Caceres’ Corner Case 157 (Update: Solution)

Dear Friends,

Spring is here and it makes us want to present easy cases. Today we are showing preoperative radiographs for ankle trauma in a 47-year-old woman.
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 #157

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    Apr 2017
    DISCUSSION 28 Comments

    28 Responses to : Caceres’ Corner Case 157 (Update: Solution)

    1. MK says:

      Good morning,

      There is an increased density next to the right cardiac border that doesn´t blured it. There is not sillhoutte sign, (different density or no medial lobe location). The retrocardiac space is occupied (pathology on the inferior lobe).

      Right paravertebral line is ok.

      Any clinical symptoms?

    2. Ren says:

      There is an opacity in the right paracardiac location not silhouetting the cardiac border and localized to the retrocardiac location in the lateral chest X-ray. The vessels are not obscured and the lesion has a relatively well defined contour suggesting it not of lung origin. Differential in this case would be hiatal hernia ,aortic aneurysm and sequestration

      • Dr Pepe says:

        If you believe the lung is not affected, the sequestration has to be extrapulmonary

    3. genchi bari italia says:

      ….piccola ernia di Bohckdalek….

    4. maurizio franz says:

      There seems to be no gastric bubble besides the meteoristic distended colon and a discrete opacification in the inferior middle mediastinum. There is also an opacity medial-basal on the right side without obscuring the right heart border and of sharp demarcation.
      DD: Hiatal Hernia without air-bubble?

      • Jose Caceres says:

        Hiatus hernia should be the first diagnosis in this type of lesion. It was not in this case.

    5. genchi bari italia says:

      .. ec Morgagni

    6. tr says:


      there is a density adjacent to the right atrial border not obscuring it. on the lateral view i can see splaying of the most anterior inferior part of the major fissure merging with the diaphragm, and possibly a small density over the anterior costophrenic recess, the density possibly represents a small major fissure effusion or a small consolidation in the anterior costophrenic recess.
      another confusing finding is the triangular shape of the lower right atrial border/IVC?, I cannot explain it! (variant, artifact?.).


    7. Parviz says:

      There ıs density in right paracardiac location and it ıs not silhouette sign. Pathology might be at azygoesophageal racers. Probably Bochdalek hernia

    8. Dimitrova says:

      Chilaiditi syndrom may be.

      • Stevan Vasiljević says:

        Chilaiditi syndrome is anterior transposition of a loop of colon between the diaphragm and the liver. No such thing here.

    9. WM says:

      LAtrium and LVentricular enlargement signs, mild RV dilated suggests heart problem.
      Dorsal primary arthrosis if age related.
      Trauma history and surgery indication thorax x-ray
      don’t exclude pulmonary thromboembolism.

    10. EMAD ESMAEEL says:

      chilaiditi’s syndrome

    11. MP says:

      Cardiophrenic fat or pericardial cyst

      • Jose Caceres says:

        Both of them occur in the cardiophrenic angle. Are you sure o your diagnosis?

    12. WaleedMD says:

      Lt upper lobe loss of volume

    13. Jaime C.Marquez says:

      Right paracardiac radiopacity of defined borders, with signs of the negative silhouette, which corresponds to a middle mediastinal lesion, later discarded in lateral incidence. Would I play for a lipoma? Or an adenopathy ?.

      • Jose Caceres says:

        You reading is correct. You cannot go any further without CT. Airless hiatus hernia should be the first diagnosis, but it isn’t.

    14. tr says:

      the lesion is located either anterior or posterior to the heart, and since it cannot be seen on the lateral view anywhere in the lungs or mediastinum, i suppose it should be a chest wall lesion.