Caceres’ Corner Case 154 (Update: Solution)

Dear Friends,

Today I present images of an 89-year-old man with COPD and occasional pulmonary infections. What do you see?

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

Click here for the answer to case #154

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    Feb 2017
    DISCUSSION 10 Comments

    10 Responses to : Caceres’ Corner Case 154 (Update: Solution)

    1. MK says:

      In both proyections, I see an hydro-aerial level at the upper mediastinum (Zenker diverticulum vs esophageal estenosis/tumor?).

      There is a parenchimal high density next to the right cardiac silhouette.
      In the laterla view there is a flatened of both hemidiaphragms because of his COPD.

    2. genchi bari italia says:

      …oltre a livello idroaereo a livello faringo-esofageo…vi è una opacità alla base diaframmatica , posteriormente, in LL e che non credo sia una semplice bozzatura diaframmatica.

    3. tr says:

      flattening of the hemidiaphragms with blunting of the costophrenic recesses and barrel chest appearance on the lateral view, all are suggestive of emphysema.
      Although, a possible mass lesion can be seen over the posterior costophrenic recess on the lateral view.


    4. tr says:

      on a second look, there is an air-fluid level posterior to the trachea at the thoracic inlet.

    5. Y.E. says:


      -Air-fluid level in the upper mediastinum.
      -Displacement of the trachea.
      -Abnormal mediastinal lines and stripes.

      Possible diagnosis: Achalasia

    6. ania says:

      Lateral view : opacity in the posterior costodiaphragmatic recess

    7. tr says:

      the DDX of the upper mediastinal air-fluid level includes mainly: zenker diverticulum, bezoar, complicated esophageal duplication cyst.
      The DDX of the posterior costophrenic mass: lung mass, pleural mass, diaphragmatic hernia, neurogenic tumor….

    8. Alberto Montemayor says:

      hay un nivel hidroaereo en el mediastino superior posiblemente por un divertículo esofágico o una estenosis alta.
      Adema cambios marcados de EPOC

    9. ZHW says:

      difficult! Old films may make it easier…
      Air fluid level – Zenkers diverticulum (can’t see a dilated oesphagus on the lateral view )
      On the lateral view I think there may be a doughnut sign but can’t see obvious adenopathy on the PA view.
      There is opacity in the posterior costophrenic region on lateral but again can’t see it on PA view.
      As a stand alone study I’d get a CT to exclude cancer.

    10. Jose Caceres says:

      Thanks to all of you for participating. Glad you saw the air-fluid level. Next case will be difficult, I promise! 😉