Caceres’ Corner Case 151 (Update: Solution)

Dear Friends,

We are starting the new year with a warm-up case. Today we are presenting a PA chest radiograph of a 57-year-old woman with a cough and sputum production.

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

1. Changes post TB
2. Congenital right lung hypoplasia
3. Mesothelioma
4. None of the above

Click here for the answer to case #151

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    Jan 2017
    DISCUSSION 15 Comments

    15 Responses to : Caceres’ Corner Case 151 (Update: Solution)

    1. RV says:

      Change s post TB

    2. MK says:

      There is an important loss of volume of the right hemithorax with displaced mediastinum towards this side. An hydroneumothorax is present so a bronceo-pleural fistula should be descarted.

      • MK says:

        Also there is a decreased space between the ribs in the right side. Any surgical hystory?

        • MK says:

          If no surgical hystory, TBC or asbestosis are good causes for chronic pleural disease and so, for broncho-pleural fístula. A pulmonary infection if another cause of broncho pleural fistula.

    3. Marco says:

      I will give it a try 🙂 I see displacement of the trachea and cardiac silhouette to the right as well as slightly diminished ipsilateral intercostal spaces. The right hemithorax appears smaller compared to the left. This indicates significant volume loss of the right lung with compensatory hyperexpansion of the left (I see 11 posterior ribs). There seems to be a small air-fluid level with meniscus sign on the right indicating an effusion. I do not see any vascular lung markings in the lateral portion of the right hemithorax which might mean there is also a right-sided pneumothorax. The right mainstem bronchus appears wider than the left. I also see opacification within the right bronchial lumen resulting in significant narrowing/obstruction.
      I think the patient has a right hydropneumothorax from an obstruction/narrowing of the right mainstem bronchus due to neoplasm or retained secretions. But without additional patient information or until a CT is done, congenital pulmonary hypoplasia/aplasia must remain part of the differential, although less common.

    4. shaimaa hassanein says:


    5. genchi bari italia says:

      …penso potrebbe trattarsi di una complicanza di una biopsia transtoracica, con idropneumotorace e completo collasso polmonare dx.

    6. UFTM radiogroup says:

      dear professor, we think it could be consequence of TB, probably with a bronchopleural fistula or direct pneumothorax.

    7. JT says:

      My hypothesis is:
      Signs of right hydropneumothorax, accompanied with ipsilateral loss of volume (a detailed description is already done by “marco”, so I won’t repeat it). There is also displacement of the main bronchial tree to the right. The cardiac silhouette is not recognisable, due to right displacement also.
      This would be cosistent to the presence of a right neoplasm. There is also sign of pleural thickening.
      Combining all these, and without additional patient information, I would consider the diagnosis of mesothelioma as more likely. The other cases remain in the differential, and I would consider secondary the post-TB changes (although I would prefer to rule out the neoplasm / mesothelioma case in a plain chest radiograph like this).

    8. ren says:

      there is volume loss in right lung. decreased intercostal spaces likely chronic etiology. right hydropneumothorax is seen. right bronchus appears narrowed distally? obstructing lesion. mediastinal lymhadenopathy due to tuberculosis could be the cause

    9. Vivi says:

      Hi I am a new member in your really interesting company and a really young radiologist!so I will make my first nice! there is volume loss of right hemithorax and mediastinal shift towards the right (so cardiac contour is not recognised). Further more I think there is abnormal wall thickening of right bronchus. As previously mentioned there are signs of pneumothorax and maybe hydropneumothorax although I cannot see an air-fluid level.I can think of an bronchopleural fistula second to an operation or if there is not surgery history, second to a malignant condition.

      • Jose Caceres says:

        Welcome Vivi. Discussion not bad for a young radiologist! You forgot TB as a cause of BPF, though.

    10. Ella says:

      Congenital right lung hipoplasia