Caceres’ Corner Case 160 (Update: Solution)

Dear Friends,

Today I am showing a case from my good friend Jordi Andreu. Radiographs belong to a 52-year-old man with chest pain.
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

Be Sociable, Share!
    May 2017
    DISCUSSION 15 Comments

    15 Responses to : Caceres’ Corner Case 160 (Update: Solution)

    1. MK says:

      Good morning!

      There is an obliteration of the left costo-phrenic angle (pleural fluid and/or laminar atelectasi) and an enlarged calcified aortic arch (in the lateral view the calcium is displaced to the middle lumen). This arch seems to be larger than the aortic root so we have to do a CT to look for aortic pathology type disection.

      I see a nodular lesion proyected over the right heart, but I can´t see it in the lateral view.

    2. MP says:

      The aortic knob o the PA is widened with what appear to be calcifications. On lateral view the descending aorta is widened and irregular. A contrast CT of chest is needed to rule out a dissection given the patient’s symptoms.
      The left costophrenic angle is occupied on the PA. On the lateral it seems like there might be a small pleural effusion or pleural adhesions in the posterior recess.

      • Diogo says:

        Agree with MP, aortic dissection. At the lateral view the calcifications on the posterior wall of the proximal descending aorta seem to be displaced inwardly. Nice!!

    3. sht says:

      Lt CP angle blunted.
      ? Lt dome raised. Segmental collapse left lower lobe seen through heart on PA.
      Unfolded aorta with mildly undulating posterior margin but not enough to be labelled coarctation. Hypertensive?
      Effusion / thickening making visible inferior part of the oblique fissure.
      Appearance of clavicle – ?anatomical variation or old healed fracture.

    4. Ren says:

      There is an obliteration of the left and left posterior costophrenic angle likely pleural effusion. Enlarged aortic arch with displacement of calcium to the middle lumenin lateral View aortic dissection to be ruled out

    5. tr says:

      flattening of the left hemidiaphragm with obliteration of the posterior costophrenic recess, apparently by a soft tissue lesion.
      it does not look like effusion, i think diaphragmatic rupture is the main consideration.

    6. Dr.Hemanth.S says:

      Both lung zones are clear.
      Frontal and lateral cardiac dimensions appear normal.
      Obliteration of left CP angle may suggest left basal effusion.
      Both hilum is normal in position and density.
      Both hemidiaphragm appear normal.
      Subtle hyperlucency with air shadow adjacent to the gastric bubble in the left hypochondriac region may suggest splenic abscess.
      Soft tissues of thorax appear normal.
      Bony thorax appear normal except for the old healed fracture of right clavicle.

    7. Dr.Hemanth.S says:

      Associated with unfolding of aorta.

    8. genchi Bari italia says:

      …..stimatissimi colleghi… dolore toracico acuto, può’ essere causato da uno dei tanti organi nel torace…..esclusi il polmone, la pleura(esiti) a Sx, il cuore e le coronarie, l’esofago, non rimane che la patologia aortico…..nel caso in esame , oltre ad un aumento di calibro dell’arco, ed un “doppio ” contorno dell’ arco in. AP, vi è ‘ un segno patognomonico per dissezione tipo A….la dislocazione “mediale” delle calcificazioni ateromasiche che ci indicano la dissezione……Prof. il Bari ha terminato il campionato con un fallimento totale…..ricorda la Iuve., bloccato Dybala, e’ in estremo affanno, …..Bari ed il G 7 ti salutano….