Caceres’ Corner Case 155 (Update: Solution)

Dear Friends,

Since you will be tired after the ECR Congress, I am showing an easy case. These images were taken during a routine check-up of a healthy 55-year-old woman. What do you think?

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 #155

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    Mar 2017
    DISCUSSION 15 Comments

    15 Responses to : Caceres’ Corner Case 155 (Update: Solution)

    1. tr says:

      I can see prominence of the left hilum on the cxr.
      on the CT scan, the lesion location and enhancement suggest pulmonary vein varix.

    2. MK says:

      Good morning,

      The aorta-pulmonary window is busied. In the coronal CT there is a communication between the vascular left hilar lesion and the left atrium, so it is a pulmonar vein increased in size.

      Perhaps an anomalous unilateral single pulmonary vein?

    3. tr says:

      interestingly, there is a small calcification within the lesion on the axial section, and two small filling defects on the coronal section which leads me to incline toward solid lesions, the lesion is enhancing homogeneously and avidly, and I think with only two sections provided, one can think of: castleman disease, enhancing middle mediastinal masses like neurogenic tumors, connective tissue tumors (leimyoma…).

      • jose caceres says:

        Your discussion is correct. Any other alternatives?

        • tr says:

          Tha calcification might be simply a calcified lymph node.
          A phlebolith in a vascular malformation can be considered, although uncommon, because of the tortuous vessel at the left side of the trachea which might be a feeding artery or a draining vein.

    4. Mkv says:

      Pulmonary artery aneurysm

    5. 19Medicus83 says:

      In the pa chest x ray an obvious rounded lesion adjacent to the aorto-pulmonary window with sharp contour is visible.
      Reformated coronal CECT shows an enhancing lesion with fat plane separating it from the pulmonary trunk, while a small calcification in axial NECT is seen.
      Being an bright enhancing lesion with small calcification in the middle mediastinum I don`t think of an vascular origin. I would also favor Castleman disease, DD: thymoma.

      • jose caceres says:

        Your discussion is correct, although I would not include thymona in the DD (middle mediastinum y too much enhancement). Can you think of other alternatives?

        • 19Medicus83 says:

          Hm, like already mentioned a partly calcified lymph node? Although systemic disorders like silicosis or sarcoidosis seem quite unlikely to me (no lung changes, normal right hilum).
          Another idea would be a teratoma (partly calcified, partly fat containing, not infiltrating) keeping in mind that anterior mediastinum is the usual location.

    6. ren says:

      i think there is a lesion in the aorto-pulmonary window
      Reformated coronal CECT shows an avidly enhancing lesion ,with a small calcification in axial NECT is seen.
      Being an bright enhancing lesion with small calcification in the middle mediastinum. vascular origin like hemangioma .castlemans ,lymphnodal mets from a hypervascular tumor, ectopic carcinoid would be my differentials

    7. Genchi Bari italia says:

      ….grande Prof……grande Barca… !!!!!