear Friends,

Today we are presenting a pre-op PA chest radiograph of a patient with inguinal hernia. What do you see?

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


Click here for the answer to case #149

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    Dec 2016
    DISCUSSION 32 Comments

    32 Responses to : Caceres’ Corner Case 149 (Update: Solution)

    1. Mauro says:

      There is a small area of bulging of the right upper mediastinal contour. Double aortic arch?

    2. MK says:

      Hello! I think that the bulging of the right mediastinal contour is because of the azygos arch. So, we can see a displaced right paraspinal interfaces, because of osteophytes.

      It is a poor inspirated PA x-ray. The right hilum is lower that the left one.

    3. ania says:

      lytic lesion of the right scapula

    4. genchi bari italia says:

      ….professore facendo nostra la tua precedente lezione ….dilatata la vena azygos…..le cause , di questa supplenza emodinamica, le hai elencate nella lezione precedente del dr Pepe….ilBari finalmente VINCE….il Barca ancora non conVINCE….

    5. Vilma says:

      Hmmm…there is pleura changes on the both sides, wide v.azygos, pulmonary art. hypertension? IX rib destruction on the left?

      • José Cáceres says:

        Ribs are OK. I would like to see prominence of the pulmonart arch before suggesting pulmonary hypertension

    6. Sht says:

      Am seeing this on phone, so maybe missing a lot of things.
      Right paratracheal bulge – ?rt sided aortic arch/ ?prominenr azygos

    7. Ren says:

      Bilateral paraspinal line widening due to ostrophytes
      Thickening along bilateral hemithoraces subpleural .this is likely due to subpleural fat.other consideration could be pleural fluid or thickenimg.

    8. Vilma says:

      Hmmm… wide v.azygos, pulmonary arterial hypertension? IX rib destrukcion on the left?

    9. José Cáceres says:

      One of you described findings that may help to suggest the etiology of the bulge in the upper mediastinum

      • MK says:

        Perhaps the right paraspinal line (tubular structure) is the margin of the continuation azygos because of the interruption of the inferior vein cava

    10. Marco says:

      The right-sided bulging of the mediastinum at the level of the aortic knob looks like continuation of the azygos vein with interruption of the inferior vena cava. A contrast enhanced CT is needed to confirm.

    11. orlando says:

      Hello Professor,

      – Well defined focal para tracheal bulge on right side
      – Prominent right para spinal line

      consistent with continuation of azygous vein with interruption of the IVC

      Confirm with CT chest and abdomen with IV contrast

    12. sandeep says:

      smooth focal right mediastinal bulge at the level of the aortic knuckle.
      Features are likely to represent prominent azygos vein with differential being double aortic arch or lymphadenopathy.

    13. José Cáceres says:

      So far you all have mentioned as the ethiology of the bulge: right aortic arch, aneurysm, enlarged azygos. You haven’t mentioned lymph nodes or other mediastinal masses. It is none of the above. You are missing a clue.

    14. Mauro says:

      Associated with the bulging I think there is widening of the space between the ribs. Maybe a posterior mediastinum neural lesion? Schwanomma?

    15. ZHW says:

      The right paratracheal lesion interupts and causes apparent displacment of the right paravertebral line so is in the posterior mediastinum. Given all the osteophytes elsewhere it could just be more of the same

    16. Nacer says:

      artic ectasia

    17. Nacer says:

      ectasia of the aorta

    18. Ridwan Fauzi says:

      what the meaning picture on your blog?